bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Your Patient Understand Their Treatment Plan? Factors Affecting Patient Understanding of Their Medical Care Treatment Plan in the Inpatient Setting
Authors: Toole Joseph , Kohansieh Michelle , Khan Umer , Romero Sandor , Ghali Mounir , Zeltser Roman , Makaryus Amgad N
Published: August 2020

The empathy and quality of communication between the physician and patient is believed to correlate with patient satisfaction and knowledge of the diagnoses and treatment plan. Examining patients’ understanding of their plan can allow providers to better aid patients upon their discharge from the hospital in the hopes of improving home care compliance. We sought to evaluate factors that we hypothesized to have an impact on a patient’s ability to understand their medical management plan in the inpatient setting. Over a 14-month period, patients were given a 10-question survey during their stay on the inpatient medical units at a safety-net tertiary care community hospital. The survey was given to patients to self-complete after our research team introduced it. A total of 366 patients were surveyed. Of the patients surveyed, more than two-thirds of participants had a clear idea of the management plan for their condition (68.5%), while 3.1% had no knowledge of their management plan. Significant associations between knowledge of the management plan and participants knowing their attending physician’s name ( P < .0005), participants having a primary care physician ( P < .0001), and educational background ( P < .0387) were found. These assessed factors can be addressed with quality communication and a strong patient–physician relationship. Accomplishing these 2 objectives with the gained knowledge of patient beliefs and perceptions from our study will likely lead to the patient having a much clearer idea of how their medical condition is being treated by his/her team and have overall positive health implications.
The Burden and Perceived Stress on Family Caregivers of Patients With Orofacial Cleft Deformities in The Perioperative Period of Cleft Repair
Authors: Gbolahan Olalere Omoyosola , Amiede Ogunmuyiwa Stella , Samuel Olowookere Anu
Published: August 2020

Different stages along the trajectory of cleft care may present with different and peculiar challenges that may negatively impact family caregivers, leading to considerable stress and burden. This study aims to evaluate the family caregiver burden and perceived stress of caring for patients with cleft deformities. Contributing factors to family caregivers’ burden in the perioperative period of cleft repair was also identified. A cross-sectional design that included 90 adult caregiver–patient pairs was employed. Semi-structured questionnaire was used to collect necessary information. The level of caregiver’s burden was assessed using the Zarit burden interview score. The results demonstrated the levels of caregiver burden as severe (4.4%), moderate to severe (21.1%), mild to moderate (40%), and little or none (34.5%). The only significant and independent predictor of caregiver burden was earning less than US$50/month (odds ratio = 2.30, 95% CI = 0.95-5.61, P = .066). Coping strategy was mainly family support (98.9%), while the greatest need expressed was financial assistance (66.7%). Our findings suggests that efforts geared at reducing direct and indirect cost of cleft care may help in reducing caregivers’ burden.
Ervebo (Ebola Zaire Vaccine, Live/rVSVΔG-ZEBOV-GP): The First Licensed Vaccine for the Prevention of Ebola Virus Disease
Authors: Piszczatoski Christopher R. , Gums John G.
Published: August 2020

Objective: To review the clinical data regarding the safety and efficacy of the Ervebo (Ebola Zaire vaccine, live/rVSVΔG-ZEBOV-GP) vaccine for the prevention of the Ebola virus disease. Data Sources: A literature search through PubMed, MEDLINE, and Cochrane Library was conducted for clinical trials published between January 2014 and June 2020 in the English language using the keywords Ervebo, rVSVΔG-ZEBOV, rVSVΔG-ZEBOV-GP, Ebola Zaire, and vaccine. Study Selection and Data Extraction: Articles were selected if they were related to the Food and Drug Administration (FDA) approval of Ervebo (Ebola Zaire vaccine, live/rVSVΔG-ZEBOV-GP) or provided novel data regarding this entity. Twelve articles noted in the FDA approval were chosen, along with 2 additional articles identified as providing novel information. Data Synthesis: The findings of the review show that Ervebo (Ebola Zaire vaccine, live/rVSVΔG-ZEBOV-GP) is a safe, immunogenic, and likely effective vaccine for the prevention of Ebola virus disease. Relevance to Patient Care and Clinical Practice: Ebola virus disease is highly infectious and often fatal. There have been multiple large outbreaks in the past 5 years, with no licensed treatments or vaccines. An effective vaccine could largely curtail current outbreaks and prevent further ones. Conclusion: The recent FDA approval of Ervebo (Ebola Zaire vaccine, live/rVSVΔG-ZEBOV-GP) offers the first approved vaccine for the prevention of Ebola virus disease. It has been shown to be safe, immunogenic, and likely effective for use in real-world applications for those at risk of contracting the disease.
A Comparison of Tertiary Drug Resources’ Consistency Regarding Drug-Drug Interactions of Adjunctive Analgesics
Authors: Lang Andrew , Veronin Michael A. , Reinert Justin P.
Published: August 2020

Background: Health care providers routinely rely on tertiary drug information resources to affirm knowledge or proactively verify the safety and efficacy of medications. Though all patient care areas are affected, the reliability of these resources is perhaps nowhere as poignant as it is in high-acuity settings, including the emergency department and the intensive care unit. As providers seek to identify adjunctive analgesics for acute pain in these areas, they must be able to rely on the integrity to whichever resource their institution has granted access. Objective: To determine the congruency of drug-drug interaction information found on 3 tertiary drug resources. Methods: A drug-drug interaction analysis was conducted on Micromedex, Lexicomp, and Medscape. Adjunctive analgesics included dexmedetomidine and ketamine, which were compared with the intravenous opioid products morphine, fentanyl, and hydromorphone. Results: Significant discrepancies were appreciated with regard to the severity of drug-drug interactions. In addition, the heterogeneity in which reaction severity and likelihood are described by each respective resource makes direct comparisons difficult. Interaction warnings for dexmedetomidine and fentanyl included a “major interaction” from Micromedex, whereas Lexicomp did not identify a risk and Medscape only recommended increased monitoring on the grounds of respiratory and central nervous system depression. Conclusions: Health care providers must remain vigilant when reviewing tertiary drug information resources. Pharmacists possess the training and skills necessary to assist interdisciplinary medical teams in providing optimal patient care through evaluating and applying the information gleaned from these resources.
How I treat venous thromboembolism in pregnancy
Authors: Middeldorp Saskia , Ganzevoort Wessel
Published: August 2020

One to 2 pregnant women in 1000 will experience venous thromboembolism (VTE) during pregnancy or postpartum. Pulmonary embolism (PE) is a leading cause of maternal mortality, and deep vein thrombosis leads to maternal morbidity, with postthrombotic syndrome potentially diminishing quality of life for a woman’s lifetime. However, the evidence base for pregnancy-related VTE management remains weak. Evidence-based guideline recommendations are often extrapolated from nonpregnant women and thus weak or conditional, resulting in wide variation of practice. In women with suspected PE, the pregnancy-adapted YEARS algorithm is safe and efficient, rendering computed tomographic pulmonary angiography to rule out PE unnecessary in 39%. Low molecular weight heparin (LMWH) in therapeutic doses is the treatment of choice during pregnancy, and anticoagulation (LMWH or vitamin K antagonists [VKAs]) should be continued until 6 weeks after delivery, with a 3-month minimum total duration. LMWH or VKA use does not preclude breastfeeding. Postpartum, direct oral anticoagulants are an option if a woman does not breastfeed and long-term use is intended. Management of delivery, including type of analgesia, requires a multidisciplinary approach and depends on local preferences and patient-specific conditions. Several options are possible, including waiting for spontaneous delivery with temporary LMWH interruption. Prophylaxis for recurrent VTE prevention in subsequent pregnancies is indicated in most women with a history of VTE.
How I manage pregnancy in carriers of hemophilia and patients with von Willebrand disease
Authors: Leebeek Frank W. G. , Duvekot Johannes , Kruip Marieke J. H. A.
Published: August 2020

Women with inherited bleeding disorders, including carriers of hemophilia A and B, or with von Willebrand disease, have an increased risk of bleeding during pregnancy and delivery. The unborn child may also be affected by the bleeding disorder for which specific measures have to be considered. This requires a multidisciplinary approach, with a team that includes a hematologist, a pediatric hematologist, a clinical geneticist, an obstetrician-perinatologist, and an anesthesiologist. An optimal approach includes prepregnancy genetic counseling, prenatal diagnostic procedures, and a treatment plan for delivery for both the mother and child. Recent retrospective studies show that even if strict guidelines are followed, these women are still at risk of postpartum bleeding. This occurs even if coagulation factor levels are normalized, either due to the pregnancy-induced rise of factor levels or by infusion of coagulation factor concentrates at the time of delivery. In this article, we describe our current diagnostic and clinical management of pregnancy and delivery in women with inherited bleeding disorders. We also briefly discuss possible interventions to improve the outcome of current strategies by increasing target factor levels during and after delivery.
The Investigation of Hybrid PEDOT:PSS/β-Ga2O3 Deep Ultraviolet Schottky Barrier Photodetectors
Authors: Zhang Tao , Shen Yixian , Feng Qian , Tian Xusheng , Cai Yuncong , Hu Zhuangzhuang , Yan Guangshuo , Feng Zhaoqing , Zhang Yachao , Ning Jing , Xu Yongkuan , Lian Xiaozheng , Sun Xiaojuan , Zhang Chunfu , Zhou Hong , Zhang Jincheng , Hao Yue
Published: August 2020

In this paper, the hybrid β-Ga2O3Schottky diodes were fabricated with PEDOT:PSS as the anode. The electrical characteristics were investigated when the temperature changes from 298 K to 423 K. The barrier heightϕbincreases, and the ideality factorndecreases as the temperature increases, indicating the presence of barrier height inhomogeneity between the polymer and β-Ga2O3interface. The mean barrier height and the standard deviation are 1.57 eV and 0.212 eV, respectively, after taking the Gaussian barrier height distribution model into account. Moreover, a relatively fast response speed of less than 320 ms, high reponsivity of 0.6 A/W, and rejection ratio ofR254 nm/R400 nmup to 1.26 × 103are obtained, suggesting that the hybrid PEDOT:PSS/β-Ga2O3Schottky barrier diodes can be used as deep ultraviolet (DUV) optical switches or photodetectors.
Multiple Cold Tolerance Trait Phenotyping Reveals Shared Quantitative Trait Loci in Oryza sativa
Authors: Shimoyama Naoki , Johnson Melineeh , Beaumont André , Schläppi Michael
Published: August 2020

Background

Developing chilling tolerant accessions of domesticated Asian rice is a potential source of significant crop improvement. The uniquely chilling sensitive nature of the tropically originating Oryza sativa make it the most important cereal crop that can gain significantly from improved tolerance to low temperatures. However, mechanisms underlying this complex trait are not fully understood. Oryza sativa has two subspecies with different levels of chilling tolerance, JAPONICA and INDICA, providing an ideal tool to investigate mechanistic differences in the chilling stress tolerance responses within this important crop species.

Results

The Rice Diversity Panel 1 (RDP1) was used to investigate a core set of Oryza sativa accessions. The tools available for this panel allowed for a comprehensive analysis of two chilling tolerance traits at multiple temperatures across a 354-cultivar subset of the RDP1. Chilling tolerance trait values were distributed as mostly subpopulation specific clusters of Tolerant, Intermediate, and Sensitive accessions. Genome-wide association study (GWAS) mapping approaches using all 354 accessions yielded a total of 245 quantitative trait loci (QTL), containing 178 unique QTL covering 25% of the rice genome, while 40 QTL were identified by multiple traits. QTL mappings using subsets of rice accession clusters yielded another 255 QTL, for a total of 500 QTL. The genes within these multiple trait QTL were analyzed for Gene Ontology (GO) term and potential pathway enrichments. Terms related to “carbohydrate biosynthesis”, “carbohydrate transmembrane transport”, “small molecule protein modification”, and “plasma membrane” were enriched from this list. Filtering was done to identify more likely candidate pathways involved in conferring chilling tolerance, resulting in enrichment of terms related to “Golgi apparatus”, “stress response”, “transmembrane transport”, and “signal transduction”.

Conclusions

Taken together, these GO term clusters revealed a likely involvement of Golgi-mediated subcellular and extracellular vesicle and intracellular carbohydrate transport as a general cold stress tolerance response mechanism to achieve cell and metabolic homeostasis under chilling stress.
Weighted single-step genomic best linear unbiased prediction integrating variants selected from sequencing data by association and bioinformatics analyses
Authors: Liu Aoxing , Lund Mogens Sandø , Boichard Didier , Karaman Emre , Guldbrandtsen Bernt , Fritz Sebastien , Aamand Gert Pedersen , Nielsen Ulrik Sander , Sahana Goutam , Wang Yachun , Su Guosheng
Published: August 2020

Background

Sequencing data enable the detection of causal loci or single nucleotide polymorphisms (SNPs) highly linked to causal loci to improve genomic prediction. However, until now, studies on integrating such SNPs using a single-step genomic best linear unbiased prediction (ssGBLUP) model are scarce. We investigated the integration of sequencing SNPs selected by association (1262 SNPs) and bioinformatics (2359 SNPs) analyses into the currently used 54K-SNP chip, using three ssGBLUP models which make different assumptions on the distribution of SNP effects: a basic ssGBLUP model, a so-called featured ssGBLUP (ssFGBLUP) model that considered selected sequencing SNPs as a feature genetic component, and a weighted ssGBLUP (ssWGBLUP) model in which the genomic relationship matrix was weighted by the SNP variances estimated from a Bayesian whole-genome regression model, with every 1, 30, or 100 adjacent SNPs within a chromosome region sharing the same variance. We used data on milk production and female fertility in Danish Jersey. In total, 15,823 genotyped and 528,981‬ non-genotyped females born between 1990 and 2013 were used as reference population and 7415 genotyped females and 33,040 non-genotyped females born between 2014 and 2016 were used as validation population.

Results

With basic ssGBLUP, integrating SNPs selected from sequencing data improved prediction reliabilities for milk and protein yields, but resulted in limited or no improvement for fat yield and female fertility. Model performances depended on the SNP set used. When using ssWGBLUP with the 54K SNPs, reliabilities for milk and protein yields improved by 0.028 for genotyped animals and by 0.006 for non-genotyped animals compared with ssGBLUP. However, with the SNP set that included SNPs selected from sequencing data, no statistically significant difference in prediction reliability was observed between the three ssGBLUP models.

Conclusions

In summary, when using 54K SNPs, a ssWGBLUP model with a common weight on the SNPs in a given region is a feasible approach for single-trait genetic evaluation. Integrating relevant SNPs selected from sequencing data into the standard SNP chip can improve the reliability of genomic prediction. Based on such SNP data, a basic ssGBLUP model was suggested since no significant improvement was observed from using alternative models such as ssWGBLUP and ssFGBLUP.
mRNA profile provides novel insights into stress adaptation in mud crab megalopa, Scylla paramamosain after salinity stress
Authors: Zhang Yin , Wu Qingyang , Fang Shaobin , Li Shengkang , Zheng Huaiping , Zhang Yueling , Ikhwanuddin Mhd , Ma Hongyu
Published: August 2020

Background

Mud crab,Scylla paramamosain, a euryhaline crustacean species, mainly inhabits the Indo-Western Pacific region. Wild mud crab spawn in high-salt condition and the salinity reduced with the growth of the hatching larvae. When the larvae grow up to megalopa, they migrate back to estuaries and coasts in virtue of the flood tide, settle and recruit adult habitats and metamorphose into the crablet stage. Adult crab can even survive in a wide salinity of 0–35 ppt. To investigate the mRNA profile after salinity stress,S. paramamosainmegalopa were exposed to different salinity seawater (low, 14 ppt; control, 25 ppt; high, 39 ppt).

Results

Firstly, from the expression profiles ofNa+/K+/2Cl- cotransporter,chloride channel protein 2, andABC transporter, it turned out that the 24 h might be the most influenced duration in the short-term stress. We collected megalopa under different salinity for 24 h and then submitted to mRNA profiling. Totally, 57.87 Gb Clean Data were obtained. The comparative genomic analysis detected 342 differentially expressed genes (DEGs). The most significantly DEGs includegamma-butyrobetaine dioxygenase-like,facilitated trehalose transporter Tret1,sodium/potassium-transporting ATPase subunit alpha,rhodanese 1-like protein, etc. And the significantly enriched pathways were lysine degradation, choline metabolism in cancer, phospholipase D signaling pathway, Fc gamma R-mediated phagocytosis, and sphingolipid signaling pathway. The results indicate that in the short-term salinity stress, the megalopa might regulate some mechanism such as metabolism, immunity responses, osmoregulation to adapt to the alteration of the environment.

Conclusions

This study represents the first genome-wide transcriptome analysis ofS. paramamosainmegalopa for studying its stress adaption mechanisms under different salinity. The results reveal numbers of genes modified by salinity stress and some important pathways, which will provide valuable resources for discovering the molecular basis of salinity stress adaptation ofS. paramamosainlarvae and further boost the understanding of the potential molecular mechanisms of salinity stress adaptation for crustacean species.
Antimicrobial resistance and molecular detection of extended spectrum β-lactamase producing Escherichia coli isolates from raw meat in Greater Accra region, Ghana
Authors: Dsani Esther , Afari Edwin Andrews , Danso-Appiah Anthony , Kenu Ernest , Kaburi Basil Benduri , Egyir Beverly
Published: August 2020

Background

Typically, raw meat can be contaminated with antibiotic resistant pathogens at unhygienic slaughter and sale points. Consumption of meat contaminated with antibiotic resistantE. coliis associated with grave health care consequences. The aim of this study was to determine the microbial quality of raw meat, the antimicrobial susceptibility and Extended Spectrum Beta Lactamase (ESBL) production inE. coliisolates from raw meat.

Results

Total Plate Counts exceeded the acceptable limit of 5.0 log CFU/ cm2in 60.5% (124/205) of raw meat samples. Total Coliform Counts in 70.7% (145/205) of samples were in excess of the acceptable limit of 2.5 log CFU/cm2.E. coliwas detected in about half of raw meat samples (48%), ranging from 9.5–79.0% among the slaughter sites. Isolates were susceptible to meropenem (100%), ceftriaxone (99%), cefotaxime (98%), chloramphenicol (97%), gentamycin (97%), ciprofloxacin (92%) and amikacin (92%), but resistant to ampicillin (57%), tetracycline (45%), sulfamethoxazole-trimethoprim (21%) and cefuroxime (17%). Multi-drug resistance (MDR) was identified in 22% of the isolates. TheblaTEM genewas detected in 4% (4/98) ofE. coliisolates in this study.

Conclusion

The levels of microbial contamination of raw meat in this study were unacceptable. Meat handlers and consumers are at risk of foodborne infections fromE. coliincluding ESBL producingE. colithat are resistant to most antibiotics in use. We recommend an enhanced surveillance for antibiotic resistance in food products for the early detection of emerging resistant bacteria species in the food chain.
FocSge1 in Fusarium oxysporum f. sp. cubense race 1 is essential for full virulence
Authors: Gurdaswani Vartika , Ghag Siddhesh B. , Ganapathi Thumballi R.
Published: August 2020

Background

Fusarium wilt disease of banana is one of the most devastating diseases and was responsible for destroying banana plantations in the late nineteenth century. Fusarium oxysporum f. sp. cubense is the causative agent. Presently, both race 1 and 4 strains of Foc are creating havoc in the major banana-growing regions of the world. There is an urgent need to devise strategies to control this disease; that is possible only after a thorough understanding of the molecular basis of this disease.

Results

There are a few regulators of Foc pathogenicity which are triggered during this infection, among which Sge1 (Six Gene Expression 1) regulates the expression of effector genes. The protein sequence is conserved in both race 1 and 4 strains of Foc indicating that this gene is vital for pathogenesis. The deletion mutant, FocSge1 displayed poor conidial count, loss of hydrophobicity, reduced pigmentation, decrease in fusaric acid production and pathogenicity as compared to the wild-type and genetically complemented strain. Furthermore, the C-terminal domain of FocSge1 protein is crucial for its activity as deletion of this region results in a knockout-like phenotype.

Conclusion

These results indicated that FocSge1 plays a critical role in normal growth and pathogenicity with the C-terminal domain being crucial for its activity.
Impact of long-term industrial contamination on the bacterial communities in urban river sediments
Authors: Zhang Lei , Tu Demei , Li Xingchen , Lu Wenxuan , Li Jing
Published: August 2020

Background

The contamination of the aquatic environment of urban rivers with industrial wastewater has affected the abiotic conditions and biological activities of the trophic levels of the ecosystem, particularly sediments. However, most current research about microorganism in urban aquatic environments has focused on indicator bacteria related to feces and organic pollution. Meanwhile, they ignored the interactions among microorganisms. To deeply understand the impact of industrial contamination on microbial community, we study the bacterial community structure and diversity in river sediments under the influence of different types of industrial pollution by Illumina MiSeq high-throughput sequencing technology and conduct a more detailed analysis of microbial community structure through co-occurrence networks.

Results

The overall community composition and abundance of individual bacterial groups differed between samples. In addition, redundancy analysis indicated that the structure of the bacterial community in river sediments was influenced by a variety of environmental factors. TN, TP, TOC and metals (Cu, Zn and Cd) were the most important driving factors that determined the bacterial community in urban river sediments (P < 0.01). According to PICRUSt analysis, the bacterial communities in different locations had similar overall functional profiles. It is worth noting that the 15 functional genes related to xenobiotics biodegradation and metabolism were the most abundant in the same location. The non-random assembly patterns of bacterial composition in different types of industrially polluted sediments were determined by a co-occurrence network. Environmental conditions resulting from different industrial pollutants may play an important role in determining their co-occurrence patterns of these bacterial taxa. Among them, the bacterial taxa involved in carbon and nitrogen cycles in module I were relatively abundant, and the bacterial taxa in module II were involved in the repair of metal pollution.

Conclusions

Our data indicate that long-term potential interactions between different types of industrial pollution and taxa collectively affect the structure of the bacterial community in urban river sediments.
Accountability, research transparency and data reporting
Authors: Licker Marc , Diaper John , Ellenberger Christoph
Published: August 2020

More than one published paper are often derived from analyzing the same cohort of individuals to make full use of the collected information. Preplanned study outcomes are generally mentioned in open databases while exhaustive information on methodological aspects are provided in submitted articles.
Clinical characteristics and factors associated with coronary stenosis proximal to a myocardial bridge: a retrospective study
Authors: Gao Wen , Zhang Jiaxi , Duan Fei , Guo Shujun , Chen Chun , Du Liping , Zhao Jianquan , Zhou Zhihong
Published: August 2020

Background

The association of myocardial bridge (MB) with cardiovascular risk and the possible cardiovascular risk factors remain unclear. This study aimed to explore the clinical characteristics and related factors of coronary stenosis proximal to an MB.

Methods

This was a retrospective study of patients with symptoms of coronary atherosclerotic heart disease admitted between 10/2011 and 12/2014 to the Emergency and Cardiology Department of Bayannur Hospital, who underwent selective coronary angiography (SCAG). The patients were assigned to the non-stenosis and stenosis groups according to whether coronary stenosis was proximal to the MB.

Results

Among 244 patients with MB and cardiovascular symptoms, 91 (37.3%) had stenosis proximal to the MB. Compared with the non-stenosis group, there were more males (80.2% vs. 55.6%,P < 0.001) and smokers (including those who had quit smoking) (P < 0.001) in the stenosis group. There were no significant differences in blood lipid-related indexes (TG, TC, HDL-C, LDL-C, and VLDL-C) between the two groups. Multivariable analysis suggested that MB location in the middle distal or distal segment of the left anterior descending artery (LAD) increased the odds of coronary stenosis proximal to the MB (OR = 0.439, 95% CI: 1.57–7.532,P = 0.002), which was then considered an independent factor associated with coronary stenosis proximal to the MB.

Conclusions

In patients diagnosed with an MB by SCAG, only MB located in the middle distal or distal segment of the LAD is independently associated with coronary stenosis proximal to the MB.
Emergency department clinical leads’ experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study
Authors: Edwards Michelle , Cooper Alison , Davies Freya , Sherlock Rebecca , Carson-Stevens Andrew , Price Delyth , Porter Alison , Evans Bridie , Islam Saiful , Snooks Helen , Anderson Pippa , Siriwardena Aloysius Niroshan , Hibbert Peter , Hughes Thomas , Cooke Matthew , Dale Jeremy , Edwards Adrian
Published: August 2020

Background

To manage increasing demand for emergency and unscheduled care NHS England policy has promoted services in which patients presenting to Emergency Departments (EDs) with non-urgent problems are directed to general practitioners (GPs) and other primary care clinicians working within or alongside emergency departments. However, the ways that hospitals have implemented primary care services in EDs are varied. The aim of this study was to describe ED clinical leads’ experiences of implementing and delivering ‘primary care services’ and ‘emergency medicine services’ where GPs were integrated into the ED team.

Methods

We conducted interviews with ED clinical leads in England (n = 19) and Wales (n = 2). We used framework analysis to analyse interview transcripts and explore differences across ‘primary care services’, ‘emergency medicine services’ and emergency departments without primary care services.

Results

In EDs with separate primary care services, success was reported when having adistinctworkforce of primary care clinicians, who improved waiting times and flow by seeing primary care-type patients in a timely way, using fewer investigations, and enabling ED doctors to focus on more acutely unwell patients. Some challenges were: trying to align their service with the policy guidance, inconsistent demand for primary care, accessible community primary care services, difficulties in recruiting GPs, lack of funding, difficulties in agreeing governance protocols and establishing effective streaming pathways. Where GPs were integrated into an ED workforce success was reported as managing the demand for both emergency and primary care and reducing admissions.

Conclusions

Introducing a policy advocating a preferred model of service to address primary care demand was not useful for all emergency departments. To support successful and sustainable primary care services in or alongside EDs, policy makers and commissioners should consider varied ways that GPs can be employed to manage variation in local demand and also local contextual factors such as the ability to recruit and retain GPs, sustainable funding, clear governance frameworks, training, support and guidance for all staff. Whether or not streaming to a separate primary care service is useful also depended on the level of primary care demand.
The aggressive surgical treatment and outcome of a colon cancer patient with COVID-19 in Wuhan, China
Authors: Gao Jinbo , Yang Ming , Liu Lian , Guo Shuang , Li Yongfeng , Cheng Chao
Published: August 2020

Background

Cancer patients are at increased risk of novel coronavirus disease 2019 (COVID-19). Currently, surgeries for cancer patients with COVID-19 are generally suggested to be properly delayed.

Case presentation

We presented a 69-year-old Chinese female colon cancer patient with COVID-19, the first case accepted the surgical treatment during the pandemic in China. The patient developed a fever on January 28, 2020. After treatments with Ceftriaxone and Abidol, her fever was not moderated yet. A repeat chest computed tomography (CT) scan showed significantly exacerbated infectious lesions with a positive result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid. An abdomen CT scan indicated the tumor of ascending colon with local wrapped changes. She was diagnosed with ‘Severe novel coronavirus pneumonia’ and ‘Incomplete bowel obstruction: Colon cancer?’. After actively anti-inflammatory and anti-viral therapies, a right colectomy with lymph node dissection was performed on March 11, followed by a pathological examination. The patient successfully recovered from COVID-19 pneumonia and incomplete bowel obstruction after surgery without any postoperative related complications and was discharged on the 9th day after operation. Significant degeneration, necrosis and slough of focal intestinal and colonic mucosal epithelial cells were observed under microscope. No surgeons, nurses or anesthetists in our team were infected with SARS-CoV-2.

Conclusions

It is meaningful and imperative to share our experience of protecting health care personnels from SARS-CoV-2 infection and providing references for optimizing treatment of cancer patients, at least for the operative intervention with absolute necessity or surgical emergency, during the outbreak of COVID-19.
Bile cholesterol and viscosity, the keys to discriminating adenomatous polyps from cholesterol polyps by a novel predictive scoring model
Authors: Kim Eun-young , Hong Tae-ho
Published: August 2020

Background

Adenomatous gallbladder polyps, premalignant lesions of the gallbladder, have fatal outcomes, whereas cholesterol polyps have benign features. Herein, we proposed a novel, predictive scoring model of adenomatous polyps to distinguish them from cholesterol polyps, by analyzing bile components and bile viscosity.

Methods

Patients with gallbladder polyp pathologically confirmed after cholecystectomies were analyzed. After dividing patients into two groups (adenomatous or cholesterol polyps), the clinicopathologic profiles and bile nature, including components and viscosity were compared and a predictive scoring model for adenomatous polyps was assessed.

Results

Eleven adenomatous polyps and 96 cholesterol polyps were analyzed. The variables significantly associated with adenomatous polyps were age > 55 years (OR = 23.550,p = 0.020), bile viscosity< 7.5 s− 1(OR = 22.539,p = 0.012), and bile cholesterol< 414.5 mg/dl (OR = 10.004,p = 0.023) and the points for each variable in the predictive scoring model were allocated as 3, 3, and 2, respectively. Final scores ranged from 0 to 8 points and the best performance of model at a cutoff of ≥6 points had 90.9% of sensitivity and 80.2% of specificity.

Conclusions

Bile viscosity and bile cholesterol accompanied by age were revealed as significant predictors of adenomatous polyps, distinguishing them from cholesterol polyps of gallbladder. It can be the cornerstone for creating accurate guidelines for preoperatively determining treatment strategies of gallbladder polyps.
Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality
Authors: Xiao Guangwen , Liao Wanqing , Zhang Yuenong , Luo Xiaodong , Zhang Cailing , Li Guodan , Yang Yingping , Xu Yunyao
Published: August 2020

Background

Fungal bloodstream infections (FBI) among intensive care unit (ICU) patients are increasing. Our objective was to characterize the fungal pathogens that cause bloodstream infections and determine the epidemiology and risk factors for patient mortality among ICU patients in Meizhou, China.

Methods

Eighty-one ICU patients with FBI during their stays were included in the study conducted from January 2008 to December 2017. Blood cultures were performed and the antimicrobial susceptibility profiles of the resulting isolates were determined. Logistic multiple regression and ROC curve analysis were used to assess the risk factors for mortality among the cases.

Results

The prevalence of FBI in ICU patients was 0.38% (81/21,098) with a mortality rate of 36% (29/81). Ninety-eight strains of bloodstream-infecting fungi, mainly Candida spp., were identified from these patients. Candida albicans was most common (43%). Two strains of C. parapsilosis were no-sensitive to caspofungin, C. glabrata were less than 80% sensitive to azole drugs. Logistic multiple regression showed that age, serum albumin, APACHE II score, three or more underlying diseases, and length of stay in ICU were independent risk factors for mortality in FBI. ROC curve analysis showed that APACHE II scores > 19 and serum albumin ≤25 g/L were the best predictors of mortality.

Conclusion

Candida spp. predominated with high mortality rates among cases of FBI in ICU. Thus, clinical staff should enhance overall patient monitoring and concurrently monitor fungal susceptibility to reduce mortality rates.
Perinatal listeriosis patients treated at a maternity hospital in Beijing, China, from 2013–2018
Authors: Li Chunyun , Zeng Huihui , Ding Xin , Chen Yi , Liu Xiaowei , Zhou Li , Wang Xin , Cheng Yumei , Hu Shanshan , Cao Zheng , Liu Ruixia , Yin Chenghong
Published: August 2020

Background

Listeriosis is a rare but severe foodborne infectious disease. Perinatal listeriosis is often associated with septicemia, central nervous system (CNS) infection, and serious adverse pregnancy outcomes (miscarriage and neonate death). Here we report the characteristics and outcomes of perinatal listeriosis cases treated over 6 years at Beijing Obstetrics and Gynecology Hospital (BOGH), the largest maternity hospital in China.

Methods

We retrospectively reviewed the records of laboratory-confirmed, pregnancy-associated listeriosis cases treated from January 1, 2013 to December 31, 2018. The clinical manifestations, laboratory results, perinatal complications and outcomes (post-natal follow-up of 6 months) were investigated.

Results

In BOGH, 12 perinatal listeriosis cases were diagnosed based on Listeria monocytogenes positive culture, including 10 single pregnancies and 2 twin pregnancies. The corresponding incidence of pregnancy-associated listeriosis was 13.7/100,000 deliveries. Among those cases, four pregnant women and four newborns had septicemia, and two of the neonates with septicemia also suffered CNS infection. All the maternal patients recovered. Two inevitable miscarriages and four fetal stillbirths occurred. Of the eight delivered newborns, six survived, and two died within 2 days from birth. None of the survivors had neurological sequelae during a 6-month follow-up. The overall feto-neonatal fatality rate was 57.1%; notably, this rate was 100% for infections occurring during the second trimester of pregnancy and only 14.3% for those occurring in the third trimester.

Conclusions

Perinatal listeriosis is associated with high feto-neonatal mortality, and thus, a public health concern. Additional large-scale studies are needed to strengthen the epidemiological understanding of listeriosis in China.
Potentialities of multi-b-values diffusion-weighted imaging for predicting efficacy of concurrent chemoradiotherapy in cervical cancer patients
Authors: Liu Bing , Ma Wan-Ling , Zhang Guang-Wen , Sun Zhen , Wei Meng-Qi , Hou Wei-Huan , Hou Bing-Xin , Wei Li-Chun , Huan Yi
Published: August 2020

Background

To testify whether multi-b-values diffusion-weighted imaging (DWI) can be used to ultra-early predict treatment response of concurrent chemoradiotherapy (CCRT) in cervical cancer patients and to assess the predictive ability of concerning parameters.

Methods

Fifty-three patients with biopsy proved cervical cancer were retrospectively recruited in this study. All patients underwent pelvic multi-b-values DWI before and at the 3rd day during treatment. The apparent diffusion coefficient (ADC), true diffusion coefficient (Dslow), perfusion-related pseudo-diffusion coefficient (Dfast), perfusion fraction (f), distributed diffusion coefficient (DDC) and intravoxel diffusion heterogeneity index(α) were generated by mono-exponential, bi-exponential and stretched exponential models. Treatment response was assessed based on Response Evaluation Criteria in Solid Tumors (RECIST v1.1) at 1 month after the completion of whole CCRT. Parameters were compared using independentttest or Mann-WhitneyUtest as appropriate. Receiver operating characteristic (ROC) curves was used for statistical evaluations.

Results

ADC-T0 (p = 0.02), Dslow-T0 (p <  0.01), DDC-T0 (p = 0.03), ADC-T1 (p <  0.01), Dslow-T1 (p <  0.01), ΔADC (p = 0.04) and Δα (p <  0.01) were significant lower in non-CR group patients. ROC analyses showed that ADC-T1 and Δα exhibited high prediction value, with area under the curves of 0.880 and 0.869, respectively.

Conclusions

Multi-b-values DWI can be used as a noninvasive technique to assess and predict treatment response in cervical cancer patients at the 3rd day of CCRT. ADC-T1 and Δα can be used to differentiate good responders from poor responders.
Protein energy-wasting associated with nephrotic syndrome – the comparison of metabolic pattern in severe nephrosis to different stages of chronic kidney disease
Authors: Matyjek Anna , Literacki Slawomir , Niemczyk Stanislaw , Rymarz Aleksandra
Published: August 2020

Background

Nephrotic syndrome (NS) is associated with a hypercatabolic state expressed as an exacerbated degradation of muscle mass. However, the clinical significance of this phenomenon has not yet been investigated.

The aim of the study was to evaluate the nutritional status of patients with severe NS (defined as nephrotic range proteinuria with hypoalbuminemia ≤2.5 g/dL) and estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m2in comparison to patients in different stages of chronic kidney disease (CKD).

Methods

Twenty men with severe NS (NS group) and 40 men without proteinuria similar in term of serum creatinine (control group) were included into the study. A retrospective cohort of 40 men with CKD stage G4 (PreD group) and 20 haemodialysis men (HD group) were added to the analysis after matching for age, height and weight using propensity score matching. The bioimpedance spectroscopy and biochemical nutritional markers were evaluated.

Results

Nephrotic patients had a significantly lower lean tissue mass (LTM;p = 0.035) and index (a quotient of LTM over height squared, LTI;p = 0.068), with an expected deficiency of LTM by 3.2 kg, and LTI by 0.9 kg/m2when compared to the control group. A significant lean tissue deficit (defined as LTI below the lower limit of the reference range by 1.0 kg/m2) was observed in 12.5% of patients in the control group in comparison to 31.7% with advanced CKD (PreD+HD;p = 0.032) and 50% with NS (p = 0.003). NS group presented with higher phosphorus (p = 0.029), uric acid (p = 0.002) and blood urea (p = 0.049) than the control group. Blood urea was strongly negatively correlated with LTM in NS (r = − 0.64,p = 0.002). Nine nephrotic patients (45%) were identified as hypercatabolic based on severe hyperphosphatemia (> 5.0 mg/dL) and/or hyperuricemia (> 8.0 mg/dL), and were characterized by higher blood urea and lower prealbumin, as well as LTM lower by 5.6 kg than in less catabolic individuals.

Conclusions

In term of lean tissue amount, NS group was more similar to advanced CKD than to the control group. We concluded that specific metabolic pattern with elevated phosphorus, uric acid and blood urea, and lean tissue deficiency may be defined as protein-energy wasting associated with nephrotic syndrome (neph-PEW).
Influence of tumor location on short- and long-term outcomes after laparoscopic surgery for rectal cancer: a propensity score matched cohort study
Authors: Yang Hong , Yao Zhendan , Cui Ming , Xing Jiadi , Zhang Chenghai , Zhang Nan , Liu Maoxing , Xu Kai , Tan Fei , Su Xiangqian
Published: August 2020

Background

This study aimed to evaluate the short- and long-term outcomes after laparoscopic resection for low rectal cancer (LRC) compared with mid/high rectal cancer (M/HRC).

Methods

Patients with rectal cancer undergoing laparoscopic resection with curative intent were retrospectively reviewed between 2009 and 2015. After matched 1:1 by using propensity score analysis, perioperative and oncological outcomes were compared between LRC and M/HRC groups. Multivariate analysis was performed to identify independent factors of overall survival (OS) and disease-free survival (DFS).

Results

Of 373 patients who met the criteria for inclusion, 198 patients were matched for the analysis. Laparoscopic surgery for LRC required longer operative time (P<0.001) and more blood loss volume (P = 0.015) compared with M/HRC, and the LRC group tended to have a higher incidence of postoperative complications (16.2% vs. 8.1%, P = 0.082). There was no significant difference in local recurrence between the two groups (9.1% vs. 4.0%, P = 0.251), whereas distant metastasis was inclined to be more frequent in LRC patients compared with M/HRC (21.2% vs. 12.1%, P = 0.086). The LRC group showed significantly inferior 5-year OS (77.0% vs. 86.4%, P = 0.033) and DFS (71.2% vs. 86.2%, P = 0.017) compared with the M/HRC group. Multivariate analysis indicated that tumor location was an independent predictor of DFS (HR = 2.305, 95% CI 1.203–4.417, P = 0.012).

Conclusion

Tumor location of the rectal cancer significantly affected the clinical and oncological outcomes after laparoscopic surgery, and it was an independent predictor of DFS.
Correction to: Suspected paracetamol overdose in Monrovia, Liberia: a matched case–control Study
Authors: Haidar Mohamad K. , Vogt Florian , Larabi Islam Amine , Takahashi Kensuke , Henaff Fanny , Umphrey Lisa , Morton Nikola , Bawo Luke , Kerkula Joseph , Ferner Robin , Porten Klaudia , Alvarez Jean-Claude , Baud Frederic J.
Published: August 2020

An amendment to this paper has been published and can be accessed via the original article.
Mental health, smoking, harm reduction and quit attempts – a population survey in England
Authors: Brose Leonie S. , Brown Jamie , Robson Debbie , McNeill Ann
Published: August 2020

Background

Tobacco control strategies have engendered overall declines in smoking; however, a large gap remains between people with and without mental health problems, causing substantial health inequalities. Population-level information on barriers and opportunities for improvements is scarce. We aimed to assess mental health status of cigarette smokers and recent ex-smokers (‘past-year smokers’) in England, and smoking and harm reduction behaviour and quit attempts by mental health status.

Methods

Data were collected from 5637 current and 434 recent ex-smokers in 2016/17 in household surveys of representative samples of adults. We calculated weighted prevalence of different indicators of mental health problem: a) ever diagnosis, b) none, moderate, serious past-month distress, c) past-year treatment. We compared weighted smoking status, cigarette type, dependence, motivation to stop smoking, cutting down, use of nicotine replacement therapy or e-cigarettes, short-term abstinence, and quit attempts according to mental health status.

Results

Among past-year smokers: 35.9% ever had a diagnosis; 24.3% had experienced moderate, an additional 9.7% serious, past-month distress; 21.9% had had past-year treatment. Those with an indication of a mental health problem were more highly dependent and more likely to smoke roll-your-own cigarettes but also more likely to be motivated to stop smoking, to cut down, use nicotine replacement therapy or e-cigarettes and to have attempted to quit in the past year.

Conclusions

About a third of cigarette smokers in England have mental health problems. Interventions should address their increased dependence and leverage higher prevalence of harm reduction behaviours, motivation to stop and attempts to stop smoking.