bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimally Invasive Reduction of Intraarticular Calcaneal Fractures With Percutaneous Fixation Using Cannulated Screws Versus Kirschner Wires: A Retrospective Comparative Study
Authors: Shams Ahmed , Gamal Osama , Mesregah Mohamed Kamal
Published: January 2021

Background

Several minimally invasive techniques were developed for management of intraarticular calcaneal fractures. This study aimed to compare the functional and radiological outcomes of 2 minimally invasive reduction and fixation techniques using cannulated screws or Kirschner wires (K-wires) for fixation.

Methods

This study was a retrospective comparative review of patients with displaced intraarticular calcaneal fractures, who were treated with cannulated screws or K-wires techniques. Clinical and radiological data were collected and compared between both groups. Functional outcomes and patient satisfaction using the Maryland Foot Score (MFS) and the visual analogue scale (VAS) of pain, in addition to the complications, were compared between both groups.

Results

In total, 70 patients were included in the study: 34 in the cannulated screws group, with a mean age of 35.2 ± 4 years, and 36 in the K-wires groups, with a mean age of 33.4 ± 3 years. The operative time was shorter in the K-wires group (40.5 ± 5.6 minutes) compared to the cannulated screw group (49.5 ± 4.5 minutes), P < .001. There were no statistically significant differences between both groups regarding the radiological parameters, including Bohler’s angle, angle of Gissane, calcaneal width, height, or length. The mean MFS, mean VAS, and complications were not different between the 2 groups.

Conclusion

Treatment of displaced intraarticular calcaneal fractures with minimally invasive reduction and fixation using either cannulated screws or K-wires can achieve similar excellent functional and radiological outcomes, with high patient satisfaction. The use of K-wires has the advantage of reduced operative time than cannulated screws.

Levels of Evidence:

Level III: Retrospective comparative study
The rise of “behavioral man”: Randomized controlled trials and the “new” development agenda
Authors: Stein Howard , Cunningham Samantha , Carmody Pádraig
Published: January 2021

Despite their ostensible differences, both randomized controlled trials (RCTs) and neoclassical economics, which undergirds neoliberalism, are characterized by unrealistic assumptions. This is not accidental but stems from a common desire for scientism, despite a substitution of “economic man” by what we call “behavioral man” in the former. However, the interactions between human behavior and context produce much greater diversity than allowed for in such approaches. As a result of these failings, RCTs do not challenge neoliberalism, but rather can be inserted into and help legitimize it. Consequently they do not alter the structural conditions producing poverty, but represent a form of “virtualism” that attempts to make the real conform to the ideal of neoclassical economics through “nudging.” This is often associated with conditionality, representing a continuation of the historically Northern-centered coloniality of power, which sometimes leads to ethical breaches and perverse development outcomes. Some examples from RCTs conducted or published by the World Bank—which has become a lead agency in promoting RCTs to assess the effectiveness of aid—in Africa are presented to illustrate our argument.
Relapsed/refractory multiple myeloma-transformed plasma-cell leukemia successfully treated with daratumumab followed by autologous stem cell transplantation
Authors: Yang Chen-lu , Jiang Neng-gang , Zhang Li , Shen Kai , Wu Yu
Published: January 2021

Daratumumab is a humanized anti-CD38 IgG1 monoclonal antibody which could be used for multiple myeloma (MM). MM with plasma-cell leukemia (PCL) transformation is highly aggressive and is resistant to conventional therapy. Novel therapeutics are needed for PCL, and daratumumab may play role. We report a case of relapsed/refractory multiple myeloma (RRMM)-transformed PCL successfully treated with daratumumab. The case was a 42-year-old man who was diagnosed with MM 2 years ago and relapsed after six cycles of bortezomib-based chemotherapy. The patient rapidly developed hyperleukocytosis and disseminated intravascular coagulation, and was diagnosed with PCL. Daratumumab-based therapy was tried and the case miraculously obtained complete remission (CR) after four doses of a weekly infusion of daratumumab. Finally the patient received autologous hematopoietic stem-cell transplantation (auto-HSCT) and maintained CR. Moreover, we monitored the immune cell dynamics by flow cytometry (FCM) during daratumumab-based treatment. The immune cell subset analysis revealed significant down-regulation of CD38+ natural killer (NK) cells, regulatory T cells (Tregs) and regulatory B cells (Bregs). Meanwhile cytotoxic T-lymphocyte expansion was observed. In conclusion, daratumumab could rapidly decrease tumor burden, improve the condition of the PCL patient, and serve as a bridging salvage chemotherapy for further chimeric antigen recptor T cell therapy (Car-T) or HSCT, which could potentially improve patient survival. The immune cell dynamic findings in this case suggest that the immunomodulatory mechanism may contribute to the antimyeloma effect of daratumumab.
Demographic polarization and the rise of the far right: Brazil’s 2018 presidential election
Authors: Layton Matthew L. , Smith Amy Erica , Moseley Mason W. , Cohen Mollie J.
Published: January 2021

Does the recent electoral success of far-right populists represent a mere rejection of the political and economic status quo, or has it revealed deeper cultural divides? Historically, demographic cleavages have been poor predictors of vote choice and partisanship in Latin America. However, during Brazil’s 2018 presidential election campaign, right-wing candidate Jair Bolsonaro fomented conflict across lines of gender, race, and religion. We argue that his candidacy activated latent, previously unexploited grievances in the electorate. Using survey data from an original five-wave online panel conducted between July 2018 and January 2019, we examine the effect of demographic cleavages on presidential vote choice. In stark contrast to prior elections, we find clear evidence of demographic divides in 2018, partially mediated by issue positions. Bolsonaro’s campaign and subsequent election thus appear to have created new identity-based alignments in Brazil’s electorate. Our findings shed further light on the global resurgence of the far right, suggesting that far-right candidates can attract new bases of support through demographic polarization, exploiting differences in values and issue preferences by gender, race, ethnicity, and religion.
Mobile geriatric team for older people: A qualitative descriptive study of relatives’ views on what creates senses of security and quality of care
Authors: Tö rnfelt Lena , Roos Susanne , Hellström Ingrid
Published: January 2021

Multimorbidity tends to increase with age. Providing care that is individualized and that focuses on the whole person rather than on separate health issues is a challenge for healthcare, due to a lack of coordination and information exchange. In the future, relatives will need to take even more responsibility for their next of kin. The aim of this study was to explore relatives’ views of aspects that create a sense of security and feelings of quality of care related to acute mobile geriatric care for older people in their own homes. Data were collected using semi-structured interviews analysed using content analysis. This study is reported in accordance with the COREQ checklist. Interpersonal factors such as straightforward communication, empathy, having time for the person, a focus on the person, and having a few known caregivers who are easy to contact, rather than more clinical factors, have been identified as central to creating a sense of security and quality of care.
Evaluation of In-Office Cryoablation of Posterior Nasal Nerves for the Treatment of Rhinitis
Authors: Gerka Stuyt John A. , Luk Lauren , Keschner David , Garg Rohit
Published: January 2021

Background

Chronic rhinitis is a common condition generally treated with medical therapies. However, 10–22% of patients are refractory to medical therapies. A cryotherapy handheld device targeting the postganglionic nerve fibers of the posterior nasal nerve (PNN) now serves as an additional option for therapy. This study evaluates the efficacy of the cryosurgical ablation device of the PNN in the clinic setting.

Methods

This was a prospective single-arm trial of 24 adult patients at seven locations within a large health maintenance organization. Patients with chronic rhinitis that failed medical therapy were offered an in-office cryoablation of PNN. Patients completed the Total Nasal Symptom Score (TNSS) questionnaire consisting of 5 items reported based on the previous 12 hours and 2 weeks at the following time points: pre-treatment, 30 days, 90 days and 1 year post-treatment.

Results

Following cryoablation of the PNN, the TNSS 12-hour symptom score improved from 6.92 (±2.9) to 3.17 (±2.4, P < 0.001) at 30 days, 2.92 (±1.4, P < 0.001) at 90 days and 3.08 (±2.6, P < 0.001) at 1 year post treatment. Similar results were noted for the 2 weeks scores improving from 7.75 (±3.1) to 3.79 (±2.1, P < 0.001) at 30 days, 3.88 (±1.9, P < 0.001) at 90 days and 3.76 (±2.1, P < 0.001) at 1 year post-treatment. 64.7% of respondents stated the procedure decreased or eliminated nasal sprays.

Conclusions

Our independent evaluation of cryoablation of the PNN shows improvement in nasal symptoms over a 1 year period and is consistent with other published data.
Costs Associated With Timely and Delayed Surgical Treatment of Spinal Metastases
Authors: van Tol Floris R. , Massier Julie R. A. , Frederix Geert W. J. , Öner F. Cumhur , Verkooijen Helena M. , Verlaan Jorrit-Jan
Published: January 2021

Study Design:

Retrospective cohort study.

Objectives:

Symptoms caused by spinal metastases are often difficult to distinguish from symptoms caused by non-malignant spinal disease, complicating timely diagnosis, referral and treatment. The ensuing delays may promote the risk of neurological deficits or severe mechanical instability and consequent emergency surgery, leading to poorer prognosis. Presumably, treatment delay may subsequently lead to more health-care consumption and therefore increased average costs of treatment.

Methods:

All patients surgically treated for spinal metastases were included in the current study. Based on the presence of alarming symptoms and urgency of the required intervention, patients were categorized as having received timely or delayed treatment. Pre-surgical, in-hospital, aftercare and total costs were analyzed and compared between the 2 groups.

Results:

In total, 299 patients were included, of which 205 underwent timely and 94 delayed treatment. There was no significant difference in pre-surigcal costs (€3.229,13 in the timely treated group vs. €2.528,70 in the delayed treatment group, p = 0.849). The in-hospital costs (€16.738,49 vs. €13.108,81, p < 0.001) and the aftercare costs (€13.950,37 vs. 3.981,93, p < 0.001) were significantly higher for delayed treatment vs. timely treatment, respectively. The total costs were €33.741,71 for delayed treatment and €20.318,52 for timely treatment (p < 0.001).

Conclusions:

The total costs for timely treated patients with spinal metastases are significantly lower compared with patients receiving delayed treatment. Investing in the optimization of referral patterns may therefore reduce the overall pretreatment delay and subsequently increase patient outcome, leading to better clinical outcomes at lower costs.
Alignment Targets, Curve Proportion and Mechanical Loading: Preliminary Analysis of an Ideal Shape Toward Reducing Proximal Junctional Kyphosis
Authors: Katsuura Yoshihiro , Lafage Renaud , Kim Han Jo , Smith Justin S. , Line Breton , Shaffrey Christopher , Burton Douglas C. , Ames Christopher P. , Mundis Gregory M. , Hostin Richard , Bess Shay , Klineberg Eric O. , Passias Peter G. , Lafage Virginie ,   on behalf of International Spine Study Group (ISSG)
Published: January 2021

Study Design:

Retrospective cohort study.

Objective:

Investigate risk factors for PJK including theoretical kyphosis, mechanical loading at the UIV and age adjusted offset alignment.

Methods:

373 ASD patients (62.7 yrs ± 9.9; 81%F) with 2-year follow up and UIV of at least L1 and LIV of sacrum were included. Images of patients without PJK, with PJK and with PJF were compared using standard spinopelvic parameters before and after the application of the validated virtual alignment method which corrects for the compensatory mechanisms of PJK. Age-adjusted offset, theoretical thoracic kyphosis and mechanical loading at the UIV were then calculated and compared between groups. A subanalysis was performed based on the location of the UIV (upper thoracic (UT) vs. Lower thoracic (LT)).

Results:

At 2-years 172 (46.1%) had PJK, and 21 (5.6%) developed PJF. As PJK severity increased, the post-operative global alignment became more posterior secondary to increased over-correction of PT, PI-LL, and SVA (all P < 0.005). Also, a larger under correction of the theoretical TK (flattening) and a smaller bending moment at the UIV (underloading of UIV) was found. Multivariate analysis demonstrated that PI-LL and bending moment offsets from normative values were independent predictors of PJK/PJF in UT group; PT and bending moment difference were independent predictors for LT group.

Conclusions:

Spinopelvic over correction, under correction of TK (flattening), and under loading of the UIV (decreased bending moment) were associated with PJK and PJF. These differences are often missed when compensation for PJK is not accounted for in post-operative radiographs.
Octogenarians Are Independently Associated With Extended LOS and Non-Routine Discharge After Elective ACDF for CSM
Authors: Elsamadicy Aladine A. , Koo Andrew B. , Reeves Benjamin C. , Freedman Isaac G. , David Wyatt B. , Ehresman Jeff , Pennington Zach , Laurans Maxwell , Kolb Luis , Sciubba Daniel M.
Published: January 2021

Study Design:

Retrospective cohort study.

Objective:

The aim of this study was to determine the impact age has on LOS and discharge disposition following elective ACDF for cervical spondylotic myelopathy (CSM).

Methods:

A retrospective cohort study was performed using the National Inpatient Sample (NIS) database from 2016 and 2017. All adult patients >50 years old undergoing ACDF for CSM were identified using the ICD-10-CM diagnosis and procedural coding system. Patients were then stratified by age: 50 to 64 years-old, 65 to 79 years-old, and greater than or equal to 80 years-old. Weighted patient demographics, comorbidities, perioperative complications, LOS, discharge disposition, and total cost of admission were assessed.

Results:

A total of 14 865 patients were identified. Compared to the 50-64 and 65-79 year-old cohorts, the 80+ years cohort had a significantly higher rate of postoperative complication (50-64 yo:10.2% vs. 65-79 yo:12.6% vs. 80+ yo:18.9%, P = 0.048). The 80+ years cohort experienced significantly longer hospital stays (50-64 yo: 2.0 ± 2.4 days vs. 65-79 yo: 2.2 ± 2.8 days vs. 80+ yo: 2.3 ± 2.1 days, P = 0.028), higher proportion of patients with extended LOS (50-64 yo:18.3% vs. 65-79 yo:21.9% vs. 80+ yo:28.4%, P = 0.009), and increased rates of non-routine discharges (50-64 yo:15.1% vs. 65-79 yo:23.0% vs. 80+ yo:35.8%, P < 0.001). On multivariate analysis, age 80+ years was found to be a significant independent predictor of extended LOS [OR:1.97, 95% CI:(1.10,3.55), P = 0.023] and non-routine discharge [OR:2.46, 95% CI:(1.44,4.21), P = 0.001].

Conclusions:

Our study demonstrates that octogenarian age status is a significant independent risk factor for extended LOS and non-routine discharge after elective ACDF for CSM.
Comparison of Anterior Approach and Posterior Circumspinal Decompression in the Treatment of Giant Thoracic Discs
Authors: Yuan Lei , Chen Zhongqiang , Liu Zhongjun , Liu Xiaoguang , Li Weishi , Sun Chuiguo
Published: January 2021

Study Design:

Retrospective cohort study.

Objectives:

The treatment of giant thoracic disc herniation (gTDH)remains challenging for surgeons worldwide because of its large volume and calcified or ossified nature and the limitations of the prior small-sample-size, single-center studies reporting comparative effectiveness. We aim to compare the anterior decompression and spinal fusion (ASF) and posterior circumspinal decompression and spinal fusion (PCDF) for patients with myelopathy due to gTDH in the largest study to date by sample size.

Methods:

Preoperative and postoperative functional status, surgical details, and complication rates were compared between the 2 groups.

Results:

A total of 186 patients were included: 63 (33.9%) ASF and 123(66.1%) PCDF. The PCDF group had significantly shorter operation duration (163.06 ± 53.49 min vs. 180.78 ± 52.06 min, P = 0.032) and a significant decrease in intraoperative blood loss(716.83 mL vs. 947.94 mL, P = 0.045), and also a shorter hospital length of stay (LOS) and postoperative LOS (6 vs. 7, P = 0.011). The perioperative complication rate (13.8% vs. 28.6%, P = 0.015) and surgery-associated complication rate(13.0% vs. 27.0%, P = 0.018) were significantly higher in the ASF group. A higher rate of complete decompression was achieved in the PCDF group. There were no observed significant differences in changes in functional status between the 2 groups.

Conclusion:

PCDF for central or paracentral gTDHs is a highly effective and reliable technique. It can be performed safely with a low complication rate. If either procedure can adequately excise a central or paracentral gTDH, a PCDF approach may be a better option.
Biomechanical Comparison of Different Numbers and Configurations of Cross-Links in Long-Segment Spinal Fixation—An Experimental Study in a Porcine Model
Authors: Hsieh Ming-Kai , Liu Mu-Yi , Tsai Tsung-Ting , Lai Po-Liang , Tai Ching-Lung
Published: January 2021

Study Design:

Biomechanical study.

Objective:

Cross-links are a type of common clinical spinal instrumentation. However, the effects of the position and number of cross-links have never been investigated in long-segment spinal fixation, and the variables have not been optimized. We conducted an in vitro biomechanical study by using a porcine long-segment spinal model with 5 different crosslink configurations to determine the optimal construct for clinical practice.

Methods:

Five modalities with paired segmental screws from T15-L5 were tested in 20 porcine spines. The spines without cross-links composed the control group, Group A; those with a single cross-link from L2-3 composed Group B; those with 2 cross-links from L1-2 and L3-4 composed Group C; those with 2 cross-links from T15-L1 and L4-5 composed Group D; and those with 3 cross-links from T15-L1, L2-3 and L4-5 composed Group E. Spinal stiffnesses in flexion, extension, lateral bending, and axial rotation were compared among 5 different cross-link configurations in 5-level porcine spinal units.

Results:

Flexional, extensional and lateral bending stiffnesses did not significantly change with an increasing number of cross-links or positions in the construct. Axial stiffness was significantly increased with 2 cross-links compared to one ( P < 0.05) and with placement more distant from the center of the long spinal fixation construct ( P < 0.05).

Conclusions:

Two cross-links individually placed proximal and distal from the center of a construct is an optimal and efficient configuration to achieve biomechanical stability in non-rigid lumbar spines undergoing long-level fixation.
Remote or Removed: Predicting Successful Engagement with Online Learning during COVID-19
Authors: Domina Thurston , Renzulli Linda , Murray Brittany , Garza Alma Nidia , Perez Lysandra
Published: January 2021

Using data from a spring 2020 survey of nearly 10,000 parents of elementary school parents in one large southeastern public school district, the authors investigate predictors of elementary school student engagement during the initial period of pandemic remote learning. The authors hypothesize that household material and technological resources, school programming and instructional strategies, and family social capital contribute to student engagement in remote learning. The analyses indicate that even after controlling for rich measures of family socioeconomic resources, students with access to high-speed Internet and Internet-enabled devices have higher levels of engagement. Exposure to more diverse socioemotional and academic learning opportunities further predicts higher levels of engagement. In addition, students whose families remained socially connected to other students’ families were more likely to engage online.
The Debate: What Are Aerosol-Generating Procedures in Dentistry? A Rapid Review
Authors: Virdi M.K. , Durman K. , Deacon S.
Published: January 2021

Introduction:

This article aims to review the current national and international dental guidance produced during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic to identify the level of consensus on aerosol-generating dental procedures (AGDPs). The outcomes intend to encourage increased collaboration with respect to dental guidelines in relation to the SARS-CoV-2 pandemic, as well as to improve decision making and safety for dental patients and staff.

Methods:

This rapid review was conducted by 2 authors (MKV and KD), with the support of a third author (SD), to assess current guidelines related to dental AGDPs. This streamlined review approach allowed synthesis of data in an efficient manner in the rapidly evolving environment associated with the SARS-CoV-2 pandemic.

Results:

The findings identified 1) a lack of consistency in reporting which procedures were deemed an AGDP; 2) that high-speed handpieces, air-water syringes, and mechanical scalers were consistently considered high-risk AGDPs; 3) a lack of consensus on the risk of coronavirus disease 2019 (COVID-19) transmission with the use of slow-speed handpieces; 4) a general agreement, when described, that rubber dam and high-volume evacuation can significantly reduce aerosol production; and 5) a lack of consistency in reporting whether procedures constitute a low, moderate, or high risk of COVID-19 transmission. The findings are discussed in relation to the guidance and future recommendations.

Conclusion:

It is recommended that future published guidance should indicate the risk stratification (low/moderate/high) of each procedure/exposure in a standardized international approach.

Knowledge Transfer Statement:

The results of this rapid review can be used by clinicians to increase their awareness of international guidance on aerosol-generating procedures in dentistry. It will also encourage those publishing future guidance to provide an internationally standardized, risk-stratified approach to describing aerosol-generating procedures. Currently, it allows clinicians to consider aerosol-generating procedures as a risk spectrum.
Book review: Shinjini Das, Vernacular Medicine in Colonial India: Family, Market and Homoeopathy
Authors: Gupta Anuradha
Published: January 2021

Shinjini Das, Vernacular Medicine in Colonial India: Family, Market and Homoeopathy. Cambridge: Cambridge University Press, 2019. 292 pp., ₹7041, ISBN: 9781108420624.
Millennials Are Interested in Botulinum Toxin Injections for Prevention of Facial Rhytids
Authors: Freeman Matthew , Sayegh Farah , Sarosi Alex , Chopra Karan , Codner Mark , Sanati-Mehrizy Paymon , Taub Peter J.
Published: January 2021

Background: Botulinum toxin has been utilized for the treatment of facial rhytids since 2002. Since development, the indications for botulinum toxin have expanded greatly. Typically utilized in older generations for the treatment of rhytids, younger generations may be pursuing botulinum toxin injections for prevention rather than solely treatment of rhytids at a younger age. Methods: A 26-question survey was designed on Qualtrics and distributed to people through Amazon Mechanical Turk (MTurk) system. The Data was extracted from the Qualtrics website and processed with Microsoft Excel. Results: Out of 516 completed surveys, 92% of respondents were familiar with botulinum toxin injections with 21% having received botulinum toxin injections and 18% have received injections for cosmetic indications. Of those who have received botulinum toxin injections, 45% utilized injections for the treatment of wrinkles, 37% for the prevention of wrinkles, and 18% for the management of a non-cosmetic indication. When all respondents were asked the purpose of botulinum toxin injections, 11% thought they were for the prevention of wrinkles, 25% believed they were for the treatment of wrinkles, while 63% believe they are for both the prevention and treatment of wrinkles. Conclusions: Younger patients are pursuing botulinum toxin injections at an earlier initial age than their older counterparts. Significantly more people believe that these injections are intended for the prevention and treatment of facial rhytids rather than treatment alone. Plastic surgeons must be aware of the shifting landscape in order to adequately access this increasing patient population.
Administration of Steroids Is Associated With Increased Length of Stay But Not Post-Operative Complications or Readmissions in Patients Undergoing Orthognathic Surgery
Authors: Jodeh Diana S. , Buller Mitchell , Nguyen Anh Thy H. , Qamar Fatima , Rottgers Alex
Published: January 2021

Purpose: The purpose of this study is to examine the association of steroid use during orthognathic surgery and postoperative outcomes including major complications, 90-day all-cause readmission, and postoperative length of stay. Methods: A retrospective review was implemented utilizing the Pediatric Health Information System (PHIS) database from 2004 to 2014 was undertaken. Steroid exposure was defined as having been billed for the generic drug code for Dexamethasone (154035) at any time for up to 7 days from the surgery date. Unadjusted and adjusted random-intercept logistic regression models were utilized to assess the association between steroid exposure and these outcomes. Results: The sample included 5194 patients, 54% of patients were exposed to steroids, with 20.16 % exposed only on the day of surgery, 27.76% on the day of surgery and after, and 6.22% after the day of surgery. In models adjusting for age, sex, race, procedure, hospital variation and complex chronic conditions, the odds-ratio of steroid exposure was 3.46 (95% CI = 2.96-4.03) for an increased length of stay, 1.05 (95% CI = 0.81-1.37) for major complications and 1.20 (95% CI = 0.95-1.52) for 90-day all-cause readmission. Conclusion: The administration of steroids in patients undergoing orthognathic surgery is significantly associated with increased odds of length of stay. This may be due to a large set of patients receiving steroids during orthognathic procedure are less healthy than those not selected to receive steroids, and thereby require an increased length of stay. The limitations of large, administrative databases do not allow determination of this, but future prospective study is warranted.
Dissemination of extreme levels of extracellular vesicles: tissue factor activity in patients with severe COVID-19
Authors: Guervilly Christophe , Bonifay Amandine , Burtey Stephane , Sabatier Florence , Cauchois Raphaël , Abdili Evelyne , Arnaud Laurent , Lano Guillaume , Pietri Léa , Robert Thomas , Velier Mélanie , Papazian Laurent , Albanese Jacques , Kaplanski Gilles , Dignat-George Françoise , Lacroix Romaric
Published: January 2021

Coronavirus disease 2019 (COVID-19) has become one of the biggest public health challenges of this century. Severe forms of the disease are associated with a thrombo-inflammatory state that can turn into thrombosis. Because tissue factor (TF) conveyed by extracellular vesicles (EVs) has been implicated in thrombosis, we quantified the EV-TF activity in a cohort of hospitalized patients with COVID-19 (n = 111) and evaluated its link with inflammation, disease severity, and thrombotic events. Patients with severe disease were compared with those who had moderate disease and with patients who had septic shock not related to COVID-19 (n = 218). The EV-TF activity was notably increased in patients with severe COVID-19 compared with that observed in patients with moderate COVID-19 (median, 231 [25th to 75th percentile, 39-761] vs median, 25 [25th to 75th percentile, 12-59] fM; P < .0001); EV-TF was correlated with leukocytes, D-dimer, and inflammation parameters. High EV-TF values were associated with an increased thrombotic risk in multivariable models. Compared with patients who had septic shock, those with COVID-19 were characterized by a distinct coagulopathy profile with significantly higher EV-TF and EV-fibrinolytic activities that were not counterbalanced by an increase in plasminogen activator inhibitor-1 (PAI-1). Thus, this article is the first to describe the dissemination of extreme levels of EV-TF in patients with severe COVID-19, which supports the international recommendations of systematic preventive anticoagulation in hospitalized patients and potential intensification of anticoagulation in patients with severe disease.
Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis
Authors: Provencher Véronique , D’Amours Monia , Menear Matthew , Obradovic Natasa , Veillette Nathalie , Sirois Marie-Josée , Kergoat Marie-Jeanne
Published: January 2021

Background

Older adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home. Discharge planning interventions developed to prevent these events do not all produce the expected effects to the same extent. This realist synthesis aimed to better understand when, where, for whom, why and how the components of these interventions produce positive outcomes.

Methods

Nine indexed databases were searched to identify scientific papers and grey literature on discharge planning interventions for older adults (65+) hospitalized following a fall. Manual searches were also conducted. Documents were selected based on relevance and rigor. Two reviewers extracted and compiled data regarding intervention components, contextual factors, underlying mechanisms and positive outcomes. Preliminary theories were then formulated based on an iterative synthesis process.

Results

Twenty-one documents were included in the synthesis. Four Intervention-Context-Mechanism-Outcome configurations were developed as preliminary theories, based on the following intervention components: 1) Increase two-way communication between healthcare providers and patients/caregivers using a family-centered approach; 2) Foster interprofessional communication within and across healthcare settings through both standardized and unofficial information exchange; 3) Provide patients/caregivers with individually tailored fall prevention education; and 4) Designate a coordinator to manage discharge planning. These components should be implemented from patient admission to return home and be supported at the organizational level (contexts) to trigger knowledge, understanding and trust of patients/caregivers, adjusted expectations, reduced family stress, and sustained engagement of families and professionals (mechanisms). These optimal conditions improve patient satisfaction, recovery, functional status and continuity of care, and reduce hospital readmissions and fall risk (outcomes).

Conclusions

Since transitions are critical points with potential communication gaps, coordinated interventions are vital to support a safe return home for older adults hospitalized following a fall. Considering the organizational challenges, simple tools such as pictograms and drawings, combined with computer-based communication channels, may optimize discharge interventions based on frail patients’ needs, habits and values.

Empirically testing our preliminary theories will help to develop effective interventions throughout the continuum of transitional care to enhance patients’ health and reduce the economic burden of avoidable care.
Atypical presentations of coronavirus disease 2019 (COVID-19) from onset to readmission
Authors: Yang Zhiqi , Chen Xiaofeng , Huang Ruibin , Li Shengkai , Lin Daiying , Yang Zhijian , Sun Hongfu , Liu Guorui , Qiu Jinming , Tang Yanyan , Xiao Jianning , Liao Yuting , Wu Xianheng , Wu Renhua , Chen Xiangguang , Dai Zhuozhi
Published: January 2021

Background

To investigate the CT imaging and clinical features of three atypical presentations of coronavirus disease 2019 (COVID-19), namely (1) asymptomatic, (2) CT imaging-negative, and (3) re-detectable positive (RP), during all disease stages.

Methods

A consecutive cohort of 79 COVID-19 patients was retrospectively recruited from five independent institutions. For each presentation type, all patients were classified into atypical vs. typical groups (i.e., asymptomatic vs.symptomatic, CT imaging-negative vs. CT imaging-positive, and RP and non-RP,respectively). The chi-square test, Student’s t test, and Kruskal-Wallis H test were performed to compare CT imaging and clinical features of atypical vs. typical patients for all three presentation categories.

Results

In our COVID-19 cohort, we found 12.7% asymptomatic patients, 13.9% CT imaging-negative patients, and 8.9% RP patients. The asymptomatic patients had fewer hospitalization days (P=0.043), lower total scores for bilateral lung involvement (P< 0.001), and fewer ground-glass opacities (GGOs) in the peripheral area (P< 0.001) than symptomatic patients. The CT imaging-negative patients were younger (P=0.002), had a higher lymphocyte count (P=0.038), had a higher lymphocyte rate (P=0.008), and had more asymptomatic infections (P=0.002) than the CT imaging-positive patients. The RP patients with moderate COVID-19 had lower total scores of for bilateral lung involvement (P=0.030) and a smaller portion of the left lung affected (P=0.024) than non-RP patients. Compared to their first hospitalization, RP patients had a shorter hospitalization period (P< 0.001) and fewer days from the onset of illness to last RNA negative conversion (P< 0.001) at readmission.

Conclusions

Significant CT imaging and clinical feature differences were found between atypical and typical COVID-19 patients for all three atypical presentation categories investigated in this study, which may help provide complementary information for the effective management of COVID-19.
The influence of previous arthroscopic treatment on subsequent primary total knee arthroplasty: the comparison between bilateral knees of the same patient
Authors: Xu Kuishuai , Zhang Liang , Shen Rui , Wang Cailin , Li Tianyu , Zhao Xia , Yu Tengbo
Published: January 2021

Background

To explore whether previous arthroscopic knee surgery affects future total knee arthroplasty (TKA) results or not.

Methods

A total of 56 patients with the previous arthroscopic treatment on one knee underwent subsequent bilateral total knee arthroplasty in our hospital from September 2012 to July 2018. Data on each patient were collected in regards to changes in postoperative clinical and functional scores, various other scores, as well as postoperative functional recovery and complications. We defined the knees with a previous arthroscopic history as group A, and the counter side as group B. The Knee Society clinical score, functional scores, range of motion (ROM), finger joint size (FJS), visual analogue scale (VAS) scores were assessed before and after surgery. Using the Kolmogorov-Smirnov Test to test the normality of continuous variables, and the chi-square test to compare the rate of reoperation and complications between two groups. For all statistical comparisons, P < 0.05 was considered significant.

Results

There were no statistically significance differences found in postoperative Knee Society clinical scores and functional scores between group A and group B, as well as in ROM, FJS, VAS scores and local complications.

Conclusion

There were no statistically significant differences found in postoperative functional recovery and complications in patients, who underwent total knee arthroplasty with previous knee arthroscopy.
Pelargonium sidoides root extract for the treatment of acute cough due to lower respiratory tract infection in adults: a feasibility double-blind, placebo-controlled randomised trial
Authors: Willcox Merlin , Simpson Catherine , Wilding Sam , Stuart Beth , Soilemezi Dia , Whitehead Amy , Morgan Alannah , Wrixon Emma , Zhu Shihua , Yao Guiqing , Webley Fran , Yan Ruiyang , Bostock Jennifer , Bell Margaret , Griffiths Gareth , Leydon Geraldine , Little Paul , Butler Christopher , Hay Alastair D. , Moore Michael
Published: January 2021

Background

Pelargonium sidoidesDC (Geraniaceae) root extract, EPs®7630 or “Kaloba®”, is a widely used herbal remedy for respiratory infections, with some evidence of effectiveness for acute bronchitis. However, it is not yet widely recommended by medical professionals in the UK. There is a need to undertake appropriately designed randomised trials to test its use as an alternative to antibiotics. The aim was to assess the feasibility of conducting a double-blind randomised controlled trial ofPelargonium sidoidesroot extract for treatment of acute bronchitis in UK primary care, investigating intervention compliance, patient preference for dosage form and acceptability of patient diaries.

Study design

Feasibility double-blind randomised placebo-controlled clinical trial.

Methods

We aimed to recruit 160 patients with cough (≤ 21 days) caused by acute bronchitis from UK general practices. Practices were cluster-randomised to liquid or tablet preparations and patients were individually randomised to Kaloba® or placebo. We followed participants up for 28 days through self-reported patient diaries with telephone support and reviewed medical records at one month. Outcomes included recruitment, withdrawal, safety, reconsultation and symptom diary completion rates. We also assessed treatment adherence, antibiotic prescribing and consumption, mean symptom severity (at days 2–4 after randomisation) and time to symptom resolution. We interviewed 29 patients and 11 health professionals to identify barriers and facilitators to running such a randomised trial.

Results

Of 543 patients screened, 261 were eligible, of whom 134 (51%) were recruited and 103 (77%) returned a completed diary. Overall, 41% (41/100) of patients took antibiotics (Kaloba® liquid group: 48% [15/31]; placebo liquid group: 23% [6/26]; Kaloba® tablet group: 48% [9/21]; placebo tablet group: 50% [11/22]). Most patients adhered to the study medication (median 19 out of 21 doses taken in week 1, IQR 18–21 - all arms combined). There were no serious adverse events relating to treatment. Most patients interviewed found study recruitment to be straightforward, but some found the diary too complex.

Conclusions

It was feasible and acceptable to recruit patients from UK primary care to a double-blind placebo-controlled trial of herbal medicine (Kaloba®) for the treatment of acute bronchitis, with good retention and low data attrition.

Trial registration

HATRIC was registered on the ISRCTN registry (ISRCTN17672884) on 16 August 2018, retrospectively registered. The record can be found athttp://www.isrctn.com/ISRCTN17672884.
Correction to: Identifying goals, roles and tasks of extended scope physiotherapy in Dutch primary care- an exploratory, qualitative multi-step study
Authors: Bastiaens Ferdinand , Barten Di-Janne , Veenhof Cindy
Published: January 2021

An amendment to this paper has been published and can be accessed via the original article.
Transitions of care interventions to improve quality of life among patients hospitalized with acute conditions: a systematic literature review
Authors: Oyesanya Tolu O. , Loflin Callan , Byom Lindsey , Harris Gabrielle , Daly Kaitlyn , Rink Lesley , Bettger Janet Prvu
Published: January 2021

Background

Although transitional care interventions can improve health among patients hospitalized with acute conditions, few interventions use patient quality of life (QOL) as the primary outcome. Existing interventions use a variety of intervention components, are not effective for patients of all races and ethnicities, do not address age-related patient needs, and do not incorporate the needs of families. The purpose of this study was to systematically review characteristics of transitional care intervention studies that aimed to improve QOL for younger adult patients of all race and ethnicities who were hospitalized with acute conditions.

Methods

A systematic review was conducted of empirical literature available in PubMed, Embase, CINAHL, and PsycINFO by November 19, 2019 to identify studies of hospital to home care transitions with QOL as the primary outcome. Data extraction on study design and intervention components was limited to studies of patients aged 18–64.

Results

Nineteen articles comprising 17 studies met inclusion criteria. There were a total of 3,122 patients across all studies (range: 28–536). Populations of focus included cardiovascular disease, chronic obstructive pulmonary disease, stroke, breast cancer, and kidney disease. Seven QOL instruments were identified. All interventions were multi-component with a total of 31 different strategies used. Most interventions were facilitated by a registered nurse. Seven studies discussed intervention facilitator training and eight discussed intervention materials utilized. No studies specified cultural tailoring of interventions or analyzed findings by racial/ethnic subgroup.

Conclusions

Future research is needed to determine which intervention components, either in isolation or in combination, are effective in improving QOL. Future studies should also elaborate on the background and training of intervention facilitators and on materials utilized and may also consider incorporating differences in culture, race and ethnicity into all phases of the research process in an effort to address and reduce any health disparities.
Impact of the COVID-19 pandemic on the Emergency Department of a tertiary children’s hospital
Authors: Raucci Umberto , Musolino Anna Maria , Di Lallo Domenico , Piga Simone , Barbieri Maria Antonietta , Pisani Mara , Rossi Francesco Paolo , Reale Antonino , Ciofi degli Atti Marta Luisa , Villani Alberto , Raponi Massimiliano
Published: January 2021

Background

Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children’s hospital, composed by two different pediatric centers, one located in Rome’s city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED’s) and urgent hospitalizations compared to prepandemic period.

Methods

The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics.

Results

The reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access.

Conclusions

In the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn’t demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.
Infections and antimicrobial resistance in intensive care units in lower-middle income countries: a scoping review
Authors: Saharman Yulia Rosa , Karuniawati Anis , Severin Juliëtte A. , Verbrugh Henri A.
Published: January 2021

Background

Intensive care units (ICUs) in lower-middle income countries (LMICs) are suspected to constitute a special risk for patients of acquiring infection due to multiple antibiotic resistant organisms. The aim of this systematic scoping review was to present the data published on ICU-acquired infections and on antimicrobial resistance observed in ICUs in LMICs over a 13-year period. A systematic scoping review was conducted according to the PRISMA extension guideline for scoping reviews and registered in the Open Science Framework.

Main body of the abstract

Articles were sought that reported on ICU-acquired infection in LMICs between 2005 and 2018. Two reviewers parallelly reviewed 1961 titles and abstracts retrieved from five data banks, found 274 eligible and finally included 51. Most LMICs had not produced reports in Q1 or Q2 journals in this period, constituting a large gap in knowledge. However, from the reported evidence it is clear that the rate of ICU-acquired infections was comparable, albeit approximately 10% higher, in LMICs compared to high income countries. In contrast, ICU mortality was much higher in LMICs (33.6%) than in high income countries (< 20%). Multidrug-resistant Gram-negative species, especially Acinetobacter baumannii and Pseudomonas aeruginosa, and Klebsiella pneumoniae played a much more dominant role in LMIC ICUs than in those in high income countries. However, interventions to improve this situation have been shown to be feasible and effective, even cost-effective.

Conclusions

Compared to high income countries the burden of ICU-acquired infection is higher in LMICs, as is the level of antimicrobial resistance; the pathogen distribution is also different. However, there is evidence that interventions are feasible and may be quite effective in these settings.

Protocol Registration The protocol was registered with Open Science Framework (https://osf.io/c8vjk)