bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of a multifaceted strategy in end-of-life care in a tertiary hospital: A quasi-experimental study
Authors: Ito Suffert Soraya Camargo , Campos Luciana Silveira , Barros Newton , Bica Claudia Giuliano
Published: November 2021

Objective

To evaluate the impact of a multifaceted strategy for quality end-of-life care in a tertiary public hospital in Brazil.

Methodology

The study design was quasi-experimental. The multifaceted strategy was applied between January and June 2017, and involved training the healthcare team in end-of-life discussions, the creation and documentation of advance directives, and consultation with the team specialized in palliative care. The periods analyzed were the pre-test period (Time 1, July 2015 to June 2016) and the post-test period (Time 2, July 2017 to June 2018).

Results

Time 1 involved 302 deaths, with an average hospital stay of 21 days; Time 2 involved 410 deaths, with an average hospital stay of 16 days. Patients were prescribed morphine (44.04% vs. 36.3% [ p = 0.367]), methadone (9.60% vs. 4.39% [ p = 0.247]), midazolam (43.05% vs. 47.80% [ p = 0.73]), blood transfusions (31.13% vs. 24.63% [ p = 0.828]), enteral feeding (56.62% vs. 38.54% [ p = 0.59]) and antibiotic therapy (50.73% vs. 50.73% [ p = 0.435]).

Conclusion

This study found no changes in the end-of-life care quality indicators after the strategy was implemented. Multimodal educational strategies that develop communication skills in palliative care may enhance the quality of end-of-life care.
“I am in other people's hands as regards my health” A sociological critique of health care encounters of people with cirrhosis. A secondary analysis
Authors: Davis Sarah , Higgs Paul , Jones Louise , Greenslade Lynda , Wilson Jo , Low Joseph TS ,   Principal Research Fellow
Published: November 2021

Objectives

People with cirrhosis are encouraged to participate in shared decision-making with their doctors, but studies suggest that doctors limit the amount of information that is shared. In this study we explore the presence of medical power in clinical encounters in 2015 from a patient perspective and highlight its effects on healthcare interactions.

Methods

Qualitative semi-structured interviews were conducted with ten people with cirrhosis attending a tertiary liver transplant centre in southern England. We explored their understanding of their disease and prognosis, and their participation in decision-making. Using the lens of medical power as a framework, we analysed findings into thematic sentences to summarise key ideas whilst preserving the complexity of identified concepts.

Results

Three key concepts explained patient perspectives of their communication with doctors: (1) portraying a positive image to doctors, (2) avoiding confrontation with doctors, (3) feeling powerless in the face of doctors’ medical knowledge. These concepts show deeper dynamic issues of power during healthcare encounters, illustrated by participants’ reluctance to voice their concerns and express themselves, challenge decisions, or seek information.

Conclusion

People with cirrhosis struggle to articulate their concerns or challenge decisions on their care and treatment and may worry about potential consequences. Our findings demonstrate the continuing persistence of issues of power at play in contemporary health care.
Acute stroke and transient ischaemic attack
Authors: Brooks Isabelle
Published: November 2021

The World Health Organization defines a stroke as ‘rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than vascular origin’. If the symptoms last less than 24 hours, typically less than 2 hours, then this is classified as a transient ischaemic attack. ‘Brain attack’ is a term that is increasingly used, as the rapid nature of treatment means the differentiating criterion of symptoms lasting at least 24 hours, is often not met before initiation of treatment.
Making health care better for all: Learning for the equality and diversity section of the RCGP curriculum
Authors: Howe Amanda
Published: November 2021

The equality, diversity and inclusion part of the RCGP curriculum can seem daunting to both trainers and AiTs. Do not panic! This article will show you how the core skills of a good GP acquired during training can help to reduce health inequalities, empower your patients and reduce misunderstanding. It will also show you how you can learn about this aspect of the curriculum and build on it in practice.
Believe-in counterfactual thinking and psychological capital
Authors: Wang Chunhua , Wang Lei
Published: November 2021

Counterfactual thinking puts a negative reality and better or worse alternative outcomes in the mind simultaneously. The implicit theory of intelligence considers whether individuals believe that intelligence can be promoted by effort or not. Previous studies suggest that counterfactual thinking interacting with the implicit theory of intelligence would evoke a belief in an attainable future or a belief that a certain future could one day be reality, thereby producing positive effects. Three studies examined the hypothesis that belief in an attainable future through counterfactual thinking would predict psychological capital, which is a positive developmental state of individuals. In Study 1 ( N = 62), belief in an attainable future was operationalized by introducing the implicit theory of intelligence and counterfactual thinking. Incremental theorists had higher psychological capital when engaged in counterfactual thinking than controls. In Study 2 ( N = 71), belief in an attainable future was operationalized by introducing the likelihood of the antecedents and of the outcomes, which were conceptualized as how people believe in their counterfactual thinking. Belief in an attainable future predicted psychological capital even after controlling for the influence of future time perspective and present-fatalistic time perspective, two concepts that depict how individuals process time-related information. In Study 3 ( N = 76), we conducted an intervention study. Participants in the experimental group were directed to construct attainable counterfactual thinking for one week. The experimental group had higher psychological capital than the control group. Across three studies, the findings consistently provided primary support for the hypothesis that belief in an attainable future would predict psychological capital.
Effects of Alternate Insulin Pump Settings in Patients With Type 1 Diabetes During Ramadan: A Randomized Pilot Study
Authors: AlGhatam Ghufran , O’Keeffe Derek , Taha Husain
Published: November 2021

Background:

Various studies have evaluated the safety and efficacy of using insulin pumps during Ramadan; some of them demonstrated favorable outcomes in reducing hypoglycemia and hyperglycemia. However, there is no consensus on the recommendations for basal insulin adjustments and the utilization of technical features of insulin pumps to improve glycemic control.

Objectives:

We aimed to investigate the effects of different insulin pump settings on time in range in patients with type 1 diabetes during Ramadan.

Methods:

In this randomized pilot study, 30 patients classified to have low to moderate risk for fasting were assigned to either a control group to receive basal insulin adjustments only or an intervention group to use the temporary basal rate and extended bolus features in addition to the basal insulin modifications. The percentage of time spent at different glucose ranges was measured by continuous glucose monitoring.

Results:

The percentage of time spent within target (70-180 mg/dL) increased significantly in the intervention group from 63.0 ± 10.7 to 76 ± 16.2% (mean difference, 27% points; P < .001). The percentage of time spent in hyperglycemia level 1 (>180 mg/dL) and level 2 (>250 mg/dL) met the criterion of significance, indicating that the intervention group spent less time in hyperglycemia. However, there was no significant difference in the percentage of time spent in hypoglycemia ranges.

Conclusions:

Incorporating technological approaches of pump therapy with clinical practice guidelines could improve glycemic control during Ramadan.
Diabetes Device Downloading: Benefits and Barriers Among Youth With Type 1 Diabetes
Authors: Palmer Benjamin A. , Soltys Karissa , Zimmerman M. Bridget , Norris Andrew W. , Tsalikian Eva , Tansey Michael J. , Pinnaro Catherina T.
Published: November 2021

Background:

The majority of youth with type 1 diabetes (T1D) fail to meet glycemic targets despite increasing continuous glucose monitoring (CGM) use. We therefore aimed to determine the proportion of caregivers who review recent glycemic trends (“retrospective review”) and make ensuant insulin adjustments based on this data (“retroactive insulin adjustments”). We additionally considered that fear of hypoglycemia and frequency of severe hypoglycemia would be associated with performing retrospective review.

Methods:

We conducted a cross-sectional survey of caregivers of youth with T1D, collecting demographics, diabetes technology usage, patterns of glucose data review/insulin dose self-adjustment, and Hypoglycemia Fear Survey (HFS).

Results:

Nineteen percent of eligible caregivers (191/1003) responded. Performing retrospective review was associated with younger child age (12.2 versus 15.4, P = .0001) and CGM use (92% versus 73%, P = .004), but was not associated with a significant improvement in child’s HbA1c (7.89 versus 8.04, P = .65). Retrospective reviewers had significantly higher HFS-behavior scores (31.9 versus 27.7, P = .0002), which remained significantly higher when adjusted for child’s age and CGM use ( P = .005). Linear regression identified a significant negative association between HbA1c (%) and number of retroactive insulin adjustments (0.24 percent lower mean HbA1c per additional adjustment made, P = .02).

Conclusions:

Retrospective glucose data review is associated with improved HbA1c when coupled with data-driven retroactive insulin adjustments. Barriers to data downloading existed even in this cohort of predominantly CGM-using T1D families.
Views of Greenery and Psychological Well-Being in Residential Aged Care Facilities: Longitudinal Associations
Authors: Sugiyama Takemi , Carver Alison , Sugiyama Masaaki , Lorenzon Alanna , Davison Tanya E.
Published: November 2021

Objectives:

This study examined associations of objectively measured views of greenery in residential aged care facilities (RACFs) with changes in multiple psychological well-being measures among residents who were newly admitted to RACFs.

Methods:

Data were collected from 52 residents (mean age: 84, 73% women) of 13 RACFs, located in Melbourne, Australia. The outcomes were changes in depression, stress, anxiety, and quality of life (QoL) between baseline and 8-week follow-up. The exposure measures were the amount and presence of greenery visible from participant’s bedroom and common areas (lounge, dining). Greenery was categorized as being either within or beyond the RACF perimeter.

Results:

Regression analyses found that greenery visible from participant’s bedroom was not associated with any outcomes. The amount of greenery visible from common areas within the RACF perimeter was adversely related to stress, unexpectedly: Each additional 1 m2 of greenery was associated with a greater increase in stress ( b = 0.05; 95% CI [0.07, 0.94]). However, greenery visible from common areas beyond the perimeter contributed favorably to stress and QoL. The presence of such greenery was associated with a lower increase in stress ( b = −3.99; 95% CI [−7.75, −0.23]; reference: no greenery), and a 1 m2 increment was associated with a greater increase in QoL ( b = 0.07; 95% CI [0.02, 0.11]).

Conclusion:

Views of greenery outside of the RACF from lounge and dining areas may be protective against residents’ stress increase and improve their QoL. Locating residents in areas with such outdoor views may prevent their psychological condition from worsening.
United we stand, divided we sue: Collective access to court for labour and social security claims in Sweden
Authors: Ghavanini Anna Wallerman
Published: November 2021

While Sweden has long enjoyed a solid reputation for protecting weaker parties through a comprehensive welfare state and a labour market governed by collective bargaining, its system for enforcing these rights has rested upon the public authorities and the social partners rather than on judicial proceedings. Against this background, this article examines the legal avenues for bringing collective actions and obtaining collective redress before courts in social security and labour law cases in Sweden. It finds that the relevant legislation does not explicitly provide for collective redress in either field. Within social security law, collective access to court is practically excluded, whereas in labour law, the current procedural framework can only with difficulty be construed as lending itself to measures of collective redress, and then only with some significant legal and practical limitations. While indicative of the general situation as regards collective redress in Sweden, whose legislation on group actions has been criticised for its toothlessness and has been put to little practical use, this also suggests that the tradition of collectivism in the Swedish social security and labour market systems still does not translate into collectivism in judicial redress.
Exploring online study behaviors of adult learners: A case study focusing on teachers’ professional development program
Authors: Çakiroğlu Ünal , Atabay Melek
Published: November 2021

It requires a lot of energy to support the adoption of online learning by adult learners. Thus, the question of how online learning intersects with adult learning may provide meaningful pathways to understanding online learning per se. This study aims to understand the online study behaviors of teachers enrolled in an online Educational Technology Master’s program. This case study involved a Research Methods course, which was part of an online project for teachers. An online control list form and interviews were used as data collection tools. The results indicated that sharing, problem solving, product development, monitoring, and research were prominent activities that shape the study behaviors. While some of the behaviors in these activities indicated the reshaping of previous study behaviors, other behaviors newly appeared during the program. Characteristics of adult learners, online setting features, and the context of the projects were the main factors that influenced study behaviors. Finally, the implications for better online adult learning experiences are addressed.
Treatment patterns and outcomes in children with infantile hemangiomas: A retrospective observational analysis
Authors: Cai Yantao , Ge Ying , Ung Carolina Oi Lam , Li Fuli , Wang Jiaqi , Xia Chenglai , Hu Hao
Published: November 2021

Objective:

This study aimed to make use of real-world medical records to explore the clinical characteristics, treatments, and outcomes of infantile hemangiomas in southeastern China.

Methods:

This study applied a retrospective observational method using real-world data derived from the electronic medical records of the Foshan Women and Children Hospital, southeastern China dated between June 2014 and June 2019.

Results:

A total of 2427 patients with infantile hemangiomas were recruited in this study, including 942 (38.8%) males and 1485 (61.2%) females. Among the participants, 620 (25.5%) were high-risk infantile hemangioma, 449 (18.5%) were medium risk, and 1358 (56.0%) were low risk. A total of 14 treatment patterns in clinical practice were identified. The top 3 treatment patterns in each group of risk levels were the same: laser therapy, a combination of laser therapy and topical timolol maleate, and topical timolol maleate. The outcomes of the top 3 treatment patterns were significantly ( P < 0.05) different in each risk group.

Conclusion:

Among the top 3 treatment patterns, laser therapy or a combination of laser therapy and topical timolol maleate were more likely to have an “Excellent” outcome.
Quality of antenatal care and associated factors among pregnant women attending government hospitals in Sidama Region, Southern Ethiopia
Authors: Kare Assefa Philipos , Gujo Amelo Bolka , Yote Nigussie Yohanes
Published: November 2021

Background:

Good-quality antenatal care improves maternal health in the least developed countries. This study was aimed at assessing the quality of antenatal care and associated factors among pregnant women attending hospitals in the Sidama Region, Southern Ethiopia.

Method:

A facility-based cross-sectional study was conducted from 1 February to 30 April 2020 among 372 pregnant women. A two-stage sampling technique—the first stage, selection of health facilities; the second stage, selection of respondents—was used. Trained data collectors administered exit interviews. Data were entered into EPI Info 7 and analyzed using IBM SPSS version 25. Quality of care was assessed using a validated questionnaire containing 68 attributes of quality. Good quality of care was determined by the proportion of respondents who scored ⩾80% of 68 variables. Bivariable and multivariable logistic regressions were used in the analysis. The outputs were presented using an adjusted odds ratio with 95% confidence intervals.

Results:

This study revealed that 41.2% (95% confidence interval: 36.2%–46.2%) of pregnant women had received good-quality antenatal care. Increased odds of the utilization of quality antenatal care were observed among women who lived in urban areas (adjusted odds ratio = 4.32, 95% confidence interval: 2.58–7.21), attained primary education and more (adjusted odds ratio = 2.68, 95% confidence interval: 1.60–4.48), earned a monthly income >3000 Ethiopia Birr (US$93.3) (adjusted odds ratio = 3.86, 95% confidence interval: 2.28–6.51), and visited hospitals for antenatal care ⩾4 times (adjusted odds ratio = 3.68, 95% confidence interval: 2.21–6.10).

Conclusions:

The proportion of women who received good-quality antenatal care was low. Good quality care was associated with residence, education status, income level, and frequency of antenatal care visits. Training care providers, strengthening counseling, and promoting women’s economic empowerment to improve the utilization of quality antenatal care are recommended.
Magnitude of death and associated factors among road traffic injury victims admitted to emergency outpatient departments of public and private hospitals at Adama Town, East Shewa Zone, Ethiopia
Authors: Demisse Amare , Shore Hirbo , Ayana Galana Mamo , Negash Belay , Raru Temam Beshir , Merga Bedasa Taye , Alemu Addisu , Oljira Lemessa
Published: November 2021

Objectives:

Road traffic injuries, disabilities, and deaths have been a major public health problem worldwide and in Ethiopia. Globally, around 1.35 million people die every year on the roads and 20–50 million sustain nonfatal injuries as a result of road traffic crashes. This study aimed to assess the magnitude of deaths and associated factors among road traffic injury victims admitted to emergency outpatient departments of public and private hospitals at Adama town, East Shewa Zone, Ethiopia.

Methods:

Institution-based cross-sectional study was conducted among 381 road traffic injury victims admitted to hospitals in Adama town, East Shewa, Ethiopia, from 14 December 2019 to 29 February 2020. Data were collected using interviewer-administered structured questionnaires. Data were entered into EpiData version 4.6.0.2 and analyzed using SPSS version 21. Bivariable and multivariable logistic regressions were fitted to identify variables significantly associated with road traffic injury–related deaths and the results were presented with adjusted odds ratios and 95% confidence interval. Statistical significance was declared at p-value < 0.05.

Results:

The magnitude of deaths among road traffic injury victims were 12.9%. Age (25–44 years) (adjusted odds ratio = 4.24, 95% confidence interval = 1.70–10.61), rural resident (adjusted odds ratio = 2.26, 95% confidence interval = 1.11–4.55), pedestrian (adjusted odds ratio = 3.72, 95% confidence interval = 1.67–7.99), night-time injury (adjusted odds ratio = 5.29, 95% confidence interval = 2.52–11.10), injuries on weekends (adjusted odds ratio = 2.32, 95% confidence interval = 1.12–4.80), not getting first aid at injury site (adjusted odds ratio = 2.64, 95% confidence interval = 1.02–6.84), and known comorbidity conditions (adjusted odds ratio = 3.01, 95% confidence interval = 1.23–7.38) were significantly associated with road traffic injuries–related deaths.

Conclusion:

A significant proportion of road traffic injuries resulted in death. Age, place of residence, pedestrians, night-time injury, and not getting first aid were associated with road traffic injuries–related deaths. Preventive strategies that focus on young adults, rural residents, pedestrians, and people with comorbidities would minimize road traffic injuries–related deaths. Moreover, strict supervision on weekend and night-time drives, and providing accessible lifesaving first aid services would have significant importance.
The occurrence of urinary tract infection and determinant factors among diabetic patients at Dessie Referral Hospital, South Wollo, Northeast Ethiopia
Authors: Walelgn Betelhem , Abdu Mehd , Kumar Prem
Published: November 2021

Introduction:

Diabetic patients have a higher tendency of developing all infections, especially infections of the genitourinary tract. Urinary tract infections cause considerable disorders in diabetic patients, and if complicated, can cause renal failure. In Ethiopia, the magnitude of diabetes mellitus-associated urinary tract infections increased from 7.1% in 2005 to 33.9% in 2019. The successful management of patients suffering from urinary tract infections in diabetic patients depends upon the identification of risk factors. This study aimed to determine the magnitude and factors affecting the urinary tract infections among diabetic patients which enable professionals to prevent infections and manage them effectively.

Methods:

Hospital-based cross-sectional study was conducted with 365 diabetic patients selected by systematic sampling technique from March to April 2020. Data were collected by trained BSc nurses via face-to-face interview and patient chart review. Urine microscopy was done to diagnose urinary tract infections. Data were coded and entered using Epi data version 3.1 and exported to Statistical Package of Social Sciences version 26 for analysis. Variables with p-value < 0.25 in bivariable logistic regression were included multivariable logistic regression and variables with a p-value < 0.05 were considered statistically significant.

Results:

The magnitude of urinary tract infections was 22.3% (95% confidence interval: 18–27). The odds of being infected by urinary tract infections were significantly higher in diabetic females (adjusted odds ratio: 2.46; 95% confidence interval: 1.40–4.32), duration of diabetes mellitus diagnosis of ⩾5 years (adjusted odds ratio: 1.98; 95% confidence interval: 1.05–3.72), with comorbidity (adjusted odds ratio: 4.87; 95% confidence interval: 2.76–8.59) and khat chewer (adjusted odds ratio: 1.84; 95% confidence interval: 1.04–3.24) compared with their counter.

Conclusion and recommendation:

Urinary tract infections were high among diabetic patients. Predictors like sex, duration of diagnosis, comorbidity, and khat chewer were found to be associated with urinary tract infections. Improvement of the regular screening of patients with diabetes mellitus for urinary tract infections will provide more effective measures in prevention and management.
Does addition of craving management tools in a stop smoking app improve quit rates among adult smokers? Results from BupaQuit pragmatic pilot randomised controlled trial
Authors: Herbec Aleksandra , Shahab Lion , Brown Jamie , Ubhi Harveen Kaur , Beard Emma , Matei Alexandru , West Robert
Published: November 2021

Objectives

Delivery of craving management tools via smartphone applications (apps) may improve smoking cessation rates, but research on such programmes remains limited, especially in real-world settings. This study evaluated the effectiveness of adding craving management tools in a cessation app (BupaQuit).

Methods

The study was a two-arm pragmatic pilot parallel randomised controlled trial, comparing a fully-automated BupaQuit app with craving management tool with a control app version without craving management tool. A total of 425 adult UK-based daily smokers were enrolled through open online recruitment (February 2015–March 2016), with no researcher involvement, and individually randomised within the app to the intervention ( n = 208) or control ( n = 217). The primary outcome was self-reported 14-day continuous abstinence assessed at 4-week follow-up. Secondary outcomes included 6-month point-prevalence and sustained abstinence, and app usage. The primary outcome was assessed with Fisher's exact test using intent to treat with those lost to follow-up counted as smoking. Participants were not reimbursed.

Results

Re-contact rates were 50.4% at 4 weeks and 40.2% at 6 months. There was no significant difference between intervention and control arms on the primary outcome (13.5% vs 15.7%; p = 0.58; relative risk = 0.86, 95% confidence interval = 0.54–1.36) or secondary cessation outcomes (6-month point prevalence: 14.4% vs 17.1%, p = 0.51; relative risk = 0.85, 95% confidence interval = 0.54–1.32; 6-month sustained: 11.1% vs 13.4%, p = 0.55; relative risk = 0.83, 95% confidence interval = 0.50–1.38). Bayes factors supported the null hypothesis ( B[0, 0, 1.0986] = 0.20). Usage was similar across the conditions (mean/median logins: 9.6/4 vs 10.5/5; time spent: 401.8/202 s vs 325.8/209 s).

Conclusions

The addition of craving management tools did not affect cessation, and the limited engagement with the app may have contributed to this.
3D Virtual Reality Imaging of Major Aortopulmonary Collateral Arteries: A Novel Diagnostic Modality
Authors: van de Woestijne Pieter C. , Bakhuis Wouter , Sadeghi Amir H. , Peek Jette J. , Taverne Yannick J.H.J. , Bogers Ad J.J.C.
Published: November 2021

Background

Major aortopulmonary collateral arteries (MAPCAs), as seen in patients with pulmonary atresia, are arteries that supply blood from the aorta to the lungs and often require surgical intervention. To achieve complete repair in the least number of interventions, optimal imaging of the pulmonary arterial anatomy and MAPCAs is critical. 3D virtual reality (3D-VR) is a promising and upcoming new technology that could potentially ameliorate current imaging shortcomings.

Methods

A retrospective, proof-of-concept study was performed of all operated patients with pulmonary atresia and MAPCAs at our center between 2010 and 2020 with a preoperative computed tomography (CT) scan. CT images were reviewed by two congenital cardiac surgeons in 3D-VR to determine additional value of VR for MAPCA imaging compared to conventional CT and for preoperative planning of MAPCA repair.

Results

3D-VR visualizations were reconstructed from CT scans of seven newborns where the enhanced topographic anatomy resulted in improved visualization of MAPCA. In addition, surgical planning was improved since new observations or different preoperative plans were apparent in 4 out of 7 cases. After the initial setup, VR software and hardware was reported to be easy and intuitive to use.

Conclusions

This study showed technical feasibility of 3D-VR reconstruction of children with immersive visualization of topographic anatomy in an easy-to-use format leading to an improved surgical planning of MAPCA surgery. Future prospective studies are required to investigate the clinical benefits in larger populations.
Modeling the Continuance Intention to Use Automated Writing Evaluation Among Chinese EFL Learners
Authors: Li Rui
Published: November 2021

Despite the growing attention being paid to the use of Automated Writing Evaluation (AWE) in China, it is still uncertain what factors lie behind EFL (English-as-a-foreign-language) learners’ continuance intention to use it. To this end, by adding two external factors (i.e., computer self-efficacy and perceived ease of use) to the expectation confirmation model (ECM), we surveyed 345 Chinese EFL learners and tested a number of proposed hypotheses using their response data. Data were analyzed using descriptive statistics and structural equation modeling (SEM). Results demonstrated that four factors directly influenced EFL learners’ continuance intention to use AWE, of which perceived ease of use was the most significant factor. Furthermore, confirmation was the most important factor impacting on EFL learners’ satisfaction and perceived ease of use of AWE. Perceived ease of use of AWE played an important role in influencing EFL learners’ perceived usefulness of AWE. Implications regarding the findings were also discussed.
Analyzing of User Attitudes Toward Intention to Use Social Media for Learning
Authors: Yuan Deli , Rahman Muhammad Khalilur , Issa Gazi Md. Abu , Rahaman Md. Atikur , Hossain Mohammad Mainul , Akter Shaharin
Published: November 2021

The study has aimed to investigate the factors affecting university students’ attitude toward intention to use social media for learning. This study embraced a cross-sectional approach and gathered quantitative data via a Google form survey, which was collected by using social media platforms, from a total of 720 respondents. The hypotheses were tested using the partial least squares (PLS) method. The study found that social media literacy, perceived ease of use, perceived behavioral control, and perceived risk has significant positive influence on users’ attitude to use social media, while ICT facility and perceived usefulness has no significant impact on attitude. Users’ attitude has a significant relationship with their intention to use social media for learning. The users’ attitude was also found to successfully mediate the relationship of social media literacy, perceived ease of use, perceived behavioral control, and perceived risk with intention to use social media. Social media literacy and perceived risk have been measured as an influential construct since it is unreasonable to anticipate the correlation between social media literacy and perceived risk dimensions in social media.
“I Want That Life a Lot…How on Earth Do I Get That?” Examining Challenges for Men With Barth Syndrome in Their Transitions to Adulthood
Authors: Mazar Iyar , Moorman Sara M.
Published: November 2021

vFor youth with life-limiting chronic illnesses, transitioning to adulthood in line with age-norms may be difficult due to symptom severity and shortened survival. This study explores whether individuals with Barth syndrome (BTHS), a condition uniquely characterized by extreme prognostic uncertainty, experience similar or different challenges compared to youth with other conditions. During focus groups with adults with BTHS ( n = 12) and caregivers ( n = 13), participants reported that the ability to independently manage one’s health condition, the social/emotional impacts of BTHS, and the ability to set goals in the context of future uncertainty challenge their transition to adulthood. This aligns with prior research, indicating that prognostic uncertainty may hinder long-term goal setting in BTHS. Implications of these findings include providing strategies for identifying meaningful alternative goals for individuals with chronic illnesses to target, promoting increased autonomy earlier in youth, and fostering coping strategies to manage non-disease related impacts.
Treatment of Limerence Using a Cognitive Behavioral Approach: A Case Study
Authors: Wyant Brandy E
Published: November 2021

Limerence is an underresearched condition of unknown prevalence that causes significant loss of productivity and emotional distress to sufferers. Individuals with limerence display an obsessive attachment to a particular person or “limerent object” (LO) that interferes with daily functioning and the formation and maintenance of healthy relationships. The current study proposes a conceptualization of the condition in a 28-year-old individual and describes a treatment approach using cognitive-behavioral techniques, most notably exposure responsive prevention as used in the treatment of obsessive-compulsive disorder. The number and type of compulsive rituals performed by the treated individual were notably decreased at 9-month follow-up after treatment, and a subjective assessment of dysfunctional thought patterns related to the LO also suggested improvement. A novel screening instrument is presented, as validated screening instruments do not yet exist. Implications for diagnosis and treatment are discussed.
Times to Diagnosis, Staging, and Treatment of Head and Neck Cancer Before and During COVID‐19
Authors: Yao Peter , Cooley Victoria , Kuhel William , Tassler Andrew , Banuchi Victoria , Long Sallie , Savenkov Oleksandr , Kutler David Ivan
Published: November 2021

Objective

The coronavirus disease 2019 (COVID‐19) pandemic has reduced the demand for, and supply of, head and neck cancer services. This study compares the times to diagnosis, staging, and treatment of head and neck cancers before and during the COVID‐19 pandemic.

Study Design

Retrospective cohort study.

Setting

Tertiary academic medical center in New York City (NYC).

Methods

The times to diagnosis, staging, and treatment of head and neck cancer for patients presenting to the clinics of 4 head and neck oncology surgeons with newly diagnosed head and neck cancers were compared between pre–COVID‐19 and COVID‐19 periods.

Results

Sixty‐eight patients in the pre–COVID‐19 period and 26 patients in the COVID‐19 period presented with newly diagnosed head and neck cancer. Patients in the COVID‐19 group had a significantly longer time to diagnosis than the pre–COVID‐19 group after adjustment for age and cancer diagnosis (P =. 02; hazard ratio [HR], 0.54; 95% CI, 0.32‐0.92). Patients in the pre–COVID‐19 and COVID‐19 groups had no statistically significant differences in time to staging (P >. 9; HR, 1.01; 95% CI, 0.58‐1.74) or time to treatment (P =. 12; HR, 1.55; 95% CI, 0.89‐2.72).

Conclusion

This study found that time to diagnosis for head and neck cancers was delayed during a COVID‐19 period compared to a pre–COVID‐19 period. However, there was no evidence of delays in time to staging and time to treatment during the COVID‐19 period. Our results prompt further investigations into the factors contributing to diagnostic delays but provide reassurance that despite COVID‐19, patients were receiving timely staging and treatment for head and neck cancers.
High Tibial Osteotomy With Miniaci Planning Using Manual and Semiautomated Digital Measures
Authors: Micicoi Grégoire , Martz Pierre , Jacquet Christophe , Fernandes Levi Reina , Khakha Raghbir , Ollivier Matthieu
Published: November 2021

Background:

Inadequate deformity analysis and planning before high tibial osteotomy (HTO) may result in correction errors with unsatisfactory clinical results.

Indications:

The purpose of this article is to describe the deformity analysis and preoperative planning before HTO. This surgery is effective for young patients with compartmental mild knee osteoarthritis. A partial deformity analysis without considering the femoral or intra-articular deformity may lead to overcorrection or excessive joint line obliquity. Preoperative planning using the Miniaci method with manual or semiautomated digital measures may help to prevent these types of errors.

Technique Description:

Landmarks are used at the proximal femoral side, distal condyles, proximal tibial plateau, and talus borders to define angles automatically on PeekMed software. Fujisawa point is determined to be 50% of the length of the proximal tibia, and Miniaci method is performed after defining the weightbearing line. The method can be performed manually or semiautomatically with the software. In this last case, the optimal procedure to be done to correct the malalignment is proposed by the software which automatically does the opening of the osteotomy to match the desired weightbearing axis and displays the size of the wedge in millimeters.

Results:

The intraobserver and interobserver reproducibility were performed by 2 different analyses and 2 different observers. The precision of the measures was confirmed based on computed tomographic (CT) scan 3-dimensional measures defined as the gold standard. All the intraobserver and interobserver reproducibility correlation coefficients and precision were satisfactory compared with the gold standard. Hip-knee-ankle angle may vary because of weightbearing situations between CT and long-axis x-rays.

Discussion/Conclusion:

The interest of semiautomated software for angular value measurements is now well recognized, and the inclusion of anatomical landmarks allows accurate and reproducible angular value measurements. Automatic knee osteotomy planning analyzes the metaphyseal deformity of both the tibia and the femur, and the software suggests the optimal procedure with the degree of openness to obtain the desired mechanical axis without creating excessive joint line obliquity
Expression of CD47 and Calr in Myeloproliferative Neoplasms: Potential New Therapeutical Targets
Authors: Boasman Kristian , Simmonds Matthew J , Rinaldi Ciro R
Published: November 2021

Myeloproliferative neoplasms (MPN) are myeloid malignancies characterized by overproduction of mature blood cells, hyperplastic bone marrow and tendency to evolve into acute myeloid leukaemia. In solid tumours, calreticulin (CALR) overexpression produces a pro-phagocytic signal and is counteracted by concomitant expression of anti-phagocytic CD47, reflecting an apoptosis vs survival mechanism. Increases of both CALR and CD47 on the cell membrane have been observed in response to chemotherapy, however their role in myeloid malignancies is poorly understood.

Aims: Investigate the expression and cellular localisation of CALR and CD47 in untreated and treated patients with essential thrombocythemia (ET), polycythemia vera (PV) myelofibrosis (MF), in comparison with healthy controls.

Methods: Mononuclear cells were collected by Ficoll separation, from peripheral blood of 30 MPN (8 PV, 16 ET, 6 MF); 18 MPN patients received cyto-reductive therapies (Hydroxyurea, Anagrelide or Ruxolitinib); and 4 controls. Cells were fractionised into 4 compartments: membrane, cytoplasm, cytosol and nucleus. Proteins were extracted using TRIzol, with CALR and CD47 protein expression analysed by western blotting.

Results: Total CALR and CD47 protein expression increased in MPN samples compared with controls (CALR- 7.9 vs 5.1; CD47- 2.7 vs 2.2 fold, respectively). CD47 showed higher expression of its overall protein on MPN cell membranes when compared with CALR (22% vs 13.9%). We observed a significant reduction of CALR expression in all MPN subtypes when patients were treated with cyto-reductive agents (ET- untreated 43.3% vs treated 2%, PV- 3.6% vs 2.2%, ET- 21% vs 11%). Interestingly we have observed a significant increase in CD47 cell membrane expression after treatment in MF and PV (CD47 in MF- untreated 11.8% vs treated 34.3%, PV-11.4% vs 35.9%), suggesting an anti-phagocytic effect induced by cytotoxic drugs. In ET cell membranes however, CD47 expression is reduced after cyto-reductive treatment (22% vs 16.6%), suggesting instead a prophagocytic effect.

Summary/Conclusion: CD47, but not CALR, is overexpressed on the membrane of patients with MPN, suggesting a role for CD47 as a strong antiphagocytic signal responsible for immune survival in MPN. We observed a significant difference in CD47 expression across different MPN subtypes with a significant increase in CD47 expression in PV and MF but not ET when patients were exposed to cytoreduction. The use of anti-CD47 antibodies could represent a new strategy to enhance the treatment response in particular in PV and MF.

Figure 1 Figure 1.

Disclosures

No relevant conflicts of interest to declare.
Efficacy and Safety of Primary Thromboprophylaxis for the Prevention of Venous Thromboembolism in Patients with Cancer and Central Venous Catheter: A Systematic Review and Meta-Analysis
Authors: Li Allen , Brandt Willem , Brown Cameron , Wang Tzu-Fei , Ikesaka Rick , Delluc Aurelien , Wells Philip S. , Carrier Marc
Published: November 2021

Background

Venous thromboembolism (VTE) is a leading cause of mortality in patients with cancer and is associated with significant morbidity and healthcare expenditure. The risk of VTE is also increased following the insertion of a central venous catheter (CVC) for chemotherapy deliverance and supportive care. The risks and benefits of primary thromboprophylaxis in patients with cancer and newly inserted CVC are unclear.

Objective

We sought to assess the rates of VTE and major bleeding complications to determine the safety and efficacy of primary thromboprophylaxis in adult patients with cancer and a CVC.

Methods

A systematic search of MEDLINE, EMBASE, and all EBM was conducted. Randomized controlled trials (RCTs) of adult patients with cancer and a CVC receiving primary thromboprophylaxis or observation/placebo were included. The primary efficacy and safety outcomes were total VTE and major bleeding episodes, respectively.

Results

A total of 9 RCTs (3155 patients) were included in the analysis. The total rates of VTE were significantly lower in patients receiving primary thromboprophylaxis compared to those not receiving primary prevention (7.6% vs. 13%; Odds Ratio (OR) 0.51, 95% CI 0.32 to 0.82, p < 0.01, I² = 52%) (Figure 1). The rate of major bleeding complication was not increased in patients receiving thromboprophylaxis (0.9% vs. 0.7%; OR 1.12, 95% CI 0.29 to 4.40, p = 0.87, I² = 32%) (Figure 2).

Conclusions

Primary thromboprophylaxis significantly reduced the risk of VTE without increasing the risk of major bleeding complications in patients with cancer and CVC. Future studies are needed to confirm these findings.

Figure 1 Figure 1.

Disclosures

Wang: Servier: Membership on an entity's Board of Directors or advisory committees; Leo Pharma: Research Funding. Ikesaka: LEO Pharma: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees. Wells: Bristol-Myers Squibb: Honoraria; Pfizer: Honoraria; Bayer: Honoraria; BMS/Pfizer: Research Funding; Servier: Honoraria. Carrier: Servier: Honoraria; Boehringer Ingelheim: Honoraria; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Aspen: Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Honoraria; Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees; LEO Pharma: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi Aventis: Honoraria, Membership on an entity's Board of Directors or advisory committees.
PRMT5 Regulates Cell Pyroptosis By Silencing CASP1 in Multiple Myeloma
Authors: Xia Tian , Liu Ming , Zhao Quan , Zhou Rongfu , Chen Bing , Xu Peipei
Published: November 2021

Protein arginine methyltransferase 5 (PRMT5), a histone methyltransferase responsible for the symmetric dimethylation of histone H4 on Arg 3 (H4R3me2s), is an enzyme that participates in tumor cell progression in a variety of hematological malignancies. However, the biological functions of PRMT5 in multiple myeloma (MM) and the underlying molecular mechanisms remain unclear. In this study, we conducted a bioinformatics analysis and found that PRMT5 expression was significantly upregulated in MM. In vitro and in vivo phenotypic experiments revealed that knockdown of PRMT5 expression enhanced cell pyroptosis in MM. Moreover, we found that CASP1 expression was negatively correlated with PRMT5 expression, and repressing PRMT5 expression rescued both the phenotype and expression markers (N-GSDMD, IL-1b and IL-18). Inhibition of PRMT5 activity increased CASP1 expression and promoted MM cell pyroptosis. Finally, high expression of PRMT5 or low expression of CASP1 was correlated with poor overall survival in MM. Collectively, our results provide a mechanism by which PRMT5 regulates cell pyroptosis by silencing CASP1 in MM.

Disclosures

No relevant conflicts of interest to declare.
Enrollment of Black Americans in Pivotal Clinical Trials Supporting Food and Drug Administration (FDA) Chimeric Antigen Receptor (CAR)-T Cell Therapy Approval in Hematological Malignancies
Authors: Al Hadidi Samer , Schinke Carolina , Thanendrarajan Sharmilan , Zangari Maurizio , van Rhee Frits
Published: November 2021

INTRODUCTION

Black Americans are under-represented in clinical trials that supported FDA drug approvals of various hematological malignancies. (Al Hadidi et.al. Ann Intern Med 2020) CAR-T cell therapy, a new significant advancement in hematological malignancies, is currently approved for use in multiple myeloma (MM), acute lymphoblastic leukemia (ALL), diffuse large B cell lymphoma (DLBCL), mantle cell lymphoma (MCL) and follicular lymphoma (FL). Enrollment of Blacks in clinical trials that supported those approvals are not well described.

METHODS

We conducted a retrospective analysis of 7 pivotal clinical trials that resulted in approval of of tisagenlecleucel for ALL in 2017, axicabtagene ciloleucel for DLBCL in 2017, tisagenlecleucel for DLBCL in 2018, brexucabtagene autoleucel for mantle cell lymphoma in 2020, lisocabtagene maraleucel for DLBCL in 2020, axicabtagene ciloleucel for follicular lymphoma in 2021 and idecabtagene vicleucel for multiple myeloma in 2021. Prevalence-corrected estimates for enrollment of Blacks were calculated as the percentage of Blacks among clinical trial participants divided by the percentage of Blacks in the disease population (participation to prevalence ratio [PPR]).A range between 0.8 and 1.2 reflects similar representation of Black Americans in the trial and disease population Data on drug products and demographic subgroups were extracted from Drugs@fda which include publically available data from the FDA.

RESULTS

Efficacy was reported in 74% (782 of 1051 patients) of enrolled patients across all the approved CAR-T products. Blacks constituted only 3.6% (28 of 782) of treated patients. Most treated patients had DLBCL (58%) or MM (16%). Two of seven studies (29%) didn't report ethnicity/race and/or included Blacks under others ethnic category. Blacks constituted only 4% of DLBCL patients, 6% of MM patients and 1% across other indications. Adjusted prevalence measures showed very low PPR in MM (0.17), a disease that is more common in Blacks and relatively better enrollment, though still sub-optimal, in DLBCL (PPR: 0.6).

CONCLUSIONS

Blacks are under-represented in clinical trials that supported CAR-T therapies for various hematological malignancies especially in MM. Efforts should be made to enroll more Blacks in clinical trials that include novel, potentially beneficial CAR-T products.

Disclosures

No relevant conflicts of interest to declare.