bluuebunny/crossref_metadata_2025 huggingface dataset:
Lessons From Learners: Adapting Medical Student Education During and Post COVID-19
Authors: Castro Maria R.H. , Calthorpe Lucia M. , Fogh Shannon E. , McAllister Sophie , Johnson Christopher L. , Isaacs Eric D. , Ishizaki Allison , Kozas Anna , Lo Daphne , Rennke Stephanie , Davis John , Chang Anna
Published: May 2021

In response to the COVID-19 pandemic, many medical schools suspended clinical clerkships and implemented newly adapted curricula to facilitate continued educational progress. While the implementation of these new curricula has been described, an understanding of the impact on student learning outcomes is lacking. In 2020, the authors followed Kern’s 6-step approach to curricular development to create and evaluate a novel COVID-19 curriculum for medical students at the University of California San Francisco School of Medicine and evaluate its learning outcomes. The primary goal of the curriculum was to provide third- and fourth-year medical students an opportunity for workplace learning in the absence of clinical clerkships, specifically for students to develop clerkship-level milestones in the competency domains of practice-based learning and improvement, professionalism, and systems-based practice. The curriculum was designed to match students with faculty-mentored projects occurring primarily in virtual formats. A total of 126 students enrolled in the curriculum and completed a survey about their learning outcomes (100% response rate). Of 35 possible clerkship-level milestones, there were 12 milestones for which over half of students reported development in competency domains including practice-based learning and improvement, professionalism, and interpersonal and communication skills. Thematic analysis of students’ qualitative survey responses demonstrated 2 central motivations for participating in the curriculum: identity as physicians-in-training and patient engagement. Six central learning areas were developed during the curriculum: interprofessional teamwork, community resources, technology in medicine, skill-building, quality improvement, and specialty-specific learning. This analysis demonstrates that students can develop competencies and achieve rich workplace learning through project-based experiential learning, even in virtual clinical workplaces. Furthermore, knowledge of community resources, technology in medicine, and quality improvement was developed through the curriculum more readily than in traditional clerkships. These could be considered as integral learning objectives in future curricular design.
Key Insights From the Development and Implementation of a Novel Virtual Interview Process for Medical School Admissions During the COVID-19 Pandemic
Authors: Garden Evan , Loebel Emma , Sanky Charles , Chudow Jacquelyn , Fallar Robert , Parkas Valerie
Published: May 2021

Problem

During the COVID-19 pandemic, medical schools have offered a virtual application process. Minimal literature is available to guide best practices.

Approach

The Icahn School of Medicine at Mount Sinai (ISMMS) implemented a completely virtual interview (VI) process in April/May 2020. Large-group sessions for applicants, interviews with applicants, and ISMMS Admissions Committee meetings occurred via Zoom (Zoom Video Communications, Inc., San Jose, California). Large-group sessions and committee meetings occurred via communal conference calls, while one-on-one, semistructured interviews occurred in individual breakout rooms. ISMMS offered live, virtual question-and-answer sessions with students and faculty, plus digital resources describing program features. After the interview day, applicants and interviewers were invited to complete anonymous surveys regarding their experiences with and perspectives of VI.

Outcomes

Of 125 applicants and 20 interviewers, 99 (79%) and 18 (90%), respectively, completed at least part of the survey. Of the applicants, 85/95 (89%) agreed VI met or exceeded expectations, with many praising the day’s organization and convenience, and 71/95 (75%) agreed they received a sufficient sense of the student body. A minority (n = 39/95 [41%]) felt limited in their ability to learn about the institution (commonly related to their inability to tour campus), and a majority (n =74/91 [81%]) would have preferred an in-person interview. Most interviewers felt comfortable assessing applicants’ verbal communication skills (n = 13/16 [81%]), and most (n = 12/17 [71%]) felt VI should be an option for future applicants.

Next Steps

VI, likely to be a temporary-but-universal fixture of upcoming application cycles, may benefit applicants and interviewers alike by saving resources and diversifying those involved. Next steps are developing programming that will permit applicants to virtually explore the institution and connect more with current students. Future research should evaluate potential bias in VI to ensure an equitable application process for all.
Cardiovascular disease (CVD) risk scores, age, or years since menopause to predict cardiovascular disease in the Women's Health Initiative
Authors: Wild Robert A. , Hovey Kathleen M. , Andrews Christopher , Robinson Jennifer G. , Kaunitz Andrew M. , Manson JoAnn E. , Crandall Carolyn J. , Paragallo Rachel , Shufelt Chrisandra , Merz C. Noel Bairey
Published: May 2021

Objective:

To assess the utility of cardiovascular disease (CVD) risk scores compared to age or years since menopause for prediction of CVD events in the WHI clinical trials.

Methods:

Briefly, in the randomized clinical trial 27,347 postmenopausal women age 50 to 79 years entered from 1993 to 1998. Women with a uterus (16,608) were randomized to receive daily oral conjugated equine estrogen (CEE) (0.625 mg) plus medroxyprogesterone acetate (2.5 mg) (5.7 years or placebo), while women with a hysterectomy (10,739) were randomized to receive daily oral CEE (0.625 mg) alone or placebo (7.2 y). CVD risk scores were assessed at baseline and CVD events were adjudicated throughout the follow-up period to the end of the main study phase and to the end of cumulative follow-up. The median follow-up time after the start of the randomized clinical trial to the end of the main study phase was 8.2 years. The median follow-up time to the end of cumulative follow-up was 17.6 years. We compared The American Heart Association/American College of Cardiology (AHA/ACC) and Framingham Heart Study risk scores to age or years since menopause all obtained at baseline to predict subsequent CVD events. The absolute event rates, hazard ratios, and C-statistics (Uno Concordance from Cox proportional models) were compared.

Results:

Overall, the hazard ratios for CVD events were highest with calculated CVD scores calculated at trial onset both at the end of the main study (ranging from 2.02 to 10.8 for Q2-Q5, compared to Q1) and at cumulative follow-up (ranging from 1.76 to 8.86 for Q2-Q5, compared to Q1). While older age and years since menopause at baseline were also associated with higher CVD event rates, better risk prediction was accomplished by using CVD risk scores. The Framingham Heart Study BMI score had the highest C-statistic at the end of the main study (0.711) and after 17.6 years through the end of follow-up (0.689).

Conclusions:

CVD risk scores can help identify postmenopausal women at higher risk for CVD beyond age or time since menopause. Risk scoring that better estimates vascular aging may facilitate CVD risk prevention. When performed prior to initiation of menopausal hormone therapy, scores can better inform HT risk/benefit discussions.

Video Summary:

http://links.lww.com/MENO/A717.
Early-onset climacterium is not associated with impaired vitamin D status: a population-based study
Authors: Lumme Johanna E. , Savukoski Susanna M. , Suvanto Eila T.J. , Pesonen Paula R.O. , Auvinen Juha P. , Sebert Sylvain , Hyppönen Elina , Järvelin Marjo-Riitta , Puukka Katri S. , Herzig Karl-Heinz , Oura Petteri , Ojaniemi Marja , Niinimäki Maarit
Published: May 2021

Objective:

To investigate vitamin D status in women with the onset of the climacteric phase by age 46 as both early menopause and inadequate vitamin D status may increase the risk of adverse health outcomes.

Methods:

A cross-sectional study included 2,544, 46-year-old women from a birth cohort. Women were divided into the following two groups according to their menstrual history and follicle-stimulating hormone (FSH) concentration: 1) climacteric (FSH ≥25 IU/L and amenorrhea ≥4 mo, n = 351) and 2) preclimacteric women (FSH <25 IU/L and having regular/irregular menstrual cycles, n = 2,193). Serum 25-hydroxyvitamin D (25(OH)D) concentrations were compared between the groups. A linear regression model was performed to investigate which factors are associated with 25(OH)D status.

Results:

Mean serum 25(OH)D concentrations were higher in climacteric compared with preclimacteric women (68.1 ± 19.8 nmol/L vs 65.2 ± 19.3 nmol/L, P = 0.01). However, in the linear regression model, climacteric status was not associated with 25(OH)D status (multivariable adjusted mean difference 4.5 nmol/L, 95% confidence interval −1.4 to 10.4, P = 0.137). A total of 76 of the climacteric women were using systemic estrogen hormone therapy (HT). In a subanalysis, including only climacteric women, the use of HT was associated with higher 25(OH)D status (multivariable adjusted mean difference 5.9 nmol/L, 95% confidence interval 1.3-10.5, P = 0.013).

Conclusions:

The onset of the climacteric phase by age 46 was not associated with inadequate 25(OH)D concentrations, whereas HT use was associated with higher 25(OH)D status in women with early-onset climacterium.
Risk factors, demographic profiles, and management of uncomplicated recurrent urinary tract infections: a single institution study
Authors: Ingram Amanda , Posid Tasha , Pandit Aroh , Rose Justin , Amin Sabrina , Bellows Fara
Published: May 2021

Objective:

Recurrent urinary tract infections (rUTI) are a common urologic chief complaint. Although rUTIs are a significant burden on the healthcare system, until recently there were no published guidelines to delineate optimal management of this condition. The objective of this study was to describe the demographic profile of rUTI patients and summarize practice patterns at a single tertiary health center, as well as to assess whether our real-life practice patterns parallel the recently published guidelines.

Methods:

We conducted a retrospective record review of female patients presenting for diagnosis of uncomplicated rUTI/cystitis between October 2010 and September 2018. Analyses were conducted to investigate (a) whether pre- versus postmenopausal women differed in their risk factors for rUTI, (b) whether providers adjust their practice patterns when treating pre- versus postmenopausal women with rUTIs, and (c) whether certain treatment regimens led to lower rates of rUTI than others.

Results:

Of the 125 cases included in the final analysis, pre- versus postmenopausal women did differ in their risk factors for rUTI, specifically age, Charlson Comorbidity Index score, and comorbidities. Although common treatments were found across menopausal status, providers did adjust their practice patterns when treating pre- versus postmenopausal women, including the use of postcoital suppression, conservative measures, cranberry juice/extract, and probiotics for premenopausal women and daily suppression and vaginal estrogens for postmenopausal women. rUTI after treatment (<40%) was highest after the use of conservative measures for all women and rates of rUTI after treatment generally did not differ as a function of menopausal status, but rather by treatment option.

Conclusions:

This single institution report sheds light on practice patterns at a major academic center, specifically as it compares to the new American Urological Association guidelines and the use of estrogen cream for postmenopausal women.
Temporal Trends in COVID-19 Incidence in Two Healthcare Worker Cohorts
Authors: McNicholas James E. , Kosnik Robert , Blanc Paul D. , Taylor Brian R. , Guntur Sandeep
Published: May 2021

Background:

Health care workers (HCWs) experience increased occupational risk of contracting COVID-19, with temporal trends that might inform surveillance.

Methods:

We analyzed data from a Veterans Affairs hospital-based COVID-19 worker telephone hotline collected over 40 weeks (2020). We calculated the proportion of COVID-19+ cases among persons-under-investigation (PUIs) for illness compared to rates from a nearby large university-based health care institution.

Results:

We observed 740 PUIs, 65 (8.8%) COVID-19+. Time trends were similar at the study and comparison hospitals; only for the first of 10 four-week observation periods was the ratio for observed to expected COVID-19+ significant (P < 0.001).

Discussion:

These data suggest that employee health COVID-19+ to PUI ratios could be utilized as a barometer of community trends. Pooling experience among heath care facilities may yield insights into occupational infectious disease outbreaks.
The effects of whole-body muscle stimulation on body composition and strength parameters
Authors: Rodrigues-Santana Luiz , Adsuar José Carmelo , Louro Hugo , Pérez-Gómez Jorge , Hernández-Mocholí Miguel Angel , Carlos-Vivas Jorge , Gomez-Campos Rossana , Campos Luis Felipe Castelli Correia de
Published: May 2021

Background:

This study will analyze the effect of Whole Body Electromyostimulation (WB-EMS) in strength and body composition outcomes in adult population.

Methods:

This study will search the following electronic databases up to July 21, 2020: PubMed, WOS, Scopus, SPORTDiscus y EMBASE. There will be no language limitation. Two authors will independently identify titles/abstracts and full text all potential studies, and will collect data from eligible studies. Additionally, study quality will be assessed by PEDro Scale risk of bias. We will conduct meta-analysis if enough trials are included.

Results:

This study will explore the effects of WB-EMS in strength and body composition outcomes.

Conclusion:

The findings of this study may summarize the effectiveness of WB-EMS in increasing strength and improving body composition in adult population.

INPLASY registration number:

INPLASY202120050
The genotype analysis of the hepatitis C virus in Heilongjiang Province, China
Authors: Cheng Xue-Di , Xu Hua-Feng , Wei Feng , Jiang Li-Xin , Zhou Hai-Zhou
Published: May 2021

Introduction: Hepatitis C virus (HCV) infection is a major public health issue. HCV genotype identification is clinically important to tailor the dosage and duration of treatment, and recombination in intra-patient populations of HCV may lead to the generation of escape mutants, as previously observed for other RNA viruses. Up to now, there is no study assessing HCV genotypes and subtypes in Heilongjiang Province, China.

Methods: To determine genotype and phylogenetic analysis of HCV in Heilongjiang Province is crucial. In this study, we amplified 3 genome regions (5’UTR, E1, and NS5B) of 30 HCV patients in Heilongjiang Province, amplified products were analyzed by bioinformatics.

Results: We found that 23 specimens had concordant subtypes in the 3 gene regions (2a and 1b), 7 HCV patients were considered the recombinants, the recombination pattern of the 7 HCV patients in the 5’UTR, E1, and NS5B region as followed: 1b/2a/1b, 2a/2a/1b, 1b/2a/2a, 1b/2a/1b, 1b/2a/1b, 1b/2a/1b, 2a/2a/1b.

Conclusions: The findings in the present study showed that a higher recombination rate (23%) than other researches, and the recombination of 2a/1b in the 5’UTR, E1, and NS5B region was only found in the present study up to now.
Predictors of patient safety culture in hospitals in Venezuela
Authors: Chirinos Muñoz Mónica Susana , Orrego Carola , Montoya Cesar , Suñol Rosa
Published: May 2021

An organization's culture with regard to patient safety is important because it defines the beliefs and practices of the organization, and consequently its efficiency and productivity.

Knowing the level of this and the factors that influence or not their dynamic represents a challenge, due to the degree of complexity and specificity of the elements involved.

The aim of this study was to analyze predictors of patient safety culture in public and private hospitals and examining the factors that contribute to it, constructing a new and specific theoretical and methodological model.

This study was carried out by reviewing medical records, detecting healthcare professionals directly involved in caring (N = 588), for patients in 2 public hospitals and 2 private hospitals in Venezuela (N = 566), conducting an “Analysis of Patient Safety Culture” questionnaire. The results were subsequently analyzed, derived 3 predictors factors and using a Patient Safety Culture Index (PSCI) for specific determination to evaluate patient safety culture level.

The analysis showed that all hospitals had a “moderately unfavorable” PSCI (public = 52.96, private = 52.67, sig = 0.90). The PSCI was calculated by assessing the weight of the following factors in the index: occupational factors (factor loading = 32.03), communication factors (factor loading = 11.83), and organizational factors (factor loading = 9.10). Traumatology presented the lowest PSCI of all the care units, falling into the “unfavorable” category (36.48), and Laboratory the highest (70.02) (sig = 0.174), falling into the “moderately favorable” category. When analyzing professional groups, nurses had the highest PSCI, with a “moderately unfavorable” rating (PSCI = 61.1) and medical residents the lowest, falling into the “unfavorable” category (35.2). Adverse event reporting is determined by “management expectations and actions” (sig = 0.048) and “direct interaction with the patient” (sig = 0.049).

The use of this theoretical and methodological approach in other contexts may provide a more objective system for identifying more specific needs and factors that influence in patient safety culture, and consequently, opportunities for improvement when constructing a patient safety culture in healthcare institutions. Efforts need to be made to improve safety culture in the hospitals studied, irrespective of whether they are public or private.
The safety and feasibility of comprehensive nutrition care in pregnant women with gestational diabetes mellitus
Authors: Long Mei , Zhang Xiangchun
Published: May 2021

Background:

The argument on the efficacy of medical nutritional therapy and comprehensive nutritional care remains to be resolved. Therefore, we conducted this protocol of systematic review and meta-analysis to evaluate the efficacy between medical nutritional therapy and comprehensive nutritional care for patients with gestational diabetes mellitus (GDM).

Methods:

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols reporting guidelines and the recommendations of the Cochrane Collaboration to conduct this study. Reviewers will search the PubMed, Cochrane Library, Web of Science, and EMBASE online databases using the key phrases “gestational diabetes mellitus,” “comprehensive nutrition care,” and “medical nutritional therapy” for all cohort studies published up to May 20, 2021. There is no restriction in the dates of publication or language in the search for the current review. The studies on cohort study focusing on comparing medical nutritional therapy and comprehensive nutrition care for GDM patients will be included in our meta-analysis. The outcomes include blood glucose levels, complications, weight change, and incidence of cesarean section. Where disagreement in the collection of data occurrs, this will be resolved through discussion.

Results:

We hypothesized that these 2 methods would provide similar therapeutic benefits.

OSF registration number:

10.17605/OSF.IO/SC8HJ.
Efficacy and safety of electroacupuncture in treatment of cervical spondylosis
Authors: Zhou YaZhou , Wang WenGang , Tian Ke , Huang Hui , Jia Mengrui
Published: May 2021

Background:

Cervical Spondylotic radiculopathy (CSR) is the most common spinal degenerative disease. Its clinical manifestations are pain and numbness in the neck and arm and limitation of neck movement, which greatly affects the life and work of patients. Acupuncture and electroacupuncture are commonly used in China, the efficacy of acupuncture has been confirmed. Existing evidence shows that electroacupuncture seems to be better than acupuncture, but there is a lack of clinical research to directly compare the two.

Methods:

This is a prospective randomized controlled trial to compare the efficacy of electroacupuncture and acupuncture in the treatment of CSR and to explore the safety and potential mechanism of electroacupuncture in the treatment of CSR. Approved by the Clinical Research Ethics Committee of our hospital, the patients are randomly divided into an experimental group (electroacupuncture group) or control group (acupuncture group). The patients are followed up for 30 days after 4 weeks of treatment. Observation indexes included VAS score, Neck Disability Index, Yasuhisa Tanaka 20 Score Scale, adverse reactions and so on. Finally, the data will be analyzed by SPSS 18.0 software.

Discussion:

This study will directly compare the advantages and disadvantages of electroacupuncture and acupuncture in the treatment of CSR. The results of this study will help to guide patients with CSR to choose appropriate treatment.

Trial registration:

OSF Registration number: DOI 10.17605/OSF.IO/9MKPN
The role of E255K/V-inclusive mutations in a Philadelphia-positive acute lymphoblastic leukemia with mutation evolution during sequential TKIs therapies
Authors: Zhao Miaomiao , Gui Xiya , Wu Qiuling , Xia Linghui , Wang Yadan
Published: May 2021

Rationale:

Until recently, the survival rate in patients with Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL) was approximately 30%. Tyrosine kinase inhibitors (TKIs), which are a new class of drugs that target BCR-ABL fusion protein, have shown to be effective in treating Ph+ ALL in adults. However, the resistance mechanisms that promote the disease recurrence have altered the initial success of these revolutionary agents.

Patient concerns:

A 71-year-old Chinese female patient who suffered from severe shoulder and back pain for 1 week.

Diagnosis:

The patient was diagnosed with Ph+ ALL (B–cell) because of the following items. Complete blood count showed extremely abnormal white blood cell count (26.26×109/l), hemoglobin concentration (65 g/l) and platelet count (14×109/l). And because that Bone marrow aspirate showed 72.5% lymphoblasts and 59.30% lymphoblasts were confirmed by flow cytometry (FCM). At mean time, Real-time fluorescent quantitative PCR analysis confirmed that the P190 BCR/ABL fusion gene expression was 5.9%. Karyotype analysis indicated the following: 45, XX, −7, t (922) (q34; q11) [cp3].

Interventions:

The patient was treated with chemotherapy and different TKIs including imatinib, dasatinib, ponatinib, and bosutinib.

Outcomes:

The patient achieved complete remissions with different TKIs after diagnose but relapsed afterward and died of infection.

Lessons:

Multidrug-resistant mutations within the BCR-ABL1 kinase domain are an emerging clinical problem for patients receiving sequential TKIs therapy. Acquisition of E255K/V-inclusive mutations is usually associated with ponatinib resistance, thus it is necessary to screen out new real pan-inhibitor compounds for all BCR/ABL mutations and figure out the potential efficacy of asciminib-based drug combinations in the future.
Lupus acute cardiomyopathy is highly responsive to intravenous immunoglobulin treatment
Authors: Meridor Katya , Shoenfeld Yehuda , Tayer-Shifman Oshrat , Levy Yair
Published: May 2021

Introduction:

Intravenous immunoglobulin (IVIg) is currently used with considerable success for the treatment of many autoimmune diseases, including systemic lupus erythematosus (SLE). Among its various indications, IVIg has also been found to be beneficial in myocarditis, whether or not it is associated with an autoimmune disease. Nevertheless, data regarding IVIg treatment for myocarditis/cardiomyopathy in patients with SLE are sparse. The objective of this case series was to describe our experience with IVIg as a treatment for lupus myocarditis and to review the literature for IVIg for this indication.

Patient concerns:

We report 5 female patients with SLE, who presented with signs of acute heart failure including pulmonary congestion and arrhythmias.

Diagnosis:

Echocardiography demonstrated new reduced left ventricular ejection fraction of 20% to 30%. Two patients underwent coronary artery angiography, which demonstrated normal coronary arteries, supporting the diagnosis of myocarditis or nonischemic cardiomyopathy.

Interventions:

High-dose IVIg treatment was initiated in all 5 patients.

Outcomes:

Following the treatment, clinical and echocardiographic improvement in cardiac function occurred within a few days to 1 month. This dramatic improvement persisted for several years.

Conclusion:

Based on our case series, we believe that IVIg has an important role in the management of lupus acute cardiomyopathy. This safe, well-tolerated optional treatment should be considered, especially in severe cases.
Risk factors of enteral feeding intolerance in severe acute pancreatitis patients
Authors: Fan Hongyun , Yang Chunchun , Duan Zhiying , Huo Xiaohui , Yang Yang
Published: May 2021

Background:

Patients with severe acute pancreatitis (SAP) have gastrointestinal dysfunction, and enteral nutrition intolerance is easy to occur during the implementation of enteral nutrition, which leads to the suspension or termination of enteral nutrition. Enteral nutrition cannot tolerate the influence of many factors. At present, there is a lack of analysis on the influencing factors of enteral nutrition intolerance in patients with SAP. Therefore, this study analyzed the factors of enteral nutrition intolerance in patients with SAP by meta-analysis, to provide a basis for the protection of enteral nutrition in patients with SAP.

Methods:

Databases (PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang) were searched using index words to find relevant studies published before March 2021. Meta-analyses of relative risk were performed for the identification of risk factors.

Results:

We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals.

Conclusion:

This study systematically reviewed the existing evidence and determined the incidence and predictors of enteral nutrition intolerance in patients with SAP.
Acupuncture for blunt chest trauma
Authors: Kao Pei-Yu , Ben-Arie Eyal , Lu Ting-Yu , Ho Wen-Chao , Lee Yu-Chen , Lin Yu-Sen , Chen Chien-Kuang , Chen Jian-Xun , Huang Tzu-Min , Chen Fang-Pey
Published: May 2021

Introduction:

Blunt chest trauma (BCT) accounts for up to 65% of polytrauma patients. In patients with 0 to 2 rib fractures, treatment interventions are typically limited to oral analgesics and breathing exercises. Patients suffering from BCT experience symptoms of severe pain, poor sleep, and inability to perform simple daily life activities for an extended period of time thereafter. In this trial, we aim to investigate the efficacy of acupuncture as a functional and reliable treatment option for blunt chest trauma patients.

Methods:

The study is designed as a double-blind randomized control trial. We will include 72 patients divided into 2 groups; the acupuncture group (Acu) and placebo group (Con). The acupuncture group will receive true acupuncture using a uniquely designed press tack needle. The control group will receive placebo acupuncture treatment through the use of a similarly designed press tack needle without the needle element. The acupoints selected for both groups are GB 34, GB 36, LI 4, LU 7, ST 36, and TH 5. Both groups will receive 1 treatment only following the initial visit to the medical facility and upon diagnosis of BCT. Patient outcome measurements include: Numerical Rating Scale, Face Rating Scale, respiratory function flowmeter, Verran Snyder-Halpern sleep scale, and the total amount of allopathic medication used. Follow-up time will be scheduled at 4 days, 2 weeks, and lastly 3 months.

Expected outcome:

The results of this study can potentially provide a simple and cost-effective analgesic solution to blunt chest trauma patients. This novel study design can serve as supporting evidence for future double-blind studies within the field of acupuncture.

Other information:

The study will be conducted in the thoracic surgical department and acupuncture department in China Medical University Hospital, Taichung, Taiwan. The study will be conducted on blunt chest trauma patients and is anticipated to have minimum risk of adverse events. Enrollment of the patients and data collection will start from March 2020. Study completion time is expected in March 2022.

Protocol Registration:

(CMUH109-REC1-002), (NCT04318496).
The efficacy and safety of moxibustion for chronic fatigue syndrome
Authors: Xue Kaiyang , Wang Yanping , Wang Xianzhu , Chen Pingnan , Xiao Caihong , Fu Jing , Cui Jin
Published: May 2021

Background:

The pathogenesis of chronic fatigue syndrome (CFS) is not clear. The main purpose of treatment is to improve autoimmune function and relieve fatigue symptoms. Moxibustion is often used to treat diseases caused by low autoimmunity, especially in relieving fatigue symptoms. It is a superior therapy for CFS in traditional Chinese medicine. At present, there is a lack of the high level clinical evidence to support the moxibustion in the treatment of CFS, so this study will systematically review and analyze the currently available randomized controlled trials to evaluate the efficacy and safety of moxibustion in the treatment of CFS.

Methods:

We will systematically search PubMed, EMBASE, Cochrane library, Sinomed, CNKI, VIP, and Wanfang Database, ClinicalTrials.gov and Chinese Clinical Trial Registry will also be searched. The time range for the search will be from database activation to March 31, 2021. The randomized controlled trials (RCTs) associated with moxibustion for CFS will be included, regardless of language.

We will use the standard proposed in Cochrane Handbook 5.1.0 to assess the bias risk of a single RCT. The main outcome index of the study is Fatigue Assessment Instrument (FAI), secondary outcome indexes will include Fatigue Scale -14 (FS-14), Fatigue Severity Scale (FSS), Pittsburgh sleep quality index (PSQI), natural killer (NK) cells, interleukin- 2 (IL-2), T lymphocyte subsets (CD4
+, CD8
+), cure rate, total efficiency and adverse reactions. The random effect model meta was used to analyze the effect data of a single RCT. Heterogeneity will be measured by Cochran Q test and I-squared statistics. We will use 2 subgroup analyses to explore the source of heterogeneity. RCTs with high bias risk was excluded and adjustment effect model was used for sensitivity analysis to test the robustness of the meta-analysis results. The publication bias included in RCTs will be assessed by funnel plot and Egger test.

Results:

This study will objectively and comprehensively evaluate the efficacy and safety of randomized controlled trials of moxibustion in the treatment of chronic fatigue syndrome, and the results will be submitted to peer-reviewed journals for publication.

Conclusion:

This systematic review will provide clinicians with the latest high-quality evidence for the use of moxibustion in the treatment of chronic fatigue syndrome.

INPLASY registration number:

INPLASY202140063.
The genotype and phenotype of chromosome 18p deletion syndrome
Authors: Jin Qiujie , Qiang Rong , Cai Bo , Wang Xiaobin , Cai Na , Zhen Shuai , Zhai Wen
Published: May 2021

Rationale:

The chromosome 18p deletion syndrome is a syndrome with a deletion of all or a portion of the short arm of the chromosome 18. The phenotypes of the chromosome 18p deletion syndrome vary widely among individuals due to differences in size and breakpoints and the involved genes on the deletions. Given the varied and untypical clinical presentation of this syndrome, the prenatal diagnosis of the syndrome still presents as a challenge.

Patient concerns:

We described 4 China cases with different chromosomal breakpoints. In case 1, a woman who with mild phenotypes gave birth to a severely deformed fetus. Three other cases were for prenatal diagnosis. Their phenotypes are the increased nuchal translucency (INT) and the noninvasive prenatal testing (NIPT) indicated deletions on the chromosome 18p and severe hydronephrosis respectively.

Diagnosis:

The 4 cases were diagnosed with chromosome 18p deletion syndrome through karyotype analysis and array-based comparative genomic hybridization (array-CGH).

Interventions:

Karyotype analysis and array-based comparative genomic hybridization were used to analyze the abnormal chromosome.

Outcomes:

Case 1 and case 2 revealed 11.51 and 12.39 Mb deletions in 18p11.32p11.21. Case 3 revealed 7.1 Mb deletions in 18p11.3218p11.23. Case 4 revealed 9.9 Mb deletions in 18p11.3218p11.22.

Lessons:

In our report, we are the first to report that mother and progeny who have the same chromosomal breakpoint have different phenotypes, significantly. In addition, we found a new phenotype of chromosome 18p deletion syndrome in fetus, which can enrich the phenotypes of this syndrome in the prenatal diagnosis. Finally, we demonstrate that the individuals with different chromosomal breakpoints of 18p deletion syndrome have different phenotypes. On the other hand, the individuals with the same chromosomal breakpoints of 18p deletion syndrome may also have remarkably different phenotypes.
Adverse events experienced with intrahospital transfer of critically ill patients
Authors: Temsah Mohamad-Hani , Al-Sohime Fahad , Alhaboob Ali , Al-Eyadhy Ayman , Aljamaan Fadi , Hasan Gamal , Ali Salma , Ashri Ahmed , Nahass Assalh Ali , Al-Barrak Rana , Temsah Omar , Alhasan Khalid , Jamal Amr A.
Published: May 2021

Research that focuses on transfers to and from the intensive care unit (ICU) could highlight important patients’ safety issues. This study aims to describe healthcare workers’ (HCWs) practices involved in patient transfers to or from the ICU.

This cross-sectional study was conducted among HCWs during the Saudi Critical Care Society's annual International Conference, April 2017. Responses were assessed using Likert scales and frequencies. Bivariate analysis was used to evaluate the significance of different indicators.

Overall, 312 HCWs participated in this study. Regarding transfer to ICUs, the most frequently reported complications were deterioration in respiratory status (51.4%), followed by deterioration in hemodynamic status (46.5%), and missing clinical information (35.5%). Regarding transfers from ICUs to the general ward, the most commonly reported complications were changes in respiratory status (55.6%), followed by incomplete clinical information (37.9%), and change in hemodynamic conditions (29%). The most-used models for communicating transfers were written documents in electronic health records (69.3%) and verbal communication (62.8%). One-fourth of the respondents were not aware of the Situation, Background, Assessment, Recommendation (SBAR) method of patients’ handover. Pearson's test of correlation showed that the HCW's perceived satisfaction with their hospital transfer guidelines showed significant negative correlation with their reported transfer-related complications (r = −0.27, P < .010).

Hemodynamic and respiratory status deterioration is representing significant adverse events among patients transferred to or from the ICU. Factors controlling the perceived satisfaction of HCWs involved in patients, transfer to and from the ICU need to be addressed, focusing on their compliance to the hospital-wide transfer and handover policies. Quality improvement initiatives could improve patient safety to transfer patients to and from the ICU and minimize the associated adverse events.
Collapsing focal segmental glomerulosclerosis in a patient with oral cavity cancer
Authors: Choi Sae Byeol , Kim Kyoung Min , Park Moon Hyang , Kang Kyung Pyo
Published: May 2021

Rationale:

Focal segmental glomerulosclerosis (FSGS) is one of the most common glomerular diseases, leading to end-stage renal disease. Among the 5 variants of FSGS, the collapsing variant is rare and has the worst prognosis. Solid and hematologic malignancies are associated with glomerular diseases, such as membranous nephropathy, minimal change disease, and FSGS. However, squamous cell carcinoma of the oral cavity is rarely associated with nephrotic syndrome, especially FSGS.

Patient concerns:

A 55-year-old woman diagnosed with oral cavity cancer presented with generalized edema with heavy proteinuria and renal dysfunction after neoadjuvant chemotherapy and wide surgical excision.

Diagnosis:

Renal biopsy shows segmental or global collapse of glomerular capillaries with marked hyperplasia and swelling of overlying epithelial cells, suggesting a collapsing variant of FSGS.

Interventions:

After the renal biopsy, we prescribed oral prednisolone at a dose of 1 mg/kg/day. Despite immunosuppressive treatment, renal function deteriorated, and hemodialysis was started.

Outcomes:

After 23 sessions of hemodialysis and high-dose oral glucocorticoid treatment, renal function gradually improved, and oral glucocorticoid therapy was discontinued after 8 months. Currently, this patient is in a cancer-free state and has normal renal function without proteinuria.

Lessons:

Unusual collapsing FSGS might be associated with neoadjuvant chemotherapy and wide surgical excision in patients with oral cavity cancer. Proper diagnostic workup, such as renal biopsy and high-dose glucocorticoid therapy, might have helped recover from nephrotic syndrome and acute renal injury in cancer patients.
Adults Followed by Pediatric Subspecialists
Authors: Rudloff James , Gittelman Mike , Pomerantz Wendy J.
Published: May 2021

Background

Adults are being seen with increasing frequency in pediatric emergency departments (PEDs), but the drivers behind this increase are unknown. Our primary aim was to compare adults seen in the PED followed by pediatric subspecialists to those who are not.

Methods

A retrospective study of patients 21 years or older presenting to the PED of a tertiary care children's hospital was performed from January 2011 through December 2018. Data included patient demographics, PED length of stay, disposition, and any subspecialty clinic encounters at the children's hospital in the prior year.

Results

A total of 10,034 adult encounters were seen in the PED over the study period; 5852 (58.3%) adult PED encounters had preceding pediatric subspecialty clinic visit(s) within a year prior. Pediatric subspecialty adult PED encounters increased by 38.9%, compared with 10.6% for other adults (P = 0.01). Encounters for pediatric subspecialty adults were significantly longer and more likely to result in admission to the children's hospital. The most common pediatric subspecialists caring for adult patients seen in the PED were hematology/oncology (1655 encounters), neurology (1572 encounters), cardiology (1217 encounters), and gastroenterology (1173 encounters).

Conclusions

Pediatric subspecialty adults are presenting to the PED at a greater rate, and they require more time and resources compared with other presenting adults. As frontline providers, PEDs, physicians, and staff must be prepared to address this growing subset of patients driving the increase in adults presenting to the PED.
Maintenance of Certification Pediatrics: Pediatric Emergency Medicine (PEM)
Authors: Iyer Maya S. , Bachur Richard , Wang Vincent , Hsu Deborah , Mistry Rakesh D. , Nagler Joshua , Mick Nathan , Althouse Linda , Du Ying , Leslie Laurel K.
Published: May 2021

Starting in 2022, the American Board of Pediatrics will launch the Maintenance of Certification Assessment for Pediatrics: Pediatric Emergency Medicine (MOCA-Peds: PEM) longitudinal assessment, which will provide an at-home alternative to the point-in-time examination. This longitudinal assessment will help engage PEM physicians participating in continuing certification in a more flexible and continuous lifelong, self-directed learning process while still providing a summative assessment of their knowledge. This commentary provides background information on MOCA-Peds and an introduction to MOCA-Peds: PEM and how it gives the PEM physician another option to participate in continuing certification.
Diagnostic Performance of Shear Wave Elastography in the Noninvasive Evaluation of Liver Inflammation of Chronic Hepatitis B Patients
Authors: Ren Xinping , Zhang Lu , Xia Shujun , Zhou Jianqiao , Lin Yanyan , Zhijie Chen , Li Ruokun , Zhan Weiwei
Published: May 2021

In the current study, we sought to delineate the elastographic characteristics and further compare the diagnostic performance of various shear wave elastography modalities in hepatitis B virus patients whose liver fibrosis stage was less than F2 by liver biopsy. We retrospectively studied the clinical and imaging data of chronic hepatitis B virus patients who underwent liver biopsy at our hospital between January 2017 and October 2017. Totally, 102 patients were eligible for the study. The mean Young modulus of sound touch elastography (STE) and sound touch quantify (STQ) gradually increased as inflammation grade of the liver rose from G0 to G3. Spearman rank correlation analysis revealed that the mean Young modulus of STE and STQ significantly correlated with hepatic inflammation grade (r = 0.341, P < 0.05). The area under the receiver operating characteristic curve (AUC) was the highest for the mean Young modulus of STE (AUC = 0.740; P = 0.015) followed by that of STQ (AUC = 0.684; P = 0.063) for G ≥ 2 hepatic inflammation and the AUC was the highest for the mean Young modulus of STE (AUC = 0.920; P = 0.000) followed by that of STQ (AUC = 0.910; P = 0.000) for G ≥ 3 hepatic inflammation. The current study demonstrated that the mean Young modulus of STE and STQ could serve as a useful diagnostic marker for hepatic inflammation of hepatitis B virus patients with no apparent liver fibrosis.
Single-Use Negative Pressure Wound Therapy Devices
Authors: Crumley Carolyn
Published: May 2021

PURPOSE:

The purpose of this technologic analysis was to evaluate single-use negative pressure wound therapy (sNPWT) devices.

APPROACH:

Published literature regarding negative pressure wound therapy, particularly focusing on single-use or disposal devices, was reviewed. Varied features of devices currently available in the United States were drawn from use instructions published by individual manufacturers. Safety information regarding sNPWT was derived from the Manufacturer and User Facility Device Experience (MAUDE) Database.

CONCLUSIONS:

Single-use or disposable negative pressure wound therapy devices provide a safe and effective alternative to traditional negative pressure wound therapy. These devices promote healing of select open wounds and reduce complication rates in closed surgical incisions, when used in accordance with manufacturer guidelines. They may be used in any setting, but they are designed for use in home care and may be applied as a primary treatment option or following a course of traditional negative pressure wound therapy.
First Atlantic satellite tracks of ‘lost years’ green turtles support the importance of the Sargasso Sea as a sea turtle nursery
Authors: Mansfield Katherine L. , Wyneken Jeanette , Luo Jiangang
Published: May 2021

In-water behaviour and long-term movements of oceanic-stage juvenile sea turtles are not well described or quantified. This is owing to technological or logistical limitations of tracking small, fast-growing animals across long distances and time periods within marine habitats. Here, we present, to our knowledge, the first long-term offshore tracks of oceanic green turtles (
Chelonia mydas
) in western North Atlantic waters. Using a tag attachment technique developed specifically for young (less than 1 year old) green turtles, we satellite-tracked 21 oceanic-stage green turtles (less than 19 cm straight carapace length) up to 152 days using small, solar-powered transmitters. We verify that oceanic-stage green turtles: (i) travel to and remain within oceanic waters; (ii) often depart the Gulf Stream and North Atlantic Subtropical Gyre currents, orienting towards waters associated with the Sargasso Sea; (iii) remain at the sea surface, using thermally beneficial habitats that promote growth and survival of young turtles; and (iv) green turtles orient differently compared to same stage loggerhead turtles (
Caretta caretta
). Combined with satellite tracks of oceanic-stage loggerhead turtles, our work identifies the Sargasso Sea as an important nursery habitat for North Atlantic sea turtles, supporting a growing body of research that suggests oceanic-stage sea turtles are behaviourally more complex than previously assumed.
Differential role of sphingomyelin in influenza virus, rhinovirus and SARS-CoV-2 infection of Calu-3 cells
Authors: Dissanayake Thrimendra Kaushika , Yan Bingpeng , Ng Anthony Chin-Ki , Zhao Hanjun , Chan Gabriella , Yip Cyril Chik-Yan , Sze Kong-Hung , To Kelvin Kai-Wang
Published: May 2021

Host cell lipids play a pivotal role in the pathogenesis of respiratory virus infection. However, a direct comparison of the lipidomic profile of influenza virus and rhinovirus infections is lacking. In this study, we first compared the lipid profile of influenza virus and rhinovirus infection in a bronchial epithelial cell line. Most lipid features were downregulated for both influenza virus and rhinovirus, especially for the sphingomyelin features. Pathway analysis showed that sphingolipid metabolism was the most perturbed pathway. Functional study showed that bacterial sphingomyelinase suppressed influenza virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication, but promoted rhinovirus replication. These findings suggest that sphingomyelin pathway can be a potential target for antiviral therapy, but should be carefully evaluated as it has opposite effects on different respiratory viruses. Furthermore, the differential effect of sphingomyelinase on rhinovirus and influenza virus may explain the interference between rhinovirus and influenza virus infection.