bluuebunny/crossref_metadata_2025 huggingface dataset:
Learning from complex elderly care: a qualitative study on motivating residents in family medicine
Authors: Koetsenruijter K. W.J. , Veldhuijzen W. , De Lepeleire J. , van Leeuwen Y , Muris J. W.M. , Teunissen P. W.
Published: December 2022

Background

More and more patients need complex care, especially the elderly. For various reasons, this is becoming increasingly difficult. The onus is essentially on family physicians to provide this care and family medicine residency programs should therefore prepare their residents for this task. We know from self-determination theory (SDT) that motivation plays a key role in learning and that in order to boost motivation, fulfillment of 3 basic psychological needs - for autonomy, competence, and relatedness – is crucial. As residents often lack motivation, residency programs face the important challenge to motivate them to learn about and engage in complex elderly care. How to do so, however, is not yet sufficiently understood.

Methods

We conducted a qualitative multi-institutional case study across four universities in Belgium and the Netherlands. In the period between June, 2015, and May, 2019, we triangulated information from semi-structured interviews, document analysis, and observations of educational moments. Guided by SDT concepts, the analysis was performed iteratively by a multidisciplinary team, using ATLAS.ti, version 8. In this process, we gained more insights into residents’ motivation to learn complex elderly care.

Results

We scrutinized 1,369 document pages and 4 films, observed 34 educational moments, and held 41 semi-structured interviews. Although we found all the 3 basic psychological needs postulated by SDT, each seemed to have its own challenges. First, a tension between the need to guide residents and to encourage their independent learning complicated fulfillment of the need for autonomy. Second, the unpredictability of complex care led to reduced feelings of competence. Yet, guidelines and models could help residents to capture and apprehend its complexity. And third, family medicine practice, patients, and educational practice, by either satisfying or thwarting the need for relatedness, were identified as key mediators of motivation. By setting the right example and encouraging residents to discuss authentic dilemmas and switch their health care approach from cure to care, educators can boost their motivation.

Conclusion

Our study has demonstrated that the degree of perceived autonomy, guidance by the education program, use of authentic dilemmas, as well as involvement of group facilitators can aid the process of motivation.

Trial registration

NVMO, ERB number 482.
Anxiety and loneliness among older people living in residential care facilities or receiving home care services in Sweden during the COVID-19 pandemic: a national cross-sectional study
Authors: Johansson-Pajala Rose-Marie , Alam Moudud , Gusdal Annelie , Heideken Wågert Petra von , Löwenmark Annica , Boström Anne-Marie , Hammar Lena Marmstål
Published: December 2022

Background

Older people were subjected to significant restrictions on physical contacts with others during the COVID-19 pandemic. Social distancing impacts older people’s experiences of anxiety and loneliness. Despite a large body of research on the pandemic, there is little research on its effects on older people in residential care facilities (RCF) and in home care services (HCS), who are the frailest of the older population. We aimed to investigate the effect of the first wave of the COVID-19 pandemic in March-May 2020 on experiences of anxiety and loneliness among older people living in RCF or receiving HCS and the impact of the progression of the pandemic on these experiences.

Methods

A retrospective cross-sectional design using data from the national user satisfaction survey (March − May 2020) by the Swedish National Board of Health and Welfare. Survey responses were retrieved from 27,872 older people in RCF (mean age 87 years) and 82,834 older people receiving HCS (mean age 84 years). Proportional-odds (cumulative logit) model was used to estimate the degree of association between dependent and independent variables.

Results

Loneliness and anxiety were more prevalent among the older persons living in RCF (loneliness: 69%, anxiety: 63%) than those receiving HCS (53% and 47%, respectively). Proportional odds models revealed that among the RCF and HCS respondents, the cumulative odds ratio of experiencing higher degree of anxiety increased by 1.06% and 1.04%, respectively, and loneliness by 1.13% and 1.16%, respectively, for 1% increase in the COVID-19 infection rate. Poor self-rated health was the most influential factor for anxiety in both RCF and HCS. Living alone (with HCS) was the most influential factor affecting loneliness. Experiences of disrespect from staff were more strongly associated with anxiety and loneliness in RCF than in HCS.

Conclusion

Older people in RCF or receiving HCS experienced increasing levels of anxiety and loneliness as the first wave of the pandemic progressed. Older people’ mental and social wellbeing should be recognized to a greater extent, such as by providing opportunities for social activities. Better preparedness for future similar events is needed, where restrictions on social interaction are balanced against the public health directives.
Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines
Authors: Boaitey Kwame Peprah , Bakhit Mina , Krzyzaniak Natalia , Hoffmann Tammy C.
Published: December 2022

Background

Many of the acute infections that are seen in primary care and sometimes managed with antibiotics are self-resolving and antibiotics may be unnecessary. Information about the natural history of these infections underpins antibiotic stewardship strategies such as delayed prescribing and shared decision making, yet whether it’s reported in guidelines is unknown. We examined, in clinical guidelines, the reporting of natural history information and relevant antibiotic stewardship strategies for acute infections commonly seen in primary care.

Methods

A systematic review of national and international guidelines (2010 onwards), available electronically, for managing acute infections (respiratory, urinary, or skin and soft tissue). We searched MEDLINE, CINAHL, EMBASE, TRIP, and GIN databases and websites of 22 guideline-publishing organisations.

Results

We identified 82 guidelines, covering 114 eligible infections. Natural history information was reported in 49 (59.8%) of the guidelines and 66 (57.9%) of the reported conditions, most commonly for respiratory tract infections. Quantitative information about the expected infection duration was provided for 63.5% (n = 42) of the infections. Delayed antibiotic prescribing strategy was recommended for 34.2% (n = 39) of them and shared decision making for 21% (n = 24).

Conclusions

Just over half of the guidelines for acute infections that are commonly managed in primary care and sometimes with antibiotics contained natural history information. As many of these infections spontaneously improve, this is a missed opportunity to disseminate this information to clinicians, promote antibiotic stewardship, and facilitate conversations with patients and informed decision making.

Systematic review registration CRD42021247048
Histopathology pattern and survival analysis of patients with kidney biopsy in the top end of Northern Australia from 2007 to 2020
Authors: Goh Kim Ling , Abeyaratne Asanga , Ullah Shahid , Rissel Chris , Priyadarshana Kelum
Published: December 2022

Aim

Royal Darwin Hospital (RDH) is the main tertiary hospital that has performed more than 600 biopsies since its establishment. Although Indigenous people in Australia’s Northern Territory (NT) has the highest rate of renal replacement therapy, the histopathology pattern of their renal diseases is still under discussed. We aimed to analyse the histopathology pattern of patients undergoing renal biopsy in RDH from June 2007 to June 2020. Secondary aims include clinical indication and survival analysis of patients with kidney biopsies.

Methods

We conducted a retrospective cohort study on all native kidney biopsy reports from patients over the age of 16, from June 2007 to June 2020. Descriptive statistics was used to summarise age, sex, indigeneity, histopathological pattern, and mortality. Categorical values were expressed as absolute frequencies and percentages. Survival analysis was performed using multivariate analyses and Cox proportional hazard regression model.

Results

There were 364 native renal biopsies included in the analysis. Sub-nephrotic proteinuria was the most common clinical indication for kidney biopsy (n = 160,47.8%). Diabetes nephropathy (DN) was the most common pathological finding (n = 71,12.8%). Indigenous population who had dialysis performs poorly compared to their non-indigenous counterpart (HR 2.37,95% CI 1.53–3.67,p < 0.001).

Conclusion

Diabetic nephropathy is the most common native kidney biopsy in the NT with higher mortality among indigenous patients. This study supports the previous findings of indigenous female excess, younger age of kidney disease requiring kidney biopsy, and excess of diabetic nephropathy in the top-end of the NT. It can be speculated that some diabetic patients had atypical features prompting a biopsy.
The expression characteristics and clinical significance of ACP6, a potential target of nitidine chloride, in hepatocellular carcinoma
Authors: Gao Li , Xiong Dan-Dan , Yang Xia , Li Jian-Di , He Rong-Quan , Huang Zhi-Guang , Lai Ze-Feng , Liu Li-Min , Luo Jia-Yuan , Du Xiu-Fang , Zeng Jiang-Hui , Li Ming-Fen , Li Sheng-Hua , Dang Yi-Wu , Chen Gang
Published: December 2022

Background

Acid phosphatase type 6 (ACP6) is a mitochondrial lipid phosphate phosphatase that played a role in regulating lipid metabolism and there is still blank in the clinico-pathological significance and functional roles of ACP6 in human cancers. No investigations have been conducted on ACP6 in hepatocellular carcinoma (HCC) up to date.

Methods

Herein, we appraised the clinico-pathological significance of ACP6 in HCC via organizing expression profiles from globally multi-center microarrays and RNA-seq datasets. The molecular basis of ACP6 in HCC was explored through multidimensional analysis. We also carried out in vitro and in vivo experiment on nude mice to investigate the effect of knocking down ACP6 expression on biological functions of HCC cells, and to evaluate the expression variance of ACP6 in xenograft of HCC tissues before and after the treatment of NC.

Results

ACP6 displayed significant overexpression in HCC samples (standard mean difference (SMD) = 0.69, 95% confidence interval (CI) = 0.56–0.83) and up-regulated ACP6 performed well in screening HCC samples from non-cancer liver samples. ACP6 expression was also remarkably correlated with clinical progression and worse overall survival of HCC patients. There were close links between ACP6 expression and immune cells including B cells, CD8 + T cells and naive CD4 + T cells. Co-expressed genes of ACP6 mainly participated in pathways including cytokine-cytokine receptor interaction, glucocorticoid receptor pathway and NABA proteoglycans. The proliferation and migration rate of HCC cells transfected with ACP6 siRNA was significantly suppressed compared with those transfected with negative control siRNA. ACP6 expression was significantly inhibited by nitidine chloride (NC) in xenograft HCC tissues.

Conclusions

ACP6 expression may serve as novel clinical biomarker indicating the clinical development of HCC and ACP6 might be potential target of anti-cancer effect by NC in HCC.
Diagnostic capabilities of self-reported psychoactive substance use among patients admitted to psychiatric consultations in Benin, West Africa
Authors: Abdelhakim Ahmat K. , Bio-Sya Assad , Damien Georgia Barikissou , Klikpo Elvyre T. E. , Gansou G. M. , Allabi Aurel C.
Published: December 2022

Background

There is a high prevalence of psychoactive substance use among patients with mental health disorders. The optimal treatment of patients with mental health disorders requires an awareness of their history pertaining substance use. Several methods are used to assess the use of substance. Each of them embodies its limitations. This study aimed at assessing the diagnostic capability of a self-report psychoactive substance use among patients at the National Psychiatric University Hospital of Cotonou, Benin.

Methods

A cross-sectional survey was conducted from August 1, 2021 to November 24, 2021. A total of 157 consenting patients admitted to psychiatric consultations were successively enrolled in the ongoing study. They were screened for the use of psychoactive substance with Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), followed by urine test using the NarcoCheck® kit for qualitative detection of substances or its metabolites. To assess the diagnostic capability, the participants’ self-responses were compared with their urine test results. The sensitivity, specificity, positive and negative predictive values, and kappa coefficient were also calculated.

Results

The frequency of lifetime psychoactive substance use according to self-report was 81.5% (95% CI: 0.746–0.873), while over the past three months (recent use) was 52.2% (95% CI: 0.441–0.603) and 58.6% based on the urine test. Alcohol, tobacco and cannabis were the most prevalent psychoactive substance used. The overall concordance between self-reported psychoactive substance use and the urine test (gold standard) was moderate (sensitivity = 66%; kappa = 0.46). Self-report cocaine use compared with urine test showed the highest concordance (sensitivity = 100%; kappa = 79%), followed by tobacco (sensitivity = 58%, kappa = 41%). On an average 70% of urine test results were consistent with self-report (VPP). Participants’ were more accurate when they were reporting no psychoactive substance use as suggested by the high negative predictive value (NPV).

Conclusion

Diagnostic capability of self-reporting of psychoactive substance use among patients admitted to psychiatric consultations was moderate. Therefore self-reporting may not estimate the exact prevalence of psychoactive substance use. Optimal identification of psychoactive substances use in psychiatric patients requires both history and urine testing. The integration of these two approaches is an excellent method to find out the level, frequency and nature of drug used.
Impulsivity and aggression in suicide ideators and suicide attempters of high and low lethality
Authors: Brokke Silje Støle , Landrø Nils Inge , Haaland Vegard Øksendal
Published: December 2022

Background

Impulsivity and aggression have been associated with all forms of suicidal behaviour and linked to theories of suicide capability. There is a need to clarify the role of impulsivity and aggression in the progression from suicidal thoughts to suicide attempts and suicide.

Method

In this naturalistic cross-sectional study, suicide ideators (35), low lethal suicide attempters (37), and high lethal suicide attempters (26) were compared with the Columbia-suicide severity rating scale (C-SSRS), Barratt impulsiveness scale (BIS-11), and the Buss & Perry aggression questionnaire (AQ).

Results

Physical aggression score (p = 0.032) contributed to the difference between predicted low lethal suicide attempt and predicted high lethal suicide attempt. This model predicting physical aggression showed a fairly weak positive relationship (OR = 1.1) to high lethal attempt and explained 13% of the variance so there is a need for further replications to verify these results. Impulsive behaviour scores in females were significantly higher in the low lethal suicide attempt group compared to suicide ideators (F(2.51) = 3.47, p = 0.039, η²= 0.12). Hostility aggression in females was significantly higher in the high lethal suicide attempters compared to suicide ideators (F(2.52) = 3.53, p = 0.037, η² = 0.12). Physical aggression scores in females were significantly higher in the high lethal attempters compared to suicide ideators (F(2.52) = 6.79, p = 0.002, η²= 0.21). When these analyses were conducted without the participants who died in suicide, men in the high lethal attempt group scored significantly higher than men in the low lethal attempt group (F(2.37) = 3.8, p = 0.031, η² = 0.17), but men did not differ in aggression and impulsivity scores in other comparisons.

Conclusion

Suicide prevention should address physical aggression, as high levels can be associated with high lethal attempts. Assessment of suicidal patients should address impulsive behaviour with the insight that it can be more prominent in female low lethal suicide attempters. It could be that assessment and treatment of suicidal patients should be tailored differently for men and women. Aggression as a feature of suicide capability could be the link that makes suicide possible.
“When I am breathless now, I don’t have the fear that’s linked to it”: a case series on the potential of EMDR to break the dyspnea-anxiety cycle in COPD
Authors: Mooren Kris , Smit Kirsten , Engels Yvonne , Janssen Daisy , Godschalx Judith
Published: December 2022

Background

Expectations can enhance the intensity and the neural processing of breathlessness. Previous breathlessness episodes may influence the perception of subsequent episodes because of psycho-traumatic consequences. In post-traumatic stress disorder, eye movement desensitization and reprocessing (EMDR) is the therapy of choice.

Aims and objectives

We explored the hypothesis that EMDR in patients with chronic obstructive pulmonary disease (COPD) and previous severe breathlessness episodes, improves breathlessness mastery by decreasing the anxiety component.

Methods

As we found no literature on previous research on this subject, we undertook a qualitative case series on four patients with COPD GOLD 4/D and refractory breathlessness who wished to undergo EMDR for psychotraumatic breathlessness episodes. Amongst others, we used the Chronic Respiratory Disease Questionnaire (CRQ) before and after EMDR, and semi-structured, face-to-face, in-depth interviews.

Results

All patients had between three and five EMDR sessions. On CRQ, subset mastery, three patients had a large improvement and one patient a moderate improvement. On subset emotional functioning, three patients showed a large improvement and one showed no change. All patients made a distinction between ‘regular’ breathlessness and breathlessness intertwined with anxiety. They all stated that the anxiety component of their breathlessness diminished or disappeared. All four would recommend EMDR for other COPD patients.

Conclusion

There is ground for a randomized controlled clinical trial to test the effects of EMDR on breathlessness mastery in a subset of COPD patients with previous severe breathlessness episodes and high levels of anxiety.
In vitro antibacterial effects of photodynamic therapy against Enterococcus faecalis in root canals of deciduous teeth
Authors: Li Meimei , Wong WenChee , Xiong Huacui , Chen Ke
Published: December 2022

Objective

This study aimed at evaluating the in vitro antibacterial efficacy of photodynamic therapy (PDT) on planktonic E. faecalis and its biofilm in the root canal of infected deciduous teeth.

Methods

Forty root canals of maxillary deciduous anterior teeth were enlarged up to #35 K-file and inoculated with E. faecalis for 21 days. The root canals were randomly assigned into four groups (n = 10): The normal saline group (control), 1% NaClO group, PDT group, and the 1% NaClO + PDT group. Paper point samples were obtained at baseline (S1) and after treatment (S2). The colony-forming units (CFU) were counted, and the bacterial growth rate calculated. From each subgroup, 5 samples were randomly selected after treatment and a scanning laser confocal microscope (CLSM) used to determine the distribution of dead / living bacteria on the biofilm surface of each subgroup. A scanning electron microscope (SEM) was used to observe bacterial morphologies in the root canal walls of the remaining 5 samples in each subgroup. The Kruskal–Wallis test and Dunn test with boferroni adjustment were used to analyze the effect of the different treatment techniques on the E. faecalis in root canals.

Results

Compared to the saline group, PDT significantly reduced bacterial counts in the root canal (p < 0.05). The CFU counts were lowest (p < 0.05) in the 1% NaClO and in 1% NaClO + PDT groups. The rate of bacterial death on the surface of the biofilm in the PDT group was significantly increased after treatment (p < 0.05), and the rate of bacterial death was highest in 1%NaClO group and 1%NaClO + PDT group (p < 0.05).

Conclusion

PDT has an antibacterial activity against E. faecalis in the root canal of deciduous teeth. Its activity against planktonic E. faecalis is better than the activity on the intact biofilm. The antibacterial activity of PDT on E. faecalis in root canals of deciduous teeth is lower compared to that of 1% NaClO.
Effects of upper-molar distalization using clear aligners in combination with Class II elastics: a three-dimensional finite element analysis
Authors: Liu Xulin , Cheng Yuxun , Qin Wen , Fang Shishu , Wang Wei , Ma Yanning , Jin Zuolin
Published: December 2022

Introduction

The effects of upper-molar distalization using clear aligners in combination with Class II elastics for anchorage reinforcement have not been fully investigated yet. The objective of this study is to analyze the movement and stress of the whole dentition and further explore guidelines for the selection of traction methods.

Methods

Three-dimensional (3D) finite element models are established to simulate the sequential molar distalization process, including the initial distalization of the 2nd molar (Set I) and the initial distalization of the 1st molar (Set II). Each group set features three models: a control model without Class II elastics (model A), Class II elastics attached to the tooth by buttons (model B), and Class II elastics attached to the aligner by precision cutting (model C). The 3D displacements, proclination angles, periodontal ligament (PDL) hydrostatic stress and alveolar bone von Mises stress in the anterior area are recorded.

Results

In all of the models, the maxillary anterior teeth are labial and mesial proclined, whereas the distal moving molars exhibit distal buccal inclination with an extrusion tendency. With the combination of Class II elastics, the anchorage was effectively reinforced; model C demonstrates superior anchorage reinforcement with lower stress distribution in comparison with model B. The upper canines in model B present an extrusion tendency. Meanwhile, the mandibular dentition in models B and C experience undesired movement tendencies with little discrepancy from each other.

Conclusions

Class II elastics are generally effective for anchorage reinforcement as the upper-molar distalization is performed with clear aligners. Class II elastics attached to an aligner by precision cutting is a superior alternative for maxillary anchorage control in cases that the proclination of upper incisors and extrusion of upper canines are unwanted.
Dental anomalies and their therapeutic implications: retrospective assessment of a frequent finding in patients with cleft lip and palate
Authors: Sander A. K. , Grau E. , Bartella A. K. , Kloss-Brandstätter A. , Neuhaus M. , Zimmerer R. , Lethaus B.
Published: December 2022

Background

Orofacial clefts are characterized by a frequent occurrence of dental anomalies. Numerous studies demonstrate the high prevalence of dental aplasia, supernumerary teeth, and hypoplastic teeth in patients with cleft lip with/without cleft palate (CL/P), yet the therapeutic consequences are rarely discussed. This study explores prevalence, localization, and association between primary and secondary dentition in a large European collective and begins to evaluate the significance of dental anomalies in the therapeutic course of patients with CL/P.

Methods

The medical reports of 1070 patients with different entities of CL/P who presented to our clinic within a 15-year investigation period were evaluated retrospectively. Dental anomalies were classified into three different diagnostic groups: dental aplasia, supernumerary teeth and hypoplastic teeth. The statistical analyses included studies of the frequency and localization of dental anomalies in different cleft entities as well as of the association between primary and secondary dentition and the therapeutic consequences.

Results

Uni- or bilateral cleft lip and palate (CLP) (47.5%) occurred most frequently, followed by cleft palate only (CPO) (32.9%) and cleft lip with or without alveolus (CL ± A) (19.6%). Dental anomalies were found significantly more often on the side of the cleft. Aplastic permanent teeth were mostly found in patients with CLP (54.8%), while supernumerary permanent teeth occurred primarily in patients with CL ± A (21.7%). Patients with CPO presented dental aplasia but no patient with CPO showed supernumerary teeth. The occurrence of dental aplasia in the primary dentition significantly increases the probability of aplastic teeth in the permanent dentition. Dental anomalies, in particular dental aplasia, significantly increase patients’ need for subsequent orthodontic therapy and orthognathic surgery.

Conclusion

Dental aplasia and hypoplasia are common in patients with CL/P not only in the cleft area but in the whole dentition. In the event of dental aplasia in the primary dentition, the frequency of aplastic teeth in the permanent dentition is significantly higher. Additionally, the need for therapeutic interventions, especially concerning orthognathic surgery, seems to be significantly higher in patients with CL/P who are affected by dental anomalies. Clinicians should take this into account when creating long-term treatment plans.
Mitochondrial toxicants in Xian-Ling-Gu-Bao induce liver injury by regulating the PI3K/mTOR signaling pathway: an in vitro study
Authors: Piao Shujuan , Lin Hongwei , Tao Xia , Chen Wansheng
Published: December 2022

Background

Drug-induced mitochondrial toxicity is thought to be a common mechanism of drug hepatotoxicity. Xian-Ling-Gu-Bao (XLGB) oral preparation is a commonly used drug for osteoporosis in China. Classical safety evaluation studies have shown that the entire preparation and six Chinese herbal medicines have high safety, but the incidence of drug-induced liver damage due to XLGB remains high, the mechanism and toxic substances causing liver injury are still unclear. The purpose of this study is to identify compounds with potential mitochondrial liabilities in XLGB, and to clarify their underlying mechanisms and related pathways.

Methods

The mitochondrial function analysis was performed using an extracellular flux assay, which simultaneously monitored both oxygen consumption rate (OCR) and extracellular acidification rate (ECAR). Through network pharmacology and in vitro experimental verification, the potential protein targets, signaling pathways and molecular mechanism of mitochondrial toxicity have been studied.

Results

We observed a significant decrease in mitochondrial respiration of Psoraleae Fructus and its five compounds in fundamental bioenergetics parameters such as basal respiration, ATP-linked production and maximal respiration, indicating mitochondrial dysfunction. The network pharmacology results showed that the influence of XLGB on mitochondrial dysfunction was closely related to PI3K-Akt signaling pathway, mTOR signaling pathway and Apoptosis. Western blot showed that the levels of mTOR, p-mTOR (Ser2448), Raptor, PI3K (p110α), Beclin 1, ATG5 and Caspase-9 were up-regulated after treatment with psoralidin, psoralen and bavachin, and the expression of Bcl-2 was down-regulated after bavachinin treatment.

Conclusions

The hepatotoxicity of XLGB is associated with mitochondrial dysfunction. Five compounds in Psoraleae Fructus showed mitochondrial damage, they are psoralidin, isobavachalcone, bavachinin, bavachin and psoralen, especially psoralidin showed significant reduction in reserve capacity and respiratory control ratios. The molecular mechanism is related to the activation of PI3K/mTOR signaling pathway to inhibit autophagy and induce mitochondrial apoptosis.
Building connections between biomedical sciences and ethics for medical students
Authors: Olaiya Oluwaseun , Hyatt Travis , Mathew Alwyn , Staudaher Shawn , Bachman Zachary , Zhao Yuan
Published: December 2022

Background

Medical ethics education is crucial for preparing medical students to face ethical situations that can arise in patient care. Instances of ethics being integrated into biomedical science education to build the connection between human science and ethics is limited. The specific aim of this study was to measure student attitudes towards an innovative curriculum design that integrates ethics education directly into a biomedical science course in pre-clinical medical curriculum.

Methods

In this cross-sectional study, three ethics learning modules were designed and built in a biomedical science course in the pre-clinical curriculum. All students of Class of 2024 who were enrolled in the course in 2021 were included in the study. Each module integrated ethics with basic science topics and was delivered with different teaching modalities. The first module used a documentary about a well-known patient with severe combined immunodeficiency disease. The second module was delivered through a clinical scenario on HIV infection. The third module used small group discussion and debate on the topic of blood transfusion. For evaluation, students were asked to self-identify the ethical challenges associated with each module and complete reflective writing to assess their knowledge and attitude. Quantitative and qualitative analyses were conducted on student perceptions of each module.

Results

Likert scale ratings on the usefulness of each module revealed significantly higher ratings for the small group discussion/debate module, seconded by the documentary and lastly the case scenario only modules. Narrative analysis on student feedback revealed three themes:General favorable impression,Perceived learning outcomes, andCritiques and suggestion. Common and unique codes were identified to measure the strengths and weaknesses of each module. Overall, students’ perception of the curriculum design was extremely positive.

Conclusions

This curriculum design enabled us to highlight foundational biomedical sciences and clinical conditions with ethical dilemmas that physicians are likely to face in practice. Students found value in the modules, with a preference for the most active learning method. This study provides insight on a novel approach for integrating medical ethics into biomedical science courses that can be tailored to any institution. Strategies learned include utilizing active learning modalities and discussion.
Reflection on near-peer shadowing program: impact on operating room student’s perception of their future profession
Authors: Mafinejad Mahboobeh Khabaz , Ebrahimpour Fatemeh , Sayarifard Azadeh , Shahbazi Fatemeh , Gruppen Larry
Published: December 2022

Background

Reflection is a key element in learning from observation and experience of future profession’s roles and responsibilities in clinical encounters. Moreover, reflection helps students cope with the challenges, complexities, and uncertainties of professional development. Students’ written reflections on clinical exposure offer valuable information, and their analysis provides instructors with invaluable insight into students' experiences. This study evaluated Operating Room students’ written reflections on their first clinical exposure experiences towards their future profession through the shadowing program.

Methods

This study was a qualitative analysis on Operating Room freshmen’s reflections in the undergraduate program of Zahedan and Zabol University of Medical Sciences in Iran. After the shadowing program, all participants were asked to write an unstructured written reflection, and these fifty written reflections were de-identified and independently analyzed‏ using the thematic analysis approach.

Results

Qualitative analysis extracted 10 subthemes and four main themes including (i) Moving towards the guiding realities of future profession, (ii) Discovering milestones of realizing professional identity, (iii) Managing the emotions affecting the perception of future profession’s desirability, and (iv) Excellence in professional growth and development.

Conclusion

Reflecting on the experience of the shadowing program, the participants described being in the OR environment as a stimulating and valuable learning opportunity. Moreover, this experience helped improve their perception of future profession’s realities, as well as initiate realization of professional identity and planning for professional developments.
“It’s too hard” – the management of latent TB in under-served populations in the UK: a qualitative study
Authors: Gray Adam Thorburn , Surey Julian , Esmail Hanif , Story Alistair , Harris Magdalena
Published: December 2022

Background

UK national guidance recommends systematic screening for latent tuberculosis infection (LTBI) in under-served populations, including people experiencing homelessness and people who use drugs. This is not routinely implemented in the UK, and the reasons for this policy-practice mismatch remain underexplored.

Methods

Semi-structured qualitative interviews were conducted with 19 healthcare professionals from across the UK. Participants were recruited using purposive sampling and snowballing, identifying individuals with excellent knowledge of their regions practice and policy of LTBI management. The interviews were conducted online, and were audio recorded, with transcripts thematically analysed using a two-stage inductive coding process to explore perceived barriers and enablers to LTBI screening.

Results

Most participants had previous experience managing LTBI in under-served populations, but none were conducting systematic screening as per national guidance. We identified service provision challenges and low prioritisation of LTBI as the key explanatory themes driving this policy-practice mismatch. Lack of resource, and the complexity of clinical decision making were two key service level barriers. System and service inertia, and lack of cost effectiveness evidence led to LTBI being deprioritised. Service integration and promotion of WHO targets for TB elimination were highlighted as potential solutions.

Conclusion

Integrating LTBI testing and treatment with existing health services for under-served populations could improve feasibility and efficacy. Promotion of UK TB elimination goals and generation of regional evidence to support commissioning for LTBI care is vital. Without such a multi-pronged approach inertia is likely to persist and the zeitgeist will remain: “it’s too hard”.
Effective gossypol removal from cottonseed meal through optimized solid-state fermentation by Bacillus coagulans
Authors: Zhang Zhenting , Yang Danlu , Liu Ling , Chang Zhangbing , Peng Nan
Published: December 2022

Background

Cottonseed meal (CSM) is the main by-product of the cottonseed oil extraction process with high protein content, which is an important protein source for feed industry. However, CSM contains free gossypol (FG), a toxic substance that is detrimental to animal health and greatly limits its application. Microbial fermentation is currently considered to be one of the most effective methods to reduce FG and other anti-nutritional factors in CSM. Previously, yeast and bacteria species are used for degradation of FG in CSM, but showing less detoxification efficiency. Bacillus coagulans combines the properties of both lactic acid bacteria and Bacillus, producing both lactic acid and spores, and is considered a potential probiotic. In this study, we aimed to evaluate and optimize the effect of the solid-state fermentation process using a Bacillus coagulans to gossypol removal contained cottonseed meal.

Results

36 B. coagulans strains were isolated and found to have the ability to remove free gossypol. Through the evaluation of strains and optimization of fermentation conditions including fermentation temperature, ratio of material to water, inoculation amount, fermentation time and pH, we have established a solid-state fermentation process using a Bacillus coagulans strain S17 on CSM substrate with 1:1 of the material-to-water ratio, 15% (v/w) seed inoculation, 2% expanded corn flour, 1% bran, and 0.3%-0.8% metal irons at 40 °C for 52 h. After fermentation, the FG content in CSM was reduced from 923.80 to 167.90 mg/kg with 81.83% detoxification efficiency. Meanwhile, the crude protein content in CSM increased from 47.98 to 52.82%, and importantly, the spore concentration of strain S17 reached 1.68 × 1010 CFU/g dry material.

Conclusion

The study showed that B. coagulans have the potential strong ability to degrade free gossypol through cottonseed meal fermentation. This study presents a feasible process for improving the resource utilization rate and nutritional value of CSM via solid-state fermentation through B. coagulans S17.
Are chemical compounds in medical mushrooms potent against colorectal cancer carcinogenesis and antimicrobial growth?
Authors: Macharia John M. , Zhang Lu , Mwangi Ruth W. , Rozmann Nora , Kaposztas Zsolt , Varjas Tímea , Sugár Miklós , Alfatafta Huda , Pintér Márton , Bence Raposa L.
Published: December 2022

After cardiovascular diseases, cancer is the second main cause of death globally. Mushrooms have been demonstrated to contain amalgamation with properties capable of inhibiting carcinogenesis and microbial growth, principally secondary metabolites such as quinolones, steroids, terpenes, anthraquinones, and benzoic acid derivatives among others. This study aimed to substantiate their potency concerning colon cancer carcinogenesis and antimicrobial growth. A systematic search of important literature was performed considering all the articles published until April 2022. Screening was performed by searching the BMC Springer, Elsevier, Embase, Web of Science, Ovid, and MEDLINE databases. In addition, Google Scholar was used to supplement information. Titles and abstracts that matched the established criteria were selected for full-text article scrutiny and subsequently used in the updated present review. Bioactive compounds present in medicinal mushrooms such as ascorbic acid, organic acids, flavonoids, polysaccharides, glycosides, phenols, linoleic acid, grifolin, and tocopherols among other compounds play a key role in suppressing the proliferation of cancerous cells and selectively act as antibacterial and antifungal agents. These metabolites actively scavenge oxygen free radicals, hydroxyl radicals, and nitrite radicals that would otherwise increase the risks of the growth and development of cancerous cells. Mushrooms' bioactive compounds and metabolites actively inhibit nuclear factor-kappa activation, protein kinase B processes, and ultimately the expression of Cyclooxygenases 2 in cancerous cells. Medicinal mushrooms should be considered as alternative natural chemo-preventive agents in the global fight against colon cancer and the evolution of drug-resistant pathogenic microorganisms, as they exhibit robust potency. They have not been reported to exhibit adverse harmful effects compared to synthetic chemotherapies, yet they have been reported to demonstrate significant beneficial effects.
Single low-dose INC280-loaded theranostic nanoparticles achieve multirooted delivery for MET-targeted primary and liver metastatic NSCLC
Authors: Sun Yige , Yang Jie , Li Yingbo , Luo Jing , Sun Jiemei , Li Daoshuang , Wang Yuchen , Wang Kai , Yang Lili , Wu Lina , Sun Xilin
Published: December 2022

Background

Non-small cell lung cancer (NSCLC) patients with primary tumors and liver metastases have substantially reduced survival. Since mesenchymal-epithelial transition factor (MET) plays a significant role in the molecular mechanisms of advanced NSCLC, small molecule MET inhibitor capmatinib (INC280) hold promise for clinically NSCLC treatment. However, the major obstacles of MET-targeted therapy are poor drug solubility and off-tumor effects, even oral high-dosing regimens cannot significantly increase the therapeutic drug concentration in primary and metastatic NSCLC.

Methods

We developed a multirooted delivery system INC280-PFCE nanoparticles (NPs) by loading INC280 into perfluoro-15-crown-5-ether for improving MET-targeted therapy. Biodistribution and anti-MET/antimetastatic effects of NPs were validated in orthotopic NSCLC and NSCLC liver metastasis models in a single low-dose. The efficacy of INC280-PFCE NPs was also explored in human NSCLC specimens.

Results

INC280-PFCE NPs exhibited excellent antitumor ability in vitro. In orthotopic NSCLC models, sustained release and prolonged retention behaviors of INC280-PFCE NPs within tumors could be visualized in real-time by 19F magnetic resonance imaging (19F-MRI), and single pulmonary administration of NPs showed more significant tumor growth inhibition than oral administration of free INC280 at a tenfold higher dose. Furthermore, a single low-dose INC280-PFCE NPs administered intravenously suppressed widespread dissemination of liver metastasis without systemic toxicity. Finally, we verified the clinical translation potential of INC280-PFCE NPs in human NSCLC specimens.

Conclusions

These results demonstrated high anti-MET/antimetastatic efficacies, real-time MRI visualization and high biocompatibility of NPs after a single low-dose.
MOF derived core-shell CuO/C with temperature-controlled oxygen-vacancy for real time analysis of glucose
Authors: Zhao Chen , Tang Xiaoying , Zhao Jinge , Cao Jie , Jiang Zhenqi , Qin Jieling
Published: December 2022

Introducing oxygen-vacancy into the surface of the non-enzymatic sensor is supposed to be an effective way to improve inherently low catalytic activity and specificity of non-enzymatic sensors. In this work, CuO/C was synthesized at different temperatures using metal-organic frameworks as sacrificial templates to receive additional content of oxygen-vacancy. The product with the highest oxygen vacancy was found at 400 °C (named CuO/C-400 °C), which increased catalytically active sites and enhanced the charge-transfer efficiency. The sensing performance was afterward explored by amperometry under an optimal applied potential at 0.5 V (vs. SCE), presenting a broad detection range from 5.0 µM to 25.325 mM (R2 = 0.9998) with a sensitivity of 244.71 µA mM− 1 cm− 2, and a detection limit of 1 µM. Furthermore, the reliability and selectivity of CuO/C-400 °C sensors were extensively explored in the presence of artificial serum/saliva samples with gradient glucose concentrations. The human blood samples were also detected with high recoveries compared with the clinical Hexokinase method. Hence, the prepared CuO/C-400 °C sensor with a broad detection range and high selectivity can be applied for the diabetes diagnosis ex vivo without further dilution for real-time analysis in practical applications.
Can alternative nicotine products put the final nail in the smoking coffin?
Authors: Fagerström Karl
Published: December 2022

This review describes the evolution of smoking prevalence in countries with relatively high adoption of alternative nicotine products such as e-cigarettes, heated tobacco, and snus compared to neighboring countries where these products are less prevalent. The data indicate that countries with high adoption of alternative nicotine products have been able to achieve lower smoking rates. The findings suggest that adoption of alternative nicotine products may help in reduce smoking prevalence faster than traditional tobacco control measures solely focused on prevention and cessation.
Comprehensive rehabilitation outcome measurement scale (CROMS): development and preliminary validation of an interdisciplinary measure for rehabilitation outcomes
Authors: Rashid Muhammed , Harish Sandeep Padantaya , Mathew Jerin , Kalidas Akshaiya , Raja Kavitha
Published: December 2022

Introduction

Comprehensive and interdisciplinary measurement of rehabilitation outcome is an essential part of the assessment and prognosis of a patient. Thus, this requires substantial contributions from the patient, their family and the rehabilitation professional working with them. Moreover, the measurement tool should be comprehensive and must consider the cultural compatibility, cost efficiency and contextual factors of the region.

Methods

The Comprehensive Rehabilitation Outcome Measurement Scale (CROMS) was developed through consensus and followed the Delphi process incorporating inputs from various rehabilitation professionals. The domains and items were finalized using Principal Component Analysis (PCA). The tool was validated in two native languages and back-translated considering the semantic equivalence of the scale. Intra-class correlation coefficient was performed to determine the agreement between the therapist and patient-reported scales.

Results

The final CROMS carries 32 comprehensive items that can be completed by the person with disability and the professional team. CROMS compares well to similar items on FIM (l ICC of 0.93) and has good internal consistency with a Cronbach's Alpha of 0.92 for both patient and therapist reported measures.

Conclusions

The 32 item CROMS is a tool that can potentially be used to evaluate the functional independence of various patient populations, predominantly patients with neurological disabilities.
Cost-effectiveness of dexamethasone compared with aflibercept in naïve diabetic macular edema
Authors: Montes Rodríguez Paula , Mateo Gabás Javier , Esteban Floría Olivia , Honrubia Grijalbo Ana , Ascaso Puyuelo Francisco J.
Published: December 2022

Background

To assess the cost-effectiveness of the delayed-release device of dexamethasone compared with aflibercept in the treatment of patients with naïve diabetic macular edema (DME) from a societal perspective in the healthcare sector Zaragoza III in Spain.

Methods

A Markov model with five states defined by visual acuity (VA) in the better-seeing eye (Snellen scale) and an additional death state were constructed. Two cohorts of patients were distributed along the VA states and treated during a year with either dexamethasone or aflibercept. One-year follow-up on each group was performed. Medical costs related to the DME treatment and follow-up, medical costs related to the DME comorbidities, and non-medical-related costs were taken into account. Costs (2020 €), health outcomes (Quality-Adjusted Life Years-QALYs), both discounted at a 3.5% annual rate, and incremental cost-effectiveness ratios (ICER: €/QALY) were determined for a lifetime horizon in the base case analysis.

Results

Patients treated with dexamethasone were €77,349 more costly and provided 2.667 additional QALYs (€29,002/QALY) than those treated with aflibercept. The variable efficiency per patient was calculated dividing the improvement in quality of life (on the VFQ-25 scale) by the cost of the treatment. With the obtained results it can be concluded that the efficiency of treating the patients with dexamethasone is significantly superior than the efficiency of treating them with aflibercept.

Conclusions

The cost per QALY gained with the delayed-release device of dexamethasone compared with the one obtained by aflibercept in the naïve DME population is just below the €30,000 threshold, below which, new drugs are sometimes regarded as cost-effective strategies in Spain. In this model, the key variables with greater impact on the cost-effectiveness results were the selected time horizon, the chosen extrapolation method and the number of aflibercept and dexamethasone injections.