bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasal foreign bodies identified by rhinoscopy in dogs: 42 cases
Authors: Dias Maria Joana , Mouro Sofia , Englar Ryane E. , Leal Rodolfo O.
Published: September 2020

Objective

To evaluate signalment, clinical presentation, location and type of nasal foreign bodies identified by rhinoscopy in dogs.

Materials and Methods

We retrospectively reviewed medical records from dogs that presented for consultation between April 2012 and June 2019 and were diagnosed with nasal foreign body via rhinoscopy.

Results

Forty‐two dogs met the study's inclusion criteria. Thirty (71.4%; 30/42) were purebreds. Males accounted for 59.5% (25/42) of cases. The median age was 4.0 years old and 76.2% (32/42) were dogs up to 7 years of age. Mean bodyweight was 21.8 kg and dogs weighing more than 10 kg were overrepresented (78.6%; 33/42). Sneezing occurred in 78.6% (33/42) of cases. Foreign body retrieval was achieved by rhinoscopy in all cases. The foreign body was extracted from the right nasal cavity in 52.4% (22/42) of cases and from the left one in 42.9% (18/42). Two dogs (4.8%; 2/42) presented with one foreign body in each nasal cavity. Most nasal cavity foreign bodies (90.5%; 38/42) were grass awns. Three (7.2%; 3/42) were mineral and one (1/42) was fabric. Follow‐up was documented for 35 patients, of which 97.1% (34/35) experienced resolution of clinical signs. Seven cases (16.7%; 7/42) were lost to follow‐up.

Clinical Significance

Nasal foreign bodies were more common in dogs up to 7 years of age and heavier than 10 kg. Sneezing was the primary clinical sign. The vast majority of foreign bodies were grass awns and rhinoscopy was an effective means of nasal cavity foreign body retrieval.
IntragastricpHof foals admitted to the intensive care unit
Authors: Wise Jessica C. , Raidal Sharanne L. , Wilkes Edwina J. A. , Hughes Kristopher J.
Published: September 2020

Background

Intragastric pH profiles of neonatal foals admitted to the intensive care unit (ICU) remain poorly characterized.

Hypothesis/Objectives

To determine intragastric pH profiles and clinical parameters associated with intragastric pH in foals admitted to the ICU.

Animals

Forty‐two neonatal foals admitted to the ICU and requiring placement of an indwelling nasogastric tube for nutritional management were included.

Methods

Intragastric pH was measured for 24 hours from the time of admission. Mean pH, % time pH <4, and % time pH >4 were determined for each foal. History, clinical findings, and clinicopathological data recorded at the time of presentation were collected.

Results

The mean pH of included foals was 5.5 ± 1.8. The median % time pH <4 was 6.3% (range: 0‐99). A history of placentitis was associated with greater mean pH (median 5.3 (range: 0.9‐7.8) versus median 7.2 (5.9‐11.3);P= .002) and less % time pH <4 (median 13 (0‐99.6) versus median 0.1 (0‐7.2);P= .01). Foals with diarrhea had a greater % time pH <4 (median 4.6% (0‐99) versus median 28.8% (1.4‐57.48);P= .02). Foals with a pH >4 for >50% recording time had a lower PaO2(mean difference 25.0 mm Hg; 95% confidence interval [CI], 14.4‐35.6;P= .03) and higher PaCO2(mean difference 14.9 mm Hg; 95% CI, 4.7‐25.2;P= .02). Surviving foals had a lower mean median hourly pH (P = .02).

Conclusions and Clinical Importance

Intragastric pH profiles were unpredictable and mostly >4 for >80% of the recording time. This study does not support the indiscriminate administration of acid suppressive treatment.
Is breast milk iodine concentration an influential factor in growth‐ and obesity‐related hormones and infants' growth parameters?
Authors: Nazeri Pantea , Tahmasebinejad Zhale , Hedayati Mehdi , Mirmiran Parvin , Azizi Fereidoun
Published: September 2020

Iodine, a key constituent of thyroid hormones, plays an indirect role in prenatal and postnatal growth. This study aimed to investigate whether breast milk iodine concentration (BMIC) is associated with growth‐ and obesity‐related hormones and subsequently the infants' anthropometric measures. In present study conducted in Tehran (Iran), 94 lactating mothers and healthy infants who were exclusively breastfed were included. Concentrations of iodine, insulin‐like growth factor‐1 (IGF‐1), adiponectin (AD) and leptin (LP) were measured in breast milk samples collected during 3‐ to 5‐day postpartum. Anthropometric measures of infants were assessed at 6 months of life, and age‐ and sex‐specific z‐score values were calculated using the World Health Organization growth standards. The median (interquartile range) iodine, IGF‐1, AD and LP concentrations were 232.5 (157.5–296.0) μg L−1, 15.7 (11.9–21.1) ng ml−1, 13.2 (5.1–29.8) mg L−1 and 1.16 (0.86–1.70) ng ml−1 in breast milk, respectively. No significant correlations were found between BMIC and IGF‐1, AD and LP concentrations during the first few days postpartum. In adjusted regression model, BMIC was positively associated with weight‐for‐length z score of infants. In the presence of IGF‐1, AD or LP, the coefficients of BMIC for weight‐for‐length z score of infants were β = .003 (P = .021), β = .002 (P = .028) or β = .003 (P = .013), respectively. No other anthropometric measurements were associated with iodine or growth‐ and obesity‐related hormones in breast milk. Our findings indicate that BMIC is a potential contributor to infants' growth status, independent of IGF‐1, AD or LP concentrations in breast milk. The underlying mechanisms remain to be elucidated.
Catheter ablation for atrial tachycardias: How to interpret the unclear activation map?
Authors: Ma Wei , Qiu Jiuchun , Lu Fengmin , Shehata Michael , Wang Xunzhang , Wu Dongyan , He Le , Xu Jing
Published: September 2020

Background

Post‐ablation atrial tachycardias (ATs) are characterized by low‐voltage signals that challenge current mapping methods. In this study, we analyzed common mistakes during activation mapping and delineated a mapping strategy for correct interpretation of tachycardia mechanisms in patients with challenging underlying substrate.

Methods and results

Thirty‐one patients referred for AT ablation were selected for the study. Three types of incorrect activation patterns were identified, which were referred to as unrecognized block line (pseudo‐macroreentry and pseudo‐fig‐8 reentry), incorrect activation timing window of interest (WOI) (chaotic activation), and mis‐annotation of complex signals (multiple sites of “early meets late”). Pseudo‐macroreentry and chaotic activation occur in focal or localized reentry AT with the error related to the WOI selection (four cases), incorrect annotation of local activation time (six cases), or a previous line of atrial block in (seven cases). Pseudo‐fig‐8 reentry (five cases) and multiple sites of “early meets late” (nine cases) occur in macroreentrant AT with blocked areas and low‐voltage atrial substrate. All ATs were successfully eliminated at the origin site.

Conclusions

We delineated a series of ATs in the setting of a disordered pattern of activation mapping encountered in patients after previous extensive ablation or atriotomy. The algorithm proposed rapidly corrects the activation map and identifies the mechanism of the AT.
Long‐term respiratory outcomes of post‐op congenital lung malformations
Authors: Dincel Alican , Yilmaz Yegit Cansu , Ergenekon Almala Pinar , Erdem Eralp Ela , Gokdemir Yasemin , Kiyan Gursu , Karadag Bulent
Published: September 2020

Background

Congenital lung malformations (CLM) are rare disorders and surgical intervention is the definitive treatment. Our aim is to evaluate the long‐term lung function of patients with CLM after surgery compared to healthy children.

Methods

Sixteen children with CLM (M/F: 9/7) and 30 age‐matched, healthy controls (M/F: 13/17) were included in the study. Demographic data were recorded and both groups were compared by spirometry and the nitrogen‐based Lung Clearance Index (LCI).

Results

Mean ± SD age of the patients was 12.0 ± 5.4 years. The mean forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced expiratory flow between 25% and 75% of force expiration (FEF25‐75) predicted was, 86.68 ± 16.65, 88.00 ± 14.58, 97.44 ± 9.89, and 79.00 ± 26.41, respectively in the patient group. Patients with CLM had significantly lower values in FEV1, FVC, FEF25‐75 than healthy controls (P = 0.002, P 0.007, P 0.045). While the mean LCI2,5% value in patients' group was 8.33 ± 1.52, it was 7.28 ± 0.80 in healthy controls (P = 0.023). Strong inverse correlation between LCI and FEV1, FEV1/FVC was detected in the patient group (P = 0.023; r: −0.581, P 0.017; r: −0.606 respectively).

Conclusion

This study revealed that, in long‐term follow‐up, patients who had surgery because of CLM have impairment in the pulmonary function compared to healthy children and LCI may be more accurate in detecting airway diseases early than spirometry.
Fluorimetric ex vivo quantification of protease debriding efficacy on natural substrate
Authors: Vootukuri Reddy Sreekanth , Philpott Mike P. , Trigiante Giuseppe
Published: September 2020

Debridement is the process of removal of necrotic and infected tissue to clean a wound or burn and expedite healing. Proteases such as papain, bromelain, and collagenase that promote debridement by degrading proteins in the dead tissue are in use today. However, the only method to measure debriding efficacy in vitro is the fluorescent monitoring of the digestion of an Artificial Wound Eschar (AWE) substrate. This AWE substrate contains a pellet of only three eschar matrix proteins collagen, elastin, and fibrin which do not account for the complexity and the composition of necrotic tissue. Here, we describe an ex vivo method using dry necrotic full thickness human skin and ortho‐phthalaldehyde (OPA), a molecule commonly used for sensitive fluorimetric protein detection to monitor debridement activity. We advocate this simple yet sensitive approach to detect debridement efficacy that can readily be used commercially to benchmark products prior to in vivo testing.
A chloride channel blocker prevents the suppression by inorganic phosphate of the cytosolic calcium signals that control muscle contraction
Authors: Ferreira Juan J. , Pequera Germán , Launikonis Bradley S. , Ríos Eduardo , Brum Gustavo
Published: September 2020

Key points

 Accumulation of inorganic phosphate (Pi) may contribute to muscle fatigue by precipitating calcium salts inside the sarcoplasmic reticulum (SR). Neither direct demonstration of this process nor definition of the entry pathway of Pi into SR are fully established.

 We showed that Pi promoted Ca2+ release at concentrations below 10 mm and decreased it at higher concentrations. This decrease correlated well with that of [Ca2+]SR.

 Pre‐treatment of permeabilized myofibres with 2 mm Cl− channel blocker 9‐anthracenecarboxylic acid (9AC) inhibited both effects of Pi.

 The biphasic dependence of Ca2+ release on [Pi] is explained by a direct effect of Pi acting on the SR Ca2+ release channel, combined with the intra‐SR precipitation of Ca2+ salts. The effects of 9AC demonstrate that Pi enters the SR via a Cl− pathway of an as‐yet‐undefined molecular nature.

Fatiguing exercise causes hydrolysis of phosphocreatine, increasing the intracellular concentration of inorganic phosphate (Pi). Pi diffuses into the sarcoplasmic reticulum (SR) where it is believed to form insoluble Ca2+ salts, thus contributing to the impairment of Ca2+ release. Information on the Pi entrance pathway is still lacking. In amphibian muscles endowed with isoform 3 of the RyR channel, Ca2+ spark frequency is correlated with the Ca2+ load of the SR and can be used to monitor this variable. We studied the effects of Pi on Ca2+ sparks in permeabilized fibres of the frog. Relative event frequency (f/fref) rose with increasing [Pi], reaching 2.54 ± 1.6 at 5 mm, and then decreased monotonically, reaching 0.09 ± 0.03 at [Pi] = 80 mm. Measurement of [Ca2+]SR confirmed a decrease correlated with spark frequency at high [Pi]. A large [Ca2+]SR surge was observed upon Pi removal. Anion channels are a putative path for Pi into the SR. We tested the effect of the chloride channel blocker 9‐anthracenecarboxylic acid (9AC) on Pi entrance. 9AC (400 µm) applied to the cytoplasm produced a non‐significant increase in spark frequency and reduced the Pi effects on this parameter. Fibre treatment with 2 mm 9AC in the presence of high cytoplasmic Mg2+ suppressed the effects of Pi on [Ca2+]SR and spark frequency up to 55 mm [Pi]. These results suggest that chloride channels (or transporters) provide the main pathway of inorganic phosphate into the SR and confirm that Pi impairs Ca2+ release by accumulating and precipitating with Ca2+ inside the SR, thus contributing to myogenic fatigue.
The Matrix: Connecting Time and Space in archaeological stratigraphic records and archives
Authors: May Keith
Published: September 2020

The records of archaeological stratigraphic data and the relationships between stratigraphic units are fundamental to understanding the overall cohesiveness of the archaeological archive of an excavation. The information about individual units of excavation identified on sites with complex stratigraphy is most often held in the site database records and stratigraphic matrix diagrams, usually documenting relationships based on the laws of stratigraphic superposition and the Harris matrix conventions (Harris 1979). However, once the matrix diagram has been used to record the information during excavation, there is far less consistency in how those stratigraphic records, and any associated phasing information, are finally deposited in the archives. For that valuable data to be successfully identified and re-used (particularly if the rest of the data is in a database), the stratigraphic and phasing data needs to be in a format that can be interrogated as part of the database. In practice, often only a (paper) copy of the matrix diagrams make the archive. This means that the critical temporal and spatio-temporal relationships upon which the phasing of sites is built, cannot usually be interrogated or (re)used without lengthy and wasteful re-keying of that data into another version of the database.

The stratigraphic, sequencing and temporal information held in a matrix is fundamental in further studies of the site records and in working out how the site may relate to other excavated sites of similar or related dates and phases. This article will suggest ways in which the stratigraphic data from excavations and the reasoning processes carried out in subsequent analysis could be better managed, to make matrices (re)useable as part of a more integrated digital archive.

This article examines how conceptual reference modelling, particularly using temporal relationships, can be used to explore these issues and how associated technologies could enable semantically-enriched deductions about the spatio-temporal and purely temporal relationships that fundamentally link archaeological data together. It will also consider where further work is needed both to deal with analysis of spatial or temporal records and to enhance Bayesian chronological modelling and associated temporal reasoning, and how this may form the basis for new linkages between archaeological information across space-time.
Investigation of Chemical Kinetic Model for Hypergolic Propellant of Monomethylhydrazine and Nitrogen Tetroxide
Authors: Hong-bo Hu , Hong-yu Chen , Yu Yan , Feng Zhang , Ji-Hui Yin , Dong Zheng
Published: September 2020

Hypergolic bipropellant of monomethylhydrazine (MMH) and nitrogen tetroxide (NTO) is extensively used in spacecraft propulsion applications and rocket engines. But studies on the chemical kinetic mechanism of MMH/NTO are limited. So, in this study by integrating the submechanisms of MMH decomposition, NTO thermal decomposition, MMH/NTO and intermediates, and small hydrocarbons, the comprehensive chemical mechanism of MMH/NTO bipropellant is proposed. The present chemical mechanism consists of 72 species and 406 elementary reactions. In two respects of ignition delay times and combustion flame temperatures, the present model has been validated against the theoretical calculation results and also compared with other kinetic models in the literature. The validations show that the predicted ignition delay times by the present kinetic model are highly consistent with the theoretical data and well describe the pressure-dependent characteristic. For combustion flame temperature, the present model also exhibits better predictions to the theoretical calculation results, which are also the same as the predictions by the MMH-RFNA model. Furthermore, the influences of initial temperature, chamber pressure, and NTO/HHM mass ratio (O/F) on the ignition delay time and combustion flame temperature are investigated. The auto-ignition behavior of MMH/NTO propellant is sensitive to initial temperature and chamber pressure, and the combustion flame temperature is more sensitive to the O/F. This study provides a detail chemical kinetics model for further mechanism simplification and combustion numerical simulation.
Neutralizing Antibody Responses Induced by HIV-1 Envelope Glycoprotein SOSIP Trimers Derived from Elite Neutralizers
Authors: Schorcht Anna , van den Kerkhof Tom L. G. M. , Cottrell Christopher A. , Allen Joel D. , Torres Jonathan L. , Behrens Anna-Janina , Schermer Edith E. , Burger Judith A. , de Taeye Steven W. , Torrents de la Peña Alba , Bontjer Ilja , Gumbs Stephanie , Ozorowski Gabriel , LaBranche Celia C. , de Val Natalia , Yasmeen Anila , Klasse Per Johan , Montefiori David C. , Moore John P. , Schuitemaker Hanneke , Crispin Max , van Gils Marit J. , Ward Andrew B. , Sanders Rogier W.
Published: September 2020

Elite neutralizers, i.e., individuals who developed unusually broad and potent neutralizing antibody responses, might serve as blueprints for HIV-1 vaccine design. Here, we studied the immunogenicity of native-like recombinant envelope glycoprotein (Env) trimers based on viral sequences from elite neutralizers. While immunization with single trimers from elite neutralization did not recapitulate the breadth and potency of neutralization observed in these infected individuals, a combination of three subtype B Env trimers from elite neutralizers resulted in some neutralization breadth within subtype B viruses. These results should guide future efforts to design vaccines to induce broadly neutralizing antibodies.
A Heterogeneous Swine Show Circuit Drives Zoonotic Transmission of Influenza A Viruses in the United States
Authors: Nelson Martha I. , Perofsky Amanda , McBride Dillon S. , Rambo-Martin Benjamin L. , Wilson Malania M. , Barnes John R. , van Bakel Harm , Khan Zenab , Dutta Jayeeta , Nolting Jacqueline M. , Bowman Andrew S.
Published: September 2020

The varying influenza A virus (IAV) exposure and infection status of individual swine facilitates introduction, transmission, and dissemination of diverse IAVs. Since agricultural fairs bring people into intimate contact with swine, they provide a unique interface for zoonotic transmission of IAV. Understanding the dynamics of IAV transmission through exhibition swine is critical to mitigating the high incidence of variant IAV cases reported in association with agricultural fairs. We used genomic sequences from our exhibition swine surveillance to characterize the hemagglutinin and full genotypic diversity of IAV at early-season shows and the subsequent dissemination through later-season agricultural fairs. We were able to identify a critical time point with important implications for downstream IAV and zoonotic transmission. With improved understanding of evolutionary origins of zoonotic IAV, we can inform public health mitigation strategies to ultimately reduce zoonotic IAV transmission and risk of pandemic IAV emergence.
Nutrition and the Gut Microbiota in 10- to 18-Month-Old Children Living in Urban Slums of Mumbai, India
Authors: Huey Samantha L. , Jiang Lingjing , Fedarko Marcus W. , McDonald Daniel , Martino Cameron , Ali Farhana , Russell David G. , Udipi Shobha A. , Thorat Aparna , Thakker Varsha , Ghugre Padmini , Potdar R. D. , Chopra Harsha , Rajagopalan Kripa , Haas Jere D. , Finkelstein Julia L. , Knight Rob , Mehta Saurabh
Published: September 2020

The impact of comprehensive nutritional status, defined as growth, nutritional blood biomarkers, dietary intakes, and feeding practices, on the gut microbiome in children living in low-resource settings has remained underreported in microbiome research. Among undernourished children living in urban slums of Mumbai, India, we observed a high relative abundance ofProteobacteria, a phylum including many potentially pathogenic species similar to the composition in preterm infants, suggesting immaturity of the gut, or potentially a high inflammatory burden. We found head circumference, fat and iron intake, and current breastfeeding were positively associated with microbial diversity, while hemoglobin and weight for length were associated with lower diversity. Findings suggest that examining comprehensive nutrition is critical to gain more understanding of how nutrition and the gut microbiota are linked, particularly in vulnerable populations such as children in urban slum settings.
Supplemental Material: Fossilization potential of marine assemblages and environments
Authors: Shaw Jack , al. et
Published: September 2020

Additional information about data processing, taxon- and geography-specific analyses, other sampling biases, determinants of fossilization potential, predictive modeling procedures, and the impact of Lagerstätten on estimating fossilization potential.
Life-threatening complications of Henoch-Schönlein purpura: diffuse alveolar haemorrhage, venous thrombosis and bowel ischaemia
Authors: Dhaliwal Kezreen Kaur , Lile Nur Atikah , Tan Chou Luan , Lim Chong Hong
Published: September 2020

Henoch-Schönlein purpura (HSP) is a common systemic vasculitis occurring in children. Making a diagnosis of HSP is often straightforward, managing its complications can be difficult. Diffuse alveolar haemorrhage (DAH), bowel ischaemia and venous thrombosis are rare complications of this disorder. We present a case of a 15-year-old teenage girl presenting with typical purpuric rash of HSP, developed DAH, bowel ischaemia and venous thrombosis. She was successfully treated with pulse methylprednisolone, intravenous Ig and intravenous cyclophosphamide.
Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysis
Authors: Altoukhi Renad M , Alshouimi Reema A , Al Rammah Shahad M , Alzahrani Mohammed Y , Almutairi Abdulaali R , Alshehri Abdulmajeed M , Alfayez Osamah M , Al Yami Majed S , Almohammed Omar A
Published: September 2020

Objective

Creating an appropriate antithrombotic therapy for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) remains a dilemma. Several clinical trials compared the use of a dual antithrombotic therapy (DAT) regimen with a direct oral anticoagulants including (apixaban, dabigatran, edoxaban or rivaroxaban) and a P2Y12inhibitor versus a triple antithrombotic therapy (TAT) that includes a vitamin K antagonist plus aspirin and a P2Y12inhibitor in patients with AF who have undergone PCI. However, there are no head-to-head trials comparing the DAT regimens to each other. We aimed to compare the efficacy and safety of DAT regimens using a network meta-analysis (NMA) approach.

Design

A systematic review and NMA of randomised clinical trials.

Methods

We conducted a systematic literature review to identify relevant randomised clinical trials and performed a Bayesian NMA for International Society on Thrombosis and Haemostasis (ISTH) major or clinically relevant non-major (CRNM) bleeding, all-cause mortality, stroke, myocardial infarction (MI) and stent thrombosis outcomes. We used NetMetaXL V.1.6.1 and WinBUGS V.1.4.3 for the NMA and estimated the probability of ranking the treatments based on the surface under the cumulative ranking curve.

Results

The comparison between DAT regimens showed no significant difference in the safety or efficacy outcomes. Apixaban regimen was ranked first as the preferred therapy in terms of ISTH major or CRNM bleeding and stroke, with a probability of 52% and 54%, respectively. Rivaroxaban regimen was the preferred therapy in terms of MI and stent thrombosis, with a probability of 34% and 27%, respectively. Dabigatran regimen was ranked first in terms of all-cause mortality, with a probability of 28%.

Conclusion

The DAT regimens are as safe and effective as TAT regimens. However, ranking probabilities for the best option in the selected outcomes can be used to guide the selection among these agents based on different patients’ conditions.
Psychosocial volunteer support for older adults with cognitive impairment: development of MyCare Ageing using a codesign approach via action research
Authors: Ayton Darshini , O'Donnell Renée , Vicary Dave , Bateman Catherine , Moran Chris , Srikanth Velandai K , Lustig Julie , Banaszak-Holl Jane , Hunter Peter , Pritchard Elizabeth , Morris Heather , Savaglio Melissa , Parikh Seema , Skouteris Helen
Published: September 2020

Background and objectives

Older adults with cognitive impairment are vulnerable to frequent hospital admissions and emergency department presentations. The aim of this study was to use a codesign approach to develop MyCare Ageing, a programme that will train volunteers to provide psychosocial support to older people with dementia and/or delirium in hospital and at home when discharged from hospital.

Setting

Melbourne, Victoria, Australia.

Research design

This study adopts an action research methodology. We report on two co-design workshops with keystakeholders: Workshop 1: identification of components from three existing programmes to inform the development of the MyCare Ageing program logic and, Workshop 2: identification of implementation strategies.

Participants

The key stakeholders and workshop participants included clinicians (geriatricians, nurses and allied health), hospital staff (volunteer coordinators and hospital executives), Baptcare staff, a consumer, researchers and implementation experts and project staff.

Results

Workshop 1 identified the components from three existing programmes—the Volunteer Dementia and Delirium Care programme, Home-Start and MyCare for inclusion in MyCare Ageing. In workshop 2, the p implementation plan was developed taking into consideration hospital-specific processes, training and support needs of volunteers and safety and risk management processes.

Discussion and conclusion

The codesign process was successfully applied to develop the MyCare Ageing programme to provide volunteer support to patients with dementia and/or delirium in hospital and their transition home. MyCare Ageing is an innovative programme that meets an identified need from hospitals and consumers to support patients with dementia and/or delirium to improve psychosocial outcomes on discharge from hospital.
Impact of physician’s sex/gender on processes of care, and clinical outcomes in cardiac operative care: a systematic review
Authors: Etherington Cole , Deng Mimi , Boet Sylvain , Johnston Amy , Mansour Fadi , Said Hussein , Zheng Katina , Sun Louise Y
Published: September 2020

Objectives

This systematic review aimed to assess the role of physician’s sex and gender in relation to processes of care and/or clinical outcomes within the context of cardiac operative care.

Design

A systematic review.

Data sources

Searches were conducted in PsycINFO, Embase and Medline from inception to 6 September 2018. The reference lists of relevant systematic reviews and included studies were also searched.

Eligibility criteria for selecting studies

Quantitative studies of any design were included if they were published in English or French, involved patients of any age undergoing a cardiac surgical procedure and specifically assessed differences in processes of care or clinical patient outcomes by physician’s sex or gender. Studies were screened in duplicate by two pairs of independent reviewers.

Outcome measures

Processes of care, patient morbidity and patient mortality.

Results

The search yielded 2095 publications after duplicate removal, of which two were ultimately included. These studies involved various types of surgery, including cardiac. One study found that patients treated by female surgeons compared with male surgeons had a lower 30-day mortality. The other study, however, found no differences in patient outcomes by surgeon’s sex. There were no studies that investigated anaesthesiologist’s sex/gender. There were also no studies investing physician’s sex or gender exclusively in the cardiac operating room.

Conclusions

The limited data surrounding the impact of physician’s sex/gender on the outcomes of cardiac surgery inhibits drawing a robust conclusion at this time. Results highlight the need for primary research to determine how these factors may influence cardiac operative practice, in order to optimise provider’s performance and improve outcomes in this high-risk patient group.
Strategies to Promote ResiliencY (SPRY): a randomised embedded multifactorial adaptative platform (REMAP) clinical trial protocol to study interventions to improve recovery after surgery in high-risk patients
Authors: Reitz Katherine Moll , Seymour Christopher W , Vates Jennifer , Quintana Melanie , Viele Kert , Detry Michelle , Morowitz Michael , Morris Alison , Methe Barbara , Kennedy Jason , Zuckerbraun Brian , Girard Timothy D , Marroquin Oscar C , Esper Stephen , Holder-Murray Jennifer , Newman Anne B , Berry Scott , Angus Derek C , Neal Matthew
Published: September 2020

Introduction

As the population ages, there is interest in strategies to promote resiliency, especially for frail patients at risk of its complications. The physiological stress of surgery in high-risk individuals has been proposed both as an important cause of accelerated age-related decline in health and as a model testing the effectiveness of strategies to improve resiliency to age-related health decline. We describe a randomised, embedded, multifactorial, adaptative platform (REMAP) trial to investigate multiple perioperative interventions, the first of which is metformin and selected for its anti-inflammatory and anti-ageing properties beyond its traditional blood glucose control features.

Methods and analysis

Within a multihospital, single healthcare system, the Core Protocol for Strategies to Promote ResiliencY (SPRY) will be embedded within both the electronic health record (EHR) and the healthcare culture generating a continuously self-learning healthcare system. Embedding reduces the administrative burden of a traditional trial while accessing and rapidly analysing routine patient care EHR data. SPRY-Metformin is a placebo-controlled trial and is the first SPRY domain evaluating the effectiveness of three metformin dosages across three preoperative durations within a heterogeneous set of major surgical procedures. The primary outcome is 90-day hospital-free days. Bayesian posterior probabilities guide interim decision-making with predefined rules to determine stopping for futility or superior dosing selection. Using response adaptative randomisation, a maximum of 2500 patients allows 77%–92% power, detecting >15% primary outcome improvement. Secondary outcomes include mortality, readmission and postoperative complications. A subset of patients will be selected for substudies evaluating the microbiome, cognition, postoperative delirium and strength.

Ethics and dissemination

The Core Protocol of SPRY REMAP and associated SPRY-Metformin Domain-Specific Appendix have been ethically approved by the Institutional Review Board and are publicly registered. Results will be publicly available to healthcare providers, patients and trial participants following achieving predetermined platform conclusions.

Trial registration number

NCT03861767.
How do users of a ‘digital-only’ contraceptive service provide biometric measurements and what does this teach us about safe and effective online care? A qualitative interview study
Authors: Baraitser Paula , McCulloch Hannah , Morelli Alessandra , Free Caroline
Published: September 2020

Objectives

To describe user experience of obtaining and uploading biometric measurements to a ‘digital-only’ contraceptive service prior to a prescription for the combined oral contraceptive (COC). To analyse this experience to inform the design of safe and acceptable ‘digital-only’ online contraceptive services.

Setting

An online contraceptive service available free of charge to women in South East London, UK.

Participants

Twenty participants who had ordered the combined oral contraceptive (COC) online. Our purposive sampling strategy ensured that we included participants from a wide range of ages and those who were and were not prescribed the COC.

Intervention

A ‘digital-only’ contraceptive service that prescribes the COCafter an online medical history and self-reported height, weight and blood pressure (BP) with pills prescribed by a GMC registered doctor, dispensed by an online pharmacy and posted to the user.

Design

Semistructured interviews with a purposive sample of 20 participants who were already enrolled in a larger study of this service.

Analysis

Inductive, thematic analysis of the interviews assisted by NVivo qualitative analysis software.

Results

Users valued the convenience of ‘digital-only care’ but experienced measuring BP but not height or weight as a significant barrier to service use. They actively engaged in work to understand and measure BP through a combination of recent/past measurements, borrowed machines, health service visits and online research. They negotiated tensions around maintaining a trusting relationship with the service, meeting its demands for accurate information while also obtaining the contraception that they needed.

Conclusion

Digital strategies to build trusting clinical relationships despite a lack of face-to-face contact are needed in ‘digital-only’ health services. This includes acknowledgement of work required, evidence of credible human support and a digital interface that communicates the health benefits of collaborating with an engaged clinical team.
Conceptualising cultural safety at an Indigenous-focused midwifery practice in Toronto, Canada: qualitative interviews with Indigenous and non-Indigenous clients
Authors: Churchill Mackenzie E , Smylie Janet K , Wolfe Sara H , Bourgeois Cheryllee , Moeller Helle , Firestone Michelle
Published: September 2020

Objective

Cultural safety is an Indigenous concept that can improve how healthcare services are delivered to both Indigenous and non-Indigenous peoples in Canada. This study explored how Indigenous and non-Indigenous clients at an urban, Indigenous-focused midwifery practice in Toronto, Canada (Seventh Generation Midwives Toronto, SGMT) conceptualised and experienced culturally safe care.

Design and setting

Interviews were conducted with former clients of SGMT as a part of a larger evaluation of the practice. Participants were purposefully recruited. Interviews were transcribed and analysed thematically using an iterative, consensus-based approach and a critical, naturalistic, and decolonising lens.

Participants

Saturation was reached after 20 interviews (n=9 Indigenous participants, n=11 non-Indigenous participants).

Results

Three domains of cultural safety emerged. Each domain included several themes: Relationships and Communication (respect and support for choices; personalised and continuous relationships with midwives; and being different from past experiences); Sharing Knowledge and Practice (feeling informed about the basics of pregnancy, birth, and the postpartum period; and having access to Indigenous knowledge and protocols), and Culturally Safe Spaces (feeling at home in practice; and having relationships interconnected with the physical space). While some ideas were shared across groups, the distinctions between the Indigenous and non-Indigenous participants were prominent.

Conclusion

The Indigenous participants conceptualised cultural safety in ways that highlight the survival and resurgence of Indigenous values, understandings, and approaches in cities like Toronto, and affirm the need for Indigenous midwives. The non-Indigenous participants conceptualised cultural safety with both congruence, illuminating Black-Indigenous community solidarities in cultural safety, and divergence, demonstrating the potential of Indigenous spaces and Indigenous-focused midwifery care to also benefit midwifery clients of white European descent. We hope that the positive impacts documented here motivate evaluators and healthcare providers to work towards a future where ‘cultural safety’ becomes a standard of care.
Is training policy for general practitioners in China charting the right path forward? a mixed methods analysis
Authors: Shi Jianwei , Du Qingfeng , Gong Xin , Chi Chunhua , Huang Jiaoling , Yu Wenya , Liu Rui , Chen Chen , Luo Li , Yu Dehua , Jin Hua , Yang Yan , Chen Ning , Liu Qian , Wang Zhaoxin
Published: September 2020

Objectives

Since 2010, the Chinese government has gradually increased its investment in the training of general practitioners (GPs) to support their role as ‘gatekeepers’ in the healthcare system. However, this training is still organised from the perspective of specialist care. We aimed to assess the appropriateness of the principal GP admission training programme curricula in China, including Residents Training for GPs (RTGP), Residents Training for Assistant GPs (RTAGP) and Training for Specialists with General Practice interest (TSGP).

Setting

The study focussed on GP training programmes in Shanghai, China.

Participants

Data on disease competences developed in three GP clinical training programmes (RTGP, RTAGP and TSGP) were derived from official programme training manuals. Data on the proportion of outpatient visits for each disease were taken from the Shanghai community healthcare centres grassroots outpatient database.

Primary and secondary outcome measures

We first conducted a quantitative analysis by comparing the structure of current training curricula with actual outpatient utilisation patterns across all community healthcare institutions in Shanghai from 2014 to 2018. Qualitative analysis was then conducted to evaluate GP training programmes based on Donabedian’s model.

Results

Quantitative analysis showed that the distribution of diseases for which competences were taught did not match the composition of outpatient visits in community healthcare institutions. Concerns identified through qualitative analysis included teachers who were mostly specialists, lack of equipment for differential diagnosis in community healthcare institutions, insufficient teaching of referral standards and GP training in large hospitals that consistently neglected communication skills.

Conclusions

The establishment and implementation of admission training programmes for GPs in China lacks a focus on general practice training and may be improved by adopting an evidence-based general perspective aligned with the medical needs of the community.
Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology
Authors: Zanetti Anna , Scirè Carlo Alberto , Argnani Lisa , Carrara Greta , Zambon Antonella
Published: September 2020

Objective

To describe the adherence to quality of care indicators in early rheumatoid arthritis (RA) and to evaluate its impact on the risk of hospitalisation in a real-world setting.

Design

Retrospective cohort study.

Setting

Patients with early-onset RA identified from healthcare regional administrative databases by means of a validated algorithm between 2006 and 2012 in the Lombardy region (Italy).

Participants

The study cohort included 14 203 early-onset RA (71% female, mean age 60 years).

Outcome measures

For each patient, a summary adherence score was calculated starting from the compliance to six quality indicators: (1–2) methotrexate or sulfasalazine or leflunomide with/without glucocorticoids, (3–4) other disease-modifying antirheumatic drugs (DMARDs) with/without glucocorticoids, (5) early interruption of glucocorticoids, (6) early clinical assessment.

The relationship between low, intermediate and high categories of the summary score and the 12-month risk of hospitalisation for all causes and for RA was assessed.

Results

During a follow-up of 1 year, 2609 hospitalisations occurred, of which 704 were for RA (main or secondary diagnosis) and 252 primarily for RA. In a 7-year period (2006–2012), early DMARDs and timely clinical monitoring treatment increased (from 52% to 62% p trend <0.001 and from 25% to 30% p trend 0.009, respectively).

Intermediate and high summary adherence score categories (compared with the low category) were related significantly with a lower risk of hospitalisation (adjusted HR 0.85 (95% CI 0.77 to 0.93), p<0.001 and HR 0.76 (95% CI 0.69 to 0.84), p<0.001, respectively). Among the indicators of the adherence score, early DMARD prescription showed the strongest positive impact, while long-term use of glucocorticoids was the worst negative one.

Conclusion

In early RA, adherence to quality standards of care is associated with a lower risk of hospitalisation. Future interventions to improve the adherence to quality standards of care in this setting should decrease the risk of hospitalisation with a significant impact on individual and population health.
Longitudinal exploration of cancer-related cognitive impairment in patients with newly diagnosed aggressive lymphoma: protocol for a feasibility study
Authors: Gates Priscilla , Gough Karla , Dhillon Haryana , Wilson Carlene , Hawkes Eliza , Dore Vincent , Perchyonok Yuliya , Rowe Christopher C , Walker Adam K , Vardy Janette L , de Ruiter Michiel , Krishnasamy Meinir
Published: September 2020

Introduction

Cancer-related cognitive impairment (CRCI) is a distressing and disabling side-effect of cancer treatments affecting up to 75% of patients. For some patients, their cognitive impairment may be transient, but for a subgroup, these symptoms can be long-standing and have a major impact on the quality of life. This paper describes the protocol for a study: (1) to assess the feasibility of collecting longitudinal data on cognition via self-report, neuropsychological testing, peripheral markers of inflammation and neuroimaging and (2) to explore and describe patterns of cancer-related cognitive impairment over the course of treatment and recovery in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent.

Methods and analysis

This is a prospective, longitudinal, feasibility study in which 30 newly diagnosed, treatment-naive patients with aggressive lymphoma will be recruited over a 12-month period. Patients will complete comprehensive assessments at three time points: baseline (time 1, pre-treatment) and two post-baseline follow-up assessments (time 2, mid-treatment and time 3, 6–8 weeks post-treatment completion). All patients will be assessed for self-reported cognitive difficulties and objective cognitive function using Stroop Colour and Word, Trail Making Test Part A and B, Hopkins Verbal Learning Test-Revised, Controlled Oral Word Association and Digit Span. Blood cell-based inflammatory markers and neuroimaging including a positron emission tomography (PET) with 18F-labelled fluoro-2-deoxyglucose (18F-FDG) and CT (18F-FDG-PET/CT) and a MRI will explore potential inflammatory and neuroanatomical or functional mechanisms and biomarkers related to CRCI. The primary intent of analysis will be to assess the feasibility of collecting longitudinal data on cognition using subjective reports and objective tasks from patients during treatment and recovery for lymphoma. These data will inform the design of a larger-scale investigation into the patterns of cognitive change over the course of treatment and recovery, adding to an underexplored area of cancer survivorship research.

Ethics and dissemination

Ethical approval has been granted by Austin Health Human Rights Ethics Committee (HREC) in Victoria Australia. Peer reviewed publications and conference presentations will report the findings of this novel study.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12619001649101).
Employment status and information needs of patients with breast cancer: a multicentre cross-sectional study of first oncology consultations
Authors: Mazzi Maria Angela , Perlini Cinzia , Deledda Giuseppe , Ghilardi Alberto , Buizza Chiara , Bottacini Alessandro , Goss Claudia , Del Piccolo Lidia
Published: September 2020

Objectives

To investigate the early information needs of women with a recent diagnosis of breast cancer (BC) according to their employment status.

Design

Cross-sectional.

Setting

Secondary-care patients attending three outpatient oncology clinics in northern Italy.

Participants

377 women with a recent diagnosis of early-stage, non-metastatic BC aged 18–75 were recruited. Of them, 164 were employed, 103 non-employed and 110 retired.

Outcome measures

The first consultation visit with an oncologist was audio-recorded and analysed for the number and type of questions asked. Linear regression models considering consultations’ and patients’ characteristics as confounding variables were applied.

Results

Employed patients asked significantly more questions than non-employed and retired patients (17 vs 13 and 14; F=6.04; p<0.01). When age and education were included in the statistical model, the significance of employment status was rearranged among all the variables and was no more significant (b=1.2, p=0.44). Employed women asked more questions concerning disease prognosis (0.7 vs 0.4 and 0.6; F=3.5; p=0.03), prevention (1.4 vs 0.6 and 0.7; F=10.7; p<0.01), illness management (7.2 vs 6 and 5.4; F=3.8; p=0.02) and social functioning (37% vs 18% and 20%; χ2=14.3; p<0.01) compared with the other two groups. Finally, they attended more frequently the consultation alone (37% vs 18% and 25%; χ2=10.90, p<0.01), were younger (50 vs 58 and 67 years; F=63.8; p<0.01) and with a higher level of education (77% vs 27% and 45%; χ2=68.2; p<0.01).

Conclusions

Employment status is related to the type of questions asked during the first consultation. Also, it interrelates with other patients' characteristics like age and education in determining the number of questions asked. Patients' characteristics including employment status could be considered in tailoring work and social-related information provided during the first oncological consultation. Future studies could explore potential differences in information needs according to the different kinds of work.