bluuebunny/crossref_metadata_2025 huggingface dataset:
Drug-related problems and associated factors among patients with kidney dysfunction at a tertiary hospital in southwestern Uganda: a prospective observational study
Authors: Kyomya Julius , Atwiine Fredrick , Shegena Efrata Ashuro , Muhindo Rose , Yadesa Tadele Mekuriya
Published: December 2023

Background

Kidney dysfunction is a common, progressive condition that is increasingly becoming a global public health issue. Because the kidneys are the major route for drug excretion, impaired renal function can change the pharmacokinetics and pharmacodynamics of drugs that are renally excreted. Additionally, patients with kidney dysfunction often have co-morbidities and the associated use of multiple medications which increases the risk of drug-related problem (DRP) occurrence. This study aimed to determine the prevalence, types, and factors associated with DRPs in patients with kidney dysfunction.

Method

We conducted a prospective observational study over 3 months among hospitalized patients diagnosed with acute kidney injury or chronic kidney disease who were hospitalized in the medical ward, and patients attending the renal outpatient clinic at Mbarara Regional Referral Hospital. A total of 183 participants were enrolled through the use of a consecutive sampling technique. DRPs were classified according to the PCNE classification version 9.1. Data analysis was carried out using SPSS version 25.

Results

A total of 174 patients with kidney dysfunction were included in the study with a mean ± SD age of 50.34 ± 18.13 years. A total of 219 DRPs were incurred by 138 (79.3%) study participants. The most common DRPs were ‘Untreated symptoms or indication’ (35.6%) followed by ‘adverse event (possibly) occurring’ (28.3%), and ‘effect of drug treatment not optimal’ (23.3%). Antimicrobials were the most involved drugs in suboptimal drug treatment (31.3%) and unnecessary drug treatment (32.1%). The study showed that length of hospital stay ≥ 5 days (AOR = 6.39, 95% CI: 1.75–23.27; p-value = 0.005) significantly increased the risk of DRP occurrence.

Conclusion

The current results, in agreement with previous literature, showed a high burden of DRPs among patients with kidney dysfunction. Antimicrobials were the most involved drugs in suboptimal as well as in unnecessary drug treatment. Longer hospital stay significantly increased the risk of DRPs. The high prevalence of DRPs in patients with kidney dysfunction and the potential impact on antimicrobial resistance underscores the importance of regular medication reviews and close monitoring of patients with renal dysfunction.
Case series of branch retinal vein occlusion secondary to rhegmatogenous retinal detachment and its surgical management
Authors: Choi Youna , Kim Sung Jun , Lee Jae Jung , Zaidi Moosa Hasan , Shin Yong Un , Byon Ik Soo , Lee Ji Eun , Park Sung Who
Published: December 2023

Background

To review cases of branch retinal vein occlusion (BRVO) secondary to rhegmatogenous retinal detachment (RRD) and its surgical management and presume their mechanism.

Methods

Medical records of patients who underwent surgery for RRD between 2015 and 2019 at a single tertiary care center were retrospectively reviewed. New BRVO secondary to RRD or its surgical procedure was diagnosed based on the fundus examination and its clinical course.

Results

A total of 734 RRD surgeries were performed for five years, and six cases of new BRVOs were noticed in the first year after surgery (incidence was 0.68%: six cases of BRVO / 734 cases of surgical RRD); five cases occurred after vitrectomy, and one occurred after scleral buckling. In three cases, retinal veins were presumed to already be partially occluded related due to a kink of the retinal vein seen before surgery. In the other three cases, the retinal veins were presumed to have incurred damage during vitrectomy.

Conclusion

In the present cohort, RRD or its related procedures caused BRVO within a year of surgery at an incidence of 0.68%. The proposed mechanisms are kinks of the retinal vein on the detached retina and damage to the retinal vein during vitrectomy.
Knowledge, attitudes and practices of patients with chronic pharyngitis toward laryngopharyngeal reflux in Suzhou, China
Authors: Zhang Qiumin , Huang Haiping , Li Jiachen , Niu Yuyu , Sun Peng , Cheng Fuwei
Published: December 2023

Background

This study aimed to investigate the knowledge, attitudes and practices (KAP) of patients with chronic pharyngitis in Suzhou, China toward laryngopharyngeal reflux (LPR).

Methods

This cross-sectional study was conducted in patients with chronic pharyngitis in Suzhou, China at the otolaryngology outpatient clinic of the First Affiliated Hospital of Soochow University between November, 2022, and May, 2023. Data was collected through a self-designed online questionnaire encompassing the sociodemographic characteristics and three dimensions of KAP. The questionnaire was administered using SoJump, and data were exported from this platform. Subsequently, statistical analysis, including Structural Equation Modeling, was performed using SPSS 22 software to evaluate the KAP scores.

Results

A total of 487 valid questionnaires were collected, with 275 (56.35%) female patients. The mean score of KAP were 4.76 ± 2.93 (possible range: 0–11), 33.10 ± 4.46 (possible range: 8–40), 31.29 ± 6.04 (possible range: 8–40), respectively. Pearson’s correlation analysis showed significant positive correlations between knowledge and attitude dimensions (r = 0.413, P < 0.001), knowledge and practice dimensions (r = 0.355, P < 0.001), and attitude and practice dimensions (r = 0.481, P < 0.001). Structural equation modeling revealed that education exhibited positive effect on knowledge (β = 0.476, P < 0.001) and attitude (β = 0.600, P < 0.001), and having family history of chronic pharyngitis showed positive effect on knowledge (β = 0.580, P = 0.047), experienced with reflux symptoms showed positive effect on knowledge (β = 0.838, P = 0.001) and attitude (β = 0.631, P = 0.085). Moreover, knowledge showed positive effect on attitude (β = 0.555, P < 0.001) and practice (β = 0.351, P < 0.001). Attitude, in turn, showed positive effect on practice (β = 0.511, P < 0.001).

Conclusion

Patients with chronic pharyngitis had inadequate knowledge, positive attitudes and suboptimal practices toward LPR. Education, family history of chronic pharyngitis, experienced with reflux symptoms might have effect on their KAP.
Disability and loneliness in the United Kingdom: cross-sectional and longitudinal analyses of trends and transitions
Authors: Emerson Eric , Stancliffe Roger J. , Aitken Zoe , Bailie Jodie , Bishop Glenda M. , Badland Hannah , Llewellyn Gwynnyth , Kavanagh Anne M.
Published: December 2023

Background

Loneliness can have a detrimental impact on health, yet little is known about the association between disability and loneliness.

Methods

Secondary analysis of three waves of data collected between 2017 and 2020 by the UK’s annual household panel study, Understanding Society. Direct age-standardisation was used to compare the prevalence of loneliness at each wave and the persistence of loneliness across all three waves for participants with/without disabilities aged 16–65 years. Transitional probabilities for the stability of loneliness, the stability of non-loneliness, the onset of loneliness and the offset of loneliness between consecutive waves were also estimated.

Results

At each wave, the prevalence of loneliness was significantly higher among respondents with disabilities than respondents without disabilities; these inequalities persisted with no evidence of change over time. The prevalence of persistent loneliness was 46% for respondents with disabilities compared with 22% for respondents without disabilities. Risk factors for the likelihood of persistent loneliness included disability, financial stress, not living as a couple, living in rented accommodation, being female and not being employed. The probability of the onset and stability of loneliness between successive waves were markedly higher for people with disabilities compared with people without disabilities.

Conclusion

Adults with disabilities were more likely to experience loneliness, become lonely and remain lonely over time than their peers. Policies and interventions aimed at reducing loneliness should ensure that they are accessible and effective for people with disabilities. Further research is needed to explore the health outcomes of persistent loneliness among people with/without disabilities.
A single session of action observation therapy versus observing a natural landscape in adults with chronic neck pain – a randomized controlled trial
Authors: Al Shrbaji Tala , Bou-Assaf Mário , Andias Rosa , Silva Anabela G.
Published: December 2023

Background

Action observation (AO) has emerged as a potential neurorehabilitation therapy for patients with neck pain (NP), but evidence of its effectiveness is scarce. This study aims to assess the effect of a single session of AO when compared to observing a natural landscape on NP intensity, fear of movement, fear-avoidance beliefs, neck muscles’ strength, pressure pain threshold, and tactile acuity.

Methods

Sixty participants with NP were randomly allocated to the AO group (n = 30) or control group (n = 30). Both groups watched an 11-minute video: the AO group watched a video of a person matched for age and sex performing neck exercises, while the control group watched a video of natural landscapes. Neck pain intensity, fear of movement, fear-avoidance beliefs, tactile acuity, pressure pain thresholds, and neck muscle strength were assessed both at baseline and post-intervention. General linear models of repeated measures (ANCOVA of two factors) were used to explore between-group differences at post-intervention.

Results

There was a significant main effect of time for pain intensity (p = 0.02; η2p = 0.09; within-group mean change and 95% CI: AO=-1.44 (-2.28, -0.59); control=-1.90 (-2.74, -1.06), but no time versus group interaction (p = 0.46). A time versus group significant interaction was found for one out of the six measurement sites of two-point discrimination and the neck flexors strength (p < 0.05) favoring the control group. No other statistically significant differences were found for the remaining variables).

Conclusions

Results suggest a similar acute benefit for both a single session of AO and observing natural landscapes for promoting hypoalgesia, but no impact on kinesiophobia, fear-avoidance beliefs, or pressure pain thresholds. Also, AO had no positive effect on two-point discrimination and muscle strength. Further research is needed, with longer interventions.

Trial registration

Clinialtrials.gov (NCT05078489).
Association between perioperative blood transfusion and length of hospital stay in patients with osteoporotic fractures
Authors: Xu Si-ming , Lu Ke , Yang Xu-feng , Ye Yao-wei , Xu Min-zhe , Shi Qin , Gong Ya-qin , Li Chong
Published: December 2023

Background

Few studies have examined the relationship between perioperative blood transfusion (PBT) and length of hospital stay (LOS) in patients with osteoporotic fractures. This research aims to study the association between PBT and LOS.

Methods

This is a retrospective cross-sectional study from the Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China, involving 2357 osteoporotic fractures (OPF) patients who received surgical treatment during hospitalization from January 2017 and March 2022. Multiple linear regression was used to analyze the relationship between PBT and LOS. In the analysis, PBT volume was the dependent variable, whereas LOS was the independent variable. Simultaneously, age, gender, body mass index, hemoglobin, primary diagnosis, American Society of Anesthesiologists, creatinine (Cr), anesthesia, surgical method, and Charlson comorbidity index were included as covariates. The generalized additive model was then used to study nonlinear associations. Two piecewise linear regression exemplary evaluated the inception results for smoothing the curve.

Results

Our results proved that PBT was positively correlated with LOS in the fully adjusted model (β, 0.21; 95% CI, 0.04 to 0.37; P < 0.0001). Furthermore, a “U-shape” nonlinear relationship existed between PBT and LOS. When the concentration of PBT was between 0 and 1.5 units, it was manifested as a negative correlation between PBT and LOS. However, there was a positive association between PBT and LOS when PBT levels exceeded 1.5 units.

Conclusions

This study demonstrated that PBT and LOS in the OPF population were independent with a nonlinear relationship. These results suggest that PBT may be protective for patients with long LOS. If these findings are confirmed, the LOS in OPF patients can be regulated through appropriate perioperative blood transfusion.
Efficacy of fosfomycin compared to second generation cephalosporin flumarin as antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: a single center retrospective study
Authors: Kim Hee Youn , Lim Daehyun , Choi Young Hyo , Yoo Je Mo , Lee Dong Sup , Lee Seung-Ju
Published: December 2023

Background

Fluoroquinolone has been the historic choice of antimicrobial prophylaxis for transrectal ultrasound (TRUS) guided prostate biopsy. However, increased fluoroquinolone resistance and recent restrictions of its use for antimicrobial prophylaxis has led to the emergence of alternative agents for antimicrobial prophylaxis for TRUS guided prostate biopsy including fosfomycin and cephalosporins. This study aimed to compare the efficacy of fosfomycin and a second-generation cephalosporin flumarin as alternative antimicrobials for TRUS-guided prostate biopsy in terms of the incidence of infectious complications after TRUS-guided prostate biopsy.

Methods

A retrospective chart review of all patients who underwent TRUS-guided prostate biopsy between November 2009 to January 2023 was undertaken. Comparison of baseline characteristics and the incidence of infectious complications was done between those who received fosfomycin as antimicrobial prophylaxis for TRUS-guided prostate biopsy and those who received flumarin. Multivariate logistic regression analysis was conducted to identify risk factors for infectious complications after TRUS-guided prostate biopsy.

Results

Of 2,900 patients identified as eligible candidates for analysis, 333 (11.5%) received fosfomycin and 2,567 (88.5%) received flumarin. The overall rate of infectious complications was approximately 3% lower in patients who received fosfomycin, although such difference did not reach statistical significance (5.7% vs. 8.6%, p = 0.074). Multivariate logistic regression analysis showed that history of operation done under general anaesthesia within six months of the biopsy (odds ratio [OR]: 2.216; 95% confidence interval [CI]: 1.042–4.713; p = 0.039) and history of prior antimicrobial use within six months (OR: 1.457; 95% CI: 1.049–2.024; p = 0.025) were significant risk factors for infectious complications after TRUS-guided prostate biopsy.

Conclusion

Fosfomycin was comparable to second-generation cephalosporin flumarin in preventing infectious complications after TRUS-guided prostate biopsy. Coupled with its properties such as ease of administration, low adverse effects, low resistance rate, and low collateral damage, fosfomycin might be an attractive alternative antimicrobial prophylaxis for TRUS-guided prostate biopsy.
Determinants and inequality of recurrent aphthous stomatitis in an Indonesian population: a cross sectional study
Authors: Novrinda Herry , Azhara Catherine Salsabila , Rahardjo Anton , Ramadhani Atik , Dong-Hun Han
Published: December 2023

Introduction

Recurrent Aphthous Stomatitis (RAS) is the most common type of ulceration in the oral cavity which can occur due to several factors.

Aims

To determine the factors related to the incidence of RAS and examine the social class inequality in RAS among the Indonesian population using data from the fifth wave of the Indonesian Family Life Survey (IFLS5) in 2014.

Methods

This study is a descriptive study with a cross-sectional design using secondary data from IFLS5 data in 2014 (n = 28,410). Socio-economic position (SEP) was calculated by Adult Equivalent Scale and categorized into 4 classes. Outcome is RAS. Mediating factors were psychosocial (stress), eating behavioral (food consumption), and systemic diseases. Descriptive analysis, chi-square and a series of logistic regressions were performed to analyze the data. Odds ratio (OR) and 95% confidence interval (CI) were used to report the results.

Results

Only 18.39% of IFLS5 respondents experienced the incidence of recurrent aphthous stomatitis in 2014. The bivariate (chi-square) results showed that there was a relationship between the incidence of RAS and the related independent variables. Logistic regression showed the highest possibility of RAS in respondents aged 18–34 years, female, unmarried, high school education level, living in the city, having frequent stress levels, having food habits that frequently drinking soda, sweet foods, chili sauce, fried food and has systemic diseases such as, asthma, cancer, rheumatism, and digestion. The lowest SEP group had the highest probability of occurrence of RAS over the other groups among the different models.

Conclusions

There are several factors that determine the incidence of RAS. There was a monotonic gradient of inequality in RAS according to SEP group. This study might be useful to provide information regarding the relationship of determinants factors with the incidence of RAS to prevent it and promote oral health in the future.
Effect of lactobacillus reuteri-derived probiotic nano-formulation on recurrent aphthous stomatitis: a double-blinded randomized clinical trial
Authors: Samiraninezhad Nazafarin , Kazemi Hojat , Rezaee Mostafa , Gholami Ahmad
Published: December 2023

Objectives

We aimed to assess the therapeutic effects of a topical probiotic nano-formulation derived from Lactobacillus reuteri on treating recurrent aphthous stomatitis.

Materials and methods

60 participants were randomly allocated into two groups (control and probiotic). Probiotic group administered topical probiotic nano-formulation three times a day for seven days. The control group administered a standard analgesic oral rinse. The size of ulcer(s) and pain severity were recorded on days 0, 3, 5, and 7 after intervention.

Results

Before the intervention, the groups had no significant differences in terms of pain severity (P-value = 0.28) and lesion size (P-value = 0.24). Both groups exhibited significant reductions in pain severity and lesion size over the course of the intervention. After one week, the probiotic group had a notably larger lesion size reduction than the control group (P-value = 0.01). The probiotic group also showed a significantly greater reduction in pain severity than the control group (P-value = 0.04).

Conclusions

Applying topical probiotic nano-formulation derived from Lactobacillus reuteri three times a day decreased lesion size and pain severity in RAS patients faster than the local analgesic oral rinse.

Clinical relevance

Lactobacillus reuteri-derived probiotic nano-formulation might be a promising treatment option for RAS.
The effect of using denture adhesives on patient satisfaction with complete dentures; a randomized clinical trial
Authors: Ereifej Nadia S. , Oweis Yara G. , Abu-Awwad Motasum
Published: December 2023

Background

Denture adhesives can be useful in improving patients’ satisfaction with complete dentures. However, comparison clinical trials are lacking. The purpose of this randomized clinical trial was to assess the satisfaction of edentulous patients and their oral health impact profile when provided with 3 types of denture adhesives.

Methods

Sixty-four completely edentulous patients seeking complete dentures for their first time were randomly divided into 3 groups. Each group received a set of complete dentures, which were adjusted at review appointments until participants reported no complaints. After 1 month of using the dentures, participants rated their overall satisfaction and their satisfaction regarding comfort, retention, stability, and efficiency of mastication and speech on a 100-mm visual analog scale (VAS). Participants also filled out the oral health impact profile for edentulous patients (OHIP-EDENT) questionnaire. Each group was then given 1 type of denture adhesive to use. Group C received Corega Ultra denture fixative cream (GlaxoSmithKline), Group O received Olivafix (Bonyf), and Group S received Sea. Bond adhesive strips (Sea.Bond). Mann-Whitney U test was used to analyze the differences in VAS scores before and after using the adhesive within each group and Wilcoxon-signed rank test was used to compare OHIP scores and total OHIP values before and after using the adhesive within each group (p = 0.05). Furthermore, Kruskal Wallis test was used to compare the differences before and after using the adhesives in VAS and OHIP values between the 3 groups.

Results

Significantly higher VAS values were detected in all groups and significantly lower values for many OHIP items in addition to total OHIP values were detected in all groups after using the adhesives (P < 0.05), except for the ease of cleaning for Group O and Group S (P > 0.05). No significant differences were found in VAS and OHIP values between the 3 groups (P > 0.05), except for the ease of cleaning which was significantly different between Group C and Group S (p = 0.005).

Conclusions

Using denture adhesives for completely edentulous patients resulted in higher patient satisfaction as indicated by higher VAS scores as well as improved quality of life as indicated by lower OHIP-EDENT scores after using the adhesives. These improvements were not dependent on the type of adhesive, except for ease of cleaning as adhesive strips were easier to clean than paste type adhesives.

Trial registration

This trial was registered at ClinicalTrials.gov (ID: NCT05496283) on 11/08/2022.
The impact of Bis-GMA free and Bis-GMA containing resin composite as posterior restoration on marginal integrity: a randomized controlled clinical trial
Authors: Reda Sara Ahmed , Hussein Yasser Fathi , Riad Mona
Published: December 2023

Background

There have been concerns surrounding the utilization of Bis-GMA, a type of bisphenol A (BPA) derivative, within the dental industry. The aim of this study was to compare the performance of bulk fill Bis-GMA-free resin composite class II restorations in respect of its marginal integrity in comparison to bulk fill Bis-GMA-containing resin composite class II restorations over a 12-month period in a parallel clinical trial utilizing a split-mouth, double-blind, randomized strategy.

Methods

20 patients participated in this study. Each patient has received one pair of class II posterior restorations, Bis-GMA-free (Admira fusion x-tra), and Bis-GMA containing (x-tra fil) on each side of the mouth (split-mouth strategy), (n = 40). The restorations’ marginal integrity was evaluated based on Ryge’s criteria (modified USPHS) at baseline (after 1 week), as well as 1 month, 3 months, 6 months, 9 months, and after 12 months of follow-up by two calibrated examiners. The statistical analyses utilizing the Friedman and Wilcoxon tests, the significance level was adjusted to 0.05.

Results

Following the 12-month period, all patients attended the recall visits to evaluate the restorations. The Wilcoxon signed-rank and Friedman tests, revealed that both types of bulk fill had 100% of Alpha (A) scores at baseline and after 1 month with no significant statistical differences. After 3, 6, 9, and 12 months, both tested bulk fill restorations showed Bravo (B) score with Bis-GMA free 10% and 5% for Bis-GMA containing with no statistically significant difference (p ≤ 0.05) for clinical marginal integrity parameter in USPHS criteria.

Conclusions

Bis-GMA-free resin composites demonstrated satisfactory, marginal integrity compared with Bis-GMA-containing resin composites within 12 months.

Trial registration

The protocol of the current study was registered at www.clinicaltrials.gov, with the identification number NCT05480852 on 29/07/2022. All procedures involving human participants were performed in accordance with the ethical standards of the Research Ethics Committee of the Faculty of Dentistry, Minia University, Egypt, under the approval number 419 on 27/06/2020.
The impact of digital healthcare and teledentistry on dentistry in the 21st Century: a survey of Hungarian dentists
Authors: Németh Orsolya , Uhrin Eszter , Girasek Edmond , Boros Julianna , Győrffy Zsuzsa
Published: December 2023

Background

The era of digitalization has arrived in the field of dentistry. Teledentistry (TD), the use of digital solutions in dentistry, is already used in practice; however, only some possibilities are considered. During the COVID-19 pandemic, remote patient monitoring and patient communication had to be solved with TD, thus causing a rapid spread of new tools. In addition to digital workflows, patient communication, AI, and online forums are also available.

Methods

An online self-administered survey was developed for the study. The Hungarian Medical Chamber contacted potential respondents in a newsletter or e-mail. The Evasys survey system was used. The weighting procedure was executed for gender, age group, and type of settlement. A digital dental index variable was created and built with a linear regression model as a dependent variable. Explanatory variables are advantages, disadvantages, what would be necessary, experienced needs from the patients, and age.

Results

A total of 171 dentists completed the survey. The best-known digital technologies are online conferences (96.5%), E-prescriptions (94.6%), and digital impressions (86.0%). Unawareness is the highest in the field of artificial intelligence in dentistry (50.5%), store-forward solutions (43.5%), and real-time solutions (41.8%). The digital dental index is 14.24 (standard deviation (SD) = 5.5), with a high power of the model.

Conclusion

Hungarian dentists need to be made aware of all the possibilities of TD. In addition to digital workflows, store-forward and real-time solutions can be beneficial to substitute face-to-face visits. TD can be used effectively to monitor oral cavity changes and develop dental confidence and proper oral care habits. Our survey suggests that it is necessary and inevitable to integrate TD into both graduate and postgraduate education, which may form the basis of primary health care in the next decade.
Pelvic organ prolapse: Women’s experiences of Accessing Care & Recommendations for improvement
Authors: Carroll Louise , Sullivan Cliona O’. , Doody Catherine , Perrotta Carla , Fullen Brona M.
Published: December 2023

Up to 50% of women will develop pelvic organ prolapse (POP) over their lifetime. Symptoms include pain, bulge, urinary, bowel and sexual symptoms affecting all aspects of a woman’s life.

Many women with POP symptoms present initially to primary care settings. Research has shown these interactions are often unsatisfactory, with women reporting their health care professional (HCP) trivialized their symptoms or appeared to have poor knowledge about pelvic floor dysfunction (PFD).

Aim The aim of this qualitative study was to explore experiences of younger women seeking treatment for POP and their recommendations for improvements.

Methods Ethics approval was obtained (LS-21-01-Carroll-Ful). Women with POP were recruited from an online support group (n = 930 members). Inclusion criteria: adult women, diagnosed with POP and aware of their POP stage. Following informed consent, a demographic questionnaire, interview questions and the Central Sensitization Inventory (CSI) were forwarded. Semi-structured zoom audio-recorded interviews were conducted. Thematic analysis was undertaken; transcripts coded, and themes identified.

Results Fourteen women aged 32–41, parity 1–3, with POP Grade 1–3 participated. Many women reported HCPs as dismissive or not appreciative of the impact of their condition. Others described interactions with HCPs who they felt listened, understood the impact of their POP, gave simple explanations, a positive prognosis and outlined a realistic treatment plan.

Current antenatal education, post-partum care and primary HCP screening for PFD were identified by women as deficient. Many highlighted delays in accessing specialist care for POP. Women made several recommendations for improvements to the current model of care.

Conclusions Increased focus on person-centred care, particularly emotional support, information and education may improve younger women’s experiences when seeking care for POP.
Development and validation of Simulation Scenario Quality Instrument (SSQI)
Authors: Mujlli Gadah , Al-Ghosen Abdulmajeed , Alrabah Rola , Munshi Fadi , Ozdemir Burhanettin
Published: December 2023

Background

Due to the unmet need for valid instruments that evaluate critical components of simulation scenarios, this research aimed to develop and validate an instrument that measures the quality of healthcare simulation scenarios.

Methods

A sequential transformative mixed-method research design was used to conduct the study. The development and validation of the instrument involved two phases: the qualitative phase, which included defining the instrument's theoretical background and instrument construction, followed by the quantitative phase, where the instrument was piloted and validated. The qualitative study included 17 healthcare simulation experts, where three focus group was conducted, and the first version of the instrument was constructed based on the focus group analysis and the theoretical framework constructed using the literature review. During the quantitative phase, the instrument’s quantitative piloting included 125 healthcare simulation scenarios; then, the instrument went through construct validity and reliability testing.

Results

Content experts confirmed the theoretical model and instrument framework. The average item content validity index (I-CVI) scores and the average of the I-CVI scores (S-CVI/Ave) for all items on the scale or the average proportion relevance judged by all experts was 0.87. The conformity factor analysis results showed a good fit for the proposed 10-factor model (CFI (the comparative fit index) = 0.998, Tucker-Lewis index = 0.998, Root mean square error of approximation (RMSEA) = 0.061. The final instrument included ten domains: 1. Learning objectives, 2. Target group, 3. Culture, 4. Scenario case, 5. Scenario narrative briefing, 6. Scenario complexity, 7. Scenario flow, 8. Fidelity, 9. Debriefing, and 10. Assessment. The SSQI included 44 items that are rated on a 3-point scale (Meets Expectations = (2), Needs Improvement, (1), Inadequate (0)).

Conclusion

This validated and reliable instrument will be helpful to healthcare educators and simulation experts who want to develop simulation-based training scenarios and ensure the quality of written scenarios.
Mental health differences in medical students based on curriculum and gender
Authors: Jestin Maxim , Sharma Shelly , Jhaveri Deval , Mitchell Brittany , Micciche Dean , Venkataraman Venkat , Lambert Kathryn
Published: December 2023

Background

The prevalence of mental health struggles among students in medical school is widely reported; however, little is known about how it is impacted by the medical school curriculum. This study aimed to evaluate differences in anxiety, depression, and emotional exhaustion in medical students based on gender, class year, and curriculum.

Methods

An anonymous online survey consisting of questions from established, validated questionnaires about demographics, anxiety, depression, emotional exhaustion, and personal health behaviors was sent to 817 medical students who attended Rowan-Virtua School of Osteopathic Medicine during the Spring of 2021. When applying to this school, each of these students had the option to choose either the problem-based learning (PBL) or lecture-based learning (LBL) curriculum track.

Results

The survey was completed by 222 students. Females experienced higher levels of anxiety, depression, and emotional exhaustion than males. Students in the PBL had lower levels of emotional exhaustion than their peers in the LBL. Increase in emotional exhaustion was most pronounced between 1st and 2nd year students. Emotional exhaustion was inversely correlated with sleep and exercise.

Conclusions

On average, students who were either male or in the PBL curriculum experienced less mental distress in the form of anxiety, depression, and emotional exhaustion than their peers. While gender continues to be an established factor in how mental distress is experienced, the reduced levels of emotional exhaustion in PBL students is a novel finding that can potentially shed light on how to better optimize medical education. Despite the inherent selection bias and lower number of PBL students, to our knowledge, this is the first study comparing two different curricula within a single institution. This finding along with a focus on good sleep and exercise habits may provide a path for improving mental health in medical students.
Recruiting students to rural longitudinal integrated clerkships: a qualitative study of medical educationists’ experiences across continents
Authors: Pinidiyapathirage Janani , Heffernan Robert , Carrigan Brendan , Walters Sherrilyn , Fuller Lara , Brumpton Kay
Published: December 2023

Introduction

Many health systems struggle in the provision of a sustainable and an efficient rural health workforce. There is evidence to suggest that Longitudinal Integrated Clerkships (LIC) placing student learners in rural community settings have positively impacted the provision of rural health care services The recruitment and engagement of students in rural LIC have significant challenges. This study explored best practice methods of recruiting and supporting the transition of medical students into rural LIC.

Methods

The study took place during the 2021 Consortium of Longitudinal Integrated Clerkships Conference, a virtual event hosted by Stellenbosch University, South Africa. Participants consisted of delegates attending the Personally Arranged Learning Session (PeArLS) themed ‘Secrets to success’. The session was recorded with the participants’ consent and the recordings were transcribed verbatim. Data was uploaded to NVivo software and coded and analyzed using constant comparative analysis. Salient themes and patterns were identified.

Results

Thirteen attendees participated in the PeArLS representing a range of countries and institutions. Strategically marketing the LIC brand, improving the LIC program profile within institutions by bridging logistics, and the need to scaffold the transition to the rural LIC learning environment emerged as key themes for success. The attendees highlighted their experiences of using peer groups, early exposure to rural LIC sites, and student allocation strategies for promotion. Unique learning styles adopted in LIC models, student anxiety and the importance of fostering supportive relationships with stakeholders to support students in their transition to the LIC environment were discussed.

Discussion

This PeArLS highlighted successful systems and processes implemented in rural settings across different countries to recruit and manage the transition of medical students to rural LIC. The process proved to be a quick and efficient way to elicit rich information and may be of benefit to educationists seeking to establish similar programs or improve existing rural LIC.
Sociodemographic factors associated with knowledge and attitudes of Peruvian dental interns about dental shade selection
Authors: Vásquez-Pérez Delia , Briceño-Vergel Gissela , Ladera-Castañeda Marysela , Córdova-Limaylla Nancy , Cervantes-Ganoza Luis , Paucar-Rodríguez Elizabeth , Allen-Revoredo Clifford , Castro-Rojas Miriam , Cayo-Rojas César
Published: December 2023

Background

The dentist should have a thorough knowledge of the science, protocols and procedures for dental shade selection in order to mimic dental tissue with restorative materials, respecting the individual needs and attitudes of each patient and providing them with a pleasant and esthetically acceptable appearance. The present study evaluated the knowledge and attitudes of dental interns from two Peruvian universities about dental shade selection and its relationship with sociodemographic factors.

Methods

The present cross-sectional and analytical study was carried out on Peruvian dental interns from the Universidad Nacional Federico Villarreal and the Universidad Privada de San Juan Bautista during May to June 2022. Two validated questionnaires on knowledge and attitudes about dental shade selection were used. A Poisson regression model with robust variance using the adjusted prevalence ratio (APR) was used to assess the influence of the variables: age group, sex, place of origin and type of university, considering a significance level of p<0.05.

Results

The results showed that 40.8% (95% CI: 34.0% - 47.6%) of the interns presented unfavorable attitudes while 90.1% (95% CI: 86.0% - 94.2%) presented insufficient knowledge. It was also found that dental interns under 29 years of age were 32% less likely to have unfavorable attitudes (APR = 0.68, 95% CI 0.48 - 0.96) and 11% more likely to have insufficient knowledge (APR = 1.11, 95% CI 1.01 - 1.24) about tooth shade selection compared to dental interns aged 29 years and older. Finally, women were 55% more likely to have unfavorable attitudes about tooth shade selection compared to men (APR = 1.55; 95% CI: 1.08 - 2.22).

Conclusion

The majority of dental interns presented insufficient knowledge and less than half had unfavorable attitudes about dental shade selection. In addition, being a student under 29 years of age was a risk factor for presenting insufficient knowledge and at the same time constituted a protective factor for presenting unfavorable attitudes. Likewise, being a female student was a risk factor for presenting unfavorable attitudes about dental shade selection.
Dapagliflozin treatment is associated with a reduction of epicardial adipose tissue thickness and epicardial glucose uptake in human type 2 diabetes
Authors: Cinti Francesca , Leccisotti Lucia , Sorice Gian Pio , Capece Umberto , D’Amario Domenico , Lorusso Margherita , Gugliandolo Shawn , Morciano Cassandra , Guarneri Andrea , Guzzardi Maria Angela , Mezza Teresa , Capotosti Amedeo , Indovina Luca , Ferraro Pietro Manuel , Iozzo Patricia , Crea Filippo , Giordano Alessandro , Giaccari Andrea
Published: December 2023

Objective

We recently demonstrated that treatment with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) leads to an increase in myocardial flow reserve in patients with type 2 diabetes (T2D) with stable coronary artery disease (CAD). The mechanism by which this occurs is, however, unclear. One of the risk factors for cardiovascular disease is inflammation of epicardial adipose tissue (EAT). Since the latter is often increased in type 2 diabetes patients, it could play a role in coronary microvascular dysfunction. It is also well known that SGLT-2i modify adipose tissue metabolism. We aimed to investigate the effects of the SGLT-2i dapagliflozin on metabolism and visceral and subcutaneous adipose tissue thickness in T2D patients with stable coronary artery disease and to verify whether these changes could explain observed changes in myocardial flow.

Methods

We performed a single-center, prospective, randomized, double-blind, controlled clinical trial with 14 T2D patients randomized 1:1 to SGLT-2i dapagliflozin (10 mg daily) or placebo. The thickness of visceral (epicardial, mediastinal, perirenal) and subcutaneous adipose tissue and glucose uptake were assessed at baseline and 4 weeks after treatment initiation by 2-deoxy-2-[18F]fluoro-D-glucose Positron Emission Tomography/Computed Tomography during hyperinsulinemic euglycemic clamp.

Results

The two groups were well-matched for baseline characteristics (age, diabetes duration, HbA1c, BMI, renal and heart function). Dapagliflozin treatment significantly reduced EAT thickness by 19% (p = 0.03). There was a significant 21.6% reduction in EAT glucose uptake during euglycemic hyperinsulinemic clamp in the dapagliflozin group compared with the placebo group (p = 0.014). There were no significant effects on adipose tissue thickness/metabolism in the other depots explored.

Conclusions

SGLT-2 inhibition selectively reduces EAT thickness and EAT glucose uptake in T2D patients, suggesting a reduction of EAT inflammation. This could explain the observed increase in myocardial flow reserve, providing new insights into SGLT-2i cardiovascular benefits.
From waste to health-supporting molecules: biosynthesis of natural products from lignin-, plastic- and seaweed-based monomers using metabolically engineered Streptomyces lividans
Authors: Seo Kyoyoung , Shu Wei , Rückert-Reed Christian , Gerlinger Patrick , Erb Tobias J. , Kalinowski Jörn , Wittmann Christoph
Published: December 2023

Background

Transforming waste and nonfood materials into bulk biofuels and chemicals represents a major stride in creating a sustainable bioindustry to optimize the use of resources while reducing environmental footprint. However, despite these advancements, the production of high-value natural products often continues to depend on the use of first-generation substrates, underscoring the intricate processes and specific requirements of their biosyntheses. This is also true for Streptomyces lividans, a renowned host organism celebrated for its capacity to produce a wide array of natural products, which is attributed to its genetic versatility and potent secondary metabolic activity. Given this context, it becomes imperative to assess and optimize this microorganism for the synthesis of natural products specifically from waste and nonfood substrates.

Results

We metabolically engineered S. lividans to heterologously produce the ribosomally synthesized and posttranslationally modified peptide bottromycin, as well as the polyketide pamamycin. The modified strains successfully produced these compounds using waste and nonfood model substrates such as protocatechuate (derived from lignin), 4-hydroxybenzoate (sourced from plastic waste), and mannitol (from seaweed). Comprehensive transcriptomic and metabolomic analyses offered insights into how these substrates influenced the cellular metabolism of S. lividans. In terms of production efficiency, S. lividans showed remarkable tolerance, especially in a fed-batch process using a mineral medium containing the toxic aromatic 4-hydroxybenzoate, which led to enhanced and highly selective bottromycin production. Additionally, the strain generated a unique spectrum of pamamycins when cultured in mannitol-rich seaweed extract with no additional nutrients.

Conclusion

Our study showcases the successful production of high-value natural products based on the use of varied waste and nonfood raw materials, circumventing the reliance on costly, food-competing resources. S. lividans exhibited remarkable adaptability and resilience when grown on these diverse substrates. When cultured on aromatic compounds, it displayed a distinct array of intracellular CoA esters, presenting promising avenues for polyketide production. Future research could be focused on enhancing S. lividans substrate utilization pathways to process the intricate mixtures commonly found in waste and nonfood sources more efficiently.
Population ageing and sustainability of healthcare financing in China
Authors: Wu Wenqing , Long Shujie , Cerda Arcadio A. , Garcia Leidy Y. , Jakovljevic Mihajlo
Published: December 2023

Background

In China, the healthcare financing structure involves multiple parties, including the government, society and individuals. Medicare Fund is an important way for the Government and society to reduce the burden of individual medical costs. However, with the aging of the population, the demand of Medicare Fund is increasing. Therefore, it is necessary to explore the sustainability of the healthcare financing structure in the context of population ageing.

Objective

The purpose of this paper is to organize the characteristics of population ageing as well as healthcare financing in China. On this basis, it analyzes the impact mechanism of population ageing on healthcare financing and the sustainability of existing healthcare financing.

Methods

This paper mainly adopts the method of literature research and inductive summarization. Extracting data from Health Statistics Yearbook of China and Labor and Social Security Statistics Yearbook of China. Collected about 60 pieces of relevant literature at home and abroad.

Results

China has already entered a deeply ageing society. Unlike developed countries in the world, China's population ageing has distinctive feature of ageing before being rich. A healthcare financing scheme established by China, composing of the government, society, and individuals, is reasonable. However, under the pressure of population ageing, China's current healthcare financing scheme will face enormous challenges. Scholars are generally pessimistic about the sustainability of China's healthcare financing scheme.

Conclusions

Population ageing will increase the expenditure and reduce the income of the Medicare Fund. This will further affect the sustainability of the healthcare financing structure. As a consequence, the state should pay particular attention to this issue and take action to ensure that the Fund continues to operate steadily.
Role of ultrasound and inflammatory factors in the management of pediatric hip joint effusion
Authors: Alamdaran Seyed Ali , Taheri-nezhad Mohadeseh , Nouri Ahmad , Khoroushi Farzaneh , Aalami Mohammad Hasan , Malek Abdoreza , Mohtasham Arezou , Alizadeh Mohamadreza
Published: December 2023

Background

Septic arthritis is an important differential diagnosis of hip joint pain. Joint aspiration analysis is a necessary diagnostic measure for septic arthritis. In order to reduce the need for joint aspiration, we compared the combination of ultrasound findings and laboratory findings to separate septic arthritis from reactive arthritis.

Methods

Children aged < 14 years who were referred to Akbar pediatric hospital in 2020–2022 with hip pain or limping were included in this longitudinal study. Participants underwent ultrasound examinations of the hip and blood samples were obtained from them. After confirming an effusion, dependent on patient status and clinical diagnosis, one of the following approaches was recommended; the close follow-up, or the ultrasound-guided aspiration of the hip joint effusion, and or arthrotomy. The various ultrasound and laboratory were documented. Data were analyzed and P < 0.001 being considered statistically significant.

Results

Overall, 115 patients with a mean age of 3.43 ± 5.76 years, 46 of whom were girls, were studied. The final diagnosis in 23 cases (20.0%) was septic arthritis and 92 (80.0%) had reactive arthritis. C-reactive protein (CRP) and The erythrocyte sedimentation rate (ESR) unlike aspirate volume, effusion volume measured on ultrasound, capsule thickness, total thickness, and recorded capsule-to-effusion ratio were significantly higher in patients with septic arthritis (P < 0.001). There was a significant agreement between the volume of measured fluid in the anterior recess and the volume of aspirated fluid (2.5 times, P < 0.001). Septic arthritis was not observed in any of the patients with effusion volume in anterior recess less than 0.5 cc and ESR less than 40 mm/hr or CRP less than 15 mg/L.

Conclusion

Since septic arthritis was not observed in any of the patients with effusion volume < 0.5 cc and normal inflammatory factors (ESR or CRP), conservative management and close follow-up can be recommended in these patients instead of joint fluid aspiration.