bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Contributing to Success in Nursing School: Experiences of African American BSN Students
Authors: Coleman Jennifer J. , Harvey Nina R. , Pritchett Tameka
Published: July 2021

The nursing workforce is not keeping pace with the racial demographics in the United States. In addition, attrition rates for ethnic minorities in schools of nursing remain high. This qualitative study examined African American students’ perceptions of factors that affect successful completion of nursing school. Five themes emerged: being invisible, sense of isolation, proving myself, focus on school as protective, and being misunderstood. Findings suggest that attention to identified influencing factors may affect minority student graduation success, increasing the likelihood of a diverse nursing workforce.
Addressing Equity in Global Medical Education During the COVID-19 Pandemic: The Global Medical Education Collaborative
Authors: Posever Natalie , Sehdev Morgan , Sylla Mariame , Mashar Ruchir , Mashar Meghavi , Abioye Abubakar
Published: July 2021

Problem

The COVID-19 pandemic has presented a unique set of challenges to medical education globally. Low- and middle-income countries (LMICs) have faced unique barriers in transitioning to virtual modalities, and many medical students in LMICs experienced dramatically reduced educational time. The authors created the Global Medical Education Collaborative (GMEC) to address this problem by providing free, online, case-based tutorials to medical students in LMICs during the pandemic.

Approach

The authors developed a needs assessment to gauge students’ educational requirements, which informed GMEC’s 2 primary goals: to provide free access to interactive online tutorials for students in LMICs and to bridge the physical distance between educators and learners via an online platform. A pilot program in Nigeria (April 26–May 26, 2020) helped inform the current strategy and logistics. Tutors and students were recruited via social media and medical education networks at the authors’ home institutions.

Outcomes

Within the first 2 months (April 26–June 26, 2020), 324 students representing 12 countries and 20+ medical schools joined GMEC. Additionally, 95 physicians and trainees joined as tutors and, collectively, delivered 52 tutorials. Students responded to a needs assessment querying confidence in various clinical domains, interest in covering clinical topics, barriers to virtual learning, and the effect of the pandemic on their education. Tutors held 1-hour, interactive tutorials over Zoom covering a variety of clinical topics. According to surveys, 91% of students (71 of 78) felt more confident in the material related to the tutorial’s topic after participating.

Next Steps

GMEC will continue to engage students, tutors, and collaborators to facilitate the delivery of innovative, high-quality tutorials to students affected by COVID-19 in LMICs. To ensure that the platform is sustainable and aligned with GMEC’s mission to promote equity in global medical education, the collaborative will need to be agile and responsive.
Mutual Rewards: Engaging the Field and Creating a Path Toward Academic Journal Editorship
Authors: Thompson Paula Y. , Bynum William E. , Schumacher Daniel J. , Park Yoon Soo , Alexandraki Irene , Balmer Dorene F.
Published: July 2021

In this commentary, the inaugural cohort of Academic Medicine assistant editors shares their experiences in this role and the value of creating a path toward academic journal editorship for early- and mid-career scholars. They are a group with diverse backgrounds and a common commitment to advance scholarship in medical education. They collectively describe how they have contributed to the journal in multiple ways, reflect on how they navigated onboarding challenges in the midst of a pandemic, and, most important, share why this role matters for the medical education scholarship community. They express how the assistant editor role has been mutually rewarding, allowing the assistant editors to gain entry to academic journal editorship while also serving the journal and its community.
Mental Health Conditions and Substance Use Disorders Among Youth Subsequently Diagnosed With Opioid Use Disorder or Opioid Poisoning
Authors: Agbese Edeanya , Stein Bradley D. , Druss Benjamin G. , Dick Andrew W. , Pacula Rosalie L. , Leslie Douglas L.
Published: July 2021

Purpose

This study examined receipt of services for mental health conditions and non-opioid substance use disorders (SUDs) among privately insured adolescents and young adults (ie, youth) with subsequent clinically diagnosed opioid use disorder (OUD) or opioid poisoning.

Methods

Among individuals aged 12 to 25 years (N = 4926), healthcare service utilization claims for the 2 years before a newly clinically diagnosed OUD or opioid poisoning were assessed for mental health and nonopioid SUD service visits.

Results

Over half (60.6%) of the youth with clinically diagnosed OUD or opioid poisoning received mental health or nonopioid SUD services in the 2 years before the opioid poisoning or OUD diagnosis.

Conclusion

Many adolescents and young adults with clinically diagnosed OUD or opioid poisoning interacted with the healthcare system to receive services for mental health conditions and nonopioid SUDs before the OUD or opioid poisoning being diagnosed. Opportunities exist to design better intervention strategies to prevent OUD or opioid poisoning among adolescents and young adults.
Severe Pain Profiles and Associated Sociodemographic and Clinical Characteristics in Individuals With Sickle Cell Disease
Authors: Knisely Mitchell R. , Tanabe Paula J. , Yang Qing , Masese Rita , Jiang Meilin , Shah Nirmish R.
Published: July 2021

Objective:

The aim of this study was to identify classes of individuals with sickle cell disease (SCD) who share distinct severe pain profiles and evaluate differences in demographic, clinical, and psychosocial characteristics between classes.

Methods:

This exploratory, cross-sectional study used data collected for the SCD Implementation Consortium Research Registry at Duke University. Using Adult Sickle Cell Quality of Life-Measurement System pain-item data from 291 adults with SCD, latent class analysis was used to determine classes of individuals sharing distinct severe pain profiles. Bivariate analyses and logistic regression models were used to assess the relationships between pain profile classes and demographic, clinical, and psychosocial characteristics.

Results:

Three classes sharing distinct severe pain profiles were identified: Low Frequency and Impact class (n=73), Moderate Frequency and Impact class (n=94), and High Frequency and Impact class (n=124). When compared with the Low Frequency and Impact class and controlling for age and sex, individuals in the Moderate Frequency and Impact class were more likely to: be female (P=0.031) and unemployed (P=0.013); report worse sleep (P=0.005) and social functioning (P=0.005); have less emotional distress (P=0.004); describe pain as “sore” (P=0.002); and have previous SCD-related lung complications (P=0.016). When compared with the Low Frequency and Impact class, individuals in the High Frequency and Impact class: had worse social functioning (P<0.001) and previous SCD-related lung complications (P=0.006); described pain as “sore” (P<0.001); and were taking pain medication daily for SCD (P=0.001).

Discussion:

Severe pain experiences in SCD are complex; however, there are subgroups of people who report similar experiences of severe pain.
A Randomized Controlled Trial Evaluating the Analgesic Effect of the Combination of Methadone With Morphine for Cancer Related Pain
Authors: Duarte Feliciano C.N. , Ferraro Leonardo H.d.C. , Ferreira Alessandra , Sakata Rioko K.
Published: July 2021

Context and Objectives:

Although opioids play an indispensable role in the management of cancer-related pain, inadequate pain relief still occurs. The primary objective of this study was to evaluate whether the combination of a low dose of methadone with morphine promotes a reduction in opioid consumption; the secondary objectives were if the association promotes lower pain intensity, and adverse effects (AEs).

Materials and Methods:

A sample if 41 patients with cancer-related pain in palliative setting were included. Patients were starting the third step of the analgesic ladder, and 1 group (n=21) achieve methadone (2.5 mg/12 h) in combination with morphine/methadone, and another group (n=20) received morphine alone. Both groups could use morphine (5 mg) as needed to maintain pain intensity <4, and adjuvant in stable dose. The following outcomes were evaluated: total morphine dose, pain intensity, and AEs.

Results:

There was no difference in the number of adjuvants, and the dose of morphine used. Pain intensity was significantly lower in the morphine/methadone group after 2 weeks, with no statistically significant difference at other timepoints. There was no difference between groups in the AEs.

Conclusion:

Low dose of methadone in combination with morphine provided faster pain control as compared with morphine alone, and although this study was not powered to show differences in AEs, we did not notice a difference.
Perioperative Normal Saline Administration and Delayed Graft Function in Patients Undergoing Kidney Transplantation: A Retrospective Cohort Study
Authors: Kolodzie Kerstin , Cakmakkaya Ozlem S. , Boparai Eshandeep S. , Tavakol Mehdi , Feiner John R. , Kim Mi-Ok , Newman Thomas B. , Niemann Claus U.
Published: July 2021

Background

Perioperative normal saline administration remains common practice during kidney transplantation. The authors hypothesized that the proportion of balanced crystalloids versus normal saline administered during the perioperative period would be associated with the likelihood of delayed graft function.

Methods

The authors linked outcome data from a national transplant registry with institutional anesthesia records from 2005 to 2015. The cohort included adult living and deceased donor transplants, and recipients with or without need for dialysis before transplant. The primary exposure was the percent normal saline of the total amount of crystalloids administered perioperatively, categorized into a low (less than or equal to 30%), intermediate (greater than 30% but less than 80%), and high normal saline group (greater than or equal to 80%). The primary outcome was the incidence of delayed graft function, defined as the need for dialysis within 1 week of transplant. The authors adjusted for the following potential confounders and covariates: transplant year, total crystalloid volume, surgical duration, vasopressor infusions, and erythrocyte transfusions; recipient sex, age, body mass index, race, number of human leukocyte antigen mismatches, and dialysis vintage; and donor type, age, and sex.

Results

The authors analyzed 2,515 records. The incidence of delayed graft function in the low, intermediate, and high normal saline group was 15.8% (61/385), 17.5% (113/646), and 21% (311/1,484), respectively. The adjusted odds ratio (95% CI) for delayed graft function was 1.24 (0.85 to 1.81) for the intermediate and 1.55 (1.09 to 2.19) for the high normal saline group compared with the low normal saline group. For deceased donor transplants, delayed graft function in the low, intermediate, and high normal saline group was 24% (54/225 [reference]), 28.6% (99/346; adjusted odds ratio, 1.28 [0.85 to 1.93]), and 30.8% (277/901; adjusted odds ratio, 1.52 [1.05 to 2.21]); and for living donor transplants, 4.4% (7/160 [reference]), 4.7% (14/300; adjusted odds ratio, 1.15 [0.42 to 3.10]), and 5.8% (34/583; adjusted odds ratio, 1.66 [0.65 to 4.25]), respectively.

Conclusions

High percent normal saline administration is associated with delayed graft function in kidney transplant recipients.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Use of a Standardized Perioperative Care Path for Adolescent Idiopathic Scoliosis Leads to Decreased Complications and Readmissions
Authors: Sundar Swetha J. , Enders Jacob J. , Bailey Kevin A. , Gurd David P. , Goodwin Ryan C. , Kuivila Thomas E. , Ballock Robert T. , Young Ernest Y.
Published: July 2021

Study Design:

Retrospective review of patients ages 10–18 who underwent posterior fusion for adolescent idiopathic scoliosis (AIS) at a single institution from 2014 to 2019.

Objective:

The aim was to evaluate a standardized Care Path to determine its effects on perioperative outcomes in patients undergoing spinal fusion for AIS.

Summary of Background Data:

AIS is the most common pediatric spinal deformity and thousands of posterior fusions are performed annually. Surgery presents several postoperative challenges, such as pain control, delayed mobilization, and opioid-related morbidity. Optimizing perioperative care of AIS is a high priority to reduce morbidity and improving health care efficiency.

Materials and Methods:

A total of 336 patients ages 10–18 were included in this study; 117 in the pre-Care Path cohort (2014–2015) and 219 in the post-Care Path cohort (2016–2019). Data compared included intraoperative details, length of stay, timing of mobilization, inpatient complications, emergency room (ER) visits, readmissions after discharge, postoperative complications, and reoperations.

Results:

The post-Care Path cohort had improved mobilization on postoperative day 0 (pre 16.7%, post 53.3%, P<0.00001), reduced length of stay (pre 4.14 days, post 3.36 days, P=0.00006), fewer total inpatient complications (pre 17.1%, post 8.1%, P=0.0469), and fewer instances of postoperative ileus (pre 8.5%, post 1.9%, P=0.0102). Within 60 days of surgery, the post-Care Path cohort had fewer ER visits (pre 12.8%, post 7.2%, P=0.0413), decreased postoperative infections (pre 5.1%, post 0.48%, P=0.00547), decreased readmissions (pre 6.0%, post 0.48%, P=0.0021), and decreased reoperations (pre 5.1%, post 0.96%, P=0.0195). There was a decrease in inpatient oral morphine equivalents in the Care Path cohort (pre 118.7, post 84.7, P=0.0003).

Conclusions:

Our Care Path for AIS patients demonstrated significant improvements in postoperative mobilization and decreases in length of stay, complications, infections, ER visits, readmissions, and reoperations.
Downregulation of RPS14 inhibits the proliferation and metastasis of estrogen receptor-positive breast cancer cells
Authors: Wang Xiu , Yao Shuang , Luo Guanghua , Zhou Ying , Fang Qi
Published: July 2021

Ribosomal protein S14 (RPS14) is a component of the 40S ribosomal subunit and is considered to be indispensable for ribosomal biogenesis. Previously, we found that RPS14 was significantly downregulated in estrogen receptor-positive (ER+) breast cancer cells following treatment with 4-hydroxytamoxifen (4-OH-TAM). However, its role in breast cancer remains poorly understood. In the present study, we sought to demonstrate, for the first time, that RPS14 is highly expressed in ER+ breast cancer tissues and its downregulation can significantly inhibit the proliferation, cycle, and metastasis of ER+ breast cancer cells, as well as induce cell apoptosis. Quantitative RT-PCR and western blotting were used to determine the expression of target genes. Herein, lentivirus-mediated small hairpin RNA (shRNA) targeting RPS14 was designed to determine the impact of RPS14 knockdown on ER+ breast cancer cells. Further, bioinformatics analysis was used to reveal the significance of differentially expressed genes in RPS14 knockdown breast cancer cells. RPS14 was highly expressed in ER+ breast cancer tissues compared to ER− tissues. The downregulation of RPS14 in two ER+ breast cancer cell lines suppressed cell proliferation, cell cycle and metastasis, and induced apoptosis. Based on bioinformatics analysis, the expression level of several significant genes, such as ASNS, Ret, and S100A4, was altered in breast cancer cells after RPS14 downregulation. Furthermore, the BAG2 and interferon signaling pathways were identified to be significantly activated. The downregulation of RPS14 in ER+ breast cancer cells can inhibit their proliferation and metastasis.
(cRGD)2 peptides modified nanoparticles increase tumor-targeting therapeutic effects by co-delivery of albendazole and iodine-131
Authors: Liu Shengli , Liu Honglian , Sun Hao , Deng Shengming , Yue Ling , Weng Zhen , Yang Jianfeng , Zuo Bin , He Yang , Zhang Bin
Published: July 2021

Albendazole (ABZ), a clinical antiparasitic drug, has shown potential antitumor effects in various tumors. Herein, we prepared dimeric cRGD [(cRGD)2] modified human serum albumin (HSA) nanosystem to co-delivery of albendazole (ABZ) and iodine-131 (131I) for chemoradiotherapy of triple-negative breast cancer (TNBC). HSA@ABZ NPs were synthesized by the self-assembly method. 131I-(cRGD)2/HSA@ABZ NPs were fabricated through covalently binding HSA@ABZ NPs with (cRGD)2 peptides, followed by chloramine T direct labeling with 131I. In vitro therapeutic effects on TNBC (MDA-MB-231 and 4T1 cells) were determined using MTT assay, crystal violet assay, wound-healing assay and western blotting analysis. In vivo treatment was performed using 4T1-bearing mice, and the tumor-targeting efficacy was assessed by gamma imaging. The distribution of NPs was quantitatively analyzed by detecting the gamma counts in tumor and main organs. The nanoparticles possessed negative charge, moderate size and good polydispersity index. Dual responding to pH and redox, the in vitro release rate of ABZ was more than 80% in 72 h. In vitro, NPs inhibited the proliferation of TNBC cells in a concentration-dependent manner and decreased cell migration. Western blotting analysis showed that the NPs, as well as free ABZ, cell-dependently induced autophagy and apoptosis by restraining or promoting the expression of p-p38 and p-JNK MAPK. In vivo, gamma imaging exhibited an earlier and denser radioactivity accumulation in tumor of 131I-(cRGD)2/HSA@ABZ NPs compared to NPs free of (cRGD)2 conjugating. Furthermore, 131I-(cRGD)2/HSA@ABZ NPs significantly suppressed tumor growth by restraining proliferation and promoting apoptosis in vivo. Our study suggested that the nanoparticles we developed enhanced tumor-targeting of ABZ and increased antitumor effects by combination of chemotherapy and radiotherapy.
Afatinib in the treatment of brain metastases of lung cancer with one rare EGFR mutation: a two-case report
Authors: Sun Liwei , Li Bing , Wang Bin , Li Jinduo , Li Jing
Published: July 2021

Brain metastasis is one of the common distant metastases of lung cancer. The prognosis of patients with brain metastasis is worse and the survival time is shorter. In this report, we described a rare mutation of EGFR G2607A (rs1050171) in two patients over 50 years of age with brain metastasis of lung cancer. These two patients were both treated with afatinib, followed up for 13 months and 45 months respectively. Both patients showed that the tumor subsided, the curative effect was identified as partial response (PR), no recurrence and progress occurred and still being under follow-up. Our study provides a support that afatinib may be a reasonable therapeutic option for patients with brain metastasis of lung cancer.
Early renal and vascular damage within the normoalbuminuria condition
Authors: Santiago-Hernandez Aranzazu , Martin-Lorenzo Marta , Martínez Paula J. , Gómez-Serrano María , Lopez Juan Antonio , Cannata Pablo , Esteban Vanesa , Heredero Angeles , Aldamiz-Echevarria Gonzalo , Vázquez Jesús , Ruiz-Hurtado Gema , Barderas Maria G. , Segura Julian , Ruilope Luis M. , Alvarez-Llamas Gloria
Published: July 2021

Objective:

A continuous association between albuminuria and cardiorenal risk exists further below moderately increased albuminuria ranges. If only based in albumin to creatinine ratio (ACR) higher than 30 mg/g, a significant percentage of individuals may be out of the scope for therapeutic management. Despite epidemiological outcomes, the identification of biochemical changes linked to early albuminuria is underexplored, and normoalbuminuric individuals are usually considered at no risk in clinical practice. Here, we aimed to identify early molecular alterations behind albuminuria development.

Methods:

Hypertensive patients under renin–angiotensin system (RAS) suppression were classified as control, (ACR < 10 mg/g) or high-normal (ACR = 10–30 mg/g). Urinary protein alterations were quantified and confirmed by untargeted and targeted mass spectrometry. Coordinated protein responses with biological significance in albuminuria development were investigated. Immunohistochemistry assays were performed in human kidney and arterial tissue to in situ evaluate the associated damage.

Results:

A total of 2663 identified proteins reflect inflammation, immune response, ion transport and lipids metabolism (P value ≤ 0.01). A1AT, VTDB and KNG1 varied in high-normal individuals (P value < 0.05), correlated with ACR and associated with the high-normal condition (odds ratio of 20.76, 6.00 and 7.04 were found, respectively (P value < 0.001)). After 12 months, protein variations persist and aggravate in progressors to moderately increased albuminuria. At tissue level, differential protein expression was found in kidney from individuals with moderately increased albuminuria and atherosclerotic aortas for the three proteins, confirming their capacity to reflect subclinical organ damage.

Conclusion:

Early renal and vascular damage is molecularly evidenced within the normoalbuminuria condition.
Self-reported periodontal health and incident hypertension: longitudinal evidence from the NutriNet-Santé e-cohort
Authors: Carra Maria Clotilde , Fessi Sabrine , Detzen Laurent , Darnaud Christelle , Julia Chantal , Hercberg Serge , Touvier Mathilde , Andreeva Valentina A. , Bouchard Philippe
Published: July 2021

Objective:

An association between periodontitis and arterial hypertension has been suggested recently. This study aimed at investigating the hypothesis that periodontal health is linked to incident arterial hypertension.

Methods:

We analyzed data from the French population-based e-cohort NutriNet-Santé, selecting participants who had completed two oral health questionnaires in 2011–2012. Pregnant women, participants with diabetes, cancer, arterial hypertension and cardiovascular diseases at inclusion were excluded. Incident cases of arterial hypertension were self-reported and/or based on the use of antihypertensive therapy. Periodontal health was evaluated by estimating the modified and validated PEriodontal Screening Score (mPESS), with mPESS at least 5 corresponding to a high probability of severe periodontitis. Descriptive statistics and Cox proportional hazards regression models, taking into account sociodemographic and lifestyle confounders, were used.

Results:

The study population consisted of 32 285 participants (mean age: 45.79 ± 13.87 years); 78.5% were women. Two thousand one hundred and sixteen incident cases of arterial hypertension were identified during a median follow-up of 8 years (April 2012--December 2019). In the fully adjusted model, an mPESS at least 5 [hazard ratio: 1.84; 95% confidence interval (CI): 1.66–2.03] and the presence of nonreplaced missing teeth (hazard ratio: 1.13; 95% CI: 1.03–1.23) were significantly associated with a greater risk of incident arterial hypertension, whereas a regular annual visit to the dentist was associated with a lower risk (hazard ratio: 0.88; 95% CI: 0.80–0.97).

Conclusion:

Self-reported assessed periodontitis was associated with incident arterial hypertension over an 8-year period. The present results highlight the importance of considering periodontal health when assessing an individual's risk of arterial hypertension.

Trial registration:

# NCT03335644
Prenatal X-ray Exposure and the Risk of Developing Pediatric Cancer—A Systematic Review of Risk Markers and a Comparison of International Guidelines
Authors: Wit Fleur , Vroonland Colinda C.J.J. , Bijwaard Harmen
Published: July 2021

Since the first Oxford Survey of Childhood Cancer’s results were published, people have become more aware of the risks associated with prenatal exposure from diagnostic x rays. As a result, it has since been the subject of many studies. In this review, the results of recent epidemiological studies are summarized. The current international guidelines for diagnostic x-ray examinations were compared to the review. All epidemiological studies starting from 2007 and all relevant international guidelines were included. Apart from one study that involved rhabdomyosarcoma, no statistically significant associations were found between prenatal exposure to x rays and the development of cancer during 2007–2020. Most of the studies were constrained in their design due to too small a cohort or number of cases, minimal x-ray exposure, and/or data obtained from the exposed mothers instead of medical reports. In one of the studies, computed tomography exposure was also included, and this requires more and longer follow-up in successive studies. Most international guidelines are comparable, provide risk coefficients that are quite conservative, and discourage abdominal examinations of pregnant women.
Evaluation of Migration Radiological Equivalence for Dual Component Nuclear Waste in a Deep Geological Repository
Authors: Ivanov V. K. , Spirin E. V. , Menyajlo A. N. , Chekin S. Y. , Lovachev S. S. , Korelo A. M. , Tumanov K. A. , Solomatin V. M.
Published: July 2021

The paper is concerned with the issue of achieving the radiological equivalence (the equivalence of radiation risks) of radioactive waste of nuclear reactors and corresponding mass of natural uranium, taking into account the different migration ability of radionuclides in geological formations and soil. This migration radiological equivalence is being investigated for the deep burial of radioactive waste in the case of the development of a two-component nuclear power system with the concurrent use of thermal neutron reactors and fast neutron reactors. Calculations were performed of radiation doses and radiation risks of cancer death arising from consumption of drinking water from a well above a disposal site. The radiation risk relating to a two-component nuclear power system is lower than that from natural uranium; i.e., after reaching the radiological equivalence (100 y of storage) over the timescale of 109 y, the principle of migration radiological equivalence is satisfied. It would take 106 y after radioactive waste disposal to reach the migration radiological equivalence if only thermal reactors were operated. As regards consumption of well drinking water, the radiation risk does not exceed 10−5 y−1 for a two-component nuclear power system, while being 10−3 y−1 (socially unacceptable level) for a power system using only thermal reactors. Radionuclides 241Am, 239Pu, and 240Pu in drinking water make the main contribution to the doses and radiation risks of people for 104 y after the disposal of radioactive waste.
Era of “Dr. YouTube”: Evaluation of YouTube Videos as a Valid Source for Patient Education on Keratoconus
Authors: Ozdemir Zeydanli E. , Alkan Abdurrahman A.
Published: July 2021

Objective:

To evaluate the content, quality, and reliability of keratoconus-related YouTube videos as sources for patient education.

Methods:

YouTube was queried using the keywords “keratoconus,” “contact lenses for keratoconus,” “corneal cross-linking,” and “corneal transplant surgery for keratoconus.” Two ophthalmologists independently classified videos as useful, misleading, or patient testimonials and rated them using the DISCERN score (range, 16–75), Journal of the American Medical Association score (JAMAS; range, 0–4), Global Quality Score (GQS; range, 1–5), and Keratoconus-Specific Score (KSS; range, 0–32). Interrater agreement was analyzed using intraclass correlation coefficients. Multivariate linear regression models were fitted to identify factors associated with quality and popularity indices.

Results:

Of the 300 videos screened, 201 were included in the study, 58% were classified as useful, 13% as misleading, and 29% as patient views. Overall video quality was poor, with an average DISCERN score of 22, JAMAS of 1.2, GQS of 1.8, and KSS of 4.5. Misleading videos scored significantly lower than average but had higher popularity compared with useful videos. Video length inversely correlated with popularity index. Television shows were more likely to share misleading information than other uploaders, whereas all videos uploaded by university channels provided useful information but constituted only 12% of all videos.

Conclusions:

Videos rated the best source of information were not the ones most popular. YouTube has great potential to change the attitude of individuals both for and against the right choice. Therefore, health professionals should act to use this potential in favor of effective and reliable health communication.
Pregnancy and the eye
Authors: Khong Edmund W.C. , Chan Helen H.L. , Watson Stephanie L. , Lim Lyndell L.
Published: July 2021

Purpose of review

The aim of this study was to summarize common eye changes that may occur during pregnancy, and how pregnancy may affect preexisting eye conditions such as glaucoma and diabetic retinopathy. Challenges and complexities surrounding the treatment of these eye conditions during pregnancy are also highlighted.

Recent findings

Refractive changes are common and may persist in the postpartum in patients with keratoconus. Although new medical and surgical glaucoma treatments are available, their safety in pregnancy is unknown. Limited use of topical and systemic glaucoma therapies is recommended, with a preference for selective laser trabeculoplasty as first line treatment in appropriate cases. The impact of pregnancy on diabetic retinopathy remains unclear. Although anti-vascular endothelial growth factor agents are first-line treatment for sight-threatening diabetic retinopathy, their effect on the developing foetus remains unknown and are therefore best avoided in the first and second trimesters. Noninfectious uveitis tends to become less active during pregnancy, allowing the potential tapering of systemic therapy and the use of local topical or injected corticosteroid treatment for active disease as required.

Significant changes can occur to the eye during pregnancy, wherein the optimal treatment for many ocular conditions remains uncertain, highlighting the need for further research to develop clear recommendations that best balance the need to preserve the mother's sight, and the health of the developing foetus. The need for preconception planning, and collaborative multidisciplinary care between the obstetrician, physician, ophthalmologist and paediatrician is paramount.
Roles and mechanisms of circulating CEACAM1 in the cirrhosis-related intestinal hyperpermeability: in vitro approach
Authors: Hsu Chien-Fu , Lin Ming-Wei , Huang Chia-Chang , Li Tzu-Hao , Liu Chih-Wei , Huang Shiang-Fen , Yang Ying-Ying , Huang Yi-Hsiang , Hou Ming-Chih , Lin Han-Chieh
Published: July 2021

Background:

Cirrhosis-related intestinal hyperpermeability and endotoxemia are characterized by intestinal epithelial cell apoptosis, impaired restitution (proliferation and migration), decreased tight junction protein levels, and subsequent barrier dysfunction. In addition to endotoxin and tumor necrosis factor-α (TNFα), carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) plays crucial roles in the regulation of apoptosis, restitution, tight junction protein-maintained barrier function of intestinal epithelial cells.

Methods:

This study aims to explore the roles and underlying mechanisms of CEACAM1 in cirrhosis-related intestinal hyperpermeability through in vitro approach.

Results:

In cirrhotic patients, high serum levels of intestinal hyperpermeability (zonulin and endotoxin) markers were accompanied by elevated serum levels of TNFα and soluble CEACAM1. In in vitro experiments, we evaluated the individual and interacted roles of TNFα and human recombinant CEACAM1 (hrCEACAM1) in LC-sera (sera of cirrhotic patients)-induced intestinal hyperpermeability-related pathogenic signals. In the cell Line human from human colon (Caucasian colon adenocarcinoma) (Caco-2) cell culture, LC-sera, TNFα, and hrCEACAM1 increased apoptosis (measured by Terminal deoxynucleotidyl transferase [TdT] dUTP nick end labeling+/annexin-5+propidium iodide+ cells and caspase-3 activity), decreased restitution capacity (proliferation and migration), and disrupted tight junction protein-maintained barrier function in Caco-2 cells. The pathogenic changes mentioned above were accompanied by an increase in intracellular reactive oxygen species (ROS) levels, lactate dehydrogenase release, and endoplasmic reticulum stress-related signals in the LC-sera or TNFα-pretreated Caco-2 cells. Concomitant incubation of Caco-2 cells with anti-CEACAM1 suppressed these LC-sera or TNFα-induced negative effects on restitution, barrier function, and cell viability.

Conclusion:

This study demonstrated that sera from cirrhotic patients contain soluble CEACAM1, which is involved in the pathogenesis of intestinal hyperpermeability. Accordingly, it is noteworthy to explore the potential use of anti-CEACAM1 treatment for cirrhosis-related intestinal hyperpermeability and endotoxemia.
Treatment of hyperprolactinemia: A single-institute experience
Authors: Chen Tse-Yu , Lee Chung-Hsin , Yang Meng-Yin , Shen Chiung-Chyi , Yang Yin-Ping , Chien Yueh , Huang Yu-Fen , Lai Chih-Ming , Cheng Wen-Yu
Published: July 2021

Background:

Dopamine agonists such as bromocriptine and cabergoline have been found to be an effective treatment for hyperprolactinemia, not only inducing adenoma shrinkage but also lowering serum prolactin levels. Among known dopamine agonists, cabergoline is the drug of choice due to its enhanced tolerability compared with bromocriptine. This study aimed to evaluate cabergoline’s effectiveness, along with transsphenoidal surgery, in the treatment of hyperprolactinemia.

Methods:

We retrieved all patients with a diagnosis of prolactinoma who were treated in our hospital during 2000–2018. A total of 208 patients were enrolled in the analysis after applying exclusion criteria. Patients were divided into four groups according to the treatments received. The demographic data, dosage and duration of cabergoline, and serum prolactin levels at different time points were collected for analysis.

Results:

Normalization was achieved in 59 patients (83.10%) within a short median duration of 2.80 months among those treated with cabergoline only. Although cabergoline alone was effective and well-tolerated, our data showed that long-term remission rates were more favorable when surgery was involved. The long-term remission rate of all patients enrolled was 53.8% (112 patients among 208 patients). The long-term remission rates for the different treatment groups were 17.8% (8 of 45 patients) in Group 1 (Operation→Drug), 83.3% (5 of 6 patients) in Group 2 (Drug→Operation), 79.0% (68 of 86 patients) in Group 3 (Operation only), and 43.7% (31 of 71 patients) in Group 4 (Drug only).

Conclusion:

Cabergoline has been demonstrated to be effective and should be considered as a first-line treatment for hyperprolactinemia. In our study, transsphenoidal surgery was also demonstrated to achieve good results compared with medical treatment. Surgical intervention may resurface as an alternative first-line treatment. When used in combination with cabergoline, surgery offers a higher disease remission rate than either drug or operation alone.
Toxicity-induced Cardiomyopathy in a Patient with Femoral Sarcoma: Heart Transplantation After Support with Ventricular Assist Device as Bridge to Transplantability
Authors: del Maria Javier Mariano Francisco , Javier Delmo Eva Maria , Hetzer Roland
Published: July 2021

This case report exemplifies how a ventricular assist device successfully supported a 15 year old tumor patient with anthracycline-induced cardiomyopathy for 419 days until she was confirmed free from tumor recurrence to undergo heart transplantation, presently with an 18 year follow up without any malignancy.
Limb Amputation Following Extracorporeal Membrane Oxygenation Therapy Among Survivors: A Nationwide Cohort Study from South Korea
Authors: Cho Hyoung-Won , Song In-Ae , Oh Tak Kyu
Published: July 2021

We aimed to investigate the incidence of limb amputation due to vascular complications related to extracorporeal membrane oxygenation (ECMO) therapy among survivors and examine its association with long-term mortality in these cases. Data from the National Health Insurance Service database in South Korea were extracted for this population-based cohort study. Adult people who underwent ECMO therapy between 2005 and 2018 were included. ECMO survivors were defined as those who survived for at least 365 days after the initiation of ECMO therapy. A total of 6,968 ECMO survivors were included in the study. Among them, 114 (1.6%) underwent limb amputation within 365 days of starting ECMO therapy. On multivariable Cox regression analysis, the risk of 3-year all-cause mortality was not significantly associated with limb amputation compared with those without limb amputation (hazard ratio: 1.53; 95% CI: 0.89–2.63; P = 0.072). In South Korea, 1.6% of ECMO survivors underwent limb amputation within 365 days after initiating ECMO therapy; however, it was not significantly associated with the 3-year all-cause mortality. Our findings warrant future studies on the impact on the quality of life and morbidity-related implications among patients who undergo limb amputation due to ECMO therapy.
Natural History and Prognosis of Patients with Unrepaired Tricuspid Regurgitation Undergoing Implantation of Left Ventricular Assist Device
Authors: Itzhaki Ben Zadok Osnat , Ben-Avraham Binyamin , Barac Yaron D. , Hammer Yoav , Rubachevski Victor , Shaul Aviv , Vaturi Mordehay , Mats Israel , Arnavitzki Rosana , Aravot Dan , Kornowski Ran , Ben Gal Tuvia
Published: July 2021

We aimed to describe the natural history of left ventricular assist device (LVAD)-supported patients with preimplantation significant tricuspid regurgitation (TR) in a single-center retrospective analysis of LVAD-implanted patients (2008–2019). TR severity was assessed semiqualitatively using color-Doppler flow: insignificant TR (iTR) was defined as none/mild TR and significant TR (sTR) as ≥moderate TR. Included were 121 LVAD-supported patients of which 53% (n = 64) demonstrated sTR preimplantation. Among patients with pre-LVAD implantation sTR and available echocardiographic data, 55% (n = 26) ameliorated their TR severity grade to iTR during the first-year postsurgery and 55% (n = 17) had iTR at 2-year follow-up. On univariate analysis, predictors for TR severity improvement post-LVAD implantation were preimplant lack of atrial fibrillation, reduced inferior vena cavae diameter, and elevated pulmonary vascular resistance. In patients who failed to improve their TR severity grade, we observed a deterioration in right ventricular (RV) function (pulmonary artery pressure index 2.0 [1.7, 2.9], a decline in RV work index 242 [150, 471] mm Hg·L/m2) and higher loop-diuretics dose requirement. At a median of 21 (IQR 8, 40) months follow-up, clinical LVAD-related complications, heart failure-hospitalizations, and overall survival were similar among patients who improved versus failed to improve their TR severity-grade post-LVAD implantation. In conclusion, LVAD implantation is accompanied by a reduction in TR severity in approximately 50% of patients. In patients who failed to improve their TR severity grade, progressive RV dysfunction was observed. Overall, an isolated LVAD implantation in patients with sTR does not adversely affect survival.
Effect of Colchicine in Reducing Inflammatory Biomarkers and Cardiovascular Risk in Coronary Artery Disease: A Meta-analysis of Clinical Trials
Authors: Sethuramalingam Sujitha , Maiti Rituparna , Hota Debasish , Srinivasan Anand
Published: July 2021

Background:

Colchicine's role in reducing inflammation and cardiovascular adverse events despite standard care in coronary artery disease (CAD) is controversial.

Study Question:

Can colchicine reduce inflammation [high-sensitivity C-reactive protein (hs-CRP)] in CAD?

Data Sources:

PubMed, Cochrane Library, and Trial registries.

Study Design:

The meta-analysis included 15 studies using add-on colchicine in patients with CAD. The outcomes evaluated were hs-CRP, white blood cell and neutrophil count, a composite end point of major cardiovascular events, myocardial infarction (MI), cardiovascular and all-cause mortality, and gastrointestinal adverse events. The analysis was performed using a random-effects model to calculate pooled mean difference and odds ratio (OR).

Results:

The meta-analysis revealed a mean reduction of 0.36 mg/L in hs-CRP levels [95% confidence interval (CI): −0.51 to −0.20] with add-on colchicine. The mean white blood cell reduction of 371.75 per µL (95% CI: −544.27 to −199.24) and the mean neutrophil reduction also favored the add-on colchicine group. There was a reduction in composite end point of major cardiovascular events [OR, 0.65 (95% CI: 0.51–0.83)] and MI [OR, 0.77 (95% CI: 0.63–0.95)] with add-on colchicine therapy. There was no reduction in cardiovascular/overall mortality. Gastrointestinal adverse events were less with low-dose colchicine than those with high dose.

Conclusion:

Add-on colchicine has reduced the inflammation in CAD as implicated by a decrease in inflammatory markers. It has also lowered the incidence of MI but not mortality. With this present trend, the authors recommend further trials to validate the effectiveness of add-on colchicine in the secondary prevention of CAD.
Toolkit to Increase Provider Knowledge, Comfort, and Adoption of POLST
Authors: Gedney-Lose Amalia , Hand Linda Liu , McCarthy Ann Marie
Published: July 2021

Background:

POLST—Portable Medical Orders—abbreviated as POLST, is a nationwide initiative to help providers document and meet a patient's end-of-life wishes.

Problem:

Provider completion of POLST documents in primary care can promote continuity and implementation of patient preferences at the end of life in community-dwelling adults. Educating and providing a clinical process to support POLST use may improve implementation.

Approach:

A POLST toolkit was developed for primary care providers with measurement of knowledge, comfort, and likelihood of use with pre- and postsurvey data collection. The POLST toolkit was used to engage primary care providers in an educational session to enhance understanding and increased utilization.

Outcomes:

Providers reported increased knowledge, self-reported comfort, and likelihood of using POLST documents.

Conclusions:

Utilization of a POLST toolkit, with an educational component, improved provider interest in POLST implementation.
Specific Elements of Team-Based Learning Used in Nursing Education
Authors: Considine Julie , Berry Debra , Allen Joshua , Hewitt Nicky , Oldland Elizabeth , Sprogis Stephanie K. , Currey Judy
Published: July 2021

Background

Team-based learning (TBL) is an evidence-based, highly structured teaching strategy.

Purpose

The purpose of this review was to explore the specific TBL structure and process design elements reported in nursing education studies.

Methods

A scoping review was undertaken according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Databases were searched on February 15, 2021, using search terms related to nursing, education, and TBL.

Results

Of 226 potentially relevant citations, 45 studies were included. The specific TBL design elements reported were team size (n = 41), team formation (n = 24), readiness assurance process (n = 45), immediate feedback (n = 42), activity sequencing (n = 42), 4S application design (n = 13), incentive structure(s) (n = 22), and peer evaluation (n = 13).

Conclusions

There was variability in the reporting of TBL design elements. Preclass preparation and individual and team Readiness Assurance Tests were well reported. Application exercise design and approach to peer evaluation were gaps in the included studies.
The Future Capacity of the Nursing Workforce
Authors: Mannino Jennifer Emilie , Watters Pamela , Cotter Elizabeth , Armstrong Normadeane , Moore Geraldine A. , Bongiorno Anne Watson , Kelley Randy
Published: July 2021

Background

Nurses are concerned for their safety and conflicted about their career, because their duty to care for patients during the pandemic involved competing ethical obligations, including their own personal safety.

Purpose

The aim was to explore the impact of COVID-19 on new nurses and nursing students in terms of safety and interest in nursing specifically related to self-efficacy, geographic region case density, and frontline experience in health care.

Methods

New nurses and nursing students (N = 472) responded to an online survey examining self-efficacy, sense of safety, and interest in nursing. The survey included an open-ended question to support response interpretation.

Results

Researchers identified significant differences among new nurses and students from contrasting case-dense regions in terms of safety and interest in nursing.

Conclusion

Concerns about personal safety and the safety of others were apparent. Over time, this may lead to a decrease in willingness to enter or remain in the nursing profession.
Barriers to Care and Root Cause Analysis of LGBTQ+ Patients’ Experiences
Authors: Nair Julie McCulloh , Waad Alex , Byam Stacey , Maher Madeline
Published: July 2021

Background

LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning, and others) people face a unique set of barriers to receiving quality healthcare. Very little exists in nursing literature that addresses these barriers.

Objective

This study aimed to analyze patient experience data to better understand the context of barriers to care that LGBTQ+ patients experience, in addition to institutional responses.

Methods

Documentary analysis was employed to review four LGBTQ+ patient experiences that resulted in formal feedback provided to the Office of Patient Relations. Each case was analyzed for content, process, and outcomes.

Results

Through the outlined analysis, the study team found three primary themes and five secondary themes across the four cases. The overarching themes identified through the study’s case review include (a) lack of provider knowledge, (b) lack of patient-centered care, and (c) lack of institutional infrastructures associated with the provision of affirming care to LGBTQ+ individuals.

Discussion

Findings suggest the need for a multipronged approach when addressing the care of LGBTQ+ communities. A combination of provider-level education and institutional capacity building to treat diverse patient populations is necessary for addressing the issues demonstrated within the data. Moreover, further research is needed to identify unique needs of transgender and nonbinary patients and determine efficacy of institutional efforts to build capacity for caring and studying the health needs of LGBTQ+ communities.