bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-Traumatic High-Flow Priapism: Accessory Pudendal Origin of Cavernosal Artery From External Iliac Artery - A Case Report
Authors: Dedhia Karan Visanji , Vignesh S. , Mukuntharajan T. , Karunakaran N. , Rajagopal Ganesh
Published: April 2023

High-flow priapism is an uncommon condition typically resulting from penile or perineal trauma, due to laceration of cavernosal artery. We present a case of 24-year-old male who presented with post-traumatic painless priapism. Ultrasound showed hematoma with arterio-cavernosal fistula. On CT Angiogram, the cavernosal artery was seen arising from accessory pudendal artery, which arose from inferior epigastric artery (IEA), branch of external iliac artery (EIA). Catheter angiogram of EIA showed fistulous communication at the base of the penis from a branch of IEA. Selective embolisation of the artery was done using 33% glue (n-butyl cyanoacrylate). Post embolisation, no residual filling of the fistula and partial detumescence of penis was noted. Transarterial embolisation is usually preferred as first line of management in high-flow fistulous priapisms.
Optional or optimal? off-label stenting for intracranial atherosclerotic stenosis: A scoping review
Authors: Zhao Zhongyu , Liang Wenzhao , Yan Lei , Zhang Kai , Kong Huijing , Mang Jing
Published: April 2023

Background

Intracranial atherosclerotic stenosis is a major cause of ischemic stroke. In addition to the Wingspan stent system, several self-expanding stents have been used off-label to treat intracranial atherosclerotic stenosis lesions. The purpose of this review is to assess the existing data on the off-label use of self-expanding stents in intracranial atherosclerotic stenosis, to highlight methodological limitations in current study designs, and thus providing strategies and precautions for clinical practice.

Methods

The PubMed, EMBASE, and the Cochrane Library databases were systematically searched for relevant articles published up to April 2022. In addition to the meta analysis of Enterprise, Neuroform EZ and closed cell stent respectively, we used a narrative synthesis to summarize and discuss the appropriate strategies and precautions for the use of each stent.

Results

We identified 17 studies (1091 patients with 1124 lesions) reporting 6 types of off-label self-expanding stents. The most common endpoints reported were incidence of short-term complications (range: 0–15.8%, median: 3.8%), long-term complications (range: 0–12.0%, median: 0%). Potential risks include infeasibility of stenting hard lesions or tortuous vessels, stent migration, and in-stent thrombosis. Less is known about the conditions that are appropriate for an optimal stent (e.g., open-cell, close-cell, hybrid cell). There was considerable heterogeneity across studies with regards to study populations and study designs.

Conclusions

The potential risks and benefits should be carefully considered when using off-label stents for intracranial atherosclerotic stenosis, particularly given the current evidence power. As a potential option for the Wingspan stent, based on device's approval only, a tailored approach with lesion-specific devices could be beneficial in certain patients.
Controlling the false-discovery rate when identifying the subgroup benefiting from treatment
Authors: Schnell Patrick M
Published: April 2023

One common goal of subgroup analyses is to determine which (if any) types of patients—sets of patients sharing a vector of baseline covariates—benefit from a particular treatment. Many approaches involve testing, implicitly or explicitly, hypotheses about many patient types which are nonexchangeable. Methods of controlling family-wise Type I error rate inflation in such approaches are available. Such methods are designed to control the rate of erroneously declaring at least one type of patient as benefiting and are, therefore, quite conservative. We present a method for instead controlling a weighted false discovery rate in the sense of controlling the expected proportion of patient types declared benefiting, weighted by their population prevalence, which do not in fact benefit from treatment. Such population-weighted false discovery rate control is analogous to maintaining the positive predictive value of a diagnostic test for expected benefit. We minimize power loss by using a resampling approach that accounts for correlation among test statistics corresponding to similar patient types. Simulation studies demonstrate successful control of the weighted false discovery rate by the proposed method, as well as anti-conservativeness in the absence of multiplicity corrections and conservativeness by methods controlling the false discovery rate without accounting for dependent test statistics or controlling the family-wise error rate. An analysis of a clinical trial of an Alzheimer’s disease treatment illustrates the approach on real data. Resampling-based methods allow weighted false discovery rate control without unnecessarily sacrificing power when treatment effect estimates are correlated among patient types, and admit useful interpretations in terms of bounding sets and positive predictive value.
Josh Hawley meets Igor Stravinsky: A leadership symphony
Authors: Bathurst Ralph
Published: April 2023

In this essay I explore two leaders: the composer Igor Stravinsky (1882–1971) and United States of America Senator Joshua Hawley (b. 1979). These two offer an opportunity to re-describe leadership as an acoustic art thereby enriching the field beyond its current ocular orientation. Through this discussion, then, I invite readers into the world of music. The year 2021 marked the 50th anniversary of Stravinsky’s death, and in that same year, Hawley came to international fame through the 6 January invasion of the United States Capitol building by people protesting the confirmation of Joe Biden as the 46th President. I offer a polyphonic analysis of Hawley and Stravinsky by operationalizing the music construct of tonal pairing which allows two tonalities to play together. I conclude the essay by noting the ubiquity of Manicheanism, a belief system that affords leaders an ability to characterize opponents as being evil. I mitigate this deleterious system by proposing that symphonic leadership calls for diversity and difference. Leadership as an acoustic art has implications for understanding the current war in Ukraine and China’s role on the international stage, including her relationship with the United States of America.
Worsening of anemia increases the risks of complications and prolonged length of stay following revision total shoulder arthroplasty
Authors: Grovu Radu , Quan Theodore , Wei Chapman , Das Avilash , Nguyen Andrew , Tabaie Sean , Zimmer Zachary R
Published: April 2023

Background

There are no studies currently in the literature that assesses complications following revision total shoulder arthroplasty (TSA) in patients with varying severity of anemia. The purpose of this study was to determine the impact of preoperative anemia severity on postoperative complications following revision TSA.

Methods

Patients undergoing revision TSA from 2013 to 2019 were queried in a national database. Based on previous studies’ definitions of anemia, three subgroups were stratified: patients without anemia (hematocrit >36% for women, hematocrit >39% for men), patients with mild anemia (hematocrit 33% to 36% for women, hematocrit 33% to 39% for men) and patients with moderate to severe anemia (hematocrit <33% for both women and men). In this analysis, patient demographics, comorbidities, and postoperative complications were compared between the three groups.

Results

Of 1559 total patients undergoing revision TSA, 1178 patients (75.6%) did not have anemia, 255 (16.3%) had mild anemia, and 126 (8.1%) had moderate/severe anemia. Following adjustment on multivariate analysis, patients with mild anemia were more likely to have postoperative transfusion and extended length of stay compared to non-anemic patients. Patients with moderate/severe anemia were at increased risk of postoperative transfusion, sepsis, extended length of stay, and reoperation compared to non-anemic patients.

Discussion

From mild anemia to moderate/severe anemia, there was a stepwise increase in the risk of postoperative complications. Our study showed that there is clinical value in the preoperative correction of anemia for these patients as it relates to complications and hospital stay.

Level of Evidence

III.
Developing Creative Potential: The Power of Process, People, and Place
Authors: Isaksen Scott G.
Published: April 2023

Creativity is increasingly seen as a key human capability that can be deliberately developed. Correspondently, a proliferation of tools, techniques, and methods are available in the academic and popular literatures. Creative problem-solving (CPS) is one framework among these, and has a 70-year history of research and development. This essay overviews this history and the key stages of its continuous development, as well as the rationale for the changes and improvements that have been made. Foundational work established the Osborn–Parnes paradigm for CPS. Initial efforts were aimed at enhancing this approach. Then came work to stretch the Osborn–Parnes approach, and ultimately to break this paradigm. Understanding these major stages of development should better differentiate contemporary CPS approaches from the variety of earlier versions. Future research and development are also highlighted that will move our understanding, learning, and application forward.
In vitro Antioxidant, Enzyme Inhibitory and Antimicrobial Evaluation of Sideritis caesarea H. Duman, Aytaç & Başer Extracts
Authors: Günbatan Tuğba , Gürbüz İlhan , Karaca Nursenem , Demirci Fatih
Published: April 2023

Sideritis caesarea H. Duman, Aytaç & Başer of the family Lamiaceae is an endemic plant with different ethnobotanical uses in Anatolia. In this present study, the antioxidant and biological activity potential of different S caesarea extracts and purified compounds were evaluated in vitro using DPPH•, CUPRAC, and ABTS• methods. In addition, their urease and chymotrypsin enzyme inhibitory activities, antimicrobial potential, and total phenol and flavonoid contents were determined. The experimental results showed that the two isolated flavonoids {4′- O-methylhypolaetin-7- O-[6″′- O-acetyl- β-D-allopyranosyl-(1→2)]-6″- O-acetyl- β-D-glucopyranoside, and isoscutellarein-7- O-[6″′- O-acetyl- β-D-allopyranosyl-(1→2)]-6″- O-acetyl- β-D-glucopyranoside}, as well as their fractions, except the n-hexane and water residue, showed remarkable antioxidant activity. Interestingly, the ethyl acetate and water residue fractions inhibited the urease enzyme activity by 49.6% and 49.1%, respectively; while the n-hexane and dichloromethane fractions attracted attention with their relative high chymotrypsin inhibitory activity of 85.8%, and 82.4%, respectively. When evaluated for their in vitro antimicrobial potential, including Helicobacter pylori, only Bacillus subtilis was susceptible to the n-butanol fraction at 1 mg/mL, while all of the studied samples showed activity against the human pathogenic yeast Candida albicans with the range of 0.25 to 1 mg/mL minimum inhibitory concentrations. The initial antioxidant activity, enzyme inhibitions, and antimicrobial results of S caesarea extracts and compounds suggest the further potential for in vivo evaluations.
A roadmap for psychedelic pharmacy in Canada: A proposed policy and operations approach for controlled access to select psychedelics for treatment of mental illness
Authors: Brandt Jaden
Published: April 2023

The unprecedented progress in the science and clinical investigation of psychedelic medicine will require those in healthcare leadership and the legislative policy arena to conceptualize how future reforms, policy creation, and clinical practice should occur to broaden access to these agents while simultaneously maximizing effectiveness and mitigating harm. The pharmacy profession has surprisingly had little engagement on this front. This article provides a perspective commentary and overview of potential future strategies in legal reform, professional regulatory authority policy creation, and pharmacy operations regarding the psychedelic agents’ psilocybin and methylenedioxymethamphetamine, using Canada as a national case study.
Promoting Chinese Students’ Creative Performance Through Collaborative Reasoning
Authors: Ma (马淑风) Shufeng , Zhou (周茜楠) Qiannan , Li (李亚光) Yaguang , Chen (陈森宇) Senyu
Published: April 2023

Purpose

Creativity is highly valued by modern society; however, in China, there is a major challenge in creating school-based curricula or courses that promote students’ creativity. This study introduced an interactive learning format called Collaborative Reasoning (CR). The goal was to investigate whether CR would improve a student's ability to generate creative ideas.

Design/Approach/Methods

The data comprised 474 seventh graders from eight classes in a rural middle school in northern China. The eight classes were randomly assigned to two conditions: Four classes participated in CR discussions, and the remaining four classes were taught via teacher-directed Chinese reading classes. After participating in the CR discussions, students completed a Realistic Presented Problem test that was designed to evaluate their creative performance.

Findings

The results indicated that compared to the control students, CR students generated more effective solutions (fluency) and proposed a greater variety of solutions (flexibility) to three realistic problems. The solutions proposed by the CR students were more unique (novelty) and more useful in real-life situations (usefulness) than those proposed by the control group.

Originality/Value

Providing abundant opportunities for the exchange of ideas in a social context can boost students’ performance in creative problem-solving.
The development of female science and technology workers in China: Achievements, problems and suggestions
Authors: Wang Hongwei , Chen Chen , Zhang Mingyan , Liu Zhuowen
Published: April 2023

Female science and technology (S&T) workers have played an increasingly important role in scientific research in China and have made remarkable contributions to that field. Using scientific surveys and publicly available awards data, this paper examines the specific status of female S&T workers, including the workforce structure, their domestic contributions and their international influence. Our analysis reveals the problems encountered by female S&T workers in research output, working time, development opportunities and professional voice, as well as the challenges they face during pregnancy and postnatal nursing. To solve these problems, relevant government departments should introduce more effective steps, respect women's contributions, step up publicity and provide effective assurance policies to promote the long-term and in-depth development of female scientific researchers.
Treatment of C5 Palsy: An International Survey of Peripheral Nerve Surgeons
Authors: Lubelski Daniel , Hersh Andrew M. , Feghali James , Sciubba Daniel M. , Witham Timothy , Bydon Ali , Theodore Nicholas , Belzberg Allan J.
Published: April 2023

Study Design

International survey.

Objectives

C5 palsy (C5P) is a neurological complication affecting 5-10% of patients after cervical decompression surgery. Most cases improve with conservative treatment; however, nearly 20% of patients may be left with residual deficits. Guidelines are lacking on C5P management and timing of surgical intervention. Therefore, we sought to survey peripheral nerve surgeons on their management of C5P.

Methods

An online survey was distributed centered around a patient with C5P after posterior cervical decompression and fusion. Questions included surgeon demographics, diagnostic modalities, and timing and choice of operation. Responses were summarized and the chi-squared and Kruskal-Wallis H tests were used to examine differences across specialties.

Results

A total of 154 surgeons responded to the survey, of which 59 (38%) indicated that they manage C5P cases. Average time prior to operating was 4.5 ± 2.2 months for complete injuries and 6.6 ± 3.2 months for partial injuries, with neurosurgeons significantly more likely to wait longer periods for complete ( P = .01) and partial injuries ( P = .03). Foraminotomies were selected by 19% of surgeons, while 92% selected nerve transfers. Transfer of the ulnar nerve to the musculocutaneous nerve was the most common choice (81%), followed by transfer of the radial nerve to the axillary nerve (58%).

Conclusion

Consensus exists among peripheral nerve surgeons on the use of nerve transfers for surgical treatment in cases with severe motor weakness failing to improve. Most surgeons advocate for early intervention in complete injuries. Disagreement concerns the type of nerve transfer employed, timing of surgery, and efficacy of foraminotomy.
Beyond the Positivism/Non-Positivism Binary as a Step Toward Inclusive Sociology
Authors: Headley Vernon , Jones Annie , Carter Shannon K.
Published: April 2023

This article contributes to a movement to interrogate the history and foundation of sociology. The current hegemonic narrative credits a few European men for establishing sociology as a mechanism for using science to understand social conditions amid the rise of industrialization and modern capitalism. This hegemonic story defines positivism as a central concern in the foundation of the discipline, justifying its continued dominance in U.S. sociology and using binary logic to position non-positivist approaches as subordinate and unscientific. In this article, we explore the ways early Black sociologists integrated positivist and non-positivist approaches in their work to arrive at truth and discuss ways that transcending binary distinctions facilitated rich developments in their understanding of social relations and institutions. We draw on existing scholarship to argue that privileging binary logic helped justify these scholars’ marginalization in the sociological canon and conclude with recommendations to move the discipline beyond the positivism/non-positivism binary as an important mechanism for transformation. In so doing, we contribute to the growing body of scholarship aimed at correcting the history of sociology and reimagining the foundational works and epistemological approaches to foster liberation within the discipline.
Visual Data in Education and Health Research: Historical Reflections and Current Prognostications
Authors: Roger Kerstin
Published: April 2023

This commentary serves to explore the relationship between photography and medicine since the 1800s, in order to establish a contemporary link between the two, and thus to act as a renewed invitation for pedagogical consideration for educators and researchers. Three themes are developed: first, there is a strong link between the advancement of photography as a technical field and the advancement of medical practices and education since the 1800s in a way which invites renewed consideration. Second, there is a strong mandate to consider the explosion of visual images in our everyday and global virtual landscapes vis a vis social media for the ongoing purpose of excellent standards for education and research. And finally, the field of narrative medicine has gained significant recognition, bringing the arts into clinical practice and training of clinicians, further suggesting the value and importance of visual data in the field of education and research. These 3 themes are the building blocks for an exploration of the value of visual data, here to stay in virtual and public educational domains. Educators in health sciences and health-related studies are invited to consider the value and strategies of visual data towards curriculum development, as transformative tools, and in regards to their potential not only for education, but also for clinical practice and research.
Efficacy of Platelet-Rich Plasma for Chronic Lateral Ankle Instability After Modified Broström-Gould surgery: A Randomized, Single-Blinded, Prospective Controlled Trial
Authors: Sabaghzadeh Amir , Zarei Kurdkandi Hooshmand , Ebrahimpour Adel , Biglari Farsad , Jafari Kafiabadi Meisam
Published: April 2023

Background:

Modified Broström-Gould (MBG) surgery is frequently used for chronic lateral ankle instability (CLAI). However, conventional postoperative management (CPOM) due to prolonged immobilization may have adverse effects on tendons, ligaments, and joints, causing stiffness. This prospective, randomized controlled trial aimed to determine outcomes among patients randomized to receive CPOM plus ultrasonography-guided triple injections of leukocyte-rich platelet-rich plasma (LR-PRP) compared to patients who receive only CPOM after MBG surgery.

Methods:

The present study included 40 patients with symptomatic CLAI who were candidates for the MBG surgery. The patients were randomized into 2 groups of 20, the control and PRP groups. In the PRP group, patients were injected with 3 doses of LR-PRP solution using ultrasonographic guidance. In the first injection, 2 mL of LR-PRP was injected near the injury site, and in the second and third injections, 4 mL of LR-PRP was injected in the tibiotalar joint. All patients received a short leg splint for 2 weeks, followed by 4 weeks in a walking boot. The primary outcome measure was the visual analog scale (VAS), and the secondary outcome measures were the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and ankle total range of motion (total ROM). The assessment was performed at baseline and 3 and 6 months after surgery.

Results:

The mean VAS and AOFAS scores improved significantly in both groups 6 months after surgery ( P < .001). However, the PRP group did not significantly improve in VAS or AOFAS scores compared with the control group. No clinically significant difference was observed between the 2 groups regarding the total ROM scores at month 3.

Conclusion:

The application of LR-PRP after MBG surgery did not show any superior clinical or functional improvement over CPOM.

Level of Evidence:

Level II, prospective randomized trial.
Introduction: Accumulation by restoration and political ecologies of repair
Authors: Huff Amber , Brock Andrea
Published: April 2023

Accumulation by Restoration (AbR) represents a shift from a conservationist ‘mode of production’ emphasizing sustainability and preservation to a ‘growth economy of repair’ in which nature becomes valued not just for its use but also for its potential for repair or restoration. The ‘repair mode’ mobilizes the assumption, imagery and mythology of degradation juxtaposed with the promise of economic and ecological redemption. Through rationalization, restoration, re-creation and/or re-cultivation, it aims to generate new, better-disciplined, more legible, ‘substitutable’ natures to multiple accumulative ends. Bridging political ecology, critical agrarian studies and science and technology studies, contributions to this themed issue explore transformations associated with AbR at across scales and involving variegated alliances, discourses, technologies and institutional dynamics giving rise to ecologies of repair. We demonstrate how the dynamics and contradictions of the repair mode are mediated and enacted through the performative, spectacular and metrological rendering of ‘mitigation’, ‘equivalence’, ‘neutrality’ and ‘repair’ as instruments and object, simultaneous means and ends. These dynamics have given rise to new materialities and technologies of governance and new intensities and spatialities of resource control and accumulation, as what were consequences of growth have become strategic goals and the foundation of a new growth economy.
Vulnerability in the Global Tropics? An Ethnography of the Experiences of International Managers in Venezuela and Mexico
Authors: Gaggiotti Hugo
Published: April 2023

The Latin American tropics have been considered spaces where the taken-for-granted vulnerability of the international assignment experience is exacerbated because of poor working conditions. In classical approaches to international management studies, the complexity attributed to the role of global managers resides in the ‘fact’ that they live under conditions of permanent confrontation, adjustment, change and adaptation. The literature typically portrays the international manager as perpetually experiencing an ‘out-of-place’ existence, as their supposed ‘national culture’ of origin is by definition different from the ‘national culture’ of the destination country. The stereotyped exoticism of the tropics – constructed as spaces for tourism and adventure, but also characterised as precarious in terms of their health infrastructures, uncomfortable climates, and socio-economic and political instability – contributes to the framing of international management in these regions as highly challenging. In this article, these stereotypical conceptions are challenged. Evidence is provided indicating that managers’ narratives about ‘the experience of working and living in the tropics’ have more to do with their negative experiences of organisational power and the creation of a singular organisational culture of control and commitment than with the experience of the tropical context per se. The analysis is based on 6 years of intermittent longitudinal ethnographic fieldwork (2005–2009; 2020–2022) with international and nomadic Latin American professionals working in two factories located in the tropics owned by an industrial corporation.
Comparison of Five Inservicing Methods in an Intensive Care Nursery
Authors: Zenk Karin E. , Lloyd W. Chris
Published: April 2023

Objective

Communicating to nurses new information on therapeutics or pharmacy procedures is a frequent challenge faced by most hospital pharmacists. Pharmacists should use the most efficient and effective methods to inservice nursing staff. The purpose of this study was to compare five methods of inservicing in a neonatal intensive care unit (NICU) to determine which method resulted in the greatest knowledge retention as assessed by a ten-question quiz.

Design

Various combinations of written guideline alone, verbal discussion by a pharmacist with and without a written guideline, and verbal discussion by a nurse with and without a written guideline were used to introduce nurses to the use of caffeine for apnea/bradycardia of the newborn. Each nurse completed a quiz to assess knowledge retention. The written guideline and quiz were prepared by a pharmacist.

Participants

Forty-eight nurses participated in the study: (1) group 1 (n=11) received the written guideline only (no verbal discussion); (2) group 2 (n=14) received verbal discussion by a pharmacist plus a written guideline; (3) group 3 (n=9) received verbal discussion by a nurse-educator plus a written guideline; (4) group 4 (n=9) received verbal discussion by a pharmacist (no written guideline); and (5) group 5 (n=5) received verbal discussion by a nurse-educator (no written guideline).

Main Outcome Measures

Mean quiz scores for all groups were compared and assessed using the Irwin-Fisher test for equality of binomial probabilities on all possible pairs of groups.

Results

Mean quiz scores for groups 1 and 3 were 10; for group 2, 8.6; for group 4, 9; and for group 5, 9.2. Using the Irwin-Fisher tests for equality of binomial probabilities on all possible pairs of groups, the probability of obtaining a perfect score on the quiz was the highest for groups 1 and 3 (p≤0.05).

Conclusions

Within the limitations and the setting of this study, the two most effective methods of nursing inservice were a pharmacist-prepared written guideline followed by a quiz, and the written guideline plus a verbal discussion by a nurse-educator followed by a quiz. Use of these methods can reduce pharmacist inservice time and improve medication knowledge of the nurses and possibly reduce errors in the NICU.
Administration of Bromocriptine by the Vaginal Route in Women Intolerant of Oral Therapy
Authors: Natrajan Rebecca , Miller Jeffrey L. , Rose Leslie I.
Published: April 2023

Objective

To assess the use of intravaginal bromocriptine mesylate in women intolerant of orally administered bromocriptine.

Participants

Two consecutive women of reproductive age with prolactin-secreting pituitary microadenomas who were intolerant of oral bromocriptine.

Results

Normoprolactinemia with eumenorrhea was obtained using intravaginal bromocriptine.

Conclusions

Intravaginal bromocriptine is recommended as an alternative route of administration in women intolerant of oral therapy.
Assessing the Appropriateness of Physician Prescribing for Geriatric Outpatients
Authors: Lipton Helene Levens , Bird Joyce Adair , Bero Lisa Anne , McPhee Stephen J.
Published: April 2023

Objective

In a randomized, controlled trial evaluating the impact of clinical pharmacists’ consultations on physicians’ prescribing decisions, a seven-member physician/pharmacist panel developed an instrument to characterize and quantify the full range of drug-prescribing problems. The instrument was tested for validity and reliability.

Sample

The instrument was applied in reviewing prescribing for 236 geriatric outpatients.

Methods

To ensure internal validity of the instrument, five panel meetings were devoted to reaching a consensus on procedures, categories, criteria, and scoring. Each case was evaluated independently by two reviewers and each drug in the regimen was evaluated for drug-drug interactions, dosage, schedule, allergic reactions, therapeutic duplication, use of drugs without established diagnoses, and inappropriate drugs for the patient's clinical conditions; discrepancies were adjudicated by the panel chairperson. Self-reported adverse effects of 60 study patients who were interviewed, and hospital readmissions of all study patients were used to test the external validity of the instrument.

Results

Inter-rater reliability improved over time, reaching a high of 97.1 percent after six months. A positive association was determined between the prescribing scores and the number of reported adverse effects (rho=0.28, p=0.02). Although the number of patients with drug-related hospital readmissions was too few to establish a significant association between the prescribing scores and readmissions, the findings were expected.

Conclusions

Given current requirements for drug utilization reviews in hospitals, health maintenance organizations, and Medicaid programs, this instrument may prove to be very useful.
Synthetic Human Calcitonin in the Treatment of Hypercalcemia of Malignancy
Authors: Linette Donna Carr , Hunter Sheila G. , Bennett Teresa A.
Published: April 2023

Objective

To determine whether synthetic human calcitonin is a safe and effective treatment for hypercalcemia of malignancy.

Data Sources

Journal articles published between 1978 and 1992; manufacturers’ package inserts.

Study Selection

Articles containing pertinent information concerning the therapeutic use and effects of calcitonin products, particularly those of salmon or human origin.

Data Extraction

Resources were evaluated independently by the authors and information was collaboratively extracted.

Data Synthesis

No studies could be located comparing human calcitonin with salmon calcitonin in the treatment of hypercalcemia. Two studies found human calcitonin to be effective for this indication.

Conclusions

Human calcitonin cannot be recommended over the salmon product in the treatment of hypercalcemia of malignancy until additional comparative studies have been performed.
Evolution of the Duty to Warn—One State's Experience
Authors: Williams Karl G.
Published: April 2023

Objective

There exist, in many jurisdictions, confusion and uncertainty with regard to the legal duty of pharmacists to warn their patients of the potential risks of their medication. Review of the legal evolution of this duty in one state with recent experience is instructive.

Data Sources

Published opinions of the Tennessee Court of Appeals.

Conclusions

The cases are consistent with the idea that if the pharmacist warned about risks that had a reasonably foreseeable potential of occurring, then there would be no liability.
Innovative Nuclear Pharmacy Service
Authors: Cheng Kenneth T. , Brown Barry M. , Sheppard Mary Stewart , Haymond David J.
Published: April 2023

Objective

To provide an overview of the investigational nuclear pharmacy service at the Medical University of South Carolina.

Data Sources

Referencess were selected from published bibliographies of nuclear pharmacy and hospital pharmacy articles and from specific-topic searches of the MEDLINE computerized database (all languages, through 1992).

Study Selection

Studies of clinical pharmacy functions that were considered relevant to the specialty practice of nuclear pharmacy were chosen.

Data Extraction

Studies were reviewed for internal consistency and appropriateness.

Data Synthesis

Data on the clinical impact of nuclear pharmacy services do not exist.

Conclusions

Based on our experience in establishing an investigational drug service, we conclude that nuclear pharmacists should take an active role in clinical investigations. The outcomes of this kind of involvement are very rewarding.
The Pharmacy Technician: A Challenge for Pharmacy Education
Authors: Ballington Don A.
Published: April 2023

Pharmacy has evolved into a highly sophisticated profession. Many daily technical tasks are being delegated to personnel other than pharmacists as responsibilities and demand for services increase. The question facing pharmacy is how to support technical activities so that the public, healthcare, and profession are served with quantity and quality of services. A logical approach would be to develop a pool of well-trained technical personnel, technicians. Pharmacy technicians are currently trained through the military, technical/community colleges, vocational schools, and hospitals. Technician education has no organization to set policy, establish standards, or require compliance. Technician training and issues are profession-wide in significance if pharmacy, healthcare, and the public are to be appropriately served.
Afebrile benign convulsions with or without a reversible splenial lesion in two pediatric patients with COVID-19
Authors: Lee Yun Young , Kim Young Ok
Published: April 2023

Background

Seizures in children with coronavirus disease 2019 (COVID-19) were markedly increased during the Omicron variant surge. Most seizures occurred with fever. New-onset afebrile seizures were rarely reported; therefore, their courses are not well-known.

Case presentation

Two patients (7 and 26 months of age, respectively) with COVID-19 showed recurrent afebrile seizures immediately after resolution of a fever lasting for 2–3 days. Bilateral convulsive seizures lasted for approximately 1 min/episode (6 of 7 total episodes) and occurred 3–4 times within 2–3 h. However, the patients were alert between seizures, which is in contrast to seizures occurring with encephalopathy or encephalitis. Only one episode required acute antiseizure medication. Brain magnetic resonance imaging showed a reversible splenial lesion in one patient. The serum uric acid level was slightly increased (7.8 mg/dL) in this patient. Electroencephalography findings were all normal. During the follow-up period, no seizures or developmental problems have been observed.

Conclusions

COVID-19-associated, afebrile benign convulsions with or without a reversible splenial lesion are similar to ‘benign convulsions with mild gastroenteritis’; therefore, continuation of antiseizure medication does not seem necessary.
24 h mortality and its predictors among road traffic accident victims in a resource limited setting; a multicenter cohort study
Authors: Kamabu Kinyamaniyi , La O Soria Jorge , Tumwesigye Deus , Okedi Xaviour Francis , Kyomukama Lauben , Muhumuza Joshua , Musinguzi Brian , Kavuma Daniel , Vivalya Bives Mutume Nzanzu , Loduk Michael , Abdullah Wani Shabani
Published: April 2023

Introduction

The incidence of road traffic accidents (RTAs) is on the rise contributing to the global burden of mortality as a major global health threat. It has been estimated that 93% of RTAs and more than 90% of the resulting deaths occur in low and middle income countries. Though death due to RTAs has been occurring at an alarming rate, there is paucity of data relating to incidence and predictors of early mortality. This study was aimed at determining the 24 h mortality and its predictors among RTA patients attending selected hospitals in western Uganda.

Methods

This was a prospective cohort that consecutively enrolled 211 RTA victims admitted and managed in emergency units of 6 hospitals in western Uganda. All patients who presented with a history of trauma were managed according to the advanced trauma life support protocol (ATLS). The outcome regarding death was documented at 24 h from injury. Data was analyzed using SPSS version 22 for windows.

Results

Majority of the participants were male (85.8%) aged 15–45 years (76.3%). The most common road user category was motorcyclists (48.8%). The 24 h mortality was 14.69%. At multivariate analysis, it was observed that a motorcyclist was 5.917 times more likely to die compared to a pedestrian (P = 0.016). It was also observed that a patient with severe injury was 15.625 times more likely to die compared to one with a moderate injury (P < 0.001).

Conclusion

The incidence of 24 h mortality among road traffic accident victims was high. Being motorcycle rider and severity of injury according to Kampala trauma score II predicted mortality. Motorcyclists should be reminded to be more careful while using the road. Trauma patients should be assessed for severity, and the findings used to guide management since severity predicted mortality.
COVID-19 severity scale for claims data research
Authors: Krause Trudy Millard , Greenberg Raymond , Ghosh Lopita , Wozny Joseph S. , Hansen Regina M. , Schaefer Caroline
Published: April 2023

Objective

To create and validate a methodology to assign a severity level to an episode of COVID-19 for retrospective analysis in claims data.

Data Source

Secondary data obtained by license agreement from Optum provided claims records nationally for 19,761,754 persons, of which, 692,094 persons had COVID-19 in 2020.

Study Design

The World Health Organization (WHO) COVID-19 Progression Scale was used as a model to identify endpoints as measures of episode severity within claims data. Endpoints used included symptoms, respiratory status, progression to levels of treatment and mortality.

Data Collection/Extraction methods

The strategy for identification of cases relied upon the February 2020 guidance from the Centers for Disease Control and Prevention (CDC).

Principal Findings

A total of 709,846 persons (3.6%) met the criteria for one of the nine severity levels based on diagnosis codes with 692,094 having confirmatory diagnoses. The rates for each level varied considerably by age groups, with the older age groups reaching higher severity levels at a higher rate. Mean and median costs increased as severity level increased. Statistical validation of the severity scales revealed that the rates for each level varied considerably by age group, with the older ages reaching higher severity levels (p < 0.001). Other demographic factors such as race and ethnicity, geographic region, and comorbidity count had statistically significant associations with severity level of COVID-19.

Conclusion

A standardized severity scale for use with claims data will allow researchers to evaluate episodes so that analyses can be conducted on the processes of intervention, effectiveness, efficiencies, costs and outcomes related to COVID-19.
Molecular mimicry and cancer vaccine development
Authors: Tagliamonte Maria , Cavalluzzo Beatrice , Mauriello Angela , Ragone Concetta , Buonaguro Franco M. , Tornesello Maria Lina , Buonaguro Luigi
Published: April 2023

Background

The development of cancer immunotherapeutic strategies relies on the identification and validation of optimal target tumor antigens, which should be tumor-specific as well as able to elicit a swift and potent anti-tumor immune response. The vast majority of such strategies are based on tumor associated antigens (TAAs) which are shared wild type cellular self-epitopes highly expressed on tumor cells. Indeed, TAAs can be used to develop off-the-shelf cancer vaccines appropriate to all patients affected by the same malignancy. However, given that they may be also presented by HLAs on the surface of non-malignant cells, they may be possibly affected by immunological tolerance or elicit autoimmune responses.

Main body

In order to overcome such limitations, analogue peptides with improved antigenicity and immunogenicity able to elicit a cross-reactive T cell response are needed. To this aim, non-self-antigens derived from microorganisms (MoAs) may be of great benefit.
The anesthesia workforce in Canada: a methodology to identify physician anesthesia providers using health administrative data
Authors: Simkin Sarah , Orser Beverley A. , Wilson C. Ruth , Bourgeault Ivy Lynn
Published: April 2023

Background

Safe and timely anesthesia services are an integral component of modern health care systems. There are, however, increasing concerns about the availability of anesthesia services in Canada. Thus, a comprehensive approach to assess the capacity of the anesthesia workforce to provide service is a critical need. Data regarding the anesthesia services provided by specialists and family physicians are available through the Canadian Institute for Health Information (CIHI) but collating the data across delivery jurisdictions has proven challenging. As a result, information related to the activity of physician anesthesia providers is routinely excluded from annual physician workforce reports. Our goal was to develop a novel approach to identifying and characterizing the anesthesia workforce on a pan-Canadian scale.

Methods

The study was approved by the University of Ottawa Office of Research Ethics and Integrity. We developed a methodology to identify physicians who provided anesthesia services in Canada between 1996 and 2018 using data elements from the CIHI National Physician Database. We iteratively consulted with expert advisors and compared the results with Scott’s Medical Database, the Canadian Medical Association (CMA) Masterfile, and the College of Family Physicians of Canada membership database.

Results

The methodology identified providers of anesthesia services using data elements from the CIHI National Physician Database, including categories of the National Grouping System, specialty designations, activity levels and participation thresholds. Physicians who provided anesthesia services only sporadically and medical residents-in-training were excluded. This methodology produced estimates of anesthesia providers that aligned with other sources. The process we followed was sequential, transparent, and intuitive, and was strengthened by collaboration and iterative consultation with experts and stakeholders.

Conclusions

Using physician activity patterns, this novel methodology allows stakeholders to identify which physician provide anesthesia services in Canada. It is an essential step in developing a pan-Canadian anesthesia workforce strategy that can be used to examine patterns and trends related to the workforce and support evidence-informed workforce decision-making. It also establishes a foundation for assessing the effectiveness of a variety of interventions aimed at optimizing physician anesthesia services in Canada.
Snack consumption patterns and their associations with risk of incident metabolic syndrome: Tehran lipid and glucose study
Authors: Gaeini Zahra , Malmir Hanieh , Mirmiran Parvin , Feizy Zahra , Azizi Fereidoun
Published: April 2023

Aim

Few studies considered the association between snack patterns and metabolic abnormalities. Here we aimed to characterize the major snack patterns among Iranian adults and determine their association with the risk of metabolic syndrome (MetS).

Methods

This study was conducted on 1713 MetS-free adults who participated in the third phase of the Tehran Lipid and Glucose Study (TLGS). At baseline, dietary intake of snack was assessed using a validated 168-items food frequency questionnaire, and snack patterns were obtained by principal component analysis (PCA). Adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs) were calculated for the association of incident MetS with the extracted snack patterns.

Results

PCA identified five major snack patterns, defined as “healthy pattern”, “low-fructose pattern”, “high-trans pattern”, “high-caffeine pattern” and “high-fructose pattern”. Participants in the highest tertile of the “high-caffeine pattern” had lower risk of MetS (HR = 0.80, 95% CI = 0.65–0.99, P for trend = 0.032). Other snack patterns have not shown any significant association with MetS incidence.

Conclusions

Our findings suggest that consuming a snack pattern with high loads of caffeine, defined as “High-caffeine pattern” in the present study, could reduce the risk of MetS in healthy adults. Further prospective studies are needed to more fully determine the association between snack patterns and MetS incidence.
Open versus closed reduction internal fixation for lateral condyle humeral fractures in children: a systematic review and meta-analysis
Authors: Zhu Suyue , Zheng Yan , Jiang Yazhou , Yin Hanjun , Zhu Dongsheng
Published: April 2023

Objective

The objective of this meta-analysis was to illustrate the clinical outcomes and safety of two different management options for Song stage 2–4 lateral condyle humeral fractures in children.

Method

In January 2023, a systematic computer-based search was conducted. Data were retrieved for patients with two different management options for lateral condyle humeral fractures in children. The primary endpoints were clinical outcomes based on infection, avascular necrosis, and nonunion. After testing for publication bias and heterogeneity between studies, the data was aggregated for stochastic effect models when necessary.

Results

Eight clinical studies with 742 patients were eventually included in the meta-analysis. There was no significant difference between the closed reduction and percutaneous pinning, and open reduction and internal fixation in terms of the clinical outcomes based on infection, avascular necrosis, and nonunion (P > 0.05).

Conclusions

Closed reduction and percutaneous pinning, as well as open reduction and internal fixation of lateral condyle humeral fractures in children, resulted in similar structural stability and functional outcomes. More high-quality randomized controlled trials are needed to determine this conclusion.
Identification of complex and cryptic chromosomal rearrangements by optical genome mapping
Authors: Shi Shanshan , Huang Peizhi , Yan Ruiling , Li Ruiman
Published: April 2023

Background

Optical genome mapping (OGM) has developed into a highly promising method for detecting structural variants (SVs) in human genomes. Complex chromosomal rearrangements (CCRs) and cryptic translocations are rare events that are considered difficult to detect by routine cytogenetic methods. In this study, OGM was applied to delineate the precise chromosomal rearrangements in three cases with uncertain or unconfirmed CCRs detected by conventional karyotyping and one case with a cryptic translocation suggested by fetal chromosomal microarray analysis (CMA).

Results

In the three cases with CCRs, OGM not only confirmed or revised the original karyotyping results but also refined the precise chromosomal structures. In the case with a suspected translocation not detected by karyotyping, OGM efficiently identified the cryptic translocation and defined the genomic breakpoints with relatively high accuracy.

Conclusions

Our study confirmed OGM as a robust alternative approach to karyotyping for the detection of chromosomal structural rearrangements, including CCRs and cryptic translocations.