bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing a Comprehensive Framework of Safeguarding Strategies to Address Anticipated Errors With Organizational High-Alert Medications
Authors: Booth Jennifer P. , Hartman Amber D.
Published: July 2023

Purpose: To describe the development of a comprehensive framework of safeguarding strategies to address observed/anticipated errors with organizational high-alert medications. Methods: Observed/anticipated errors were identified for organizational high-alert medications and medication classes based on a review of external literature and alerts as well as internal voluntary error reporting. Anticipated or frequently reported errors were categorized into common cause error types. Error reduction strategies to address each common cause error were identified in collaboration with medication safety specialists and specialty practice pharmacists. Results: The review of externally and internally reported errors identified 101 observed/anticipated common cause errors across the 19 high-alert medication classes (median 5 error types per medication class, interquartile range 3-6). Safeguarding strategies specific to high-alert medications were identified in the following domains: separate or sequestered storage; restricted ordering; active alerts; dispensing in patient-specific dosing, unit of use, or unit-dose packaging; dispensing from pharmacy only; auxiliary labeling; level of care restriction; required monitoring; independent double checks; certification/privileging of staff; specific guidelines for use/monitoring; and other/miscellaneous. Identification of the observed/anticipated errors and the associated safeguarding strategies facilitated the development of a comprehensive tool and visual framework for addressing common cause errors associated with organizational high-alert medications. Conclusion: A comprehensive framework of safeguarding strategies to address anticipated errors with organizational high-alert medications is proposed. Although individual safeguards are institution-specific, the framework can be leveraged by all hospitals in order to take inventory of error-reduction strategies and prospectively identify gaps to address common cause errors.
An exploration of risk factors in a community sample of low socioeconomic status youth in South Africa
Authors: Pillay Lingum G , Pillay Basil J , Kliewer Wendy , Sibanda Wilbert
Published: July 2023

Youth in low socioeconomic status communities experience multiple risks which disrupts their emotional, cognitive, and psychological development. In South Africa, there is a tacit acceptance of risk constructs as researched globally. This study examines risk occurrence with the aim of identifying and examining the uniqueness of risks in a community sample of youth. Data were collected from youth and their maternal caregivers through interviews and standardized instruments. Youth from grade 7 and grade 10, 9 to 18 years ( M = 13.11; SD = 1.54) were recruited. Sixty-five percent were female. Thirty-five frequent risk factors were identified using a z-test for proportion of means. Five risk factors, namely, low household income, race, English not being the primary home language of the parent, low maternal self-esteem, and low dyadic satisfaction, emerged as significant risks. Other risk factors (e.g., single-parent household), which feature prominently in international studies, did not emerge as significantly present. While risk occurrence in our sample shares commonalities with international trends, our study further highlights how risk is underscored and shaped by South Africa’s socioeconomic and political history. We argue that traditional concepts, like family, race, and language require conceptual review when undertaking research and developing policies and interventions that are relevant to South African communities.
Relationship Between Fear of COVID-19, Conspiracy Beliefs About Vaccines and Intention to Vaccinate Against COVID-19: A Cross-National Indirect Effect Model in 13 Latin American Countries
Authors: Caycho-Rodríguez Tomás , Tomás José M. , Yupanqui-Lorenzo Daniel E. , Valencia Pablo D. , Carbajal-León Carlos , Vilca Lindsey W. , Ventura-León José , Paredes-Angeles Rubí , Arias Gallegos Walter L. , Reyes-Bossio Mario , Delgado-Campusano Mariel , Gallegos Miguel , Rojas-Jara Claudio , Polanco-Carrasco Roberto , Cervigni Mauricio , Martino Pablo , Lobos-Rivera Marlon Elías , Moreta-Herrera Rodrigo , Palacios Segura Diego Alejandro , Samaniego-Pinho Antonio , Buschiazzo Figares Andrés , Puerta-Cortés Diana Ximena , Camargo Andrés , Torales Julio , Monge Blanco J. Arkangel , González Pedronel , Smith-Castro Vanessa , Petzold-Rodriguez Olimpia , Corrales-Reyes Ibraín Enrique , Calderón Raymundo , Matute Rivera Wendy Yamilet , Ferrufino-Borja Daniela , Ceballos-Vásquez Paula , Muñoz-del-Carpio-Toia Agueda , Palacios Jorge , Burgos-Videla Carmen , Florez León Ana María Eduviges , Vergara Ibeth , Vega Diego , Shulmeyer Marion K. , Barria-Asenjo Nicol A. , Urrutia Rios Hassell Tatiana , Lira Lira Arelly Esther
Published: July 2023

The present study explored the predictive capacity of fear of COVID-19 on the intention to be vaccinated against COVID-19 and the influence in this relationship of conspiracy beliefs as a possible mediating psychological variable, in 13 Latin American countries. A total of 5779 people recruited through non-probabilistic convenience sampling participated. To collect information, we used the Fear of COVID-19 Scale, Vaccine conspiracy beliefs Scale-COVID-19 and a single item of intention to vaccinate. A full a priori Structural Equation Model was used; whereas, cross-country invariance was performed from increasingly restricted structural models. The results indicated that, fear of COVID-19 positively predicts intention to vaccinate and the presence of conspiracy beliefs about COVID-19 vaccines. The latter negatively predicted intention to vaccinate against COVID-19. Besides, conspiracy beliefs about COVID-19 vaccines had an indirect effect on the relationship between fear of COVID-19 and intention to vaccinate against COVID-19 in the 13 countries assessed. Finally, the cross-national similarities of the mediational model among the 13 participating countries are strongly supported. The study is the first to test a cross-national mediational model across variables in a large number of Latin American countries. However, further studies with other countries in other regions of the world are needed.
Toward Strengthening the Capacity of the Health System: A Cross-Sectional Study of Factors Predicting Quality of Life in 545 Nigerian Children Exposed to Sexual Abuse
Authors: Ogueji Ifeanyichukwu Anthony , Rodrigues Edilia Mendes , Buremoh Ayotunde Isaac , Ogunsola Olabanjo Okunlola , Onyeama Franca Chidera , Abdalla Nuha Mohamed , Olutekunbi Olanike Abosede , Maloba May , Adekunle Toluwani E. , Orjingene Obinna , Helmy Mai , Ajayi Oluseye Ayodele
Published: July 2023

In Nigeria, the predictors of quality of life among children exposed to sexual abuse are unknown. Addressing this gap may strengthen the capacity of the health system to care for this population. Thus, this cross-sectional study selected 545 (mean age = 14.4 ± 1.4 years) Nigerian children exposed to sexual abuse. Results show that self-compassion, resilience, and meaning in life jointly predicted quality of life and explained 39% variance. The independent prediction of each predictor variable shows that self-compassion, resilience, and meaning in life have significant independent predictions, with self-compassion showing the greatest independent prediction, followed by resilience and meaning in life. Sex, age, and how long ago respondents were exposed to sexual abuse jointly predicted quality of life and explained 6% variance. However, how long ago respondents were exposed to sexual abuse shows a significant independent prediction. Results offer clinical implications that may strengthen the capacity of the health system to care for this population.
Humanoid path planning on even and uneven terrains using an efficient memory-based gravitational search algorithm and evolutionary learning strategy
Authors: Vikas  , Parhi Dayal R
Published: July 2023

The increasing demand for automation and material transportation has shown an incline toward optimal path navigation. The present work implements an intelligent Memory-based gravitational search algorithm (MGSA) with an evolutionary learning strategy to achieve a globally optimal collision-free path. The Evolutionary learning strategy helps improve the diversity among the Gravitational masses/agents, hence improving the overall exploration capability of the model. While the other approaches focus more on an evolutionary strategy based on mutation and cross-overs, the present technique implements the evolutionary strategy based on the position of the fit agents to improve the position of the unfit agents in the population. It ensures a fast-converging path planning result with an improved trajectory. Further, adding a memory-based approach helps the model remember the location of the best agent within the population. The controller is tested with multiple Humanoids on even and uneven terrains and showed a minimal improvement of more than 4% in path length with a minimum 5% deviation in the simulation and experimental results. The proposed approach showed a further improvement of more than 6% compared to the different intelligent path-planning approaches in a similar environment.
Proximalization of arteriovenous inflow as native loop utilizing the upper arm basilic and forearm cephalic veins for the treatment of hemodialysis access induced hand ischemia
Authors: Hartono Yinhui-Lim , Shahverdyan Robert
Published: July 2023

Background:

Up to 10% of hemodialysis patients with an arteriovenous fistula (AVF) suffer hemodialysis access induced distal ischemia (HAIDI). We report a treatment option of HAIDI by proximalization of arterial inflow (PAI) to the axillary artery as native upper arm loop and salvaging the matured forearm cephalic vein after previous creation of a radio-cephalic AVF (RCAVF).

Methods:

A 79-years-old multimorbid male patient with end-stage kidney disease presented with an elsewhere placed left-sided RCAVF. With the start of cannulations, the patient suffered severe HAIDI. Due to the low/normal AVF-flow of 550 ml/min, a PAI procedure using the matured forearm cephalic and upper arm basilic veins in a form of native upper arm loop was performed.

Results:

Patient’s symptoms resolved postoperatively with successful cannulations and tunneled dialysis catheter removal after 5 weeks. During a follow-up period of 64 months, several interventions were performed to maintain the patency, yet the AVF remained patent for >5 years.

Conclusions:

This modified PAI technique using native vessels in form of upper arm loop graft is a feasible and durable option to maintain long-term cumulative patency and should be considered as a valid native treatment option for HAIDI.
The whole earth and apartheid: Media, peer-production, segregation
Authors: Pringle Thomas Patrick
Published: July 2023

This article revisits arguments in new media studies regarding how the Whole Earth Catalog and publications from the appropriate technology (AT) movement established models of networked media communication antecedent to peer-production. By emphasizing the agricultural pedagogy of back-to-the-land and rural developmental print-based communication networks, this article traces how a group of White, educated South African environmentalists, the Environmental and Development Agency (EDA), produced humanitarian AT manuals to circulate in the segregated areas of apartheid in the late 1970s and early 1980s. Reading together archival materials with Stuart Hall’s theoretical response to the historiography of imperialism and land dispossession in South Africa, Pringle argues that EDA’s print-based media communication network enacted a cultural effort consistent with what would become peer-production, and that this case study is instructive for contemporary critiques of capital-intensive digital agriculture in postcolonial contexts.
Matrix metalloproteinases are key targets of acupuncture in the treatment of ulcerative colitis
Authors: Zhang Rui-Bin , Dong Long-Cong , Huang Qin , Shen Yuan , Li Hong-Ying , Yu Shu-Guang , Wu Qiao-Feng
Published: July 2023

The aim of this study was to elucidate the key targets of acupuncture in the colon of ulcerative colitis (UC) mice model using full-length transcriptome sequencing. 2.5% dextran sodium sulfate (DSS)–induced colitis mice were treated with or without acupuncture. Intestinal pathology was observed, and full transcriptome sequencing and bioinformatic analysis were performed. The results demonstrated that acupuncture treatment reduced the UC symptoms, disease activity index score, and histological colitis score and increased body weight, colon length, and the number of intestinal goblet cells. In addition, acupuncture can also decrease the expression of necrotic biomarker phosphorylates mixed lineage kinase domain-like pseudo kinase (p-MLKL). Full-length transcriptome analysis indicated that acupuncture reversed the expression of 987 of the 1918 upregulated differentially expressed genes (DEGs), and 632 of the 1351 downregulated DEGs induced by DSS. DEGs regulated by acupuncture were mainly involved in inflammatory responses and intestinal barrier pathways. The protein–protein interaction network analysis revealed that matrix metalloproteinases (MMPs) are important genes regulated by acupuncture. Gene set enrichment analysis revealed that extracellular matrix (ECM)–receptor interaction was an important target of acupuncture. In addition, alternative splicing analysis suggested that acupuncture improved signaling pathways related to intestinal permeability, the biological processes of xenobiotics, sulfur compounds, and that monocarboxylic acids are closely associated with MMPs. Overall, our transcriptome analysis results indicate that acupuncture improves intestinal barrier function in UC through negative regulation of MMPs expression.
Legal Issues 101: Documentation and School Records
Authors: Moss Eileen
Published: July 2023

This article is part of a series of articles titled “Legal Issues 101” addressing some common questions and misconceptions around the law and school health. Nursing documentation, a recording of interactions between a nurse and a patient, is a vital part of nursing care. Timely, thorough documentation allows for patient safety, risk reduction, continuity of care, and the availability of data for work process analysis. In the school setting, nursing documentation encompasses a record of student treatment in the health office as well as communication with parents, school team members, and healthcare providers. Student health records are intersected by educational and health privacy laws, which can create confusion around record management. The purpose of this article is to clarify frequently asked questions related to health office documentation.
Safety and Outcomes of Bariatric Surgery in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Authors: Wilson Hillary , Verhoeff Kevin , Dang Jerry , Kung Janice Y. , Switzer Noah J. , Birch Daniel , Madsen Karen , Karmali Shahzeer , Mocanu Valentin
Published: July 2023

Background:

The need for surgical management of severe obesity in the context of inflammatory bowel disease (IBD) is becoming an increasingly common clinical scenario, yet has been met with significant reservation due to the paucity of current data from which to inform evidence-based clinical decision making. The aim of our study was to perform a systematic review to characterize and evaluate the safety and efficacy of bariatric surgery in IBD patients.

Methods:

A medical librarian developed and executed comprehensive searches on November 2, 2021. The population of interest was adult subjects (>18 years) diagnosed with inflammatory bowel disease (IBD) undergoing any type of bariatric surgery. Meta-analysis was used to evaluate outcomes using RevMan 5.4.1.

Results:

A total of 330 687 patients were identified within the 11 studies included. Within all included studies there were 1595 patients with IBD. Patients had a mean weighted age of 46.0, with a female predominance (n = 1287, 80.7%). The mean duration of follow up was 39.7 months. Metabolic and anthropometric outcomes were only reported in noncomparative studies evaluating only patients with IBD, limiting the ability to complete meta-analysis. Meta-analysis revealed that IBD was associated with increased rates of postoperative complications (RR 2.14; 95% CI 1.87-2.44; P < .00001) in comparison to controls without IBD.

Conclusion:

While bariatric surgery presents an effective weight loss option for patients with IBD, these patients are associated with higher rates of postoperative complications. This work highlights the need to better delineate the effect of bariatric procedures for patients with IBD with respect to both metabolic and IBD-related outcomes.
Cardiomyopathy as cause of death in Duchenne muscular dystrophy: a longitudinal observational study
Authors: Lechner Annabel , Herzig Joël J. , Kientsch Jacqueline G. , Kohler Malcolm , Bloch Konrad E. , Ulrich Silvia , Schwarz Esther I.
Published: July 2023

Background

Cardiomyopathy has become an important life-limiting factor since survival in Duchenne muscular dystrophy (DMD) has greatly increased with long-term ventilation and cough assistance. The aim of this study was to investigate the association between impaired left ventricular ejection fraction (LVEF) and survival.

Methods

In a >20-year observational study in patients with DMD (age ≥16 years) with at least three echocardiograms, the association between LVEF and survival and time to cardiac or non-cardiac death was investigated using Kaplan–Meier survival analysis and Cox regression (for LVEF).

Results

In 67 DMD patients (430 echocardiograms), the decrease in LVEF over a mean±sdfollow-up period of 9.1±5.1 years was −10.0±13.9% absolute, but LVEF progression varied widely. 84% were receiving an angiotensin-converting enzyme inhibitor and 54% a β-blocker at last follow-up with an LVEF of 37.5±12.4% at that time-point. Median (interquartile range) survival was 33 (25–40) years. 28 out of 67 (42%) of the cohort had died and LVEF was a significant negative predictor of survival (hazard ratio 0.95 (95% CI 0.91–0.99); p<0.007). Those who died of cardiac death (53% of known causes of death) had significantly lower LVEF at the time of death (LVEF −11.0% (95% CI −21.1– −0.9%); p=0.035) compared with non-cardiac death and tended to die at a younger age.

Conclusions

Cardiomyopathy with systolic heart failure is the leading cause of death and lower LVEF is an independent predictor of mortality at younger ages in patients with DMD. Patients with DMD appear to be undertreated with respect to heart failure drug therapy.
Echocardiographic evaluation of right ventricular diastolic function in pulmonary hypertension
Authors: Yogeswaran Athiththan , Rako Zvonimir A. , Yildiz Selin , Ghofrani Hossein Ardeschir , Seeger Werner , Brito da Rocha Bruno , Gall Henning , Kremer Nils C. , Douschan Philipp , Papa Silvia , Vizza Carmine Dario , Filomena Domenico , Tedford Ryan J. , Naeije Robert , Richter Manuel J. , Badagliacca Roberto , Tello Khodr
Published: July 2023

Background

Right ventricular (RV) diastolic dysfunction may be prognostic in pulmonary hypertension (PH). However, its assessment is complex and relies on conductance catheterisation. We aimed to evaluate echocardiography-based parameters as surrogates of RV diastolic function, provide validation against the gold standard, end-diastolic elastance (Eed), and define the prognostic impact of echocardiography-derived RV diastolic dysfunction.

Methods

Patients with suspected PH who underwent right heart catheterisation including conductance catheterisation were prospectively recruited. In this study population, an echocardiography-based RV diastolic function surrogate was derived. Survival analyses were performed in patients with precapillary PH in the Giessen PH Registry, with external validation in patients with pulmonary arterial hypertension at Sapienza University (Rome).

Results

In the derivation cohort (n=61), the early/late diastolic tricuspid inflow velocity ratio (E/A) and early tricuspid inflow velocity/early diastolic tricuspid annular velocity ratio (E/e′) did not correlate with Eed (p>0.05). Receiver operating characteristic analysis revealed a large area under the curve (AUC) for the peak lateral tricuspid annulus systolic velocity/right atrial area index ratio (S′/RAAi) to detect elevated Eed (AUC 0.913, 95% confidence interval (CI) 0.839–0.986) and elevated end-diastolic pressure (AUC 0.848, 95% CI 0.699–0.998) with an optimal threshold of 0.81 m2·s−1·cm−1. Subgroup analyses demonstrated a large AUC in patients with preserved RV systolic function (AUC 0.963, 95% CI 0.882–1.000). Survival analyses confirmed the prognostic relevance of S′/RAAi in the Giessen PH Registry (n=225) and the external validation cohort (n=106).

Conclusions

Our study demonstrates the usefulness of echocardiography-derived S′/RAAi for noninvasive assessment of RV diastolic function and prognosis in PH.
Diabetes in a hospital cohort of persons living with HIV: a descriptive and comparative study in French Guiana
Authors: Nacher Mathieu , Rabier Sebastien , Lucarelli Aude , Hureau Louise , Adenis Antoine , Hafsi Nezha , Sabbah Nadia
Published: July 2023

Background

In French Guiana (population 294,000) the prevalence of type 2 diabetes (10%) and of HIV(1.1%) are very high. Our objective was to determine the prevalence of diabetes and its complications in a HIV cohort.

Materials and methods

We enrolled HIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals between January 1, 1992 and December 31, 2021 in the French Hospital Database for HIV (FHDH) a national database compiling data from all French regions.

Results

There was no difference of diabetes prevalence between men (8.2%) and women (8.8%), P = 0.4. Patients with diabetes were older (56 years ± 13.4) than those without diabetes (44.7 years ± 13.6) and prevalence increased with age. The proportion of persons with diabetes was greater among virologically suppressed persons (10%) than those with a detectable viral load under antiretroviral treatment (5.8%). Persons with diabetes had substantially greater CD4 counts at diagnosis than persons without diabetes. The majority of macro and microvascular complications were observed in people with diabetes. Persons with diabetes and HIV were significantly less likely to have had AIDS (1.6 versus 2.2 per 100 person-years, respectively). Overall, 374 persons living with HIV of 4167 had died (9%) the proportion of persons with diabetes among the dead was greater than those who did not die 11.7% versus 8.1%, respectively, p = 0.017. However, persons with diabetes were older and hence died older, 62.3 years (SD = 1.9) for deceased persons with diabetes versus 50.4 years (SD = 0.8), P < 0.0001. However, using Cox regression to adjust for age, initial CD4 count, country of birth there was no significant difference in the Hazard for death between persons with diabetes and persons without diabetes (aHR = 0.99, 95%CI = 0.65–1.5), P = 0.9.

Conclusions

The prevalence of diabetes in our HIV cohort was high. Persons with diabetes had greater CD4 counts, earlier care, and greater virological suppression than persons without diabetes. There were no significant differences between persons with diabetes and without diabetes in terms of survival.
Clinical effect of early enteral nutrition support on critically ill neonates with extracorporeal membrane oxygenation
Authors: Lin Ze-Wei , Liu Ying-Ying , Chen Xiu-Hua , Zheng Yi-Rong , Cao Hua , Chen Qiang
Published: July 2023

Objective

To investigate the feasibility and clinical outcomes of early enteral nutrition (EN) in critically ill neonates supported by extracorporeal membrane oxygenation (ECMO).

Methods

We retrospectively analyzed the clinical data of 16 critically ill neonates who received ECMO support for respiratory and circulatory failure from July 2021 to December 2022 at our center. The patients were divided into two groups: the early EN group (< 24 h) and the late EN group (> 24 h). The related clinical and nutrition-related indicators between the groups were compared.

Results

There was a significant difference in the time from ECMO treatment to the start of EN between the early EN group (9 patients, 56.2%) and the late EN group (7 patients, 43.8%) (P < 0.05). However, there were no significant differences in ECMO duration, hospitalization time, vasoactive-inotropic score (VIS), intestinal oxygen saturation, or routine stool occult blood (OB) test between the two groups (all P > 0.05). The incidence of complications such as intestinal obstruction, abdominal distension, diarrhea, and necrotizing enterocolitis (NEC) was slightly lower in the early EN group, but the differences were not statistically significant (all P > 0.05). The early EN group had a shorter time [3.6 (3.5, 5) vs. 7.5 (5.9, 8.5) d] to reach full gastrointestinal nutrition compared to the late EN group (P < 0.05).

Conclusion

Providing early nutritional support through enteral feeding to critically ill neonates receiving ECMO treatment is both safe and practical, but close monitoring of clinical and nutritional indicators is essential.
Changes in the patterns of respiratory support and incidence of bronchopulmonary dysplasia; a single center experience
Authors: Algarni Saleh S. , Ali Kamal , Alsaif Saif , Aljuaid Nemer , Alzahrani Raghad , Albassam Maha , Alanazi Rawan , Alqueflie Dana , Almutairi Maather , Alfrijan Hessah , Alanazi Ahmad , Ghazwani Abadi , Alshareedah Saad , Alotaibi Tareq F , Alqahtani Mohammed M , Aljohani Hassan , Ismaeil Taha T , Alwadeai Khalid S , Siraj Rayan A , Alsaif Abdurahman , Asiri Sabreen , Halabi Shaimaa , Alanazi Abdullah M M
Published: July 2023

Background

With the advances in neonatal intensive care, the survival rate of extremely preterm infants is increasing. However, bronchopulmonary dysplasia (BPD) remains a major cause of morbidity among infants in this group. This study examined the changes in respiratory support modalities, specifically heated humidified high-flow nasal cannula (HHHFNC), and their association with BPD incidence among preterm infants born at < 29 weeks of gestation.

Method

This population-based retrospective cohort study included infants born at < 29 weeks of gestation between 2016 and 2020. Data regarding the use and duration of respiratory support modalities were obtained, including mechanical ventilation, continuous positive airway pressure, HHHFNC, and low-flow oxygen therapy. Additionally, the incidence of BPD was determined in the included infants. Trend analysis for each respiratory support modality and BPD incidence rate was performed to define the temporal changes associated with changes in BPD rates. In addition, a logistic regression model was developed to identify the association between BPD and severity grade using HHHFNC.

Results

Three Hundred and sixteen infants were included in this study. The use and duration of HHHFNC therapy increased during the study period. Throughout the study period, the overall incidence of BPD was 49%, with no significant trends. The BPD rate was significantly higher in the infants who received HHHFNC than in those who did not (52% vs. 39%, P = 0.03). Analysis of BPD severity grades showed that both grade 1 BPD (34% vs. 21%, P = 0.03) and grade 2 BPD (12% vs. 1%, P < 0.01) were significantly more common among infants who received HHHFNC than among those who did not. In contrast, the incidence of grade 3 BPD was lower in infants who received HHFNC (6% vs. 17%, P < 0.01). The duration in days of HHHFNC was found to significantly predict BPD incidence (OR 1.04 [95%CI: 1.01–1.06], P < 0.01) after adjusting for confounding variables.

Conclusion

The use of HHHFNC in extremely preterm infants born at < 29 weeks of gestation is increasing. There was a significant association between the duration of HHHFNC therapy and the development of BPD in extremely preterm infants born at < 29 weeks of gestation.
Factors affecting survival and prognosis in surgically treated patients with spinal metastases arising from renal cell carcinoma
Authors: Lei Ming , Miao Jun
Published: July 2023

Background

The objective of this study was to explore the prognostic factors for renal cell carcinoma (RCC) patients with spinal metastasis who underwent surgical treatment in our hospital.

Methods

We retrospectively analyzed the clinical data and survival status of 49 patients with spinal metastases arising from RCC. All patients with spinal metastases underwent surgical treatment. We analyzed a range of factors that may affect the prognosis of patients with RCC. Using Kaplan-Meier method to perform univariate analysis of the factors that might affect spine metastasis free survival (SMFS)and survival after spinal metastasis (OS) respectively. Establish Cox proportional hazards model to extract independent prognostic factors for SMFS and OS.

Results

The mean time of SMFS was 27 months (median 8, range 0–180 months). The mean time of OS was 12.04 months (median 9, range 2–36 months). RCC with visceral metastasis (p = 0.001,HR 11.245,95%CI 2.824–44.776) and AJCC RCC Stage (p = 0.040,HR 2.809,95%CI 1.046–7.543) can significantly affect SMFS. Furthermore, WHO/ISUP Grade (p < 0.001, HR 2.787,95%CI 1.595–4.870), ECOG Score (p = 0.019, HR 0.305,95%CI 0.113–0.825) and multiple spinal metastases (p < 0.001, HR 0.077,95%CI 0.019–0.319) have significant effects on OS.

Conclusions

RCC with visceral metastasis and AJCC RCC Stage were independent prognostic factors for SMFS. WHO/ISUP Grade, ECOG Scores and multiple spinal metastases were independent prognostic factors for OS.
Effect of a Baduanjin intervention on the risk of falls in the elderly individuals with mild cognitive impairment: a study protocol for a randomized controlled trial
Authors: Wu Ziyi , Kuang Yuxing , Wan Yiwen , Shi Jiao , Li Shuqian , Xia Rui , Wan Mingyue , Chen Shangjie
Published: July 2023

Background

Falls are a global public problem and may be an important cause of death in older adults. However, older adults with mild cognitive impairment(MCI) are more likely to fall and suffer more damage than older adults with normal cognitive function, which shows the importance of preventing falls. More and more evidence shows that Baduanjin can improve the balance function of the elderly and reduce the risk of falls in the elderly with MCI, but the mechanism is still unclear. The main purpose of this study is to verify the intervention effect of Baduanjin training on the risk of falls in elderly people with MCI and to elucidate the underlying mechanism of Baduanjin training in reducing the risk of falls in MCI patients.

Methods

In this prospective study, outcome assessor-blind, three-arm randomized controlled trial, a total of 72 eligible participants will be randomly allocated (1:1:1) into the 12-week Baduanjin exercise intervention (60 min per session, three sessions per week), the 12-week brisk walking group(60 min per session, three sessions per week) or the 12-week health education group. Primary outcome is the Fall-Risk Self-Assessment Questionnaire(FRQ), and secondary outcomes are fall efficacy index, gait assessment, balance function, lower limb muscle strength, cognitive function, activities of daily living(ADL) and MRI scans. In addition to the MRI scans, which will be measured before and after the intervention,other primary and secondary outcomes will be assessed at baseline, 6 weeks, and 12 weeks (at the end of the intervention) and after an additional 12-week follow-up period. The mixed linear model will be conducted to observe the intervention effects.

Discussion

This trial will investigate the effect of Baduanjin exercise on the prevention of falls in elderly individuals with MCI, explore the imaging mechanism of Baduanjin exercise to reduce the risk of falls in elderly individuals with MCI from the perspective of vestibular neural network, and provide strong evidence for Baduanjin exercise to reduce the risk of falls in elderly individuals with MCI, as well as provide new ideas and approaches for the central mechanism of Traditional Chinese Medicine(TRC) rehabilitation methods to intervene in falls in elderly.

Trial registration

Chictr.org.cn, ID: ChiCTR2200057520. Registered on 14 March 2022, https://www.chictr.org.cn/showproj.html?proj=146592.
Application of the time-driven activity-based costing methodology to a complex patient case management program in Portugal
Authors: Ortet Yasmara , Seringa Joana , Santana Rui
Published: July 2023

Background

The number of people with chronic diseases has increased globally, as has the number of chronic diseases per person. Faced with this reality, the term “complex patient” is current and actual.

The healthcare costs associated with these patients are high and are expected to increase since most healthcare systems are not yet ready to provide integrated long-term care. In Portugal, several health institutions have made efforts to provide integrated care: case management models have been implemented to complex patients follow-up. However, studies related to cost of these programs are still limited. Therefore, a qualitative investigation was conducted, approaching the design criteria of a case study research, to design a case management program for complex patients and determine its direct costs, following the Time-Driven Activity-Based Costing methodology, in Local Health Unit setting.

Method

The direct costs of providing care to a complex patient involved in a case management program were determined, using the Time-Driven Activity-Based Costing methodology.

A map of the complex patient was drawn, considering a standard flow in the program. Times and costs were allocated to the activities on the map, following Portuguese and international practices of case management models.

Results

A total of 684,45€/year is spent for each new patient in the case management program, of which 452,65€ corresponds to cost of remuneration of professionals involved; and 663,85€/year, for each patient who is in the case management program (over 1 year), where 432,05€ corresponds to cost of the remuneration of the professionals involved.

Follow-up is the most costly phase (80.82%) and where more time is spent (85.62%).

Conclusion

The time spent by professionals and resources involved and the costs associated with each patient were obtained. The economic impact of the analysed activities was not studied, however, according to international authors, when well applied and selected, integrated care models lead to cost reduction and improved health outcomes.
Saying and doing are different things: a scoping review on how health equity is conceptualized when considering healthcare system performance
Authors: Lee-Foon Nakia K. , Haldane Victoria , Brown Adalsteinn
Published: July 2023

Introduction

Ensuring healthcare systems provide equitable, high quality care is critical to their users’ overall health and wellbeing. Typically, systems use various performance frameworks and related indicators to monitor and improve healthcare. Although these frameworks usually include equity, the extent that equity is reflected in these measurements remains unclear. In order to create a system that meets patients’ needs, addressing this uncertainty is important. This paper presents findings from a scoping review that sought to answer the question ‘How is equity conceptualized in healthcare systems when assessing healthcare system performance?’.

Methods

Levac’s scoping review approach was used to locate relevant articles and create a protocol. Included, peer-reviewed articles were published between 2015 to 2020, written in English and did not discuss oral health and clinician training. These healthcare areas were excluded as they represent large, specialized bodies of literature beyond the scope of this review. Online databases (e.g., MEDLINE, CINAHL Plus) were used to locate articles.

Results

Eight thousand six hundred fifty-five potentially relevant articles were identified. Fifty-four were selected for full review. The review yielded 16 relevant articles. Six articles emanated from North America, six from Europe and one each from Africa, Australia, China and India respectively. Most articles used quantitative methods and examined various aspects of healthcare. Studies centered on: indicators; equity policies; evaluating the equitability of healthcare systems; creating and/or testing equity tools; and using patients’ sociodemographic characteristics to examine healthcare system performance.

Conclusion

Although equity is framed as an important component of most healthcare systems’ performance frameworks, the scarcity of relevant articles indicate otherwise. This scarcity may point to challenges systems face when moving from conceptualizing to measuring equity. Additionally, it may indicate the limited attention systems place on effectively incorporating equity into performance frameworks. The disjointed and varied approaches to conceptualizing equity noted in relevant articles make it difficult to conduct comparative analyses of these frameworks. Further, these frameworks’ strong focus on users’ social determinants of health does not offer a robust view of performance. More work is needed to shift these narrow views of equity towards frameworks that analyze healthcare systems and not their users.
The successes and challenges of harmonising juvenile idiopathic arthritis (JIA) datasets to create a large-scale JIA data resource
Authors: Lawson-Tovey Saskia , Smith Samantha Louise , Geifman Nophar , Shoop-Worrall Stephanie , Ng Sandra , Barnes Michael R. , Wedderburn Lucy R. , Hyrich Kimme L. ,   CLUSTER consortium, Kartawinata Melissa , Wanstall Zoe , Jebson Bethany R. , McNeece Alyssia , Ralph Elizabeth , Alexiou Vasiliki , Dekaj Fatjon , Kimonyo Aline , Merali Fatema , Sumner Emma , Robinson Emily , Feilding Freya L. , Dick Andrew , Beresford Michael W. , Carlsson Emil , Fairlie Joanna , Gritzfeld Jenna F. , Ramanan Athimalaipet , Duerr Teresa , Eyre Stephen , Raychaudhuri Soumya , Morris Andrew , Yarwood Annie , Smith Samantha , Bowes John , Martin Paul , Tordoff Melissa , Stadler Michael , Thomson Wendy , Tarasek Damian , Wallace Chris , Lin Wei-Yu , Clarke Sarah , Kent Toby , Sornasse Thierry , Dastros-Pitei Daniela , Mukherjee Sumanta , Roberts Jacqui , Kallala Rami , Neale Helen , Ioannou John , Al-Mossawi Hussein
Published: July 2023

Background

CLUSTER is a UK consortium focussed on precision medicine research in JIA/JIA-Uveitis. As part of this programme, a large-scale JIA data resource was created by harmonizing and pooling existing real-world studies. Here we present challenges and progress towards creation of this unique large JIA dataset.

Methods

Four real-world studies contributed data; two clinical datasets of JIA patients starting first-line methotrexate (MTX) or tumour necrosis factor inhibitors (TNFi) were created. Variables were selected based on a previously developed core dataset, and encrypted NHS numbers were used to identify children contributing similar data across multiple studies.

Results

Of 7013 records (from 5435 individuals), 2882 (1304 individuals) represented the same child across studies. The final datasets contain 2899 (MTX) and 2401 (TNFi) unique patients; 1018 are in both datasets. Missingness ranged from 10 to 60% and was not improved through harmonisation.

Conclusions

Combining data across studies has achieved dataset sizes rarely seen in JIA, invaluable to progressing research. Losing variable specificity and missingness, and their impact on future analyses requires further consideration.
HIV-1 molecular transmission network and drug resistance in Chongqing, China, among men who have sex with men (2018–2021)
Authors: Tan Tianyu , Bai Chongyang , Lu Rongrong , Chen Fangfang , Li Long , Zhou Chao , Xiang Xu , Zhang Wei , Ouyang Ling , Xu Jing , Tang Houlin , Wu Guohui
Published: July 2023

Background

Over the past few years, HIV transmission among men who have sex with men (MSM) in China has increased significantly. Chongqing, located in the southwest of China, has the highest prevalence of HIV among MSM in the country.

Methods

Blood samples were taken from 894 MSM in Chongqing who had recently been diagnosed with HIV-1 infection and had not yet started getting treatment. In order to determine the distribution of HIV-1 subtypes, transmitted drug resistance, and assessments of molecularly transmitted clusters, we sequenced the Pol genes and employed them in phylogenetic analysis. The genetic distance between molecular clusters was 1.5%. To find potential contributing factors, logistic regression analyses were performed.

Results

Of the 894 HIV-1 pol sequences acquired from study participants, we discovered that CRF07_BC (73.6%) and CRF01_AE (19.6%) were the two most prevalent HIV-1 genotypes in Chongqing among MSM, accounting for 93.2% of all infections. In addition, CRF08_BC (1.1%), B subtype (1.0%), CRF55_01B (3.4%), and URF/Other subtypes (1.3%) were less frequently observed. Among MSM in Chongqing, transmitted drug resistance (TDR) was reported to be present at a rate of 5.6%. 48 clusters with 600 (67.1%, 600/894) sequences were found by analysis of the molecular transmission network. The distributions of people by age, sexual orientation, syphilis, and genotype were significantly differentially related to being in clusters, according to the multivariable logistic regression model.

Conclusion

Despite the low overall prevalence of TDR, the significance of genotypic drug resistance monitoring needs to be emphasized. CRF07_BC and CRF01_AE were the two main genotypes that created intricate molecular transmission networks. In order to prevent the expansion of molecular networks and stop the virus’s spread among MSM in Chongqing, more effective HIV intervention plans should be introduced.
Gut microbes involvement in gastrointestinal cancers through redox regulation
Authors: Yangyanqiu Wang , Jian Chu , Yuqing Yang , Zhanbo Qu , Shuwen Han
Published: July 2023

Gastrointestinal (GI) cancers are among the most common and lethal cancers worldwide. GI microbes play an important role in the occurrence and development of GI cancers. The common mechanisms by which GI microbes may lead to the occurrence and development of cancer include the instability of the microbial internal environment, secretion of cancer-related metabolites, and destabilization of the GI mucosal barrier. In recent years, many studies have found that the relationship between GI microbes and the development of cancer is closely associated with the GI redox level. Redox instability associated with GI microbes may induce oxidative stress, DNA damage, cumulative gene mutation, protein dysfunction and abnormal lipid metabolism in GI cells. Redox-related metabolites of GI microbes, such as short-chain fatty acids, hydrogen sulfide and nitric oxide, which are involved in cancer, may also influence GI redox levels. This paper reviews the redox reactions of GI cells regulated by microorganisms and their metabolites, as well as redox reactions in the cancer-related GI microbes themselves. This study provides a new perspective for the prevention and treatment of GI cancers.
MRI for nodal restaging after neoadjuvant therapy in rectal cancer with histopathologic comparison
Authors: Zhang Zhiwen , Chen Yan , Wen Ziqiang , Wu Xuehan , Que Yutao , Ma Yuru , Wu Yunzhu , Liu Quanmeng , Fan Wenjie , Yu Shenping
Published: July 2023

Background

After neoadjuvant therapy, most of the lymph nodes (LNs) will shrink and disappear in patients with rectal cancer. However, LNs that are still detectable on MRI carry a risk of metastasis. This study aimed to evaluate the performance of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) criterion (short-axis diameter ≥ 5 mm) in diagnosing malignant LNs in patients with rectal cancer after neoadjuvant therapy, and whether nodal morphological characteristics (including shape, border, signal homogeneity, and enhancement homogeneity) could improve the diagnostic efficiency for LNs ≥ 5 mm.

Methods

This retrospective study included 90 patients with locally advanced rectal cancer who underwent surgery after neoadjuvant therapy and performed preoperative MRI. Two radiologists independently measured the short-axis diameter of LNs and evaluated the morphological characteristics of LNs ≥ 5 mm in consensus. With a per node comparison with histopathology as the reference standard, a ROC curve was performed to evaluate the diagnostic performance of the size criterion. For categorical variables, either a χ2 test or Fisher’s exact test was used.

Results

A total of 298 LNs were evaluated. The AUC for nodal size in determining nodal status was 0.81. With a size cutoff value of 5 mm, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 65.9%, 87.0%, 46.8%, 93.6% and 83.9%, respectively. No significant differences were observed in any of the morphological characteristics between benign and malignant LNs ≥ 5 mm (all P > 0.05).

Conclusions

The ESGAR criterion demonstrated moderate diagnostic performance in identifying malignant LNs in patients with rectal cancer after neoadjuvant therapy. It was effective in determining the status of LNs < 5 mm but not for LNs ≥ 5 mm, and the diagnostic efficiency could not be improved by considering nodal morphological characteristics.
Combatting rumors around the French election: the memorability and effectiveness of fact-checking articles
Authors: Fazio Lisa K. , Hong Min Kyung , Pillai Raunak M.
Published: July 2023

Across four studies, we examined the how design decisions influenced the effectiveness of fact-checking articles created by CrossCheck France during the 2017 French election. We measured both memory for the article and belief in the false rumor. We saw no difference in fact check efficacy based on the type of headline (question vs negation) or the number of newsroom logos present around the article (one, four, or seven). In addition, informative design features such as an icon identifying the type of misinformation were ignored by readers. Participants failed to remember many of the details from the article, but retrieval practice was beneficial in reducing forgetting over a 1-week delay. In both US and French samples, reading the fact check decreased belief in the false information, even 1 week later. However, the articles were much more effective in the US sample, who lacked relevant prior knowledge and political beliefs. Overall, fact-checking articles can be effective at reducing belief in false information, but readers tend to forget the details and ignore peripheral information.