bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetes and infectious disease mortality in Mexico City
Authors: Bragg Fiona , Kuri-Morales Pablo , Berumen Jaime , Garcilazo-Ávila Adrián , Gonzáles-Carballo Carlos , Ramírez-Reyes Raúl , Santacruz-Benitez Rogelio , Aguilar-Ramirez Diego , Gnatiuc Friedrichs Louisa , Herrington William G , Hill Michael , Trichia Eirini , Wade Rachel , Collins Rory , Peto Richard , Emberson Jonathan R , Alegre-Diaz Jesus , Tapia-Conyer Roberto
Published: March 2023

Introduction

Although higher risks of infectious diseases among individuals with diabetes have long been recognized, the magnitude of these risks is poorly described, particularly in lower income settings. This study sought to assess the risk of death from infection associated with diabetes in Mexico.

Research design and methods

Between 1998 and 2004, a total of 159 755 adults ≥35 years were recruited from Mexico City and followed up until January 2021 for cause-specific mortality. Cox regression yielded adjusted rate ratios (RR) for death due to infection associated with previously diagnosed and undiagnosed (HbA1c ≥6.5%) diabetes and, among participants with previously diagnosed diabetes, with duration of diabetes and with HbA1c.

Results

Among 130 997 participants aged 35–74 and without other prior chronic diseases at recruitment, 12.3% had previously diagnosed diabetes, with a mean (SD) HbA1c of 9.1% (2.5%), and 4.9% had undiagnosed diabetes. During 2.1 million person-years of follow-up, 2030 deaths due to infectious causes were recorded at ages 35–74. Previously diagnosed diabetes was associated with an RR for death from infection of 4.48 (95% CI 4.05–4.95), compared with participants without diabetes, with notably strong associations with death from urinary tract (9.68 (7.07–13.3)) and skin, bone and connective tissue (9.19 (5.92–14.3)) infections and septicemia (8.37 (5.97–11.7)). In those with previously diagnosed diabetes, longer diabetes duration (1.03 (1.02–1.05) per 1 year) and higher HbA1c (1.12 (1.08–1.15) per 1.0%) were independently associated with higher risk of death due to infection. Even among participants with undiagnosed diabetes, the risk of death due to infection was nearly treble the risk of those without diabetes (2.69 (2.31–3.13)).

Conclusions

In this study of Mexican adults, diabetes was common, frequently poorly controlled, and associated with much higher risks of death due to infection than observed previously, accounting for approximately one-third of all premature mortality due to infection.
Consequences of early thyroid ultrasound on subsequent tests, morbidity and costs: an explorative analysis of routine health data from German ambulatory care
Authors: Hueber Susann , Biermann Valeria , Tomandl Johanna , Warkentin Lisette , Schedlbauer Angela , Tauchmann Harald , Klemperer David , Lehmann Maria , Donnachie Ewan , Kühlein Thomas
Published: March 2023

Objectives

This study aims to evaluate whether the use of thyroid ultrasound (US) early in the work-up of suspected thyroid disorders triggers cascade effects of medical procedures and to analyse effects on morbidity, healthcare usage and costs.

Study design

Retrospective analysis of claims data from ambulatory care (2012–2017).

Setting

Primary care in Bavaria, Germany, 13 million inhabitants.

Participants

Patients having received a thyroid stimulating hormone (TSH) test were allocated to (1) observation group: TSH test followed by an early US within 28 days or (2) control group: TSH test, but no early US. Propensity score matching was used adjusting for socio-demographic characteristics, morbidity and symptom diagnosis (N=41 065 per group after matching).

Primary and secondary outcome measures

Using cluster analysis, groups were identified regarding frequency of follow-up TSH tests and/or US and compared.

Results

Four subgroups were identified: cluster 1: 22.8% of patients,mean (M)=1.6 TSH tests; cluster 2: 16.6% of patients,M=4.7 TSH tests; cluster 3: 54.4% of patients,M=3.3 TSH tests, 1.8 US; cluster 4: 6.2% of patients,M=10.9 TSH tests, 3.9 US. Overall, reasons that explain the tests could rarely be found. An early US was mostly found in clusters 3 and 4 (83.2% and 76.1%, respectively, were part of the observation group). In cluster 4 there were more women, thyroid-specific morbidity and costs were higher and the early US was more likely to be performed by specialists in nuclear medicine or radiologists.

Conclusion

Presumably unnecessary tests in the field of suspected thyroid diseases seem to be frequent, contributing to cascades effects. Neither German nor international guidelines provide clear recommendations for or against US screening. Therefore, guidelines on when to apply US and when not are urgently needed.
Cross-sectional survey and Bayesian network model analysis of traditional Chinese medicine in Austria: investigating public awareness, usage determinants and perception of scientific support
Authors: Eigenschink Michael , Bellach Luise , Leonard Sebastian , Dablander Tom Eric , Maier Julian , Dablander Fabian , Sitte Harald H
Published: March 2023

Objectives

Despite the paucity of evidence verifying its efficacy and safety, traditional Chinese medicine (TCM) is expanding in popularity and political support. Decisions to include TCM diagnoses in the International Classification of Diseases 11th Revision and campaigns to integrate TCM into national healthcare systems have occurred while public perception and usage of TCM, especially in Europe, remains undetermined. Accordingly, this study investigates TCM’s popularity, usage and perceived scientific support, as well as its relationship to homeopathy and vaccinations.

Design/Setting

We performed a cross-sectional survey of the Austrian population. Participants were either recruited on the street (in-person) or online (web-link) via a popular Austrian newspaper.

Participants

1382 individuals completed our survey. The sample was poststratified according to data derived from Austria’s Federal Statistical Office.

Outcome measures

Associations between sociodemographic factors, opinion towards TCM and usage of complementary medicine (CAM) were investigated using a Bayesian graphical model.

Results

Within our poststratified sample, TCM was broadly known (89.9% of women, 90.6% of men), with 58.9% of women and 39.5% of men using TCM between 2016 and 2019. Moreover, 66.4% of women and 49.7% of men agreed with TCM being supported by science. We found a positive relationship between perceived scientific support for TCM and trust in TCM-certified medical doctors (ρ=0.59, 95% CI 0.46 to 0.73). Moreover, perceived scientific support for TCM was negatively correlated with proclivity to get vaccinated (ρ=−0.26, 95% CI −0.43 to –0.08). Additionally, our network model yielded associations between TCM-related, homeopathy-related and vaccination-related variables.

Conclusions

TCM is widely known within the Austrian general population and used by a substantial proportion. However, a disparity exists between the commonly held public perception that TCM is scientific and findings from evidence-based studies. Emphasis should be placed on supporting the distribution of unbiased, science-driven information.
Evaluation of frameworks demonstrating the role of private sector in non-communicable disease management and control: a systematic review and thematic synthesis
Authors: Somani Nadia Amin , Marshall Keiko , Durrani Hammad , Tang Kun , Mogilevskii Roman , Bhutta Zulfiqar
Published: March 2023

Objectives

Conduct a systematic review of existing frameworks to understand the for-profit private sector’s roles in non-communicable disease (NCD) control and management. Control includes population-level control measures that prevent NCDs and mitigate the magnitude of the NCD pandemic, and management includes treatment and management of NCDs. The for-profit private sector was defined as any private entities that make profit from their activities (ie, pharmaceutical companies, unhealthy commodity industries, distinct from not-for-profit trusts or charitable organisations).

Design

A systematic review and inductive thematic synthesis was performed. Comprehensive searches of PubMed, EMBASE, Cochrane Library, Web of Science, Business Source Premier and Proquest/ABI Inform were conducted on 15 January 2021. Grey literature searches were conducted on 2 February 2021 using the websites of 24 relevant organisations. Searches were filtered to only include articles published from the year 2000 onwards, in English. Articles that included frameworks, models or theories and the for-profit private sector’s role in NCD control and management were included. Two reviewers performed the screening, data extraction and quality assessment. Quality was assessed using the tool developed by Hawkeret alfor qualitative studies.

Setting

The for-profit private sector.

Results

There were 2148 articles initially identified. Following removal of duplicates, 1383 articles remained, and 174 articles underwent full-text screening. Thirty-one articles were included and used to develop a framework including six themes that outlined the roles that the for-profit private sector plays in NCD management and control. The themes that emerged included healthcare provision, innovation, knowledge educator, investment and financing, public–private partnerships, and governance and policy.

Conclusion

This study provides an updated insight on literature that explores the role of the private sector in controlling and monitoring NCDs. The findings suggest that the private sector could contribute, through various functions, to effectively manage and control NCDs globally.
Gender integration and female participation in scientific and health research in Zambia: a descriptive cross-sectional study protocol
Authors: Sialubanje Cephas , Sumbwa Phyllis Ingutu , Zulu Nyondwa , Mwanza Nchimunya B , Chavula Malizgani Paul , Zulu Joseph
Published: March 2023

Introduction

Despite the Zambian government making progress on prioritising gender mainstreaming, female participation in science, technology and innovation in academia, research and development is still low. This study aims to determine the integration of gender dimensions and the factors that influence female participation in science and health research in Zambia.

Methods and analysis

We propose a descriptive cross-sectional study design employing in-depth interviews (IDIs) and survey as data collection techniques. Twenty schools offering science-based programmes will be purposively selected from University of Zambia (UNZA), Copperbelt University, Mulungushi University and Kwame Nkrumah University. In addition, two research institutions, Tropical Disease Research Centre and Mount Makulu Agricultural Research Station, will be included. Survey respondents will include a random sample of 1389 academic and research staff from the selected schools. A total of 30 IDIs will be conducted with staff and heads of selected schools and research institutions. Data collection will be conducted over a 12-month period. Before commencement of data collection, in-depth literature search and record review on gender dimensions in science and health research will be conducted to gain insight into the subject matter and inform research instrument design. Survey data and IDIs will be collected using a structured paper-based questionnaire and semistructured interview guide, respectively. Descriptive statistics will be computed to summarise respondents’ characteristics. Bivariate analysis (χ2test and independent t-test) and multivariate regression analysis will be conducted to test the association and identify factors influencing female participation in science and health research (adjusted ORs, p<0.05). An inductive approach will be used to analyse qualitative data using NVivo. Survey and IDI will be corroborated.

Ethics and dissemination

This study involves human participants and was approved by UNZA Biomedical Research Ethics Committee (UNZABREC; UNZA BREC 1674-2022). Participants gave informed consent to participate in the study before taking part. Study findings will be disseminated through a written report, stakeholder meetings and publication in a peer-reviewed international journal.
Association between obstructive sleep apnoea and cancer: a cross-sectional, population-based study of the DISCOVERY cohort
Authors: Palm Andreas , Theorell-Haglöw J , Isakson Johan , Ljunggren Mirjam , Sundh Josefin , Ekström Magnus Per , Grote Ludger
Published: March 2023

Objectives

Nocturnal hypoxia in obstructive sleep apnoea (OSA) is a potential risk factor for cancer. We aimed to investigate the association between OSA measures and cancer prevalence in a large national patient cohort.

Design

Cross-sectional study.

Settings

44 sleep centres in Sweden.

Participants

62 811 patients from the Swedish registry for positive airway pressure (PAP) treatment in OSA, linked to the national cancer registry and national socioeconomic data (the course of DIsease in patients reported to Swedish CPAP, Oxygen and VEntilator RegistrY cohort).

Outcome measures

After propensity score matching for relevant confounders (anthropometric data, comorbidities, socioeconomic status, smoking prevalence), sleep apnoea severity, measured as Apnoea-Hypopnoea Index (AHI) or Oxygen Desaturation Index (ODI), were compared between those with and without cancer diagnosis up to 5 years prior to PAP initiation. Subgroup analysis for cancer subtype was performed.

Results

OSA patients with cancer (n=2093) (29.8% females, age 65.3 (SD 10.1) years, body mass index 30 (IQR 27–34) kg/m2) had higher median AHI (n/hour) (32 (IQR 20–50) vs 30 (IQR 19–45), n/hour, p=0.002) and median ODI (n/hour) (28 (IQR 17–46) vs 26 (IQR 16–41), p<0.001) when compared with matched OSA patients without cancer. In subgroup analysis, ODI was significantly higher in OSA patients with lung cancer (N=57; 38 (21–61) vs 27 (16-43), p=0.012)), prostate cancer (N=617; 28 (17–46) vs 24, (16–39)p=0.005) and malignant melanoma (N=170; 32 (17–46) vs 25 (14–41),p=0.015).

Conclusions

OSA mediated intermittent hypoxia was independently associated with cancer prevalence in this large, national cohort. Future longitudinal studies are warranted to study the potential protective influence of OSA treatment on cancer incidence.
Effect of multimodal comprehensive communication skills training with video analysis by artificial intelligence for physicians on acute geriatric care: a mixed-methods study
Authors: Kobayashi Masaki , Katayama Mitsuya , Hayashi Tomofumi , Hashiyama Takuhiro , Iyanagi Toshinori , Une Saki , Honda Miwako
Published: March 2023

Objectives

To quantitatively analyse by artificial intelligence (AI) the communication skills of physicians in an acute care hospital for geriatric care following a multimodal comprehensive care communication skills training programme and to qualitatively explore the educational benefits of this training programme.

Design

A convergent mixed-methods study, including an intervention trial with a quasi-experimental design, was conducted to quantitatively analyse the communication skills of physicians. Qualitative data were collected via physicians’ responses to an open-ended questionnaire administered after the training.

Setting

An acute care hospital.

Participants

A total of 23 physicians.

Interventions

In a 4-week multimodal comprehensive care communication skills training programme, including video lectures and bedside instruction, from May to October 2021, all the participants examined a simulated patient in the same scenario before and after their training. These examinations were video recorded by an eye-tracking camera and two fixed cameras. Then, the videos were analysed for communication skills by AI.

Main outcome measures

The primary outcomes were the physicians’ eye contact, verbal expression, physical touch and multimodal communication skills with a simulated patient. The secondary outcomes were the physicians’ empathy and burnout scores.

Results

The proportion of the duration of the participants’ single and multimodal types of communication significantly increased (p<0.001). The mean empathy scores and the personal accomplishment burnout scores also significantly increased after training. We developed a learning cycle model based on the six categories that changed after training from the physicians’ perspective: multimodal comprehensive care communication skills training; increasing awareness of and sensitivity to changes to geriatric patients’ condition; changes in clinical management; professionalism; team building and personal accomplishments.

Conclusions

Our study showed that multimodal comprehensive care communication skills training for physicians increased the proportions of time spent performing single and multimodal communication skills by video analysis through AI.

Trial registration number

UMIN Clinical Trials Registry (UMIN000044288;https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050586).
Adherence to Mediterranean diet in Italy (ARIANNA) cross-sectional survey: study protocol
Authors: Cardamone Erica , Di Benedetto Rita , Lorenzoni Giulia , Gallipoli Silvia , Ghidina Marco , Zobec Federica , Iacoponi Francesca , Gregori Dario , Silano Marco
Published: March 2023

Introduction

There is evidence, although limited, that the Italian population has been no longer following a Mediterranean dietary pattern. The ARIANNA (Adherence to the Mediterranean Diet in Italy) project consists of a survey-based cross-sectional study with the objective of gaining a greater knowledge of adherence to the Mediterranean Diet and its main determinants in different age groups of the Italian population.

Methods/analysis

The ARIANNA study will involve males and females aged ≥7 years, born and resident in Italy, and proficient in Italian. The voluntary enrolment will be in the period between March 2023 and May 2023. The data, which will include sociodemographic factors and dietary habits, will be collected through a web-based questionnaire. Adherence to the Mediterranean Diet will be assessed through the use of two validated score systems: the Mediterranean Diet Quality Index in children and adolescents for participants aged ≤16 years and the Mediterranean Diet Serving Score for participants aged ≥17 years. A review of the scientific literature will be carried out to collect historical data on adherence to the Mediterranean dietary pattern in the Italian population, which will be compared with those collected within this project.

Ethics and dissemination

The ARIANNA study has been approved by the Ethics Committee of Istituto Superiore di Sanità. The results will be disseminated through peer-reviewed papers, leaflets and documents for the general public. A report will be presented to the national policy makers, to give them the tools to implement appropriate intervention to improve, in necessary, the adherence to Mediterranean dietary pattern in Italy.
One virus, many lives: a qualitative study of lived experiences and quality of life of adults from diverse backgrounds living in the UK during the COVID-19 pandemic
Authors: Gogoi Mayuri , Chaloner Jonathan , Qureshi Irtiza , Wobi Fatimah , Al-Oraibi Amani , Wilson Heather , Suleman Mehrunisha , Nellums Laura , Pareek Manish
Published: March 2023

Objectives

The coronavirus disease 2019 (COVID-2019) pandemic has had far-reaching consequences for people’s lives. In the UK, more than 23 million have been infected and nearly 185 000 have lost their lives. Previous research has looked at differential outcomes of COVID-19, based on socio-demographic factors such as age, sex, ethnicity and deprivation. We conducted a qualitative study with a diverse sample of adults living in the UK, to understand their lived experiences and quality of life (QoL) during the pandemic.

Methods

Participants were recruited with the help of civil society partners and community organisations. Semi-structured interviews were conducted between May and July 2021. Interviews were recorded with permission and transcribed. Transcripts were analysed following an inductive analytical approach as outlined in the Framework Method.

Results

18 participants (≥16 years) representing different ethnicities, sexes, migration and employment statuses and educational qualifications took part. Five key themes and 14 subthemes were identified and presented using the QoL framework. The five key themes describe how COVID-19 affected the following aspects of QoL: (1) financial and economic, (2) physical health, (3) social, (4) mental health and (5) personal fulfilment and affective well-being. The narratives illustrated inequities in the impact of COVID-19 for individuals with intersecting social, economic, and health disparities.

Conclusion

Our findings demonstrate the multidimensional and differential impact of the pandemic on different population groups, with most of the negative economic impacts being borne by people in low-paid and insecure jobs. Similarly, adverse social, physical and mental health impacts particularly affected people already experiencing displacement, violence, physical and mental illnesses or even those living alone. These findings indicate that COVID-19 impacts have been influenced by intersecting health and socioeconomic inequalities, which pre-existed. These inequities should be taken into consideration while designing pandemic recovery and rebuilding packages.
Prevalence of polypharmacy in pregnancy: a systematic review
Authors: Anand Astha , Phillips Katherine , Subramanian Anuradhaa , Lee Siang Ing , Wang Zhaonan , McCowan Rebecca , Agrawal Utkarsh , Fagbamigbe Adeniyi Frances , Nelson-Piercy Catherine , Brocklehurst Peter , Damase-Michel Christine , Loane Maria , Nirantharakumar Krishnarajah , Azcoaga-Lorenzo Amaya
Published: March 2023

Objectives

The use of medications among pregnant women has been rising over the past few decades but the reporting of polypharmacy has been sporadic. The objective of this review is to identify literature reporting the prevalence of polypharmacy among pregnant women, the prevalence of multimorbidity in women taking multiple medications in pregnancy and associated effects on maternal and offspring outcomes.

Design

MEDLINE and Embase were searched from their inception to 14 September 2021 for interventional trials, observational studies and systematic reviews reporting on the prevalence of polypharmacy or the use of multiple medications in pregnancy were included.

Data on prevalence of polypharmacy, prevalence of multimorbidity, combinations of medications and pregnancy and offspring outcomes were extracted. A descriptive analysis was performed.

Results

Fourteen studies met the review criteria. The prevalence of women being prescribed two or more medications during pregnancy ranged from 4.9% (4.3%–5.5%) to 62.4% (61.3%–63.5%), with a median of 22.5%. For the first trimester, prevalence ranged from 4.9% (4.7%–5.14%) to 33.7% (32.2%–35.1%). No study reported on the prevalence of multimorbidity, or associated pregnancy outcomes in women exposed to polypharmacy.

Conclusion

There is a significant burden of polypharmacy among pregnant women. There is a need for evidence on the combinations of medications prescribed in pregnancy, how this specifically affects women with multiple long-term conditions and the associated benefits and harms.

Tweetable abstract

Our systematic review shows significant burden of polypharmacy in pregnancy but outcomes for women and offspring are unknown.

PROSPERO registration number

CRD42021223966.
Utilisation of private general practitioners to provide caesarean deliveries in five rural district public hospitals in South Africa: a mixed-methods study
Authors: Doherty Tanya , Solanki Geetesh , Daviaud Emmanuelle , Bartmann Yvandi , Hawkridge Anthony , Fawcus Sue
Published: March 2023

Objective

Researching how public–private engagements may promote universal access to safe obstetric care including caesarean delivery is essential. The aim of this research was to document the utilisation of private general practitioners (GPs) contracted to provide caesarean delivery services in five rural district hospitals in the Western Cape, the profile and outcomes of caesarean deliveries. We also describe stakeholder experiences of these arrangements in order to inform potential models of public–private contracting for obstetric services.

Design

We used a mixed-methods study design to describe rural district hospitals’ utilisation of private GP contracting for caesarean deliveries. Between April 2021 and March 2022, we collated routine data from delivery and theatre registers to capture the profile of deliveries and maternal outcomes. We conducted 23 semistructured qualitative interviews with district managers, hospital-employed doctors and private GPs to explore their experiences of the contracting arrangements.

Setting

The study was conducted in five rural district hospitals in the Western Cape province, South Africa.

Results

The use of private GPs as surgeon or anaesthetist for caesarean deliveries differed widely across the hospitals. Overall, the utilisation of private GPs for anaesthetics was similar (29% of all caesarean deliveries) to the utilisation of private GPs as surgeons (33% of all caesarean deliveries). The proportion of caesarean deliveries undertaken by private GPs as the primary surgeon was inversely related to size of hospital and mean monthly deliveries. Adverse outcomes following a caesarean delivery were rare. Qualitative data provided insights into contributions made by private GPs and the contracting models, which did not incentivise overservicing.

Conclusion

The findings of this study suggest that private GPs can play an important role in filling gaps and expanding quality care in rural public facilities that have insufficient obstetric skills and expertise. Different approaches to enable access to safe caesarean delivery are needed for different contexts, and contracting with experienced private GP’s is one resource for rural district hospitals to consider.
Development of rapid and effective risk prediction models for stroke in the Chinese population: a cross-sectional study
Authors: Qiu Yuexin , Cheng Shiqi , Wu Yuhang , Yan Wei , Hu Songbo , Chen Yiying , Xu Yan , Chen Xiaona , Yang Junsai , Chen Xiaoyun , Zheng Huilie
Published: March 2023

Objectives

The purpose of this study was to use easily obtained and directly observable clinical features to establish predictive models to identify patients at increased risk of stroke.

Setting and participants

A total of 46 240 valid records were obtained from 8 research centres and 14 communities in Jiangxi province, China, between February and September 2018.

Primary and secondary outcome measures

The area under the receiver operating characteristic curve (AUC), sensitivity, specificity and accuracy were calculated to test the performance of the five models (logistic regression (LR), random forest (RF), decision tree (DT), extreme gradient boosting (XGBoost) and gradient boosting DT). The calibration curve was used to show calibration performance.

Results

The results indicated that XGBoost (AUC: 0.924, accuracy: 0.873, sensitivity: 0.776, specificity: 0.916) and RF (AUC: 0.924, accuracy: 0.872, sensitivity: 0.778, specificity: 0.913) demonstrated excellent performance in predicting stroke. Physical inactivity, hypertension, meat-based diet and high salt intake were important prediction features of stroke.

Conclusion

The five machine learning models all had good predictive and discriminatory performance for stroke. The performance of RF and XGBoost was slightly better than that of LR, which was easier to interpret and less prone to overfitting. This work provides a rapid and accurate tool for stroke risk assessment, which can help to improve the efficiency of stroke screening medical services and the management of high-risk groups.
COVID-19-related stress among emergency physicians: a scoping review protocol on the stressors and coping strategies
Authors: Yau Sze-Yuen , Lee Ching-Yi , Lai Hung-Yi , Lee Ching-Hsin
Published: March 2023

Objective

This scoping review aims to identify the COVID-19-related stressors and the corresponding coping strategies among emergency physicians during and following the pandemic.

Introduction

In the midst of an unprecedented COVID-19 crisis, healthcare professionals confront a diverse set of difficulties. Emergency physicians are under immense pressure. They must provide frontline care and make quick decisions in a high-pressure environment. This can lead to a variety of physical and psychological stressors, including extended working hours, increased workload, personal risk of infection and the emotional toll of caring for infected patients. It is critical that they be informed of the numerous stressors they face, as well as the various coping methods accessible to them, in order to deal with these pressures.

Inclusion criteria

This paper will summarise the findings of primary or secondary investigations on emergency physicians’ stressors and coping strategies during and following the COVID-19 epidemic. All journals and grey literature in English and Mandarin published after January 2020 are eligible.

Methods

The Joanna Briggs Institute (JBI) method will be used to conduct the scoping review. A thorough literature search will be performed on OVID Medline, Scopus and Web of Science to find eligible studies, using the keywords related toemergency physicians,stressandcoping strategies. Two reviewers will independently revise all of the full-text articles, extract data and evaluate the study quality. A narrative overview of the findings from included studies will be given.

Ethics and dissemination

This review will involve secondary analysis of published literature, and therefore ethics approval is not required. The Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist will be used to guide translation of findings. Results will be disseminated through peer-reviewed journals and presented in conferences via abstract and presentation.
Evaluation of the implementation of single points of access for unattached patients in primary care and their effects: a study protocol
Authors: Breton Mylaine , Lamoureux-Lamarche Catherine , Deslauriers Véronique , Laberge Maude , Arsenault Josée , Gaboury Isabelle , Beauséjour Marie , Pomey Marie-Pascale , Motulsky Aude , Talbot Annie , St-Yves Annie , Smithman Mélanie Ann , Deville-Stoetzel Nadia , Sauvé Carine , Abou Malham Sabina
Published: March 2023

Introduction

Attachment to a primary care provider is an important component of primary care as it facilitates access. In Québec, Canada, attachment to a family physician is a concern. To address unattached patients’ barriers to accessing primary care, the Ministry of Health and Social Services mandated Québec’s 18 administrative regions to implement single points of access for unattached patients (Guichets d’accès première ligne(GAPs)) that aim to better orient patients towards the most appropriate services to meet their needs. The objectives of this study are to (1) analyse the implementation of GAPs, (2) measure the effects of GAPs on performance indicators and (3) assess unattached patients’ experiences of navigation, access and service utilisation.

Methods and analysis

A longitudinal mixed-methods case study design will be conducted. Objective 1. Implementation will be analysed through semistructured interviews with key stakeholders, observations of key meetings and document analysis. Objective 2. GAP effects on indicators will be measured using performance dashboards produced using clinical and administrative data. Objective 3. Unattached patients’ experiences will be assessed using a self-administered electronic questionnaire. Findings for each case will be interpreted and presented using a joint display, a visual tool for integrating qualitative and quantitative data. Intercase analyses will be conducted highlighting the similarities and differences across cases.

Ethics and dissemination

This study is funded by the Canadian Institutes of Health Research (# 475314) and the Fonds de Soutien à l’innovation en santé et en services sociaux (# 5-2-01) and was approved by the CISSS de la Montérégie-Centre Ethics Committee (MP-04-2023-716).
Fidelity and tolerability of two high-intensity interval training protocols in patients with COPD: a randomised cross-over pilot study
Authors: Nymand Stine Buus , Hartmann Jacob , Rasmussen Iben Elmerdahl , Iepsen Ulrik Winning , Ried-Larsen Mathias , Christensen Regitse Højgaard , Berg Ronan Martin Griffin
Published: March 2023

Objectives

High-intensity interval training (HIIT) during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD) may alleviate the symptom burden, but the fidelity and tolerability of HIIT using long or short intervals in patients with COPD are unknown.

Methods

Twelve patients with moderate-to-severe COPD were included in a randomised cross-over pilot study. They completed two supervised HIIT protocols (4×4 and 10×1). To compare the two HIIT protocols, completed training amount, exercise intensity and perceived tolerability (assessed by a 10-point Likert scale) were integrated in a red–amber–green rating system. If a training session received a red ranking, it was considered unacceptable, if it received an amber ranking it was applicable with precautions, and if it received a green ranking it was considered feasible.

Results

All patients completed the total training amount in both protocols. The 4×4 protocol resulted in three amber training sessions due to low perceived tolerability. The 10×1 protocol resulted in two red training sessions due to intensity reductions, and two amber training sessions because of low perceived tolerability. There was no statistical difference in perceived tolerability or time spent with an HR ≥85% of HRmax.

Conclusions

HIIT using longer intervals (4×4) at a relatively lower intensity resulted in higher fidelity expressed by fewer adjustments to the protocol, whereas there was no difference between protocols in perceived tolerance. The 4×4 protocol seems to have a higher fidelity compared with the 10×1 protocol in patients with moderate-to-severe COPD.

Trial registration number

NCT05273684.
Blocking soluble TNFα sensitizes HER2-positive breast cancer to trastuzumab through MUC4 downregulation and subverts immunosuppression
Authors: Bruni Sofia , Mauro Florencia L , Proietti Cecilia J , Cordo-Russo Rosalia I , Rivas Martin A , Inurrigarro Gloria , Dupont Agustina , Rocha Dario , Fernández Elmer A , Deza Ernesto Gil , Lopez Della Vecchia Daniel , Barchuk Sabrina , Figurelli Silvina , Lasso David , Friedrich Adrián D , Santilli María C , Regge María V , Lebersztein Gabriel , Levit Claudio , Anfuso Fabiana , Castiglione Teresa , Elizalde Patricia V , Mercogliano Maria F , Schillaci Roxana
Published: March 2023

Background

The success of HER2-positive (HER2+) breast cancer treatment with trastuzumab, an antibody that targets HER2, relies on immune response. We demonstrated that TNFα induces mucin 4 (MUC4) expression, which shields the trastuzumab epitope on the HER2 molecule decreasing its therapeutic effect. Here, we used mouse models and samples from HER2+ breast cancer patients to unravel MUC4 participation in hindering trastuzumab effect by fostering immune evasion.

Methods

We used a dominant negative TNFα inhibitor (DN) selective for soluble TNFα (sTNFα) together with trastuzumab. Preclinical experiments were performed using two models of conditionally MUC4-silenced tumors to characterize the immune cell infiltration. A cohort of 91 patients treated with trastuzumab was used to correlate tumor MUC4 with tumor-infiltrating lymphocytes.

Results

In mice bearing de novo trastuzumab-resistant HER2+ breast tumors, neutralizing sTNFα with DN induced MUC4 downregulation. Using the conditionally MUC4-silenced tumor models, the antitumor effect of trastuzumab was reinstated and the addition of TNFα-blocking agents did not further decrease tumor burden. DN administration with trastuzumab modifies the immunosuppressive tumor milieu through M1-like phenotype macrophage polarization and NK cells degranulation. Depletion experiments revealed a cross-talk between macrophages and NK cells necessary for trastuzumab antitumor effect. In addition, tumor cells treated with DN are more susceptible to trastuzumab-dependent cellular phagocytosis. Finally, MUC4 expression in HER2+ breast cancer is associated with immune desert tumors.

Conclusions

These findings provide rationale to pursue sTNFα blockade combined with trastuzumab or trastuzumab drug conjugates for MUC4+ and HER2+ breast cancer patients to overcome trastuzumab resistance.
Systemic inflammation shapes clinical outcomes in response to immune checkpoint blockade treatment: moving toward optimizing antitumor immunity
Authors: Zheng Ming
Published: March 2023

Background

Immune checkpoint blockade (ICB) treatment may induce durable disease remission, but only in a minority of patients with cancer. One important question is how to identify patients who may benefit from ICB treatment. ICB treatment relies on unleashing patients’ pre-existing immune responses. Focusing on the key components of immune response, this study proposes the neutrophil-to-lymphocyte ratio (NLR) as a simplified indicator of patients’ immune status to predict ICB treatment outcomes.

Methods

This study analyzed a large pan-cancer cohort of 16 cancer types, including 1714 patients with cancer who received ICB treatment. Clinical outcomes in response to ICB treatment were measured by overall survival (OS), progression-free survival (PFS), objective response rate, and clinical benefit rate. The non-linear relationships of NLR with OS and PFS were investigated by a spline-based multivariate Cox regression model. A total of 1000 randomly resampled cohorts were bootstrapped to estimate the variability and reproducibility of NLR-related ICB responses.

Results

By interrogating a clinically representative cohort, this study revealed a previously unreported finding that the pretreatment NLR levels were associated with ICB treatment outcomes in a U-shaped dose-dependent manner rather than a linear manner. An NLR range between 2.0 and 3.0 was remarkably associated with optimal ICB treatment outcomes, including increased patient survival, delayed disease progression, improved treatment response, and significant clinical benefit. Comparatively, either decreasing (< 2.0) or increasing (>3.0) NLR levels were indicators of worse ICB treatment outcomes. Furthermore, this study presents a comprehensive landscape of NLR-related ICB treatment outcomes across different patient populations defined by demographics, baseline characteristics, treatment, cancer-type-specific ICB responsiveness, and individual cancer type.

Conclusions

The NLR range from 2.0 to 3.0 might indicate an optimal balance between innate (neutrophils) and adaptive (lymphocytes) immune responses that potentiates antitumor immunity, which was observed in only 18.6% of patients. A majority of patients showed decreasing NLR (<2.00; 10.9% patients) or increasing NLR (>3.00; 70.5% patients), representing two distinct types of immune dysregulation associated with ICB resistance. This study translates routine blood tests into a precision medicine-based approach to immunotherapy, with important implications for clinicians in clinical decision-making as well as for regulatory agencies in drug approvals.
Patients, doctors and risk attitudes
Authors: Makins Nicholas
Published: March 2023

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are.
Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease
Authors: Leon Leticia , Madrid-Garcia Alfredo , Lopez-Viejo Patricia , González-Álvaro Isidoro , Novella-Navarro Marta , Freites Nuñez Dalifer , Rosales Zulema , Fernandez-Gutierrez Benjamin , Abasolo Lydia
Published: March 2023

Objectives

Most studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyse whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analysed.

Methods

A longitudinal multicentre study of patients with RA was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease and management being perceived as problematic by the rheumatologist and/or patient). The main variable was disease activity in the early stages. The covariates were sociodemographic, clinical and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA.

Results

The study population comprised 631 patients and 35 (5.87%) developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, 28-joint Disease Activity Score (DAS28) score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.89; p=0.01).

Conclusions

In this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that younger patients and those with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.
Mg-doped LaAlO3 structure: a theoretical investigation of indirect to direct bandgap and brittle to ductile transition
Authors: Zahoor Aliza , Mahmood Tariq , Khan Muhammad Isa
Published: March 2023

Integrating chemical dopants into a pure lattice has fueled a novel concept of tuning the physical and chemical properties of existing materials under and beyond ambient conditions. By using density functional theory (DFT) calculations, we report the structural, electronic, elastic, and optical properties of pure and Mg-doped LaAlO3 structure (La1- xMgxAlO3 and LaAl1- xMgxO3), respectively, with the doping concentrations of x = 0%, 20%, 40%, 60%, 80%, and 100%. Our results show that the doping of Mg along La sites introduce new band (s, p) in the valence bands that is moved towards the conduction bands with increase of doping ration (at x = 60% with a reduced bandgap of 0.04 eV), as well as indirect to direct bandgap transition along Al sites. The density of states shows that the valence band shifts towards the Fermi level by inducing a metallicity in La1-xMgxAlO3 format at 60% configuration. Elastically, LaAlO3 experiences brittle to ductile transition for both doping systems except LaAl1-xMgxO3 at 40% configuration. The higher ranges of optical peaks for both systems are identified for 0%‒40% ranges as compared to other configurations. Fortunately, this study reveals the tunability of LaAlO3 structure in structural, electronic, elastic, and optical aspects, and also extends the availability of this material for future optoelectronic and mechanical applications.
Thermal management of storage unit reporting unsteady physical behavior of NEPCM
Authors: Melaibari Ammar A. , Abu-Hamdeh Nidal H. , Daqrouq Khaled O. , Alkhateeb Abulhameed F. , Nusier Osama K. , Saad Hosam A. , Musa Awad
Published: March 2023

Researchers always like to find way for improving the performance of system integrated with PCM. In this paper, the container was combined with fins and PCM was mixed with nanoparticles to obtain quicker discharging process. Two significant variables related to second technique are fraction of additives ([Formula: see text] and their shapes ([Formula: see text]. To involve these factors in equations, single phase formulation was applied. Low magnitude of velocity of liquid material in freezing leads to simplification of equations of this transient procedure. Galerkin method which was applied for this modeling has good accommodation with previous publication. As [Formula: see text] soars, the solidification time declines from 4802.97s to 4244.61s and 3738.37s when blade shape particles were applied. This means that adding additive can enhance the rate of process about 22.16%. Moreover, augmenting the shape factor to higher level causes time to drop about 5.7%.
Thermosolutal Marangoni stagnation point GO–MoS2/water hybrid nanofluid over a stretching sheet with the inclined magnetic field
Authors: Mohanty D. , Mahanta G. , Shaw S. , Das M.
Published: March 2023

The graphene oxide–molybdenum disulfide (GO–MoS2) exhibited the performance of photocatalytics under solar light radiation and the problem is more significant during Marangoni convection. In this scenario, the thermosolutal Marangoni stagnation point flow over a stretching sheet where the GO–MoS2 nanoparticles are embedded in a base fluid water are taken into consideration. The inclined magnetic field with the Joule heating effect, thermal radiation, chemical reaction and Soret and Dufour effect is introduced in the system. The leading equations are simplified by applying the proper similarity transformation and then solved numerically with the help of the MATLAB bvp4c routine. The impact of several parameters on the velocity, temperature and concentration with other physical properties such as skin friction, local Nusselt number and local Sherwood number has been displayed. Moreover, the results of this paper demonstrate a brief equivalency between nanofluid and hybrid nanofluid. It is experimented that the Marangoni effect arises due to a fluctuation in temperature as well as a chemical reaction. Surface tension refers to mean temperature and mean concentration restricts the fluid velocity. GO–MoS2 exhibits the increase in antimicrobial effects with enhancement in the glutathione oxidation and it is also used for DNA detection. The impact of GO and MoS2 in the flow of hybrid nanofluid shows significance with a huge application in medical science.