bluuebunny/crossref_metadata_2025 huggingface dataset:
The association between levels of serum homocysteine and chronic heart failure
Authors: Wang Xi , Wang Fu , Feng Zhiquan , Cai Jun , Liu Jianbin
Published: February 2021

Background:

Homocysteine (Hcy) is one of the main factors leading to arteriosclerosis, which is closely related to cardiovascular disease. Recent studies have found that serum Hcy levels are increased in patients with chronic heart failure (CHF), and it is speculated that Hcy may be a risk factor for CHF, but evidence-based medicine evidence is lacking. The aim of this study was to investigate the correlation between serum Hcy levels and CHF by means of systematic review.

Methods:

The databases of PubMed, Embase, The Cochrance Library, Web of Science, CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), Wanfang and China Biology Medicine disc were searched by computer. In addition, Baidu Scholar and Google Scholar were manually searched to collect all case–control studies related to serum Hcy and CHF. The search time limit was from database establishment to November 2020. Two reviewers independently screened the literatures, extracted the data and evaluated the risk of bias of the included literatures.

Results:

In this study, we evaluated the correlation between serum Hcy levels and CHF by the levels of serum Hcy in CHF patients and non-CHF patients.

Conclusions:

This study will provide reliable evidence for the clinical value of serum Hcy in the field of CHF disease.

OSF Registration number:

DOI 10.17605/OSF.IO/QMPRC.
Meta-analysis of P53 expression and sensitivity to platinum-based chemotherapy in patients with non-small cell lung cancer
Authors: Lin Sheng , Li Xiaoqin , Lin Ming , Yue WenXiang
Published: February 2021

Background:

The relationship between p53 expression and chemosensitivity of non-small cell lung cancer (NSCLC) is unclear. This study aims to explore the correlation between p53 expression and sensitivity to platinum-based chemotherapy in patients with NSCLC.

Methods:

Pubmed, Web of Science, EMBASE, CNKI, China Wanfang databases were searched for studies on the relationship between the p53 expression and the chemosensitivity to platinum drugs in patients with NSCLC. The last search time was May 2020. Stata 15.0 software was used for statistical analysis.

Results:

A total of 21 studies were included, covering 1387 patients in total. The results showed that the pooled OR = 1.55 (95%CI: 1.05∼2.29, P < .05), for Asian population, the pooled OR = 1.67 (95%CI: 0.95∼3.09, P > .05), for Caucasian population, the pooled OR = 1.34 (95%CI: 0.74∼2.43), there was no significant difference between Asian and Caucasian. The results of subgroup analysis of publication year showed that, the pooled OR = 2.07 (95%CI: 1.39∼3.07, P < .01), the heterogeneity among the studies decreased remarkably after 2005. The subgroup analysis of advanced patients showed that the pooled OR = 1.93 (95%CI: 1.27∼2.93), the difference was statistically significant.

Conclusion:

Patients with p53 negative expression is more sensitive to platinum-based chemotherapy than those with p53 positive expression in NSCLC, especially in advanced NSCLC.
Chinese herbal medicine for immune infertility
Authors: Jiang Cui , Wang Zhaodi , Yuan Shiqing , Jiang Yong , Ye Ying
Published: February 2021

Background:

Infertility is a reproductive disorder caused by multiple causes and is an adverse event of reproductive health for couples in the reproductive period. Women who do not avoid sex for at least 12 months and are not pregnant are said to be infertile. 10% to 20% of infertility is caused by immune factors. At present, there is no unified diagnostic standard for immunological infertility. Clinically, it is considered that abnormal ovulation and reproductive system function of women are excluded, and no obvious pathogenic factors occur; routine examination of male semen is normal, but there is evidence of anti-reproductive immunity, thus causing infertility is immunological infertility. Traditional Chinese medicine (TCM) has a long history of treating infertility and has remarkable curative effect. It plays an important role in the treatment of gynecological and obstetrical diseases in China. The purpose of this study is to evaluate the efficacy and safety of traditional Chinese medicine for the treatment of immune infertility.

Method:

we searched the literature from following databases: Cochrane Library, PubMed, China Biomedical Literature Database (CB), EMBASE, Chinese Journal of Science and Technology (VIP), China National Knowledge Infrastructure Database (CNKI) and Wanfang Database were searched. All the databases mentioned above will be searched from the start date to the latest version. A manual search of all references to the included trials, published randomized controlled trials (RCTs) whether blind or unblind, any languages and length of follow up were included. Treatments included Chinese medicinal herbs (single or compound). Controlls were placebo and western medicine, or no intervention. Key outcomes will include pregnancy rates, the efficiency of Chinese herbal medicine (at least one negative antibody for infertility), birth rates (the ratio of the number of pregnant women giving birth to their babies normally after herbal treatment to the total number of patients treated), recurrence rate and safety index. Two evaluators independently retrieved and extracted data and import it into Endnote X8. Then they conduct methodological evaluation on the quality of the included studies, and meta-analysis was conducted with RevMan 5.3 and Stata 13.0 software. We will use the Cochrane risk analysis tool to assess the risk of bias. Differences will be resolved by consensus or through the participation of third parties. All analysis will be performed based on the Cochrane Handbook for Systematic Reviews of Interventions.

Results:

The purpose of this study is to evaluate the efficacy and safety of traditional Chinese herb medicine in the treatment of immune infertility.

Conclusion:

This meta-analysis can provide evidence for clinicians to help patients make better choices.

Trial registration number:

INPLASY2020120073.
Sentinel lymph node biopsy in head and neck cutaneous melanomas
Authors: Zhang Yingyi , Liu Chuanqi , Wang Zihuai , Zhu Guonian , Zhang Yange , Xu Yuyang , Xu Xuewen
Published: February 2021

Background:

Head and neck melanomas (HNMs) behave differently from cutaneous melanomas in other sites, and the efficacy of sentinel lymph node biopsy (SLNB) for patients with HNMs remains controversial.

Methods:

Studies on prognosis following SLNB were included. The prognostic role of SLNB and other potential predictors were analyzed using pooled relative risk (RR) or hazard ratio (HR).

Results:

Pooled statistics showed that SLNB improved overall survival of HNMs patients (HR = 0.845; 95% CI: 0.725–0.986; P = .032). The positive status of SN was proved as a risk factor of poor prognosis in HNMs (HR = 3.416; 95% CI: 1.939–6.021; P < .001). SLNB did not have significant correlation with lower recurrences (RR = .794; 95% CI: 0.607–1.038; P = .091).

Conclusions:

SLNB is associated with better overall survival and the SN status is a promising risk factor of poor prognosis for HNMs patients.
Sunitinib-associated hyperammonemic encephalopathy successfully managed with higher intensity conventional hemodialysis
Authors: Haroon Sabrina , Ko Stephanie , Wong Alvin , Tan Poh-Seng , Lee Evan , Lau Titus
Published: February 2021

Rationale:

Hyperammonemia encephalopathy is a rare but severe complication that has been reported in association with the use of sunitinib, a tyrosine kinase inhibitor. We report here a unique case of a patient with end stage renal disease that was initiated on sunitinib for metastatic renal cell carcinoma.

Patient concerns:

A 65-year-old man with end stage renal disease on maintenance conventional hemodialysis and had concomitant stable Child-Pugh class B liver cirrhosis consequent of hepatitis C infection was started on sunitinib for metastatic renal cell carcinoma. He developed confusion few weeks after starting therapy with no other indication of worsening liver dysfunction otherwise.

Diagnosis:

He was later diagnosed with hyperammonemia encephalopathy.

Interventions:

His treatment was discontinued and reinitiated at a lower dose after recovery and titrated according to tolerance. As ammonia is a very low molecular weight molecule and is cleared well with diffusive clearance, we intensified his dialysis regimen by increasing intensity for each session and frequency per week.

Outcomes:

With this change in dialysis regimen, patient was able to continue treatment with sunitinib.

Lessons:

Clinicians prescribing sunitinib should be vigilant to monitor for this complication in patients receiving sunitinib, apart from the more usual presentation of hepatotoxicity. We found that a more intensive hemodialysis regimen consisting of 4× a week conventional high-flux hemodialysis (HD) can permit the continuation of treatment with sunitinib in an end stage renal disease (ESRD) patient with Child-Pugh class B liver cirrhosis.
Clinical features and risk factors for severe-critically ill COVID-19 adult patients in Jiangsu, China
Authors: Zhao Jiangnan , Zhu Meiying , Su Xin , Huang Mao , Yang Yi , Huang Jianan , Songshi Ni , Cao Quan , Gu Qin , Li Jun , Li Jiashu , Zhao Wenjing , Shi Bin , Shi Yi
Published: February 2021

Coronavirus disease 2019 (COVID-19) becomes a global pandemic in 2020. Early identification of severe ill patients is a top priority for clinicians. We aimed to describe clinical features and risk factors of severe-critically ill patients with COVID-19 in Jiangsu Province.

This multi-centered retrospective study collected the information of 631 laboratory-confirmed COVID-19 patients hospitalized at 28 authorized hospitals in Jiangsu province from January 23, 2019 to March 13, 2020.

A total of 583 adult patients with laboratory-confirmed COVID-19 were enrolled for final analysis, including 84 severe-critically ill patients and 499 mild-moderate patients. Median age of the severe-critically ill patients was 57.0 years old (interquartile range, 49.0–65.8), and 50 (59.5%) were males. Multisystemic laboratory abnormalities were observed on admission for severe-critically ill patients. These patients showed more noticeable radiologic abnormalities and more coexisting health issues as compared to the mild-moderate patients. Most of the severe-critically ill COVID-19 patients became deteriorated in 2 weeks after diagnosis. Age, D-dimer, and lymphocytes were independently associated with the progression of severe-critically illness.

Older age, higher D-dimer levels and less lymphocyte counts on admission are potential risk factors for COVID-19 patients to develop into severe and critically illness.
Acupuncture therapy for tennis elbow
Authors: Zhou Yumei , Chen Chen , Yang Yulin , Yu Haibo , Yang Zhuoxin
Published: February 2021

Background:

Acupuncture is widely used for analgesia in China and western countries. Lateral epicondylitis (LE) is a common disease, which influences the quality of life for many patients. The clinical practice indicates that acupuncture has a therapeutic effect on the LE; however, whether acupuncture is superior to sham acupuncture and some conventional therapy methods has been controversial. Hence, we will provide a protocol to explore the effectiveness and safety for acupuncture for LE.

Methods:

We will search only the randomized controlled trials (RCTs) literatures of acupuncture for LE from the following seven databases, including PubMed, Cochrane Central Register of Controlled Trials (The Cochrane Library), Excerpta Medica Database (EMBASE), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang Data, and Chinese Scientific Journals Database (VIP). The Visual Analogue Scale (VAS) will be considered as the primary outcome and the secondary outcome will include effective rate and function recovery. Adverse events incidence caused by acupuncture will also be discussed, such as dizziness, nausea, vomiting, and weariness. The searching strategy, inclusion and exclusion criteria were made according to the principle of evidence-based medicine. The quality was evaluated by Cochrane Handbook for Systematic Reviews of Interventions (V5.1). All analyses will be conducted by Review Manager Software (V5.3).

Result:

The results of this review will be submitted to a recognized journal for publication.

Conclusion:

This proposed meta-analysis will assess the efficacy and safety of acupuncture therapy for LE.
Surveillance of foodborne diseases in Taiwan
Authors: Yu Chia-Peng , Chou Yu-Ching , Wu Ding-Chung , Cheng Chun-Gu , Cheng Chun-An
Published: February 2021

Foodborne pathogens cause diseases and death, increasing the economic burden. It needs to identify incident places, media food and pathgens. Our aim is to survey empirical data that provide a retrospective historical perspective on foodborne diseases and explore the causes and trends of outbreaks.

We examined publicly available annual summary data on reported foodborne disease outbreaks in Taiwan from 2014 to 2018. We calculated the percentage of places, media food, bacteria and natural toxin sources in foodborne diseases and performed a chi-square test for difference evaluation. The higher risk of places and causes in 2018 compared with 2014 was empolyzed with univariate logistic regression.

There were 26847 patients with foodborne diseases during the period from 2014 to 2018. The top 2 primary source locations of the foodborne diseases were schools and restaurants. The top 2 primary food media classifications of the foodborne diseases were boxed meals and compounded foods. The top 2 primary incident bacterial classifications of the observed foodborne diseases were Bacillus cereus and Staphylococcus aureus. The top 2 primary natural toxin classifications of the foodborne diseases were plants and histamines. The incidence of foodborne disease in military facilities, fruits and vegetables, and Staphylococcus aureus was increased in our study.

Our study confirmed the high risk and increased incidence of foodborne diseases, food media classifications, bacterial classifications, and natural toxins in Taiwan. It is worthy of attention for the government health department-designed policy to promote disease prevention.
Efficacy and safety of an innovatively modified cutting seton technique for the treatment of high anal fistula
Authors: Jiang Jie , Zhang Yang , Ding Xufeng , Zhang Naijin , Ji Lijiang
Published: February 2021

Background:

Anal fistula is a common anorectal disease. So far, operation is still the optimal method to cure anal fistula. High anal fistula (HAF) is an even more clinically difficult disease to treat. Evidence suggested that seton placement can be a definitive treatment for HAF. However, tightening the seton brings great pain to patients, which affects the clinical application of the therapy. Also, this may lead to difficulty in controlling anal fluids and gas because of the larger scar left and the local defect in the anal after the operation. We propose an innovative seton technique for the treatment of HAF, after long term attempts, the operation of the modified seton cutting technique. The aim of our present study is to compare the difference of anal function, healing time, pain severity, recurrence, and complications between the procedure of the modified seton cutting technique and the conventional cutting seton operation against HAF with a randomized, controlled, prospective study.

Methods:

204 participants in this trial will be randomly divided into treatment group (procedure of the modified seton cutting technique) and control group (cutting seton technique) in a 1:1 ratio. The outcomes of continence state, pain severity after tightening, complete healing of fistula, duration to healing, operation time, recurrence rates, and postoperative complications will be recorded at 1, 2, 3, 4 weeks, then every month in the outpatient clinic. Data will be analyzed by SPSS version 22.

Conclusions:

The findings of the study will help to explore the efficacy and safety of the procedure of the modified seton cutting technique against AF.

Trial registration number:

DOI 10.17605/OSF.IO/V6G2S
Pulmonary lymphoepithelioma-like carcinoma
Authors: Zhou Lin , Liu Xin-Yi , He Ya , Li Lu-ting , Zhang Shao-Jin
Published: February 2021

Rationale:

Pulmonary lymphoepithelioma-like carcinoma (PLELC) is a rare type of primary malignant lung tumor characterized by Epstein-Barr virus infection, with, to the authors’ knowledge, a total of only 500 reported cases during the past 30 years worldwide. Histologically, PLELC is similar to undifferentiated nasopharyngeal carcinoma and poorly differentiated squamous cell carcinoma. However, although PLELC accounts for <1% of all lung cancers, it has a better prognosis and is usually detected in non-smokers and individuals of Asian ancestry.

Patient concerns:

The patient presented with chest distress of no apparent cause, dizziness, headaches, and a feeling of disequilibrium without remission, as well as a pulmonary nodule incidentally detected on contrast-enhanced computed tomography (CT).

Diagnosis:

PLELC was confirmed histopathologically rather than on preoperative CT; nevertheless, CT findings still contributed to the diagnosis.

Interventions:

The patient underwent thoracoscopic wedge resection of the affected lung.

Outcomes:

The patient recovered after the lung nodule was completely removed, and was discharged. No evidence of recurrence or metastasis was found at the latest follow-up appointment 2 months after the operation.

Lessons:

PLELC is a rare bronchogenic carcinoma associated with lymphatic tissue with a favorable prognosis in most cases. With nonspecific clinical symptoms, specific radiological findings may facilitate an early diagnosis in some cases, followed by timely surgical intervention.
Acquiring sepsis competencies through simulation-based learning bundle during intermediate care unit internship
Authors: Fernández-Ros Nerea , Alegre Félix , Huerta Ana , Gil-Alzugaray Belén , Landecho Manuel F. , García Nicolás , Quiroga Jorge , Lucena Juan Felipe
Published: February 2021

Intermediate care units (ImCUs) have been shown as appropriate units for the management of selected septic patients. Developing specific protocols for residents in training may be useful for their medical performance. The objective of this study was to analyze whether a simulation-based learning bundle is useful for residents while acquiring competencies in the management of sepsis during their internship in an ImCU.

A prospective study, set in a tertiary-care academic medical center was performed enrolling residents who performed their internship in an ImCU from 2014 to 2017. The pillars of the simulation-based learning bundle were sepsis scenario in the simulation center, instructional material, and sepsis lecture, and management of septic patients admitted in the ImCU. Each resident was evaluated in the beginning and at the end of their internship displaying a sepsis-case scenario in the simulation center. The authors developed a sepsis-checklist that residents must fulfill during their performance which included 5 areas: hemodynamics (0–10), oxygenation (0–5), antibiotic therapy (0–9), organic injury (0–5), and miscellaneous (0–4).

Thirty-four residents from different years of residency and specialties were evaluated. The total median score (interquartile range) increased significantly after training: 12 (25) vs 23 (16), P = .001. First-year residents scored significantly lower than older residents at baseline: 10 (14) vs 14.5 (19), P = .024. However, the performance at the end of the training period was similar in both groups: 21.5 (11) vs 23 (16), P = 1.000. Internal Medicine residents scored significantly higher than residents from other specialties: 18 (17) vs 10.5 (21), P = .007. Nonetheless, the performance at the end of the training period was similar in both groups: 24.5 (9) vs 22 (13), P = 1.000.

Combining medical simulation with didactic lectures and a rotation in an ImCU staffed by hospitalists seems to be useful in acquiring competencies to manage critically ill patients with sepsis. We designed a checklist to assure an objective evaluation of the performance of the residents and to identify those aspects that could be potentially improved.
Association of non-alcoholic fatty liver disease and all-cause mortality in hospitalized cardiovascular disease patients
Authors: Saokaew Surasak , Kanchanasurakit Sukrit , Thawichai Kanitta , Duangprom Prommanee , Wannasri Monnapha , Khankham Sirintip , Kositamongkol Chayanis , Chaiyakunapruk Nathorn , Phisalprapa Pochamana
Published: February 2021

Background:

Controversy remains concerning the association of the all-cause mortality risk of hospitalized cardiovascular disease (CVD) patients with non-alcoholic fatty liver disease (NAFLD). This study investigated the risks of all-cause mortality among hospitalized CVD patients with NAFLD.

Methods:

We used related keywords to search for studies in 3 electronic databases: PubMed, EMBASE, and Cochrane Library. All eligible studies published up to April 2020 were reviewed. The findings of those studies reporting the mortality outcomes of hospitalized CVD patients with and without NAFLD were examined, and the various study results were pooled and analyzed using a random-effects model. A quality assessment using the Newcastle–Ottawa scale was performed on the studies selected for inclusion in a meta-analysis.

Results:

A total of 2135 studies were found, of which 3 were included in this meta-analysis. All studies were considered good quality. The mean age of the patients in the analysis was 73 years, and about half of them were men. The comorbidities reported were hypertension, diabetes mellitus, and dyslipidemia. The results showed that hospitalized CVD patients with NAFLD were at a significantly higher risk of all-cause mortality than non-NAFLD patients (adjusted hazard ratio of 2.08 [95% confidence interval, 1.56–2.59], P < .001). The included studies showed low heterogeneity (I

2
 = 0.0%, P = .473), and Begg and Egger tests revealed no apparent publication bias (P = .327 and P = .682, respectively).

Conclusions:

Hospitalized CVD patients with NAFLD were at a higher risk of all-cause mortality than those without NAFLD. More studies that further explore this association are needed.
ETS1 polymorphism rs73013527 in relation to serum RANKL levels among patients with RA
Authors: Yang Bin , Luo Limei , Chen Lin , Niu Qian , Zhang Junlong , Xu Huan , Wu Yifeng , Huang Zhuochun
Published: February 2021

We previously identified E26 transformation specific sequence 1 (ETS1) rs73013527 single nucleotide polymorphism associated with RA susceptibility and disease activity. In the present study, we aims to further investigate the association between ETS1 rs73013527 and receptor activator of nuclear factor kappa B ligand (RANKL), an index related to bone destruction and was reported to elevate in RA.

We determined genotypes of ETS1 rs73013527, serum RANKL concentration, clinical characteristics (disease duration, disease activity score for 28 painful/swollen joints), and laboratory markers (rheumatoid factor, anti-citrullinated protein antibody, anti-keratin antibody, c-reactive protein, erythrocyte sedimentation rate) of 254 RA cases. Univariate and multivariate analysis were employed to explore the association between ETS1 rs73013527 and serum RANKL levels in RA patients.

Univariate and multivariate analysis indicated no association of serum RANKL levels with patient age, gender, clinical characteristics, and laboratory markers. Univariate analysis, not multivariate analysis indicated genotype CT/TT of ETS1 rs73013527 was significantly associated with elevated RANKL levels in RA patients.

ETS1 rs73013527 is in relation to serum RANKL levels among patients with RA. ETS1 probably might be an indirect factors involved in RANKL regulation in RA.
Different acupuncture intervention time-points for improving capacity in motor function and activities of daily living after stroke
Authors: Zhuo Yue , Deng Shifeng , Xu Ming , Zhang Yuchen , Lu Xiaoye , Wu Boyu , Zhang Hong
Published: February 2021

Background:

The incidence of stroke has been found in an increasing trend worldwide, resulting in significant negative effects and severe impairments to survivors in terms of motor function and activities of daily living. Acupuncture therapy has been widely used in the clinical treatment of stroke for a long time, meanwhile, the efficacy has been confirmed by many studies. However, the optimal intervention time-point of acupuncture in stroke is controversial. Therefore, the purpose of our study is to provide scientific evidence and reasonable suggestions for this issue.

Methods:

A computer-based retrieval will be employed in 7 electronic databases: EMBASE Database, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang databases, Chinese Scientific Journals Database (VIP) and China Biological Medicine Database (CBM), from the establishment date of each database throughout October 2020. Only randomized controlled trials of acupuncture for stroke will be recruited and language is limited to English or Chinese. The outcomes we focus on include the Fugl-Meyer Assessment score and the Barthel Index. Additionally, safety assessments such as adverse events and drop-out cases may also be taken into consideration. The network meta-analysis will be performed based on the Bayesian framework and literature selection will be conducted by 2 trained reviewers. All data analysis will be calculated by Revman5.3, WinBUGS 1.4.3, Stata13.0, and R software 3.6.1. The Assessment of heterogeneity, inconsistency, subgroup, sensitivity, and publication bias will also be done under the guidelines of Cochrane Collaboration's tool.

Results:

The results of this study will be submitted to a peer-reviewed journal for publication.

Conclusion:

This network meta-analysis will provide evidence-based references to evaluate the efficacy of different acupuncture intervention time-points during the treatment of stroke. Furthermore, it will help the clinicians to formulate appropriate medical plans and improve clinical efficacy.

Trials registration number:

INPLASY2020120060
An Innovative Wellness Partner Program to Support the Health and Well-being of Nurses During the COVID-19 Pandemic
Authors: Teall Alice M. , Mazurek Melnyk Bernadette
Published: February 2021

Responding to the coronavirus disease-2019 (COVID-19) pandemic is likely to exacerbate anxiety, burnout, fatigue, and distress already being experienced by nurses in ever greater numbers. An innovative Wellness Partner Program was developed with an aim to enhance the health and well-being of nurses on the front lines during the COVID-19 pandemic and beyond. Nurses across the country opted in to the program, and were paired with advanced practice nursing (APN) graduate students who served as the nurses' wellness partners. Areas emphasized in the program included (1) personalized support for wellness; (2) prioritizing physical activity, healthy eating, sleep, and stress management; and (3) establishment of strength-based, sustainable solutions to improve health and well-being. Partnerships were implemented for 188 nurses who were coached by 49 APN students; 104 nurses participated for 6 weeks. In the program evaluation, 98% of nurses shared that the wellness support program helped them engage in self-care and wellness, and 94.7% agreed or strongly agreed that The Wellness Partner Program helped them improve their mental and physical health. In the midst of the pandemic, nurses were supported to cope with stress, focus on self-care and wellness goals, and address challenges to their well-being.
The COVID-19 Crucible
Authors: Graystone Rebecca , Hartman Nicole M. , Vose Courtney
Published: February 2021

This article describes how a national nursing association and a major academic medical center responded to the coronavirus disease-2019 (COVID-19) pandemic during the first wave of the outbreak in the United States (January to August 2020). The organizations share their lived experiences as they quickly found themselves at the forefront of the crisis. The article discusses how early warning signs from a world away sparked collaboration, innovation, and action that grew to a coordinated, organization-wide response. It also explores how leaders in 2 distinct but interrelated environments rose to the challenge to leverage the best their organizations had to offer, relying on the expertise of each to navigate changes that were made to almost every aspect of work. From tentative first steps to rapid implementation of innovative policies and procedures, the organizations share lessons learned and benefits reaped. The article includes practical crisis response strategies for the nursing profession and health care systems moving forward.
Opportunities in Chaos
Authors: Williamson Kathleen M. , Nininger Jami , Dolan Scott , Everett Todd , Joseph-Kemplin Mitch
Published: February 2021

The impact of the global coronavirus disease-2019 (COVID-19) pandemic has triggered changes in nursing education at a pace not previously experienced in academia. Academic nursing leaders have been faced with challenges of balancing the impact of the pandemic responses in the face-to-face classroom, laboratory, and clinical learning, ensuring the safety of the college community, and supporting alternative educational delivery formats with assurance that desired learning outcomes and demanded professional competencies are attained. The challenge faced by these leaders is unprecedented. However, there is opportunity in crisis for leaders. This article details how the leadership at one institution leveraged transformational change theory to support faculty, staff, and students during this time of rapid change. Additionally, the article discusses the use of transformational change theory and the ongoing institutional commitment to meeting curricular goals and objectives while maintaining a commitment to being student focused.
Changes in Fatigue Levels and Sleep Measures of Hospital Nurses During Two 12-Hour Work Shifts
Authors: Cho Hyeonmi , Brzozowski Sarah , Arsenault Knudsen Élise N. , Steege Linsey M.
Published: February 2021

OBJECTIVE

The aims of this study were to explore nurses' fatigue levels and sleep measures during two 12-hour consecutive day shifts and examine the relationships between nurses' fatigue levels within shifts and their previous-night sleep characteristics.

BACKGROUND

Monitoring changes in fatigue and sleep is important to enable effective fatigue management.

METHODS

This was a descriptive, repeated-measures study. Data were collected using surveys and actigraphy 4 times during each consecutive shift (7:00 am-7:30 pm).

RESULTS

General fatigue levels started trending up 4 hours after the start of work; highest levels were reported at 7:30 pm. Fatigue levels accumulated across consecutive shifts. Subjective sleep quality was higher the night before the 2nd shift than the night before the 1st shift. Nurses' poor sleep the night before a shift was related to increased fatigue levels during the next shift.

CONCLUSION

It is important to consider when fatigue management interventions will be most effective and to consider previous-night's sleep when monitoring fatigue.
A Qualitative Study Describing Nurses' Experiences With Presenteeism
Authors: Rainbow Jessica G. , Dudding Katherine M. , Bethel Claire
Published: February 2021

OBJECTIVE

The aim of this study was to understand nurse awareness of coping and decision making regarding presenteeism and the consequences thereof.

BACKGROUND

Nurses report high levels of presenteeism or not being able to fully function in the workplace, but we currently lack understanding of nurse perceptions of presenteeism and its consequences.

METHODS

A qualitative descriptive method was used to evaluate the perceptions of nurses from medical surgical units at 2 different hospitals.

FINDINGS

For purposes of the study, presenteeism was defined as being present at work when not fully engaged. Most respondents experienced presenteeism in the month before data collection. Five categories of themes were identified: 1) factors leading to presenteeism, 2) awareness and symptoms of presenteeism, 3) coping with presenteeism on and off shift, 4) decision making regarding presenteeism, and 5) consequences of presenteeism.

CONCLUSIONS

Both personal and work factors contribute to presenteeism. To decrease presenteeism, healthcare leaders and systems should consider reviewing and changing sick/leave polices, unit cultures, and a lack of resources that contribute to and encourage an awareness of presenteeism, thereby decreasing nurse fatigue.
An Exploration of Factors Associated With Nurses' Perceptions of Decisional Involvement
Authors: Promes Jennifer , Barnason Susan
Published: February 2021

OBJECTIVE

The purpose of this study was to evaluate nurses' perceptions of decisional involvement (DI).

BACKGROUND

Decisional involvement is a measure or gauge of nurses' perceived shared leadership. There has been limited research examining factors associated with actual and preferred DI.

METHODS

A descriptive, observational study design was used. A total of 189 RNs completed the Decisional Involvement Scale and Evidence-Based Practice Implementation Scale. Nurses' preferred DI (DI-P) and actual DI (DI-A) were analyzed, and DI total and subscale scores were compared based on nurses' demographic and clinical practice characteristics.

RESULTS

The DI-A and DI-P total scores were significantly different, including subscales for DI-A compared with DI-P score. Dissonance scores by subscale were highest for recruitment, governance, and support. Unit-based council (UBC) participants had significantly higher actual DI, compared with non-UBC participants. Nurses' perceptions of implementing evidence-based practice (EBP) was not significantly different by low versus high EBP implementation; nor were the scores significantly correlated with their DI-A or DI-P scores.

CONCLUSIONS

Findings indicate nurses' perceptions of DI-A and DI-P. This study provided further examination of the differences and interrelationships between DI and nurses' demographic and clinical practice characteristics. Dissonance DI scores provide opportunities for targeting interventions to engage nurses in shared leadership.
A Framework for National Collaboration to Reduce Documentation Burden and Design for Usable and Reusable Data
Authors: Englebright Jane , Michel Sarah , Boyd David L. , Hulett Shannon L.
Published: February 2021

A focused effort is needed to capture the utility and usability of the electronic health record for providing usable and reusable data while reducing documentation burden. A collaborative effort of nurse leaders and experts was able to generate national consensus recommendations on documentation elements related to admission history. The process used in this effort is summarized in a framework that can be used by other groups to develop content that reduces documentation burden while maximizing the creation of usable and reusable data.
Leveraging Professional Governance During the COVID-19 Pandemic
Authors: Hancock Beverly , Catrambone Cathy , Mayer Karen M. , Hoskins Jackie L. , Chierici Colleen , Start Rachel E.
Published: February 2021

Dynamic nursing leadership and engagement of nursing at all levels are critical to effective care delivery. During the COVID-19 crisis, many organizations suspended non-COVID-related meetings, including professional governance councils where practice decisions are made. This article highlights how shared or professional governance was leveraged during this global pandemic at a large academic medical center and community hospital effectively sustaining autonomous nursing practice while responding to a rapidly changing environment and impacting quality patient care.
Leptospira dzianensis and Leptospira putramalaysiae are later heterotypic synonyms of Leptospira yasudae and Leptospira stimsonii
Authors: Casanovas-Massana Arnau , Vincent Antony T. , Bourhy Pascale , Neela Vasantha Kumari , Veyrier Frederic J. , Picardeau Mathieu , Wunder Jr. Elsio A.
Published: February 2021

Leptospira dzianensis

and

Leptospira putramalaysiae

were recently described as novel species and published almost concurrently with

Leptospira yasudae

and

Leptospira stimsonii

. Genome comparisons based on average nucleotide identity of the type strain genomes indicate that

L. dzianensis

and

L. putramalaysiae

are conspecific with

L. yasudae

and

L. stimsonii

, respectively. Based on the rules of priority,

L. dzianensis

should be reclassified as a later heterotypic synonym of

L. yasudae

, and

L. putramalaysiae

should be reclassified as a later heterotypic synonym of

L. stimsonii

.
Reproduction as a Means of Evaluating Policy Models: A Case Study of a COVID-19 Simulation
Authors: Chattoe-Brown E. , Gilbert N. , Robertson D. A. , Watts C.
Published: February 2021

This article proposes (and demonstrates the effectiveness of) a new strategy for assessing the results of epidemic models which we designate reproduction. The strategy is to build an independent model that uses (as far as possible) only the published information about the model to be assessed. In the example presented here, the independent model also follows a different modelling approach (agent-based modelling) to the model being assessed (the London School of Hygiene and Tropical Medicine compartmental model which has been influential in COVID lockdown policy). The argument runs that if the policy prescriptions of the two models match then this independently supports them (and reduces the chance that they are artefacts of assumptions, modelling approach or programming bugs). If, on the other hand, they do not match then either the model being assessed is not provided with sufficient information to be relied on or (perhaps) there is something wrong with it. In addition to justifying the approach, describing the two models and demonstrating the success of the approach, the article also discusses additional benefits of the reproduction strategy independent of whether match between policy prescriptions is actually achieved.
Role of Heterogeneous Transmission in the Decline of COVID-19 Cases During Winter of 2020/2021 in Massachusetts
Authors: Choi Yeon-Woo , Castro Marcia C. , Eltahir Elfatih A. B.
Published: February 2021

Importance

Heterogeneity in transmission of COVID-19 is a significant multiscale phenomenon. However, the role of this heterogeneity in shaping the overall dynamics of disease transmission is not well understood.

Objective

To investigate the role of heterogeneous transmission among different towns in Massachusetts in shaping the dynamics of COVID-19 transmission, especially the recent decline during winter of 2020/2021.

Design, Setting, Participants

Analysis of COVID-19 data collected and archived by the Massachusetts Department of Public Health.

Exposures

The entire population of the state of Massachusetts is exposed to the virus responsible for COVID-19, to varying degrees. This study quantifies this variation.

Main outcome measures

Weekly observations, by town, on confirmed COVID-19 cases in Massachusetts, during the period (April 15th, 2020 to February 9th 2021).

Results

The relative decline in COVID-19 cases, during January 12th, 2021 to February 9th, 2021, in the group of towns with higher total accumulated cases in the period before January 12th, 2021 is significantly larger than the corresponding relative decline in the group of towns with lower accumulated cases during the same period.

Conclusions and Relevance

Heterogeneous nature of transmission is playing a significant role in shaping the rapid recent decline (January 12th to February 9th, 2021) in reported cases in Massachusetts, and probably around the country. These findings are relevant to how we estimate the threshold defining “herd” immunity, suggesting that we should account for effects due to heterogeneity.

Key Points

Question

Does heterogeneity in disease transmission play a role in shaping the overall dynamics of COVID-19 in Massachusetts, including the recent decline in cases during the 2020/2021 winter.

Findings

Based on analysis of data on cases in Massachusetts, the consistent and widespread decline of COVID-19 spread during winter of 2020/2021 (January 12th, 2021 to February 9th, 2021) appears to be shaped to a significant degree by the heterogeneous nature of transmission at the scale of different towns. Towns with a history of high (low) transmission rates during 2020 are experiencing a faster (slower) relative decline.

Meaning

We suggest that heterogeneity in transmission of COVID-19 may impact the dynamics of disease transmission including the emergence of “herd” immunity, in line with some recent theoretical studies. This finding deserves some attention from other research groups investigating “herd” immunity, and from federal and state public health authorities concerned with the future evolution of the pandemic.
“SARS-Cov-2 testing in the United Arab Emirates: Population Attitudes and Beliefs”
Authors: AlKetbi Latifa Mohammad Baynouna , Nagelkerke Nico , Abdelbaqi Hanan , ALBlooshi Fatima , AlSaedi Mariam , Almansoori Shamsa , AlNuaimi Ruqaya , AlKhoori Amal , AlAryani Aysha , Jiziri Ahmed Al , AlMestika Naji , AlShamsi Mariam , Kayani Fatima , Alblooshi Noura , AlKhajeh Shamma , Hammadi Ibrahim Al , AlDhahei Saeed , AlFalahi Jehan
Published: February 2021

Objectives

The United Arab Emirates responded to the SARS-COV-2 pandemic and widely implemented test-and-trace strategy. In this cross-sectional questionnaire-based study 531 subjects presenting for SARS-COV-2 testing were recruited to study population’s beliefs and choices regarding testing and were compared to 156 who never been tested.

Results

The community uptake in Abu Dhabi Emirate reached 90% (average of 68% overall). In the great majority it was self-motivated as 6% only had doctor referral. Those who had not taken a test were younger in age (p < 0.001), more likely performing activities such as shopping and eating out (p = 0.001), have a medical illness (p < 0.0001), and working from home (p = 0.005). The tested group reported significantly more agreement with the statement, if someone had negative result no need to stay home or wear mask. In conclusion, SARS-COV-2 testing had extensive coverage and high acceptability in the UAE. Acting on concluded beliefs and attitude are key to ensure the testing coverage efficiency and public empowerment.
Beliefs associated with Intentions of Non-Physician Healthcare Workers to Receive the COVID-19 Vaccine in Ontario, Canada
Authors: Desveaux Laura , Savage Rachel D. , Tadrous Mina , Kithulegoda Natasha , Thai Kelly , Stall Nathan M. , Ivers Noah M.
Published: February 2021

Achieving herd immunity of SARS-CoV-2 through vaccines will require a concerted effort to understand and address barriers to vaccine uptake. We conducted a web-based survey of non-physician HCWs, informed by the Theoretical Domains Framework, measuring intention to vaccinate, beliefs and sources of influence relating to the COVID-19 vaccines, and sociodemographic characteristics. Vaccination non-intent was associated with beliefs that vaccination was not required because of good health, lower confidence that the COVID-19 vaccine would protect their family and patients, and that getting vaccinated was a professional responsibility. Vaccination non-intent was strongly associated with mistrust about how fast the vaccines were developed and vaccine safety concerns. Communication directed at non-physician HCWs should be tailored by ethnic subgroups and settings to increase salience. Messaging should leverage emotions (e.g., pride, hope, fear) to capture interest, while addressing safety concerns and confirming the low risk of side effects in contrast to the substantial morbidity and mortality of COVID-19. Emergent data about reduced transmission post-vaccination will be helpful.
Healthcare personnel knowledge, motivations, concerns and intentions regarding COVID-19 vaccines: a cross-sectional survey
Authors: Jain Vivek , Doernberg Sarah B. , Holubar Marisa , Huang Beatrice , Marquez Carina , Brown Lillian , Rubio Luis , Sample Hannah A. , Bollyky Jenna , Padda Guntas , Valdivieso Daisy , Kempema Amanda , Leung Christopher , Sklar Matthew , Julien Aida , Paoletti Marcus , Jaladanki Sravya , Wan Emerald , Ghahremani Jacob , Chao Jessica , Weng Yingjie , Lu Di , Glidden David , Grumbach Kevin , Maldonado Yvonne , Rutherford George
Published: February 2021

Background

Healthcare personnel (HCP) are prioritized for earliest SARS-CoV-2 vaccine administration, yet relatively few data exist on HCP’s knowledge, motivations, concerns, and intentions regarding COVID-19 vaccines.

Methods

We conducted a cross-sectional survey Nov.16-Dec.8, 2020 among HCP enrolled in a cohort study at three Northern California medical centers serving diverse roles including COVID-19 patient care. Eligible HCP were adult (age≥18) on-site employees of the University of California, San Francisco, San Francisco General Hospital, and Stanford Healthcare. A one-time electronically-administered survey was sent to cohort HCP on November 16, 2020 and responses analyzed.

Results

Overall, among 2,448 HCP invited, 2,135 completed the COVID-19 vaccine survey (87.2% response rate). HCPs had mean age 41 years, were 73% female, and had diverse jobs including COVID-19 patient contact. Enthusiasm for vaccination was overall strong, and more HCP (1,453, 69%) said they would definitely/likely receive vaccine if formally FDA-approved versus if approved via emergency use authorization only (785, 35%). While 541 (25%) respondents wanted to be among the earliest to receive vaccine, more desired vaccination after the first round (777, 36%) or >2 months after vaccinations began (389, 18%). Top factors increasing motivation for vaccination included perceiving risk from COVID-19 to self (1,382, 65%) or to family/friends (1355, 63%). Top concerns were vaccine side effects, cited by 596 (28%), and concerns about political involvement in FDA’s approval process (249, 12%).

Conclusions

HCP were enthusiastic about COVID-19 vaccination for individual protection and protecting others, but harbored concerns about vaccine side effects. Our data may inform emerging vaccine education campaigns.

Key Points

Among 2,135 healthcare personnel surveyed, we found enthusiasm for COVID-19 vaccination both for individual benefit and protecting others. However, healthcare personnel rated their knowledge of COVID-19 vaccines as only moderate and harbored concerns about vaccine side effects. Education raising awareness of vaccine efficacy and side effects may help maximize vaccine uptake.