bluuebunny/crossref_metadata_2025 huggingface dataset:
Canadian perspectives of digital mental health supports: Findings from a national survey conducted during the COVID-19 pandemic
Authors: Shen Nelson , Kassam Iman , Chen Sheng , Ma Clement , Wang Wei , Boparai Navi , Jankowicz Damian , Strudwick Gillian
Published: May 2022

Objectives

The impact of the COVID-19 pandemic on population mental health has highlighted the potential for digital mental health to support the needs of those requiring care. This study sought to understand the digital mental health experiences and priorities of Canadians affected by mental health conditions (i.e. seekers, patients, and care partners).

Methods

A national cross-sectional electronic survey of Canadians was administered through a market research firm's survey panel. Seekers, patients, and care partners were asked about their digital mental health experiences (e.g. uptake, barriers to access) and priorities. Survey responses were summarized using descriptive statistics.

Results

Overall, 1003 participants completed the survey. 70.2% of participants routinely use digital mental health supports to support themselves or those they care for; however, only 28.6% of participants are satisfied with the available digital mental health supports. Most participants (73.3%) have encountered some barriers when accessing digital mental health supports. Awareness of digital mental health supports was a top barrier identified by participants. The top digital mental health priorities consisted of digital mental health curation, navigation, and a digital mental health passport.

Conclusions

Most participants use digital mental health supports for themselves or others, however, many are unaware of digital mental health supports available. Efforts to improve navigating access to digital and in-person mental health services are seen as a top priority, highlighting the need to enable seekers, patients, and care partners to find the appropriate support and make decisions on how to best improve their mental health.
Developing the Integrated Marketing Communication (IMC) through Social Media (SM): The Modern Marketing Communication Approach
Authors: Rehman Shakeel ul , Gulzar Rafia , Aslam Wajeeha
Published: May 2022

The increased usage of social media forced the brands to integrate social media in their marketing communication channel, as it becomes the need of the hour, as it determines overall brand identity, brand image, and company performance in the present marketing competition. This research aimed to track the evolution and advancement of the IMC concept, and how it reformed the way of marketing communications. Moreover, the study highlights the importance of social media, as how it can influence consumer behavior in a substantial way. The study developed a theoretical framework through systematic review in the context that serve to integrate the existing conceptual framework of IMC with social media (SM) that is also called consumer generated media (CGM) and offer implications for understanding the manifestation as a tool of augmentation for marketing practice. The present study reviews and explains the liaison between social media/consumer generated media and IMC through enhanced IMC outcomes in the modern-day marketing communication approach. The findings of the study serve as a springboard for future research and applications in the field of marketing mix, in order to build strong foundations of the brand physically as well as virtually in the mind of customers.
The Bibliometric Analysis on Finite Mixture Model
Authors: Phoong Seuk Yen , Khek Shi Ling , Phoong Seuk Wai
Published: May 2022

A finite mixture model is well-known in statistics due to its versatility and is being actively researched. This paper reviews finite mixture model literature via bibliometric analysis, focusing on the trend and link between finite mixture model studies. The bibliometric analysis consists of four main phases; formulating research questions, locating research, research selection, evaluation, and analyzing and synthesizing selected papers. There are 667 journal articles extracted from the Web of Science (WoS) database from publications within 1988 to 2020. The Biblioshiny with R packages and VOSViewer were used as analytical tools. The findings show that there is an increasing trend of annual publication on the finite mixture model study. The results also outline key journals and the highest cited articles. Network analysis was also conducted and explored in scientific cooperation in the finite mixture model study. This study proposed a research agenda in the finite mixture model by identifying its current state and population trends.
Assessing the Antecedents of E-Government Adoption: A Case of the Ghanaian Public Sector
Authors: Azamela John Coffie , Tang Zhiwei , Ackah Owusu , Awozum Swanzy
Published: May 2022

For decades, E-government has been integrated into the governance aspect of developed and developing economies. Its adoption enabled public officials and agencies to discharge their functions and make data-driven decisions in an equitable and timely manner. Literature however is limited in terms of explaining the cognitive and attitudinal factors that contribute to the adoption and utilization of e-government systems and platforms. This study contributes to the ongoing discussions by means of exploring behavioral factors that could influence individuals’ attitudes and behavior toward e-government adoption. The study utilized the theory of planned behavior to assess the psychological and cognitive influencers that elicit the attitude and behavior of employees toward the use of the new technology. The case study was conducted among the public sector institutions in Ghana. The structural model connecting the variables in the study was examined using Partial Least Squares (PLS) Structural Equation Model (SEM) techniques. Findings from the study indicate that subjective norms and attitudes have a significant effect on individuals’ behavioral intentions. However, perceived behavioral control was found not to have a significant effect on the behavioral intentions of employees as suggested by previous studies. Although the findings contribute to theory by elucidating which components of the theory of planned behavior truly impact individuals’ attitudes and mental models, it pays limited attention to the role of cultural dynamics and how it can influence the behavioral intentions of individuals. This can be addressed in future studies.
Skeletal Status in Patients Scheduled for Elective Lumbar Spine Surgery: Comparison of Discectomy, Decompression, Fusion, and Revision
Authors: Schaefer Christian , Mafi Afshin , Beil Frank Timo , Schroeder Malte , Rolvien Tim
Published: May 2022

Study Design

Retrospective Cohort Study

Objectives

To investigate and compare the prevalence of low bone mineral density (BMD) and abnormal laboratory bone metabolism parameters in patients undergoing elective primary discectomy, decompression, and fusion and to outline possible differences in these parameters between patients undergoing revision for skeletal vs non-skeletal complications.

Methods

We retrospectively evaluated BMD measurements by dual-energy x-ray absorptiometry (DXA) in 389 consecutive patients scheduled for elective lumbar spine surgery. Next to demographic characteristics, laboratory bone metabolism parameters were assessed. Group comparisons were performed between primary discectomy, decompression, and fusion. In patients scheduled for revision surgery after fusion, potential differences in the skeletal status between those with skeletal vs non-skeletal complications were analyzed.

Results

Osteoporosis by T-score was detected in 6.7%, 11.0% and 14.7% of the patients undergoing discectomy, decompression and fusion, respectively. While vitamin D deficiency (67.6%) and hyperparathyroidism (16.4%) were frequently detected, no differences in laboratory bone metabolism markers could be found between the groups. Female sex (P<.001), higher age (P=.01) and lower BMI (P<.001) were associated with lower BMD. In the cohort of patients undergoing revision surgery due to complications after fusion, those with skeletal complications did not differ in BMD or bone metabolism from those with non-skeletal complications.

Conclusions

Osteoporosis represents a relevant comorbidity in patients scheduled for elective spine surgery, which is why DXA should be routinely performed in these patients. However, DXA may provide limited information in identifying patients at increased risk for skeletal complications after fusion.
Hispanic-Serving Institutions as Racialized Organizations: Elevating Intersectional Consciousness to Reframe the “H” in HSIs
Authors: Vega Blanca Elizabeth , Liera Román , Boveda Mildred
Published: May 2022

Conceptualizations of servingness must include an understanding of how racial ideologies shape Hispanic-Serving Institutions (HSIs). Three Latinx scholars offer testimonios on our experiences as students, faculty, and researchers at teaching and research-intensive HSIs. From our testimonios, we found that practices of Blanqueamiento (Whitening of a population) and Mestizaje (racial mixture) operate at HSIs to flatten our understanding of Hispanics in U.S. society. To make sense of our testimonios within these HSI contexts and constraints, we applied an intersectional consciousness perspective on racialized organizations. Findings include Whiteness operating as a credential, legitimizing unequal resources, diminishing agency among minoritized groups, and continued use of Mestizaje (disguised as Hispanic) as a prevailing ideology. We provide considerations for HSI leaders, researchers, and administrators to elevate their intersectional consciousness and disrupt how HSIs contribute to essentialist notions of Latinxs.
Cultivating Value Creation
Authors: Davidow Moshe
Published: May 2022

This article takes a critical look at what is holding organizations back from implementing value creation. It highlights some of the current misguided thinking of the past 20 years and suggests ways to change the thinking. The financial benefit of these changes is discussed, and ideas for the implementation of a new value creation culture based on complaint management are suggested. It is now up to the managers to implement.
Adopting Entrepreneurship Education—Teachers′ Professional Development
Authors: Oksanen Lea , Oikkonen Elena , Pihkala Timo
Published: May 2022

This study explores teachers’ professional development in entrepreneurship education (EE). It examines empirically the change in teachers’ EE practices among Finnish teachers in 2011–2017. Overall, the quantitative analysis reveals that entrepreneurship education practices are increasing, albeit unevenly. Three groups of teachers, EE experimenters, EE critics, and EE selectors show different profiles in their use of EE practices. Furthermore, these groups seem to represent different stages of EE professionalization. The analysis shows that teachers’ EE practices increase on the introductory stage but decrease deeply after. Moreover, the study suggests that teachers’ implementation of EE evolves along with their teaching experience. It reveals that teachers in different stages of professional development need different types of support and that the adoption of EE practices depends on the institutional and social support offered to teachers. The results of the investigation contribute to the literature of EE by introducing a new typology of teachers, also presenting empirical evidence of the teachers’ ability to absorb EE as a new approach. Furthermore, the study shows that for the adoption of EE it is not enough to emphasize the introductory stage but instead also the later stages of teacher’s professionalization need to be considered.
Identifying boundary spanning reporter roles in patient safety events
Authors: Hurley Vanessa Beth , Boxley Christian , Sloss Elizabeth Ann , Fong Allan
Published: May 2022

Objective

We evaluated patterns in reporter roles among individuals who submitted patient safety event (PSE) reports with a focus upon understanding the extent of boundary spanning behavior through the novel use of an information entropy measure.

Methods

A total of 81,759 reports submitted by 13,348 unique reporters to a voluntary, centralized incident reporting system database of a large Mid-Atlantic healthcare system between January 1, 2018 and December 31, 2020 were analyzed. We used an entropy measure to identify individuals with boundary spanning roles across departments and general event types.

Results

We find that high department entropy characterizes technicians, administrators and physician roles while high event type entropy is noted among physicians and nurses. Physicians had both high event type and department entropy, while no other role appeared to have both high event type and departmental entropy. Several roles were associated with inversely related entropies, including nurses who demonstrated high event type entropy and low department entropy . Pharmacists demonstrated low event type entropy and high department entropy.

Conclusion

Our findings echo existing literature that has suggested that nurses often exhibit boundary spanning tendencies at the same time that we underscore their role in reporting diverse types of PSEs. We also find that administrators, physicians and technicians are more likely to report events from across departmental boundaries. Such information may provide health care systems with a unique perspective on PSEs and be instrumental in efforts to identify key staff roles for quality improvement in the patient safety context.
SARS-CoV-2 Survivors With Chronic Health Conditions: A Pilot Study on “COVID Long-Haulers”
Authors: Evans Kevin D. , Bloom Isaiah W. , Stigall-Weikle Nicole , Weaver Tara , Gunasena Manuja , Funderburg Nicholas T. , Liyanage Namal P. M.
Published: May 2022

Objective:

As the global pandemic resulting from this virus continues, surviving patients continue to report chronic symptoms long after a diagnosis of coronavirus disease (COVID-19). A pilot study was conducted with a convenient sample to ascertain the proper diagnostic testing for detecting chronic disease.

Materials and Methods:

A convenient group of nine patients were directed by their primary care physician to be evaluated based on a variety of symptoms being reported by those surviving the acute phase of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patients who volunteered provided sonographic imaging data of the lungs, kidney, and heart. This modified sonographic assessment was completed in a Family Practice office, with a laptop ultrasound equipment system, a blood draw, as well as completion of the EuroQol (EQ-5D) questionnaire. The data were collected as part of the patients 3- to 4-month follow-up primary care visit.

Results:

In this cohort, six patients were diagnosed and were able to recover at home. The other three patients chose to undergo monoclonal antibody therapy. The two subgroups’ data are provided and describe the types of residual effects that some individuals continue to suffer.

Conclusion:

Those patients with residual symptoms of SARS-CoV-2 have been dubbed “COVID long-haulers.” This combination of diagnostic tests, specifically renal sonography, flow cytometry, and dynamic sonographic assessment, may hold promise for guiding the treatment and surveillance of these patients.
A Transthoracic Ultrasound-Guided Needle Biopsy Provided the Diagnosis for a Synovial Sarcoma of the Pleura
Authors: Palumbo Maria Giovanna , Quarato Carla Maria Irene , Lacedonia Donato , Lucia Dimitri , Simeone Anna , Di Micco Concetta , De Cosmo Salvatore , Scioscia Giulia , Foschino Barbaro Maria Pia , Sperandeo Marco
Published: May 2022

A case report is presented of a 72-year-old woman with monophasic synovial sarcoma of the buttocks, diagnosed four years before. The tumor was treated with surgical removal followed by radiotherapy. The patient regularly underwent follow-up examinations and the last chest computed tomogram (CT) showed a left-sided pleural mass and ipsilateral effusion. The patient was admitted in hospital to obtain a specific histological diagnosis before treatment of chest pathology was initiated. An ultrasound (US)-guided fine needle aspiration biopsy (FNAB) of the pleural lesion and US-guided thoracentesis with drainage of blood serum pleural fluid were performed. The pathological examination of the lesion revealed a definitive diagnosis of synovial sarcoma of the pleura. For pleural-based lesions, the diagnostic accuracy of US-guided biopsy is similar to that of CT-guided biopsy, with a lower complication rate, the absence of radiation exposure to patients, and a significantly reduced procedural time. The presence of pleural effusion creates a favorable acoustic window for US-guided biopsy of pleural lesion, which is useful for the diagnosis.
Inherited bone marrow failure in the pediatric patient
Authors: Dokal Inderjeet , Tummala Hemanth , Vulliamy Tom
Published: May 2022

Inherited bone marrow (BM) failure syndromes are a diverse group of disorders characterized by BM failure, usually in association with ≥1 extrahematopoietic abnormalities. BM failure, which can involve ≥1 cell lineages, often presents in the pediatric age group. Furthermore, some children initially labeled as having idiopathic aplastic anemia or myelodysplasia represent cryptic cases of inherited BM failure. Significant advances in the genetics of these syndromes have been made, identifying more than 100 disease genes, giving insights into normal hematopoiesis and how it is disrupted in patients with BM failure. They have also provided important information on fundamental biological pathways, including DNA repair: Fanconi anemia (FA) genes; telomere maintenance: dyskeratosis congenita (DC) genes; and ribosome biogenesis: Shwachman-Diamond syndrome and Diamond-Blackfan anemia genes. In addition, because these disorders are usually associated with extrahematopoietic abnormalities and increased risk of cancer, they have provided insights into human development and cancer. In the clinic, genetic tests stemming from the recent advances facilitate diagnosis, especially when clinical features are insufficient to accurately classify a disorder. Hematopoietic stem cell transplantation using fludarabine-based protocols has significantly improved outcomes, particularly in patients with FA or DC. Management of some other complications, such as cancer, remains a challenge. Recent studies have suggested the possibility of new and potentially more efficacious therapies, including a renewed focus on hematopoietic gene therapy and drugs [transforming growth factor-β inhibitors for FA and PAPD5, a human poly(A) polymerase, inhibitors for DC] that target disease-specific defects.
Non-COVID-19 respiratory viral infection
Authors: Nunes-Silva Cláudio , Vilares Ana Teresa , Schweitzer Valentijn , Castanhinha Susana , Martins António , Lopes Maria João , Ascoli-Bartoli Tommaso , Canelas Gabriela , Keir Holly R. , Cunha Flávia , Silva-Pinto André , Rebelo Sandra , Cunha Rui Guimarães , Tavares Margarida
Published: May 2022

Implemented control measures brought about by the coronavirus disease 2019 (COVID-19) pandemic have changed the prevalence of other respiratory viruses, often relegating them to a secondary plan. However, it must not be forgotten that a diverse group of viruses, including other human coronaviruses, rhinoviruses, respiratory syncytial virus, human metapneumoviruses, parainfluenza and influenza, continue to be responsible for a large burden of disease. In fact, they are among the most common causes of acute upper and lower respiratory tract infections globally. Viral respiratory infections can be categorised in several ways, including by clinical syndrome or aetiological agent. We describe their clinical spectrum. Distinctive imaging features, advances in microbiological diagnosis and treatment of severe forms are also discussed.

Educational aims

To summarise the knowledge on the spectrum of disease that respiratory viral infections can cause and recognise how often they overlap.

To learn the most common causes of respiratory viral infections and acknowledge other less frequent agents that may target certain key populations (e.g.immunocompromised patients).

To improve awareness of the recent advances in diagnostic methods, including molecular assays and helpful features in imaging techniques.

To identify supportive care strategies pivotal in the management of severe respiratory viral infections.
Lack of STAT6 enhances murine acute lung injury through NLRP3/p38 MAPK signaling pathway in macrophages
Authors: Hu Lu , Shao Changzhou , Pan Linyue , Jiang Zhilong
Published: May 2022

Background

Signal transducer and activator of transcription 6 (STAT6) is an intracelluar transcriotion factor and NLRP3 (Nod-like receptor containing a pyrin domain 3) is a component of NLRP3 inflammasome in pyroptotic cells. There was increased activation of STAT6 and expression of NLRP3 in mice with murine acute lung injury (ALI). However, it is unknown their roles in the development of murine ALI. We in this study, investigated the effects of STAT6 signaling on murine ALI and pyroptosis in STAT6 knock-out (KO) mice and macrophages.

Results

STAT6 was activated in the lung tissues of mice 2 days after intratracheal treatmemt with 5 mg/kg LPS. Lack of STAT6 expression in KO mice induced more severe lung inflammation, associated with elevated neutrophil influx and expression of TNF-alpha, IL-6 and IL-1beta in the inflamed lung tissues. In addition, the expression of NLRP3, ASC (apoptosis-associated speck-like protein containing a CARD), p-p38 MAPK (p38 mitogen-activated protein kinase) and ratio of LC3-II/I (microtubule-associated protein-1 light chain-3) was increased, accompanied with the increased polarization of Siglec-F(−) subtype macrophages in KO mice with ALI. Further studies in bone marrow-derived macrophages (BMDMs) revealed that lack of STAT6 increased the expression of NLRP3 and p-p38 MAPK, in association with elevated expression of TNF-alpha, IL-1beta and Calreticulin in LPS-treated KO BMDMs.

Conclusions

Lack of STAT6 exacerbated murine ALI through improving the expression of NLRP3 and activation of p38 MAPK in macrophages. STAT6 has an immune suppressive role in the development of ALI and would be a promising therapeutic target in the treatment of ALI and possibly among patients with acute respiratory distress syndrome (ARDS).
Suboptimal prehospital decision- making for referral to alternative levels of care – frequency, measurement, acceptance rate and room for improvement
Authors: Magnusson Carl , Hagiwara Magnus Andersson , Norberg-Boysen Gabriella , Kauppi Wivica , Herlitz Johan , Axelsson Christer , Packendorff Niclas , Larsson Glenn , Wibring Kristoffer
Published: May 2022

Background

The emergency medical services (EMS) have undergone dramatic changes during the past few decades. Increased utilisation, changes in care-seeking behaviour and competence among EMS clinicians have given rise to a shift in EMS strategies in many countries. From transport to the emergency department to at the scene deciding on the most appropriate level of care and mode of transport. Among the non-conveyed patients some may suffer from “time-sensitive conditions” delaying diagnosis and treatment. Thus, four questions arise:

How often are time-sensitive cases referred to primary care or self-care advice?

How can we measure and define the level of inappropriate clinical decision-making?

What is acceptable?

How to increase patient safety?

Main text

To what extent time-sensitive cases are non-conveyed varies. About 5–25% of referred patients visit the emergency department within 72 hours, 5% are hospitalised, 1–3% are reported to have a time-sensitive condition and seven-day mortality rates range from 0﻿.3 to 6%.

The level of inappropriate clinical decision-making can be measured using surrogate measures such as emergency department attendances, hospitalisation and short-term mortality. These measures do not reveal time-sensitive conditions. Defining a scoring system may be one alternative, where misclassifications of time-sensitive cases are rated based on how severely they affected patient outcome.

In terms of what is acceptable there is no general agreement. Although a zero-vision approach does not seem to be realistic unless under-triage is split into different levels of severity with zero-vision in the most severe categories.

There are several ways to reduce the risk of misclassifications. Implementation of support systems for decision-making using machine learning to improve the initial assessment is one approach. Using a trigger tool to identify adverse events is another.

Conclusion

A substantial number of patients are non-conveyed, including a small portion with time-sensitive conditions. This poses a threat to patient safety. No general agreement on how to define and measure the extent of such EMS referrals and no agreement of what is acceptable exists, but we conclude an overall zero-vision is not realistic. Developing specific tools supporting decision making regarding EMS referral may be one way to reduce misclassification rates.
Coerced syphilis self-testing among men who have sex with men: a nationwide cross-sectional study in China
Authors: Zhao Peizhen , Shi Yijia , Wang Cheng
Published: May 2022

Background

Syphilis testing uptake remains low among men who have sex with men (MSM) in many low-and middle-income countries. Syphilis self-testing is an efficacious approach on increasing syphilis testing coverage. However, one unintended consequence is the syphilis self-testing coercion from others (including partners, healthcare providers, friends, etc.). This study aimed to examine the prevalence, pattern and correlates of coerced syphilis self-testing among MSM in China.

Methods

A nationwide online cross-sectional study was conducted from 14 to 28 July 2018. Sociodemographic characteristics, sexual behaviors and coerced syphilis self-testing variables were collected through a questionnaire that targeted MSM in China. Multivariable logistic regression was used to explore associated factors with syphilis self-testing coercion.

Results

Overall, 174 MSM were recruited in this study, 31 men (17.8%) reported ever experiencing syphilis self-testing coercion. The most common types of coercion before syphilis self-testing were verbal abuse (38.7%, 12/31) and threatening to end a relationship (38.7%, 12/31). After obtaining the self-test results, men were mostly subjected to end a relationship (45.2%, 14/31) and threaten of violence (35.5%, 11/31). Multivariable logistic regression indicated that men who used condoms inconsistently in the past three months, ever used substances before or during sex, ever had group sex with males and commercial sex were more likely to experience syphilis self-testing coercion.

Conclusions

Coerced syphilis self-testing was prevalent among MSM in China. Innovative intervention to reduce coerced syphilis self-testing is necessary among MSM in China.
The pathway and characteristics of patients with non-specific symptoms of cancer: a systematic review
Authors: Jensen Ellen , Kristensen Jette Kolding , Bjerglund Rikke Tveden , Johnsen Søren Paaske , Thomsen Janus Laust
Published: May 2022

Background

Non-specific symptoms are  common and often sign of a non-serious disease. Because of this, patients with non-specific symptoms of cancer (NSSC) present a challenge for general practitioners (GP). Studies describing characteristics of patients with NSSC have been done after fast-track pathways were created to diagnose and treat patients with NSSC. This study reviews characteristics of patients with NSSC and their patient pathways.

Materials and methods

Database searches of Embase, Cochrane, PubMed, Cinahl and Web of Science were performed. Search terms used were cancer, patient pathway, and NSSC with their synonyms. The flow diagram Preferring Reporting Items for Systematic Review was applied to the systematic search. The Newcastle–Ottawa Assessment Scale (NOS) was used to compare the quality of the included studies.

Results

Twelve studies met the inclusion criterias. All studies were considered to be of high methodological quality.

Patient Pathway: 11–35% of patients were diagnosed with cancer. Median number of days through diagnostic process was 7–10.

Patient Characteristics: The most prevalent cancers included hematological-(14–30%), gastrointestinal-(13–23%) and lung cancers (13%). Rheumatological, musculoskeletal and gastrointestinal diseases were among the most common non-malignant diseases diagnosed. Weight loss, fatigue, pain and loss of appetite were the most common symptoms. Cardiovascular diseases, lung diseases, diabetes and previous diagnosed cancer were the most common comorbidities. Mean age of included patients was 60–72 years.

Conclusion

Limited number of studies were found and they lacked sufficient heterogenic data to conduct a metaanalysis. Symptoms, diagnoses, age and gender were described with some heterogenic results. Further studies should be conducted to gather broader knowledge about patients with NSSC.
A randomized controlled phase III study comparing hadrontherapy with carbon ions versus conventional radiotherapy – including photon and proton therapy – for the treatment of radioresistant tumors: the ETOILE trial
Authors: Balosso Jacques , Febvey-Combes Olivia , Iung Annie , Lozano Hélène , Alloh Abdoulkader Soumai , Cornu Catherine , Hervé Magali , Akkal Zohra , Lièvre Michel , Plattner Valérie , Valvo Francesca , Bono Cristina , Fiore Maria Rosaria , Vitolo Viviana , Vischioni Barbara , Patin Stéphanie , Allemand Hubert , Gueyffier François , Margier Jennifer , Guerre Pascale , Chabaud Sylvie , Orecchia Roberto , Pommier Pascal
Published: May 2022

Background

Some cancers such as sarcomas (bone and soft tissue sarcomas) and adenoid cystic carcinomas are considered as radioresistant to low linear energy transfer radiation (including photons and protons) and may therefore beneficiate from a carbon ion therapy. Despite encouraging results obtained in phase I/II trials compared to historical data with photons, the spread of carbon ions has been limited mainly because of the absence of randomized medical data. The French health authorities stressed the importance of having randomized data for carbon ion therapy.

Methods

The ETOILE study is a multicenter prospective randomized phase III trial comparing carbon ion therapy to either advanced photon or proton radiotherapy for inoperable or macroscopically incompletely resected (R2) radioresistant cancers including sarcomas and adenoid cystic carcinomas.

In the experimental arm, carbon ion therapy will be performed at the National Center for Oncological Hadrontherapy (CNAO) in Pavia, Italy. In the control arm, photon or proton radiotherapy will be carried out in referent centers in France.

The primary endpoint is progression-free survival (PFS). Secondary endpoints are overall survival and local control, toxicity profile, and quality of life. In addition, a prospective health-economic study and a radiobiological analysis will be conducted.

To demonstrate an absolute improvement in the 5-year PFS rate of 20% in favor of carbon ion therapy, 250 patients have to be included in the study.

Discussion

So far, no clinical study of phase III has demonstrated the superiority of carbon ion therapy compared to conventional radiotherapy, including proton therapy, for the treatment of radioresistant tumors.

Trial registration

ClinicalTrials.gov identifier: NCT02838602. Date of registration: July 20, 2016. The posted information will be updated as needed to reflect protocol amendments and study progress.
Tilt and decentration of posterior and anterior iris-claw intraocular lenses: a pilot study using anterior segment optical coherence tomography
Authors: Calzetti Giacomo , Bellucci Carlo , Tedesco Salvatore Antonio , Rossi Maurizio , Gandolfi Stefano , Mora Paolo
Published: May 2022

Background

Information on the centration and tilt of iris-claw intraocular lenses (IC-IOLs) is limited. In this study, we tested the capacity of an anterior segment optical coherence tomography (AS-OCT) instrument to measure decentration and tilt of anterior and posterior IC-IOLs through an integrated software.

Methods

The present observational, cross-sectional study was conducted at University Eye Clinic of Parma (Parma, Italy). The CASIA2 swept-source AS-OCT (Tomey Corp.) was used to measure the tilt and decentration of posterior and anterior IC-IOLs in patients implanted at least 6 months in advance. After failure with full-automation, semi-manual IOL tracing was applied. In-the-bag (IB) contralateral IOLs, when present, were measured automatically. The Bland-Altman method was used to evaluate the agreement between repeated measurements (2 images for each study eye). The amount and direction of tilt and decentration were recorded and plotted into polar charts for evaluation.

Results

A total of 21 patients were included: 14 with posterior and 7 with anterior IC-IOL fixation. In 17 eyes (81%), the AS-OCT provided a repeatable measurement of tilt and decentration. All contralateral eyes with IB IOL were automatically measured. The median decentration was 0.67 mm, 0.24 mm, and 0.24 mm in posterior IC-IOLs, anterior IC-IOLs, and IB IOLs group, respectively. The median tilt was 5.0°, 5.6°, and 5.6° for posterior IC-IOLs, anterior IC-IOLs, and IB IOLs, respectively. Tilt direction was mainly temporal, while decentration was inferior-temporal with posterior IC-IOLs and scattered with anterior IC-IOLs and IB IOLs.

Conclusions

The semi-manual tracing function of the CASIA2 AS-OCT provides repeatable and affordable measurements of the decentration and tilt of IC-IOLs in both the anterior and posterior chamber. Data from the former group were similar to the IB group.
Inter-centre comparison of data on surgery and speech outcomes at 5 years of age based on the Swedish quality registry for patients born with cleft palate with or without cleft lip
Authors: Klintö Kristina , Eriksson Marie , Abdiu Avni , Brunnegård Karin , Cajander Jenny , Hagberg Emilie , Hakelius Malin , Havstam Christina , Mark Hans , Okhiria Åsa , Peterson Petra , Svensson Kristina , Becker Magnus
Published: May 2022

Background

The objective of the Swedish cleft lip and palate registry (CLP registry) is to promote quality control, research and improvement of treatment, by the comparison of long-term results. The aim was to compare data from the CLP registry among the six treatment centres, regarding data on surgery and speech outcomes at 5 years of age.

Methods

The participants were 430 children born in Sweden from 2009 to 2014, with cleft palate with or without cleft lip and without known syndromes and/or additional malformations. The number of primary and secondary palatal surgeries up to 5 years of age, timing of the last primary palatal surgery, percentage consonants correct, percentage non-oral speech errors and perceived velopharyngeal competence at 5 years were assessed. Multivariable binary logistic regression adjusted for sex and cleft type was used to compare results between the six centres.

Results

At one centre (centre 4), the palate was closed in one to three stages, and at the remaining centres in one or two stages. At centre 4, more children underwent a higher number of palatal surgeries, and the last primary palatal surgery was performed at a higher age. Children in centre 4 were also less likely to achieve ≥86% correct consonants (OR = 0.169,P = < 0.001), have no non-oral speech errors (OR = 0.347,P = < 0.001), or have competent or marginally incompetent velopharyngeal competence (OR = 0.244,P = < 0.001), compared to the average results of the other centres. No clear association between patient volume and speech outcome was observed.

Conclusions

The results indicated the risk of a negative speech result if the last primary palatal surgery was performed after 25 months of age. Whether the cleft in the palate was closed in one or two stages did not affect speech outcome. The Swedish CLP registry can be used for open comparisons of treatment results to provide the basis for improvements of treatment methods. If deviating negative results are seen consistently at one centre, this information should be acted upon by further investigation and analysis, making changes to the treatment protocol as needed.
Reliability and validity of depression anxiety stress scale (DASS)-21 in screening for common mental disorders among postpartum women in Malawi
Authors: Moya Ernest , Larson Leila M. , Stewart Robert C. , Fisher Jane , Mwangi Martin N. , Phiri Kamija S.
Published: May 2022

Background

Approximately one in five women who have recently given birth suffer from common mental disorder (CMD), particularly depression and/or anxiety. Most available CMD screening tools in most low- and middle-income countries do not screen for more than one mental health problem. Having a screening tool that is free to use, short in assessment time, and used to screen for more than one CMD is appealing in a resource-constrained setting.

Method

We conducted a criterion validation study of the Chichewa translated and adapted DASS-21 instrument against gold standard diagnoses of depression and anxiety disorders using an independently administered Structured Clinical Interview for DSM-IV (SCID). We compared the performance of the DASS-depression subscale with the Edinburgh Postpartum Depression Scale (EPDS). Internal reliability was reported using both Cronbach’s alpha and ordinal alpha. The DASS-21 and EPDS ability to discriminate cases from non-cases was assessed by receiver operating characteristics (ROC) analysis. We selected cut-off points for DASS-21 and EPDS that maximise both sensitivity and specificity.

Results

One hundred fifteen participants were administered all the measures. Approximately 11.3% and 14.8% had depression and anxiety diagnoses respectively using SCID. The overall Cronbach’s alpha for the DASS-21 scale was 0.74. The DASS-21 subscales had Cronbach’s alpha values of 0.66, 0.29 and 0.52 for depression (DASS-D), anxiety (DASS-A) and stress (DASS-S), respectively. The ordinal alpha for DASS-D, DASS-A and DASS-S subscales were 0.83, 0.74 and 0.87, respectively. The area under the ROC curve was 0.76 (95% CI: 0.61; 0.91) for DASS-D and 0.65 for DASS-A. At a cut-off point of one or more, the sensitivity and specificity for DASS-D were 69.2% and 75.5%, whilst DASS-A was 52.9% and 75.5%, respectively. Pearson correlation coefficient for the association between DASS-D and EPDS was r = 0.61, p < 0.001.

Conclusion

The DASS-21 had good internal reliability (Cronbach’s alpha), and its ordinal alpha demonstrated good internal reliability for all its sub-scales. Regarding the criterion validation, only the DASS-D and EPDS demonstrated a satisfactory ability to discriminate cases from non-cases. Our findings suggest that health practitioners can use DASS-D as an alternative tool in screening depression as it has fewer questions than EPDS.
Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model
Authors: Wallis Marianne , Craswell Alison , Marsden Elizabeth , Taylor Andrea
Published: May 2022

Background

Frail older adults require specific, targeted care and expedited shared decision making in the emergency department (ED) to prevent poor outcomes and minimise time spent in this chaotic environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to help limit these undesirable consequences. This qualitative study aimed to explore the ways in which two hospital implementation sites implemented the structures and processes of the GEDI model and to examine the ways in which the i-PARIHS (innovation-Promoting Action on Research Implementation in Health Services) framework influenced the implementation.

Methods

Using the i-PARIHS approach to implementation, the GEDI model was disseminated into two hospitals using a detailed implementation toolkit, external and internal facilitators and a structured program of support. Following implementation, interviews were conducted with a range of staff involved in the implementation at both sites to explore the implementation process used. Transcribed interviews were analysed for themes and sub-themes.

Results

There were 31 interviews with clinicians involved in the implementation, conducted across two hospitals, including interviews with the two external facilitators. Major themes identified included: (i) elements of the GEDI model adopted or (ii) adapted by implementation sites and (iii) factors that affected the implementation of the GEDI model. Both sites adopted the model of care and there was general support for the GEDI approach to the management of frail older people in the ED. Both sites adapted the structure of the GEDI team and the expertise of the team members to suit their needs and resources. Elements such as service focus, funding, staff development and service evaluation were initially adopted but adaptation occurred over time. Resourcing and cost shifting issues at the implementation sites and at the site providing the external facilitators negatively impacted the facilitation process.

Conclusions

The i-PARIHS framework provided a pragmatic approach to the implementation of the evidenced-based GEDI model. Passionate, driven clinicians ensured that successful implementation occurred despite unanticipated changes in context at both the implementation and host facilitator sites as well as the absence of sustained facilitation support.
Implementing a mHealth intervention to increase colorectal cancer screening among high-risk cancer survivors treated with radiotherapy in the Childhood Cancer Survivor Study (CCSS)
Authors: Henderson Tara O. , Bardwell Jenna K. , Moskowitz Chaya S. , McDonald Aaron , Vukadinovich Chris , Lam Helen , Curry Michael , Oeffinger Kevin C. , Ford Jennifer S. , Elkin Elena B. , Nathan Paul C. , Armstrong Gregory T. , Kim Karen
Published: May 2022

Background

Cancer survivors treated with any dose of radiation to the abdomen, pelvis, spine, or total body irradiation (TBI) are at increased risk for developing colorectal cancer (CRC) compared to the general population. Since earlier detection of CRC is strongly associated with improved survival, the Children’s Oncology Group (COG) Long-Term Follow-Up Guidelines recommend that these high-risk cancer survivors begin CRC screening via a colonoscopy or a multitarget stool DNA test at the age of 30 years or 5 years following the radiation treatment (whichever occurs last). However, only 37% (95% CI 34.1–39.9%) of high-risk survivors adhere to CRC surveillance. TheActivating cancerSurvivors and theirPrimary care providers (PCP) toIncrease colorectal cancerScreening (ASPIRES) study is designed to assess the efficacy of an intervention to increase the rate of CRC screening among high-risk cancer survivors through interactive, educational text-messages and resources provided to participants, and CRC screening resources provided to their PCPs.

Methods

ASPIRES is a three-arm, hybrid type II effectiveness and implementation study designed to simultaneously evaluate the efficacy of an intervention and assess the implementation process among participants in the Childhood Cancer Survivor Study (CCSS), a North American longitudinal cohort of childhood cancer survivors. The Control (C) arm participants receive electronic resources, participants in Treatment arm 1 receive electronic resources as well as interactive text messages, and participants in Treatment arm 2 receive electronic educational resources, interactive text messages, and their PCP’s receive faxed materials. We describe our plan to collect quantitative (questionnaires, medical records, study logs, CCSS data) and qualitative (semi-structured interviews) intervention outcome data as well as quantitative (questionnaires) and qualitative (interviews) data on the implementation process.

Discussion

There is a critical need to increase the rate of CRC screening among high-risk cancer survivors. This hybrid effectiveness-implementation study will evaluate the effectiveness and implementation of an mHealth intervention consisting of interactive text-messages, electronic tools, and primary care provider resources. Findings from this research will advance CRC prevention efforts by enhancing understanding of the effectiveness of an mHealth intervention and highlighting factors that determine the successful implementation of this intervention within the high-risk cancer survivor population.

Trial registration

This protocol was registered atclinicaltrials.gov(identifierNCT05084833) on October 20, 2021.
Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US
Authors: Harwood Kenneth J. , Pines Jesse M. , Andrilla C. Holly A. , Frogner Bianca K.
Published: May 2022

Background

Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs.

Methods

Using national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis. Exclusion criteria included individuals with a diagnosis of LBP or any serious medical conditions or an opioid prescription recorded in the 6 months prior to the index date. Outcome measures included use of imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care) twelve months post-index date. We used a two-stage residual inclusion (2SRI) estimation approach comparing copay for the initial provider visit and differential distance as the instrumental variable to reduce selection bias in the choice of first provider, controlling for demographics.

Results

Among 3,799,593 individuals, cost and utilization varied considerably based on the first provider seen by the patient. Copay and differential distance provided similar results, with copay preserving a greater sample size. The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. The frequency and time to serious illness varied little across providers. Total cost of care was lowest when starting with a chiropractor ($5093) or primary care physician ($5660), and highest when starting with an orthopedist ($9434) or acupuncturist ($9205).

Conclusion

The first provider seen by individuals with LBP was associated with large differences in health care utilization, opioid prescriptions, and cost while there were no differences in delays in diagnosis of serious illness.