bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effectiveness and Implementation of Psychological First Aid as a Therapeutic Intervention After Trauma: An Integrative Review
Authors: Wang Ling , Norman Ian , Edleston Victoria , Oyo Christopher , Leamy Mary
Published: January 2024

Psychological First Aid (PFA) is known to be an initial early intervention following traumatic exposure, yet little is known about its optimal implementation and effectiveness. This review aims to examine the evidence for the effectiveness of PFA interventions and how PFA interventions have been designed, implemented, and experienced. MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsychINFO, Embase, Web of Science, PILOTS, and China National Knowledge Infrastructure (in Chinese) databases were searched. Twenty studies from 4,735 records were included and quality rated, followed by an integrative synthesis of quantitative and qualitative evidence. PFA intervention following trauma exposure shows a positive effect for reducing anxiety and facilitating adaptive functioning in the immediate and intermediate term, yet the evidence for reducing Post-traumatic stress disorder/depressive symptoms is less compelling. Furthermore, commonalities in the components and techniques across different PFA approaches identified tend to align with four of Hobfoll’s five essential elements: safety, calm, efficacy, and connectedness (as reflected among 7/11 PFA protocols), whereas the “hope” element was less developed. These commonalities include active listening, relaxation/stabilization, problem-solving/practical assistance, and social connection/referral. Intensive techniques such as cognitive reconstruction have also been incorporated, intensifying PFA delivery. The substantial variation observed in PFA format, timing, and duration, coupled with inadequate documentation of fidelity of implementation and adaptation, further constrains the ability to inform best practices for PFA. This is concerning for lay frontline providers, vital in early trauma response, who report implementation challenges despite valuing PFA as a time-sensitive, supportive, and practical approach.
Mediators of Outcome in Trauma-Focused Psychotherapy with Youth: A Systematic Review
Authors: Protić Sonja , Wittmann Lutz , Taubner Svenja , Conejo-Cerón Sonia , Ioannou Yianna , Heinonen Erkki , Saliba Andrea , Moreno-Peral Patricia , Volkert Jana , Barkauskiene Rasa , Julia Schmidt Stefanie , Rangel Santos Henriques Margarida Isabel , Pinheiro Mota Catarina , Sales Célia M.D. , Røssberg Jan Ivar , Adler Asta , Giacomo Dina Di , Mucha Vieira Filipa , Drndarević Nikola , Ulberg Randi , Stepisnik Perdih Tjasa , Mestre Jose M.
Published: January 2024

This article aimed to provide a systematic narrative synthesis of existing studies on the mediators of change in psychotherapy with adolescents (10–19 years) and transition age youth (TAY) (20–29 years) who have experienced trauma-related symptoms or posttraumatic disorder. Additionally, we were interested in identifying psychotherapy-, trauma type-, and clients’ age- and gender-specific mediators of treatment outcome. Following the preferred reporting items for systematic reviews and meta-analyses, a total of 3,723 studies published in PubMed and PsycINFO databases were screened against inclusion criteria, revealing 15 eligible studies. No studies with only TAY were found; therefore, all results were limited to therapy with adolescents. Cognitive mediators were tested in 66% of selected studies, followed by parents/family-related, mental-health-related, therapy-related, and behavioral mediators. Moderate evidence was found for posttraumatic cognitions, whereas therapeutic alliance seemed to be a promising candidate for future research. Striking absence of non-cognitive-behavioral therapy interventions, emotional and adolescent-specific mediators, as well as studies with males and in non-Western societies was evident. Future original studies would benefit from applying methodological rigor in respect to mediation testing.
Study of Drug Targets Associated With Oncogenesis and Cancer Cell Survival and the Therapeutic Activity of Engineered Ashwagandha Extract Having Differential Withanolide Constitutions
Authors: Cavaleri Franco , Chattopadhyay Sukalpa , Palsule Vrushalee , Kar Pradip Kumar , Chatterjee Ritam
Published: January 2024

Ashwagandha ( Withania somnifera) has gained worldwide popularity for a multitude of health benefits inclusive of cancer-preventive and curative effects. Despite numerous research data supporting the benefits of this wonder herb, the actual use of ashwagandha for cancer treatment in clinics is limited. The primary reason for this is the inconsistent therapeutic outcome due to highly variable composition and constitution of active ingredients in the plant extract impacting ashwagandha’s pharmacology. We investigate here an engineered yield: an ashwagandha extract (Oncowithanib) that has a unique and fixed portion of active ingredients to achieve consistent and effective therapeutic activity. Using the MCF7 cell line, Oncowithanib was studied for its anti-neoplastic efficacy and drug targets associated with cell cycle regulation, translation machinery, and cell survival and apoptosis. Results demonstrate a dose-dependent decline in Oncowithanib-treated MCF7 cell viability and reduced colony-forming ability. Treated cells showed increased cell death as evidenced by enhancement of Caspase 3 enzyme activity and decreased expressions of cell proliferation markers such as Ki67 and Aurora Kinase A. Oncowithanib treatment was also found to be associated with expressional suppression of key cellular kinases such as RSK1, Akt1, and mTOR in MCF7 cells. Our findings indicate that Oncowithanib decreases MCF7 cell survival and propagation, and sheds light on common drug targets that might be good candidates for the development of cancer therapeutics. Further in-depth investigations are required to fully explore the potency and pharmacology of this novel extract. This study also highlights the importance of the standardization of herbal extracts to get consistent therapeutic activity for the disease indication.
Comprehensive Evaluation of Traditional Herbal Medicine Combined With Adjuvant Chemotherapy on Post-Surgical Gastric Cancer: A Systematic Review and Meta-Analysis
Authors: Kim Soo-Dam , Kim Jong-Hee , Kim Dong-Hyun , Park Ji-Hye , Gong Yabin , Sun Chengbing , Yoo Hwa-Seung , Park So-Jung
Published: January 2024

Background:

Gastric cancer is a common cause of global mortality, with significant challenges during treatment due to side effects and complications. Traditional herbal medicine (THM) has emerged as a potential adjuvant therapy to enhance cancer treatment by reducing side effects and bolstering the immune response. This study conducted a meta-analysis to assess the efficacy and safety of THM as an adjuvant therapy in post-surgical gastric cancer patients.

Methods:

PubMed, Cochrane Library, EMBASE, CNKI, CiNii, KMBASE, KISS, OASIS, RISS, and ScienceON databases were searched from inception through December, 2021. The outcomes considered in this analysis encompassed tumor response, quality of life (QoL), side effects, and tumor markers. Additionally, a frequency analysis of the most commonly used herbs in the included studies was conducted. A total of 36 randomized controlled trials (RCTs) were included, and data were extracted according to study design. The analysis compared groups receiving chemotherapy alone with those receiving both chemotherapy and THM treatment.

Results:

The group receiving both chemotherapy and THM showed substantial improvement in tumor response compared to the chemotherapy-only control group (RR 1.25, 95% CI [1.09, 1.45]). QoL also significantly increased in the THM-treated group. Most drug adverse reactions displayed statistical significance, except for platelet reduction. Tumor markers CEA, CA19-9, and CA72-4 exhibited significant improvements, but CA125 did not. The 1, 2, and 3-year survival rates improved, with RR values of 1.08 (95% CI [1.02, 1.14]), 1.32 (95% CI [1.19, 1.47]), and 1.42 (95% CI [1.12, 1.79]) respectively. However, some publication bias was indicated.

Conclusion:

THM may offer potential benefits as a complementary approach to post-surgical anticancer therapy in gastric cancer patients. Improved tumor response, quality of life, and survival rates were reported. However, it is important to exercise caution due to the possibility of publication bias, and further research is needed to confirm these findings. Registration:PROSPERO CRD 42022354133
Initiating and Maintaining Complete Decongestive Therapy Self-Management of Lymphedema Among Breast Cancer Survivors: Descriptive Qualitative Study
Authors: Sun Yuanlu , Fu Mei Rosemary , Jiang Yun , Little Amy S.
Published: January 2024

Purpose:

This study aimed to identify determinants that promote the initiation and maintenance of complete decongestive therapy (CDT) as well as effective strategies for mitigating barriers to self-management of lymphedema among breast cancer survivors.

Methods:

A descriptive and qualitative design was used. In-depth interviews were conducted with 13 breast cancer survivors who were managing breast cancer-related lymphedema. Interviews were transcribed verbatim. An iterative descriptive data analysis method was employed to examine the data, compare codes, challenge interpretations, and inductively identify themes.

Results:

A realization that lymphedema requires daily self-management was the primary determinant leading breast cancer survivors to initiate CDT self-management. The determinants for maintaining daily CDT self-management included the perceived effectiveness of CDT, being willing to assume accountability, and perceived efficacy to undertake CDT. Developing strategies to integrate CDT regimens into daily life is key to maintaining CDT self-management of lymphedema. Three core concepts mediate initiation and maintenance of CDT self-management: understanding lymphedema as a chronic condition that can be managed with CDT self-management, being worried about lymphedema exacerbation, and having support from patient peers and family.

Conclusions:

Interventions should be tailored to promote the initiation and maintenance of CDT self-management. While clinicians provided knowledge-based and clinical skills-based information, patient peers provided daily life examples, and real-life implementation strategies for CDT self-management. Ongoing patient-provider and patient-peer communication functioned as effective support for maintaining CDT self-management. Reliable and realistic methods of symptom self-assessment are important for maintaining CDT at home.
Development of GO Move: A Website for Children With Unilateral Cerebral Palsy
Authors: Shierk Angela , Roberts Heather , Habeeb Youstina , Dursun Nigar , Cekmece Cigdem , Bonikowski Marcin , Pyrzanowska Weronika , Carranza Jorge , Granados Garcia Gabriela , Clegg Nancy , Delgado Mauricio R.
Published: January 2024

It is unknown if an online tool is wanted by therapists and parents of individuals with unilateral cerebral palsy (UCP) to support implementation of goal-directed home programs, and if wanted, the recommended features for the tool. The objective was to explore the experiences of therapists and parents who have implemented home programs, seek guidance on translating a paper-based home program toolbox into a mobile website, and develop the website. Qualitative descriptive methodology guided data collection using semi-structured interviews and thematic analysis, validated with field notes and member checking. A team science, iterative approach was used to integrate the themes into the development of the mobile website. Five primary themes including recommendations for the functionality, features, content, and naming of the mobile website were identified. Parents and therapists value home programs. Participants provided recommendations regarding content and features, and the GO Move mobile website was developed based on the recommendations.
Race and Ethnicity Reporting in Occupational Therapy Research Among Autistic Youth
Authors: Little Lauren M. , Avery Anna , Tomchek Scott , Baker Alissa , Wallisch Anna , Dean Evan
Published: January 2024

Historically marginalized racial and ethnic groups are underrepresented in autism research broadly; however, patterns of inclusion in occupational therapy research are unknown.

In this secondary data analysis, we examined race and ethnicity reporting across articles included in a systematic review of evidence related to occupational therapy practice with autistic individuals <18 years (2013–2021).

Two team members reached >90% interrater coding agreement in race and ethnicity reporting across articles in ADLs/IADLs, education/work, play, sleep, and social participation in clinics, homes/communities, and schools.

Intervention outcomes of ADL/IADLs (66.7%) and play (66.7%) had low rates of reporting, while social participation in schools (100%) and education/work (100%) had higher rates of reporting. Sample diversity was greatest among research in schools and most limited in clinic-based settings.

Systemic racism that limits individuals’ participation in occupational therapy research perpetuates racial and ethnic health inequities among autistic children and adolescents.
Accuracy of Duplex Ultrasound for Detecting Renal Artery Stenosis: A Systematic Review
Authors: MacLeod Jessica R. , Kivell Matthew J. , Shivgulam Madeline E. , Liu Haoxuan , O’Brien Myles W.
Published: January 2024

Background: Duplex ultrasound (DUS) is a well-tolerated, noninvasive imaging technique. Renal artery stenosis (RAS)—a narrowing of the arteries that supply the kidney—is involved in the cause of renal failure, and its gold-standard method of detection is digital subtraction angiography (DSA). Whether DUS is a suitable alternative to DSA or other angiographic modalities has only been reviewed up to 2005, producing mixed results with studies based on older ultrasound technology without a measurement of study quality. Purpose: To provide an up-to-date review of the diagnostic accuracy of DUS for the diagnosis of RAS in comparison with angiography. Methods: Our registered systematic review (DOI: 10.17605/OSF.IO/SE9VN) examined articles post-2005. Studies must have compared RAS diagnosis between DUS and angiography. Sources were searched in November 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier (1749 citations; final: n = 34; DSA only: n = 9). Study quality was assessed using the Quality Assessment of Diagnostic Studies 2 tool and results are presented narratively. A total of 2968 (1281 females) patients were included. Duplex ultrasound exhibited moderately high agreement with DSA and other well-established angiographic criteria with the existing literature having low risk of bias and low concern for patient applicability. Studies exhibiting low agreement were generally in smaller samples or used unique definitions of stenosis. Conclusions: Improved study reporting, consistent definitions of stenosis, and a common statistical battery are needed.
Coupling dynamics of pedestal looseness and impact-rub for rotor system with nonlinear support
Authors: Nan Guofang , Yao Jingya , Chen Xu , Jiang Shan
Published: January 2024

It is easy for the rotor system to produce the plastic deformation at the support after a long-term operation, this change will cause looseness of the bolt. Due to the particularity of the material and the structure for the bearing base and foundation, the elastic force of the support is nonlinear. Larger vibration of the loosening rotor under the nonlinear support will occur, resulting in the impact-rub between the rotor and stator. In order to study the dynamic behaviors of the loosening-rubbing coupling rotor system under the nonlinear support, the model is established to analyze the influencing mechanism of the key parameters such as the eccentricity, the disk offset, the looseness gap, the rubbing gap, and the nonlinear parameters on the vibrational responses of the system. The piecewise cubic nonlinear expression is applied to describe the nonlinear support with the loosing bolt; Coulomb friction is employed to characterize the rubbing of the impact-rub. The research results show that the nonlinear support will stimulate and amplify the nonlinear dynamic behaviors of the rotor system; there exists a threshold for the effect of the loosening gap on the vibrational characteristics of the system; increasing nonlinear parameters to a certain degree will cause the increase of the proportion of quasi-period and chaos. The research focus and conclusions are certain innovative in this paper. The work is of great value for fault diagnosis and structural design.
Adaptive collision-free control for UAVs with discrete-time system based on reinforcement learning
Authors: Huo Xiaoyu , Guo Yanan
Published: January 2024

A flexible reinforcement learning (RL) optimal collision-avoidance control formulation for unmanned aerial vehicles (UAVs) with discrete-time frameworks is revealed in this work. By utilizing the neural network (NN) estimating capacity and the actor-critic control scheme of the RL technique, an adaptive RL optimal collision-free controller with a minimal learning parameter (MLP) is formulated, which is based on a novel strategic utility function. The optimal collision-avoidance control issue, which couldn’t be addressed in the prior literature, can be resolved by the suggested approaches. Furthermore, the proposed MPL adaptive optimal control formulation allows for a reduction in the quantity of adaptive laws, leading to reduced computational complexity. Additionally, a rigorous stability analysis is provided, demonstrating that the uniform ultimate boundedness (UUB) of all signals in the closed-loop system is ensured by the proposed adaptive RL. Finally, the simulation outcomes illustrate the effectiveness of the proposed optimal RL control approaches.
Application of linguistic fuzzy neural network to landing control
Authors: Chien Li-Hsiang , Juang Jih-Gau
Published: January 2024

Most aircraft accidents occurred during the final approach. Wind disturbance is one of the significant factors in these accidents. During the landing phase, the Automatic Landing System (ALS) can help aircraft land safely and significantly reduce the pilot’s work loading. Control schemes of the conventional ALS usually use gain-scheduling and traditional PID control techniques. A traditional controller cannot control the aircraft if the weather conditions are beyond the allowed limits. To improve the performance of the landing control, this study applies a linguistic fuzzy neural network (LFNN) to replace the conventional controller of ALS. Adaptive learning rules are proposed to enhance the LFNN control ability. The method used to obtain adaptive learning rules is the Lyapunov stability theory. Moreover, the convergence of the system performance error is proved by the Lyapunov theory. This study also compares previously proposed control schemes in aircraft landing control. Different turbulence strengths are implemented into the flight simulation to make the proposed controller more robust and adaptive to various wind disturbance conditions. The LFNN controller can successfully overcome 75 ft/s wind speed, while the adaptive LFNN can reach 80 ft/s with optimal learning rates. Using optimal convergence theorems, the proposed controller performs better than the controllers trained by a fixed learning rate.
Looking for immediate and downstream evidence of lexical prediction in eye movements during reading
Authors: Wong Roslyn , Veldre Aaron , Andrews Sally
Published: January 2024

Previous investigations of whether readers make predictions about the full identity of upcoming words have focused on the extent to which there are processing consequences when readers encounter linguistic input that is incompatible with their expectations. To date, eye-movement studies have revealed inconsistent evidence of the processing costs that would be expected to accompany lexical prediction. This study investigated whether readers’ lexical predictions were observable during or downstream from their initial point of activation. Three experiments assessed readers’ eye movements to predictable and unpredictable words, and then to subsequent downstream words, which probed the lingering activation of previously expected words. The results showed novel evidence of processing costs for unexpected input but only when supported by a plausible linguistic environment, suggesting that readers could strategically modulate their predictive processing. However, there was limited evidence that their lexical predictions affected downstream processing. The implications of these findings for understanding the role of prediction in language processing are discussed.
Improving eye care in an intensive care unit
Authors: Sevgi Mertcan , Monachello Emma , Yates Mark , Lockington David , Cowan Richard
Published: January 2024

In Intensive Care Units (ICUs), patients are at risk of developing ocular complications, especially exposure keratopathy. Plan, Do, Study, Act for PDSA cycle. Despite national guidelines, implementation remains challenging. Using the PDSA cycle, we devised an eye care protocol integrated into the electronic patient record system, complemented by a poster summary of guidelines. An initial audit showed 2% adherence to eye exposure guidelines; post-intervention, adherence rose to 76%. A 9-month analysis revealed 16% of patients experienced eye exposure in ICU. This initiative emphasises the new protocol’s efficacy and the role of education in its adoption, advocating a more standardised approach to eye care in ICUs.
Modeling and analysis of Alpine skiing downhill based on the DPAS model considering four-way inhomogeneous environmental winds with digital twins at downhill course of the Beijing Olympic Winter Games
Authors: Li Bo , Li Zhiyang , Shen Ruifang , Huang Hui , Wang Zheyao , Zhang Yuanzhao
Published: January 2024

In Alpine skiing, the influence of the environment wind on the athlete is crucial. To accurately analyze the coupling effect of environment wind speed, wind direction, and the athlete’s skiing process, this paper establishes the kinematic equations of the athlete based on Newtonian classical mechanics and computational fluid dynamics (CFD) and proposes a discretization method for the course. Simulation results were obtained by using CFD to obtain digital twins for the course and its surroundings. The simulation results were also used as input to the wind parameters to analyze the athletes’ sliding performance. The Downhill Process in Alpine Skiing (DPAS) model was constructed to validate the actual downhill course in the Beijing Olympic Winter Games. An analytical framework for downhill skiing with way inhomogeneous winds was demonstrated to be a good simulation and validation of our analytical framework, proving its good simulatability and reliability. The downhill process is also subdivided into four phases: start-up acceleration phase, core acceleration phase, intermittent acceleration phase, and endurance sprint phase, based on the velocity-time curve derived from the actual course simulation. Tactical skiing strategies for skiers to improve their performance are proposed for the different stages of the process. We believe that the DPAS model can also be applied to other parts of Alpine skiing such as slalom, giant slalom, and super-G, and that the results can be used to suggest tactical strategies to improve performance.
Efficacy of bortezomib, cyclophosphamide, and dexamethasone for newly diagnosed POEMS syndrome patients
Authors: Fang Fang , Lan Xiao-Xi , Hu Rong-Hua , Hui Wu-Han , Zhao Hong , Guo Yi-Xian , Ji Bing-Xin , Liu Hong-Jun , Su Li , Sun Wan-Ling
Published: January 2024

Background:

Due to the rarity of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome, the best first-line treatment has not been established, although there are several options in guidelines. The preferred treatments vary according to the preference of the physician and anecdote.

Objectives:

First, to analyze the efficacy of a new treatment mode in POEMS syndrome that uses the four-cycle treatment as the induction regimen, followed by sequential transplantation as the consolidation regimen for transplantation-eligible patients, or received another two-cycle treatment for transplantation-ineligible patients. Second, to compare the efficacy and safety of regimens with a proteasome inhibitor (bortezomib–cyclophosphamide–dexamethasone, BCD) or without a proteasome inhibitor (cyclophosphamide–dexamethasone ± thalidomide, CD ± T).

Design:

We conducted a retrospective study using real-world data from Capital Medical University, Xuanwu Hospital.

Methods:

A total of 34 newly diagnosed POEMS syndrome patients met Dispenzieri’s diagnostic criteria, and those who completed at least four cycles of treatment from July 2013 to March 2021 were included.

Results:

The overall vascular endothelial growth factor (VEGF) response rate of this new treatment mode was 100%. The cumulative VEGF complete remission (CRV) rate was 67.9%, and the cumulative complete hematological response (CRH) rate was 55.6%. During the median 49-month follow-up, the 5-year-overall survival (OS) rate was 90.7%, the 3-year-progression-free survival (PFS) rate was 78.4%, and the 5-year-PFS rate was 73.8%. The BCD regimen achieved a 75% CRV rate (median time from diagnosis to CRV = 130 days) and 66.7% CRH rate (median time from diagnosis to CRH = 218 days). In addition, the VEGF response was less than the partial remission (PRV) after four-cycle induction treatment, which, together with a decrease on the Overall Neurological Limitation Scale of less than three points 1 year after consolidation treatment, was an independent poor prognostic factor.

Conclusion:

Bortezomib was well-tolerated by patients with POEMS syndrome. Compared with CD ± T regimen, BCD as the induction regimen achieved better VEGF response and earlier hematological remission. Autologous stem cell transplantation used as consolidation therapy further improved the neurological and hematological remission rates, resulting in better OS and PFS.
A nationwide real-world study for evaluation of effectiveness and safety of T-DM1 in patients with HER2-positive metastatic breast cancer in Korea (KCSG BR19-15)
Authors: Baek Sun Kyung , Jeong Jae-ho , Jung KyungHae , Ahn Hee Kyung , Kim Min Hwan , Sohn Joohyuk , Park In Hae , Ahn Jin Seok , Lee Dae-Won , Im Seock-Ah , Sim Sung Hoon , Lee Keun Seok , Hyun Kim Jee , Shim Hyun-Jeong , Chae Yeesoo , Koh Su-Jin , Lee Hyorak , Lee Jieun , Byun Jae-Ho , Seol Youngmi , Lee Eun Mi , Jee Hee-Jung , An Hyonggin , Park Eun Byeol , Suh Young Ju , Lee Kyoung Eun , Park Yeon Hee ,   Korean Cancer Study Group (KCSG)
Published: January 2024

Purpose:

This study aimed to investigate clinical practices and factors related to the outcomes of T-DM1 use in patients with HER2-positive metastatic breast cancer (mBC).

Methods:

We included patients with HER2-positive mBC who received T-DM1 as a palliative therapy between August 2017 and December 2018. The safety and outcomes of T-DM1, including overall response rate (ORR), progression-free survival (PFS), and overall survival (OS), were evaluated. A Cox proportional hazards model was used to estimate the hazard ratio and 95% confidence interval (CI) for mortality or progression to HER2-positive mBC.

Results:

In total, 824 patients were enrolled during the study period. The mean age of patients was 58 years, and 516 (62.6%) patients relapsed after curative treatment. Excluding a history of endocrine therapy, 341 (41.4%) patients previously received none or first-line chemotherapy, 179 (21.7%) received second-line therapy, and 303 (36.9%) received third-or later-line chemotherapy before T-DM1 therapy. During a median follow-up of 16.8 months, the ORR was 35%, the median PFS was 6.6 months, and the median OS was not reached. The clinical factors associated with the hazard of progression were age (<65 years), poor performance status (⩾2), advanced line of palliative chemotherapy (⩾2), prior pertuzumab use, and treatment duration of palliative trastuzumab (<10 months). Common grade 3–4 adverse events were thrombocytopenia ( n = 107, 13.2%), neutropenia ( n = 23, 2.8%), anemia ( n = 21, 2.6%), and elevated liver enzyme ( n = 20, 2.5%). Hypokalemia (⩽3.0 mmol/L) and any-grade bleeding events occurred in 25 (3.1%) and 94 (22.6%) patients, respectively.

Conclusion:

This is the first nationwide real-world study of T-DM1 use in patients with HER2-positive mBC in Korea. The effectiveness and toxicity profiles of T-DM1 in real-world practice were comparable to those in randomized trials. Moreover, patient factors and previous anti-HER2 therapy could predict the outcomes of T-DM1 therapy.
Anti-inflammatory role of glucagon-like peptide 1 receptor agonists and its clinical implications
Authors: Alharbi Saleh Hadi
Published: January 2024

Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have emerged as promising therapeutic agents with potent anti-inflammatory properties and diverse clinical implications. This in-depth review article explores the mechanisms behind the anti-inflammatory actions of GLP-1RAs and assesses their prospective applicability in a wide range of disease scenarios. The current review establishes the significance of comprehending the anti-inflammatory role of GLP-1RAs and identifies pertinent research gaps. A concise overview of inflammation and its clinical consequences underscores the critical need for effective anti-inflammatory interventions. Subsequently, the article elucidates the intricate mechanisms through which GLP-1RAs modulate immune cell signaling and regulate the nuclear factor-kappa B (NF-κB) pathway. Detailed discussions encompass their impact on inflammatory responses, cytokine production, and attenuation of oxidative stress. The exposition is substantiated by a collection of pertinent examples and an extensive array of references from both preclinical and clinical investigations. The historical trajectory of GLP-1RA drugs, including exenatide, lixisenatide, liraglutide, and semaglutide, is traced to delineate their development as therapeutic agents. Moreover, the review emphasizes the therapeutic potential of GLP-1RAs in specific disease contexts like type 2 diabetes, a neurodegenerative disorder, and inflammatory bowel disease (IBD), shedding light on their anti-inflammatory effects through rigorous examination of preclinical and clinical studies. The article also provides an outlook on future perspectives for GLP-1RAs, encompassing the domains of diabetes, neurodegenerative diseases, and IBD. In conclusion, GLP-1RAs exhibit substantial anti-inflammatory effects, rendering them promising therapeutic agents with broad clinical implications. They are very useful in a wide variety of diseases because they regulate immunological responses, block NF-κB activation, and decrease production of pro-inflammatory cytokines. Ongoing research endeavors aim to optimize their therapeutic use, delineate patient-specific treatment paradigms, and explore novel therapeutic applications. GLP-1RAs represent a significant breakthrough in anti-inflammatory therapy, offering novel treatment options, and improved patient outcomes.
Drug-induced interstitial lung disease: a real-world pharmacovigilance study of the FDA Adverse Event Reporting System from 2004 to 2021
Authors: Jiang Tingting , Su Hui , Xu Jing , Li Chen , Zhang Ni , Li Yanping , Wu Yuanlin , Ni Rui , Ming Yue , Li Ziwei , Li Li , Liu Yao
Published: January 2024

Background:

Drug-induced interstitial lung disease (DILD) is an increasingly common cause of morbidity and mortality. However, due to the lack of specificity, DILD detection remains an unsolved public health challenge.

Objectives:

For the first time, we aimed to examine DILD reports submitted to the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) to identify demographic characteristics and top drugs associated with DILD at a group level (including age, sex, drug class, and country stratification) and individual drug level.

Design:

A retrospective analysis of the FAERS database was examined by disproportionality analysis.

Methods:

We reviewed the FAERS database from 2004 to 2021, using search terms ‘interstitial lung disease’ and sorting cases by generic drug name. The reporting odds ratio, proportional reporting ratio, and Bayesian confidence propagation neural network were calculated as the measure of strength of association.

Results:

There were 32,821 DILD reports in the FAERS. After excluding reports without age, sex, or country data according to the specific measurement, the median age of patients was 68 (interquartile range: 59), 54.77% were male, and 46.00% of reports came from Japan. The top drug classes related to DILD in the FAERS were antineoplastic, followed by cardiovascular and antirheumatic agents, in varying order in different sexes. Fam-trastuzumab deruxtecan-nxki, ramucirumab, and eribulin were the top three drugs with the highest strength of association. We also found some drugs without DILD in the labels, such as amiodarone, temsirolimus, and ursodiol. There are significant differences in DILD reports in various countries. For example, the United States and France reported more cardiovascular agents, whereas Canada reported more antirheumatic agents.

Conclusion:

We found the top drugs and drug classes that were associated with DILD in the FAERS, which provides a real-world window for different ages, sexes, and countries to formulate precise pharmacovigilance policies.
Association of thrombopoietin-related drugs with thromboembolic events: Mendelian randomization and a real-world study
Authors: Liang Cuilv , Chen Qiying , Zhang Yin
Published: January 2024

Background:

Studies have shown conflicting results when using thrombopoietin-related drugs (TPORD) for thromboembolic events (TEEs). Our study aimed to explore the correlation between TPORDs and TEEs.

Method:

Drug-targeted Mendelian randomization (MR) and multivariate MR (MVMR) analysis were used to explore the causal relationship between TPORDs and TEEs such as venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI) and ischemic stroke (STR). At the same time, a real-world study was conducted by extracting adverse events (AEs) from the FDA Adverse Event Reporting System database included in AERSMine to further validate our findings.

Outcome:

In drug-target MR, TPORDs were associated with VTE (OR = 1.193, 95% confidence interval (CI): 1.001–1.423, p = 0.049], DVT (OR = 1.321, 95% CI: 1.027–1.700, p = 0.030), MI (OR = 1.216, 95% CI: 1.010–1.464, p = 0.039), STR (OR = 1.224, 95% CI: 1.021–1.468, p = 0.029). VTE/DVT/STR remained stable in MVMR (VTE: OR = 1.3, 95% CI: 1.187–1.422, p < 0.001; DVT: OR = 1.465,95% CI:1.285–1.671, p < 0.001; STR: OR = 1.119, 95% CI: 1.018–1.229, p = 0.019) and real-world studies [lower bound of proportional reporting ratio (ROR) greater than 1]. The significance of myocardial infarction disappeared in MVMR (OR = 0.996, 95% CI: 0.894–1.109, p = 0.942) and in real-world studies (lower ROR lower than 1). There was no evidence of a causal relationship between TPORD and PE (OR = 1.244, 95% CI: 0.969-1.597, p = 0.087), but it generated a signal from a real-world study (lower bound of ROR greater than 1).

Conclusion:

This study suggests that TPORDs may be associated with an increased risk of TEEs, particularly AEs leading to VTE/DVT/STR. In addition, the relationship between TPORDs and PE/MI is debatable and requires more research.
Evaluation of early retinal changes in patients on long-term hydroxychloroquine using optical coherence tomography angiography
Authors: Zhao Huanhuan , Pan Menglu , Liu Yaping , Cheng Fangyue , Shuai Zongwen
Published: January 2024

Background:

Connective tissue diseases (CTD), including systemic lupus erythematosus and rheumatoid arthritis (RA), have long been treated with hydroxychloroquine (HCQ). However, prolonged HCQ use poses a risk of adverse effects, particularly retinopathy.

Objective:

To detect early retinal changes assessed by optical coherence tomography angiography (OCTA) in CTD patients with long-term HCQ treatment and to explore the relationship between OCTA parameters and the concentrations of HCQ and its metabolites.

Design:

A cross-sectional study conducted from March 2020 to October 2021 at the First Affiliated Hospital of Anhui Medical University.

Methods:

The area and perimeter of the foveal avascular zone (FAZ), the thickness of the fovea and parafovea, and the vascular density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in each area of the macula were measured by OCTA in 43 CTD patients treated with HCQ for over 6 months. Meantime, blood concentrations of HCQ and its metabolites were determined by high-performance liquid chromatography-tandem mass spectrometry, and the clinical documents of all 43 involved patients were collected.

Results:

There is no significant correlation between OCTA outcomes and the patient’s age, disease duration, and weight-dependent dose. HCQ cumulative duration positively correlated with FAZ area and perimeter ( r = 0.419, p = 0.005 and r = 0.407, p = 0.007, respectively) and negatively correlated with the foveal vessel density in DCP ( r = −0.378, p = 0.012). HCQ cumulative dose had a positive correlation with FAZ area and perimeter ( r = 0.445, p = 0.003 and r = 0.434, p = 0.004, respectively) and had a negative correlation with foveal vessel density in SCP and DCP ( r = −0.383, p = 0.011 and r = −0.424, p = 0.005, respectively). OCTA outcomes did not correlate with HCQ and its metabolite concentrations.

Conclusion:

OCTA could be used to detect microvascular changes in the macula of CTD patients with long-term HCQ therapy. It was not found the concentrations of HCQ and its metabolites were associated with retinal vascular changes.
Direct oral anticoagulant use in hospitalized patients with atrial fibrillation across body mass index categories: design and rationale for a retrospective cohort study
Authors: Shaikh Fahad , Wynne Rochelle , L. Castelino Ronald , Inglis Sally C. , Davidson Patricia M. , Ferguson Caleb
Published: January 2024

Background:

Atrial fibrillation (AF) and obesity are common conditions globally; yet, there remains suboptimal pharmacological management contributing to high rates of hospitalization in patients with AF. The altered pathophysiology of both obese and underweight individuals may influence the pharmacology of medications, including those used to manage AF. This, in turn, increases the risk of adverse events and impacts patient risk for stroke and rehospitalization. Despite the well-established complications of obesity, research investigating the relationship between obesity and AF is scant.

Objectives:

The primary aim of this study is to describe cardiovascular-related hospitalization in AF patients according to BMI categories. A secondary aim is to describe anticoagulant and antiarrhythmic prescribing practice patterns in patients with AF, according to the BMI category.

Design:

A retrospective, exploratory descriptive observational cohort study, using routinely collected electronic medical record data from five public hospitals within a single health district, with a population dominantly that is culturally and linguistically diverse, and has a low socioeconomic status.

Methods and analysis:

Data extraction will include a 24-month period (January 2017 to December 2018) with a 12-month follow-up. All adult (⩾18 years) patients at discharge diagnosed with AF, prescribed any oral anticoagulant and/or oral rate/rhythm control agent, will be eligible for inclusion.

Ethics and dissemination:

Ethics approval from the health district and the University of Wollongong has been granted. Findings will seek to demonstrate associations between management strategies and patient outcomes, as well as describe patterns of acute care management from prescribers. These data will be used to inform and generate hypotheses for large-scale studies examining the impact of body weight on anticoagulation prescribing at national and global scales.
Assessment of knowledge, attitudes, and practices of occupational risks and diseases among healthcare providers of the Regional Hospital Center of Dosso, Niger
Authors: Nassirou-Sabo Halimatou , Toudou-Daouda Moussa
Published: January 2024

Background:

In Niger, a low-income country, occupational medicine is little known and practiced, particularly in the health sector, where healthcare workers are exposed to numerous occupational risks. This study aimed to assess knowledge, attitudes, and practices about occupational risks and diseases among healthcare providers working at the Hospital of Dosso (Niger) to determine their knowledge, attitudes, and practices level about occupational risks and diseases.

Methods:

A descriptive and quantitative census-based study was conducted among the 105 healthcare providers practicing at the hospital of Dosso between 1 April and 31 May 2023, using a self-administered questionnaire in the French language comprising a sociodemographic part and a knowledge, attitudes, and practices part about occupational risks and diseases. Knowledge, attitudes, and practices scores were calculated and Mann–Whitney U or Kruskal–Wallis tests were used to assess their association with sociodemographic characteristics.

Results:

In total, 83 healthcare providers agreed to participate in the study, with a participation rate of 79%. A total of 28% of participants had received training on occupational risks and diseases. The knowledge score about occupational risks and diseases showed that 55.4% of participants had a knowledge level varying from medium to high. The score of attitudes and practices showed that 68.7% of responders had an attitudes and practices level varying from medium to high about occupational risks and diseases. According to the composite score of knowledge, attitudes, and practices, 53% of participants had a knowledge, attitudes, and practices level between medium and high. A significant association was found between the composite score of knowledge, attitudes, and practices and the workstation occupied, mainly medical imaging service ( p = 0.006).

Conclusion:

The study showed that 53% of responders had an overall level of knowledge, attitudes, and practices about occupational risks and diseases between medium and high. Among their sociodemographic characteristics, only the workstation occupied (mainly medical imaging service) was statistically associated with the composite score of knowledge, attitudes, and practices. Considering these findings, the administrators of the Hospital of Dosso must recruit an occupational medicine specialist to provide information and prevention visits on occupational risks and diseases to healthcare providers working in this institution.
Assessment of Family Medicine Obstetrics Fellowship Websites in the United States: Content and Usability
Authors: Owens Robert , Whittaker T. Carl , Galt Annie , Spiess Saskia , Mervis Matthew , Lockrey Alex , Gardner Elena , Stoesser Kirsten , Ose Dominik
Published: January 2024

Introduction:

The United States is experiencing maternity care shortages. Family physicians can play a role in addressing these shortages. Family medicine obstetrics fellowships train family physicians in obstetrics care. Fellowship websites are important for promoting programs and attracting applicants. However, whether websites provide sufficient program information is unknown. This study aimed to assess completeness and utility of family medicine obstetrics fellowship websites across the United States.

Method:

The study analyzed 46 family medicine obstetrics fellowship websites. The component analysis evaluated the presence of 17 components related to orientation, curriculum, program, personnel, and additional content. The qualitative analysis included ratings for navigation and application, information quality, and esthetics. Analysis included percentages for websites and components and average qualitative ratings.

Results:

Common components included overviews, training requirements, and contact information. Description of the patient population was the least common component. Usability ratings varied across programs, with higher ratings observed for navigation and application, and information quality. Esthetics and visual appeal received lower ratings. Regional analysis indicated that websites from fellowships in the West and Southwest tended to include more components compared to those in the Southeast.

Discussion:

Family medicine obstetrics fellowship websites serve as valuable sources of program information for prospective applicants. However, not all websites include essential program details. Some information is rarely provided. Given the shortage of maternity care providers, it is crucial to develop informative and functional websites to attract applicants. Improving website content and design could prove to be a cost-effective strategy to increase the number of applicants.
Building Authentic Connection in the Patient-Physician Relationship
Authors: Fuehrer Sheryl , Weil Amy , Osterberg Lars G. , Zulman Donna M. , Meunier Matthew R. , Schwartz Rachel
Published: January 2024

Introduction/Objectives:

Delivering optimal patient care is impacted by a physician’s ability to build trusting relationships with patients. Identifying techniques for rapport building is important for promoting patient-physician collaboration and improved patient outcomes. This study sought to characterize the approaches highly skilled primary care physicians (PCPs) use to effectively connect with diverse patients.

Methods:

Using an inductive thematic analysis approach, we analyzed semi-structured interview transcripts with 10 PCPs identified by leadership and/or colleagues for having exceptional patient communication skills. PCPs practiced in 3 diverse clinic settings: (1) academic medical center, (2) Veterans Affairs clinic, and (3) safety-net community clinic.

Results and Conclusions:

The thematic analysis yielded 5 themes that enable physicians to establish connections with patients: Respect for the Patient, Engaged Curiosity, Focused Listening, Mutual Participation, and Self-Awareness. Underlying all of these themes was a quality of authenticity, or a state of symmetry between one’s internal experience and external words and actions. Adopting these communication techniques while allowing for adaptability in order to remain authentic in one’s interactions with patients may facilitate improved connection and trust with patients. Encouraging physician authenticity in the patient-physician relationship supports a shift toward relationship-centered care. Additional medical education training is needed to facilitate authentic connection between physicians and patients.