bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of chest X-ray scoring in predicting disease severity and outcomes of patients hospitalised with COVID-19 in Bangladesh
Authors: Nahar Shaima Shamsun , Haque Md Ahshanul , Sarmin Monira , Nuzhat Sharika , Jahan Yasmin , Bushra Matin Fariha , Shahrin Lubaba , Afroze Farzana , Saha Haimanti , Timu Rehnuma Tabassum , Kamal Mehnaz , Shahid Abu Sadat Mohammad Sayeem Bin , Sultana Nadia , Mamun Gazi Md. Salahuddin , Chisti Mohammod Jobayer , Ahmed Tahmeed
Published: January 2024

Introduction:

Evaluation of potential outcomes of COVID-19-affected pneumonia patients using computed tomography scans may not be conceivable in low-resource settings. Thus, we aimed to evaluate the performance of chest X-ray scoring in predicting the disease severity and outcomes of adults hospitalised with COVID-19.

Methods:

This was a retrospective chart analysis consuming data from COVID-19-positive adults who had chest X-ray availability and were admitted to a temporary COVID unit, in Bangladesh from 23rd April 2020 to 15th November 2021. At least one clinical intensivist and one radiologist combinedly reviewed each admission chest X-ray for the different lung findings. Chest X-ray scoring varied from 0 to 8, depending on the area of lung involvement with 0 indicating no involvement and 8 indicating ⩾75% involvement of both lungs. The receiver operating characteristic curve was used to determine the optimum chest X-ray cut-off score for predicting the fatal outcomes.

Result:

A total of 218 (82.9%) out of 263 COVID-19-affected adults were included in the study. The receiver operating characteristic curve demonstrated the optimum cut-off as ⩾3 and ⩾5 for disease severity and death, respectively. In multivariate logistic regression analysis, a chest X-ray score of ⩾3 was found to be independently associated with disease severity (aOR: 8.70; 95% CI: 3.82, 19.58, p < 0.001) and a score of ⩾5 with death (aOR: 16.53; 95% CI: 4.74, 57.60, p < 0.001) after adjusting age, sex, antibiotic usage before admission, history of fever, cough, diabetes mellitus, hypertension, total leukocytes count and C-reactive protein.

Conclusion:

Using chest X-ray scoring derived cut-off at admission might help to identify the COVID-19-affected adults who are at risk of severe disease and mortality. This may help to initiate early and aggressive management of such patients, thereby reducing their fatal outcomes.
Solutions in search of a problem: Opening policy windows for Business Improvement Districts in the Nordic countries
Authors: Valli Chiara , Olesen Kristian , Parker Peter
Published: January 2024

Policy mobility literature invites us to consider the power-laden processes of how urban policies are exported, mimicked, and transformed in different urban contexts. However, recent critique has highlighted the need for a fuller understanding of urban policy context to understand where and when policies come to be implemented in new settings and how they are transformed. The purpose of this study is to explore understandings of urban policy context in a comparative study of policy mobility, and specifically relations between internationally packaged concepts, local pilot projects and national level actors. We develop a framework for understanding these relations in policy mobility based on case studies of BID policy development in Sweden and Denmark drawing on both Policy Mobility literature and a Multiple Streams Approach. The main finding is that local pilots play a key role in translating packaged policy concepts but also serve as ‘proof of concept’ for further institutionalization. The way these pilots are discursively situated in relation to ‘problems’ is therefore of central importance for further implementation. Furthermore, the study highlights the role of policy entrepreneurs that connect local pilots (and discursive problems) with national level actors, and political opportunities.
Culturally proficient leadership: Equipping educators to better serve refugee students during a crisis
Authors: Arar Khalid , Brion Corinne , Abo-Zaed Arar Eman , Saiti Anna
Published: January 2024

Purpose: The purpose of this paper is to explore the proficiency of leadership practices in dealing with refugee students’ cultural needs during the COVID-19 pandemic. Design/methodology/approach: Semi-structured interviews were employed to elucidate data from teachers, counselors, and leaders in a U.S. Midwestern suburban community that had recorded a significant increase in the number of refugee students. Findings: The findings identified that suburban districts do not usually have the cultural experience or training on how to best serve their refugee students. Indeed, prior to the pandemic, most participants were culturally blind or pre-competent. However, the pandemic afforded participants an opportunity to learn about their refugee students’ cultures. The evidence of the current research suggests that cultural proficiency should constitute an integral part of leadership’s crisis management plans. Originality: The emotions that develop in a teacher’s working environment at a time of crisis, as well as their levels of emotional engagement, are two important factors that affect a school’s functioning. As such, this work recognizes the need to exercise empathy when addressing vulnerable students’ needs. Furthermore, this work recognizes that a school leader exhibiting awareness and empathy will help the teachers of that school to improve their effectiveness in exercising empathy.
Modeling Non-profit Organisations’ Funding Diversification
Authors: Jegers Marc
Published: January 2024

There is a rich literature connecting for profit financial portfolio theory to non-profit organisations’ funding diversification policies. This research typically ignores fundamental specificities of the non-profit context. The present paper integrates three of these specificities: non-profits’ performance being measured by other standards than their financial profitability, the non-proportionality between funding expenses and expected incoming funds due to varying marginal effects of the former, and crowding in/out effects between non-profit funding sources. It is shown that, contrary to what is the case in financial portfolio theory, a positive relation between expected performance and its variability cannot be taken for granted when increasing the number of non-profit’s funding sources. An important reason for this is the presence of crowding effects, which therefore cannot be ignored when looking for the best non-profit’s funding diversification strategy.
Large-scale damage assessment of buildings considering SSI and site amplification: The case of Thessaloniki
Authors: Amendola Chiara , Pitilakis Dimitris
Published: January 2024

Our study introduces a methodology to improve large-scale seismic damage assessment by incorporating site-specific fragility curves, considering soil–structure interaction (SSI) and site amplification (SAmp) effects. The proposed method proposes an enhanced building exposure model, using publicly available data and the open-source OpenQuake Engine software. The objective is to determine whether a more refined approach incorporating SSI and SAmp can impact the final damage calculation. We evaluate our approach by estimating the damage distribution for the Thessaloniki 1978 earthquake scenario using the actual building stock of Thessaloniki. We present several maps with aggregated damages at different levels to investigate the spatial variability of SSI and SAmp, and their influence on the resulting damages. Our estimated physical damages have been compared with those obtained using approaches from the existing literature. Apparently, using an updated building exposure model to assess damages makes any comparison with past observed damages challenging. Nevertheless, incorporating SSI and SAmp in large-scale damage assessment can provide valuable support for strategic decision-making in cities and improve the accuracy of the expected loss assessment due to a seismic event.
CALR mutation burden in essential thrombocythemia and disease outcome
Authors: Guglielmelli Paola , Szuber Natasha , Gangat Naseema , Capecchi Giulio , Maccari Chiara , Harnois Michaël , Karrar Omer , Abdelmagid Maymona , Balliu Manjola , Nacca Elena , Atanasio Alessandro , Sestini Ilaria , Désilets Audrey , Loscocco Giuseppe Gaetano , Rotunno Giada , Busque Lambert , Tefferi Ayalew , Vannucchi Alessandro Maria
Published: January 2024

Among 281 patients with essential thrombocythemia and calreticulin (CALR) mutation, we found a variant allele frequency of ≥60% to be associated with significantly shortened myelofibrosis-free survival, mostly apparent with CALR type-1 and CALR type-indeterminate mutations.
Nephron sparing surgery for renal hilar tumours: short-term follow-up of predominantly robot-assisted surgery cohort
Authors: Murugesan Anandan , Chinnusamy Ramesh , Madhavan Devdas
Published: January 2024

Background

Hilar tumours are the renal tumours, which abut the renal artery or vein. Nephron sparing surgery (NSS) is of proven benefit among those with small renal masses. Hilar tumours are usually offered radical surgery due to the presumed difficulty in dissection, upgrading to tumour stage, and risk of conversion to radical surgery. We present our results of patients with hilar tumour undergoing nephron sparing surgery.

Methods

We performed a retrospective analysis of patients who underwent NSS for renal hilar tumours in our tertiary referral institute from June 2017 to December 2022. The case sheets of all the patients who had undergone NSS were analysed and their radiology images reviewed. Those with hilar tumours were analysed based on demographic characters, perioperative and postoperative and follow-up details.

Results

Among a total of 21 patients undergoing partial nephrectomy, ten had hilar tumours. The median age was 43 years. Nine patients had robot-assisted partial nephrectomy and one underwent open partial nephrectomy. Seven patients had incidentally detected tumours. One had Grade 3 chronic kidney disease. The mean operative time and robot console time were 225 and 125 min, respectively. Median warm ischaemia time (WIT) was 36 min (25–48 min). One patient had grade 2 complication and two had grade 3 complication. Eight had clear cell renal cell carcinoma and one had positive margin. None had recurrence at a median follow-up of 38 months.

Conclusion

Nephron sparing surgery, especially with robot-assisted approach, is feasible in hilar tumours with prognosis and complications similar to non-hilar tumours in short-term follow-up.
The role of lymphatic vessels in corneal fluid homeostasis and wound healing
Authors: Hadrian Karina , Cursiefen Claus
Published: January 2024

The cornea, essential for vision, is normally avascular, transparent, and immune-privileged. However, injuries or infections can break this privilege, allowing blood and lymphatic vessels to invade, potentially impairing vision and causing immune responses. This review explores the complex role of corneal lymphangiogenesis in health and diseases. Traditionally, the cornea was considered devoid of lymphatic vessels, a phenomenon known as "corneal (lymph)angiogenic privilege." Recent advances in molecular markers have enabled the discovery of lymphatic vessels in the cornea under certain conditions. Several molecules contribute to preserving both immune and lymphangiogenic privileges. Lymphangiogenesis, primarily driven by VEGF family members, can occur directly or indirectly through macrophage recruitment. Corneal injuries and diseases disrupt these privileges, reducing graft survival rates following transplantation. However, modulation of lymphangiogenesis offers potential interventions to promote graft survival and expedite corneal edema resolution.

This review underscores the intricate interplay between lymphatic vessels, immune privilege, and corneal pathologies, highlighting innovative therapeutic possibilities. Future investigations should explore the modulation of lymphangiogenesis to enhance corneal health and transparency, as well as corneal graft survival, and this benefits patients with various corneal conditions.
Application of cold argon plasma on germination, root length, and decontamination of soybean cultivars
Authors: Sayahi Khadijeh , Sari Amir Hossein , Hamidi Aidin , Nowruzi Bahareh , Hassani Farshid
Published: January 2024

Applying cold discharge plasma can potentially alter plants' germination characteristics by triggering their physiological activities. As a main crop in many countries, soybean was examined in the present study using cultivars such as Arian, Katoul, Saba, Sari, and Williams in a cold argon plasma. This study has been motivated by the importance of plant production worldwide, considering climate change and the increasing needs of human populations for food. This study was performed to inspect the effect of cold plasma treatment on seed germination and the impact of argon plasma on microbial decontamination was investigated on soybeans. Also, the employed cultivars have not been studied until now the radicals generated from argon were detected by optical emission spectrometry (OES), and a collisional radiative model was used to describe electron density. The germination properties, including final germination percentage (FGP), mean germination time (MGT), root length, and electrical conductivity of biomolecules released from the seeds, were investigated after the plasma treatments for 30, 60, 180, 300, and 420 s. The decontamination effect of the plasma on Aspergillus flavus (A.flavus) and Fusarium solani (F.solani) was also examined. The plasma for 60 s induced a maximum FGP change of 23.12 ± 0.34% and a lowest MGT value of 1.40 ± 0.007 days. Moreover, the ultimate root length was 56.12 ± 2.89%, in the seeds treated for 60 s. The plasma exposure, however, failed to yield a significant enhancement in electrical conductivity, even when the discharge duration was extended to 180 s or longer. Therefore, the plasma duration of 180 s was selected for the blotter technique. Both fungi showed successful sterilization; their infectivity inhibition was 67 ± 4 and 65 ± 3.1%, respectively. In general, the cold plasma used for soybeans in the present study preserved their healthy qualities and reduced the degree of fungal contamination.
Effect of COVID-19 on infections associated with medical devices in critical care
Authors: Hernández Fredy Leonardo Carreño , Virguez Juanita Valencia , Vesga Juan Felipe González , Castellanos María Lucía , Beltrán Gabriela Ruiz , Toquica Laura Daniela Lorza , Gomez Carol Natalia Sánchez , Ríos Maria Valentina Stozitzky , Bolívar Yenny Rocío Cárdenas , Sanchez Jorge Iván Alvarado
Published: January 2024

Objectives

This study explores the hypothesis that COVID-19 patients are at a heightened risk of healthcare-associated infections (HAIs) associated with medical device usage compared to non-COVID-19 patients. Our primary objective was to investigate the correlation between COVID-19 infection in ICU patients and subsequent HAIs following invasive medical device insertion. Additionally, we aim to assess the impact of SARS-CoV-2 infection on onset times concerning specific microorganisms and the type of medical device, providing valuable insights into this intricate relationship in intensive care settings.

Methodology

A retrospective cohort study was conducted using ICU patient records at our hospital from 2020 to 2022. This investigation entailed evaluating the timing of HAIs while distinguishing between patients with and without SARS-CoV-2 infection. We identified and analyzed the type of isolation and infection attributed to the medical device while controlling for ICU duration and ventilator days using Cox regression.

Results

Our study included 127 patients without SARS-CoV-2 infection and 140 patients with SARS-CoV-2 infection. The findings indicated a higher incidence of HAI caused by various microorganisms associated with any medical device in patients with SARS-CoV-2 (HR = 6.86; 95% CI-95%: 3.26–14.43; p < 0.01). After adjusting for ICU duration and ventilator days, a heightened frequency of HAIs persisted in SARS-CoV-2-infected individuals. However, a detailed examination of HAIs revealed that only ventilation-associated pneumonia (VAP) displayed a significant association (HR = 6.69; 95% CI: 2.59–17.31; p < 0.01). A statistically significant correlation between SARS-CoV-2 infection and the isolation of S. aureus was also observed (p = 0.034). The prevalence of S. aureus infection was notably higher in patients with SARS-CoV-2 (RR = 8.080; 95% CI: 1.052–62.068; p < 0.01).

Conclusions

The frequency of pathogen isolates in invasive medical devices exhibited an association with SARS-CoV-2 infection. Critically ill patients with SARS-CoV-2 are more prone to developing early-onset VAP than those without SARS-CoV-2 infection.
An analysis of differences in Carbapenem-resistant Enterobacterales in different regions: a multicenter cross-sectional study
Authors: Guo Bo , Li Peili , Qin Bingyu , Wang Shanmei , Zhang Wenxiao , Shi Yuan , Yang Jianxu , Niu Jingjing , Chen Shifeng , Chen Xiao , Cui Lin , Fu Qizhi , Guo Lin , Hou Zhe , Li Hua , Li Xiaohui , Liu Ruifang , Liu Xiaojun , Mao Zhengrong , Niu Xingguo , Qin Chao , Song Xianrong , Sun Rongqing , Sun Tongwen , Wang Daoxie , Wang Yong , Xu Lanjuan , Xu Xin , Yang Yuejie , Zhang Baoquan , Zhou Dongmin , Li Zhaozhen , Chen Yinyin , Jin Yue , Du Juan , Shao Huanzhang
Published: January 2024

Objective

This study aimed to explore the characteristics of carbapenem-resistant Enterobacterales (CRE) patients in the intensive care unit (ICU) in different regions of Henan Province to provide evidence for the targeted prevention and treatment of CRE.

Methods

This was a cross-sectional study. CRE screening was conducted in the ICUs of 78 hospitals in Henan Province, China, on March 10, 2021. The patients were divided into provincial capital hospitals and nonprovincial capital hospitals for comparative analysis.

Results

This study involved 1009 patients in total, of whom 241 were CRE-positive patients, 92 were in the provincial capital hospital and 149 were in the nonprovincial capital hospital. Provincial capital hospitals had a higher rate of CRE positivity, and there was a significant difference in the rate of CRE positivity between the two groups. The body temperature; immunosuppressed state; transfer from the ICU to other hospitals; and use of enemas, arterial catheters, carbapenems, or tigecycline at the provincial capital hospital were greater than those at the nonprovincial capital hospital (P < 0.05). However, there was no significant difference in the distribution of carbapenemase strains or enzymes between the two groups.

Conclusions

The detection rate of CRE was significantly greater in provincial capital hospitals than in nonprovincial capital hospitals. The source of the patients, invasive procedures, and use of advanced antibiotics may account for the differences. Carbapenem-resistant Klebsiella pneumoniae (CR-KPN) was the most prevalent strain. Klebsiella pneumoniae carbapenemase (KPC) was the predominant carbapenemase enzyme. The distributions of carbapenemase strains and enzymes were similar in different regions.
Diagnostic value of applying preoperative breast ultrasound and clinicopathologic features to predict axillary lymph node burden in early invasive breast cancer: a study of 1247 patients
Authors: Shao Hua , Sun Yixin , Na Ziyue , Jing Hui , Li Bo , Wang Qiucheng , Zhang Cui , Cheng Wen
Published: January 2024

Background

Since the Z0011 trial, the assessment of axillary lymph node status has been redirected from the previous assessment of the occurrence of lymph node metastasis alone to the assessment of the degree of lymph node loading. Our aim was to apply preoperative breast ultrasound and clinicopathological features to predict the diagnostic value of axillary lymph node load in early invasive breast cancer.

Methods

The 1247 lesions were divided into a high lymph node burden group and a limited lymph node burden group according to axillary lymph node status. Univariate and multifactorial analyses were used to predict the differences in clinicopathological characteristics and breast ultrasound characteristics between the two groups with high and limited lymph node burden. Pathological findings were used as the gold standard.

Results

Univariate analysis showed significant differences in ki-67, maximum diameter (MD), lesion distance from the nipple, lesion distance from the skin, MS, and some characteristic ultrasound features (P < 0.05). In multifactorial analysis, the ultrasound features of breast tumors that were associated with a high lymph node burden at the axilla included MD (odds ratio [OR], 1.043; P < 0.001), shape (OR, 2.422; P = 0.0018), hyperechoic halo (OR, 2.546; P < 0.001), shadowing in posterior features (OR, 2.155; P = 0.007), and suspicious lymph nodes on axillary ultrasound (OR, 1.418; P = 0.031). The five risk factors were used to build the predictive model, and it achieved an area under the receiver operating characteristic (ROC) curve (AUC) of 0.702.

Conclusion

Breast ultrasound features and clinicopathological features are better predictors of high lymph node burden in early invasive breast cancer, and this prediction helps to develop more effective treatment plans.
Curricular and pedagogical approaches for physical activity prescription training: a mixed-methods study of the “Exercise is Medicine” workshops in Colombia
Authors: Páez Diana C. , Flórez Johanna , Gómez María Teresa , García Daniel , Arango-Paternina Carlos M. , Duperly John
Published: January 2024

Background

The physical activity (PA) prescription workshop for physicians, through the global health initiative “Exercise is Medicine” (EIM), has trained more than 4000 health care professionals (HCPs) in Latin America. It has shown to be effective in increasing PA prescription knowledge and awareness among HCPs. The purpose of this paper is to evaluate the curricular and pedagogical approach used by EIM Colombia at the PA prescription workshops implemented between 2014 and 2015.

Methods

A mixed methods study, with a sequential explanatory design was implemented among a convenience sample of HCPs attending twenty-six PA prescription workshops. HCPs health status, PA personal habits, and medical practices were collected using a questionnaire at baseline among 795 participants (pre-test measurement), and subsequently quantitatively analyzed. A workshop satisfaction survey was administered after the completion of the workshop among 602 HCPs. The curricular and pedagogical approach of the workshop, the designers’ and students’ contextual factors, and perceptions about the workshop were measured using qualitative methods (analysis of the procedures manual, two workshop observations, three semi-structured interviews, and one focus group including 8 HCPs).

Results

The workshop is student-centered and guided by an expert with an academic and clinical background. Learning was achieved with theoretical and practical components using authentic performance and collaborative learning. An active teaching and learning approach was used with strategies such as interactive lectures, hands-on elements, and role-playing (patient-counselor). The workshop emphasized an individual approach when prescribing PA integrating in clinical practice not only health benefits but also patient´s beliefs, motivations, needs, and barriers.

Conclusions

Evidence-based practices and authentic performance were the most salient pedagogical elements used by EIM Colombia at the PA prescription workshop. A knowledge assessment that includes the practical aspect is suggested for future workshops. The curricular and pedagogical approach of the PA prescription workshop implemented in Colombia is well received by the medical community and a useful continuing medical education intervention with a potential contribution to current, and future health promotion needs.
Exploring workplace-based learning in distributed healthcare settings: a qualitative study
Authors: Verhees Myrthe J. M. , Landstra Anneke M. , Engbers Rik , Koksma Jur J. , Laan Roland F. J. M.
Published: January 2024

Background

Distributed healthcare settings such as district hospitals, primary care, and public health facilities are becoming the real-life settings for workplace-based learning required to educate the future healthcare workforce. Therefore, a major focus should be on designing and developing workplace-based learning in these learning environments. Healthcare professionals and educational policymakers play a significant role in these settings as role models in workplace-based learning, and as leaders in integrating learning into their work environments. It is relevant to explore their beliefs, attitudes, and behaviors towards workplace-based learning in their own settings, in order to provide context-relevant recommendations that can assist in shaping workplace-based learning environments.

Methods

We used individual interviews to understand professionals’ experiences with workplace-based learning in distributed healthcare settings. We - three clinicians, an educationalist, and a philosopher - thematically analyzed transcripts of 13 interviews with healthcare professionals and educational policymakers from different healthcare settings who were involved in the clinical phase of undergraduate medical education.

Results

Clustering and categorizing of the data led to the construction of five overarching themes: Identification with and attitude towards medical education, Sense of ownership, Perceived time and space, Mutual preconceptions and relations, and Curriculum for a changing profession.

Conclusions

These themes accentuate aspects relevant to the development of workplace-based learning in distributed healthcare settings on the individual, team, or organizational level. We highlight the significance of individual professionals in the development of workplace-based learning and emphasize the need for recognition and support for those occupying the ‘broker’ role at the intersection of education and practice. For future research and educational practice, we recommend prioritizing initiatives that build on good-practices in workplace-based learning and involve dedicated individuals in distributed healthcare settings.
Effectiveness of blended pedagogy for radiographic interpretation skills in operative dentistry - a comparison of test scores and student experiences at an undergraduate dental school in Pakistan
Authors: Iqbal Marium , Dias Jacqueline Maria , Sultan Amber , Raza Hussain Ahmed , Zaman Laeeq-uz
Published: January 2024

Background

Utilizing Blended pedagogy (BP) in radiographic skills may prove to be an effective teaching strategy. However, studies on the use of BP in dentistry are quite limited in Pakistan, where teaching has mostly been via traditional Didactic Lectures (DL); and radiographic interpretation skills of undergraduate dental students are suboptimal. Therefore, this study aims to assess whether utilizing BP to teach radiographic interpretation skills is an effective teaching methodology in Pakistan.

Methods

This mixed-method study was conducted on final year dental students at Jinnah Medical and Dental College (JMDC). Two groups of students were utilized for this study, one taught by traditional DL and the other taught by BP for the same module. BP was conducted over six weeks. A post-module test was conducted in both groups. Additionally, the BP group completed a modified Community of Inquiry (CoI) survey tool and volunteered to discuss their experiences through a focused group discussion (FGD). Descriptive statistics were computed and independent sample t-test was used to analyse the difference between the scores of the two groups. Thematic analysis was performed for the qualitative data.

Results

The mean post-test scores were found to be significantly higher in the BP group (61.0 ± 10.2) compared to the DL group (44.4 ± 12.3) (p = < 0.001, CI = 95%, Cronbach Alpha > 0.8). The mean scores for the modified CoI instrument were 4.0 ± 0.29 for the whole instrument; 4.25 ± 0.22 for Teaching Presence, 3.71 ± 0.23 for Social Presence and 3.97 ± 0.16 Cognitive Presence, with all three having a Cronbach’s alpha > 0.75. Thematic analysis revealed that BP students mutually agreed that BP method was beneficial with the appreciation of strong support from the facilitator. However, challenges like interrupted power supply and increased effort requirement from students were pointed out.

Conclusion

Students taught radiographic interpretation skills with BP in comparison to DL had higher test scores and expressed a positive experience demonstrated via a modified CoI survey and FGD. Considering the encouraging results found, dental schools should incorporate BP in their teaching methodology and follow-up studies are needed to further support the use of BP as an effective teaching methodology in Dentistry.
Quality in care requires kindness and flexibility – a hermeneutic-phenomenological study of patients’ experiences from pathways including transitions across healthcare settings
Authors: Walløe Sisse , Beck Malene , Lauridsen Henrik Hein , Morsø Lars , Simonÿ Charlotte
Published: January 2024

Background

The number of people living with chronic conditions is increasing worldwide, and with that, the need for multiple long-term complex care across care settings. Undergoing transitions across healthcare settings is both challenging and perilous for patients. Nevertheless, knowledge of what facilitates quality during transitions in healthcare settings from the lifeworld perspective of patients is still lacking. Therefore, we aimed to explore the lived experience in healthcare quality for Danish adult patients during healthcare pathways including transitions across settings.

Methods

Within a hermeneutic-phenomenological approach, interviews were conducted with three women and five men with various diagnoses and care paths between 30 and 75 years of age. Data underwent a three phased thematic analysis leading to three themes.

Results

Patients with various illnesses’ experiences of quality of care is described in the themes being powerless in the face of illness; burdensome access and navigation; and being in need of mercy and striving for kindness. This highlights that patients’ experiences of quality in healthcare pathways across settings interweaves with an overall understanding of being powerless at the initial encounter. Access and navigation are burdensome, and system inflexibility adds to the burden and enhances powerlessness. However, caring care provided through the kindness of healthcare professionals supports patients in regaining control of their condition.

Conclusions

This hermeneutical-phenomenological study sheds light on the lived experiences of people who are at various stages in their care paths with transitions across healthcare settings. Although our findings are based on the lived experiences of 8 people in a Danish context, in light of the discussion with nursing theory and other research, the results can be reflected in two main aspects: I) kind and merciful professional relationships and II) system flexibility including access and navigation, were essential for their experiences of care quality during healthcare transitions. This is important knowledge when striving to provide patients with a clear voice regarding quality in care pathways stretching across settings.
A patient activation intervention in primary care for patients with chronic pain on long term opioid therapy: results from a randomized control trial
Authors: Does Monique B. , Adams Sara R. , Kline-Simon Andrea H. , Marino Catherine , Charvat-Aguilar Nancy , Weisner Constance M. , Rubinstein Andrea L. , Ghadiali Murtuza , Cowan Penney , Young-Wolff Kelly C. , Campbell Cynthia I.
Published: January 2024

Background

Given significant risks associated with long-term prescription opioid use, there is a need for non-pharmacological interventions for treating chronic pain. Activating patients to manage chronic pain has the potential to improve health outcomes. The ACTIVATE study was designed to evaluate the effectiveness of a 4-session patient activation intervention in primary care for patients on long-term opioid therapy.

Methods

The two-arm, pragmatic, randomized trial was conducted in two primary care clinics in an integrated health system from June 2015—August 2018. Consenting participants were randomized to the intervention (n = 189) or usual care (n = 187). Participants completed online and interviewer-administered surveys at baseline, 6- and 12- months follow-up. Prescription opioid use was extracted from the EHR. The primary outcome was patient activation assessed by the Patient Activation Measure (PAM). Secondary outcomes included mood, function, overall health, non-pharmacologic pain management strategies, and patient portal use. We conducted a repeated measure analysis and reported between-group differences at 12 months.

Results

At 12 months, the intervention and usual care arms had similar PAM scores. However, compared to usual care at 12 months, the intervention arm demonstrated: less moderate/severe depression (odds ratio [OR] = 0.40, 95%CI 0.18–0.87); higher overall health (OR = 3.14, 95%CI 1.64–6.01); greater use of the patient portal’s health/wellness resources (OR = 2.50, 95%CI 1.42–4.40) and lab/immunization history (OR = 2.70, 95%CI 1.29–5.65); and greater use of meditation (OR = 2.72; 95%CI 1.61–4.58) and exercise/physical therapy (OR = 2.24, 95%CI 1.29–3.88). At 12 months, the intervention arm had a higher physical health measure (mean difference 1.63; 95%CI: 0.27–2.98).

Conclusion

This trial evaluated the effectiveness of a primary care intervention in improving patient activation and patient-reported outcomes among adults with chronic pain on long-term opioid therapy. Despite a lack of improvement in patient activation, a brief intervention in primary care can improve outcomes such as depression, overall health, non-pharmacologic pain management, and engagement with the health system.

Trial Registration

The study was registered on 10/27/14 on ClinicalTrials.gov (NCT02290223).
Evaluating the impact of ‘Ask the Specialist Plus’: a training program for improving cultural safety and communication in hospital-based healthcare
Authors: Kerrigan Vicki , McGrath Stuart Yiwarr , Doig Cassandra , Herdman Rarrtjiwuy Melanie , Daly Shannon , Puruntatameri Pirrawayingi , Lee Bilawara , Hefler Marita , Ralph Anna P.
Published: January 2024

Background

First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver cultural safety training but there is limited evidence on how to teach cultural safety. To that end, we created Ask the Specialist Plus: a training program that focuses on improving healthcare providers intercultural communication skills to improve cultural safety. Our aim is to describe training implementation and to evaluate the training according to participants.

Methods

Inspired by cultural safety, Critical Race Theory and Freirean pedagogy, Ask the Specialist Plus was piloted at Royal Darwin Hospital in Australia’s Northern Territory in 2021. The format combined listening to an episode of a podcast called Ask the Specialist with weekly, one-hour face-to-face discussions with First Nations Specialists outside the clinical environment over 7 to 8 weeks. Weekly surveys evaluated teaching domains using five-point Likert scales and via free text comments. Quantitative data were collated in Excel and comments were collated in NVivo12. Results were presented following Kirkpatrick’s evaluation model.

Results

Fifteen sessions of Ask the Specialist Plus training were delivered. 90% of participants found the training valuable. Attendees enjoyed the unique format including use of the podcast as a catalyst for discussions. Delivery over two months allowed for flexibility to accommodate clinical demands and shift work. Students through to senior staff learnt new skills, discussed institutionally racist systems and committed to behaviour change. Considering racism is commonly denied in healthcare, the receptiveness of staff to discussing racism was noteworthy. The pilot also contributed to evidence that cultural safety should be co-taught by educators who represent racial and gender differences.

Conclusion

The Ask the Specialist Plus training program provides an effective model for cultural safety training with high potential to achieve behaviour change among diverse healthcare providers. The training provided practical information on how to improve communication and fostered critical consciousness among healthcare providers. The program demonstrated that training delivered weekly over two months to clinical departments can lead to positive changes through cycles of learning, action, and reflection.
Fipronil disturbs the antigen-specific immune responses and GABAergic gene expression in the ovalbumin-immunized BALB/c mice
Authors: Kuo Jui-Fang , Cheng Yin-Hua , Tung Chun-Wei , Wang Chia-Chi
Published: January 2024

Background

Fipronil (FPN) is a broad-spectrum pesticide and commonly known as low toxicity to vertebrates. However, increasing evidence suggests that exposure to FPN might induce unexpected adverse effects in the liver, reproductive, and nervous systems. Until now, the influence of FPN on immune responses, especially T-cell responses has not been well examined. Our study is designed to investigate the immunotoxicity of FPN in ovalbumin (OVA)-sensitized mice. The mice were administered with FPN by oral gavage and immunized with OVA. Primary splenocytes were prepared to examine the viability and functionality of antigen-specific T cells ex vivo. The expression of T cell cytokines, upstream transcription factors, and GABAergic signaling genes was detected by qPCR.

Results

Intragastric administration of FPN (1–10 mg/kg) for 11 doses did not show any significant clinical symptoms. The viability of antigen-stimulated splenocytes, the production of IL-2, IL-4, and IFN-γ by OVA-specific T cells, and the serum levels of OVA-specific IgG1 and IgG2a were significantly increased in FPN-treated groups. The expression of the GABAergic signaling genes was notably altered by FPN. The GAD67 gene was significantly decreased, while the GABAR β2 and GABAR δ were increased.

Conclusion

FPN disturbed antigen-specific immune responses by affecting GABAergic genes in vivo. We propose that the immunotoxic effects of FPN may enhance antigen-specific immunity by dysregulation of the negative regulation of GABAergic signaling on T cell immunity.
Targeted long-read sequencing identified a causal structural variant in X-linked nephrogenic diabetes insipidus
Authors: Strych Lukáš , Černá Monika , Hejnalová Markéta , Zavoral Tomáš , Komrsková Pavla , Tejcová Jitka , Bitar Ibrahim , Sládková Eva , Sýkora Josef , Šubrt Ivan
Published: January 2024

Background

X-linked nephrogenic diabetes insipidus (NDI) is a rare genetic renal disease caused by pathogenic variants in the AVPR2 gene. Single nucleotide variants and small insertions/deletions in AVPR2 are reliably detected by routine clinical sequencing. Nevertheless, structural variants involving AVPR2 are challenging to identify accurately by conventional genetic testing. Here, we report a novel deletion of AVPR2 in a Czech family identified for the first time by targeted long-read sequencing (T-LRS).

Methods

A male proband with X-linked NDI underwent clinical sequencing of the AVPR2 gene that failed and thus indicated possible whole-gene deletion. Therefore, PCR mapping and subsequent targeted long-read sequencing (T-LRS) using a Pacific Biosciences sequencer were applied to search for the suspected deletion. To validate the deletion breakpoints and prove variant segregation in the family with X-linked NDI, Sanger sequencing of the deletion junction was performed. Quantitative real-time PCR was further carried out to confirm the carrier status of heterozygous females.

Results

By T-LRS, a novel 7.5 kb deletion of AVPR2 causing X-linked NDI in the proband was precisely identified. Sanger sequencing of the deletion junction confirmed the variant breakpoints and detected the deletion in the probands´ mother, maternal aunt, and maternal cousin with X-linked NDI. The carrier status in heterozygous females was further validated by quantitative real-time PCR.

Conclusions

Identifying the 7.5 kb deletion gave a precise molecular diagnosis for the proband, enabled genetic counselling and genetic testing for the family, and further expanded the spectrum of structural variants causing X-linked NDI. Our results also show that T-LRS has significant potential for accurately identifying putative structural variants.
Nasopharyngeal carcinoma: current views on the tumor microenvironment's impact on drug resistance and clinical outcomes
Authors: Liu Huai , Tang Ling , Li Yanxian , Xie Wenji , Zhang Ling , Tang Hailin , Xiao Tengfei , Yang Hongmin , Gu Wangning , Wang Hui , Chen Pan
Published: January 2024

The incidence of nasopharyngeal carcinoma (NPC) exhibits significant variations across different ethnic groups and geographical regions, with Southeast Asia and North Africa being endemic areas. Of note, Epstein-Barr virus (EBV) infection is closely associated with almost all of the undifferentiated NPC cases. Over the past three decades, radiation therapy and chemotherapy have formed the cornerstone of NPC treatment. However, recent advancements in immunotherapy have introduced a range of promising approaches for managing NPC. In light of these developments, it has become evident that a deeper understanding of the tumor microenvironment (TME) is crucial. The TME serves a dual function, acting as a promoter of tumorigenesis while also orchestrating immunosuppression, thereby facilitating cancer progression and enabling immune evasion. Consequently, a comprehensive comprehension of the TME and its intricate involvement in the initiation, progression, and metastasis of NPC is imperative for the development of effective anticancer drugs. Moreover, given the complexity of TME and the inter-patient heterogeneity, personalized treatment should be designed to maximize therapeutic efficacy and circumvent drug resistance. This review aims to provide an in-depth exploration of the TME within the context of EBV-induced NPC, with a particular emphasis on its pivotal role in regulating intercellular communication and shaping treatment responses. Additionally, the review offers a concise summary of drug resistance mechanisms and potential strategies for their reversal, specifically in relation to chemoradiation therapy, targeted therapy, and immunotherapy. Furthermore, recent advances in clinical trials pertaining to NPC are also discussed.
Predictive value of lipoprotein(a) for left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation patients with low CHA2DS2-VASc scores: a cross-sectional study
Authors: Kamili Kamila , Zheng Tingting , Luo Chaodi , Wang Xuan , Tian Gang
Published: January 2024

Objective

Current guidelines are debated when it comes to starting anticoagulant therapy in patients with non-valvular atrial fibrillation (NVAF) and low CHA2DS2-VASc scores (1–2 in women and 0–1 in men). However, these individuals still have a high likelihood of developing left atrial thrombus/spontaneous echo contrast (LAT/SEC) and experiencing subsequent thromboembolism. Recent research has demonstrated that lipoprotein(a) [Lp(a)] may increase the risk of thrombosis, but the relationship between Lp(a) and LAT/SEC in NVAF patients is not clearly established. Therefore, this study sought to evaluate the predictive ability of Lp(a) for LAT/SEC among NVAF patients with low CHA2DS2-VASc scores.

Methods

NVAF patients with available transesophageal echocardiography (TEE) data were evaluated. Based on the TEE results, the subjects were classified into non-LAT/SEC and LAT/SEC groups. The risk factors for LAT/SEC were examined using binary logistic regression analyses and were validated by using 1:1 propensity score matching (PSM). Subsequently, novel predictive models for LAT/SEC were developed by integrating the CHA2DS2-VASc score with the identified factors, and the accuracy of these models was tested using receiver operating characteristic (ROC) analysis.

Results

In total, 481 NVAF patients were enrolled. The LAT/SEC group displayed higher Lp(a) concentrations. It was found that enlarged left atrial diameter (LAD), high concentrations of Lp(a), and a history of coronary heart disease (CHD) were independent predictors of LAT/SEC. Lp(a) and LAD still had predictive values for LAT/SEC after adjusting for PSM. In both the highest quartile groups of Lp(a) (>266 mg/L) and LAD (>39.5 mm), the occurrence of LAT/SEC was higher than that in the corresponding lowest quartile. By incorporating Lp(a) and the LAD, the predictive value of the CHA2DS2-VASc score for LAT/SEC was significantly improved.

Conclusion

Elevated Lp(a) and enlarged LAD were independent risk factors for LAT/SEC among NVAF patients with low CHA2DS2-VASc scores. The prediction accuracy of the CHA2DS2-VASc score for LAT/SEC was significantly improved by the addition of Lp(a) and LAD. When evaluating the stroke risk in patients with NVAF, Lp(a) and LAD should be taken into account together with the CHA2DS2-VASc score.

Trial registration

Retrospectively registered.
High lipoprotein(a) concentration is associated with moyamoya disease
Authors: Chen Xinyue , Song Chenxin , Ma Xianrun , Tao Junjie , Hu Lijuan , Xu Yuan , Yi Yingping , Yang Xinlei , Jiang Long
Published: January 2024

Background

Moyamoya disease (MMD) has attracted the attention of scholars because of its rarity and unknown etiology.

Methods

Data for this study were sourced from the Second Affiliated Hospital of Nanchang University. Regression analyses were conducted to examine the association in Lipoprotein [Lp(a)] and MMD. R and IBM SPSS were conducted.

Results

A cohort comprising 1012 MMD patients and 2024 controls was established through the propensity score matching method. Compared with controls, MMD patients showed higher median Lp(a) concentrations [18.5 (9.6–37.8) mg/dL vs. 14.9 (7.8–30.5) mg/dL, P < 0.001]. The odds ratios and 95% confidence intervals for Lp(a) were calculated in three models: unadjusted model, model 1 (adjusted for body mass index and systolic blood pressure), and model 2 (adjusted for model 1 plus triglyceride, C-reactive protein, homocysteine, and low-density lipoprotein cholesterol). Results were [1.613 (1.299–2.002), P < 0.001], [1.598 (1.286–1.986), P < 0.001], and [1.661 (1.330–2.074), P < 0.001], respectively. Furthermore, age, sex, or hypertension status had nothing to do with this relationship.

Conclusions

Positive relationship exists between Lp(a) and MMD.