bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review
Authors: Janela Dora , Costa Fabíola , Weiss Brandon , Areias Anabela C. , Molinos Maria , Scheer Justin K. , Lains Jorge , Bento Virgílio , Cohen Steven P. , Correia Fernando Dias , Yanamadala Vijay
Published: June 2023

Background

Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown.

Objective

To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions.

Methods

This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated.

Results

Fourteen trials were included: 10 using motion tracker technology ( N = 1284) and four with camera-based biofeedback ( N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19–1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11–0.13; very low evidence). No study found superior results in a control group.

Conclusions

Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.
Veterans Finding Community and a “Home” Within an Emergency Housing Environment
Authors: Lynch Kimberly A. , McCoy Matthew , Gabrielian Sonya
Published: June 2023

In April 2020, the Department of Veterans Affairs responded to the COVID-19 pandemic and escalating unsheltered homelessness in Los Angeles by sanctioning a tent turned tiny shelter encampment at the West Los Angeles Veterans Affairs medical center. Initially, staff offered linkages to on-campus VA healthcare. However, as many Veterans living in the encampment struggled to avail themselves of these services, our “encampment medicine” team was launched to provide on-site care coordination and healthcare at the tiny shelters. This case study showcases the team’s engagement with a Veteran experiencing homelessness struggling with opioid use disorder and depicts how this co-located, comprehensive care team allowed for trusting care relationships formed with, and empowerment of the Veterans living in the encampment. The piece highlights a healthcare model that engages with persons experiencing homelessness on their own terms while building trust and solidarity, focuses on the sense of community that formed in the tiny shelter encampment, and gives recommendations for how homeless services might adapt to use the strengths of this unique community.
Preoperative Hemoglobin <10 g/DL Predicts an Increase in Major Adverse Cardiac Events in Patients With Hip Fracture Over 80 Years: A Retrospective Cohort Study
Authors: Li Min , Chen Chen , Shen Jiang , Yang Linyi
Published: June 2023

Background

Preoperative anemia has been associated with perioperative morbidity and mortality in patients undergoing cardiac and non-cardiac surgery. Preoperative anemia is common in elderly hip fracture patients. The primary objective of the study was to explore the relationship between preoperative hemoglobin levels and postoperative major adverse cardiovascular events (MACEs) in hip fracture patients over 80 years.

Methods

The retrospective study enrolled hip fracture patients over 80 years from January 2015 to December 2021 in our center. The data were collected from the hospital’s electronic database after approval by the ethics committee. The primary objective of the study was to investigate MACEs, and the secondary objectives included in-hospital mortality, delirium, acute renal failure, ICU admission rate, and transfusion (>2 U).

Results

912 patients were entered for final analysis. Based on the restricted cubic spline, the risk of preoperative hemoglobin (<10 g/DL) was associated with an increased risk of postoperative complications. With univariable logistic analysis, a hemoglobin level <10 g/DL was associated with increased MACEs [OR 1.769, 95% CI (1.074, 2.914), P = .025], in-hospital mortality [OR 2.709, 95% CI (1.215, 6.039), P = .015] and transfusion >2 U risk [OR 2.049, 95% CI (1.56, 2.69), P < .001]. Even after adjustment for confounding factors, MACEs [OR 1.790, 95% CI (1.073, 2.985), P = .026], in-hospital mortality [OR 2.81, 95% CI (1.214, 6.514), P = .016] and transfusion >2 U rate [OR 2.002, 95% CI (1.516, 2.65), P < .001] were still higher in the lower hemoglobin level cohort. Moreover, a log-rank test showed increased in-hospital mortality in the cohort with a preoperative hemoglobin level of <10 g/DL. However, there was no difference in delirium, acute renal failure, and ICU admission rates.

Conclusions

In conclusion, for hip fracture patients over 80 years, preoperative hemoglobin levels <10 g/DL might be associated with increased postoperative MACEs, in-hospital mortality, and transfusion >2 U.
Exploring the Role of “Double Cycle” and Industrial Structure in High-Quality Economic Development in China
Authors: Tan Junlan , Wang Fayuan , Wang Rong
Published: June 2023

The outbreak of the new crown epidemic has impacted the global industrial chain and caused significant changes in the world economic and political landscape. In the post-epidemic era, promoting high-quality economic development (HQED) has become an important issue. The study selects the spatial econometric model and mediating effect model to verify the role of industrial upgrading in the double cycle for HQED, and concludes as follows: (1) “double cycle” can significantly promote HQED, and there is a significant spatial effect of the double cycle; industrial structure upgrading “ can significantly promote HQED, and there is a significant spatial effect of industrial structure upgrading, which may have a positive impact on the neighboring regions; (2) domestic circulation can promote HQED in the region, but the spatial effect is not significant; international circulation can not only promote HQED in the region, but also promote HQED in neighboring regions . There is a significant positive spatial effect of industrial structure upgrading. (3) The industrial structure upgrading plays a part in the mediating effect of the “double cycle” on the HQED. This study has important implications for the realization of HQED in Chinese regions.
People With Dementia as Active Agents in Nursing Homes: A Scoping Review
Authors: Ingard Cecilia , Sjölund Maria , Trygged Sven
Published: June 2023

People with dementia (PWD) are fragile and need aid and care in their daily lives. This scoping review explores the extent to which PWD can be involved in society and their daily lives. Publications were selected according to PRISMA guidelines. We graded the level of participation/involvement in daily life and research using a five-level participation model developed by Shier. A higher grade means a greater ambition to involve PWD in decisions. Of the 11 included studies, three reached level three according to Shier’s model. The studies describe ways of and potentials for participation, capabilities of PWD, caregivers’ opportunities to foster involvement, and cooperation between PWD caregivers and relatives. Caregivers and managers must have the attitude that PWD can be involved in decisions and caregivers need opportunities to actively promote such involvement. Shier’s model can be a tool with which organizations strive to involve PWD.
Assessment of knowledge, accessibility, and adherence to the use of personal protective equipment and standard preventive practices among healthcare workers during the COVID-19 pandemic
Authors: Abdulrahman Yusuf Khalifa , Isa Saad Mohamed , Al-Abdullah Amal Faisal , AlHakeem Hala Abdulmalek
Published: June 2023

Background:

Healthcare workers are at risk of acquiring infectious agents while providing services to patients. Thus, the need for evaluating and closely monitoring healthcare worker knowledge, perception, and adherence levels is critical. This study evaluates the knowledge, accessibility, and adherence regarding personal protective equipment (PPE) and preventive protocols among healthcare workers during the COVID-19 pandemic.

Design and methods:

A web-based cross-sectional survey was conducted from March to September 2021. The study participants were 187 healthcare workers who replied to a 31-item questionnaire using an online tool.

Results:

A total of 187 participants responded to the questionnaire. Most of the participants 102 (54.5%) were in the age group of 25–34 years. Of the 187 participants, 98 (52.4%) were medical doctors, and 92 (49.2%) had correct knowledge regarding donning and doffing of PPE. The vast majority (93.7%) had access to essential PPE. The average adherence level was 82.1%. Accessibility (p = 0.003) and adherence (p < 0.01) were found to be significantly high in older age participants.

Conclusion:

The study showed most of the healthcare workers had appropriate knowledge and, they also adhered to the proper use of PPE and infection control protocols. However, few of them identified with poor knowledge about COVID-19, inappropriate doffing of PPE, non-adherence to the protocol, and unacceptable practices. We recommend the provision of adequate training that will lead to minimizing the risk of exposure to and transmission of COVID-19 among healthcare providers.
Investigation of spatial pattern of apnea disorder using geographic information system (GIS)-case study of Kermanshah metropolis
Authors: Khazaie Habibolah , Zanganeh Alireza , Ziapour Arash , Teimouri Raziyeh , Saeidi Shahram , Zakiei Ali , Salimi Saeed , Moghadam Shahrzad , Pourmirza Kalhori Reza , Khezeli Mehdi , Farahmandmoghadam Naser
Published: June 2023

Background:

Apnea disorder is influenced by social and environmental factors. By assessing its hot spots and geography, the foci of this disorder and its at-risk groups can be identified for health interventions. This study was conducted to investigate the spatial pattern of apnea disorder using GIS in the Kermanshah metropolis.

Methods:

In cross-sectional study was conducted in kermanshah, the statistical population were 119 people (73.95% male and 26.05% female) of Kermanshah residents, which referred to the sleep center from 2012 to 2018 due to apnea disorder. Information was collected from the records of patients referred to the Sleep Disorder Center of Farabi Hospital, which is the only service center in the west part of Iran. The statistical tests were the mean center, standard distance, Getis-Ord Gi * index, nearest neighbor index, and kernel density estimation test in GIS software.

Results:

The spatial pattern of patients with apnea disorder has cluster formation in the Kermanshah metropolis. The age group of 50–54 had more apnea disorder than other age groups. In this age group, women were more prone to apnea than men. In terms of education, people with high education are more affected by this disorder; So that with the increase in education level, apnea disorder had also increased. Also, the findings showed that the disorder was more common in unemployed, married, overweight people with BMI (25–30), and obese people (30–40).

Conclusion:

The spatial pattern of patients with apnea disorder was clustered and does not correspond to the high population density centers located in the marginal and slum areas of the city. These can be used by stakeholders, including governmental organizations and health authorities at the national-regional level.
Household heads satisfaction and associated factors on community-based health insurance scheme in Gudeya Bila District, Oromia, Ethiopia
Authors: Asfaw Ajibew , Etana Belachew , Mulatu Befirdu , Babure Zalalem Kaba
Published: June 2023

Background:

Community-Based Health Insurance (CBHI) scheme refers to a non-profit type of health insurance for the informal sector. There is a paucity of information on this topic in Gudeya Bila, Ethiopia. This study aimed to assess the level of household (HH) satisfaction with the CBHI scheme and its associated factors.

Method:

A community-based cross-sectional study design was employed from November 1–30, 2020, and a sample of 630 HHs who enrolled in the CBHI scheme were included. A multi-stage sampling and systematic random sampling were employed. Data was entered into Epidata version 3.1 and analyzed using SPSS for windows program version 25. A 95% CI was calculated and variables having p-value < 0.05 were considered statistically significant. Descriptive statistics, bivariate, and multivariable logistic regression analyses were performed.

Result:

All HHs heads (630) with a response rate of 100% were involved in the study. The overall HH satisfaction on CBHI was 56.2%. Attending CBHI scheme-related meetings (AOR = 1.948, 95% CI = 1.16–3.27), healthcare provider respectfulness (AOR = 9.209, 95% CI = 2.73–31.06), able to get the ordered laboratory test service (AOR = 2.143, 95% CI = 1.127–4.072) and having paid extra money for drug supply at private health facilities (AOR = 0.492, 95% CI = 0.285–0.847) were independent predictors.

Conclusion:

HH satisfaction level on CBHI scheme was moderate. Attending CBHI scheme-related meetings, health-care provider respectfulness, being able to get the ordered laboratory test services and extra payments for drug supply were significant predictors of satisfaction with CBHI. Therefore, attention should be given to increasing the satisfaction of HHs with CBHI through improving the quality of health services.
A cognition perspective revisit on teaching of pictophonetic characters: A case study on the new HSK level 3 common verbs
Authors: Liu Yafen
Published: June 2023

This article discusses the teaching of Chinese characters’ pictophonetic characters from a cognitive perspective. First of all, it clearly explains the characteristics of pictophonetic characters, meaning components are used as expressing categories, and sound components express sound and meaning at the same time. It also discusses the combination of pictophonetic characters in the square character space. Secondly, it introduces the main literacy methods of Chinese character teaching at present, and uses the image teaching method and the assortment method among them. Then, on the basis of the previous knowledge, the “conceptual integration theory” (conceptual integration) is used to integrate the sound and meaning of pictophonetic characters with the shape of the characters. After that, it compares the common core pictophonetic verbs in the new Chinese Proficiency Test Syllabus (Level 3) (also known as the Chinese Proficiency Test) with the Contemporary Corpus (COCT, National Institute of Education, Taiwan), and selects the overlapping items. Among them, 22 Chinese characters conform to the core verb vocabulary of the new HSK (Level 3). There are 13 core verb pictophonetic characters suitable for “positive cognition” teaching. This article first introduces five examples of the strongest phonetic association: standing zhàn (standing), staying zhù (live), singing gē (song), singing chàng (singing) and discussing/discussing yì (discussion). Lastly it deliberates conceptual integration theory, analyzing its rationale, reconstructing and demonstrating its diversified literacy teaching methods.
Tailored therapeutic decision of rheumatoid arthritis using proteomic strategies: how to start and when to stop?
Authors: Chen Shuo-Fu , Yeh Fu-Chiang , Chen Ching-Yun , Chang Hui-Yin
Published: June 2023

Unpredictable treatment responses have been an obstacle for the successful management of rheumatoid arthritis. Although numerous serum proteins have been proposed, there is a lack of integrative survey to compare their relevance in predicting treatment outcomes in rheumatoid arthritis. Also, little is known about their applications in various treatment stages, such as dose modification, drug switching or withdrawal. Here we present an in-depth exploration of the potential usefulness of serum proteins in clinical decision-making and unveil the spectrum of immunopathology underlying responders to different drugs. Patients with robust autoimmunity and inflammation are more responsive to biological treatments and prone to relapse during treatment de-escalation. Moreover, the concentration changes of serum proteins at the beginning of the treatments possibly assist early recognition of treatment responders. With a better understanding of the relationship between the serum proteome and treatment responses, personalized medicine in rheumatoid arthritis will be more achievable in the near future.
Validation of MAP (Mayo Adhesive Probability) score and preoperative factors to predict adherent perinephric fat in robotic-assisted partial nephrectomy
Authors: Prajapati Rajan , Pathak Niramya , Ganpule Arvind , Kareem Zeeshan , Singh Abhishek , Sabnis Ravindra , Desai Mahesh
Published: June 2023

Background

Mayo Adhesive Probability (MAP) score is based on posterior perinephric fat thickness and perinephric fat stranding and ranges from 0 to 5. We intend to validate the score and identify preoperative factors predictive of Adherent Perinphric Fat (APF) encountered in robotic-assisted partial nephrectomy.

Methods

The retrospective and prospective observational study was done at a single tertiary care hospital after appropriate ethical clearance. Sixty-two patients with clinical stage cT1 renal mass planned for robotic-assisted partial nephrectomy were selected over a study period of 3 years after obtaining informed consent. Data that were collected included demographic details and perioperative details including CT renal angiography which was done in all patients preoperatively. Intraoperative and postoperative data were collected. Associations of patient and tumor characteristics with the presence of APF during RAPN were evaluated by multivariable logistic regression models and using Chi-square test to calculate p value.

Results

Out of total 62 patients included; 24 patients (38.7%) had intraoperative Adhesive Perinephric Fat (APF). Three patients required conversion to open surgery and three patients underwent conversion to radical nephrectomy. Thirty-five patients were males. Mean age was 51.27(20–77) years. We noted an increased likelihood of APF with an increase in age (p = 0.003), higher preoperative creatinine (p = 0.003), greater posterior perinephric fat thickness (p = 0.002), and perirenal fat stranding (p < 0.001). From these four variables, posterior perinephric fat thickness and fat stranding were the most predictive. The combined score given to these two highly predictive factors for APF and the calculated score, termed Mayo Adhesive Probability (MAP) score ranges from 0 to 5. APF was seen in 10.7% of patients with a MAP score of 0, 25% with a score of 1, 50% with a score of 2, 44.4% with a score of 3, 88.8% with a score of 4, and 100% of patients with a score of 5 was found. Our study validates the MAP score given by Davidiuk et al. Smoking, high BMI, Sex of patient, tumor size, lateral perinephric fat thickness do not significantly predict APF in our study.

Conclusion

MAP score can be easily calculated from a CT scan. We validate the MAP score in RAPN. Higher MAP score has higher APF which would be useful to all urologists doing RAPN.
Genomic signatures of local adaptation in recent invasive Aedes aegypti populations in California
Authors: Soudi Shaghayegh , Crepeau Marc , Collier Travis C. , Lee Yoosook , Cornel Anthony J. , Lanzaro Gregory C.
Published: June 2023

Background

Rapid adaptation to new environments can facilitate species invasions and range expansions. Understanding the mechanisms of adaptation used by invasive disease vectors in new regions has key implications for mitigating the prevalence and spread of vector-borne disease, although they remain relatively unexplored.

Results

Here, we integrate whole-genome sequencing data from 96 Aedes aegypti mosquitoes collected from various sites in southern and central California with 25 annual topo-climate variables to investigate genome-wide signals of local adaptation among populations. Patterns of population structure, as inferred using principal components and admixture analysis, were consistent with three genetic clusters. Using various landscape genomics approaches, which all remove the confounding effects of shared ancestry on correlations between genetic and environmental variation, we identified 112 genes showing strong signals of local environmental adaptation associated with one or more topo-climate factors. Some of them have known effects in climate adaptation, such as heat-shock proteins, which shows selective sweep and recent positive selection acting on these genomic regions.

Conclusions

Our results provide a genome wide perspective on the distribution of adaptive loci and lay the foundation for future work to understand how environmental adaptation in Ae. aegypti impacts the arboviral disease landscape and how such adaptation could help or hinder efforts at population control.
Modeling and optimizing concentration of exogenous application of γ-aminobutyric acid on NaCl-stressed pineapple mint (Mentha suaveolens) using response surface methodology: an investigation into secondary metabolites and physiological parameters
Authors: Ahmadi Hosein , Farhadi Habib , Morshedloo Mohammad Reza , Maggi Filippo
Published: June 2023

Salinity, a severe worldwide issue, compromises the economic production of medicinal plants including mints and causes drug-yield decline. γ-Aminobutyric acid (GABA) is a tolerance-inducing signaling bio-molecule in various plant physiological processes. Pineapple mint (Mentha suaveolensEhrh.) is a valuable medicinal herb with an exhilarating scent of citrus fruit. Piperitenone oxide is the major bioactive constituent of its essential oil, having significant demand by pharmaceutical industries. Nonetheless, modeling and optimizing the effective concentration of GABA remain within twin foci of interest. Therefore, a two factor-five level (NaCl 0-150 mM and GABA 0-2.4 mM) central composite design was conducted to model and optimize drug yield and physiological responses ofM.suaveolens. Based on the design of experiments (DoE) approach, different linear, quadratic, cubic, and quartic models were assigned to the response variables. Change trends of shoot and root dry weights followed a simple linear model, whereas sophisticated models (i.e., multiple polynomial regression) were fitted to the other traits. NaCl stress inevitably reduced root and shoot dry weight, piperitenone oxide content, relative water content, pigments content, and maximum quantum yield of PSII. However, content of malondialdehyde (MDA) and total flavonoid, and DPPH radical scavenging activity were increased under salinity. Under severe NaCl stress (150 mM), the essential oil content (0.53%) was increased three times in comparison with control (0.18%). Optimization analysis demonstrated that the highest amount of essential oil (0.6%) and piperitenone oxide (81%) as a drug yield-determining component would be achievable by application of 0.1–0.2 mM GABA under 100 mM NaCl. The highest dry weight of root and shoot was predicted to be achieved at 2.4 mM GABA. Overall, extremely severe NaCl stress (i.e., more than 100 mM) in which a sharp drop in yield components value was observed seemed to be out ofM. suaveolenssalinity tolerance range. Hence, it is rationale to compensate the decrease of drug yield by foliar application of a dilute GABA solution (i.e., 0.1–0.2 mM) under 100 mM NaCl stress or lower levels.
Prevalence estimates of the insulin resistance and associated prevalence of heart failure among United Status adults
Authors: Li Xiaozhong , Wang Jihong , Niu Liyan , Tan Ziqi , Ma Jianyong , He Ling , Yu Peng , Liu Xiao , Li Juxiang
Published: June 2023

Background

The triglyceride glucose (TyG) index, a metric for estimating insulin resistance (IR), is linked with cardiovascular disease (CVD) morbidity and mortality among the population regardless of diabetic status. However, IR prevalence and the association between the TyG index and heart failure (HF) in Americans is unclear.

Methods

The Nation Health and Nutrition Examination Survey (NHANES) (2009–2018) dataset was used. IR was defined by homeostatic model assessment of insulin resistance (HOMA-IR) > 2.0 and 1.5. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. A weighted logistic regression was applied to evaluate the association between the TyG index and the prevalence of HF.

Results

This study comprised 12,388 people, including 322 (2.6%) individuals with HF. The average prevalence of IR was found to be 13.9% and 22.7% for cutoff values greater than 2.0 and 1.5, respectively. HOMA-IR and the TyG index showed a moderate correlation (r = 0.30). There is a significant positive association between the TyG index and HF prevalence (per 1-unit increment; adjusted OR [aOR]: 1.34; 95% confidence interval [CI]: 1.02–1.76). Patients with higher TyG values were associated with a prevalence of HF (OR:1.41; 95% CI: 1.01,1.95) (quartiles 4 vs 1–3). The TyG index is associated with a higher prevalence of dyslipidemia, coronary heart disease, and hypertension but not a stroke (cerebrovascular disease).

Conclusions

Our results show that IR does not considerably increase from 2008 to 2018 in American adults. A moderate correlation is noted between HOMA-IR and the TyG index. TyG index is associated with the prevalence of HF, as were other cardiovascular diseases.
Parkinson’s disease in a patient with GBA and LRRK2 covariants after acute hypoxic insult: a case report
Authors: Tang Yuting , Wei Lijian , Wu Zhuohua , Xu Pingyi , Mo Mingshu
Published: June 2023

Background

The glucocerebrosidase (GBA) and leucine-rich repeat kinase 2 (LRRK2) genes are associated with the risk of sporadic Parkinson’s disease (PD). As an environmental factor, hypoxic insults may impair dopamine neurons in the substantia nigra and exacerbate PD symptoms. However, covariants of GBA and LRRK2 combined with hypoxic insults in clinical cases of Parkinsonism have not yet been reported.

Case presentation

A 69-year-old male patient with PD and his relatives were clinically characterized and sequenced using the whole-exome technique. A novel covariant, c.1448 T > C (p. L483P, rs421016) on GBA and c.691 T > C (p. S231P, rs201332859) on LRRK2 were identified in this patient who first developed bradykinesia and rigidity in the neck at one month after an acute hypoxic insult during mountaineering. The patient presented with a mask-like face, festinating gait, asymmetric bradykinesia, and moderate rigidity. These symptoms were treated with levodopa and pramipexole, resulting in a 65% improvement in the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score. These parkinsonian symptoms persisted and developed with hallucinations, constipation, and rapid eye movement sleep behavior disorder. After 4 years, the patient exhibited a wearing-off phenomenon and died from pulmonary infection 8 years after disease onset. His parents, wife, and siblings were not diagnosed with PD, and his son carried p. L483P without Parkinsonism-like symptoms.

Conclusions

This is a case report of PD after hypoxic insult in a patient carrying a covariant of GBA and LRRK2. This study may help us understand the interaction between genetic and environmental factors in clinical PD.
An eHealth symptom and complication management program for cancer patients with newly created ostomies and their caregivers (Alliance): a pilot feasibility randomized trial
Authors: Xu Shenmeng , Tan Xianming , Ma Chunxuan , McElyea Rebecca S. , Shieh Karl , Stover Angela M. , Smith Angela , Stitzenberg Karyn , Basch Ethan , Song Lixin
Published: June 2023

Background

Cancer patients with newly created ostomies face complications that reduce quality of life (QOL) and increase morbidity and mortality. This proof-of-concept study examined the feasibility, usability, acceptability, and initial efficacy of an eHealth program titled the “Patient Reported Outcomes-Informed Symptom Management System” (PRISMS) during post-ostomy creation care transition.

Methods

We conducted a 2-arm pilot randomized controlled trial among 23 patients who received surgical treatment with curative intent for bladder and colorectal cancer and their caregivers. After assessing QOL, general symptoms, and caregiver burden at baseline, participants were randomly assigned to PRISMS (n = 16 dyads) or usual care (UC) (n = 7 dyads). After a 60-day intervention period, participants completed a follow-up survey and post-exit interview. We used descriptive statistics and t-tests to analyze the data.

Results

We achieved an 86.21% recruitment rate and a 73.91% retention rate. Among the PRISMS participants who used the system and biometric devices (n = 14, 87.50%), 46.43% used the devices for ≥ 50 days during the study period. Participants reported PRISMS as useful and acceptable. Compared to their UC counterparts, PRISMS patient social well-being scores decreased over time and had an increased trend of physical and emotional well-being; PRISMS caregivers experienced a greater decrease in caregiver burden.

Conclusions

PRISMS recruitment and retention rates were comparable to existing family-based intervention studies. PRISMS is a useful and acceptable multilevel intervention with the potential to improve the health outcomes of cancer patients needing ostomy care and their caregivers during post-surgery care transition. A sufficiently powered RCT is needed to test its effects.

Trial registration

ClinicalTrial.gov ID: NCT04492007. Registration date: 30/07/2020.
An electrocardiographic score to predict pulmonary hypertension in children with atrial septal defect
Authors: Murni Indah K , Kato Taichi , Wirawan Muhammad Taufik , Arafuri Nadya , Hermawan Kristia , Hartopo Anggoro Budi , Anggrahini Dyah Wulan , Nugroho Sasmito , Noormanto Noormanto , Emoto Noriaki , Dinarti Lucia Kris
Published: June 2023

Background

In limited resource settings, identification of factors that predict the occurrence of pulmonary hypertension(PH) in children with atrial septal defect(ASD) is important to decide which patients should be prioritized for defect closure to prevent complication. Echocardiography and cardiac catheterization are not widely available in such settings. No scoring system has been proposed to predict PH among children with ASD. We aimed to develop a PH prediction score using electrocardiography parameters for children with ASD in Indonesia.

Methods

A cross-sectional study reviewing medical record including ECG record was conducted among all children with newly diagnosed isolated ASD admitted to Dr Sardjito Hospital in Yogyakarta, Indonesia during 2016–2018. Diagnosis of ASD and PH was confirmed through echocardiography and/or cardiac catheterization. Spiegelhalter Knill-Jones approach was used to develop PH prediction score. Accuracy of prediction score was performed using a receiver operating characteristic (ROC) curve.

Results

Of 144 children, 50(34.7%) had PH. Predictors of pulmonary hypertension were QRS axis ≥120°, P wave ≥ 3 mm at lead II, R without S at V1, Q wave at V1, right bundle branch block (RBBB), R wave at V1, V2 or aVR > normal limit and S wave at V6 or lead I > normal limit. ROC curve from prediction scores yielded an area under the curve (AUC) 0.908(95% CI 0.85–0.96). Using the cut-off value 3.5, this PH prediction score had sensitivity of 76%(61.8–86.9), specificity 96.8%(91.0-99.3), positive predictive value 92.7%(80.5–97.5), negative predictive value 88.4%(82.2–92.6), and positive likelihood ratio 23.8(7.7–73.3).

Conclusions

A presence of PH in children with ASD can be predicted by the simple electrocardiographic score including QRS axis ≥120°, P wave ≥3 mm at lead II, R without S at V1, Q wave at V1, RBBB, R wave at V1, V2 or aVR > normal limit and S wave at V6 or lead I > normal limit. A total score ≥ 3.5 shows a moderate sensitivity and high specificity to predict PH among children with ASD.
Preventing sexual violence in Vietnam: qualitative findings from high school, university, and civil society key informants across regions
Authors: Yount Kathryn M. , Anderson Katherine M. , Trang Quach Thu , Bergenfeld Irina
Published: June 2023

Background

Sexual violence by young men against women is common, but efficacious primary prevention interventions tailored to men are limited in low- and middle-income settings like Vietnam. GlobalConsent, a web-based sexual violence prevention intervention tailored to university men in Hanoi, is efficacious. Implementation research is needed to understand facilitators and barriers to scaling GlobalConsent and prevention programs generally. We conducted qualitative research with key informants from three youth-focused organizational settings to understand the context of implementation in Vietnam.

Methods

Interviews with university (n = 15), high-school (n = 15) and non-governmental (n = 15) key informants focused on perceptions about sexual violence among young people and prevention programming. Four focus group discussions with 22 interviewed informants, following the Consolidated Framework for Implementation Research, asked about facilitators and barriers to implementing GlobalConsent. Narratives were transcribed, translated, and coded inductively and deductively to identify salient themes.

Results

Outer-setting influences included greater expectations for sex among young people alongside norms favoring men’s sexual privilege, ostensibly ambiguous and lax laws on sexual violence, government ministries as bureaucratic but potential allies, external subject-matter experts, and the media. Inner-setting influences included variable cultures regarding openness to discuss sexual violence and equitable gender norms, variable departmental coordination, limited funding and ‘red tape’ especially in public institutions, inconsistent student access to technologies, and limited time and competing priorities among students and teachers. Several actors were considered influential, including institutional leaders, human-resource staff, the Youth Union, and student-facing staff. Important characteristics of individuals for implementation included subject-matter expertise, science or social science training, younger age, engagement in social justice related activities, and more open attitudes about sex. Regarding characteristics of sexual violence prevention programming, some participants preferred online formats for busy students while others suggested hybrid or in-person formats, peer education, and incentives. Participants generally accepted the content of GlobalConsent and suggested adding more content for women, ancillary support services, and adapted content for high-school students.

Conclusions

Implementation of sexual violence prevention programs in youth-focused organizations in Vietnam requires multilevel strategies that connect outer-setting subject-matter experts with supportive inner-setting leaders and student-facing staff to overcome normative and organizational constraints, and thereby, to deliver institution-wide programming.
Supported self-management for all with musculoskeletal pain: an inclusive approach to intervention development: the EASIER study
Authors: Healey Emma L. , Lewis Martyn , Corp Nadia , Shivji Noureen A. , van der Windt Danielle A. , Babatunde Opeyemi O. , Simkins Joanna , Bartlam Bernadette , Rowlands Gill , Protheroe Joanne
Published: June 2023

Background

Supported self-management interventions for patients with musculoskeletal (MSK) conditions may not adequately support those with limited health literacy, leading to inequalities in care and variable outcomes. The aim of this study was to develop a model for inclusive supported self-management intervention(s) for MSK pain that take account of health literacy.

Methods

A mixed methods study with four work-packages was conducted: work package 1: secondary analysis of existing data to identify potential targets for intervention; work package 2: evidence synthesis to assess effective components of self-management interventions taking into account health literacy; work package 3: views of community members and healthcare professionals (HCPs) on essential components; work package 4: triangulation of findings and an online modified Delphi approach to reach consensus on key components of a logic model.

Findings

Findings identified targets for intervention as self-efficacy, illness perceptions, and pain catastrophizing. A range of intervention components were identified (e.g. information in diverse formats offered at specific times, action planning and visual demonstrations of exercise). Support should be multi-professional using a combination of delivery modes (e.g. remote, face-to-face).

Conclusions

This research has developed a patient-centred model for a multi-disciplinary, multi-modal approach to supported self-management for patients with MSK pain and varying levels of health literacy. The model is evidence-based and acceptable to both patients and HCPs, with potential for significant impact on the management of MSK pain and for improving patient health outcomes. Further work is needed to establish its efficacy.
A randomized controlled trial evaluating the short-term efficacy of a single-administration intramuscular injection with the fixed combination of thiocolchicoside-diclofenac versus diclofenac monotherapy in patients with acute moderate-to-severe low back pain
Authors: Iliopoulos Konstantinos , Koufaki Panagiota , Tsilikas Stavros , Avramidis Kyriakos , Tsagkalis Antonios , Mavragani Clio , Zintzaras Elias
Published: June 2023

Background

Non-specific acute low back pain (LBP) is a common health problem that may be accompanied by muscle spasm and decreased mobility. The combination of non-steroidal anti-inflammatory drugs and muscle relaxants represents an advantageous therapeutic option, however, available data on their combined use are conflicting.

This prospective, randomized, single-blind, two-parallel-group trial assessed the efficacy of a single intramuscular (IM) injection of the fixed-dose combination (FDC) diclofenac (75 mg)-thiocolchicoside (4 mg/4 ml) product (test treatment) compared to diclofenac (75 mg/3 ml) alone (reference treatment) for the symptomatic relief of acute LBP. Tolerability and safety were also assessed as secondary variables.

Methods

One hundred thirty-four patients were enrolled (safety population) and randomly allocated to the combination or single-agent regimen. Pain intensity and muscle spasm, assessed respectively by the patient-reported visual analogue scale and investigator-performed finger-to-floor distance test, were determined prior to the injection as well as 1 and 3 h post-injection in 123 patients (per-protocol population). The patients were blinded to treatment. Safety was assessed up to 24 h post-injection.

Results

The test treatment was superior in both alleviating the pain intensity and reducing the finger-to-floor distance at both 1 (p < 0.01 and p = 0.023 respectively) and 3 h post-injection (p < 0.01). A higher percentage of patients experienced > 30% reduction in pain intensity at 1 and 3 h with the test treatment (p = 0.037 and p < 0.01 respectively). The corresponding VAS (SD) scores for the test treatment group were at baseline, 1 and 3 h post-injection 72.03 (± 11.72), 45.37 (± 16.28) and 31.56 (± 15.08) respectively and for the reference treatment group 65.20 (± 12.16), 48.98 (± 18.76) and 44.52 (± 17.33) respectively. No adverse effects were reported with the combination treatment, whereas two patients treated with diclofenac reported dizziness.

Conclusions

The FDC treatment is an effective and well-tolerated option for the symptomatic treatment of LBP. Clinical and patient-reported assessments confirmed that a single IM injection of FDC diclofenac-thiocolchicoside was more effective than diclofenac alone in conferring rapid and sustained improvement in mobility and pain intensity.

Trial registration

EudraCT No: 2017–004530-29 Available at https://eudract.ema.europa.eu/ Registered 04 Dec 2017.
An estimation of the endoscopist's musculoskeletal injury risk for right and left lateral decubitus positions during colonoscopy: a field-based ergonomic study
Authors: Landry Maxim , Mackey Sarah , Hossain Intekhab , Fairbridge Nicholas , Greene Alison , Borgaonkar Mark , Cullen Kimberley , Pace David , De Carvalho Diana
Published: June 2023

Background

Colonoscopy exposes endoscopists to awkward postures and prolonged forces, which increases their risk of musculoskeletal injury. Patient positioning has a significant impact on the ergonomics of colonoscopy. Recent trials have found the right lateral decubitus position is associated with quicker insertion, higher adenoma detection rates, and greater patient comfort compared to the left lateral decubitus position. However, this patient position is perceived as more strenuous by endoscopists.

Methods

Nineteen endoscopists were observed performing colonoscopies during a series of four-hour endoscopy clinics. Durations of each patient position (right lateral decubitus, left lateral decubitus, prone, and supine) were recorded for all observed procedures (n = 64). Endoscopist injury risk was estimated by a trained researcher for the first and last colonoscopies of the shifts (n = 34) using Rapid Upper Limb Assessment (RULA), an observational ergonomic tool that estimates risk of musculoskeletal injury by scoring postures of the upper body and factors such as muscle use, force, and load. The total RULA scores were compared with a Wilcoxon Signed-Rank test for patient position (right and left lateral decubitus) and time (first and last procedures) with significance taken at p < 0.05. Endoscopist preferences were also surveyed.

Results

The right lateral decubitus position was associated with significantly higher RULA scores than the left lateral decubitus position (median 5 vs. 3, p < 0.001). RULA scores were not significantly different between the first and last procedures of the shifts (median 5 vs. 5, p = 0.816). 89% of endoscopists preferred the left lateral decubitus position, primarily due to superior ergonomics and comfort.

Conclusion

RULA scores indicate an increased risk of musculoskeletal injury in both patient positions, with greater risk in the right lateral decubitus position.
Risk factors for intraoperative hemorrhage of Type I neurofibromatosis
Authors: Gao Qianqian , Qu Siwei , Ma Ning , Wang Weixin , Chen Sen , Yang Zhe , Li Yangqun
Published: June 2023

Introduction

Neurofibromatosis (NF) is an inherited disease and a benign tumor originating from nerve sheath cells. Neurofibromatosis type I (NF1) is the most common type, and most cases are characterized by neurofibromas. Neurofibromas in NF1 are mainly treated by surgery. Our study explores the risk factors for intraoperative hemorrhage in Type I neurofibromatosis patients who underwent neurofibroma resection.

Methods

A cross-sectional comparison of the patients who had undergone resection of neurofibroma for NF1. Data regarding patient characteristics and data about operative outcomes were recorded. The definition of intraoperative hemorrhage group was the intraoperative blood loss greater than 200 ml.

Results

Of 94 eligible patients, 44 patients were in the hemorrhage group and 50 patients were in the non-hemorrhage group. Multiple logistic regression analysis demonstrated that the area of excision, classification, surgical site, primary surgical, and organ deformation were significant independent predictors of hemorrhage.

Conclusion

Early treatment can reduce the tumor cross-sectional area, avoid organ deformation, and reduce intraoperative blood loss. For plexiform neurofibroma or neurofibroma of the head and face, the amount of blood loss should be predicted correctly, and preoperative evaluation and blood preparation should be paid more attention to.
“To teach or not to teach- that is the question” The educational and clinical impact of introducing an outcome based, modular curriculum in Social Emergency Medicine (SEM) at a private tertiary care center in Karachi, Pakistan
Authors: Ali Saima , Saleem Syed Ghazanfar , Khatri Adeel , Mukhtar Sama
Published: June 2023

Introduction

An enhanced knowledge of Emergency Medicine (EM) personnel regarding negative Social Determinants of Health (SDH) can impact EM service provision in a resource limited country like Pakistan. Interventions to build capacity in identifying and addressing these SDH through education in Social Emergency Medicine (SEM) can be one of the ways in which EM key performance indicators (KPIs) can be improved.

Method

A SEM based curriculum was administered to the EM residents at a tertiary care center in Karachi, Pakistan. Pre, post and delayed post-test was conducted for knowledge of EM residents and analyzed using Repeated Measures ANOVA (RMANOVA). Clinical impact of this intervention was assessed through the ability of the residents to identify the patients’ SDH and determining appropriate disposition. Comparison of the bounce-back of patients in the pre-intervention (2020) and post-intervention year (2021) year was appreciated to see the clinical impact of this intervention.

Result

A significant improvement was seen in post intervention (p < 0.001) and follow up knowledge (p < 0.001) of residents regarding negative SDH. Bounce-back rate was higher in the pre-SEM curriculum (43%) as compared to the post-SEM curriculum year (27.7%). Post-intervention, the residents were able to identify the unique Pakistani SDH, however appropriate patient disposition needs further reinforcement.

Conclusion

The study highlights the beneficial impact of an educational intervention in SEM upon the knowledge of EM residents and the bounce-back of patients in the emergency department (ED) of a low resource setup. This educational intervention can be scaled up to other EDs across Pakistan for potential improvement in knowledge, EM process flow and KPIs.