bluuebunny/crossref_metadata_2025 huggingface dataset:
Thinking Clearly: A Preventative Cognitive Health Visit Integrated in Primary Care
Authors: Buchanan Amy L. , Kotecha Rachana
Published: August 2024

Objective:

The pandemic contributed to increased mental and cognitive health concerns as well as reduced utilization of preventive and treatment focused care. Deferred care can contribute to negative clinical outcomes, including increased acuity of mental and cognitive health concerns that benefit from early intervention. A new visit type was launched with the aim of reaching patients who may need care and supporting early identification of cognitive and mental health issues.

Methods:

We developed the Healthy Mind visit, a preventative visit administered by Primary Care Providers (PCPs) within outpatient clinics. The Healthy Mind visit included use of a pre-visit mental health screener as well as a brief computerized cognitive assessment. The clinical interaction focused on identifying mental and cognitive health concerns and developing a plan for wellness. Outcomes data collection occurred over nearly 2.5 years and focused on analyzing booking patterns, depression screening and follow-up, and clinical outcomes such as health confidence and post-visit motivation.

Results:

The visit was effective in supporting depression screening and follow-up with 29.6% of those participating in a Healthy Mind visit receiving a PHQ-9, and 82.5% of patients with elevated PHQ-9 scores attending a subsequent visit with their PCP. Improvements in health confidence and high patient reported motivation post-visit represent other notable clinical outcomes. The visit also promoted care utilization, with 73.5% of patients who attended a Healthy Mind visit being new to the practice or those who had not attended an appointment in the past 6 months.

Conclusions:

The Healthy Mind visit, with a focus on mental and cognitive health, was successful in reaching patients who may not have otherwise sought care and supported positive clinical outcomes including early identification and treatment of depression and increased health confidence.

Recommendations:

These findings reflect the importance of developing innovative programs to connect patients with care, especially those who may have deferred care due to a variety of factors. Focusing on mental and cognitive health with the use of innovative tools such as a computerized assessment, can drive patient interest in care offerings and support positive clinical outcomes.
Paper 02: Combined ACL Reconstruction and Lateral Extra-Articular Procedures Reduce Graft Ruptures in Patients Over the Age of 30 Years Old: A Matched-Pair Analysis of 1102 Patients
Authors: Saithna Adnan , Pettinari Francesco , Ali Ahmad Abed , Alayne Ali , Dutra Vieira Thais , Sonnery-Cottet Bertrand
Published: August 2024

Objectives:

Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament (ACL) and Lateral Extra-Articular Procedures (LEAP) over isolated ACL reconstruction (ACLR), in terms of reducing graft rupture and reoperation rate. However, most of the published studies included young patients, and there are no studies focusing on population over 30 years old. The purpose of this study was to compare the outcomes of isolated ACLR versus ACLR + LEAP at mid-term follow-up in patients over the age of 30 years old. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture.

Methods:

Patients older than 30 years old who underwent primary ACLR + LEAP between January 2003 and December 2020 were propensity matched in a 1:1 ratio to patients who underwent isolated ACLR. A retrospective analysis of prospectively collected data was achieved to determine whether patients had experienced any complications or reoperations. Graft survivorship was assessed using Kaplan-Meier method. Risk factors associated with the occurrence of graft failure were analyzed using a Cox proportional hazards model.

Results:

Two groups of 551 patients were included in the study with a mean follow-up of 97.19 ± 47.23 months. The mean age for both groups was 37 ± 6.14. The LEAP group was composed by 516 (93.6%) anterolateral ligament and 35 (6.4%) Lemaire. Overall, 19 (1.7%) patients had graft failure, 15 (2.7%) in the No LEAP group and 4 (0.7%) in the LEAP group (P = .0116). The risk of graft failure was significatively associated with the absence of LEAP (hazard ratio [HR], 3.309 [1.088; 10.065], P = 0.0350) and age between 30 to 35 years old (HR 4.533 [1.484; 13.841] P = .0080). A higher rate of reoperation for secondary meniscectomy were founded in the No LEAP group (5.6% vs 2.2%; P = .0031).

Conclusions:

Patients over 30 years old who underwent combined ACLR and LEAP experienced > 3-fold lower risk of ACL graft failure compared to isolated ACLR. Furthermore, the group without LEAP also experienced a higher rate of reoperation for secondary meniscectomy.
Paper 10: 5-Year Outcomes: Arthroscopic Anatomic Glenoid Augmentation is Superior to Bankart Repair
Authors: Wong Ivan , Pancura Devan , Ma Jie
Published: August 2024

Objectives:

Arthroscopic anatomic glenoid reconstruction (AAGR) is an increasingly popular treatment approach for shoulder instability. AAGR shows a promising short-term safety profile and clinicoradiological outcomes, suggesting its efficacy is comparable to Bankart repair. Recurrence rates reported in the literature are up to 30% following Bankart repair, however, there is a lack of literature comparing the long-term outcomes of AAGR versus Bankart repair. The purpose was to compare recurrence rates and patient-reported outcomes in patients who received AAGR to patients who received Bankart repair with a minimum of 5-year follow-up.

Methods:

This was a retrospective study comparing 73 patients who underwent AAGR and 76 patients who underwent Bankart repair consecutively between 2012 and 2018. Patients who had a minimum 5-year follow-up were included in the final analysis. Data collected included demographics, pre- and postoperative Western Ontario Shoulder Instability (WOSI) Index and Disabilities of the Arms, Shoulders, and Hands (DASH) Scores, postoperative complications and recurrence. The primary outcome measure was dislocation recurrence, with secondary outcome measures of patient-reported outcomes and postoperative complications.

Results:

The demographics and preoperative outcome scores were similar between groups. Patients in the AAGR group presented with significantly higher bone loss (>10%, p<0.05) than those in the Bankart group. There were fewer incidences of recurrence in the AAGR group (1.4%) than the Bankart group (18.4%). There was a significant difference in pre-to-post operative WOSI (p=0.02) and DASH (p=0.01) scores between groups, as well as a significant difference in the number of patients who met the WOSI (p<0.001) and the DASH (p<0.001) minimum clinically important difference threshold, with the AAGR group showing a greater improvement pre- to postoperatively.

Conclusions:

AAGR has better long-term outcomes and fewer incidences of recurrence compared to Bankart repair.
Paper 11: Open Latarjet Procedure in Athletes with a Minimum of 5 Years Follow Up: An Analysis of Factors Associated with Success
Authors: Doyle Tom , Keogh Carl , Kearney Jack , Kilkenny Conor , Moore Thomas , Albesharah Bader , Khan Sami , Hurley Eoghan , Mullett Hannan
Published: August 2024

Objectives:

The open Latarjet (OL) is a bony transfer procedure used in the treatment of anterior shoulder instability in those at greater risk of recurrence. OL has shown excellent return to play (RTP) and low recurrence in athletes, but there is limited published evidence for outcomes over long-term follow-up. The purpose of this study was to evaluate the outcomes of athletes 5-years postoperatively following the OL procedure, and to evaluate factors associated with satisfaction and shoulder function, as defined by subjective shoulder value (SSV).

Methods:

A retrospective review of athletes who underwent OL under a single surgeon with a minimum of 5-year follow-up was performed. Recurrence, Visual Analogue Scale (VAS) for pain, satisfaction, SSV, Rowe score, Shoulder Instability-Return to Sport After Injury (SI-RSI) score, whether they would undergo the same surgery again, along with rate, level and timing of RTP, were evaluated. Multilinear regression models were used to evaluate factors affecting postoperative satisfaction and SSV level.

Results:

Overall, 126 shoulder in 117 male athletes who underwent OL were included, with a mean age of 22.8 ± 5.8 years old, with mean follow-up of 71.5 ±10.3 months (range 60-84 months). At final follow-up, 92.46% were satisfied/very satisfied, and the mean SSV was 85.5 ± 14.9. Overall, the rate of RTP was 90.5%, with 79.8% returning at the same level or higher level at a mean of 7.3 ± 2.9 months. There were 9 athletes (7.1%) who experienced further dislocation, all during contact sports. In total, 9 (7.1%) athletes had a further operation, 3 (2.4%) of which were for further instability. The mean SI-RSI score was 82.3 ± 27.3 and the mean Rowe score was 84.7 ± 17.4, while the mean VAS score was 2.1 ± 1.9. Linear regression revealed that the SI-RSI score (p < 0.001), SSV (p = 0.003), and RTP (p = 0.049) were associated with satisfaction. The SI-RSI score (p = 0.023), VAS score (p < 0.001), Rowe score (p = 0.028), and RTP (p = 0.013), were all associated with SSV score.

Conclusions:

At a minimum 5-year follow-up, there was a very high rate of satisfaction, with excellent patient-reported outcomes, low rates of recurrent instability, and a high rate of RTP among athletes. This study identified that the SI-RSI score, VAS score, Rowe score and ability to RTP at the same level were associated with both satisfaction and SSV score.
Paper 46: Modern Hip Arthroscopy for FAIS Delays the Natural History of Osteoarthritis in a Fourth of Patients: A 12-Year Follow-Up Analysis
Authors: Ramkumar Prem , Olsen Reena , Shaikh Hashim , Nawabi Danyal , Kelly Bryan
Published: August 2024

Objectives:

Little is known about the impact of modern hip arthroscopy on the natural history of femoroacetabular impingement syndrome (FAIS) with respect to joint preservation. The purpose of this investigation was to (1) characterize the natural history of FAIS and (2) understand the impact of modern hip arthroscopy by radiographically comparing the hips of patients who underwent only unilateral primary hip arthroscopy with a minimum follow-up of ten years.

Methods:

Between 2010-2012, 619 consecutive patients were reviewed from the practice of a single fellowship-trained hip arthroscopist. Inclusion criteria were FAIS, primary unilateral hip arthroscopy (labral repair, femoroplasty, capsular closure), and minimum ten-year follow-up. The preoperative and minimum ten-year postoperative radiographs of patients were evaluated at each timepoint. Both operative and nonoperative hips were graded using the Tönnis classification or the presence of hip arthroplasty by two independent reviewers. Subgroup analyses were performed.

Results:

A total of 200 hips from 100 patients were available with 74% follow-up at a mean of 12.0 years were evaluated. The nonoperative hip advanced to a worse Tönnis grade in 48% (48/100) of cases compared to 28% (28/100) among operative hips (Table 1). At follow-up, Tönnis grades between hips were equal in 70% (70/100) of the cases, the operative hip had a better grade 25% (25/100) of the time, and the nonoperative hip had a better grade 5% (5/100) of the time (Table 2). Modern hip arthroscopy conferred a relative risk reduction of 42% in osteoarthritis progression. Borderline dysplasia, age, preoperative Tönnis grade, and alpha angle > 65° were key risk factors in the radiographic progression of osteoarthritis.

Conclusions:

While the majority of patients (70%) undergoing hip arthroscopy for FAIS did not experience differences between operative and nonoperative hips in terms of the radiographic progression of osteoarthritis, the natural history was favorably altered in a quarter of patients after arthroscopic correction (Figure 1). Modern hip arthroscopy indications and techniques represent a valid joint preservation procedure conferring a relative risk reduction of 42% in the progression of osteoarthritis. Mixed patterns of impingement and instability that underwent arthroscopy were the fastest to degenerate.
Paper 51: Characteristics of Unsalvageable Osteochondritis Dissecans Lesions From the ROCK Prospective Cohort
Authors: ROCK Study Group
Published: August 2024

Objectives:

The goal of treatment of osteochondritis dissecans (OCD) is most commonly to preserve the native chondral surface to avoid long term development of osteoarthritis. However, some OCD lesions are not considered amenable to fixation and therefore deemed unsalvageable. Little is known about the OCD subpopulation presenting with such lesions or the detailed characteristics of unsalvageable lesions and their treatment. The purpose of this study is to investigate the characteristics of lesions and their treatment in a large volume of patients with OCD lesions that were determined to be unsalvageable upon presentation.

Methods:

A review of the ROCK (Research in Osteochondritis of the Knee) study group’s prospective cohort database from 2014 to 2022 was performed to identify condylar lesions in patients <20 years old that were deemed unsalvageable, based on a cartilage resurfacing technique being preliminary treatment performed. Demographic data, radiographic descriptors, intraoperative lesion findings, and treatments performed were analyzed. Treatments for lesions considered unsalvageable were categorized as marrow stimulation (e.g. microfracture, McFx), osteochondral autograft transplantation surgery (e.g. OATS), osteochondral allograft transplantation (OCA), and cultured chondrocyte/cell-based therapy (e.g. MACI). Comparative analysis was performed between the cohort with unsalvageable lesions and those who underwent lesion preservation techniques associated with unstable lesions (ie fixation).

Results:

A total of 590 out of 1291 (45.7%) surgically treated OCDs (mean age 13.7 years old, 2:1 male: female) were included with 10.8% considered unsalvageable. The distribution of techniques for unsalvageable lesions was McFx (4.4%), OCA (2.9%), and MACI (2.0%). Compared to the lesion preservation cohort, the unsalvageable was older (15.9 vs. 14.6; p=-0.006), had a higher body mass index (24.2 vs. 22.7; p<0.001), and was more likely to have had prior surgery (33.3% vs. 10.3%; p<0.001). The presence of bone in the progeny, a linear signal on MRI, and bone edema were less common in unsalvageable lesions (p<0.05 for all). A multivariate analysis model resulted in significant associated in unsalvageable OCD lesions with prior surgery (p<0.001, OR 1.97, CI 2.736-19.929).

Conclusions:

OCD patients with unsalvageable lesions are more likely to be identified in those that have undergone prior surgical procedure, but MRI signs of instability still undergo preservation techniques. Given the implications of long-term joint health, comparative analyses of outcomes of the different cartilage resurfacing techniques for such lesions is of critical importance for future study.
Poster 152: Clinical Outcomes for Dermal Allograft Glenoid Augmentation in Patients With Anterior Shoulder Instability and Subcritical Bone Loss
Authors: Bailey Kevin , Wang Patrick , Akhavan Sam , Wells Corey
Published: August 2024

Objectives:

To assess minimum 1-year magnetic resonance imaging (MRI) and clinical outcomes for 20 cases of dermal allograft augmentation of subcritical glenoid bony defects.

Methods:

Twenty patients with subcritical glenoid bone loss underwent arthroscopic dermal allograft augmentation along with labral repair. All patients were evaluated with postoperative MRI at a minimum of 12-month follow-up. Preoperative and postoperative patient-reported outcomes were collected including University of California Los Angeles Shoulder (UCLA) scores, Visual Analogue Scale (VAS) scores, and American Shoulder and Elbow Surgeons (ASES) scores. Scores were assessed for statistical significance using the analysis of variance test.

Results:

Average postoperative follow-up was 19 months (range 12-54 months). The average preoperative bony defect size was 16% (range 6.6-39%), with 19 of the patients having defects under 20%. Postoperative MRIs (Figure 1) revealed an average of 32% (range 27.7-37.4%) increase in glenoid diameter size and the average glenoid size was restored to 102.3% (range 94-114%), with excellent incorporation of the graft. There were statistically significant improvements in preoperative and postoperative scores with respect to UCLA scores (21.25 to 33.7, p < 0.05), VAS scores (5.4 to 0.2, p < 0.05) and ASES scores (58.6 to 96.4, p < 0.05). One patient had a recurrent traumatic dislocation (5%) and underwent a Latarjet procedure at 13 months from the index surgery. At the time of the Latarjet, the dermal allograft was harvested and sent for histologic analysis. Histologic analysis of the glenoid augmentation graft at the time of revision surgery revealed recellularization with fibroblast-like cells, revascularization, and incorporation of the graft into the surrounding tissue with bony ingrowth. (Figure 2)

Conclusions:

Subcritical glenoid bone loss has been associated with high failure rates when treated with standard labral repair. While a Latarjet procedure can provide stability, high complication rates and the risk of long-term arthritis makes this procedure less than ideal when bone loss is under 20%. Arthroscopic labrum repair with the addition of a dermal allograft is a viable option in patients with subcritical bone loss. In the case series with 1-year follow-up, 20 patients who underwent arthroscopic labrum repair with the addition of a dermal allograft had a significant improvement in outcome scores, and excellent incorporation of the graft as seen on MRI at 12 months from the index procedure. In the 1 failure that later underwent revision surgery, histologic analysis demonstrated recellularization and revascularization, with incorporation of the graft.
Poster 204: Periacetabular Osteotomy: A Case Series of More Than 500 Cases with Sub-Analysis Based on Patient Age at Surgery
Authors: Kraeutler Matthew J. , Girardi Nicholas G. , Lee Jessica H. , Mei-Dan Omer
Published: August 2024

Objectives:

The purpose of this study is to report outcomes of a unique periacetabular osteotomy (PAO) technique for hip dysplasia developed at our institution.

Methods:

This was a retrospective, single-surgeon case series of prospectively collected data on all primary PAOs performed by the senior surgeon between April 2015 and April 2023. The technique has previously been described in the literature. This technique provides direct visualization of the sciatic nerve during the ischial osteotomy and allows for immediate weight bearing postoperatively. All patients underwent hip arthroscopy for treatment of intra-articular pathology and cam-type femoroacetabular impingement 3 to 10 days prior to PAO. Some patients also underwent de-rotational femoral osteotomy (DFO) for treatment of femoral torsion abnormalities. Revision PAOs or cases with concomitant hamstring or gluteus repair were excluded. Follow-up occurred at 6 weeks; 3 and 6 months; and 1, 2, and 5 years postoperatively. Patient-reported outcomes (PROs) included the Non-Arthritic Hip Score (NAHS) and the 12-item International Hip Outcome Tool (iHOT-12). A subanalysis was performed to compare 2-year PROs between 3 groups of patients based on age at the time of surgery: 13 to 29 years old, 30 to 39 years old, and >40 years old.

Results:

A total of 511 hips underwent primary PAO during the study period. The mean age at the time of surgery was 31 years old (range, 13 to 61 years old). Female patients accounted for 90% of hips included in this study. A concomitant DFO was performed in 25 hips (4.9%). The mean NAHS improved from 58.7 preoperatively to 85.9 at 2-year follow-up (p < 0.0001) and 83.4 at 5-year follow-up (p < 0.0001). The mean iHOT-12 improved from 41.0 preoperatively to 77.5 at 2-year follow-up (p < 0.0001) and 72.7 at 5-year follow-up (p < 0.0001). No significant differences were found in postoperative NAHS (p = 0.82) or iHOT-12 scores (p = 0.73) between age groups.

Conclusions:

PAO enables corrective realignment of symptomatic acetabular dysplasia with good outcomes up to 5 years postoperatively. Careful patient selection can result in good outcomes regardless of patient age at the time of surgery.
Poster 306: Establishing the Minimum Clinically Important Difference Two Years Following Medial Patellofemoral Ligament Reconstruction
Authors: Elias Tristan , Haneberg Erik , Phillips Andrew , Kaplan Daniel , Sachdev Divesh , Chahla Jorge , Forsythe Brian , Verma Nikhil , Cole Brian , Yanke Adam
Published: August 2024

Objectives:

Medial patellofemoral ligament (MPFL) reconstruction is used to address cases of recurrent patellar instability. Minimal clinically important difference (MCID) is an important marker that relays the smallest clinical improvement in which patients feel a significant change after surgery. MCID has been previously established for MPFL reconstruction after 6 months and 1 year. To date, no study has established MCID for patient reported outcomes 2 years after MPFL reconstruction. The purpose of this study is to define the MCID for the Kujala, International Knee Documentation Committee (IKDC), and Knee Injury and Osteoarthritis Outcome Score for Joint Reconstruction (KOOS JR) at minimum two-year follow-ups after isolated MPFL reconstruction.

Methods:

All patients undergoing isolated MPFL reconstruction for recurrent patellar instability at a single institution between December 2015-June 2021 were included. Patients with concomitant osseous procedures beyond chondroplasty and any ligamentous procedure were excluded. A distribution-based approach was used to calculate the MCID. This was performed by determining the standard deviation (SD) of the delta two-year patient reported outcome scores (PROS) and then multiplying the SD by 0.5. The number of patients achieving MCID were then presented as a percentage.

Results:

Eighty-six of 117 patients who underwent isolated MPFL reconstruction completed preoperative and a two-year follow-up PRO survey (59 female, 27 male; age 21.1 ± 8.7 years). For Kujala, the preoperative mean was 59.3 ± 17.1, two-year follow-up mean was 87.6 ± 13.6, and MCID was 9.2 with 88% of the cohort achieving MCID. For IKDC, preoperative mean was 50.2 ± 17.2, two-year mean was 80.5 ± 18.6, and MCID was 12.4 with 80% of patients achieving MCID. KOOS JR had a preoperative man of 66.0 ± 14.6, two-year follow-up mean of 88.8 ± 11.9, and MCID of 8.5 with 72% of patients meeting this MCID (Figure 1).

Conclusions:

At two years following MPFL reconstruction, the MCID’s for clinically relevant subjective PROS were 9.2 (Kujala), 12.5 (IKDC), and 8.5 (KOOS JR). MCID’s for MPFL reconstruction are already established for 6-month and 1-year time points, and this was the first presentation of two-year MCID values. Establishing the 2-year MCID for MPFL reconstruction gives surgeons another tool to use in the diagnoses of patellar instability patients who may be struggling post-operatively.
Poster 313: Short-Term Patient Reported Outcomes and Physical Performance Tests Following Anterior Cruciate Ligament Reconstruction With and Without Modified Lemaire Tenodesis in Younger Patients: a Prospective Comparison
Authors: van der List Jelle , Blom Ingmar , Benner Joyce , Jonkers Freerk , Hofstee Dirk Jan
Published: August 2024

Objectives:

Anterior cruciate ligament (ACL) reconstruction (ACLR) is commonly performed in the younger or active population, but failure rates have been disappointing in high-risk patients. Recently, a modified Lemaire extra-articular tenodesis (LET) has been added to the procedure, which has been shown to decrease failure rates. However, not much is currently known about the short-term rehabilitation following this procedure. Therefore, the goal was to assess the short-term patient-reported outcomes (PROMS), strength-testing and functional testing following ACLR with and without LET.

Methods:

A prospective study was performed for all patients undergoing ACL reconstruction in a regional teaching hospital from 2019 to 2022, in which LET was added in 2020. All patients underwent standard four- or five-strand autologous hamstring ACL reconstruction using femoral button fixation and tibial screw fixation and one group underwent additional LET with anchor fixation. Preoperatively, patients completed patient-reported outcome measures (PROMs; International Knee Documentation Committee questionnaire, Lysholm, Numeric Rating Scale questionnaires for pain, EQ5D), Biodex testing for flexion and extension strength at 60 and 180 peak torque, and range of motion. These outcomes were also obtained at 3, 6, 9 and 12 months postoperatively and single-leg and timed-6m-hop tests were performed at 6 and 9 months postoperatively.

Results:

One-hundred-sixty-seven patients were prospectively enrolled of which 61 (36.5%) received additional LET. Patients preoperatively had similar age, gender, Body Mass Index (BMI), meniscus and chondral damage, collateral ligament injury, PROMs or Biodex, except thicker grafts in the LET group (9.0 vs 8.7 mm, p=0.009). At three months, Lemaire patients reported less pain (NRS 16.2 vs. 35.6, p<0.001) and better Lysholm score (78.4 vs. 70.8, p=0.039) compared to the isolated ACLR group. At six months, Lemaire patients had better LSI for 6m hop tests (115% vs 105%, p=0.011). At 12 months, the Lemaire group reported higher Tegner score (7.3 vs 6.2, p=0.062), and more patients returned to their preinjury Tegner level compared to isolated ACLR (80% vs. 51%, p=0.032).

Conclusions:

This prospective comparative study noted that patients undergoing ACLR with LET had less pain and better Lysholm scores at 3 months, and better LSI for 6m hop tests at 6 months follow-up. Furthermore, patients with additional LET had a higher postoperative Tegner activity level and a higher percentage of patients reaching pre-injury level of sports at 1-year follow-up.
Abated crowding by fast-tracking the Throughput component of the ED for patients in no need of hospitalization with competency managed personnel
Authors: Larsen Jesper Juul , Lauridsen Halfdan , Gundersen Laurits Wullum , Riecke Birgit Falk , Schmidt Thomas A.
Published: August 2024

Background

Emergency department (ED) crowding is a major patient safety concern and has a negative impact on healthcare systems and healthcare providers. We hypothesized that it would be feasible to control crowding by employing a multifaceted approach consisting of systematically fast-tracking patients who are mostly not in need of a hospital stay as assessed by an initial nurse and treated by decision competent physicians.

Methods

Data from 120,901 patients registered in a secondary care ED from the 4tth quarter of 2021 to the 1st quarter of 2024 was drawn from the electronic health record’s data warehouse using the SAP Web Intelligence tool and processed in the Python programming language. Crowding was compared before and after ED transformation from a uniform department into a high flow (α) and a low flow (β) section with patient placement in gurneys/chairs or beds, respectively. Patients putatively not in need of hospitalization were identified by nurse, placed in in the α setting and assessed and treated by decision competent physicians. Incidence of crowding, number of patients admitted per day and readmittances within 72 h following ED admission before and after changes were determined. Values are number of patients, mean ± SEM and mean differences with 95% CIs. Statistical significance was ascertained using Student’s two tailed t-test for unpaired values.

Results

Before and after ED changes crowding of 130% amounted to 123.8 h and 19.3 h in the latter. This is a difference of -104.6 ± 23.9 h with a 95% CI of -159.9 to -49.3, Δ% -84 (p = 0.002).

There was the same amount of patients / day amounting to 135.8 and 133.5 patients / day Δ% = -1.7 patients 95% CI -6.3 to 1.6 (p = 0.21).

There was no change in readmittances within 72 h before and after changes amounting to 9.0% versus 9.5%, Δ% = 0.5, 95%, CI -0.007 to 1.0 (p > 0.052).

Conclusion

It appears feasible to abate crowding with unchanged patient admission and without an increase in readmittances by fast-track assessment and treatment of patients who are not in need of hospitalization.
Understanding the role of video direct observed therapy for patients on an oral short-course regimen for multi-drug resistant tuberculosis: findings from a qualitative study in Eswatini
Authors: Mukooza Esther , Schausberger Bernadette , Mmema Nqobile , Dlamini Velibanti , Aung Aung , Kerschberger Bernhard , Ciglenecki Iza , Vambe Debrah , Wringe Alison
Published: August 2024

Background

Improving treatment success rates among multi drug-resistant tuberculosis (MDR-TB) patients is critical to reducing its incidence and mortality, but adherence poses an important challenge. Video-based direct observed therapy (vDOT) may provide adherence benefits, while addressing the time and cost burden associated with community treatment supporter (CTS)-DOT. This study explored experiences of patients, family members and healthcare workers with different DOT modalities for adherence support in Eswatini.

Methods

Between April 2021 and May 2022, thirteen men and five women with MDR-TB, ten healthcare workers, and nine caregivers were purposively sampled to include a range of characteristics and experiences with DOT modalities. Data were generated through individual in-depth interviews and a smartphone messaging application (WhatsApp). Data coding was undertaken iteratively, and thematic analysis undertaken, supported by Nvivo.

Results

Four themes emerged that reflected participants’ experiences with different DOT modalities, including stigma, efficiency, perceived risks of TB acquisition, and patient autonomy. vDOT was appreciated by patients for providing them with privacy and shielding them from stigmatisation associated with being seen in TB clinics or with community treatment supporters. vDOT was also seen as more efficient than CTS-DOT. Health workers acknowledged that it saved time, allowing them to attend to more patients, while many patients found vDOT more convenient and less expensive by removing the need to travel for in-person consultations. Health workers also appreciated vDOT because it reduced risks of TB acquisition by minimising exposure through virtual patient monitoring. Although many patients appreciated greater autonomy in managing their illness through vDOT, others preferred human contact or struggled with making video recordings. Most family members appreciated vDOT, although some resented feeling removed from the process of supporting loved ones.

Conclusions

vDOT was generally appreciated by MDR-TB patients, their family members and health workers as it addressed barriers to adherence which could contribute to improved treatment completion rates and reduced workplace exposure. However, patients should be offered an alternative to vDOT such as CTS-DOT if this modality does not suit their circumstances or preferences.
Exploration of the molecular characteristics and potential clinical significance of shared immune-related genes between preterm preeclampsia and term preeclampsia
Authors: Huang Zhengrui , Sun Lu , Gao Yudie , Shi Meiting , Zhang Ping , Ding Yuzhen , Wang Jian , Wei Jiachun , Yang Xiuli , Li Ruiman
Published: August 2024

Background

Preeclampsia is a severe obstetric disorder that significantly affects the maternal and neonatal peri-partum safety and long-term quality of life. However, there is limited research exploring the common mechanisms and potential clinical significance between early-onset preeclampsia and full-term preeclampsia from an immunological perspective.

Methods

In this study, data analysis was conducted. Initially, immune-related co-expressed genes involving both subtypes of preeclampsia were identified through Weighted Gene Co-expression Network Analysis (WGCNA). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were further employed to investigate the shared pathways regulated by immune-related genes. Binary logistic regression identified co-expressed genes with diagnostic value for preeclampsia, and a diagnostic model was constructed. Gene Set Enrichment Analysis (GSEA) predicted the potential biological functions of the selected genes. Lasso and Cox regression analyses identified genes closely associated with gestational duration, and a risk score model was established. A 4-gene feature, immune-related gene model for predicting the risk of preterm birth in preeclamptic pregnant women, was developed and validated through qPCR experiments. Immune cell infiltration analysis determined differences in immune cell infiltration between the two subtypes of preeclampsia.

Results

This study identified 4 immune-related co-expressed genes (CXCR6, PIK3CB, IL1RAP, and OSMR). Additionally, diagnostic and preterm birth risk prediction models for preeclampsia were constructed based on these genes. GSEA analysis suggested the involvement of these genes in the regulation of galactose metabolism, notch signaling pathway, and RIG-I like receptor signaling pathway. Immune pathway analysis indicated that the activation of T cell co-inhibition could be a potential intervention target for immunotherapy in early-onset preeclampsia.

Conclusion

Our study provides promising insights into immunotherapy and mechanistic research for preeclampsia, discovering novel diagnostic and intervention biomarkers, and offering personalized diagnostic tools for preeclampsia.
Balancing confidentiality and care coordination: challenges in patient privacy
Authors: Ibrahim Ateya Megahed , Abdel-Aziz Hassanat Ramadan , Mohamed Heba Ali Hamed , Zaghamir Donia Elsaid Fathi , Wahba Nadia Mohamed Ibrahim , Hassan Ghada. A. , Shaban Mostafa , EL-Nablaway Mohammad , Aldughmi Ohoud Naif , Aboelola Taghreed Hussien
Published: August 2024

Background

In the digital age, maintaining patient confidentiality while ensuring effective care coordination poses significant challenges for healthcare providers, particularly nurses.

Aim

To investigate the challenges and strategies associated with balancing patient confidentiality and effective care coordination in the digital age.

Methods

A cross-sectional study was conducted in a general hospital in Egypt to collect data from 150 nurses across various departments with at least six months of experience in patient care. Data were collected using six tools: Demographic Form, HIPAA Compliance Checklist, Privacy Impact Assessment (PIA) Tool, Data Sharing Agreement (DSA) Framework, EHR Privacy and Security Assessment Tool, and NIST Cybersecurity Framework. Validity and Reliability were ensured through pilot testing and factor analysis.

Results

Participants were primarily aged 31–40 years (45%), with 75% female and 60% staff nurses. High compliance was observed in the HIPAA Compliance Checklist, especially in Administrative Safeguards (3.8 ± 0.5), indicating strong management and training processes, with an overall score of 85 ± 10. The PIA Tool showed robust privacy management, with Project Descriptions scoring 4.5 ± 0.3 and a total score of 30 ± 3. The DSA Framework had a mean total score of 20 ± 2, with Data Protection Measures scoring highest at 4.0 ± 0.4. The EHR assessments revealed high scores in Access Controls (4.4 ± 0.3) and Data Integrity Measures (4.3 ± 0.3), with an overall score of 22 ± 1.5. The NIST Cybersecurity Framework had a total score of 18 ± 2, with the highest scores in Protect (3.8) and lower in Detect (3.6). Strong positive correlations were found between HIPAA Compliance and EHR Privacy (r = 0.70, p < 0.05) and NIST Cybersecurity (r = 0.55, p < 0.05), reflecting effective data protection practices.

Conclusion

The study suggests that continuous improvement in privacy practices among healthcare providers, through ongoing training and comprehensive privacy frameworks, is vital for enhancing patient confidentiality and supporting effective care coordination.
The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis
Authors: Senaratne Dhaneesha N. S. , Thakkar Bhushan , Smith Blair H. , Hales Tim G. , Marryat Louise , Colvin Lesley A.
Published: August 2024

Background

Adverse childhood experiences (ACEs) have been implicated in the aetiology of a range of health outcomes, including multimorbidity. In this systematic review and meta-analysis, we aimed to identify, synthesise, and quantify the current evidence linking ACEs and multimorbidity.

Methods

We searched seven databases from inception to 20 July 2023: APA PsycNET, CINAHL Plus, Cochrane CENTRAL, Embase, MEDLINE, Scopus, and Web of Science. We selected studies investigating adverse events occurring during childhood (< 18 years) and an assessment of multimorbidity in adulthood (≥ 18 years). Studies that only assessed adverse events in adulthood or health outcomes in children were excluded. Risk of bias was assessed using the ROBINS-E tool. Meta-analysis of prevalence and dose–response meta-analysis methods were used for quantitative data synthesis. This review was pre-registered with PROSPERO (CRD42023389528).

Results

From 15,586 records, 25 studies were eligible for inclusion (total participants = 372,162). The prevalence of exposure to ≥ 1 ACEs was 48.1% (95% CI 33.4 to 63.1%). The prevalence of multimorbidity was 34.5% (95% CI 23.4 to 47.5%). Eight studies provided sufficient data for dose–response meta-analysis (total participants = 197,981). There was a significant dose-dependent relationship between ACE exposure and multimorbidity (p < 0.001), with every additional ACE exposure contributing to a 12.9% (95% CI 7.9 to 17.9%) increase in the odds for multimorbidity. However, there was heterogeneity among the included studies (I2 = 76.9%, Cochran Q = 102, p < 0.001).

Conclusions

This is the first systematic review and meta-analysis to synthesise the literature on ACEs and multimorbidity, showing a dose-dependent relationship across a large number of participants. It consolidates and enhances an extensive body of literature that shows an association between ACEs and individual long-term health conditions, risky health behaviours, and other poor health outcomes.
Circulating interleukin-8 and osteopontin are promising biomarkers of clinical outcomes in advanced melanoma patients treated with targeted therapy
Authors: Levati Lauretta , Tabolacci Claudio , Facchiano Antonio , Facchiano Francesco , Alvino Ester , Antonini Cappellini Gian Carlo , Scala Enrico , Bonmassar Laura , Caporali Simona , Lacal Pedro Miguel , Bresin Antonella , De Galitiis Federica , Russo Giandomenico , D’Atri Stefania
Published: August 2024

Background

Circulating cytokines can represent non-invasive biomarkers to improve prediction of clinical outcomes of cancer patients. Here, plasma levels of IL-8, CCL4, osteopontin, LIF and BDNF were determined at baseline (T0), after 2 months of therapy (T2) and, when feasible, at progression (TP), in 70 melanoma patients treated with BRAF and MEK inhibitors. The association of baseline cytokine levels with clinical response, progression-free survival (PFS) and overall survival (OS) was evaluated.

Methods

Cytokine concentrations were measured using the xMAP technology. Their ability to discriminate between responding (Rs) and non-responding (NRs) patients was assessed by Receiver Operating Characteristics analysis. PFS and OS were estimated with the Kaplan–Meier method. The Cox proportional hazard model was used in the univariate and multivariate analyses to estimate crude and adjusted hazard ratios with 95% confidence intervals.

Results

CCL4 and LIF were undetectable in the majority of samples. The median osteopontin concentration at T0 and T2 was significantly higher in NRs than in Rs. The median T0 and T2 values of IL-8 were also higher in NRs than in Rs, although the statistical significance was not reached. No differences were detected for BDNF. In 39 Rs with matched T0, T2, and TP samples, osteopontin and IL-8 significantly decreased from T0 to T2 and rose again at TP, while BDNF levels remained unchanged. In NRs, none of the cytokines showed a significant decrease at T2. Only osteopontin demonstrated a good ability to discriminate between Rs and NRs. A high IL-8 T0 level was associated with significantly shorter PFS and OS and higher risk of progression and mortality, and remained an independent negative prognostic factor for OS in multivariate analysis. An elevated osteopontin T0 concentration was also significantly associated with worse OS and increased risk of death. Patients with high IL-8 and high osteopontin showed the lowest PFS and OS, and in multivariate analysis this cytokine combination remained independently associated with a three- to six-fold increased risk of mortality.

Conclusion

Circulating IL-8 and osteopontin appear useful biomarkers to refine prognosis evaluation of patients undergoing targeted therapy, and deserve attention as potential targets to improve its clinical efficacy.
Magnesium sulphate to prevent perioperative atrial fibrillation in cardiac surgery: a randomized clinical trial
Authors: Meerman Manon , Buijser Marit , van den Berg Lettie , van den Heuvel Anne-Marthe , Hoohenkerk Gerard , van Driel Vincent , Munsterman Luuk , de Vroege Roel , Bailey Michael , Bellomo Rinaldo , Ludikhuize Jeroen
Published: August 2024

Background

Postoperative atrial fibrillation (POAF) is a common and potentially serious complication post cardiac surgery. Hypomagnesaemia is common after cardiac surgery and recent evidence indicates that supplementation of magnesium may prevent POAF. We aim to investigate the effectiveness of continuous intravenous magnesium sulphate administration in the perioperative period to prevent POAF as compared to placebo.

Methods

The (POMPAE) trial is a phase 2, single-center, double-blinded randomized superiority clinical study. It aims to assess the impact of perioperative continuous intravenous magnesium administration on the occurrence of cardiac surgery-related POAF. A total of 530 patients will be included. Eligible patients will be randomized in 1:1 ratio to the intervention or placebo group with stratification based on the presence of valvular surgery. The objective of the infusion is to maintain ionized magnesium levels between 1.5 and 2.0 mmol/L.

Discussion

The primary outcome measure is the incidence of de novo POAF within the first 7 days following surgery, with censoring at hospital discharge. This trial may generate crucial evidence for the prevention of POAF and reduce clinical adverse events in patients following cardiac surgery.

Trial registration

The POMPAE trial was registered at ClinicalTrials.gov under the following identifier NTC05669417, https://clinicaltrials.gov/ct2/show/NCT05669417. Registered on December 30, 2022.

Protocol version

Version 3.3, dated 13–01-2023.
Deep learning based enhanced secure emergency video streaming approach by leveraging blockchain technology for Vehicular AdHoc 5G Networks
Authors: Awais Muhammad , Saeed Yousaf , Ali Abid , Jabbar Sohail , Ahmad Awais , Alkhrijah Yazeed , Raza Umar , Saleem Yasir
Published: August 2024

VANET is a category of MANET that aims to provide wireless communication. It increases the safety of roads and passengers. Millions of people lose their precious lives in accidents yearly, millions are injured, and others incur disability daily. Emergency vehicles need clear roads to reach their destination faster to save lives. Video streaming can be more effective as compared to textual messages and warnings. To address this issue, we proposed a methodology to use visual sensors, cameras, and OBU to record emergency videos. Initially, the frames are detected. After re-recording, the frames detection algorithm detects the specific event from the video frames. Blockchain encrypts an emergency or specific event using hashing algorithms in the second layer of our proposed framework. In the third layer of the proposed methodology, encrypted video is broadcast with the help of 5G wireless technology to the connected nodes in the VANET. The dataset used in this research comprises up to 72 video sequences averaging about 120 seconds per video. All videos have different traffic conditions and vehicles. The ResNet-50 model is used for the feature extraction process of extracted frames. The model is trained using Tensorflow and Keras deep learning models. The Elbow method finds the optimal K number for the K Means model. This data is split into training and testing. 70% is reserved for training the support vector machine (SVM) model and test datasets, while 30%. 98% accuracy is achieved with 98% precision and 99% recall as results for the proposed methodology.
Antibiotic consumption in hospitals in humanitarian settings in Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia and South Sudan
Authors: Skender Kristina , Versace Gabriel , Lenglet Annick Danyele , Clezy Kate
Published: August 2024

Background

Antimicrobial resistance is of great global public health concern. In order to address the paucity of antibiotic consumption data and antimicrobial resistance surveillance systems in hospitals in humanitarian settings, we estimated antibiotic consumption in six hospitals with the aim of developing recommendations for improvements in antimicrobial stewardship programs.

Methods

Six hospitals supported by Médecins sans Frontières were included in the study: Boost-Afghanistan, Kutupalong-Bangladesh, Baraka and Mweso-Democratic Republic of Congo, Kule-Ethiopia, and Bentiu-South Sudan. Data for 36,984 inpatients and antibiotic consumption data were collected from 2018 to 2020. Antibiotics were categorized per World Health Organization Access Watch Reserve classification. Total antibiotic consumption was measured by Defined Daily Doses (DDDs)/1000 bed-days.

Results

Average antibiotic consumption in all hospitals was 2745 DDDs/1000 bed-days. Boost hospital had the highest antibiotic consumption (4157 DDDs/1000 bed-days) and Bentiu the lowest (1598 DDDs/1000 bed-days). In all hospitals, Access antibiotics were mostly used (69.7%), followed by Watch antibiotics (30.1%). The most consumed antibiotics were amoxicillin (23.5%), amoxicillin and clavulanic acid (14%), and metronidazole (13.2%). Across all projects, mean annual antibiotic consumption reduced by 22.3% during the study period, mainly driven by the reduction in Boost hospital in Afghanistan.

Conclusions

This was the first study to assess antibiotic consumption by DDD metric in hospitals in humanitarian settings. Antibiotic consumption in project hospitals was higher than those reported from non-humanitarian settings. Routine systematic antibiotic consumption monitoring systems should be implemented in hospitals, accompanied by prescribing audits and point-prevalence surveys, to inform about the volume and appropriateness of antibiotic use and to support antimicrobial stewardship efforts in humanitarian settings.