bluuebunny/crossref_metadata_2025 huggingface dataset:
Developmental Behavioral Pediatrician Perspectives on Decision-Making in Early Treatment Planning for Children with Autism Spectrum Disorder
Authors: Mulé Christina M. , Sliwinski Samantha K. , Israel Rebecca , Lavelle Tara A.
Published: October 2021

Objective:

Providers of children with autism spectrum disorder (hereafter “autism”) report higher levels of shared decision-making during initial diagnostic and treatment planning visits than observed. The goal of this study was to qualitatively explore this discrepancy by investigating provider perceptions of the parent-provider decision-making process in early treatment planning and the role for parents in this process.

Methods:

We conducted semistructured qualitative interviews with developmental behavioral pediatricians (DBPs; n = 15) to investigate how they approach early treatment planning with parents. We analyzed participant characteristics using descriptive statistics. Interviews were audio-recorded, transcribed, and independently coded by 2 researchers until consensus was reached. Analyses were conducted using a modified grounded theory framework.

Results:

DBPs reported that their primary role during early treatment planning was to provide diagnostic clarification and that parents' primary role was to learn as much as they can about autism. Most DBPs wanted treatment planning to be collaborative, and perceived that parents had the same preference but might not have the knowledge or skills to effectively participate. DBPs identified additional barriers that influence the extent to which they engage parents in the collaborative decision-making and provided recommendations for enhancing the process.

Conclusion:

DBPs are proponents of collaborative treatment planning between parents and providers; however, there are many obstacles that prevent this. Strategies such as decision tools or aids and larger systemic reforms are necessary to support DBPs and parents in this process.
The Quality of Interactive Behaviors in the Context of Prematurity: Fathers, Mothers, Daughters, and Sons
Authors: Toscano Carolina , Soares Isabel , Baptista Joana , Moutinho Vanessa , Mesman Judi
Published: October 2021

Objective:

This study examined the quality of interaction between preterm-born preschoolers and their mothers and fathers, focusing on the role of child and parental sex.

Methods:

Participants included 88 preterm-born children (<37 wk gestational age) and 44 full-term–born children (≥37 wk gestational age) aged 3 1/2 years and their parents. Mother-child and father-child dyads were observed during a structured interactive task. Children's cooperation-compliance and negativity-hostility behaviors were coded using the Coding System for Mother-Child Interactions, and parents' sensitive behavior was coded using the Ainsworth Sensitivity Scale.

Results:

There was no association between preterm birth and the quality of child and parents' interactive behaviors. In the full-term group, fathers exhibited lower levels of sensitive behavior than mothers, but in the preterm group, both parents exhibited similar levels of sensitive behavior. Preterm boys exhibited more interactive difficulties than preterm girls, but there was no significant effect of child sex on full-term children's interactive behaviors. Children exhibited more compliance-cooperation and less negativity-hostility toward fathers than toward mothers.

Conclusion:

The findings suggest that prematurity in itself does not affect the quality of parent-preterm child interactive behaviors as the children enter the preschool period. Preterm boys seem to be at higher risk for interactive difficulties than girls, and thus, child sex should be considered when monitoring and examining the development of preterm children.
Important scoring systems for assessing the severity of COVID-19 based on COVID-19-related deaths in Wuhan, China
Authors: Yang Feihong , Zou Hao , Gan Jiaohong , Zhang Zhongxiang , Zhao Yan , Jiang Cheng , Xia Jian
Published: October 2021

Background:

This study aimed to investigate the clinical characteristics of 21 deaths and evaluate potential factors affecting disease severity and mortality risk in patients with coronavirus disease (COVID-19).

Methods:

This retrospective analysis assessed clinical data of 21 patients who died owing to COVID-19. Disease severity and mortality risk were assessed using Acute Physiology and Chronic Health Evaluation II (APACHE II); Sepsis-related Organ Failure Assessment (SOFA); multilobular infiltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hypertension and age (MuLBSTA); and pneumonia severity index (PSI) scores.

Results:

The mean age of the patients was 66 ± 14 years and 15 (71.4%) patients were men. Sixteen (76.2%) patients had chronic medical illnesses. Twelve (57.1%) patients were overweight. Decreased lymphocyte proportions were observed in 17 (81.0%) patients on admission. Elevated D-dimer levels were observed in 11 (52.4%) patients, and the levels significantly increased when pneumonia deteriorated. The initial APACHE II and SOFA scores demonstrated that 18 (85.7%) and 13 (61.9%) patients, respectively, were in the middle-risk level. MuLBSTA and PSI scores after admission were associated with higher risks of mortality in 13 (61.9%) patients. Most patients developed organ failure and subsequently died.

Conclusions:

Older, overweight, male patients with a history of chronic illnesses and continuously decreased lymphocyte proportions and increased D-dimer levels might have higher risks of death owing to COVID-19. The combination of general scoring (SOFA) and pneumonia-specific scoring (MuLBSTA and PSI) systems after admission might be sensitive in assessing the mortality risk of patients with COVID-19 who are in critical condition.
Bioinformatics analysis of SARS-CoV-2 infection-associated immune injury and therapeutic prediction for COVID-19
Authors: Zhang Haomin , Chen Haoran , Zhang Jundong , Chen Ximeng , Guo Bin , Zhi Peng , Li Zhuoyang , Liu Geliang , Yang Bo , Chi Xiaohua , Wang Yixing , Cao Feng , Ren Jun , Lu Xuechun
Published: October 2021

Background:

Severe acute respiratory syndrome coronavirus 2 is a highly contagious viral infection, without any available targeted therapies. The high mortality rate of COVID-19 is speculated to be related to immune damage.

Methods:

In this study, clinical bioinformatics analysis was conducted on transcriptome data of coronavirus infection.

Results:

Bioinformatics analysis revealed that the complex immune injury induced by coronavirus infection provoked dysfunction of numerous immune-related molecules and signaling pathways, including immune cells and toll-like receptor cascades. Production of numerous cytokines through the Th17 signaling pathway led to elevation in plasma levels of cytokines (including IL6, NF-κB, and TNF-α) followed by concurrent inflammatory storm, which mediates the autoimmune response. Several novel medications seemed to display therapeutic effects on immune damage associated with coronavirus infection.

Conclusions:

This study provided insights for further large-scale studies on the target therapy on reconciliation of immunological damage associated with COVID-19.
The effect of prone position for ventilator-associated pneumonia in adult patients: a systematic review and meta-analysis
Authors: Zhu Xingxing , Lu Zongqing , Xiao Wenyan , Zhang Jin , Jia Di , Yang Min
Published: October 2021

Background:

The effect and safety of prone position (PP) in ventilator-associated pneumonia (VAP) patients was uncertain. We systematically reviewed the literature published to investigate whether PP benefits for patients with VAP compared with conventional supine position (SP).

Methods:

PubMed, EMbase, Cochrane Library, CNKI and WanFang Database were electronically searched to collect randomized controlled trials (RCTs) about the PP ventilation and SP ventilation in intensive care unit (ICU) patients from inception to May 2020. Meta-analysis was performed by Revan 5.3 software.

Results:

A total of 7 RCTs involving 1604 patients were included. Compared to regular SP ventilation, the PP ventilation group had no statistical significance in the four aspects. The results of subgroup analysis showed that the incidence of VAP and all-cause mortality were not affected by the patient's initial oxygenation index. However, the incidence of VAP tended to decrease when the duration of PP ventilation was less than 16 hours per day. Meanwhile, the all-cause mortality was significantly decreased while the daily time was more than 16 hours.

Conclusions:

Current evidence showed that the PP ventilation could not decrease the incidence of VAP, all-cause mortality, length of mechanical ventilation, and ICU stay. However, the daily duration of PP ventilation may have an impact on the incidence of VAP and all-cause mortality in critical patients.
Expert Consensus by Qilu Hospital of Shandong University on the diagnosis, management, and treatment of suspected COVID-19 cases (English version)
Authors: Chen Yuguo
Published: October 2021

We devised a protocol to establish a standardized method of screening, diagnosing, and managing suspected cases of coronavirus disease (COVID-19) and to enhance the management of COVID-19 suspected cases. The protocol that included diagnostic criteria, preventive measures, and control measures against COVID-19 was developed based on new evidence regarding the epidemiological and clinical characteristics of COVID-19. A consensus document was subsequently formulated. The consensus focused on the clinical management of patients with suspected fever and reviewed the procedure for undergoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid testing. This consensus will contribute to the ongoing efforts worldwide for the prevention and control of COVID-19.
Critical Time Windows for Air Pollution Exposure and Birth Weight in a Multicity Canadian Pregnancy Cohort
Authors: Johnson Markey , Shin Hwashin Hyun , Roberts Eric , Sun Liu , Fisher Mandy , Hystad Perry , Van Donkelaar Aaron , Martin Randall V. , Fraser William D. , Lavigne Eric , Clark Nina , Beaulac Vanessa , Arbuckle Tye E.
Published: October 2021

Background:

Maternal prenatal exposure to air pollution has been associated with adverse birth outcomes. However, previous studies focused on a priori time intervals such as trimesters reported inconsistent associations.

Objectives:

We investigated time-varying vulnerability of birth weight to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) using flexible time intervals.

Methods:

We analyzed 1,300 live, full-term births from Maternal–Infant Research on Environmental Chemicals, a Canadian prospective pregnancy cohort spanning 10 cities (2008–2011). Daily PM2.5 and NO2 concentrations were estimated from ground-level monitoring, satellite models, and land-use regression, and assigned to participants from pre-pregnancy through delivery. We developed a flexible two-stage modeling method—using a Bayesian Metropolis–Hastings algorithm and empirical density threshold—to identify time-dependent vulnerability to air pollution without specifying exposure periods a priori. This approach identified critical windows with varying lengths (2–363 days) and critical windows that fell within, or straddled, predetermined time periods (i.e., trimesters). We adjusted the models for detailed infant and maternal covariates.

Results:

Critical windows associated with reduced birth weight were identified during mid- to late-pregnancy for both PM2.5 and NO2: –6 g (95% credible interval: –11, –1 g) and –5 g (–10, –0.1 g) per µg/m3 PM2.5 during gestational days 91–139 and 249–272, respectively; and –3 g (–5, –1 g) per ppb NO2 during days 55–145.

Discussion:

We used a novel, flexible selection method to identify critical windows when maternal exposures to air pollution were associated with decrements in birth weight. Our results suggest that air pollution impacts on fetal development may not be adequately captured by trimester-based analyses.
Effect of Modified Septal Extension Grafts on the Nasal Tip in Rhinoplasty
Authors: El Badawy Yasser , El Saloussy Yasmeen
Published: October 2021

Background:

One of the faced difficulties of nasal tip surgery is progressive loss of nasal tip projection and rotation postoperatively. Nasal base stabilization by septal extension grafts has shown to improve this loss over time. The aim of this study was to demonstrate that a modified septal extension graft can provide the required tip rotation/derotation by changing the angle of the graft’s insertion. In addition, it maintains nasal tip projection without creating a rigid tip. Other than that it avoids the requirement of a large amount of cartilage.

Materials/Methods:

This study involves a retrospective review of 37 patients who underwent open rhinoplasty for primary or secondary cases over a period of 12 months. The average age of the patients was 28 years (range = 20–43 years), and all patients were of Middle Eastern origin. Subjective evaluation based on photographic analysis was used pre and postoperatively.

Results:

All cases included in this study maintained their operative results of tip rotation. Two cases showed a minimal decrease in tip projection documented upon review 6–12 months postoperatively. No patient needed secondary revision surgery due to changes in tip projection or rotation. The objective pre and postoperative findings were satisfying for the patients and surgeons.

Conclusions:

The modified septal extension graft is an effective tool for rotation of the nasal tip as well as derotation of an over rotated tip. It is also capable of maintaining nasal tip projection.
Eliminating Hormones With Orally Active Gonadotropin-releasing Hormone Antagonists
Authors: Kotlyar Alexander M. , Pal Lubna , Taylor Hugh S.
Published: October 2021

Gonadotropin-releasing hormone (GnRH) analogues have been used in clinical practice for nearly 3 decades. Beginning with GnRH agonists, these agents have been used to treat hormone-dependent disease and to suppress gonadotropin production in assisted reproductive technologies. With the development of GnRH antagonists and especially small-molecule antagonists, our ability to achieve gonadotropin and sex steroid suppression has become increasingly effective and convenient. In this review, we will briefly describe the development of GnRH analogues, review the evolution of orally active small-molecule GnRH antagonists and provide an overview of the expanding role of small-molecule GnRH antagonists in clinical practice.
Effect of Cardiac Rehabilitation on Glomerular Filtration Rate Using Serum Cystatin C Concentration in Patients With Cardiovascular Disease and Renal Dysfunction
Authors: Hama Tomoaki , Ushijima Akiko , Goto Tadahiro , Nagamatsu Hirofumi , Morita Norishige , Yoshimachi Fuminobu , Ikari Yuji , Kobayashi Yoshinori
Published: October 2021

Purpose:

Among patients with chronic kidney disease (CKD), little is known about whether the effect of cardiac rehabilitation (CR) on renal function differs across baseline estimated glomerular filtration rate using the serum concentration of cystatin C (eGFRcys). The aim of this study was to evaluate the effect of CR on renal function in patients with CKD.

Methods:

We performed a retrospective cohort study of patients with CKD (15 ≤ eGFRcys < 60 mL/min/1.73 m2) who participated in our CR program for cardiovascular disease. First, the patients were divided into three groups according to the baseline severity of the eGFRcys: G3a, G3b, and G4 groups. We compared the eGFRcys before and after the CR in each group. Second, to determine the association of baseline eGFRcys with the effect of CR, we fitted a linear regression model using the percent change in the eGFRcys (%ΔeGFRcys) as an outcome.

Results:

Of the 203 patients, 122 were in G3a, 60 were in G3b, and 21 were in G4 groups. The mean improvement of eGFRcys in each group was 1.3, 3.1, and 4.8 mL/min/1.73 m2, respectively. The %ΔeGFRcys was larger among patients with lower baseline eGFRcys (0.47% greater improvement of %ΔeGFRcys/one lower baseline eGFRcys; 95% CI, 0.23-0.72%). This association remained significant after adjustment for potential confounders (0.63% greater improvement of %ΔeGFRcys/one lower baseline eGFRcys; 95% CI, 0.35-0.91%).

Conclusions:

The effect of CR on renal function was greater in patients with worse renal dysfunction measured by eGFRcys. A CR program could be useful for patients with severe renal dysfunction and it might have a beneficial effect on their renal function.
STARDUST SIGN AND RETINAL TEAR DETECTION ON SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY
Authors: Itakura Hirotaka , Itakura Mariko , Sato Taku
Published: October 2021

Purpose:

The causes of floaters include posterior vitreous detachment and fundus hemorrhage, both of which are risk factors for retinal tears. We observed the vitreous of patients with floaters using swept source optical coherence tomography.

Methods:

Fundus examination was performed, and the vitreous was observed using swept source optical coherence tomography in 202 eyes of 202 patients with floaters. Patients with uveitis, diabetic retinopathy, and other fundus diseases were excluded.

Results:

Swept source optical coherence tomography revealed posterior vitreous detachment in 145 of 202 eyes (71.8%) and dot reflex like stardust in the vitreous in 42 of 202 eyes (20.8%). Posterior vitreous detachment occurred in 35 of 42 eyes (83.3%) and 110 of 160 eyes (68.8%) in the stardust (+) and stardust (−) groups, respectively; a significant difference was observed (P <0.001). In the stardust (+) group, 11 of 42 eyes (26.2%) had retinal tears with posterior vitreous detachment and 21 of 42 eyes (50.0%) had fundus hemorrhage. Three of 160 eyes (1.9%) and 4 of 160 eyes (2.5%) in the stardust (−) group had retinal tears with posterior vitreous detachment and fundus hemorrhage, respectively. Both tears and fundus hemorrhage were more frequent in the stardust (+) group than in the stardust (−) group (P <0.001).

Conclusion:

The stardust sign on swept source optical coherence tomography indicates the risk of retinal tear.
Topical Medication Adherence and Visual Field Progression in Open-angle Glaucoma: Analysis of a Large US Health Care System
Authors: Shu Yu-Hsiang , Wu Jun , Luong Tiffany , Mattox Cynthia , Fang Ervin N. , Lee Brian L. , Jones Jason P. , Campbell Joanna , Shih Vanessa , Zhao Changgeng , Fong Donald S.
Published: October 2021

Précis:

Modeling of visual field and pharmacy data (Kaiser Permanente, 2001 to 2014) from open-angle/pseudoexfoliation glaucoma patients in clinical practice indicated a significant inverse association between the level of medication adherence and rate of visual field progression.

Purpose:

The aim was to quantify the effect of nonadherence to topical hypotensive medication on glaucomatous visual field progression in clinical practice.

Methods:

Retrospective analysis of combined visual field and pharmacy data from Kaiser Permanente Southern California’s HealthConnect electronic health record database. Patients with a diagnosis of primary open-angle glaucoma or pseudoexfoliation glaucoma (2001 to 2011) and ≥3 subsequent visual field tests of the same Swedish Interactive Threshold Algorithm type were followed up from first medication fill to final visual field test. Medication adherence (proportion of days covered) was estimated from pharmacy refill data. A conditional growth model was used to estimate the effect of adherence level in modifying the progression of mean deviation over time after adjusting for potential confounders, including age, sex, race/ethnicity, baseline glaucoma severity, and comorbidity.

Results:

In total, 6343 eligible patients were included in the study and followed for (mean) 5.8 years; average treatment adherence during follow-up was 73%. After controlling for confounders and the interaction between time and baseline disease severity, the model indicated that mean deviation progression was significantly (P=0.006) reduced by 0.006 dB per year for each 10% (absolute) increase in adherence. Model estimates of time to glaucoma progression (mean deviation change −3 dB from baseline) were 8.3 and 9.3 years for patients with adherence levels of 20% and 80%, respectively.

Conclusions:

Improving patient adherence to topical glaucoma medication may result in slower deterioration in visual function over time.
Resting-state occipital alpha power is associated with treatment outcome in patients with chronic migraine
Authors: Pan Li-Ling Hope , Chen Wei-Ta , Wang Yen-Feng , Chen Shih-Pin , Lai Kuan-Lin , Liu Hung-Yu , Hsiao Fu-Jung , Wang Shuu-Jiun
Published: October 2021

Preventive treatment is crucial for patients with chronic migraine (CM). This study explored the association between resting-state cortical oscillations and 3-month treatment outcome in patients with CM. Treatment-naïve patients with CM were recruited with their demographic data, psychosocial data, and headache profiles as well as the healthy controls (HCs). Resting-state cortical activities were recorded using an electroencephalogram and analysed using source-based and electrode-based spectral power method. The regions of interest were the bilateral primary somatosensory (S1) and visual (V1) cortices. After 3-month treatment with flunarizine, patients with CM were categorized into responders and nonresponders. Demographic, clinical, and electroencephalogram data from 72 patients with CM and 50 HCs were analysed. Elevated anxiety, depression, and stress were observed in patients with CM. Theta power in bilateral S1 and alpha and gamma powers in the right S1 increased in patients with CM. Nonresponders (n = 34) exhibited larger alpha powers in bilateral V1 than those in responders (n = 38). Alpha powers also exhibited significant correlations with changes of monthly headache days. Notably, in responders and nonresponders, occipital alpha powers did not differ at baseline and in the third month. In conclusion, patients with CM who were not responsive to preventive treatment were associated with augmented resting-state occipital alpha activity. Moreover, changes in migraine attack frequency were associated with baseline occipital alpha power. However, the prognostic feature of visual alpha oscillation seems to be inherent because it is not altered by flunarizine treatment. These findings may be useful for developing personalised migraine treatment plans.
The Value of the Patient-Centered Medical Home in Getting Adults Suffering From Acute Conditions Back to Work
Authors: Taylor-Clark Tanekkia M. , Swiger Pauline A. , Hearld Larry R. , Loan Lori A. , Li Peng , Patrician Patricia A.
Published: October 2021

Acute conditions are the leading cause of work restrictions and missed workdays, contributing to over $27 billion in lost productivity each year and negatively impacting workers' health and quality of life. Primary care services, specifically patient-centered medical homes (PCMHs), play an essential role in supporting timely acute illness or injury recovery for working adults. The purpose of this review is to synthesize the evidence on the relationship between PCMH implementation, care processes, and outcomes. In addition, we discuss the empirical connection between this evidence and return-to-work outcomes, as well as the need for further research.
Antipsychotic-Related Fatal Poisoning, England and Wales, 1993–2019
Authors: Handley Simon Alfred , Every-Palmer Susanna , Flanagan Robert James
Published: October 2021

Background

Deaths from antipsychotic (AP) poisoning have increased in England and Wales despite restriction of the use of thioridazine in 2000.

Methods

We analyzed data from the Office for National Statistics drug-related death database, England and Wales, 1993–2019, to investigate fatal AP poisoning.

Results

There were 2286 deaths (62% male patients). Annual numbers of intentional AP-related fatal poisonings (suicides) were relatively stable (1993, 35; 2019, 44; median, 44; range, 30–60). Intentional overdose deaths involving clozapine (96 male, 25 female) increased from 1 in 1994 to 5 in 2003 and have since remained relatively constant (median, 6; range, 3–10 per annum). Unintentional second-generation AP-related fatal poisonings have increased steadily since 1998, featuring in 828 (74%) of all unintentional, AP-related fatal poisonings in the period studied (2019, 89%). There were 181 unintentional clozapine-related deaths, (107 [59%] alone without other drugs ± alcohol) as compared with 291 quetiapine-related deaths (86 [30%] alone without other drugs ± alcohol) and 314 unintentional olanzapine-related deaths (77 [25%] alone without other drugs ± alcohol). Some 75% of all unintentional clozapine- and olanzapine-related deaths were of male patients (78% and 73%, respectively) as compared with 58% of unintentional quetiapine-related fatal poisonings. Clozapine now features prominently in intentional and in unintentional AP-related fatal poisoning in England and Wales. Deaths of male patients predominate in both categories. There were also 77 and 86 deaths attributed to unintentional poisoning with olanzapine and with quetiapine, respectively, in the absence of other drugs.

Conclusions

More effort is needed to prevent unintentional deaths not only from clozapine but also from olanzapine and quetiapine.
Guidelines for the Diagnosis and Treatment of Rosacea in China (2021 Edition)#
Authors: Gu Heng , Hao Fei , He Wei , Jian Dan , Jian Zhe , Jiang Xian , Ju Qiang , Kang Xiao-Jing , Lai Wei , Li Heng-Jin , Li Ji , Li Tie-Nan , Lin Xin-Yu , Liu Wei , Tao Xiao-Hua , Wang Ben , Xie Hong-Fu , Xu Hong-Hui , Xu Yang , Yan Shu-Xian , Yang Jie , Yu Bo
Published: October 2021

Rosacea is a chronic inflammatory skin disease that primarily affects the centrofacial areas and mainly manifests as recurrent flushing and erythema. In recent years, there has been progress in the understanding of the diagnosis and treatment of rosacea. Therefore, a group of dermatological experts updated the guidelines based on the 2016 expert consensus statement on rosacea diagnosis and treatment in China. These new guidelines propose diagnostic criteria for rosacea at different sites to further standardize the diagnosis and treatment of rosacea in China.
The Forensic Nurse's Evolving Role in Addressing Elder Maltreatment in the United States
Authors: Carney Amy
Published: October 2021

U.S. forensic nurses' specialization in elder maltreatment has evolved over the last 30 years. Significant progress in research has led to the ability to define and respond to elder abuse. This article describes the foundation for a specialization in nursing that led to inter vention in abuse and neglect, historical milestones as steps to elder justice, and the evolution of forensic nurse practice with senior victims of abuse.
Effects of Professional Autonomy and Leadership Style on the Team-Based Practice of Acute Care Nurse Practitioners in Taiwan
Authors: HSU Hsiu-Ying , TUNG Heng-Hsin , KAU Kevin , HUANG Sheng-Shiung , TSAY Shiow-Luan
Published: October 2021

Background

Little is known regarding the factors that affect the team-based practice of nurse practitioners (NPs). Examining the relationships between these factors and team-based practice may provide important insights into the strength of the NP practice.

Purpose

This study was designed to examine the effects of practice autonomy and leadership style on the team-based practice of acute care NPs working in hospitals.

Methods

A cross-sectional, national survey design was conducted to examine the autonomy, leadership, and team-based practice of NPs. One thousand three hundred ninety-one NPs completed the questionnaire, which included demographic and practice variables, the Dempster Practice Behavior Scale, the Multifactor Leadership Questionnaire, and the NP–physician relations subscale of the Nurse Practitioner Primary Care Organizational Climate Questionnaire. The hierarchical linear model was used to differentiate between the NP-level and organization-level effects on team-based practice. Multiple regression was applied to explore the factors associated with team-based practice.

Results

The hierarchical linear model results identified no organization-level effect on team-based practice. Moreover, the results of the regression model found that NPs with greater autonomy in actualization, empowerment and readiness, and idealized influence leadership style enhanced the performance of the doctor of medicine–NP team-based practice. The final model explained 39% of the variance in doctor of medicine–NP team-based practice. Autonomy in actualization and empowerment were identified as the two most important predictors.

Conclusions/Implications for Practice

The practice autonomy and leadership style of NPs influence the efficiency of team-based practice in Taiwan. To improve the team-based practice of NPs, healthcare administrators must support the practice autonomy of NPs.
New treatments for primary immune thrombocytopenia
Authors: Mingot-Castellano María Eva
Published: October 2021

Primary immune thrombocytopenia (ITP) is an autoimmune disease leading to a decreased platelet count and an ensuing haemorrhagic risk. First-line treatment against ITP consists in the administration of immunomodulators aimed at decreasing platelet destruction. Up to 70% of individuals with an ITP diagnosis treated with corticosteroids do not achieve a clinical response or demonstrate a high relapse rate, requiring treatment to prevent a haemorrhagic risk. Less than 30% of patients treated with thrombopoietin analogues, 60% of those treated with splenectomy and 20% of those treated with rituximab reach sustained remission in the absence of treatment. Because of these reasons, it is unquestionable that treatment of patients with ITP should be optimized. Through this study, we will review new actual and future options of treatment.
The role of genetics in the diagnosis and treatment of haemorrhagic diathesis: a historical perspective
Authors: Fernández María Fernanda López
Published: October 2021

The rapid development of genetic studies, not only in haemophilia but also in other congenital coagulopathies and platelet-related alterations, has been made possible by massive sequencing (e.g. next-generation sequencing or NGS), which allows a rapid and automatic analysis of the whole gene, simultaneous study of several genes and multiple individuals, detection of genetic variants and the possibility to create personalized panels [16]. The new technologies have also changed the way results are evaluated. Currently, our interest goes beyond the study of carriers, extending to the relationship between the mutation and the risk of developing an inhibitor and the latter's role in the classification of diseases [17]. There is also great interest in understanding the genotype/phenotype relationship, analytical discrepancies and variations in the response to treatment [18].
An Interrupted Time-series Evaluation of the Association Between State Laws Mandating Prescriber Use of Prescription Drug Monitoring Programs and Discontinuation of Chronic Opioid Therapy in US Veterans
Authors: Arnold Jonathan , Zhao Xinhua , Cashy John P. , Sileanu Florentina E. , Mor Maria K. , Moyo Patience , Thorpe Carolyn T. , Good Chester B. , Radomski Thomas R. , Fine Michael J. , Gellad Walid F.
Published: October 2021

Background:

Most states have recently passed laws requiring prescribers to use prescription drug monitoring programs (PDMPs) before prescribing opioid medications. The impact of these mandates on discontinuing chronic opioid therapy among Veterans managed in the Veterans Health Administration (VA) is unknown. We assess the association between the earliest of these laws and discontinuation of chronic opioid therapy in Veterans receiving VA health care.

Methods:

We conducted a comparative interrupted time-series study in the 5 states mandating PDMP use before August 2013 (Ohio, West Virginia, Kentucky, New Mexico, and Tennessee), adjusting for trends in the 17 neighboring control states without such mandates. We modeled 25 months of prescribing for each state centered on the month the mandate became effective. We included Veterans prescribed long-term outpatient opioid therapy (305 of the preceding 365 d). Our outcomes were discontinuation of chronic opioid therapy (primary outcome) and the average daily quantity of opioids per Veteran over the following 6 months (secondary outcome).

Results:

We included 250 monthly cohorts with 225,665 unique Veterans and 3.4 million Veteran-months. Baseline discontinuation rates before the PDMP mandates were 0.4%–2.7% per month. Kentucky saw a discontinuation increase of 1 absolute percentage point following its PDMP mandate which decreased over time. The other 4 states had no significant association between their mandates and change in opioid discontinuation. There was no evidence of decreasing opioid quantities following PDMP mandates.

Conclusion:

We did not find consistent evidence that state laws mandating provider PDMP use were associated with the discontinuation of chronic opioid therapy within the VA for the time period studied.
Impact of 18F-fluciclovine PET/CT on salvage radiotherapy plans for men with recurrence of prostate cancer postradical prostatectomy
Authors: Payne Heather , Bomanji Jamshed , Bottomley David , Scarsbrook Andrew F. , Teoh Eugene J. ,   on behalf of the FALCON study group
Published: October 2021

Objectives

Imaging options to localize biochemical recurrence (BCR) of prostate cancer after radical prostatectomy (RP) are limited, especially at low prostate-specific antigen (PSA) levels. The FALCON study evaluated the impact of 18F-fluciclovine PET/CT on management plans for patients with BCR. Here, we evaluate salvage radiotherapy decisions in patients post-RP.

Methods

We conducted a subgroup analysis of post-RP patients enrolled in FALCON who had a prescan plan for salvage radiotherapy (± androgen-deprivation therapy). Patients’ treatment plans post-18F-fluciclovine PET/CT were compared with their prescan plans. Fisher exact test was used to determine the impact of PSA and Gleason sum on positivity and anatomical patterns of uptake.

Results

Sixty-five (63%) FALCON patients had undergone RP. Of these, 62 (median PSA, 0.32 ng/mL) had a prescan plan for salvage radiotherapy. Twenty-one (34%) had 18F-fluciclovine-avid lesions. Disease was confined to the prostate bed in 11 patients (52%) and to the pelvis in a further 5 (24%), while 5 (24%) had extrapelvic findings. Trends towards more disseminated disease with increasing PSA or Gleason sum were observed but did not reach statistical significance. Postscan, 25 (40%) patients had a management change; 17 (68%) were changed to the treatment modality (8 to systemic therapy, 8 to active surveillance, 1 other) and 8 (32%) were radiotherapy field modifications.

Conclusions

Incorporating 18F-fluciclovine PET/CT into treatment planning may help identify patients suitable for salvage radiotherapy, help augment planned radiotherapy to better target lesions and support the clinician to optimise patient management.
Effectiveness of Immersive Virtual Reality in Nursing Education
Authors: Choi Jeeyae , Thompson C Elise , Choi Jeungok , Waddill Colette B. , Choi Soyoung
Published: October 2021

Background:

Digital education using immersive virtual reality (VR) technology is available in nursing. Evidence of its effectiveness is essential.

Purpose:

This review analyzed the effectiveness of and barriers to using immersive VR in nursing education.

Methods:

A structured search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsycINFO, Web of Science, and ProQuest Nursing & Allied Health Database. The Medical Education Research Study Quality Instrument was used to assess the quality of studies.

Results:

The final review was composed of 9 studies of moderate to high quality published between 2018 and 2020. The review indicated that immersive VR increased learning, cognitive, and psychomotor performance. Most participants of the studies preferred using immersive VR in education and with a variety of experiential scenarios. Barriers were associated with technological hardware and software (eg, simulation sickness, lack of visual comfort).

Conclusion:

The review supports the viability of immersive VR technology in nursing education.
Experiences of Home Care Nurses During the COVID-19 Pandemic
Authors: Ruíz-Fernández María Dolores , Fernández-Medina Isabel María , Gálvez Ramírez Felisa , Granero-Molina José , Fernández-Sola Cayetano , Hernández-Padilla José Manuel
Published: October 2021

Background

The COVID-19 pandemic has provoked several changes in home care. Understanding home care nurses’ experiences during the COVID-19 pandemic plays an essential role in home care management.

Objective

This study aimed to explore and articulate the experience of home care nurses during the COVID-19 pandemic in Spain.

Design

A qualitative study using hermeneutic phenomenology was carried out. Twenty home care nurses were interviewed by teleconference between January and March 2021. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative data analysis software.

Results

Three main themes with five subthemes emerged from the data analysis: (a) “The effect of COVID-19 pandemic on home care,” with the subtheme “the reorganization of home care nurses’ competencies”; (b) “The role of telehealth in home care,” which included the subthemes “home care nurses’ satisfaction with telehealth” and “barriers to implement telehealth in home care”; and (c) “Effects of the pandemic on home care nurses’ lives,” including the subthemes “working in a pandemic is emotionally draining” and “the continuing fear of infecting others.”

Discussion

The findings from this study demonstrate the profound effect that home care has experienced during the COVID-19 pandemic. Home care nurses’ competencies were modified to care for and diagnose COVID-19 patients. Face-to-face home care was replaced by telehealth. All home care nurses experienced physical and psychological symptoms and the fear of infecting others.
Leadership development for orthopaedic trauma surgeons in Latin America: opportunities for and barriers to skill acquisition
Authors: MacKechnie Madeline C. , MacKechnie Michael A. , Lieshout Esther M.M. van , Verhofstad Michael H.J. , Quintero Jose Eduardo , Padilla Rojas Luis G. , Tabares Neyra Horacio , Russo Bibiana Dello , Giordano Vincenzo , Vilensky Eduardo , Fuehrer Sheryl L. , Miclau Theodore
Published: October 2021

Introduction:

There is growing interest in leadership courses for physicians. Few opportunities are available in global regions with limited resources. This study describes orthopaedic trauma surgeons’ desired leadership skill acquisition, opportunities, and barriers to course participation in Latin America.

Methods:

Latin American orthopaedic trauma surgeons from the Asociación de Cirujanos Traumatólogos de las Americas (ACTUAR) network were surveyed. This survey solicited and gauged the surgeons’ level of interest in leadership topics and their relative importance utilizing a 5-point Likert-scale. Additionally, comparisons were calculated between middle-income countries (MICs) and high-income countries (HICs) to ascertain if needs were different between groups. The survey included demographic information, nationality, level of training, years in practice, leadership position, needs assessment, and perceived barriers for leadership educational opportunities.

Results:

One hundred forty-four orthopaedic surgeons completed the survey, representing 18 countries across Latin America; 15 MICs and 3 HICs. Participants had more than 20 years in practice (49%) and held leadership positions (81%) in hospital settings (62%), national orthopaedic societies (45%), and/or clinical settings (40%). Sixty-three percent had never attended a leadership course due to lack of opportunities/invitations (69%), difficulty missing work (24%), and costs (21%). Ninety-seven percent expressed interest in attending a leadership course. No difference in needs was determined between respondents from MICs and HICs. Professional Ethics, Crisis Management/Organizational Change Management, and High Performing Team-Building were identified as the most important leadership topics.

Conclusion:

Orthopaedic surgeons in Latin America demonstrate an interest in acquiring additional leadership skills but have few opportunities. Identifying interests, knowledge gaps, and core competencies can guide the development of such opportunities.
“Palliative Syringe Driver”? A Mixed-Methods Study in Different Hospital Departments on Continuous Infusions of Sedatives and/or Opioids in End-of-Life Care
Authors: Meesters Sophie , Grüne Bettina , Bausewein Claudia , Schildmann Eva
Published: October 2021

Objectives

Continuous infusions of sedatives and/or opioids (continuous infusions) are frequently used in end-of-life care. Available data indicate challenges in nonspecialist palliative care settings. We aimed to assess the use of continuous infusions during the last week of life in different hospital departments.

Methods

In a sequential mixed-methods design, a retrospective cohort study was followed by consecutive qualitative interviews in 5 German hospital departments. Medical records of 517 patients who died from January 2015 to December 2017 were used, and 25 interviews with physicians and nurses were conducted. Recorded sedatives were those recommended in guidelines for “palliative sedation”: benzodiazepines, levomepromazine, haloperidol (≥5 mg/d), and propofol. Exploratory statistical analysis (R 3.6.1.) and framework analysis of interviews (MAXQDA 2018.2) were performed.

Results

During the last week of life, 359 of 517 deceased patients (69%) received continuous infusions. Some interviewees reported that continuous infusions are a kind of standard procedure for “palliative” patients. According to our interviewees’ views, equating palliative care with continuous infusion therapy, insufficient experience regarding symptom control, and fewer care needs may contribute to this approach. In addition, interviewees reported that continuous infusions may be seen as an “overall-concept” for multiple symptoms. Medical record review demonstrated lack of a documented indication for 80 of 359 patients (22%). Some nurses experienced concerns or hesitations among physicians regarding the prescription of continuous infusions.

Conclusions

Continuous infusions seem to be common practice. Lack of documented indications and concerns regarding the handling and perception of a “standard procedure” in these highly individual care situations emphasize the need for further exploration and support to ensure high quality of care.
Eight-Year Trends in Direct-Acting Oral Anticoagulant Dosing, Based on Age and Kidney Function, in Patients With Atrial Fibrillation
Authors: Bezabhe Woldesellassie M. , Bereznicki Luke R. , Radford Jan , Wimmer Barbara C. , Salahudeen Mohammed S. , Peterson Gregory M.
Published: October 2021

Objective

Concerns have been raised over the appropriateness of dosing of direct-acting oral anticoagulants (DOACs) in clinical practice. We investigated this issue in patients who were initiated on a DOAC in Australian general practices.

Methods

This was a retrospective study among patients newly diagnosed with atrial fibrillation (AF) who were prescribed DOACs, using data obtained from 417 general practice sites across Australia over 8 years (2011–2019). Direct-acting oral anticoagulant dosing was compared with published recommendations, in relation to age and kidney function.

Results

A total of 11,251 patients (mean age, 72.8 y; 46.8% female) newly diagnosed with AF were prescribed a DOAC. Of these, 2667 patients (23.7%) had a recorded prescription of a potentially inappropriate DOAC dosage, of whom 2304 (86.4%) and 283 (10.6%) were prescribed lower and higher than the recommended dosage, respectively. The remaining 80 patients (3.0%) were initiated on DOACs when contraindicated based on renal function. Overall, the proportion of patients who seemed to be initiated on a potentially inappropriate DOAC dose decreased from 38.3% (95% confidence interval, 26.1%–51.8%) in 2012 to 22.7% (95% confidence interval, 19.8%–26.0%; P < 0.001) in 2019. By 2019, 19.4%, 20.3%, and 9.3% of the patients with a recorded prescription of apixaban, rivaroxaban, and dabigatran, respectively, received a lower-than-guideline-recommended dose. The patients were more likely to be prescribed a potentially inappropriate dosage if they were elderly with multiple comorbidities.

Conclusions

Potential inappropriate DOAC dosing is a problem in the prevention of stroke associated with AF. Nearly 1 in 5 patients received a lower-than-guideline-recommended dose, indicating a need for strategies to raise awareness among prescribers.
Root Cause Analysis Using the Prevention and Recovery Information System for Monitoring and Analysis Method in Healthcare Facilities: A Systematic Literature Review
Authors: Driesen Babiche E.J.M. , Baartmans Mees , Merten Hanneke , Otten René , Walker Camilla , Nanayakkara Prabath W.B. , Wagner Cordula
Published: October 2021

Objectives

Unintended events (UEs) are prevalent in healthcare facilities, and learning from them is key to improve patient safety. The Prevention and Recovery Information System for Monitoring and Analysis (PRISMA)-method is a root cause analysis method used in healthcare facilities. The aims of this systematic review are to map the use of the PRISMA-method in healthcare facilities worldwide, to assess the insights that the PRISMA-method offers, and to propose recommendations to increase its usability in healthcare facilities.

Methods

PubMed, EMBASE.com, CINAHL, and The Cochrane Library were systematically searched from inception to February 26, 2020. Studies were included if the PRISMA-method for analyzing UEs was applied in healthcare facilities. A quality appraisal was performed, and relevant data based on an appraisal checklist were extracted.

Results

The search provided 2773 references, of which 25 articles reporting 10,816 UEs met our inclusion criteria. The most frequently identified root causes were human-related, followed by organizational factors. Most studies took place in the Netherlands (n = 20), and the sample size ranged from 1 to 2028 UEs. The study setting and collected data used for PRISMA varied widely. The PRISMA-method performed by multiple persons resulted in more root causes per event.

Conclusions

To better understand UEs in healthcare facilities and formulate optimal countermeasures, our recommendations to further improve the PRISMA-method mainly focus on combining information from patient files and reports with interviews, including multiple PRISMA-trained researchers in an analysis, and modify the Eindhoven Classification Model if needed.