bluuebunny/crossref_metadata_2025 huggingface dataset:
Iatrogenic Vascular Injuries in Western Saudi Arabia
Authors: Zahrani H. A. Al , Salen T. R.
Published: September 2024

A group of 30 consecutive patients with iatrogenic vascular injury were studied to determine the aetiology of the condition and to investigate its possible prevention. Of the patients, 18 were males and 12 females; mean age was 37.0 years (range 2 weeks to 70 years). Most injuries ( n = 25) involved the arterial system; eight cases (27%) were recognized during the operative procedure. The most common presentations were bleeding and chronic ischaemia. Cannulation of vessels was the cause of injury in 14 cases (47%); two-thirds of these were iatrogenic in nature. A conservative policy was adopted in nine patients; surgery was planned but not performed in two. A total of 19 patients were operated on (17 reconstructions, one ligation, one fasciotomy); two died from causes related to their original condition. In order to reduce the incidence of iatrogenic injury, medical personnel should be informed of possible vessel damage, especially during cannulation. All surgical and radiological procedures should be carefully audited.
Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery: An Unusual Cause of Angina
Authors: Ladowski J. S. , Belvedere D. A. , Wuest L. F.
Published: September 2024

Origin of the right coronary artery from the pulmonary trunk rather than the aorta is a rare congenital anomaly. Only five cases of this anomaly have presented with signs and symptoms of ischemia. One of these cases, along with objective evidence for the cause of the ischemia and recommendations regarding surgical repair, is presented here.
Prevention of Left Ventricular Thrombus Formation during Pneumatic Pump Assist
Authors: Sakamoto T. , Maruyama T. , Sugano T. , Arai H. , Suzuki A.
Published: September 2024

A postcardiotomy patient with a pneumatic pulsatile pump for left ventricular assist showed a smoke-like swirling echo within the left ventricle during pump assist. The image disappeared partially during intra-aortic balloon pumping, which was performed as usual. Subsequently three pumps (native left ventricle, pneumatic and intra-aortic balloon) were driven synchronously; that is. the ventricular assist pump ejected the blood in the first half of the diastole of the native heart beat, and the intra-aortic balloon was inflated during the second half. With this bisected diastolic driving, the abnormal echo disappeared completely. The patient died 52 days after operation, but no thromboembolic episode was observed during the course, and no fresh thrombus was found within the left ventricle at autopsy The bisected diastolic driving method served as an aid to prevent stagnation of blood and thrombus formation within the native left ventricle in this patient with a left ventricular assist device.
Peripheral Thrombolysis: State of the Art
Authors: Earnshaw J. J. , Birch P.
Published: September 2024

Peripheral thrombolysis has become established in the last decade as an alternative method of treatment for acute limb ischaemia. New techniques of accelerated thrombolysis have expanded the indications to include almost all affected patients. Attention to detail and avoidance of known pitfalls, together with close cooperation between vascular surgeon and radiologist, ensure optimum results with minimum complications. A modern integrated lysis programme may vary from initial thrombolytic treatment for all patients with acute limb ischaemia to a selective policy of surgery and thrombolysis depending on the aetiology and severity of ischaemia.
Does Interruption of Normothermic Cardioplegia Have Adverse Effects on Myocardium? a Retrospective and Prospective Clinical Evaluation
Authors: Rousou J. A. , Engelman R. M. , Flack J. E. , Deaton D. W. , Rifkin R. , Elmansoury A.
Published: September 2024

A total of 154 patients who underwent isolated coronary revascularization (coronary artery bypass grafting) using retrograde, near-continuous, warm cardioplegia for myocardial protection, were arbitrarily divided into three groups according to the cumulative cardioplegic interruption (i.e. the sum total of all the short cardioplegic interruption periods, expressed as a percentage of the cardiac arrest period). Group 1 (39 patients) had <20% interruption (mean(s.e.m.) 12.5(0.01)%), group 2 (82 patients) had 20-39% interruption (mean(s.e.m.) 30.1(0.01)%) and group 3 (33 patients) had >40% interruption (mean(s.e.m.) 45.4(0.01)%). The three groups were comparable except for longer clamp time in group 3 and a lower cardiac index in group 1. The mean number and duration of cardioplegic interruptions and reperfusions and multiple clinical outcomes were recorded. Clinical outcomes (Q) wave perioperative infarction, use of an intra-aortic balloon pump, mortality, and length of stay in the intensive care unit and hospital) were the same in all groups despite significant differences in percent, number and duration of interruption and reperfusion as well as cardiac arrest. The only significant differences found were in the level of creatine kinase-MB (CK-MB) and use of inotropes after surgery, both being higher in group 1 than in groups 2 and 3 (which is the opposite of what would be expected). Intraoperative hemodynamic (cardiac index and left ventricular ejection fraction) and metabolic evaluations (CK-MB, lactate production and oxygen extraction) in 22 additional patients who underwent coronary artery bypass grafting showed no significant differences between two groups having <30% versus >30% cumulative cardioplegic interruption. It is concluded that warm cardioplegic interruption as used clinically has no adverse effects on the myocardium in patients undergoing coronary revascularization. Warm retrograde near-continuous blood cardioplegia is an effective method of myocardial protection.
Surgical Treatment of an Aortopulmonary Artery Fistula Complicating a Syphilitic Aortic Aneurysm
Authors: Pessotto R. , Santini F. , Bertolini P. , Faggian G. , Chiominto B. , Mazzucco A.
Published: September 2024

Spontaneous rupture of an aortic aneurysm into the pulmonary artery is unusual and is rarely reported in the literature. The case of a patient with a syphilitic aneurysm of the ascending aorta perforated into the pulmonary artery is presented. In an attempt to define the best surgical treatment for this complication the literature has been comprehensively reviewed.
Carotid Arterial Trauma: Assessment with the Glasgow Coma Scale (GCS) as a Guide to Surgical Management
Authors: Teehan E. P. , Padberg F. T. , Thompson P. N. , Lee B. C. , Silva M. , Jamil Z. , Swan K. G. , Hobson R. W.
Published: September 2024

Management of carotid arterial injuries associated with focal neurological deficit or altered state of consciousness (SCON) remains unresolved. Experience with these injuries in one particular hospital was reviewed and the Glasgow Coma Scale (GCS) utilized to assist with clinical stratification of these patients. A literature review was also conducted to better define indications for repair or ligation of carotid injuries. From 1978 to 1990, 34 patients with carotid arterial injuries were reviewed with reference to the GCS, focal deficit, hypotension, anatomic site and mechanism of injury. The literature from 1952 to 1993 was surveyed for carotid artery injuries (1316 patients). Outcome of treatment with or without repair was compared with pre-operative neurologic status. Thirty-four patients with injuries of the common (24) or internal (10) carotid arteries were managed with repair (68%), ligation (24%) or observation (9%). The SCON was normal in 18 patients; 16 patients (88%) underwent repair and all remained normal. All patients with GCS 9–14 regained a normal SCON after surgical repair, while 10 patients with GCS < 8 had repair (5), ligation (3), and non-operative management (2); five returned to normal, four died and one remained comatose. However, outcomes correlated poorly with management. Of 1316 patients cited in the surgical literature, patients with no deficit and patients with pre-operative deficits did significantly better after repair as compared with ligation ( P < 0.001). In comatose patients, management did not affect outcome. It is concluded that carotid arterial injuries should be repaired in patients with normal neurologic evaluation, focal pre-operative neurologic deficits and in patients with GCS > 9. Comatose patients with GCS < 8 do poorly regardless of management. The GCS provides an objective for stratification of patients with altered SCON who benefit from repair of carotid arterial injuries.
Long-Term Survival after Aortic Valve Replacement for Native Active Infective Endocarditis
Authors: Pompilio G. , Brockmann C. , Bruneau M. , Buche M. , Amrani M. , Louagie Y. , Eucher P. , Rubay J. , Jamart J. , Dion R. , Schoevaerdts J.-C.
Published: September 2024

Background:

The objective of this study was to analyse the impact of acute surgery for native aortic valve endocarditis and its influence on the long-Term prognosis after surgery.

Methods:

A total of 161 patients underwent aortic valve replacement for native active aortic valve endocarditis (NAAVE) during a 29-year period, from 1967 to 1995 (age range: 10 to 72 years; mean 48 ± 12). The main indication for surgery was progressive congestive heart failure (76%). Other indications were untreatable sepsis (27%), peripheral or central emboli (12%) and, from 1978, echocardiographic evidence of friable, pedunculated vegetations (3%). Streptococcal and staphylococcal infections predominated. Concomitant procedures were performed in 27% of the patients, including mitral and tricuspid valve surgery and coronary bypass procedures.

Results:

Operative mortality was 8% in the majority of cases caused by heart failure or multiorgan failure. Multivariate logistic regression analysis identified NYHA class IV to be an independent predictor for postoperative death. Long-term survival for discharged patients was 75% at 10 years and 58% at 15 years, with a mortality rate of 3.6%/patient/year. Cox regression analysis identified the year of operation, trivalvular endocarditis and staphylococcal infection as independent predictors of survival. At 10 and 15 years after aortic valve replacement, 91% and 84% of the patients, respectively, were free of recurrent endocarditis. The presence of an abscess cavity at first operation was found to be predictive of recurrent endocarditis.

Conclusions:

Valve replacement for NAAVE offers a good chance for a cure and satisfactory long-term survival. Improvements in pre- and per-operative management of the very ill patient, and the use of allograft valves are likely to further improve long-term results. Finally, the presence of staphylococcal endocarditis requires long-term postoperative antibiotic therapy.
The Dose-Dependent Effects of L-Carnitine in Myocardial Protection in Normothermic Ischemia
Authors: Tatlıcan O. , Kalaycıoğlu S. , Gökgöz L. , Oktar L. , Öz E. , Soncul H. , Sinci V. , Türközkan N. , Yener A. , Ersöz A.
Published: September 2024

L-Carnitine has been shown to improve the post-ischemic recovery of myocardial function and metabolic measurements that are reduced in the course of ischemia and reperfusion of the heart. In this study we used 40 male guinea-pigs in order to determine if the effect of L-carnitine which is used in the protection of the post-ischemic reperfused heart, is dose-dependent or not. All harvested hearts were perfused for 30 min on modified Langendorf apparatus with oxygenized Krebs–Henseleit solution. After this period, in ( n = 10), 5 mmol and 10 mmol (group B, n = 10) of L-carnitine were added into a Krebs–Henseleit solution. After 20 min, perfusion was complete and the hearts were then exposed to normothermic ischemia for 20 minutes. Following the ischemia, hearts were reperfused with the same solutions for 30 min. In group C ( n = 10), 10 mmol of L-carnitine was added into the solution at the post-ischemic reperfusion step. In the control group, the same procedures were performed without using L-carnitine. Matching was done according to the contractile force of the heart rate and the levels of malondialdehyde and adenosine deaminase. When 10 mmol L-carnitine was added into the perfusion solutions at the pre-ischemic period, the best results were obtained and myocardial damage was much less than the control group. The protective effects of L-carnitine in normothermic ischemia is dose-dependent and it must be given at the pre-ischemic period.
A New Accurate, Rapid and Cost-Effective Protocol for Stroke-Prevention Screening
Authors: Lavenson G. S.
Published: September 2024

The three immediate causes of stroke are cervical carotid artery disease, atrial fibrillation and hypertension. Recognition and appropriate management of these causes can prevent the majority of strokes they would have caused. The purpose of this study was to develop a new protocol for screening for these causes that is more accurate, rapid and cost effective than existing protocols. In this protocol, rather than relying on auscultation with a stethoscope, the carotid artery was screened with a newly developed and more accurate quick color image scan ultrasound technique and a lead 2 EKG rhythm strip was used to find atrial fibrillation. The focus in this protocol was on the rapid detection of the three immediate causes of stroke and did not include a lengthy questionnaire or long counseling. A cholesterol determination was not included and there was little or no cost to the participants. In stroke screening trials of the new protocol at two institutions, 176 participants were screened at a rate of one every 2.7 minutes. There were 26 with > 50% carotid stenosis, 16 with previously unknown cardiac arrhythmias and 104 had hypertension. It was concluded that this protocol provides an accurate, rapid and cost-effective means of screening for the three immediate causes of stroke and can on broad application result in significant stroke reduction.
Cultured Neonatal Rat Cardiomyocytes and 99mTc-Sestamibi to Assess the Direct Effects of Cardioplegia
Authors: Camilleri L. , Moins N. , Mouchonière M. , Renoux M. , Bailly P. , Veyre A. , Maublant J. , de Riberolles Ch.
Published: September 2024

The efficacy of cardioplegia in neonatal myocardial protection is still a matter of debate. 99mTc-sestamibi cellular accumulation reflects sarcolemmal and mitochondrial electrical gradients. It was used to monitor the direct effects of two cardioplegic solutions, modified St Thomas' Hospital and Bretschneider, on normoxic and metabolically-inhibited cultured cells. Cellular accumulation of 99mTc-sestamibi, expressed by the ratio between intra and extra cellular concentrations, was assessed in three different sets of neonatal rat cardiomyocytes. Cells were either treated with different concentrations of modified St Thomas' solution (50, 75, 100%), they were treated or recovering from a treatment with modified St Thomas and Bretschneider solutions at 50% concentrations, or were recovering from treatment with modified St Thomas' and Bretschneider solution at 50% concentrations mixed with metabolic inhibitors. Cardioplegia depressed the tracer accumulation in a concentration-dependent manner. This effect was independent of the type of cardioplegia (120-min uptake, as a percentage of control values, modified St Thomas' 68 ± 12 and Bretschneider 59 ± 7) and was rapidly reversible. Cardioplegia was unable to prevent the depression of tracer accumulation induced by metabolic inhibitors and even induced a deleterious effect (120-min uptake, as a percentage of control values, metabolic inhibitors 69 ± 12, metabolic inhibitors + modified St Thomas 38 ± 14, metabolic inhibitors + Bretschneider 43 ± 6) during recovery after 30 min of metabolic inhibition. It was concluded that cardioplegia has an apparent detrimental effect on neonatal cardiomyocytes accumulation of 99mTc-sestamibi during recovery from an ischaemic-like insult.
Understanding Determinants of Managerial Competencies of FPO (Farmer Producer Organization) Leadership for Driving Sustainable Growth: A Strategic Framework and Policy Implications
Authors: Yanduri Prabhavathi , Siddayya
Published: September 2024

The study aims to determine the key variables influencing the competencies of managerial teams of farmer producer organizations (FPOs) that impact their performance and progress towards attaining sustainable growth in the state of Andhra Pradesh. Primary data was collected from a random sample of 15 FPOs involving 94 managerial team members and secondary data from FPO financial statements spanning over 2019–2022. Statistical techniques, namely index scores, ANOVA, ordinal logit and financial ratios, are used for empirical analysis. Higher formal education, exposure to previous business activities and digital media and experience in leadership roles in community-based organizations (CBOs) are identified as key competency determinants of FPO managerial teams. FPOs are categorized into supported existence, stagnant, self-sustained and sustained growth based on their financial performance. Sustained growth FPOs comparatively demonstrated better performance over their counterparts, attributed to higher competency determinants that enabled them to adopt a holistic value chain approach. Thus, findings indicated a positive relation between competencies and performance. In the light of findings, a strategic four I (4I) model and sustained growth matrix are proposed to enhance business competencies for improved performance of FPOs to grow as potential social enterprises.
The Ethical Implications of Prosocial Synthetic Resuscitation: Analysing User Comments to a Deepfake Campaign Addressing Intimate Partner Violence
Authors: Lowenstein Hila , Steinfeld Nili , Rosenberg Hananel
Published: September 2024

In recent years, the ‘digital resurrection’ of the deceased through Deepfake technology has become a reality accessible to the general public and has raised profound ethical discussions in society. While the academic literature focuses primarily on regulatory and political implications, the public reception of digital resurrection remains largely unexplored. Furthermore, much of the public discourse around Deepfakes centres on their malicious applications, despite the potential for digital resurrection to serve prosocial purposes. This study focuses on an Israeli campaign called ‘Listen to My Voice’ (2021), which ‘resurrected’ women murdered by their partners, having them ‘tell’ the stories of the abusive relationships that preceded their deaths. An analysis of viewer responses shows that the campaign elicited strong reactions straddling the line between technology and ethics. Quantitatively, most comments supported the use of Deepfakes, given the importance of the cause and the impactful messaging. Qualitatively, two key themes emerged: one technical, indicating that visceral realism sparked both emotional connections and fundamental misunderstandings of the technology itself. The second highlighted an ethical tension between desires to protect autonomy and justifications for posthumously using an individual’s likeness for positive aims. The findings suggest Deepfakes’ technical attributes, particularly tangibility, significantly shape its ethical reception—a phenomenon we term ‘the ethics of technological misunderstanding’.
An Unusual Neurological Complication of Multiple Wasp Stings: AIDP
Authors: Kaur Amandeep , Gupta Monica , Ahuja Ishreen , Koul Anuka
Published: September 2024

Background and Aims:

Wasp stings often result in vascular problems and local irritation. Rarely neurological difficulties result from a delayed immune response, which causes acute inflammatory demyelinating polyradiculopathy, stroke and Parkinson’s disease.

Patient’s Concern:

Here we are describing a young male, who presented to us with ascending paralysis a few days after being stung by multiple wasps. The patient did not have any infection or recent vaccination. Nerve conduction velocity (NCV) suggested increased latencies in peripheral nerves. Hence, a temporality between Guillain–Barré syndrome (GBS) and the wasp sting was hypothesised.

Intervention:

After establishing a diagnosis, the patient received standard treatment for acute inflammatory demyelinating polyneuropathy (AIDP). Intravenous immunoglobulins were given over 5 days in divided doses. The patient had gross improvement in the weakness by day 7 and fully recovered in 2 months.

Conclusion:

This case study highlights the possibility of acute demyelinating polyradiculopathy, a serious neurological consequence that can arise from wasp stings. Nevertheless, the pathophysiology of the same is not well recognised in the literature. This emphasises the importance of identifying uncommon causes of GBS and comprehending the mechanism and curative measures.
Calcific Myonecrosis of the Leg: A Clinical and Diagnostic Dilemma
Authors: Hussein Mohsin , Iyengar Karthikeyan P. , Beale David , Botchu Rajesh
Published: September 2024

Background:

Calcific myonecrosis (CMN) is a rare condition, often considered to be a late sequela of antecedent trauma.

Case Report:

We describe here our experience in managing a 56-year-old male referred with a painless swelling on the lateral aspect of the left lower leg with a suspicion of a tumour.

Results:

Clinical and imaging features were classic of CMN.

Conclusion:

Clinical assessment, role of ultrasound scan in reaching a diagnosis and the management are highlighted.
The DSW to the Rescue? A Response to Feldman
Authors: Thyer Bruce A.
Published: September 2024

Feldman's appraisal of the current status of social work research, using as its touchstone the 1991 Austin Report, is a frank and fair appraisal of how the discipline has come short of fulfilling its aspirations to become a more science-based profession. In many ways, Feldman has stood in the center of research developments within our field for the past 40 years or longer. He offers informed and thoughtful analyses of what we have accomplished and what is left undone. He asserts that part of the problem is the sluggish growth in the number of research doctorates being produced in our field. Obviously, without the production of highly trained social work researchers, the scholarly and science-based contributions to our field are limited. In this response, I contend that the burgeoning growth of the number of practice doctoral graduates, Doctor of Social Works (DSWs), may provide significant resources to augment the science of social work. In reality, the older generation of DSW graduates made highly important contributions to the science of social work, and the new generation stands poised to replicate this phenomenon.
Parenting Practices and Children's Mental Health: Moderating COVID-19 Stressors Experienced by Brazilian Parents
Authors: Valandro Graciana Sanchotene , Reis Rodrigues Gabriel dos , Marin Angela Helena
Published: September 2024

Aim: To examine whether the stressors of the COVID-19 pandemic moderate the relationship between parental educational practices and children's emotional and behavioral problems. Background: The COVID-19 pandemic has significantly altered family routines, and children, with their limited ability to understand and interpret these changes, have been particularly vulnerable to stress. Method: An explanatory design was used with a sample of 135 Brazilian parents (mothers or fathers) who lived with a child aged between 6 and 11 years. Participants completed the Sociodemographic Data Questionnaire, the Parenting Practices Inventory, the Strengths and Difficulties Questionnaire, and the COVID-19 Stress Response Questionnaire remotely. Results: Coercive discipline significantly interacted with COVID-19 stressors in relation to emotional and behavioral problems. Increased perception of stressors intensified the association between coercive discipline and conduct problems, peer issues, and internalizing problems in children. Conclusion: The COVID-19 pandemic has exacerbated the use of coercive discipline, negatively impacting children's mental health. Implications: The findings highlight the need to enhance and reinforce parenting skills to better manage stressful situations, thereby safeguarding the parent-child relationship and mitigating the negative effects of the pandemic on children.
Pathways of Socioeconomic Disadvantage and Peer Bullying in Children and Youth: A Scoping Review
Authors: Runions Kevin C , Sae-Koew Jonathan H , Pearce Natasha , Sarasjärvi Kiira , Attey Matilda , Mitrou Francis
Published: September 2024

Growing up in socioeconomic disadvantage increases risk of peer bullying at school. Both socioeconomic status and involvement in bullying are predictive of a range of adverse developmental outcomes. However, neither (a) the mechanisms whereby disadvantage increases bullying risk nor (b) the developmental outcomes for which bullying may mediate disadvantage are clear. This review scoped the literature on the relationships between socioeconomic disadvantage, bullying, and health and developmental outcomes for school-aged children and adolescents. Four databases were searched up to June 3, 2023 with 565 studies retrieved, of which 17 met criteria. Most studies were cross-sectional, and studies varied greatly in their definition and measurement of both bullying involvement and disadvantage. No intervention studies were found. Mediators of the disadvantage-bullying association ranged from individual level (e.g., depression) to the national level (e.g., homicide rate); only two studies examined bully–victim status. Of studies where bullying was a mediator, none examined bullying perpetration; the range of outcomes examined was narrowly focused on mental health, failing to capture the full range of developmental outcomes associated with either socioeconomic disadvantage or bullying involvement. This review highlights that future research is needed on identifying and understanding the mediators of the association between disadvantage and bullying victimization, and on the developmental outcomes mediated by bullying perpetration for disadvantaged children. These insights are critical to increase the effectiveness of community- and school-based bullying prevention, particularly in communities with high proportions of socioeconomically disadvantaged families.
Prevalence of Fovea Plana in patients with rhegmatogenous retinal detachment
Authors: Chatzistergiou Vasileia , Lejoyeux Raphaël , Bonnin Sophie , Tadayoni Ramin
Published: September 2024

Purpose

To assess the prevalence of fovea plana in patients with rhegmatogenous retinal detachment and compare characteristics of the detachment between patients with and without fovea plana.

Methods

This retrospective, cross-sectional, case–control study included individuals with rhegmatogenous retinal detachment. We collected demographics and data on the operated eye, spherical equivalent, best-corrected visual acuity, lens status, macula status, number of retinal holes or tears, and presence of intravitreal hemorrhage, macular hole, epiretinal membrane, posterior vitreous detachment and proliferative vitreoretinopathy. The type of surgery, the tamponade, and cataract surgery following retinal surgery were also recorded. Spectral-domain optical coherence tomography macular cubes were used to evaluate the fovea by using the Spectralis HRA-OCT device (Heidelberg Engineering, Germany). Images were graded by two different investigators and a third investigator in case of disagreement.

Results

We included 204 individuals; 35 (17.2%) had fovea plana, a proportion significantly higher than in the general population (p = 0.041). Individuals with and without fovea plana did not differ in any of the characteristics mentioned above apart from posterior vitreous detachment, which was more frequent in those with than without fovea plana (p = 0.038).

Conclusion

The prevalence of fovea plana is higher in patients with rhegmatogenous retinal detachment, which suggests an association between fovea plana and potential vitreoretinal interface changes.
“How Can You Be a Feminist if You’re Always Online?” Online Activisms, Ambivalence, and Dis/Connection
Authors: Caldeira Sofia P. , Jorge Ana , Kubrusly Ana
Published: September 2024

Digital presence and participation are often imagined as essential for contemporary feminist practices and identities. However, feminist engagements with digital and social media platforms can be tempered by drawbacks and tensions. This leads activists and everyday feminists to the need to negotiate digital dis/connection in their everyday lives. This article explores the affective dimensions of social media dis/connection in feminist contexts, grounding it on 22 in-depth interviews with people engaged with online feminisms and activisms in the Portuguese context. The article foregrounds the relationship between digital activisms and different affective ambiences, both internal and platform-driven. It explores the pressures felt by activists, the sense of disillusionment that paradoxically co-exists with discourses of political potential of social media, and, finally, practices of partial or temporary disconnection that emerge as means to negotiate the affective ambivalences of digital activism.
Novel Retractor–Camera System Facilitates Less Traumatic Minimally Invasive Procedures and Declutters the Operation Field
Authors: Sazzad Faizus , Ng Wee Han , Feng Gao , Moideen Irwan Shah Bin Mohd , Gohary Abdulrahman El , Han Kim Ki , Stevens John C. , Kofidis Theo
Published: September 2024

Objective:

To develop a novel endoscopic system that reduces trauma to the patient and declutters the surgical field for the surgeon in minimally invasive heart valve surgery.

Methods:

We designed and developed a retractor–camera combination for minimally invasive heart surgery; the cable and camera were connected to the underbelly of the left atrial retractor blade to provide an illuminated, wide-angle view of the mitral valve. We conducted ex vivo, in vivo, and, ultimately, a first-in-man randomized, nonanonymized clinical trial on 20 patients who required minimally invasive mitral valve surgery. Data from the preoperative period and the immediate postoperative period were gathered, and patients were followed for 3 months.

Results:

Our camera–retractor combo demonstrated safe and efficient exposure and vision in all detailed studies. The total operation time for the intervention group (316.5 ± 65.1 min) was slightly shorter than for the control group (317.5 ± 50.8 min). There was no significant difference in the ability to provide exposure of the mitral valve and surrounding left atrial tissue for both control and test articles. The novel camera–retractor reduced clutter in the operation field substantially and eliminated chest penetration for the camera. We also observed that the camera did not fog, did not stain with blood, and did not require frequent corrections to its position.

Conclusions:

We launch a novel atrial retraction–imaging platform that is less invasive for the patient and eliminates clutter and redundant movements for the surgeon.
The effect of oral clonidine and intravenous dexmedetomidine administration on the quality of functional endoscopic sinus surgery
Authors: Samadi Shahram , Ghahremaniyeh Zahra , Khanahmadi Shima , Ghavipanjeh Rezaiy Somayeh , Bagheri Shalaleh , Prakash Pasupulla Ajay , Khalilollah Shayan , Fassbinder Marius , Kazemi Haki Behzad , Khanahmadi Shahriar , Mohtashami Saghar
Published: September 2024

Background:

Clonidine and dexmedetomidine are alpha-2 receptor blockers administered for haemorrhage control during surgery in limited settings. Functional endoscopic sinus surgery (FESS) may be associated with bleeding, thus making it challenging. This study aims to evaluate the effect of dexmedetomidine and clonidine on haemorrhage control during FESS and surgical outcomes.

Methods:

This three-blinded prospective study included 102 patients who underwent FESS at the Imam Khomeini public referral hospital at the Imam Khomeini public referral hospital, in Urmia, Iran. It was either American Society of Anaesthesiologists (ASA) class I or II. They were divided into three groups (clonidine, dexmedetomidine, and placebo). The volume of blood loss, mean arterial pressure, surgical field visualisation, and surgeon satisfaction were assessed in the three groups. Data analysis was performed using SPSS version 23.0.

Results:

Dexmedetomidine and clonidine decreased mean arterial pressure, heart rate, and blood loss volume while improving surgical field visualisation. The effect of dexmedetomidine was associated significantly statistically with surgeon satisfaction (p < 0.0001). Furthermore, dexmedetomidine improved the surgical field and reduced operating times in the dexmedetomidine group (p < 0.0001).

Conclusion:

The present clinical trial findings indicated that the administration of dexmedetomidine during FESS decreased mean arterial pressure, provided balanced anaesthesia and appropriate analgesia, and improved the visibility of the surgical field and increased surgeon satisfaction.
Performance-based reimbursement for digital therapeutics in Germany: A misconceptualized opportunity
Authors: Benning Leo , Teepe Gisbert Wilhelm , Pooth Jan-Steffen , Hans Felix Patricius
Published: September 2024

Background

Germany has one of the oldest social security systems in the world. Population coverage has subsequently increased, reaching coverage of approximately 90% of the population in the statutory health insurance (SHI) system today. Before this background, Germany has been pioneering the integration of digital therapeutics (DTx) into its SHI system by the introduction of the Digital Healthcare Law (Digitale-Versorgung-Gesetz, DVG) in 2019. Thereby, patients became eligible for digital health applications (Digitale Gesundheitsanwendungen, DiGA), which are available upon prescription by qualified healthcare professionals.

Challenge

As conventional healthcare delivery often lacks direct outcome measures as and is mostly still reimbursed on a fee-for-service basis, DiGA offer the opportunity to continuously provide individual outcome and performance data. They are, therefore, well-suited for a performance-based payment framework. While the DVG introduced the option for performance-based reimbursement components in 2019 already, the ongoing debate about the value of DiGA and to what extent they can contribute to the healthcare system has now been reflected in a 2023 health policy bill by the German Federal Ministry of Health, which aims to introduce a mandatory performance-based reimbursement component for DiGA.

Proposal

In this light, we propose a framework for performance-based reimbursement of DiGA, involving an intervention-specific, performance-linked reimbursement framework with shared accountability between manufacturers and payers. The approach aims to align the often contradicting interests of the involved stakeholders to incentivize the delivery of high-value digital health care. Yet, the proposal also acknowledges the need for further research to establish a robust foundation for implementing such a framework.
Sectoral Convergence Trends in per Capita Energy Use Among US States
Authors: Tzeremes Panayiotis
Published: September 2024

This research studies the convergence hypothesis in per capita energy consumption across 51 US states, not only at an aggregated level but also at a sectoral one during the period 1960–2018. As regards methodology, we applied Phillips and Sul’s framework, and as a robustness test, we used the von Lyncker and Thoennessen calculation. Initially, the findings unveil the rejection of full panel convergence at total energy consumption and at the sectoral level, but when it comes to subgroup analysis, a crucial number of clubs are detected. By and large, for the total energy consumption per capita sample, the club clustering algorithm shows the presence of four convergent clubs and one divergent group. Concerning the commercial sector, the absence of a divergent group is found, while we can detect two subgroups. The convergence findings of the electric power sector divulged four subgroups and one state with divergent action. As regards the industrial sector, the outcomes reported seven clubs and one divergent group, while three clubs and one divergent group emerged in the residential sector. Lastly, with respect to the transportation sector, four clubs and one divergent group are revealed. It could be said then that policy implications are substantial and valuable not only for the convergent states but also for the divergent states.

JEL Classifications: C33, O47, Q4, Q40
“Trying to twist your way out of your skin” — different faces of Chinese Canadian experience in selected poems by Grace Lau
Authors: Antoniak Joanna
Published: September 2024

The notions of inclusion, exclusion, and otherness remain at the core of the diasporic experience and an integral part of the history of Chinese diaspora in Canada. In her debut collection The Language We Were Never Taught to Speak (2021), Grace Lau, a Chinese Canadian poet, explores these ideas and their impact on individuals and on the whole Chinese diaspora. Through the analysis of four of Lau’s poems — “When Yuhua Hamasaki Went Home”, “3 a.m. Communion”, “Pedicure at Pinky’s”, and “Escape Artist” — this article discusses how the poet connects experiences of inclusion and exclusion with both historical instances of prejudice and discrimination and their modern counterparts, highlighting the role consumerism plays in those processes.
Decisional needs for older adults, home health care nurses and dental hygienists during team-based oral health assessments in ordinary home settings – a qualitative study
Authors: Persson Kylén Jessica , Björns Sara , Hägglin Catharina , Grönbeck-Lindén Ingela , Piper Laurence , Wårdh Inger
Published: September 2024

Background

Participation by all actors involved in health planning is a prerequisite for person-centred care and healthy ageing. Understanding the multiple knowledge needs and the values that shape oral health assessments in home settings is important both to enable participation in oral health planning and to contribute to healthy ageing.

Objective

The aim of this study was to investigate decisional needs during oral health assessments in ordinary home settings from the perspectives of older adults, home health care nurses and dental hygienists.

Methods

Data was collected in ordinary home settings through 24 team-based oral assessments and 39 brief, semi-structured interviews including older adults (n = 24), home health care nurses (n = 8) and dental hygienists (n = 7). Data was analysed using content analysis with a deductive approach. The analysis was guided by the Ottawa Decision Support Guide.

Results

The analysis revealed that all participants considered participation in decision-making important but until now, older adults might not have participated in making decisions regarding oral health issues. The older adults considered participation important because the decisions had a strong impact on their lives, affecting their health. The professionals considered decision-making important for knowing what step to take next and to be able to follow up and evaluate previous goals and treatments. Organizational and personal barriers for shared decision-making among home health care nurses and dental hygienists were identified. Of the 24 older adults, 20 had different oral health conditions that objectively indicated the need for treatment. An initial important decision concerned whether the older adult wanted to make an appointment for dental care, and if so, how. Another decisional conflict concerned whether and how assisted oral care should be carried out.

Conclusion

It is important for key participants in ordinary home settings to participate in interprofessional teams in home health care. To further anchor this in theory, conceptual models for professionals from different care organizations (municipal care, dental care) need to be developed that also involve older adults as participants. Future research could bridge theory and practice by including theories of learning while exploring interorganizational oral health planning in home settings.
Utilization frequency and patient-reported effectiveness of symptomatic therapies in post-COVID syndrome
Authors: Reuner Miriam , Krehbiel Johannes , Rech Jürgen , Greiner Brigitte , Schäfer Isabel , Herold Regina , Morawa Eva , Erim Yesim
Published: September 2024

Background

To date there is no causal treatment for post-COVID syndrome, leaving symptomatic treatments as the primary recourse. However, the practical implementation and effectiveness of these interventions remain underexplored. This study aimed to investigate the utilization frequency of symptomatic therapies and patient-reported effectiveness across various treatment modalities at a German post-COVID center.

Methods

As the baseline investigation we conducted a single-cohort retrospective study to analyze the frequency of symptomatic therapies among post-COVID patients who attended the post-COVID center of the University Hospital of Erlangen, between December 2022 to July 2023. Additionally, we administered a follow-up at least 3 months after the initial presentation, using a questionnaire to assess patient-reported improvements in post-COVID symptoms associated with the symptomatic therapies received.

Results

Our study included 200 patients (mean age: 44.6 ± 12.6 years; 69.0% women; mean duration since acute infection: 15.3 ± 8.3 months). Pharmacotherapy was the predominant symptomatic treatment (79.5%), with psychotropic drugs (32.5%) and analgesics (31.5%) being the most frequently prescribed. Over half of the patients (55.5%) utilized vitamins and nutritional supplements. Hospital admission rates to acute care occurred in 35.5% of cases; 33.0% underwent inpatient rehabilitation and 31.0% pursued outpatient psychotherapy. Cardiologists (76.5%), pulmonologists (67.5%), and neurologists (65.5%) were the most consulted specialists. Therapies involving medical devices were infrequently employed (12.0%). In a follow-up questionnaire (response rate: 82.5%, 6.3 ± 2.2 months post-baseline), beta-blockers were the most effective pharmacological intervention with 31.5% of patients reporting strong to very strong symptom improvement, followed by antibiotics (29.6%). Furthermore, 33.0% of the patients perceived plasmapheresis to strongly alleviate symptoms. Only a small proportion of the sample attributed a strong or very strong symptom improvement to outpatient psychotherapy (11.0%).

Conclusion

This study provides initial insights into symptomatic therapy utilization and patient-reported symptom improvement in post-COVID syndrome. Further research into symptoms clusters and interdisciplinary collaboration are warranted to comprehensively address the multifaceted physical and psychological symptomatology.

Trial registration

The study was registered at the German Clinical Trials Register (DRKS-ID: DRKS00033621) on March 20, 2024.
Implementing telemedicine with 5G technologies in a nursing home for reducing emergency admissions– study protocol of a mixed-methods study
Authors: Lubasch Johanna Sophie , Eder Patrick Andreas , Kaiser Christian , Klausen Andrea Diana , Overheu Daniel , Partheymüller Anja , Rashid Asarnusch , Schäfer Simon Thomas , Scharonow Maximilian , Seeger Insa
Published: September 2024

Background

By transmitting various types of data, telemedical care enables the provision of care where physicians and patients are physically separated. In nursing homes, telemedicine has the potential to reduce hospital admissions in nonemergency situations. In this study, telemedicine devices were implemented with the new 5G mobile communications standard in selected wards of a large nursing home in Northwest Germany. The main aim of this study is to investigate which individual and organizational factors are associated with the use of telemedicine devices and how users perceive the feasibility and implementation of such devices. Moreover, it is investigated whether the telemedical devices help to reduce the number of emergency admissions.

Methods

Telemedicine devices are implemented over an 18-month period using a private 5G network, and all users receive training. This study uses qualitative and quantitative methods: To assess the individual and organizational factors associated with the use of telemedicine devices, survey data from employees before and after the implementation of these devices are compared. To assess the perception of the implementation process as well as the feasibility and usability of the telemedical devices, the nursing staff, physicians, medical assistants and residents are interviewed individually. Moreover, every telemedicine consultation is evaluated with a short survey. To assess whether the number of emergency admissions decreased, data from one year before implementation and one year after implementation are compared. The data are provided by the integrated dispatch centre and emergency medical services (EMS) protocols. The interview data are analysed via structured qualitative content analysis according to Kuckartz. Survey data are analysed using multivariable regression analysis.

Discussion

Learnings from the implementation process will be used to inform future projects implementing telemedicine in care organizations, making the final telemedicine implementation and care concept available to more nursing homes and hospitals. Moreover, the study results can be used to provide use cases for appropriate and targeted application of telemedicine in nursing homes and to define the role of 5G technologies in these use cases. If the intervention is proven successful, the results will be used to promote 5G network rollout.

Trial registration

German Clinical Trials Register – trial registration number: DRKS00030598.
Integrated bioinformatic analysis of protein landscape in gingival crevicular fluid unveils sequential bioprocess in orthodontic tooth movement
Authors: Chen Yao , Mei Li , Qian Yuran , Zhou Xinlianyi , Zhao Zhihe , Zheng Wei , Li Yu
Published: September 2024

Background

The biological mechanisms driving orthodontic tooth movement (OTM) remain incompletely understood. Gingival crevicular fluid (GCF) is an important indicator of the periodontal bioprocess, providing valuable cues for probing the molecular mechanisms of OTM.

Methods

A rigorous review of the clinical studies over the past decade was conducted after registering the protocol with PROSPERO and adhering to inclusion criteria comprising human subjects, specified force magnitudes and force application modes. The thorough screening investigated differentially expressed proteins (DEPs) in GCF associated with OTM. Protein-protein interaction (PPI) analysis was carried out using the STRING database, followed by further refinement through Cytoscape to isolate top hub proteins.

Results

A comprehensive summarization of the OTM-related GCF studies was conducted, followed by an in-depth exploration of biomarkers within the GCF. We identified 13 DEPs, including ALP, IL-1β, IL-6, Leptin, MMP-1, MMP-3, MMP-8, MMP-9, PGE2, TGF-β1, TNF-α, OPG, RANKL. Bioinformatic analysis spotlighted the top 10 hub proteins and their interactions involved in OTM. Based on these findings, we have proposed a hypothetic diagram for the time-course bioprocess in OTM, which involves three phases containing sequential cellular and molecular components and their interplay network.

Conclusions

This work has further improved our understanding to the bioprocess of OTM, suggesting biomarkers as potential modulating targets to enhance OTM, mitigate adverse effects and support real-time monitoring and personalized orthodontic cycles.