bluuebunny/crossref_metadata_2025 huggingface dataset:
Content and structure of ward rounds focusing interprofessional collaboration on an internal medicine ward: An observational study of interprofessional collaboration
Authors: Källén Ella , Nimström Stephanie , Rosengren Kristina
Published: November 2021

Ward rounds are crucial for the exchange of information among healthcare professionals to achieve joint planning and shared decision-making in healthcare to enhance patient safety. The aim of this study was to describe the content and structure of ward rounds focusing on interprofessional collaboration on an internal medicine ward at a university hospital in Western Sweden. An inductive qualitative approach was used to explore 13 participatory observations of ward rounds (sitting/team rounds). Qualitative content analysis was used. The analysis revealed one category, titled interprofessional teamwork, that utilises all available resources, which consisted of three subcategories: usefulness of specialist competencies, collaboration for patient safety, and leading healthcare to achieve goal fulfilment. It was also found that the participating specialists’ competencies were not being optimally used before patients were discharged from the hospital. Therefore, communication and leadership skills were revealed as ways to improve interprofessional teamwork to achieve goal fulfilment and patient safety regarding care and treatment issues on the ward. We found that reversing the order of ward rounds to start with the sitting round followed by the team round (i.e. hybrid distance participation methods), with the same ward round leader who has skills in leadership and interprofessional teamwork, could eliminate the need for healthcare providers to repeat questions and tasks (i.e. double work) on their ward rounds. Second, patient involvement is grounded in collaboration, and can be emphasised through person-centred care to facilitate patient safety during hospital stays.
Valor behind the Burqa: Afghan women's fight against Covid-19
Authors: Bagai Mithila Urmila
Published: November 2021

The paper studies the gendered impact of the pandemic in a war ravaged Afghanistan. For majority of Afghan women, the onslaught of Covid has exacerbated their already dire condition and adversely impacted their social, economical, physical and cultural aspects of life. The research also underlines that the imposition of lockdown has caused the reversal of war gains. The paper also highlights the notable works of various Afghan women carried out during the corona pandemic that has contributed to their emancipation and upliftment of the society at large. It brings forth strong and courageous women who are combatting terrorism, everyday conflicts, frequent bombings, societal restrictions and now the deadly coronavirus and yet contributing majorly in re-building the Afghan society. This paper is an attempt to dispel the dominant narrative of their state of helplessness and despondency around Afghan women before the withdrawal of American troops and Taliban takeover. Both primary and secondary sources have complemented this research.
Infant Ross-Konno, Endocardial Fibroelastosis Resection and Mitral Valve Repair
Authors: Najm Hani , Gupta Sohini , Weingarten Noah , Stewart Robert , Ahmad Munir , Lane John , Amdani Shahnawaz , Karamlou Tara
Published: November 2021

Optimal management of critical aortic stenosis (AS) in infants depends on the left ventricle's (LV's) ability to maintain adequate output. Determining feasibility of biventricular repair may be difficult, particularly in those with mitral disease, endocardial fibroelastosis (EFE), multi-level obstruction, and uncertain physiologic capacity. We report a case of a three-month-old with critical AS, severely reduced LV function, EFE, and moderate mitral regurgitation (MR), who underwent a Ross-Konno procedure with concomitant EFE resection and mitral valve repair. Although the technical sequence is challenging, definitive surgery completely relieved multi-level obstruction and MR with markedly improved LV function.
Chosen trauma and saffronization of India
Authors: Ahmed Raja Qaiser , Tamoor Maryum , Saleem Muhammad Waqas , Iqbal Babar Summar
Published: November 2021

The research undertakes the structural transformation of India by the ideology of Hindutva embodied by the contemporary government of the Bhartiya Janata Party. This study is a first of its kind as it attempts to decipher the genesis of this metamorphosis from a psychoanalytical perspective. India has been accredited as a stalwart of democracy and an uploader of an inclusive multicultural and multireligious society. The interplay of Hindu nationalist elements and reinvigoration of past experiences supplemented by historical myths and present ontological insecurities has consequently plagued the secular fabric of India. The study further explicates all the undercurrents and nuances that underscore the ideology of Hindutva, the proselytized culture of victimization and indigenization in society resultantly impacting the society and relations of state in the region.
Removing Faculty: Patterns and Processes of Retrenchment and Restructuring
Authors: Cain Timothy Reese , Leach Erin A.
Published: November 2021

This article uses 30 years of investigatory and special reports by the American Association of University Professors’ Committee A on Academic Freedom and Tenure to understand how retrenchment and restructuring practices have been enacted on ways detrimental to both individual and the corporate faculty. Informed by changes in the logics in higher education and broader understandings of retrenchment, we identified larger patterns of where retrenchment and restructuring in violation of academic norms took place. We further identified three main themes in the reports: Declaring Exigency and / or Launching Restructuring, Faculty Roles and Rights during Retrenchment/Restructuring, and Criteria Used in Removing Faculty. Together, they demonstrate how faculty were excluded from decisions to declare financial exigency or undertake restructuring, denied meaningful roles in enacting changes once exigency or restructuring had been announced, were targeted for removal in violation of tenure rights, and were denied academic due process.
Leveraging Integrated Student Support to Identify and Address COVID-19-Related Needs for Students, Families, and Teachers
Authors: Pollack Courtney , Theodorakakis Maria , Walsh Mary E.
Published: November 2021

As COVID-19 shuttered schools, it created widespread student and family needs and exacerbated challenges stemming from long-standing racial and economic inequities. Here, we examine how an evidenced-based, integrated student support intervention responded to systematically identify and address the academic and nonacademic needs of students and families in 94 high-poverty, urban schools. We conduct thematic analysis of open-ended survey responses about intervention personnel’s work in spring 2020 and triangulate findings with descriptive analyses of service provision records and mid-spring estimates of crucial needs. We find that intervention schools developed specific processes to respond to immediate needs, which included resource, academic, and socioemotional support. To accomplish this, the intervention leveraged existing processes and relationships to maintain intervention-specific practices, facilitate referrals and connections to resources, and expand direct intervention for education stakeholders. Findings elucidate practices for meeting academic and nonacademic needs that affect student learning and that may arise in future schooling disruptions.
Visualizing Partisan Identification Switching in the General Social Survey Panel, 2016–2020
Authors: Bock Sean , Schnabel Landon
Published: November 2021

This visualization captures shifts in partisan identification in the 2016–2020 General Social Survey Panel. Although most partisans remained stable in their identifications, a significant proportion of respondents either shifted to the opposing party or became independents. These patterns have important implications for our understanding of recent party realignment, trends in partisanship, and the care needed when using party identification as an independent variable.
Developing Workforce Planning Skills in Human Resource Management Courses: A Data-Driven Exercise
Authors: Doll Jessica L.
Published: November 2021

Workforce planning is prevalent and recognized as a good strategic practice in many organizations. However, business students may have little experience with workforce planning or workforce analytics. The purpose of this article is to present a workforce planning exercise for use in a face-to-face or online classroom setting. In this exercise, students practice applying workforce planning concepts to calculate internal employment data, find and collect external employment data, and combine multiple, sometimes conflicting, data to make workforce predictions and recommendations for a hypothetical organization. This exercise is designed to help students develop career-relevant skills and is intended for use in human resource management, talent acquisition, talent management, staffing, and/or selection classes.
Paths of Emergency Department Care: Development of a Decision Aid to Facilitate Shared Decision Making in Goals of Care Discussions in the Acute Setting
Authors: Walker Laura E. , Bellolio M. Fernanda , Dobler Claudia C. , Hargraves Ian G. , Pignolo Robert J. , Shaw Kevin , Strand Jacob J. , Thorsteinsdottir Bjorg , Wilson Michael E. , Hess Erik P.
Published: November 2021

Background

Goals of care (GOC) conversations in the emergency department (ED) are often a brief discussion of code status rather than a patient-oriented dialogue. We aimed to develop a guide to facilitate conversations between ED clinicians and patients to elicit patient values and establish goals for end-of-life care, while maintaining ED efficiency. Paths of ED Care, a conversation guide, is the product of this work.

Design

A multidisciplinary/multispecialty group used recommended practices to adapt a GOC conversation guide for ED patients. ED clinicians used the guide and provided feedback on content, design, and usability. Patient-clinician interactions were recorded for discussion analysis, and both were surveyed to inform iterative refinement. A series of discussions with patient representatives, multidisciplinary clinicians, bioethicists, and health care designers yielded feedback. We used a process similar to the International Patient Decision Aid Standards and provide comparison to these.

Results

A conversation guide, eight pages with each page 6 by 6 inches in dimension, uses patient-oriented prompts and includes seven sections: 1) evaluation of patient/family understanding of disease, 2) explanation of possible trajectories, 3) introduction to different pathways of care, 4) explanation of pathways, 5) assessment of understanding and concerns, 6) code status, and 7) personalized summary.

Limitations

Recruitment of sufficient number of patients/providers to the project was the primary limitation. Methods are limited to qualitative analysis of guide creation and feasibility without quantitative analysis.

Conclusions

Paths of ED Care is a guide to facilitate patient-centered shared decision making for ED patients, families, and clinicians regarding GOC. This may ensure care concordant with patients’ values and preferences. Use of the guide was well-received and facilitated meaningful conversations between patients and providers.
Exploring Decisional Conflict With Measures of Numeracy and Optimism in a Stated Preference Survey
Authors: Sutphin Jessie , DiSantostefano Rachael L. , Leach Colton , Hauber Brett , Mansfield Carol
Published: November 2021

Objectives

Low optimism and low numeracy are associated with difficulty or lack of participation in making treatment-related health care decisions. We investigated whether low optimism and low self-reported numeracy scores could help uncover evidence of decisional conflict in a discrete-choice experiment (DCE).

Methods

Preferences for a treatment to delay type 1 diabetes were elicited using a DCE among 1501 parents in the United States. Respondents chose between two hypothetical treatments or they could choose no treatment (opt out) in a series of choice questions. The survey included a measure of optimism and a measure of subjective numeracy. We used latent class analyses where membership probability was predicted by optimism and numeracy scores.

Results

Respondents with lower optimism scores had a higher probability of membership in a class with disordered preferences ( P value for optimism coefficient = 0.032). Those with lower self-reported numeracy scores were more likely to be in a class with a strong preference for opting out and disordered preferences ( P = 0.000) or a class with a preference for opting out and avoiding serious treatment-related risks ( P = 0.015).

Conclusions

If respondents with lower optimism and numeracy scores are more likely to choose to opt out or have disordered preferences in a DCE, it may indicate that they have difficulty completing choice tasks.
ArtClimateRoad and Revelations: Wood textures and experiential metaphors
Authors: Thorsnes Tollef
Published: November 2021

This Multimodal Sensations article explores embodied experiential metaphors. It focuses on the salient modalities of interaction with wood texture. As both an artist and researcher, I have been particularly concerned with how social semiotic theory can be applied to my work, and specifically, how concepts from multimodal analysis can be transformed into the process of multimodal artistic creation. This article reflects on an example linking a historic anniversary, the texture of ancient wood and interaction of a local participant audience. The analysis applies a combination of concepts gleaned from the theories of Theo van Leeuwen (2016), Juhani Pallasma (2012) and Kjetil Røed (2019) to participant reflections from an art project called ArtClimateRoad.
Coping strategies in patients with acute myeloid leukemia
Authors: Amonoo Hermioni L. , Bodd Monica H. , Reynolds Matthew J. , Nelson Ashley M. , Newcomb Richard , Johnson Patrick Connor , Dhawale Tejaswini M. , Plotke Rachel , Heuer Lauren , Gillani Sabah , Yang Daniel , Deary Emma C. , Daskalakis Elizabeth , Goldschen Lauren , Brunner Andrew , Fathi Amir T. , LeBlanc Thomas W. , El-Jawahri Areej
Published: November 2021

Patients diagnosed with acute myeloid leukemia (AML) face sudden-onset life-threatening disease that requires intensive treatments. Although their early disease trajectory is characterized by significant, toxic side effects, limited data are available describing coping strategies among patients with AML and how these inform patient-reported outcomes. We used cross-sectional secondary data analyses to describe coping in 160 patients with newly diagnosed high-risk AML. The Brief COPE, Hospital Anxiety and Depression Scale, Post-Traumatic Stress Disorder Checklist–Civilian Version, and Functional Assessment of Cancer Therapy–Leukemia were used at time of AML diagnosis to measure coping strategies, psychological distress, and quality of life (QOL), respectively. The median split method for distribution of coping domains and multivariate regression models were used to assess the relationship between coping and patient-reported outcomes. Participants (median age, 64.4 years) were mostly non-Hispanic White (86.3%), male (60.0%), and married (73.8%). Most (51.9%) had high utilization of approach-oriented coping strategies, whereas 38.8% had high utilization of avoidant coping strategies. At time of diagnosis, use of approach-oriented coping was associated with less psychological distress (anxiety, β = –0.262, P = .002; depression symptoms, β = –0.311, P < .001; and posttraumatic distress disorder symptoms, β = –0.596, P = .006) and better QOL (β = 1.491, P = .003). Use of avoidant coping was associated with more psychological distress (anxiety, β = 0.884, P < .001; depression symptoms, β = 0.697, P < .001; and posttraumatic distress disorder symptoms, β = 3.048, P < .001) and worse QOL (β = –5.696, P < .001). Patients with high-risk AML use various approach-oriented and avoidant coping strategies at time of diagnosis. Use of approach-oriented coping strategies was associated with less psychological distress and better QOL, suggesting a possible target for supportive oncology interventions.
Fibroblast growth factor 21 attenuates salt-sensitive hypertension-induced nephropathy through anti-inflammation and anti-oxidation mechanism
Authors: Weng Hua-Chun , Lu Xin-Yu , Xu Yu-Peng , Wang Yi-Hong , Wang Dan , Feng Yi-Ling , Chi Zhang , Yan Xiao-Qing , Lu Chao-Sheng , Wang Hong-Wei
Published: November 2021

Background

Patients with salt-sensitive hypertension are often accompanied with severe renal damage and accelerate to end-stage renal disease, which currently lacks effective treatment. Fibroblast growth factor 21 (FGF21) has been shown to suppress nephropathy in both type 1 and type 2 diabetes mice. Here, we aimed to investigate the therapeutic effect of FGF21 in salt-sensitive hypertension-induced nephropathy.

Methods

Changes of FGF21 expression in deoxycorticosterone acetate (DOCA)-salt-induced hypertensive mice were detected. The influence of FGF21 knockout in mice on DOCA-salt-induced nephropathy were determined. Recombinant human FGF21 (rhFGF21) was intraperitoneally injected into DOCA-salt-induced nephropathy mice, and then the inflammatory factors, oxidative stress levels and kidney injury-related indicators were observed. In vitro, human renal tubular epithelial cells (HK-2) were challenged by palmitate acid (PA) with or without FGF21, and then changes in inflammation and oxidative stress indicators were tested.

Results

We observed significant elevation in circulating levels and renal expression of FGF21 in DOCA-salt-induced hypertensive mice. We found that deletion of FGF21 in mice aggravated DOCA-salt-induced nephropathy. Supplementation with rhFGF21 reversed DOCA-salt-induced kidney injury. Mechanically, rhFGF21 induced AMPK activation in DOCA-salt-treated mice and PA-stimulated HK-2 cells, which inhibited NF-κB-regulated inflammation and Nrf2-mediated oxidative stress and thus, is important for rhFGF21 protection against DOCA-salt-induced nephropathy.

Conclusion

These findings indicated that rhFGF21 could be a promising pharmacological strategy for the treatment of salt-sensitive hypertension-induced nephropathy.
Altered static and dynamic functional network connectivity in post-traumatic headache
Authors: Li Fengfang , Lu Liyan , Shang Song’an , Chen Huiyou , Wang Peng , Muthaiah Vijaya Prakash , Yin Xindao , Chen Yu-Chen
Published: November 2021

Background

Post-traumatic headache (PTH) is a very common symptom following mild traumatic brain injury (mTBI), yet much remains unknown about the underlying pathophysiological mechanisms of PTH. Neuroimaging studies suggest that aberrant functional network connectivity (FNC) may be an important factor in pain disorders. The present study aimed to investigate the functional characteristics of static FNC (sFNC) and dynamic FNC (dFNC) in mTBI patients with PTH.

Methods

With Institutional Review Board (IRB) approval, we prospectively recruited 50 mTBI patients with PTH, who were diagnosed with ICHD-3 beta diagnostic criteria and 39 mTBI without PTH who were well matched for age, gender and education. Resting-state functional magnetic resonance imaging (fMRI) scanning (3.0 T, Philips Medical Systems, Netherlands), Montreal Cognitive Assessment (MoCA) and headache symptom measurement (headache frequency and headache intensity) were performed. The resting-state fMRI sequence took 8 min and 10 s. Independent component analysis and sliding window method were applied to examine the FNC on the basis of nine resting-state networks, namely, default mode network (DMN), sensorimotor network (SMN), executive control network (ECN), auditory network (AuN), attention network (AN), salience network (SN), visual network (VN), and cerebellum network (CN). The differences in sFNC and dFNC were determined and correlated with clinical variables using Pearson rank correlation.

Results

For sFNC, compared with mTBI patients without PTH, mTB with PTH group showed four altered interactions, including decreased interactions in SN-SMN and VN-DMN pairs, increased sFNC in SN-ECN and SMN-DMN pairs. For dFNC, significant group differences were found in State 2, including increased connectivity alteration in the DMN with CN, DMN with SMN, and AuN with CN. Significant reduced connectivity changes in the DMN with VN was found in State 4. Furthermore, the number of transitions (r=0.394, p=0.005) between states was positively associated with headache frequency. Additionally, dwell time (r=-0.320, p=0.025) in State 1 was negatively correlated with MoCA score.

Conclusions

MTBI patients with PTH are characterized with altered sFNC and dFNC, which could provide new perspective to understand the neuropathological mechanism underlying the PTH to determine more appropriate management, and may be a useful imaging biomarker for identifying and predicting mTBI with PTH.
cosinoRmixedeffects: an R package for mixed-effects cosinor models
Authors: Hou Ruixue , Tomalin Lewis E. , Suárez-Fariñas Mayte
Published: November 2021

Background

Wearable devices enable monitoring and measurement of physiological parameters over a 24-h period, and some of which exhibit circadian rhythm characteristics. However, the currently available R package cosinor could only analyze daily cross-sectional data and compare the parameters between groups with two levels. To evaluate longitudinal changes in the circadian patterns, we need to extend the model to a mixed-effect model framework, allowing for random effects and interaction between COSINOR parameters and time-varying covariates.

Results

We developed the cosinoRmixedeffects R package for modelling longitudinal periodic data using mixed-effects cosinor models. The model allows for covariates and interactions with the non-linear parameters MESOR, amplitude, and acrophase. To facilitate ease of use, the package utilizes the syntax and functions of the widely used emmeans package to obtain estimated marginal means and contrasts. Estimation and hypothesis testing involving the non-linear circadian parameters are carried out using bootstrapping. We illustrate the package functionality by modelling daily measurements of heart rate variability (HRV) collected among health care workers over several months. Differences in circadian patterns of HRV between genders, BMI, and during infection with SARS-CoV2 are evaluated to illustrate how to perform hypothesis testing.

Conclusion

cosinoRmixedeffects package provides the model fitting, estimation and hypothesis testing for the mixed-effects COSINOR model, for the linear and non-linear circadian parameters MESOR, amplitude and acrophase. The model accommodates factors with any number of categories, as well as complex interactions with circadian parameters and categorical factors.
Whole-transcriptome sequencing reveals a vernalization-related ceRNA regulatory network in chinese cabbage (Brassica campestris L. ssp. pekinensis)
Authors: Shi Fengyan , Xu Hezi , Liu Chuanhong , Tan Chong , Ren Jie , Ye Xueling , Feng Hui , Liu Zhiyong
Published: November 2021

Background

The transition from vegetative growth to reproductive growth involves various pathways. Vernalization is a crucial process for floral organ formation and regulation of flowering time that is widely utilized in plant breeding. In this study, we aimed to identify the global landscape of mRNAs, microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs) related to vernalization in Chinese cabbage. These data were then used to construct a competitive endogenous RNA (ceRNA) network that provides valuable information to better understand the vernalization response.

Results

In this study, seeds sampled from the Chinese cabbage doubled haploid (DH) line ‘FT’ with or without vernalization treatment were used for whole-transcriptome sequencing. A total of 2702 differentially expressed (DE) mRNAs, 151 DE lncRNAs, 16 DE circRNAs, and 233 DE miRNAs were identified in the vernalization-treated seeds. Various transcription factors, such as WRKY, MYB, NAC, bHLH, MADS-box, zinc finger protein CONSTANS-like gene, and B3 domain protein, and regulatory proteins that play important roles in the vernalization pathway were identified. Additionally, we constructed a vernalization-related ceRNA–miRNA–target gene network and obtained 199 pairs of ceRNA relationships, including 108 DEmiRNA‒DEmRNA, 67 DEmiRNA‒DElncRNA, and 12 DEmiRNA‒DEcircRNA interactions, in Chinese cabbage. Furthermore, several important vernalization-related genes and their interacting lncRNAs, circRNAs, and miRNAs, which are involved in the regulation of flowering time, floral organ formation, bolting, and flowering, were identified.

Conclusions

Our results reveal the potential mRNA and non-coding RNAs involved in vernalization, providing a foundation for further studies on the molecular mechanisms underlying vernalization in Chinese cabbage.
Whole genome sequencing facilitates intragenic variant interpretation following modifier screening in C. elegans
Authors: Jean Francesca , Stasiuk Susan , Maroilley Tatiana , Diao Catherine , Galbraith Andrew , Tarailo-Graovac Maja
Published: November 2021

Background

Intragenic modifiers (in-phase, second-site variants) are known to have dramatic effects on clinical outcomes, affecting disease attributes such as severity or age of onset. However, despite their clinical importance, the focus of many genetic screens in model systems is on the discovery of extragenic variants, with many labs still relying upon more traditional methods to identify modifiers. However, traditional methods such as PCR and Sanger sequencing can be time-intensive and do not permit a thorough understanding of the intragenic modifier effects in the context of non-isogenic genomic backgrounds.

Results

Here, we apply high throughput approaches to identify and understand intragenic modifiers using Caenorhabditis elegans. Specifically, we applied whole genome sequencing (WGS) to a mutagen-induced forward genetic screen to identify intragenic suppressors of a temperature-sensitive zyg-1(it25) allele in C. elegans. ZYG-1 is a polo kinase that is important for centriole function and cell divisions, and mutations that truncate its human orthologue, PLK4, have been associated with microcephaly. Combining WGS and CRISPR/Cas9, we rapidly identify intragenic modifiers, show that these variants are distributed non-randomly throughout zyg-1 and that genomic context plays an important role on phenotypic outcomes.

Conclusions

Ultimately, our work shows that WGS facilitates high-throughput identification of intragenic modifiers in clinically relevant genes by reducing hands-on research time and overall costs and by allowing thorough understanding of the intragenic phenotypic effects in the context of different genetic backgrounds.
Developmental regulation of lupulin gland-associated genes in aromatic and bitter hops (Humulus lupulus L.)
Authors: Patzak Josef , Henychová Alena , Matoušek Jaroslav
Published: November 2021

Background

Hop (Humulus lupulus L.) bitter acids are valuable metabolites for the brewing industry. They are biosynthesized and accumulate in glandular trichomes of the female inflorescence (hop cone). The content of alpha bitter acids, such as humulones, in hop cones can differentiate aromatic from bitter hop cultivars. These contents are subject to genetic and environmental control but significantly correlate with the number and size of glandular trichomes (lupulin glands).

Results

We evaluated the expression levels of 37 genes involved in bitter acid biosynthesis and morphological and developmental differentiation of glandular trichomes to identify key regulatory factors involved in bitter acid content differences. For bitter acid biosynthesis genes, upregulation of humulone synthase genes, which are important for the biosynthesis of alpha bitter acids in lupulin glands, could explain the higher accumulation of alpha bitter acids in bitter hops. Several transcription factors, including HlETC1, HlMYB61 and HlMYB5 from the MYB family, as well as HlGLABRA2, HlCYCB2–4, HlZFP8 and HlYABBY1, were also more highly expressed in the bitter hop cultivars; therefore, these factors may be important for the higher density of lupulin glands also seen in the bitter hop cultivars.

Conclusions

Gene expression analyses enabled us to investigate the differences between aromatic and bitter hops. This study confirmed that the bitter acid content in glandular trichomes (lupulin glands) is dependent on the last step of alpha bitter acid biosynthesis and glandular trichome density.
Adding a low-concentration sciatic nerve block to total knee arthroplasty in patients susceptible to the adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs): a randomized controlled trial
Authors: Sirivanasandha Busara , Sutthivaiyakit Kulwadee , Kerdchan Thippatai , Poolsuppasit Suppachai , Tangwiwat Suwimon , Halilamien Pathom
Published: November 2021

Background

This study compared the effects of adductor canal blocks with those of a low concentration of popliteal-sciatic nerve block (SNB) and dexamethasone as an adjunctive technique for total knee arthroplasties (TKA) in patients susceptible to the adverse effects of NSAIDs.

Methods

A prospective, double-blinded, randomized controlled trial was performed in 50 patients susceptible to the adverse effects of NSAIDs undergoing unilateral TKAs. All patients received spinal anesthesia, adductor canal blocks, and periarticular infiltration. The 25 patients in the intervention group received SNB (0.125% bupivacaine [20 ml] and dexamethasone [5 mg]).

Results

The SNB group significantly had lower median resting pain scores at 6, 12, and 18 h: the control group, 1 (0–4.5), 3 (0–5), and 3 (2–5); the intervention group, 0 (0–0), 0 (0–3), and 1 (0–3); p-values, 0.012, 0.021, and 0.010, respectively. Movement-evoked pain scores at 6, 12, and 18 h were also lower: control group, 3 (0–5.5), 5 (2.5–6.5), and 7 (4–9); intervention group, 0 (0–1.5), 2 (0–4), and 3 (2–5); p-values, 0.019, 0.005, and 0.001, respectively. There were no differences in motor function. Moreover, the mean morphine consumption 24 h was also reduced in the SNB group: control group, 3.80 ± 2.48 mg; intervention group, 1.96 ± 2 mg; p-value, 0.005.

Conclusion

For patients susceptible to the adverse effects of NSAIDs, a low concentration of SNB and dexamethasone is an effective adjunctive technique for early postoperative pain control (especially on movement) following TKAs, without an increase in motor weakness.

Trial registration

ClinicalTrials.gov, NCT03486548, Registered 3 April 2018.
High-protein intake and early exercise in adult intensive care patients: a prospective, randomized controlled trial to evaluate the impact on functional outcomes
Authors: de Azevedo José Raimundo Araujo , Lima Hugo César Martins , Frota Pedro Henrique Dias Brasiliense , Nogueira Ivna Raquel Olimpio Moreira , de Souza Suellen Christine , Fernandes Erika Arana Arraes , Cruz Adlyene Muniz
Published: November 2021

Background

We evaluated the efficacy of high protein intake and early exercise versus standard nutrition care and routine physiotherapy on the outcome of critically ill patients.

Methods

We randomized mechanically ventilated patients expected to stay in the intensive care unit (ICU) for 4 days. We used indirect calorimetry to determine energy expenditure and guide caloric provision to the patients randomized to the high protein and early exercise (HPE) group and the control group. Protein intakes were 1.48 g/kg/day and 1.19 g/kg/day medians respectively; while the former was submitted to two daily sessions of cycle ergometry exercise, the latter received routine physiotherapy. We evaluated the primary outcome physical component summary (PCS) score at 3 and 6 months) and the secondary outcomes (handgrip strength at ICU discharge and ICU and hospital mortality).

Results

We analyzed 181 patients in the HPE (87) and control (94) group. There was no significant difference between groups in relation to calories received. However, the amount of protein received by the HPE group was significantly higher than that received by the control group (p < 0.0001). The PCS score was significantly higher in the HPE group at 3 months (p = 0.01) and 6 months (p = 0.01). The mortality was expressively higher in the control group. We found an independent association between age and 3-month PCS and that between age and group and 6-month PCS.

Conclusion

This study showed that a high-protein intake and resistance exercise improved the physical quality of life and survival of critically ill patients.

Trial registration

Research Ethics Committee of Hospital São Domingos: Approval number 1.487.683, April 09, 2018. The study protocol was registered in ClinicalTrials.gov (NCT03469882, March 19,2018).
Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes
Authors: Zafrir Barak , Saliba Walid , Widder Rachel Shay Li , Khoury Razi , Shemesh Elad , Halon David A.
Published: November 2021

Background

The increased risk for cardiovascular events in diabetics is heterogeneous and contemporary clinical risk score calculators have limited predictive value. We therefore examined the additional value of coronary artery calcium score (CACS) in outcome prediction in type 2 diabetics without clinical coronary artery disease (CAD).

Methods

The study examined a population-based cohort of type 2 diabetics (n = 735) aged 55–74 years, recruited between 2006 and 2008. Patients had at least one additional risk factor and no history or symptoms of CAD. Risk assessment tools included Pooled Cohort Equations (PCE) and Multi-Ethnic Study of Atherosclerosis (MESA) 10-year risk score calculators and CACS. The occurrence of myocardial infarction (MI), stroke or cardiovascular death (MACE) was assessed over 10-years.

Results

Risk score calculators predicted MACE and MI and cardiovascular death individually but not stroke. Increasing levels of CACS predicted MACE and its components independently of clinical risk scores, glycated hemoglobin and other baseline variables: hazard ratio (95% confidence interval) 2.92 (1.06–7.86), 6.53 (2.47–17.29) and 8.3 (3.28–21) for CACS of 1–100, 101–300 and > 300 Agatston units respectively, compared to CACS = 0. Addition of CACS to PCE improved discrimination of MACE [AUC of PCE 0.615 (0.555–0.676) versus PCE + CACS 0.696 (0.642–0.749); p = 0.0024]. Coronary artery calcium was absent in 24% of the study population and was associated with very low event rates even in those with high estimated risk scores.

Conclusions

CACS in asymptomatic type 2 diabetics provides additional prognostic information beyond that obtained from clinical risk scores alone leading to better discrimination between risk categories.
Does the time of the day affect multiple trauma care in hospitals? A retrospective analysis of data from the TraumaRegister DGU®
Authors: Fitschen-Oestern Stefanie , Lippross Sebastian , Lefering Rolf , Klüter Tim , Weuster Matthias , Franke Georg Maximilian , Kirsten Nora , Müller Michael , Schröder Ove , Seekamp Andreas ,   TraumaRegister DGU
Published: November 2021

Background

Optimal multiple trauma care should be continuously provided during the day and night. Several studies have demonstrated worse outcomes and higher mortality in patients admitted at night. This study involved the analysis of a population of multiple trauma patients admitted at night and a comparison of various indicators of the quality of care at different admission times.

Methods

Data from 58,939 multiple trauma patients from 2007 to 2017 were analyzed retrospectively. All data were obtained from TraumaRegister DGU®. Patients were grouped by the time of their admission to the trauma center (6.00 am–11.59 am (morning), 12.00 pm–5.59 pm (afternoon), 6.00 pm–11.59 pm (evening), 0.00 am–5.59 am (night)). Incidences, patient demographics, injury patterns, trauma center levels and trauma care times and outcomes were evaluated.

Results

Fewer patients were admitted during the night (6.00 pm–11.59 pm: 18.8% of the patients, 0.00–5.59 am: 4.6% of the patients) than during the day. Patients who arrived between 0.00 am–5.59 am were younger (49.4 ± 22.8 years) and had a higher injury severity score (ISS) (21.4 ± 11.5) and lower Glasgow Coma Scale (GCS) score (11.6 ± 4.4) than those admitted during the day (12.00 pm–05.59 pm; age: 55.3 ± 21.6 years, ISS: 20.6 ± 11.4, GCS: 12.6 ± 4.0). Time in the trauma department and time to an emergency operation were only marginally different. Time to imaging was slightly prolonged during the night (0.00 am–5.59 am: X-ray 16.2 ± 19.8 min; CT scan 24.3 ± 18.1 min versus 12.00 pm- 5.59 pm: X-ray 15.4 ± 19.7 min; CT scan 22.5 ± 17.8 min), but the delay did not affect the outcome. The outcome was also not affected by level of the trauma center. There was no relevant difference in the Revised Injury Severity Classification II (RISC II) score or mortality rate between patients admitted during the day and at night. There were no differences in RISC II scores or mortality rates according to time period. Admission at night was not a predictor of a higher mortality rate.

Conclusion

The patient population and injury severity vary between the day and night with regard to age, injury pattern and trauma mechanism. Despite the differences in these factors, arrival at night did not have a negative effect on the outcome.
Qualitative development and content validation of the “SPART” model; a focused ethnography study of observable diagnostic and therapeutic activities in the emergency medical services care process
Authors: Dercksen Bert , Struys Michel M. R. F. , Cnossen Fokie , Paans Wolter
Published: November 2021

Background

Clinical reasoning is a crucial task within the Emergency Medical Services (EMS) care process. Both contextual and cognitive factors make the task susceptible to errors. Understanding the EMS care process’ structure could help identify and address issues that interfere with clinical reasoning. The EMS care process is complex and only basically described.

In this research, we aimed to define the different phases of the process and develop an overarching model that can help detect and correct potential error sources, improve clinical reasoning and optimize patient care.

Methods

We conducted a focused ethnography study utilizing non-participant video observations of real-life EMS deployments combined with thematic analysis of peer interviews.

After an initial qualitative analysis of 7 video observations, we formulated a tentative conceptual model of the EMS care process. To test and refine this model, we carried out a qualitative, thematic analysis of 28 video-recorded cases. We validated the resulting model by evaluating its recognizability with a peer content analysis utilizing semi-structured interviews.

Results

Based on real-life observations, we were able to define and validate a model covering the distinct phases of an EMS deployment. We have introduced the acronym “SPART” to describe ten different phases: Start, Situation, Prologue, Presentation, Anamnesis, Assessment, Reasoning, Resolution, Treatment, and Transfer.

Conclusions

The “SPART” model describes the EMS care process and helps to understand it. We expect it to facilitate identifying and addressing factors that influence both the care process and the clinical reasoning task embedded in this process.
A simulation study for evaluating the performance of clustering measures in multilevel logistic regression
Authors: Adam Nicholas Siame , Twabi Halima S. , Manda Samuel O.M.
Published: November 2021

Background

Multilevel logistic regression models are widely used in health sciences research to account for clustering in multilevel data when estimating effects on subject binary outcomes of individual-level and cluster-level covariates. Several measures for quantifying between-cluster heterogeneity have been proposed. This study compared the performance of between-cluster variance based heterogeneity measures (the Intra-class Correlation Coefficient (ICC) and the Median Odds Ratio (MOR)), and cluster-level covariate based heterogeneity measures (the 80% Interval Odds Ratio (IOR-80) and the Sorting Out Index (SOI)).

Methods

We used several simulation datasets of a two-level logistic regression model to assess the performance of the four clustering measures for a multilevel logistic regression model. We also empirically compared the four measures of cluster variation with an analysis of childhood anemia to investigate the importance of unexplained heterogeneity between communities and community geographic type (rural vs urban) effect in Malawi.

Results

Our findings showed that the estimates of SOI and ICC were generally unbiased with at least 10 clusters and a cluster size of at least 20. On the other hand, estimates of MOR and IOR-80 were less accurate with 50 or fewer clusters regardless of the cluster size. The performance of the four clustering measures improved with increased clusters and cluster size at all cluster variances. In the analysis of childhood anemia, the estimate of the between-community variance was 0.455, and the effect of community geographic type (rural vs urban) had an odds ratio (OR)=1.21 (95% CI: 0.97, 1.52). The resulting estimates of ICC, MOR, IOR-80 and SOI were 0.122 (indicative of low homogeneity of childhood anemia in the same community); 1.898 (indicative of large unexplained heterogeneity); 0.345-3.978 and 56.7% (implying that the between community heterogeneity was more significant in explaining the variations in childhood anemia than the estimated effect of community geographic type (rural vs urban)), respectively.

Conclusion

At least 300 clusters with sizes of at least 50 would be adequate to estimate the strength of clustering in multilevel logistic regression with negligible bias. We recommend using the SOI to assess unexplained heterogeneity between clusters when the interest also involves the effect of cluster-level covariates, otherwise, the usual intra-cluster correlation coefficient would suffice in multilevel logistic regression analyses.
Effects of personalized invitation letters on research participation among general practitioners: a randomized trial
Authors: Hennrich Patrick , Arnold Christine , Wensing Michel
Published: November 2021

Background

Participation of general practitioners is crucial for health care studies. However, recruiting them is an ongoing challenge and participation rates of general practitioners around the globe are often low. One feasible and cost-efficient approach to potentially enhance participation rates among general practitioners are personalized invitation letters, since they may increase one’s attention to and appreciation of a study. Still, evidence whether this method actually affects participation is scarce and ambiguous in relation to physicians.

Methods

We undertook a randomized trial in a sample of general practitioners from three German states in the context of a large, observational study on physicians’ coordination and uptake of recommended cardiovascular ambulatory care. An intervention group (n = 757 general practitioners) received a personalized invitation to participate in the observational study, the control group (n = 754 general practitioners) received a generic invitation. Both groups were blinded to group assignment. Eventual participation rates as well as the number and types of responses overall were compared between arms. Besides the main intervention, sociodemographic and geographical context factors were considered as well.

Results

The overall participation rate among physicians was 2.6% (2.8% in the intervention group and 2.4% in the control group). No statistically significant effect of personalization on participation of physicians was found (relative risk to participate when receiving a personalized invitation of 1.17 [95%-CI: 0.62, 2.21]). However, the number of responses to the invitation varied significantly between the geographical regions.

Conclusions

Personalization of first written contact alone did not improve research participation among general practitioners, which was overall very low.

Trial registration

The study in which the trial was embedded has been registered prospectively at the German Clinical Trials Register (DRKS) under registration number DRKS00019219.
Altered cytokine profiles in relapsed paucibacillary leprosy: a case report
Authors: Sameshima Tomoyuki , Maeda Yumi , Mukai Tetsu , Goto Masamichi
Published: November 2021

Background

Individuals with relapses of leprosy should be monitored carefully, however, with respect to paucibacillary (PB) leprosy, it is sometimes difficult to make a definitive diagnosis of relapse, because the bacillary index is often negative. To evaluate the usefulness of cytokine profiling in a patient with relapsed PB leprosy who tested negative for anti-phenolic glycolipid-I antibodies, we analyzed the Mycobacterium leprae protein-induced cytokine expression in peripheral blood mononuclear cells of the patient.

Case presentation

An 89-year-old-male relapsed PB patient, first treated for leprosy over 50 years prior, was examined. In April 2012, he noticed three skin lesions consisting of annular erythema in the thighs. Slit skin smear tests were negative, and skin biopsies revealed a pathology of indeterminate-to-borderline tuberculoid leprosy. He received 600 mg of rifampicin once per month and 75 mg of dapsone daily for 12 months. The annular erythemas disappeared after starting treatment. Before treatment, and 6 and 12 months after starting treatment, the Th1/Th2 cytokine profiles in the supernatant of mononuclear cells from the patient before and after stimulation with Mycobacterium leprae soluble protein (MLS) were examined using a Cytometric Bead Array (CBA) Human Th1/Th2 Cytokine Kit II. The CBA Enhanced Sensitivity Flex Set system was applied to detect small amounts of cytokines in the serum just before treatment and one year before relapse. In the culture supernatant, just before treatment, increases in IFN-γ level and the IFN-γ/IL-10 ratio and a decreased IL-6 level were observed without stimulation. Upon stimulation with MLS, just before treatment, both the IFN-γ and TNF levels increased markedly, and twelve months after starting treatment, the IFN-γ and TNF levels decreased greatly. In the serum, just before treatment, increases in IFN-γ and TNF levels and the IFN-γ/IL-10 ratio were evident compared with those measured one year before relapse.

Conclusions

Cytokine profiling using culture supernatants and serum samples may be useful for the diagnosis of relapsed PB leprosy.