bluuebunny/crossref_metadata_2025 huggingface dataset:
Combination of graphene oxide and platelet-rich plasma improves tendon–bone healing in a rabbit model of supraspinatus tendon reconstruction
Authors: Bao Dingsu , Sun Jiacheng , Gong Min , Shi Jie , Qin Bo , Deng Kai , Liu Gang , Zeng Shengqiang , Xiang Zhou , Fu Shijie
Published: August 2021

The treatment of rotator cuff tear is one of the major challenges for orthopedic surgeons. The key to treatment is the reconstruction of the tendon–bone interface (TBI). Autologous platelet-rich plasma (PRP) is used as a therapeutic agent to accelerate the healing of tendons, as it contains a variety of growth factors and is easy to prepare. Graphene oxide (GO) is known to improve the physical properties of biomaterials and promote tissue repair. In this study, PRP gels containing various concentrations of GO were prepared to promote TBI healing and supraspinatus tendon reconstruction in a rabbit model. The incorporation of GO improved the ultrastructure and mechanical properties of the PRP gels. The gels containing 0.5 mg/ml GO (0.5 GO/PRP) continuously released transforming growth factor-β1 (TGF-β1) and platelet-derived growth factor (PDGF)-AB, and the released TGF-β1 and PDGF-AB were still at high concentrations, ∼1063.451 pg/ml and ∼814.217 pg/ml, respectively, on the 14th day. In vitro assays showed that the 0.5 GO/PRP gels had good biocompatibility and promoted bone marrow mesenchymal stem cells proliferation and osteogenic and chondrogenic differentiation. After 12 weeks of implantation, the magnetic resonance imaging, micro-computed tomography and histological results indicated that the newly regenerated tendons in the 0.5 GO/PRP group had a similar structure to natural tendons. Moreover, the biomechanical results showed that the newly formed tendons in the 0.5 GO/PRP group had better biomechanical properties compared to those in the other groups, and had more stable TBI tissue. Therefore, the combination of PRP and GO has the potential to be a powerful advancement in the treatment of rotator cuff injuries.
Using the catastrophe theory to discover transformative research topics
Authors: Xu Haiyun , Winnink Jos , Wu Huawei , Pang Hongshen , Wang Chao
Published: August 2021

This study approaches the identification and prediction of transformative research topics by using the concepts of catastrophe theory. Based on the evaluation model of catastrophe theory, 11 indicators were selected for four different aspects: growth rate, economic and social influence, network characteristics and the degree of uncertainty in evaluating an emerging topics’ transformative potential. The stem cell research field is used as case study. The results of this study show that there are differences between various emerging research topics (ERTs) within the stem cell research field and their potential ability to induce changes and innovation. The method developed in this article is able to identify and predict the future transformative potential of ERTs and provides reference information for scientific and technological planning, industrial policy and scientific research management.
Clinical and peculiar immunological manifestations of SARS-CoV-2 infection in systemic lupus erythematosus patients
Authors: Schioppo Tommaso , Argolini Lorenza Maria , Sciascia Savino , Pregnolato Francesca , Tamborini Francesco , Miraglia Paolo , Roccatello Dario , Sinico Renato Alberto , Caporali Roberto , Moroni Gabriella , Gerosa Maria
Published: August 2021

Objectives

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with SLE remains unclear and data on clinical manifestations after infection are lacking. The aim of this multicentre study is to describe the effect of SARS-CoV-2 in SLE patients.

Methods

SLE patients referring to four Italian centres were monitored between February 2020 and March 2021. All patients with SARS-CoV-2 infection were included. Disease characteristics, treatment, disease activity and SARS-CoV-2-related symptoms were recorded before and after the infection.

Results

Fifty-one (6.14%) SLE patients were included among 830 who were regularly followed up. Nine (17.6%) had an asymptomatic infection and 5 (9.8%) out of 42 (82.6%) symptomatic patients developed interstitial pneumonia (no identified risk factor). The presence of SLE major organ involvement (particularly renal involvement) was associated with asymptomatic SARS-CoV-2 infection (P = 0.02). Chronic corticosteroid therapy was found to be associated with asymptomatic infection (P = 0.018). Three SLE flares (5.9%) were developed after SARS-CoV-2 infection: one of them was characterized by MPO-ANCA-positive pauci-immune crescentic necrotizing glomerulonephritis and granulomatous pneumonia.

Conclusions

SARS-CoV-2 infection determined autoimmune flares in a small number of patients. Our data seem to confirm that there was not an increased risk of SARS-CoV-2 in SLE. Patients with asymptomatic SARS-CoV-2 infections were those having major SLE organ involvement. This may be explained by the high doses of corticosteroids and immunosuppressive agents used for SLE treatment.
Telemedicine in rheumatology: high specificity and sensitivity of follow-up virtual video consultations during COVID-19 pandemic
Authors: Piga Matteo , Floris Alberto , Congia Mattia , Chessa Elisabetta , Cangemi Ignazio , Cauli Alberto
Published: August 2021

Objective

To evaluate the reliability of virtual video-assisted visits, added to the tight-control strategy for inflammatory rheumatic diseases (IRDs), in identifying patients who need treatment adjustment.

Methods

Tightly followed-up adult patients with RA, PsA, AS or SLE took part in a video consultation during COVID19 lockdown and repeated the same rheumatology evaluations through a face-to-face visit within 2 weeks. The sensitivity and specificity of the virtual visits for treatment decisions (categorized as: unchanged, adjusted/escalated, tapered/discontinued, need for further examinations), and the intraclass correlation coefficient (ICC) for virtually measured disease activity and patient-reported outcomes (PROs) were calculated with 95% CIs using face-to-face visits as the reference method.

Results

In 89 out of 106 patients (84.0%), face-to-face visits confirmed the remotely delivered treatment decision. Video-visiting showed excellent sensitivity (94.1% with 95% CI: 71.3%, 99.9%) and specificity (96.7%; 95% CI: 90.8%, 99.3%) in identifying the need for treatment adjustment due to inadequate disease control. The major driver for the low sensitivity of virtual video consultation (55.6%; 95% CI: 21.2%, 86.3%) in identifying the need for treatment tapering was SLE diagnosis [odds ratio (OR) 10.0; 95% CI: 3.1, 32.3; P <0.001], mostly because of discordance with face-to-face consultation in glucocorticoid tapering. Remotely evaluated PROs showed high reliability (ICC range 0.80–0.95), while disease activity measures had less consistent data (ICC range 0.50–0.95), especially for those diseases requiring more extensive physical examination, such as in SLE and PsA.

Conclusion

Video-visiting proved to have high reliability in identifying the need for treatment adjustment and might support the IRDs standard tight-control strategy.
Gender Dynamics and Social Assistance in Chinese Villages
Authors: Yang Lichao , Walker Robert
Published: August 2021

The UN’s Sustainable Development Goals encourage states to implement social assistance as China has recently done. However, ethnography, guided by field theory, conducted in eight villages in Shanxi Province, reveals interactions between poverty, patriarchy, and migration with unanticipated consequences for social assistance and gender dynamics. Forced back to patrilocal villages by falling urban job opportunities, migrant women find employment more easily than men. They exploit their city-learned skills largely to protect their husband’s face against poverty-related shame, and to field abuse when seeking social assistance. Thus, ignoring culture when implementing social assistance can undermine its effectiveness and negatively affect women.
Making Mothers Stay at Home? Analyzing the Impact of Partisan Cueing on Attitudes Toward Maternal Employment
Authors: Neimanns Erik
Published: August 2021

After decades of value change toward more favorable views of maternal employment, the trend has slowed down and even reversed in some Western countries. This article argues that political parties play a crucial yet neglected role in shaping the trajectories of value change: the dynamics resulting from interparty competition place parties in a position to provide cues to the electorate and to actively shape attitudes toward maternal employment. Partisan cueing should become particularly relevant with a declining relevance of party competition on economic issues. The results from multilevel regression models provide empirical support for this perspective.
Family perceptions related to isolation during COVID-19 hospitalization
Authors: Eden Candace , Fowler Susan B.
Published: August 2021

During the COVID-19 pandemic, visitor limitations were implemented in hospitals and long-term-care facilities to prevent transmission of the virus from patients to family members. It is unknown how the context of visitor limitations due to COVID-19 influenced the state of emotions and experiences in family members unable to physically visit their loved ones in person during hospitalization. This article details a study of the perceptions of family members related to being isolated from patients who are hospitalized with confirmed positive COVID-19.
Nurses on the front line
Authors: Keeling Arlene W.
Published: August 2021

Due to advances in science and medicine, nursing is far different today than it was in 1918. During a pandemic, however, skilled nursing care remains critical to patient outcomes. This article identifies and describes the experiences of US nurses during the 1918 influenza pandemic and compares them to the experiences of nurses responding to the COVID-19 pandemic.
Music to reduce stress in hospitalized patients
Authors: Miller Chari R. , Patmon Frances L. , Knapp Herschel
Published: August 2021

Purpose:

To determine the impact of music on the physiologic and psychological stress experienced by hospital inpatients.

Methods:

This pilot study monitored vital signs; utilized pain, anxiety, and agitation rating scales; and gathered verbal feedback from 50 participating inpatients at the authors' healthcare facility as they listened to music via an audiovisual interactive patient engagement technology system.

Results:

After listening to music for 30 minutes, patients reported significantly lower pain and anxiety.

Conclusion:

Music offered a helpful tool to reduce pain and anxiety for patients in the ICU and telemetry units at the authors' healthcare facility. Future research may be geared toward incremental expansion and monitoring of this music intervention in other units.
In the “Shadow of Shame”: A Phenomenological Exploration of the Nature of Shame Experiences in Medical Students
Authors: Bynum William E. , W. Teunissen Pim , Varpio Lara
Published: August 2021

Purpose

Shame occurs when an individual blames a globally flawed self for a negative outcome. Much of the focus on shame in medical education has been directed toward graduate medical education with less recognition paid to shame occurring in medical school. In particular, while research has explored the triggers of medical students’ shame, little is known about what shame feels like, what it makes an individual want to do, and what perceived effects it causes. Thus, this study asks: After shame has been triggered in medical students, how is it experienced?

Method

The authors selected hermeneutic phenomenology to provide a rich description of the structures and meaning of medical students’ lived experiences of shame. Sixteen medical students from a private medical school in the United States were recruited for the study. Data were collected using one-on-one semistructured interviews and analyzed in accordance with Ajjawi and Higgs’ 6 steps of hermeneutic analysis.

Results

Data analysis yielded component parts of participants’ shame experiences, including affective feelings, physical manifestations, cognitive processes, action tendencies, and effects. Analysis of the relationships among these component parts yielded specific phenomenological structures, including patterns of shame (e.g., chronic shame, flashbacks), self-evaluative processes (e.g., battling voices, skewed frames of reference), and perceived effects of shame (e.g., isolation, psychological distress). An overarching theme of shame as a destabilizing emotion emerged across the dataset.

Conclusions

Shame is a complex emotion in medical students that, through its destabilizing effects, can lead to withdrawal, isolation, psychological distress, altered professional identity formation, and identity dissonance. The authors highlight the possibility that shame may be occurring as a response to educational trauma, present a metaphor of dominoes to conceptualize the destabilizing nature of shame, and outline the implications for individuals and institutions in medical education.
“When No One Sees You as Black”: The Effect of Racial Violence on Black Trainees and Physicians
Authors: Wyatt Tasha R. , Taylor Taryn R. , White DeJuan , Rockich-Winston Nicole
Published: August 2021

Purpose

The United States has an implicit agreement known as the racial contract that exists between white and non-white communities. Recently, the racial contract has produced much tension, expressed in racial violence and police brutality. This study explores how this racial violence and police brutality have affected the practice and education of Black trainees and physicians who are members of the racial community being targeted.

Method

This qualitative cross-sectional study interviewed 7 Black trainees and 12 physicians from 2 Southern medical schools in 2020. Interview data were collected using aspects of constructivist grounded theory, and then analyzed using the concept of racial trauma; a form of race-based stress minoritized individuals experience as a result of inferior treatment in society. Data were then organized by the causes participants cited for feeling unsafe, conditions they cited as producing these feelings, and the consequences these feelings had on their education and practice.

Results

The results show that even though participants were not direct victims of racial violence, because their social identity is linked to the Black community, they experienced these events vicariously. The increase in racial violence triggered unresolved personal and collective memories of intergenerational racial trauma, feelings of retraumatization after more than 400 years of mistreatment, and an awakening to the fact that the white community was unaware of their current and historical trauma. These events were felt in both their personal and professional lives.

Conclusions

As more minoritized physicians enter medicine and medical education, the profession needs a deeper understanding of their unique experiences and sociohistorical contexts, and the effect that these contexts have on their education and practice. While all community members are responsible for this, leaders play an important role in creating psychologically safe places where issues of systemic racism can be addressed.
Development and Validation of a Machine Learning-Based Decision Support Tool for Residency Applicant Screening and Review
Authors: Burk-Rafel Jesse , Reinstein Ilan , Feng James , Kim Moosun Brad , Miller Louis H. , Cocks Patrick M. , Marin Marina , Aphinyanaphongs Yindalon
Published: August 2021

Purpose

Residency programs face overwhelming numbers of residency applications, limiting holistic review. Artificial intelligence techniques have been proposed to address this challenge but have not been created. Here, a multidisciplinary team sought to develop and validate a machine learning (ML)-based decision support tool (DST) for residency applicant screening and review.

Method

Categorical applicant data from the 2018, 2019, and 2020 residency application cycles (n = 8,243 applicants) at one large internal medicine residency program were downloaded from the Electronic Residency Application Service and linked to the outcome measure: interview invitation by human reviewers (n = 1,235 invites). An ML model using gradient boosting was designed using training data (80% of applicants) with over 60 applicant features (e.g., demographics, experiences, academic metrics). Model performance was validated on held-out data (20% of applicants). Sensitivity analysis was conducted without United States Medical Licensing Examination (USMLE) scores. An interactive DST incorporating the ML model was designed and deployed that provided applicant- and cohort-level visualizations.

Results

The ML model areas under the receiver operating characteristic and precision recall curves were 0.95 and 0.76, respectively; these changed to 0.94 and 0.72, respectively, with removal of USMLE scores. Applicants’ medical school information was an important driver of predictions—which had face validity based on the local selection process—but numerous predictors contributed. Program directors used the DST in the 2021 application cycle to select 20 applicants for interview that had been initially screened out during human review.

Conclusions

The authors developed and validated an ML algorithm for predicting residency interview offers from numerous application elements with high performance—even when USMLE scores were removed. Model deployment in a DST highlighted its potential for screening candidates and helped quantify and mitigate biases existing in the selection process. Further work will incorporate unstructured textual data through natural language processing methods.
Eco-Normalization: Evaluating the Longevity of an Innovation in Context
Authors: Hamza Deena M. , Regehr Glenn
Published: August 2021

Purpose

When initiating an educational innovation, successful implementation and meaningful, lasting change can be elusive. This elusiveness stems from the difficulty of introducing changes into complex ecosystems. Program evaluation models that focus on implementation fidelity examine the inner workings of an innovation in the real-world context. However, the methods by which fidelity is typically examined may inadvertently limit thinking about the trajectory of an innovation over time. Thus, a new approach is needed, one that focuses on whether the conditions observed during the implementation phase of an educational innovation represent a foundation for meaningful, long-lasting change.

Method

Through a critical review, authors examined relevant models from implementation science and developed a comprehensive framework that shifts the focus of program evaluation from exploring snapshots in time to assessing the trajectory of an innovation beyond the implementation phase.

Results

Durable and meaningful “normalization” of an innovation is rooted in how the local aspirations and practices of the institutional system and the people doing the work interact with the grand aspirations and features of the innovation. Borrowing from Normalization Process Theory, the Consolidated Framework for Implementation Research, and Reflexive Monitoring in Action, the authors developed a framework, called Eco-Normalization, that highlights 6 critical questions to be considered when evaluating the potential longevity of an innovation.

Conclusions

When evaluating an educational innovation, the Eco-Normalization model focuses our attention on the ecosystem of change and the features of the ecosystem that may contribute to (or hinder) the longevity of innovations in context.
Clinical Empathy for the Surgical Patient: Lessons From W.H. Auden’s Prose and Poetry
Authors: Kamhi Sophie V. , Begunova Yelyzaveta , Tang Sunny , Rodríguez Jiménez Roberto S. , Soybel David I.
Published: August 2021

Clinical empathy is a professional skill, representing a conscious commitment to showing patients that they are heard, understood, and accepted. Here, we explore ways in which masters of language, such as the mid-20th century poet W. H. Auden, use prose and poetry to teach us the patient’s expectations of a truly empathic physician and surgeon.
Implementing Oral Care as a Nursing Intervention to Reduce Hospital-Acquired Pneumonia Across the United States Department of Veterans Affairs Healthcare System
Authors: Munro Shannon , Phillips Toni , Hasselbeck Rachael , Lucatorto Michelle A. , Hehr Andrew , Ochylski Sheila
Published: August 2021

Hospital-acquired pneumonia is a preventable complication. The primary source of pneumonia among hospitalized and long-term care residents is aspiration of bacteria present in the oral biofilm. Reducing the bacterial burden in the mouth through consistent oral care is associated with a reduction in the incidence of hospital-acquired pneumonia. Following a significant reduction in pneumonia among non-ventilated patients in the research pilots, the Veterans Health Administration deployed the evidence-based, nurse-led oral care intervention called Hospital Acquired Pneumonia Prevention by Engaging Nurses as quality improvement nationwide. In this article, nursing informatics experts on the team describe the design and implementation of process and outcome measures of Hospital-Acquired Pneumonia Prevention by Engaging Nurses and outline lessons learned. The team used standardized terms and observations embedded within the EHR documentation templates to measure the oral care intervention in acute care areas. They also developed a tracking system for hospital-acquired pneumonia cases among non-ventilated patients. In addition to improving patient safety and care quality, Hospital-Acquired Pneumonia Prevention by Engaging Nurses links evidence-based practice with nursing informatics principles to generate numerous opportunities to measure the value of nursing at the point of care. This initiative was reported using SQUIRE 2.0: Standards for QUality Improvement Reporting Excellence.
Desmoplakin and clinical manifestations of desmoplakin cardiomyopathy
Authors: Yuan Zhong-Yu , Cheng Li-Ting , Wang Ze-Feng , Wu Yong-Quan
Published: August 2021

Desmoplakin (DSP), encoded by the DSP gene, is the main desmosome component and is abundant in the myocardial tissue. There are three DSP isoforms that assume the role of supporting structural stability through intercellular adhesion. It has been found that DSP regulates the transcription of adipogenic and fibrogenic genes, and maintains appropriate electrical conductivity by regulating gap junctions and ion channels. DSP is essential for normal myocardial development and the maintenance of its structural functions. Studies have suggested that DSP gene mutations are associated with a variety of hereditary cardiomyopathy, such as arrhythmia cardiomyopathy, dilated cardiomyopathy (DCM), left ventricular noncompaction, and is also closely associated with the Carvajal syndrome, Naxos disease, and erythro-keratodermia-cardiomyopathy syndrome with skin and heart damage. The structure and function of DSP, as well as the clinical manifestations of DSP-related cardiomyopathy were reviewed in this article.
Combination strategies of immunotherapy in non-small cell lung cancer: facts and challenges
Authors: Li Chu-Ling , Song Yong
Published: August 2021

Immunotherapy has dramatically altered the treatment of non-small cell lung cancer. Currently, the emergence of combination strategies in immunotherapy has brightened the prospects of improved clinical outcomes and manageable safety profiles in the first/second-line settings. However, sub-optimal response rates are still observed in several clinical trials. Hence, alternative combination models and candidate selection strategies need to be explored. Herein, we have critically reviewed and commented on the published data from several clinical trials, including combined immunotherapy and chemotherapy, anti-angiogenic agents, epidermal growth factor receptor/anaplastic lymphoma kinase tyrosine kinase inhibitors, radiotherapy, and other immune checkpoint inhibitors.
Impact of Surgeon Type and Rurality on Treatment and Survival of Ovarian Cancer Patients
Authors: Weeks Kristin S. , Lynch Charles F. , West Michele M. , Carnahan Ryan M. , O’Rorke Michael A. , Oleson Jacob J. , McDonald Megan E. , Charlton Mary E.
Published: August 2021

Background:

National Comprehensive Cancer Network guidelines recommend ovarian cancer patients receive cancer-directed surgery from a gynecologic oncologist surgeon. We aimed to determine if rurality impacts type of surgeon and estimate if the interaction between rurality and type of surgeon impacts cytoreductive surgery, chemotherapy initiation, and survival.

Methods:

Our population-based cohort of Iowan (N=675) ovarian cancer patients included women diagnosed with histologically confirmed stages IB-IV cancer in 2010 to 2016 at the ages of 18 to 89 years old and who received cancer-directed surgery in Iowa. Multivariable logistic regression analysis and Cox proportional hazards models were used.

Results:

Rural (vs. urban) patients were less likely to receive surgery from a gynecologic oncologist (adjusted odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.30-0.78). Rural patients with a gynecologic oncologist (vs. nongynecologic oncologist) surgeon were more likely to receive cytoreduction (OR: 2.84; 95% CI: 1.31-6.14) and chemotherapy (OR: 4.22; 95% CI: 1.82-9.78). Gynecologic oncologist-provided surgery conferred a 3-year cause-specific survival advantage among rural patients (adjusted hazard ratio: 0.57; 95% CI: 0.33-0.97) and disadvantage among urban patients (hazard ratio: 1.77; 95% CI: 1.02-3.06) in the model without treatment covariates. Significance dissipated in models with treatment variables.

Discussion:

The variation in the gynecologic oncologist survival advantage may be because of treatment, referral, volume, or nongynecologic oncologist surgeons’ specialty difference by rurality. This is the first study to investigate the ovarian cancer survival advantage of having a gynecologic oncologist surgeon by rurality.
SARS-CoV-2: An Empirical Investigation of Rose’s Population-based Logic
Authors: Bruckner Tim , Das Abhery , Singh Parvati , Boden-Albala Bernadette
Published: August 2021

Background:

Geoffrey Rose’s paper “Sick Individuals, Sick Populations” highlights the counterintuitive finding that the largest share of morbidity arises from populations engaging in low- to moderate-risk behavior. Scholars refer to this finding as the prevention paradox. We examine whether this logic applies to SARS-CoV-2 infected persons considered low to moderate risk.

Methods:

We conducted a population-representative survey and sero-surveillance study for SARS-CoV-2 among adults in Orange County, California. Participants answered questions about health behaviors and provided a finger-pin-prick sample from 10 July to 16 August 2020.

Results:

Of the 2979 adults, those reporting low- and moderate-risk behavior accounted for between 78% and 92% of SARS-CoV-2 infections. Asymptomatic individuals, as well as persons with low and moderate scores for self-reported likelihood of having had SARS-CoV-2, accounted for the majority of infections.

Conclusions:

Our findings support Rose’s logic, which encourages public health measures among persons who self-identify as unlikely to have SARS-CoV-2. See video abstract at, http://links.lww.com/EDE/B860.
Reference values of central blood pressure and central haemodynamic parameters and their relationship with cardiovascular risk factors in a Spanish population: early vascular ageing study
Authors: Gómez-Sánchez Marta , Gómez-Sánchez Leticia , Patino-Alonso Carmen , Recio-Rodríguez Jose I. , Alonso-Domínguez Rosario , Sánchez-Aguadero Natalia , Sánchez Cristina Lugones , Sánchez Emiliano Rodríguez , García-Ortiz Luis , Gomez-Marcos Manuel A.
Published: August 2021

Objectives:

Central blood pressure (BP) predicts mortality independent of office brachial BP. The aim was to describe reference values for central blood pressure and pulsatile hemodynamic parameters, and their relationship with cardiovascular risk factors in an adult Spanish population without cardiovascular disease.

Methods:

Cross-sectional study. We included 501 participants stratified by age and sex by random sampling, with a mean age of 56 years (50.3% women). The SphygmoCor System device's pulse wave analysis software was used to perform the measurements.

Results:

The following values were obtained: central blood pressure median (109/76 mmHg), central pulse pressure (33 mmHg), pulse pressure amplification (8.5 mmHg), ejection duration (130 ms) and subendocardial viability ratio (163%). All parameters were greater in men, except heart rate and ejection duration. In the logistic regression analysis, controlled for age, sex and taking antihypertensive drugs, being hypertensive was associated with cSBP (OR = 1.265), cDBP (OR = 1.307), cPP (OR = 1.067), pulse wave amplification (OR = 1.034) and SEVR (OR = 0.982); being diabetic was associated with SEVR (OR = 0.982); being obese was associated with cSBP (OR = 1.028) and cDBP (OR = 1.058) and being a smoker was associated with ejection duration (OR = 0.980) and SEVR (OR = 0.984).

Conclusion:

This study provides reference values for central blood pressure and parameters derived from the pulse wave analysis in a random sample of the Spanish population. The only risk factor that is not associated with any of the parameters analysed is dyslipidaemia.

Trial registration number:

https://clinicaltrials.gov/ct2/show/NCT02623894
Oxidative stress is associated with characteristic features of the dysfunctional chronic pain phenotype
Authors: Bruehl Stephen , Milne Ginger , Schildcrout Jonathan , Shi Yaping , Anderson Sara , Shinar Andrew , Polkowski Gregory , Mishra Puneet , Billings Frederic T.
Published: August 2021

The dysfunctional chronic pain (Dysfunctional CP) phenotype is an empirically identifiable CP subtype with unclear pathophysiological mechanisms that cuts across specific medical CP diagnoses. This study tested whether the multidimensional pain and psychosocial features that characterize the dysfunctional CP phenotype are associated broadly with elevated oxidative stress (OS). Measures of pain intensity, bodily extent of pain, catastrophizing cognitions, depression, anxiety, sleep disturbance, pain interference, and function were completed by 84 patients with chronic osteoarthritis before undergoing total knee arthroplasty. Blood samples were obtained at the initiation of surgery before incision or tourniquet placement. Plasma levels of F2-isoprostanes and isofurans, the most highly specific measures of in vivo OS, were quantified using gas chromatography/negative ion chemical ionization mass spectrometry. The results indicated that controlling for differences in age, sex, and body mass index, higher overall OS (mean of isoprostanes and isofurans) was associated with significantly (P< 0.05) greater pain intensity, more widespread pain, greater depressive symptoms and pain catastrophizing, higher pain interference, and lower function. OS measures were not significantly associated with sleep disturbance or anxiety levels (P>0.10). The results build on prior case-control findings suggesting that presence of a CP diagnosis is associated with elevated OS, highlighting that it may specifically be individuals displaying characteristics of the dysfunctional CP phenotype who are characterized by elevated OS. Clinical implications of these findings remain to be determined.
Evaluation of placebo fidelity and trial design methodology in placebo-controlled surgical trials of musculoskeletal conditions: a systematic review
Authors: Anderson David B. , Beard David J. , Sabet Tamer , Eyles Jillian P. , Harris Ian A. , Adie Sam , Buchbinder Rachelle , Maher Christopher G. , Ferreira Manuela L.
Published: August 2021

The number of placebo surgical trials on musculoskeletal conditions is increasing, but little is known about the quality of their design and methods. This review aimed to (1) assess the level of placebo fidelity (ie, degree to which the placebo control mimicked the index procedure) in placebo trials of musculoskeletal surgery, (2) describe the trials' methodological features using the adapted Applying Surgical Placebo in Randomised Evaluations (ASPIRE) checklist, and (3) describe each trial's characteristics. We searched 4 electronic databases from inception until February 18, 2021, for randomised trials of surgery that included a placebo control for any musculoskeletal condition. Protocols and full text were used to assess placebo fidelity (categorised as minimal, low, or high fidelity). The adapted 26-item ASPIRE checklist was also completed on each trial. PROSPERO registration number: CRD42021202131. A total of 30,697 studies were identified in the search, and 22 placebo-controlled surgical trials of 2045 patients included. Thirteen trials (59%) included a high-fidelity placebo control, 7 (32%) used low fidelity, and 2 (9%) minimal fidelity. According to the ASPIRE checklist, included trials had good reporting of the “rationale and ethics” (68% overall) and “design” sections (42%), but few provided enough information on the “conduct” (13%) and “interpretation and translation” (11%) of the placebo trials. Most trials sufficiently reported their rationale and ethics, but interpretation and translation are areas for improvement, including greater stakeholder involvement. Most trials used a high-fidelity placebo procedure suggesting an emphasis on blinding and controlling for nonspecific effects.
The Pancreatitis Activity Scoring System Predicts Clinical Outcomes in Patients With Infected Pancreatic Necrosis
Authors: Thiruvengadam Nikhil R. , Miranda Janille , Kim Christopher , Behr Spencer , Arain Mustafa A.
Published: August 2021

Objectives

The Pancreatitis Activity Scoring System (PASS) is an objective tool validated in acute pancreatitis but not in infected pancreatic necrosis (IPN). Our aim was to evaluate the role of PASS in IPN.

Methods

We performed a retrospective cohort study of IPN patients admitted to the University of California, San Francisco from January 2011 to March 2019. Daily PASS scores were calculated for each patient. Receiver operator characteristic analysis was used to define the optimal cutoff PASS score to predict outcomes. The primary and secondary outcomes were 72 hours postintervention multiorgan failure (MOF) and early readmission (within 30 days), respectively.

Results

One hundred and four patients underwent intervention (median age, 55 years). Thirty-five patients (33.6%) developed MOF postintervention. A 72-hour postintervention PASS greater than 250 was strongly associated with postintervention MOF (area under curve, 0.87; adjusted odds ratio, 26.83; 95% confidence interval, 6.37–112.86; P < 0.001). Discharge PASS greater than 150 was associated with 30-day readmission (area under curve, 0.82; adjusted odds ratio, 26.44; 95% confidence interval, 8.48–82.43; P < 0.001).

Conclusions

The PASS score was associated with postintervention clinical outcomes and early readmission, suggesting it is a valid measure of disease activity in patients with IPN. Further prospective validation of PASS in IPN is needed.
Immunoglobulin G4-Related Disease Responder Index Correlates With the Risk of 1-Year Relapse in Type 1 Autoimmune Pancreatitis
Authors: Rogger Teresa Marzia , De Marchi Giulia , Brozzi Lorenzo , Amodio Antonio , Orsolini Giovanni , de Pretis Nicolò , Conti Bellocchi Maria Cristina , Crinò Stefano Francesco , Gabbrielli Armando , Ciccocioppo Rachele , Frulloni Luca
Published: August 2021

Objectives

Type 1 autoimmune pancreatitis (AIP) is a manifestation of immunoglobulin G4–related diseases (IgG4-RD). To evaluate the activity of the disease, the IgG4-RD responder index (RI) has been created. This study evaluated the IgG4-RD RI as prognostic factor of 1-year disease relapse.

Methods

Patients diagnosed with type 1 AIP between January 2012 and December 2016, with available magnetic resonance imaging and IgG4 dosage, were enrolled. Immunoglobulin G4-RD RI was calculated at baseline (time 0), and at 3 to 6 and 12 to 18 months after the end of steroid therapy (time 1 and time 2, respectively).

Results

Thirty-three patients were included in the study. Immunoglobulin G4-RD RI was 8.9 (standard deviation [SD], 3.8) at time 0, 2.4 (SD, 3.1) at time 1 (P < 0.0001 vs time 0), and 4.2 (SD, 3.9) at time 2 (P = 0.02 vs time 1). Fourteen patients who relapsed within 1 year showed a higher mean value of IgG4-RD RI at time 0 (10.9; SD, 4.3) versus 19 who did not (7.4; SD, 2.6; P = 0.012). This difference was observed also at time 2 (6.8 vs 2.1; P = 0.002).

Conclusions

Immunoglobulin G4-RD RI correlates with type 1 AIP disease activity, and it predicts disease relapse within 1 year.
Gemcitabine Plus Nab-Paclitaxel Versus FOLFIRINOX in Locally Advanced, Unresectable Pancreatic Cancer
Authors: Arima Shiho , Kawahira Machiko , Shimokawa Mototsugu , Ido Akio , Koga Futa , Ueda Yujiro , Nakazawa Junichi , Komori Azusa , Otsu Satoshi , Fukahori Masaru , Makiyama Akitaka , Taguchi Hiroki , Honda Takuya , Shibuki Taro , Mitsugi Kenji , Nio Kenta , Ide Yasushi , Ureshino Norio , Mizuta Toshihiko , Shirakawa Tsuyoshi , Otsuka Taiga
Published: August 2021

Objectives

FOLFIRINOX (FFX, a combination of oxaliplatin, irinotecan, fluorouracil, and leucovorin) and gemcitabine plus nab-paclitaxel (GnP) have been used as standard, first-line treatments for advanced pancreatic cancer. However, no study has compared the efficacy of the 2 regimens. This study retrospectively compared the efficacy and safety of the 2 regimens in patients with locally advanced pancreatic cancer.

Methods

We reviewed the records of patients with locally advanced pancreatic cancer who started FFX or GnP as first-line chemotherapy as part of a multicenter retrospective study in patients with unresectable pancreatic cancer treated with FFX or GnP (NAPOLEON study).

Results

Sixteen of the 63 patients were treated with FFX, and the other 47 patients were treated with GnP between December 2013 and March 2017. There were no significant differences in median overall survival rate between the GnP (15.5 months) and FFX (14.3 months, P = 0.60) groups or median progression-free survival rate between the GnP (8.8 months) and FFX (8.1 months, P = 0.51) groups. Both treatments were generally well tolerated, although anorexia was more severe in the FFX group than in the GnP group.

Conclusions

The effects of FFX and GnP were similar but resulted in different toxicities, which could guide agent choice.
Mucous Fistula Refeeding Promotes Earlier Enteral Autonomy in Infants With Small Bowel Resection
Authors: Woods Sean D. , McElhanon Barbara O. , Durham Megan M. , Figueroa Janet , Piazza Anthony J.
Published: August 2021

Objective:

Infants requiring intestinal resection because of necrotizing enterocolitis (NEC) or small bowel atresia (SBA) may benefit from mucous fistula refeeding (MFR) of enterostomy output to improve nutrition and bowel adaptation before reanastomosis. Previous series demonstrated improved outcomes with MFR but did not account for varied patient characteristics as potential sources of bias. We performed a cohort analysis using multivariable adjusted models to compare outcomes of patients with and without MFR.

Methods:

Retrospective chart review was performed for patients with NEC or SBA and small bowel resection with enterostomy and MF. Demographic and outcome data was compared between MFR and non‐MFR groups using adjusted multivariable analysis for potential confounding variables.

Results:

MFR was performed in 65 of 101 patients (64%), including 45 of 75 patients with NEC and 20 of 26 patients with SBA. Reasons for not receiving MFR included bowel stricture, technical limitation, or not otherwise specified. NEC patients receiving MFR had 14 fewer days to achieve full enteral feeds after intestinal reconnection, 22 fewer days of parenteral nutrition, lower peak direct bilirubin by 2.4 mg/dL, and 77% less odds of ursodiol use (all P < 0.01). SBA patients had similar trends not reaching statistical significance. Growth parameters were improved in MFR groups. There were no complications or increased infections from MFR.

Conclusions:

This study suggests that MFR safely improves nutritional outcomes in infants with intestinal resection, related to decreased total parenteral nutrition (TPN) dependence and earlier enteral autonomy.
The Academic-Practice Partnership
Authors: Robertson Bethany , McDermott Carrie , Star Jessica , Clevenger Carolyn K.
Published: August 2021

Strong partnerships are essential to lead the innovative change needed to prepare future nurses who demonstrate quality and safety competence. Successful models involve senior leadership, a shared vision, mutual goals, mutual respect, and an access to shared knowledge. The academic-practice partnership between a private university-based school of nursing and its affiliated health care system facilitated the implementation of a new Accelerated Bachelor of Science in Nursing (ABSN) program track to provide a seamless education to practice pathway for graduate nurses educated with quality and safety competencies and to meet the workforce demands of the health care system. The academic-practice model is based on the Guiding Principles outlined by the American Association of Colleges of Nursing-American Organization of Nurse Leaders (AACN-AONL) Task Force on Academic Practice Partnerships. As a result of this partnership, 84% of the program's graduates accepted a position with the health care partner as an advanced medical-surgical nurse, and student outcomes in quality and safety competencies were encouraging.
Reliability and Role of Mutation-specific H3F3A (Histone 3-3) G34W Immunohistochemistry to Differentiate Giant Cell Tumor of Bone From its Clinicoradiologic and Histologic Mimics: An Institutional Study
Authors: Pasricha Sunil , Pruthi Manish , Jajodia Ankush , Kumar Ankur , Gupta Gurudutt , Sharma Anila , Tiwari Akshay , Rohela Himanshu , Durga Garima , Kamboj Meenakshi , Koyyala Venkata P.B. , Mehta Anurag
Published: August 2021

Giant cell tumor of bone (GCTB) is a benign neoplasm, which can sometimes be a diagnostic challenge, especially in small biopsies, due to its histologic benign and malignant mimics. We evaluated the role of H3.3 G34W immunohistochemistry (IHC) antibody in diagnosing GCTB and its role in differentiating it from its close histologic mimics. A total of 120 cases (80 cases of GCTB and 40 cases of histologic mimics) were retrieved and subjected to IHC. Of 80 cases of GCTB, 72 cases showed a positive nuclear immunoexpression, while all 40 cases of histologic mimics of GCTB showed a negative staining for H3.3 G34W IHC. Sensitivity and specificity of this mutation-specific antibody for diagnosis of GCTB was 90% and 100%, respectively, while, the positive predictive value and the negative predictive value were 100% and 83.3%, respectively. A positive expression of H3.3 G34W was seen in all 5 cases of GCTB, postdenosumab therapy, as well as, in all 3 cases of malignant giant cell tumor. The presented study showed that H3.3 G34W mutation-specific IHC is a reliable and specific marker for GCTB and can help distinguish it from the histologic mimics due to distinct therapeutic implications.
Barriers to Universal Suicide Risk Screening for Youth in the Emergency Department
Authors: Seag Dana E. M. , Cervantes Paige E. , Baroni Argelinda , Gerson Ruth , Knapp Katrina , Tay Ee Tein , Wiener Ethan , Horwitz Sarah McCue
Published: August 2021

Objective

Given the increasing rates of youth suicide, it is important to understand the barriers to suicide screening in emergency departments. This review describes the current literature, identifies gaps in existing research, and suggests recommendations for future research.

Methods

A search of PubMed, MEDLINE, CINAHL, PsycInfo, and Web of Science was conducted. Data extraction included study/sample characteristics and barrier information categorized based on the Exploration, Preparation, Implementation, Sustainment model.

Results

All studies focused on inner context barriers of implementation and usually examined individuals' attitudes toward screening. No study looked at administrative, policy, or financing issues.

Conclusions

The lack of prospective, systematic studies on barriers and the focus on individual adopter attitudes reveal a significant gap in understanding the challenges to implementation of universal youth suicide risk screening in emergency departments.
Resource Utilization During Low-Acuity Pediatric Emergency Department Visits
Authors: Li Joyce , Ramgopal Sriram , Marin Jennifer R.
Published: August 2021

Objectives

The aims of the study were to estimate testing and treatment rates among pediatric low-acuity emergency department (ED) visits and to compare testing and treatment patterns at general and pediatric-specific EDs.

Methods

We performed a cross-sectional study of triage level 4 or 5 pediatric visits from a complex survey of nonfederal US EDs from 2008 to 2017. We analyzed demographics, vital signs, disposition, testing, and treatment. We calculated proportions for each data element and used χ2tests to determine differences between general and pediatric EDs.

Results

There were an estimated 306.2 million pediatric visits with 129.1 million acuity level 4 or 5 visits (57.2%; 95% confidence interval, 55.4%–58.9%), with diagnostic testing performed in 47.1% and medications administered in 69.6% of the visits. Most low-acuity visits (82.0%) were to general EDs. Tests performed more frequently in general EDs compared with pediatric EDs included radiographs (25.8% vs 15.7%,P< 0.01), complete blood count (6.4% vs 3.9%,P< 0.01), electrolytes (11.6% vs 3.7%,P< 0.01), and glucose (2.0% vs 0.9%,P< 0.01). Ultrasound was used less frequently in general EDs (0.5 vs 0.7,P< 0.01). There were similar rates of intravenous fluid and overall medication administration and a higher proportion of patients receiving antibiotics in general EDs (28.7% vs 23.8%,P< 0.01).

Conclusions

More than half of pediatric visits to the ED are low acuity. Although general EDs relied on more imaging, blood testing and antibiotics, and pediatric EDs on ultrasound, overall resource utilization was high in this population across both ED types and can likely be reduced.