bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood meal analysis of Culicoides species associated with livestock in West Bengal, India
Authors: Kar Surajit , Mondal Biswajit , Pal Arjun , Harsha Rupa , Mazumdar Abhijit
Published: May 2022

Knowledge gaps exist on the feeding pattern and host range of bluetongue virus vectors, Culicoides species, associated with livestock in India. Adult midges were trapped with ultraviolet light traps at 13 household farms adjacent to human biotope. Host DNA was isolated from individual females (n = 101; blood engorged‐82, gravid‐4 and parous‐15) and subjected to PCR amplification targeting CytB and 16S rRNA gene fragments followed by sequencing of amplified DNA samples. However, DNA sequences from only 71 individuals (70.3%) comprising of 10 Culicoides species were obtained. Blood meal analysis revealed at least 10 species that fed on five mammalian hosts including humans, but surprisingly none tested positive for birds. Results revealed that Culicoides innoxius tested positive for four not previously recognized species indicating a potential role as a vector species. Likewise, Culicoides shortti and Culicoides hegneri preferred goat and cattle respectively as hosts, whereas Culicoides palpifer preferred cattle along with buffalo as hosts, which is being reported for the first time. This is the first document on DNA‐based blood meal identification and feeding preference of Culicoides midges associated with livestock in India.
The relationships among gut microbiota, hypoxia‐inducible factor and anaemia with chronic kidney disease
Authors: Liu Lifen , Xu Wenwen , Kong Pingping , Dou Yanna
Published: May 2022

Gut microbiota plays a vital role in human intestinal homeostasis, correlating strongly with the progression of numerous diseases. Recent researches provide powerful evidence that the connections exist between gut microbiota and renal anaemia. Gut microbiota may have an impact on renal anaemia by regulating the hypoxia‐inducible factor (HIF) signalling, iron metabolism and inflammatory state. Because of this relationship, there may be potential treatments for renal anaemia. In this review, we will first provide an overview of current research progression on anaemia in chronic kidney disease and then introduce the relations among gut microbiota, HIF, and renal anaemia to explore the possible treatment options.
Navigating the pathway to ceasing driving—A voyage of discovery
Authors: Waterworth Susan , Dakin Mike
Published: May 2022

Background

Ceasing driving for older people is a life transition and can be associated with a sense of loss and decreased wellbeing. Nurses can play a key role in supporting the older person to manage the transitions, especially as the work involved in ceasing driving is often hidden. For example, finding alternative and accessible means of travel and maintaining mobility. Travel itself can be viewed as essential, for example attending health appointments and shopping. Discretionary travel may not be viewed as essential, but provides an important means of maintaining activity and social connection.

Method

A case study is presented of Mike's journey in ceasing driving. The concept of transition helps in co‐creating with Mike his journey of discovery. Semi‐structured interviews took place with Mike over a six‐month period and a journey pathway created, which was subject to further iterations during subsequent interviews.

Results

Ceasing driving involves a number of transitions encompassing a series of losses, managing uncertainty, problem‐solving and learning new skills. Being able to access and adapt to maintain mobility and travel are influenced by structural and environmental barriers.

Conclusion

The World Health Organization's strategy to create age‐friendly cities and communities is admirable. Like any other strategy this is a long‐term plan, and in meantime action needs to happen to support older people in ceasing driving and creating a non‐driving life and limit a decrease in well‐being. Starting conversations on transitional travel planning is proposed, with nurses playing a central role in making this process happen.
Does Analytic Thinking Insulate Against Pro‐Kremlin Disinformation? Evidence From Ukraine
Authors: Erlich Aaron , Garner Calvin , Pennycook Gordon , Rand David G.
Published: May 2022

Pro‐Kremlin disinformation campaigns have long targeted Ukraine. We investigate susceptibility to this pro‐Kremlin disinformation from a cognitive‐science perspective. Is greater analytic thinking associated with less belief in disinformation, as per classical theories of reasoning? Or does analytic thinking amplify motivated system 2 reasoning (or “cultural cognition”), such that analytic thinking is associated with more polarized beliefs (and thus more belief in pro‐Kremlin disinformation among pro‐Russia Ukrainians)? In online (N = 1,974) and face‐to‐face representative (N = 9,474) samples of Ukrainians, we find support for the classical reasoning account. Analytic thinking, as measured using the Cognitive Reflection Test, was associated with greater ability to discern truth from disinformation—even for Ukrainians who are strongly oriented towards Russia. We find similar, albeit weaker, results when operationalizing analytic thinking using the self‐report Actively Open‐Minded Thinking scale. These results demonstrate a similar pattern to prior work using American participants. Thus, the positive association between analytic thinking and the ability to discern truth versus falsehood generalizes to the qualitatively different information environment of postcommunist Ukraine. Despite low trust in government and media, weak journalistic standards, and years of exposure to Russian disinformation, Ukrainians who engage in more analytic thinking are better able to tell truth from falsehood.
Centred worlds, personal identity and imagination
Authors: Sauchelli Andrea
Published: May 2022

The Centred View offers an account of the connection between imagination and possibility that combines the centred world framework with some allegedly appealing intuitions regarding our persistence over time. In particular, Dilip Ninan suggests that the Centred View has the theoretical advantage of respecting our intuitions about cases of personal identity in certain imaginative scenarios while also being compatible with physicalism. Unfortunately, the Centred View faces a series of serious objections and should ultimately be rejected.
Effect of Age on Thoracic, Lumbar, and Pelvis Coordination During Trunk Flexion and Extension
Authors: Kakar Rumit S. , Higgins Seth , Tome Joshua M. , Knight Natalie , Finer Zachary , Doig Zachary , Li Yumeng
Published: May 2022

The purpose of this study was to investigate normative and age-related differences in trunk and pelvis kinematics and intersegmental coordination during sagittal plane flexion–extension. Trunk and pelvis kinematics were recorded while 76 participants performed a maximal range of motion task in the sagittal plane. Cross-correlation was calculated to determine the phase lag between adjacent segment motion, and coupling angles were calculated using vector coding and classified into one of 4 coordination patterns: in-phase, antiphase, superior, and inferior phase. A 2-way mixed-model multivariate analysis of variance was used to compare lumbar spine and pelvis angular kinematics, phase lags, and cross-correlation coefficients between groups. Young participants exhibited greater trunk range of motion compared with middle-aged participants. The lumbar spine and pelvis were predominantly rotating with minimum phase lag during flexion and extension movement for both age groups, and differences in coordination between the groups were seen during hyperextension and return to upright position. In conclusion, middle-aged adults displayed lower range of motion but maintained similar movement patterns to young adults, which could be attributed to protective mechanisms. Healthy lumbar and pelvis movement patterns are important to understand and need to be quantified as a baseline, which can be used to develop rehabilitation protocols for individuals with spinal ailments.
Supervised Aerobic Exercise Training and Increased Lifestyle Physical Activity to Reduce Cardiovascular Disease Risk for Women With Polycystic Ovary Syndrome: A Randomized Controlled Feasibility Trial
Authors: Woodward Amie , Broom David , Dalton Caroline , Metwally Mostafa , Klonizakis Markos
Published: May 2022

Background: Polycystic ovary syndrome (PCOS) is a complex, heterogeneous endocrinopathy. Women with PCOS often present with cardiovascular disease risk factors. Physical activity (PA) interventions reduce cardiovascular disease risk factors in women with PCOS. However, sedentary behaviors have a distinct deleterious effect on cardiometabolic health. Increasing PA and reducing sedentary behaviors may be a worthwhile therapeutic target to improve cardiovascular health in this population. This study investigated the feasibility of 2 PA interventions to decrease cardiovascular disease risk in women with PCOS. Methods: This was a feasibility randomized controlled trial of 2 PA interventions in 36 women with PCOS. Participants were randomized to a supervised exercise intervention (n = 12), a lifestyle physical activity group intervention aimed at reducing sedentary behaviors (n = 12), or a control group (n = 12), for 12 weeks. Primary outcomes included the feasibility and acceptability of the interventions and procedures. Results: Recruitment rate was 56%. Adherence rate was 53% and 100% to the exercise intervention and lifestyle PA intervention, respectively. Secondary outcome data indicate a reduction in oxidized low-density lipoprotein concentrations in the exercise group, and weight loss in both intervention groups. Conclusions: The procedures for recruitment, allocation, and outcome measurements were acceptable. However, before progression to a full-scale trial, adherence to the exercise program should be addressed.
Evolution of a
cis
-Acting SNP That Controls Type VI Secretion in Vibrio cholerae
Authors: Ng Siu Lung , Kammann Sophia , Steinbach Gabi , Hoffmann Tobias , Yunker Peter J. , Hammer Brian K.
Published: May 2022

Organisms sense external cues with regulatory circuits that trigger the production of transcription factors, which bind specific DNA sequences at promoters (“
cis
” regulatory elements) to activate target genes. Mutations of transcription factors or their regulatory elements create phenotypic diversity, allowing exploitation of new niches.
The Transcription Factor Roc1 Is a Key Regulator of Cellulose Degradation in the Wood-Decaying Mushroom
Schizophyllum commune
Authors: Marian Ioana M. , Vonk Peter Jan , Valdes Ivan D. , Barry Kerrie , Bostock Benedict , Carver Akiko , Daum Chris , Lerner Harry , Lipzen Anna , Park Hongjae , Schuller Margo B. P. , Tegelaar Martin , Tritt Andrew , Schmutz Jeremy , Grimwood Jane , Lugones Luis G. , Choi In-Geol , Wösten Han A. B. , Grigoriev Igor V. , Ohm Robin A.
Published: May 2022

Wood-degrading fungi in the phylum Basidiomycota play a crucial role in nutrient recycling by breaking down all components of wood. Fungi have evolved transcriptional networks that regulate expression of wood-degrading enzymes, allowing them to prioritize one nutrient source over another.
Prenatal diagnosis of craniorachischisis totalis
Authors: Costa Paulina , Fontoura Oliveira Andreia , Baptista Vilaça António
Published: May 2022

Craniorachischisis totalis (anencephaly with total open spina biﬁda) is the most severe form of neural tube defects. The exact aetiology of neural tube defects remains poorly understood. We report a case of a primigravida in her 20s with a fetus in which craniorachischisis totalis was diagnosed during the first-trimester ultrasound at 11 weeks of gestation. The parents opted for pregnancy termination and the diagnosis was confirmed postnatally. Besides the lack of folic acid supplementation during preconception, no other risk factor was found. This case highlights the importance of the first-trimester ultrasound in the diagnosis of severe malformations. The right diagnosis is crucial for future prenatal counselling, yet investigation is still required to better understand the aetiology behind neural tube defects and assess the possibility of underlying genetic features, thus enabling better counselling.
Portopulmonary hypertension: a patient with shortness of breath
Authors: Ryan Aidan , Miah Nahima , Saleh Mohamed
Published: May 2022

Portopulmonary hypertension (PoPH) is a poorly understood complication of liver disease which affects about 10% of patients with pulmonary hypertension. This case report outlines the difficulties in diagnosing and managing a patient with advanced disease, and the impact of these delays on the patient.

PoPH has a significant risk of mortality with a 2-year survival rate of 67%. There are also few treatment options available and those which do exist are associated with multiple contraindications and risks. Patients with PoPH commonly present with dyspnoea, pulmonary hypertension and portal hypertension. The presence of coexisting chronic liver disease is also sometimes present. Traditional management for heart failure can temporarily alleviate symptoms but there is no proven long-term benefit. As a result, an understanding of the pathophysiology, diagnostics and management is crucial to ensure the best possible patient outcomes.
Postoperative risks of stoma formation in patients with dementia
Authors: Jarratt Barnham Isaac , Kent Niall
Published: May 2022

Stoma formation for patients with dementia presents an increasing problem in a global ageing population. While potentially lifesaving, stomas impose significant, long-term postoperative burdens on patients, and may particularly challenge those with cognitive impairment.

In this case, a patient was considered for colostomy to manage a colovesical fistula. The patient’s cognitive status significantly influenced clinicians’ beliefs concerning suitability for stoma formation.

The relevance of dementia to stoma formation is underdiscussed within the literature. In this report, we outline the postoperative risks to which those with dementia undergoing stoma formation are particularly vulnerable. These include increased risk of psychological harm, of relocation to a nursing home, and of stoma-related complications.

We hope an increased appreciation of these postoperative challenges will inform decisions concerning suitability for stoma formation in this patient group.
Beyond what clinicians see: missed diagnosis and misdiagnosis of a woman with autism spectrum disorder
Authors: Isaac Joana , Jeremias Daniela , Rocha Almeida Carolina , Albuquerque Rui
Published: May 2022

A young woman with autism spectrum disorder was admitted to the hospital via the emergency care unit. On being admitted, she was improperly diagnosed with a psychotic disorder due to her erratic behaviour and incomprehensible refusal to eat. As a result, the patient was hospitalised against her will. For accurate and correct diagnosis and treatment, it was necessary to collect the patient’s detailed clinical history, while being hospitalised.
Paracentral acute middle maculopathy in Susac syndrome after dual exposure to SARS-CoV-2 antigen
Authors: Malerbi Fernando Korn , Schoeps Vinicius Andreoli , T F Matos Kimble
Published: May 2022

We report a case of Susac syndrome after SARS-CoV-2 infection and subsequent vaccination that presented with meningitis and retinal microembolisation in the form of paracentral acute middle maculopathy (PAMM). After presenting with headache, fever and myalgia followed by scotomata, a woman in her 50s was hospitalised for meningitis; she had had mild COVID-19 infection 2 months prior to admission, having received the first vaccine dose 1 month prior to the neurological manifestation. Eye fundus examination and optical coherence tomography were suggestive of PAMM. D-dimer levels and erythrocyte sedimentation rate were elevated. Before infectious investigation results were available, she was started on empirical antibiotic and antiviral treatment. Having ruled out infectious causes, she was started on high-dose prednisolone. After 1 month, there was partial resolution of retinal lesions. This case highlights that exposure to SARS-CoV-2 antigen may be related to this rare syndrome; treatment with steroids may improve central and retinal impairment.
Metastatic osteosarcoma bowel perforation secondary to chemotherapy-induced tumour necrosis
Authors: Bhadbhade Megha , Connolly Elizabeth , Badiani Sarit , Yeo David , Bhadri Vivek
Published: May 2022

Osteosarcoma is the most common paediatric and adolescent primary bone malignancy and is highly chemosensitive. Gastrointestinal metastases from osteosarcomas are rare. Bowel perforation secondary to chemotherapy is a potential serious complication reported in ovarian, colorectal and haematological malignancies. We report the first documented case of chemotherapy-mediated bowel perforation in an osteosarcoma patient with gastrointestinal metastases. A man in his 20s, with a history of resected osteosarcoma in remission, presented with abdominal pain. A computed tomography (CT) scan demonstrated a large calcified intrabdominal mass (15×13×9 cm) consistent with new peritoneal disease. After one cycle of palliative ifosfamide and etoposide chemotherapy, he developed a large bowel perforation and neutropenic sepsis consequently requiring resection of the perforated mass. Chemotherapy-induced bowel perforation is a rare but serious complication that should be considered in patients with osteosarcoma, and other chemosensitive malignancies, with intra-abdominal metastases. Recommencement of systemic therapies after bowel complications must be assessed cautiously on a case-by-case basis.
Chondrocutaneous conchal graft for optimal reconstruction of full-thickness lower eyelid defect: a reconstructive challenge
Authors: Panuganti Achyuth , Sahu Madhu Priya , Rao Neeraj , Malhotra Manu
Published: May 2022

Non-melanoma skin cancers of the head and neck region require optimal management encompassing oncological safety, minimal functional and cosmetic morbidity. The eyelid reconstruction poses a reconstructive challenge as it should include both anatomical and functional integrity. Full-thickness eyelid defects post resection can be managed with chondrocutaneous grafts. We present to you a case of a man in his 70s, who presented with left lower eyelid squamous cell carcinoma, who had a full-thickness eyelid defect, post ablative resection. Composite chondrocutaneous conchal graft with forehead flap was used to provide adequate functional and cosmetic outcomes. The patient has normal vision, with no exposure keratitis and complications.
CT imaging of an unusual malignant inguinal mass: metastatic parafunicular dedifferentiated liposarcoma
Authors: Marzocchi Guido , Gentilini Mattia , Cavini Marco , Lovato Luigi
Published: May 2022

A man in his 50s was redirected by his general practitioner to our University Hospital for a radiological evaluation after the complaint of a left inguinal swelling. The preliminary ultrasound and CT scan showed a left parafunicolar mass located between the root of the penis and the spermatic cord. The lesion was biopsied shortly after and histologically diagnosed as a dedifferentiated liposarcoma. The patient underwent a cycle of neoadjuvant radiotherapy, which proved to be ineffective. He was then subjected to an organ sparing surgical removal of the mass, followed by a second organ sparing removal of some residual disease. The last CT scan showed absence of the inguinal disease; however, lung and hepatic metastasis were detected, which are scheduled to be treated with a course of chemotherapy and radiofrequency.
Warm autoimmune haemolytic anaemia seen in association with primary sclerosing cholangitis in the setting ofKlebsiella pneumoniaebacteraemia
Authors: Yohannan Binoy , Chan Kok Hoe , Sridhar Arthi , Idowu Modupe
Published: May 2022

Warm autoimmune haemolytic anaemia mediated by warm agglutinins is a rare and heterogeneous disease which can be idiopathic or secondary to an underlying disease. Primary sclerosing cholangitis is a chronic autoimmune cholangiopathy that is very rarely associated with haemolytic anaemia. Infections can also act as triggers for immune haemolytic anaemia. Here, we report a case of a woman in her 50s with a history of primary sclerosing cholangitis and a positive direct antiglobulin test with no evidence of haemolysis who developed overt warm autoimmune haemolytic anaemia in the setting of cholangitis andKlebsiella pneumoniaebacteraemia. She was treated conservatively with appropriate antibiotics and cautious red blood cell transfusion with complete resolution of haemolysis; immunosuppression was avoided given sepsis on presentation. This case highlights a rare association of warm immune haemolytic anaemia in the setting ofK. pneumoniaebacteraemia and the role of a tailored treatment approach to treat this heterogeneous disease.
Ulcerative colitis complicated with linear immunoglobulin A bullous dermatosis
Authors: Ozaki Ryo , Saito Daisuke , Mizukawa Yoshiko , Hisamatsu Tadakazu
Published: May 2022

Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is a rare disorder involving subepidermal blistering characterised by IgA deposition along the basement membrane. The clinical features of LABD are variable but can include bullae, vesicles and erythematous lesions. Histopathology reveals formation of subepidermal bullae and linearly deposition of IgA in the basement membrane of the epidermis. LABD has been reported as a rare complication of ulcerative colitis (UC). We report the case of a young woman with UC complicated by LABD. The latter manifested as vesicles with erythema on almost the entire body. A biopsy of the skin lesions revealed linear IgA deposits in the basement membrane according to a direct immunofluorescence assay. Prednisolone administration resulted in clinical remission of UC but poor improvement of skin lesions. Oral administration of diaminodiphenyl sulfone led to improvement of blisters. Thereafter, abdominal and skin symptoms did not recur and she was discharged from hospital.
Total neurological recovery after surgical decompression and treatment with denosumab of large unresectable spinal giant cell tumour expanding to mediastinum
Authors: Anusitviwat Chirathit , Ruangchainikom Monchai , Korwutthikulrangsri Ekkapoj , Sutipornpalangkul Werasak
Published: May 2022

There is a controversy over the medical treatment of unresectable spinal giant cell tumour (GCT) regarding dosing and duration. We studied a spinal GCT case that had expanded to the thoracic spinal canal and mediastinum and was successfully treated by surgical decompression and denosumab. A woman in her 30s presented with weakness in both the lower extremities. MRI revealed a large tumour in the posterior mediastinum expanding from the thoracic vertebrae (T3–6), which compressed the spinal cord. The patient underwent urgent spinal decompression with instrumentation and her tissue was sent for a pathology study. Histologically and immunohistochemistry confirmed the diagnosis of GCT. Since it was an unresectable tumour, this patient was treated with denosumab. Her neurological problem resolved after 6 months of treatment. After 4 years of follow-up, the patient displayed no further progression and no side effects from long-term denosumab usage.
Severe multisystem inflammatory syndrome in a vaccinated adult with COVID-19
Authors: Selvaraj Vijairam , Finn Arkadiy , Santos Michael , Dapaah-Afriyie Kwame
Published: May 2022

The ability of SARS-CoV-2 to trigger hyperinflammatory response in children and adults is increasingly recognised. However, the detailed features that distinguish severe COVID-19-associated hyperinflammation from multisystem inflammatory syndrome in adults (MIS-A) is not yet known. We describe a young, vaccinated patient with no prior SARS-CoV-2 exposure who developed COVID-19 and MIS-A. We also provide a review of the current literature on MIS-A and COVID-19-associated hyperinflammation.
Adolescent onset of autoimmune polyglandular syndrome type 2
Authors: Murphy Siobhan A , Mohd Din Fazly Helmi , O'Grady Michael Joseph
Published: May 2022

An adolescent female was evaluated for fatigue, anorexia and unintentional weight loss of 7 kg. Initial investigations revealed subclinical autoimmune thyroid dysfunction, which progressed to overt hypothyroidism necessitating thyroxine replacement. She had entered early puberty, but this did not appear to be progressing. A high index of suspicion for coexisting endocrinopathies resulted in a diagnosis of Addison’s disease and consequently autoimmune polyglandular syndrome type 2 (Schmidt syndrome). While basal gonadotropins were normal, anti-Mullerian hormone was low and ovarian autoantibodies were positive, consistent with preclinical premature ovarian failure. Glucocorticoid and mineralocorticoid replacement were instituted. Puberty progressed and menarche was subsequently attained. Screening for other autoantibodies was undertaken; however, none are positive to date.
Universal health insurance in Africa: a narrative review of the literature on institutional models
Authors: Ly Mamadou Selly , Bassoum Oumar , Faye Adama
Published: May 2022

Introduction

Several African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries use different approaches. The purpose of this article is to study their institutional characteristics and their contribution to the achievement of universal health coverage (UHC) goals.

Method

This study is a narrative review. It focused on African countries with a UHI programme for at least 4 years. We identified 16 countries. We then compared how these UHI schemes mobilise, pool and use funds to purchase healthcare. Finally, we synthesised how all these aspects contribute to achieving the main objectives of UHC (access to care and financial protection).

Results

Ninety-two studies were selected. They found that government-run health insurance was the dominant model in Africa and that it produced better results than community-based health insurance (CBHI). They also showed that private health insurance was marginal. In a context with a large informal sector and a substantial number of people with low contributory capacity, the review also confirmed the limitations of contribution-based financing and the need to strengthen tax-based financing. It also showed that high fragmentation and voluntary enrolment, which are considered irreconcilable with universal insurance, characterise most UHI systems in Africa.

Conclusion

Public health insurance is more likely to contribute to the achievement of UHC goals than CBHI, as it ensures better management and promotes the pooling of resources on a larger scale.
Knowledge translation and evidence generation to increase the impact of vector control in Burkina Faso, Cameroon and Malawi
Authors: Mwendera Chikondi Andrew , Mzilahowa Themba , Njiokou Flobert , N’falé Sagnon , Amegee Quach Jessica , Thomsen Edward , Dabire Roch , Ranson Hilary , Alhassan Nurudeen , Oronje Rose , Worrall Eve
Published: May 2022

Lack of context-specific evidence and inadequate evidence-use for decision-making contribute to poor health. This paper reports on our work aimed at addressing the knowledge translation (KT) gap between evidence generators and users. We present our experiences of strengthening KT via technical advisory groups (TAGs) in parallel with increasing evidence generation through research fellowships and operational research. Vectorborne diseases (VBDs) impose substantial health and economic burdens in sub-Saharan Africa despite being preventable with vector control. The Partnership for Increasing the Impact of Vector Control aimed to reduce the burden of VBDs in Burkina Faso, Cameroon, Malawi and at regional and global levels. TAGs can promote evidence-use in policy and practice by engaging relevant stakeholders in both research and policy processes. TAGs and related activities are best facilitated by a coordinator with skills in research and policy. Contextual factors should influence the design and governance of TAGs, which will likely evolve over time. Relevant national stakeholders should be included in TAGs and be actively involved in developing research agendas to increase the relevance and acceptability of research findings for decision-making. The countries present three differing contexts with longer-term research and evaluation necessary to draw lessons on impact.
Interexaminer reproducibility for subjective refractions for an ametropic participant
Authors: Mathebula Solani David , Rubin Alan
Published: May 2022

Objective

To investigate interexaminer reproducibility of non-cycloplegic subjective refractions. Subjective refractions are frequently determined, and it is important to know whether differences in refractive state over time constitute meaningful, non-random change.

Methods and analysis

Fifty registered and experienced (≥5 years) optometrists from a single geographic region performed non-cycloplegic subjective refractions for a participant with moderate left eye(OS) to severe right eye (OD) ametropia. Subjective refractions were transformed to power matrices for analysis with stereopairs, distribution ellipsoids and polar profiles of variance of dioptric power. Absolute 95% limits of reproducibility (1.96(2)(SD)) for excesses of subjective refractions for the right and left eyes separately from mean subjective refractions were determined.

Results

Mean subjective refractions were −7.68–4.50×10 and −4.59–1.85×178 for the right and left eyes, respectively. The 95% absolute reproducibility limits for the stigmatic coefficients (spherical equivalents) were ≤1.71 D and ≤0.75 D for the right and left eyes, but corresponding limits for astigmatic coefficients were smaller (≤0.69 D).

Conclusion

Removal of possible outliers for OD and OS, respectively, reduces the absolute 95% reproducibility limits for the stigmatic and astigmatic coefficients to ≤0.97 D and ≤0.49 D, thus improving interexaminer reproducibility. However, these results suggest caution with analysis of refractive data where subjective rather than objective methods are applied for longitudinal and epidemiological studies.
Initiative to improve quality of paediatric ward-round documentation by application of ‘SOAP’ format
Authors: Joshi Neha , Bakshi Himanshi , Chatterjee Abhishek , Bhartia Saru
Published: May 2022

Background

Audits on record keeping practices at our multidisciplinary hospital revealed unstructured ward-round notes which were dissimilar from each other on aspects of patient information. Written as per the discretion of the rounding physician, the practice compromised team communication and medicolegal safety and risked patient harm. Paediatricians decided to address this concern for their department and proposed to improve the quality of documentation by structuring their notes using subjective, objective, assessment and planning (SOAP) format. On observing only 13% compliance with SOAP use despite education and training to use it, a series of interventions were explored to increase its application.

Methods

Brainstorming sessions with the paediatricians provided practical solutions. These were tested one by one using plan–do–study–act cycles to understand their impact. Team feedback was pursued towards the end of each cycle to understand the opinion of each team member.

Interventions

Interventions included verbal reminders, individual feedback and SOAP acronym display. Each of these were tested singularly and serially. Acronym display proved successful until the arrival of COVID-19, which disrupted its implementation and redirected paediatricians’ work priorities. This led to exploration of a new solution, and paediatricians recommended use of visual reminders at the handover site. Quantitative information was analysed to reject or retain the ideas.

Results

Verbal reminders and individual feedback made no difference to SOAP usage. Acronym display improved compliance from 13% to 90% but it fell to 45% during COVID-19. Its replacement with visual reminders during pandemic times reinstated the compliance to a median of 84%.

Conclusions

Selection of a change idea that respected front liner’s constraints and suited local work environment proved valuable. Both acronym display and visual reminders served as visual reinforcements towards embracing a note format and proved effective. Perceived benefits from methodically written notes encouraged paediatricians to re-establish simpler measures to retain SOAP application, otherwise disrupted during the COVID-19 pandemic.
Improving access to pre-exposure prophylaxis for HIV prescribing in a primary care setting
Authors: Lumsden Joshua , Dave Amish J , Johnson Camille , Blackmore Craig
Published: May 2022

Although emtricitabine–tenofovir was approved for HIV pre-exposure prophylaxis (PrEP) in 2012, use by persons at risk of acquiring HIV has been limited. Because many primary care providers lacked familiarity and comfort prescribing PrEP, at our institution PrEP prescribing was concentrated among the infectious disease specialists, effectively limiting access. This project sought to increase the number of patients receiving new prescriptions for PrEP. The interventions targeted primary care providers (including internal medicine and family medicine), and were designed to increase the number of unique providers offering PrEP to their patients. The overall strategy was to expand the clinical scope of practice for primary care providers through education and provision of detailed care templates in the electronic health record. These initiatives were implemented through a series of informal Plan–Do–Study–Act cycles, then generalised throughout the medical system. To evaluate the success of the project, we queried the electronic medical record for all new prescriptions for PrEP, with provider name and specialty, for all outpatients 18 years of age and older from 2012 through 2020. In 2015, prior to the intervention, only 78 patients received new prescriptions for PrEP at our institution, and only 38% (30 of 78) of these were from primary care clinicians. After the intervention, the number of patients receiving PrEP increased to 190 in 2019, with 85% (162 of 190) prescribed by primary care providers. In addition, the number of primary care providers making a new prescription for PrEP increased from 20 in 2015 to 73 in 2019. We conclude that targeted clinical education, combined with electronic health record templates, was associated with a significant increase in PrEP prescribing.
Access to and quality of sexual and reproductive health services in Britain during the early stages of the COVID-19 pandemic: a qualitative interview study of patient experiences
Authors: Bosó Pérez Raquel , Reid David , Maxwell Karen J , Gibbs Jo , Dema Emily , Bonell Christopher , Mercer Catherine H , Sonnenberg Pam , Field Nigel , Mitchell Kirstin R
Published: May 2022

Introduction

Access to quality sexual and reproductive health (SRH) services remains imperative even during a pandemic. Our objective was to understand experiences of delayed or unsuccessful access to SRH services in Britain during the early stages of the COVID-19 pandemic.

Methods

In October and November 2020 we conducted semi-structured telephone interviews with 14 women and six men reporting an unmet need for SRH services in the Natsal-COVID survey, a large-scale quasi-representative web-panel survey of sexual health and behaviour during COVID-19 (n=6654). We purposively sampled eligible participants using sociodemographic quotas. Inductive thematic analysis was used to explore service access and quality and to identify lessons for future SRH service delivery.

Results

Twenty participants discussed experiences spanning 10 SRH services including contraception and antenatal/maternity care. Participants reported hesitancy and self-censorship of need. Accessing telemedicine and ‘socially-distanced’ services required tenacity. Challenges included navigating changing information and procedures; perceptions of gatekeepers as obstructing access; and inflexible appointment systems. Concerns about reconfigured services included reduced privacy; decreased quality of interactions with professionals; reduced informal support; and fewer preventive SRH practices. However, some participants also described more streamlined services and staff efforts to compensate for disruptions. Many viewed positively the ongoing blending of telemedicine with in-person care.

Conclusion

The COVID-19 pandemic impacted access and quality of SRH services. Participants’ accounts revealed self-censorship of need, difficulty navigating shifting service configurations and perceived quality reductions. Telemedicine offers potential if intelligently combined with in-person care. We offer initial evidence-based recommendations for promoting an equitable restoration and future adaption of services.
Should COVID-specific arrangements for abortion continue? The views of women experiencing abortion in Britain during the pandemic
Authors: Lohr Patricia A , Lewandowska Maria , Meiksin Rebecca , Salaria Natasha , Cameron Sharon , Scott Rachel H , Reiter Jennifer , Palmer Melissa J , French Rebecca S , Wellings Kaye
Published: May 2022

Background

During the COVID-19 pandemic, the British governments issued temporary approvals enabling the use of both medical abortion pills, mifepristone and misoprostol, at home. This permitted the introduction of a fully telemedical model of abortion care with consultations taking place via telephone or video call and medications delivered to women’s homes. The decision was taken by the governments in England and Wales to continue this model of care beyond the original end date of April 2022, while at time of writing the approval in Scotland remains under consultation.

Methods

We interviewed 30 women who had undergone an abortion in England, Scotland or Wales between August and December 2021. We explored their views on the changes in abortion service configuration during the pandemic and whether abortion via telemedicine and use of abortion medications at home should continue.

Results

Support for continuation of the permission to use mifepristone and misoprostol at home was overwhelmingly positive. Reasons cited included convenience, comfort, reduced stigma, privacy and respect for autonomy. A telemedical model was also highly regarded for similar reasons, but for some its necessity was linked to safety measures during the pandemic, and an option to have an in-person interaction with a health professional at some point in the care pathway was endorsed.

Conclusions

The approval to use abortion pills at home via telemedicine is supported by women having abortions in Britain. The voices of patients are essential to shaping acceptable and appropriate abortion service provision.
Systems leadership: how chief executives manage tension between organisation and system pressures
Authors: Gordon Ben , Thomas Matthew Gwynfryn , Darzi Ara , Aufegger Lisa , Bicknell Colin
Published: May 2022

Aim

System leadership is the requirement for a leader of a single organisation to operate on behalf of a wider system, rather than their individual organisation. The current policy landscape does not incentivise system leadership, as many national structures emphasise a focus on individual organisations. This study aims to understand how chief executives in the National Health Service (NHS) in England implement system leadership in practice when faced with decisions that benefit the system to the detriment of their own trust.

Methodology

Semistructured interviews were conducted with ten chief executives from various NHS trust types to understand their perceptions and decision-making process in practice. Semantic thematic analysis was used to draw out themes in relation to how chief executives approach decisions which weigh up the system and organisation.

Results

Interviewees expressed advantages (such as support in managing demand) and disadvantages (such as increased bureaucracy) of system leadership and practical considerations in operationalisation (such as the importance of interpersonal relationships). Interviewees endorsed system leadership in principle, but did not feel that current organisational incentives support the implementation of system leadership in practice. However, this was not seen as a major challenge or impediment to effective leadership.

Conclusion

As a specific policy area, a direct focus on systems leadership is not necessarily helpful. Chief executives should be supported to make decisions in a complex environment, without a specific focus on healthcare systems as a unit of operation.
Embedding research (ER) led by nurses, midwives and allied health professionals (NMAHPs): the NMAHP-ER model
Authors: Whitehouse Claire Louise , Tinkler Linda , Jackson Carolyn , Hall Helen , Webster Jonathan , Hardy Sally , Copping Jacky , Morris Paul , Manley Kim
Published: May 2022

Background

Previous embedded researcher models have focused predominantly on an individual being a temporary team member and embedded for a project-limited short-term placement.

Aim

To develop an innovative research capacity building model to address the challenges of developing, embedding and sustaining, research led by Nurses, Midwives, and Allied Health Professionals (NMAHPs) in complex clinical environments. This healthcare and academic research partnership model offers an opportunity to support the ‘how’ of enabling NMAHP research capacity building from within the researchers’ clinical area of expertise.

Method

Collaboration between three healthcare and academic organisations and the iterative process of cocreation, development and refinement took place over 6 months during 2021. The collaboration relied on virtual meetings, emails, telephone calls and document review.

Results

A codesigned NMAHP embedded research (ER) model is ready for trialling with the individual being an existing clinician working collaboratively within the healthcare setting and with academia to develop the skills to become the ER.

Conclusion

This model supports NMAHP-led research activity in clinical organisations in a visible and manageable way. As a shared, long-term vision, the model will contribute to research capacity and capability of the wider healthcare workforce. It will lead, facilitate and support research in and across clinical organisations in collaboration with higher education institutions.
Changing estimates of leadership ability before a programme: retrospective self-assessments and response-shift bias
Authors: Lyons Oscar , Kingsley-Smith Harry , Kotze Koot , Nandra Karandeep , Galante Joao R , Fahy Nicholas , Canter Richard
Published: May 2022

Background

Most evaluations of clinical leadership development programmes rely on self-assessments. Self-assessments are vulnerable to response-shift bias. Using retrospective then-tests may help to avoid this bias.

In this study, we investigate whether post-programme then-tests (retrospective self-assessments) are more sensitive to change in clinical leadership development programme participants than traditional pre-programme pre-tests when paired with post-test self-assessments.

Methods

17 healthcare professionals participated in an 8-month single-centre multidisciplinary leadership development programme. Participants completed prospective pre-test, retrospective then-test and traditional post-test self-assessments using the Primary Colours Questionnaire (PCQ) and Medical Leadership Competency Framework Self-Assessment Tool (MLCFQ). Pre–post pairs and then–post pairs were analysed for changes using Wilcoxon signed-rank tests and compared with a parallel multimethod evaluation organised by Kirkpatrick levels.

Results

A greater number of significant changes were detected using then-test pairs than pre-test pairs for both the PCQ (11 of 12 vs 4 of 12 items) and MLCFQ (7 of 7 vs 3 of 7 domains). The multimethods data showed positive outcomes at all Kirkpatrick levels.

Conclusions

In ideal circumstances, both pre-test and then-test evaluations should be conducted. We cautiously suggest that if only one post-programme evaluation can be conducted, then-tests may be appropriate means of detecting change.
Impact of leadership on the nursing workforce during the COVID-19 pandemic
Authors: Phillips Natasha , Hughes Luke , Vindrola-Padros Cecilia , Petrella Anika , Fern Lorna A , Panel-Coates Flo , Taylor Rachel M
Published: May 2022

Background

The aim was to determine how the learning about protective factors from previous pandemics was implemented and the impact of this on nurses’ experience.

Methods

Secondary data analysis of semistructured interview transcripts exploring the barriers and facilitators to changes implemented to support the surge of COVID-19 related admissions in wave 1 of the pandemic. Participants represented three-levels of leadership: whole hospital (n=17), division (n=7), ward/department-level (n=8) and individual nurses (n=16). Interviews were analysed using framework analysis.

Results

Key changes that were implemented in wave 1 reported at whole hospital level included: a new acute staffing level, redeploying nurses, increasing the visibility of nursing leadership, new staff well-being initiatives, new roles created to support families and various training initiatives. Two main themes emerged from the interviews at division, ward/department and individual nurse level: impact of leadership and impact on the delivery of nursing care.

Conclusions

Leadership through a crisis is essential for the protective effect of nurses’ emotional well-being. While nursing leadership was made more visible during wave 1 of the pandemic and processes were in place to increase communication, system-level challenges resulting in negative experiences existed. By identifying these challenges, it has been possible to overcome them during wave 2 by employing different leadership styles to support nurse's well-being. Challenges and distress that nurses experience when making moral decisions requires support beyond the pandemic for nurse’s well-being. Learning from the pandemic about the impact of leadership in a crisis is important to facilitate recovery and lessen the impact in further outbreaks.
Preoperative virtual video visits only: a convenient option that should be offered to caregivers beyond the pandemic
Authors: Dougherty Danielle , Thompson Allison R , Speck Karen Elizabeth , Perrone Erin E
Published: May 2022

Objective

During the COVID-19 pandemic, our group implemented preoperative video visits (VVs) to limit physical contact. The aim of this study was to determine caregivers’ and providers’ perceptions of this practice and to determine feasibility for continuation.

Methods

All patients who had only a preoperative VV prior to an elective surgery were identified from March–October 2020. Caregivers, surgeons, and clinic staff were surveyed about their experiences.

Results

Thirty-four preoperative VVs were followed by an elective surgery without a preceding in-person visit. Of the 31 caregiver surveys completed, the majority strongly agreed that the VV was more convenient (87%, n=27). Eighty-one percent (n=25) strongly agreed or agreed that the VV saved them money. Ninety-four percent (n=29) strongly agreed or agreed that they would choose the VV option again. Caregivers saved an average travel distance of 60.3 miles one way (range 6.1–480). Of the 13/17 providers who responded, 77% (n=10) expressed that the practice should continue.

Conclusions

Virtual health became a necessity during the pandemic, and caregivers were overwhelmingly satisfied. Continuing VVs as an option beyond the pandemic may be a reasonable and effective way to help eliminate some of the hurdles that impede healthcare-seeking behavior and should be offered.