bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of radiotherapy combined with immune checkpoint inhibitors in patients with melanoma: a systemic review and meta-analysis
Authors: Yin Gaofei , Guo Wei , Huang Zhigang , Chen Xiaohong
Published: February 2022

The purpose of this study is to review the efficacy of radiotherapy combined with immune checkpoint inhibitors (ICIs) in the treatment of melanoma and systematically evaluate the efficacy and safety of this combined treatment compared with ICIs alone. We searched a number of online databases up to 1 July 2021. Comprehensive Meta-Analysis 2.0 and RevMan 5.0 were used for summary analysis. The overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and treatment adverse effects (AEs) were calculated. In total, 624 patients were included from 12 studies, including nine published studies and the results of three clinical trials. Radiotherapy combined with ICIs had a higher ORR compared with ICIs alone (35.00 vs. 20.39%). In terms of survival effect, radiotherapy combined with ICIs had no obvious advantage in OS. There was no statistically significant difference between 6-month and 12-month OS (P = 0.13; P = 0.69). There was no significant difference in PFS at 6 months (P = 0.08), but there was a significant difference in PFS at 12 months (P = 0.005). For patients with melanoma, radiotherapy combined with ICIs can improve the effective rate of treatment. Although there is no obvious OS advantage, it can improve PFS without serious adverse effects. Most of the studies included in this article are retrospective analyses, and there are few randomized controlled studies at present. Therefore, more prospective studies are still needed to explore the efficacy of radiotherapy combined with immunotherapy in melanoma.
What Role do Mitochondria Have in Diastolic Dysfunction? Implications for Diabetic Cardiomyopathy and Heart Failure With Preserved Ejection Function
Authors: McCandless Martin G. , Altara Raffaele , Booz George W. , Kurdi Mazen
Published: February 2022

Diastolic dysfunction is common to both diabetic cardiomyopathy and heart failure with preserved ejection fraction (HFpEF). Although commonly attributed to increased fibrosis, alterations in mitochondrial function and associated Ca2+ handling may contribute to impaired cardiac function. With mitochondrial dysfunction, increased reactive oxygen species (ROS), inflammation, and decreased adenosine triphosphate/adenosine diphosphate ratio may lead to increased extracellular matrix and diminished contractile relaxation. In this article, we discuss recent research implicating deficient mitochondria-associated endoplasmic reticulum membranes (MAMs) as it relates to impaired metabolic function and what role that may have in diastolic dysfunction in diabetic cardiomyopathy. The contribution of mitochondrial dysfunction to diastolic dysfunction in HFpEF is less established, but equally credible based on preclinical studies. However, there are notable differences between diabetic cardiomyopathy and HFpEF. Recent evidence implicates impaired endoplasmic reticulum signaling, in particular the unfolded protein response (UPR), in the pathogenesis of HFpEF. With HFpEF, enhanced pressure on the mitochondrial “gas pedal” because of increased cytosolic Ca2+ may perturb mitochondrial homeostasis. For diabetic cardiomyopathy and HFpEF, a better understanding of how altered cellular ion and redox status affect mitochondrial function is needed. Finally, we discuss the implications that mitochondrial dysfunction may have in devising novel therapeutic strategies for diabetic cardiomyopathy and HFpEF.
Effect of Channel Assembly (KCNQ1 or KCNQ1 + KCNE1) on the Response of Zebrafish IKs Current to IKs Inhibitors and Activators
Authors: Haverinen Jaakko , Hassinen Minna , Vornanen Matti
Published: February 2022

In cardiac myocytes, the slow component of the delayed rectifier K+ current (IKs) ensures repolarization of action potential during beta-adrenergic activation or when other repolarizing K+ currents fail. As a key factor of cardiac repolarization, IKs should be present in model species used for cardiovascular drug screening, preferably with pharmacological characteristics similar to those of the human IKs. To this end, we investigated the effects of inhibitors and activators of the IKs on KCNQ1 and KCNQ1 + KCNE1 channels of the zebrafish, an important model species, in Chinese hamster ovary cells. Inhibitors of IKs, chromanol 293B and HMR-1556, inhibited zebrafish IKs channels with approximately similar potency as that of mammalian IKs. Chromanol 293B concentration for half-maximal inhibition (IC50) of zebrafish IKs was at 13.1 ± 5.8 and 13.4 ± 2.8 µM for KCNQ1 and KCNQ1+KCNE1 channels, respectively. HMR-1556 was a more potent inhibitor of zebrafish IKs channels with IC50 = 0.1 ± 0.1 µM and 1.5 ± 0.8 µM for KCNQ1 and KCNQ1 + KCNE1 channels, respectively. R-L3 and mefenamic acid, generally identified as IKs activators, both inhibited zebrafish IKs. R-L3 almost completely inhibited the current generated by KCNQ1 and KCNQ1 + KCNE1 channels with similar potency (IC50 1.1 ± 0.4 and 1.0 ± 0.4 µM, respectively). Mefenamic acid partially blocked zebrafish KCNQ1 (IC50 = 9.5 ± 4.8 µM) and completely blocked KCNQ1 + KCNE1 channels (IC50 = 3.3 ± 1.8 µM). Although zebrafish IKs channels respond to IKs inhibitors in the same way as mammalian IKs channels, their response to activators is atypical, probably because of the differences in the binding domain of KCNE1 to KCNQ1. Therefore, care must be taken when translating the results from zebrafish to humans.
Exercise and Quality-of-Life Outcomes of Two Versus Three Weekly Sessions of Pulmonary Rehabilitation
Authors: Li Guanhua , Roberts Mary , Wheatley John , Leung Winnie , Harding Elise , Liu Abby , Boehm Christiane , Sausa Christine , Cho Jin-Gun
Published: February 2022

Purpose:

This study aimed to assess whether there are differences in exercise or health-related quality-of-life (HRQoL) outcomes following twice-weekly supervised sessions of pulmonary rehabilitation (PR) compared with three times weekly over an 8-wk program in patients with chronic obstructive pulmonary disease (COPD).

Methods:

We conducted a quasi-experimental, single-center observational study using 198 subjects who completed two supervised PR sessions (intervention group) compared with 208 historical controls who completed three weekly sessions. We assessed between-group differences in outcomes after balancing groups using inverse probability of treatment weighting (IPTW) of propensity scores, followed by regression adjustment.

Results:

Both groups achieved clinically and statistically significant improvements in exercise and HRQoL following the PR program. After IPTW and regression adjustment, the intervention group had a lower post-PR 6-min walk time by 1.2: 95% CI, −12.9 to 10.5 m (P = .84), compared with the control group. Although post-PR COPD Assessment Test (CAT) scores decreased in both groups, the intervention group had a higher post-PR CAT score by 1.5: 95% CI, 0.37 to 2.66 a.u. (P = .01), compared with the control group. All other HRQoL measures failed to reach statistical significance. None of the between-group differences reached minimal clinically important differences for COPD.

Conclusions:

Our findings support current international guidelines for twice-weekly supervised PR sessions combined with unsupervised home exercise sessions. We conclude there is no disadvantage in running a PR program for patients with COPD using twice-weekly supervised sessions compared with three times weekly supervised sessions.
Cardiorespiratory Fitness, Inflammation, and Risk of Chronic Obstructive Pulmonary Disease in Middle-Aged Men
Authors: Kunutsor Setor K. , Jae Sae Young , Mäkikallio Timo H. , Laukkanen Jari A.
Published: February 2022

Purpose:

Chronic obstructive pulmonary disease (COPD) is characterized by chronic lung inflammation. The relationship between cardiorespiratory fitness (CRF) and COPD has not been well characterized. We aimed to evaluate the independent and joint associations of inflammation (high-sensitivity C-reactive protein [hsCRP]) and CRF with COPD risk in a cohort of White men.

Methods:

Among 2274 men aged 42-61 yr at baseline, serum hsCRP level was measured using an immunometric assay and CRF was assessed using a respiratory gas exchange analyzer. The level of hsCRP was categorized as normal and high (≤3 and >3 mg/L, respectively) and CRF as low and high. We corrected for within-person variability in exposures using repeat measurements taken several years apart.

Results:

A total of 116 COPD cases occurred during a median follow-up of 26.0 yr. The age-adjusted regression dilution ratio of hsCRP and CRF was 0.57 (95% CI, 0.50-0.64) and 0.58 (95% CI, 0.53-0.64), respectively. Comparing high versus normal hsCRP levels, the multivariable-adjusted HR for COPD was 1.79 (95% CI, 1.20-2.68). The COPD risk decreased linearly with increasing CRF. The multivariable-adjusted HR for COPD per 1-SD increase in CRF was 0.75 (95% CI, 0.60-0.95). Compared with men with normal hsCRP-low CRF, high hsCRP-low CRF was associated with an increased COPD risk, 1.80 (95% CI, 1.12-2.89), with no evidence of an association for high hsCRP-high CRF and COPD risk, 1.35 (95% CI, 0.68-2.69).

Conclusions:

Both hsCRP and CRF are associated with COPD risk in middle-aged men. However, high CRF levels attenuate the increased COPD risk related to high hsCRP levels.
Tuck-in deep anterior lamellar keratoplasty for the management of post-radial keratotomy keratectasia
Authors: Nagpal Ritu , Sharma Namrata , Bafna Rahul Kumar , Muraleekrishna Manu , Vajpayee Rasik Bihari
Published: February 2022

Purpose:

To evaluate the outcomes of tuck-in deep anterior lamellar keratoplasty (DALK) for the management of post-radial keratotomy (RK) keratectasia.

Setting:

Institution.

Design:

Retrospective.

Methods:

Medical records of all cases presenting with post-RK keratectasia from January 2012 to December 2019 were included. Data on corrected distance visual acuity (CDVA), refraction, keratometry, ultrasonic pachymetry, corneal topography, endothelial cell count, applanation tonometry, and dilated fundus examination recorded at all follow-up visits were included. Details of surgical steps, including intraoperative and postoperative complications and any secondary procedures performed subsequently, were also recorded.

Results:

7 eyes of 5 patients that developed corneal ectasia after a previous RK procedure underwent DALK with peripheral tuck-in. All eyes had CDVA ≤6/24, preoperatively. The surgical procedure was successfully performed in all eyes without any intraoperative complications. CDVA at the final follow-up ranged between 6/9 and 6/60, with 6 eyes achieving CDVA of 6/18 or better. The median keratometric cylinder reduced from a preoperative value of 7.2 ± 9.27 diopters (D) to 2 ± 1.83 D at the final follow-up. The median central corneal thickness at the final follow-up was 598 ± 40.01 μm, and spherical equivalent ranged between −1.75 D and −3.5 D (median −2 ± 0.57). The percentage of endothelial cell loss ranged between 2.1% and 8.4%. All eyes retained graft clarity, and none showed any evidence of significant interface haze or corneal vascularization.

Conclusions:

Tuck-in DALK could successfully address corneal ectasia developing after RK, achieving visual gains. Moreover, it was able to restore the peripheral corneal thickness with a minimal risk for dehiscence of RK incisions.
Segmental and descending control of primary afferent input to the spinal lamina X
Authors: Krotov Volodymyr , Agashkov Kirill , Krasniakova Marharyta , Safronov Boris V. , Belan Pavel , Voitenko Nana
Published: February 2022

Despite being involved in a number of functions, such as nociception and locomotion, spinal lamina X remains one of the least studied central nervous system regions. Here, we show that Aδ- and C-afferent inputs to lamina X neurons are presynaptically inhibited by homo- and heterosegmental afferents as well as by descending fibers from the corticospinal tract, dorsolateral funiculus, and anterior funiculus. Activation of descending tracts suppresses primary afferent-evoked action potentials and also elicits excitatory (mono- and polysynaptic) and inhibitory postsynaptic responses in lamina X neurons. Thus, primary afferent input to lamina X is subject to both spinal and supraspinal control being regulated by at least 5 distinct pathways.
Visually evoked pain and its extinction using virtual reality in a patient with complex regional pain syndrome type II
Authors: Harvie Daniel S. , Stanton Tasha R. , Kennedy Hannah , Coppieters Michel W.
Published: February 2022

In this case report, we used virtual reality (VR) to explore pain evoked by only the appearance of being touched (rather than actually being touched) in a person with complex regional pain syndrome type II. Furthermore, we explored the degree to which this visually evoked pain could be extinguished by applying exposure principles in VR. In stage 1, we identified 4 specific scenarios where pain was triggered by visually simulated touch (without physical stimulation) and used these scenarios to quantify baseline sensitivity to visuotactile stimulation. In stage 2, the patient undertook a 12-week virtual exposure program, and the visual triggers were reassessed 3 weeks after the commencement and immediately upon completion of the program. At baseline, severe pain and a profound cold sensation were immediately and consistently evoked in concert with visually simulated touch. At 12-week follow-up, only one of the initially provocative visual stimuli triggered pain and only after 60 seconds of repeated stimulation. Unfortunately, the transfer of desensitisation from VR to the real world was limited. This case report describes the phenomena of visually evoked pain. Moreover, it describes the near complete extinguishing of visually evoked pain through virtual graded exposure. How improvements gained in VR might be better transferred to real-word improvements merits further investigation.
Pandemic-Related Experiences and Stress Among Children’s Hospital Staff Predict Psychosocial Risk
Authors: Grasso Damion J. , Lewin Matthew M. , Adams Basia , Lapidus Garry
Published: February 2022

Goal:

COVID-19 has imposed unique challenges for healthcare workers who have faced increased risk of exposure to the virus, heightened work demands, and disruptions in work–life balance. For some healthcare workers, these challenges may have contributed to increased stress, burnout, and psychosocial impairment, including symptoms of depression and anxiety. The current study addresses a knowledge gap of associations between pandemic-related experiences and psychosocial risk among medical and nonmedical pediatric healthcare staff.

Methods:

A sample of 369 staff (90% female) employed at an acute care, freestanding pediatric hospital in Connecticut completed an online survey. The survey assessed specific pandemic-related experiences and perceived impact with the Epidemic-Pandemic Impacts Inventory, and depression and anxiety risk with the 2-item Patient Health Questionnaire depression screen and 2-item Generalized Anxiety Disorder screen, respectively. Enrollment and survey completion occurred over a 6-week period during the pandemic (summer 2020).

Principal Findings:

High rates of adverse pandemic-related experiences included workplace experiences (e.g., inadequate support, interpersonal difficulties), home life (e.g., childcare difficulties, partner conflict), and experiences reflecting social isolation and quarantine, child and adult mental health difficulties, increased alcohol or substance use, and unhealthy lifestyle behaviors. Medical relative to nonmedical staff reported significantly more adverse and fewer positive experiences, and a significantly higher perceived negative impact of workplace experiences. A positive screen for depression or anxiety was significantly predicted by cumulative adverse workplace experiences (OR = 1.15), changes in emotional/physical health (OR = 1.35), and perceived negative impact of workplace experiences (OR = 1.32).

Applications to Practice:

The present study joins recent reports of increased adverse experiences and psychosocial outcomes among healthcare workers during the COVID-19 pandemic. Findings underscore the need for pediatric hospitals to innovate ways to reduce burden and connect staff to mental health services during similar public health crises. Such services might include (1) assisting healthcare staff to navigate disruptions in their home and social lives as a result of new challenges faced at work, (2) adapting the hospital environment and culture to mitigate stress experienced by staff because of these challenges, and (3) bolstering mental health screening and services to address exacerbated or emerging mental health symptoms, such as depression and anxiety.
Possible Effect of Chelation Treatment on Metabolomic and Lipidomic Analysis in Lead Exposure
Authors: Çetin Tugce , Samadi Afshin , Reçber Tuba , Dinçer Asli Karacan , Eser Burcu , Yalcinkaya Ahmet , Nemutlu Emirhan , Öztaş Yesim , Lay Incilay , Sabuncuoğlu Suna
Published: February 2022

Objective:

This study aimed to examine patients with lead poisoning in terms of metabolomic profiles and bioactive lipids (oxysterols and sphingosine 1-phosphate [S1P]) before and after chelation therapy.

Methods:

Consent was obtained from 42 individuals diagnosed with lead poisoning and blood and urine samples were collected before and after chelation therapy. The levels of 7-ketocholesterol (7-KC), cholestan-3b,5a,6b-triol (Ctriol), and S1P were measured via LC-MS/MS. Metabolomic analysis was performed via GC—MS.

Results:

7-KC and C-triol levels were detected higher before chelation therapy compared with after therapy (P < 0.001 for both). S1P levels were measured higher before the therapy. The results also showed that sphingolipid metabolism-related pathways were affected by lead toxicity as well as other related pathways.

Conclusion:

This preliminary study showed that lipid metabolism is affected in lead exposure and chelation therapy is effective in reversing possible damage.
Differential Impacts of the COVID-19 Pandemic on Mental Health Symptoms and Working Conditions for Senior and Junior Doctors in Australian Hospitals
Authors: Pascoe Amy , Johnson Douglas , Putland Mark , Willis Karen , Smallwood Natasha
Published: February 2022

Objective:

This study investigated severity, prevalence, and predictors of workplace disruption and mental health symptoms in Australian junior and senior hospital medical staff during the COVID-19 pandemic.

Methods:

A cross-sectional survey collected data on demographics, workplace disruption, personal relationships, and mental health.

Results:

One thousand twenty-one (62.1%) senior and 745 (37.9%) junior medical staff, located primarily in Victoria, completed the survey. Work disruptions were common but varied by seniority, withjunior staff more frequently exposed to COVID- 19 (P < 0.001). Symptoms of anxiety, depression, post-traumatic stress disorder and burnout were common but significantly higher in junior doctors (P 
= 0.011 to < 0.001). Common predictors for experiencing mental health symptoms were identified, including prior mental health diagnoses and worsening personal relationships.

Conclusions:

COVID-19 has had significant but varied impacts on junior and senior doctors, with junior doctors particularly susceptible to harm to mental health. Interventions to safeguard hospital medical staff and prevent attrition of this important workforce are urgently needed.
Factors Associated With Mode of Separation for People With Palliative Diagnoses With Preference for Home Death Receiving Care From a Nurse-Led End of Life (Palliative Extended and Care at Home) Program
Authors: Agar Meera R. , Xuan Wei , Lee Jessica , Barclay Greg , Oloffs Alan , Jobburn Kim , Harlum Janeane , Maurya Nutan , Chow Josephine Sau Fan ,   On behalf of the PEACH Research and Evaluation Working Group
Published: February 2022

Palliative Extended and Care at Home (PEACH) is a rapid response nurse-led package of care mobilized for palliative care patients who have an expressed preference to die at home. This study aimed to identify the demographic and clinical predictors of home death for patients receiving the package. Deidentified data were used from administrative and clinical information systems. Univariate and multivariate analyses were conducted to assess association of sociodemographic factors with mode of separation. Furthermore, 1754 clients received the PEACH package during the study period. Mode of separation was home death (75.7%), hospital/palliative care unit admission (13.5%), and alive/discharged from the PEACH Program (10.8%). Of participants with clear preference to die at home, 79% met their wish. Multivariate analysis demonstrated cancer diagnosis, patients who wished to be admitted when death was imminent, and patients with undecided preference for location of death were associated with an increased likelihood of being admitted to the hospital. Compared with those with spousal caregivers, those cared for by their child/grandchild and other nonspouse caregivers were significantly associated with a decreased likelihood of being admitted to the hospital/palliative care unit. Our results show that opportunities to tailor home care based on referral characteristics to meet patient preference to die at home, at individual, system, and policy levels, exist.
Reducing Burnout and Promoting Professional Development in the Palliative Care Service
Authors: Soper Kristin
Published: February 2022

Previous research suggests that health care providers working with issues of death and dying may experience increased stress and risk of burnout. Despite previous research on the problem of burnout faced by palliative care providers, there have been few interventions studied to prevent further burnout. Research does support allowing time away from a stressful health care environment to promote wellness and to decrease burnout. This pilot study ensured that each palliative care advanced practice provider received an 8-hour day monthly to work on professional development activities remotely. The Professional Quality of Life Scale was completed before and after the addition of the professional development day to measure satisfaction, burnout, and secondary trauma impact. Qualitative feedback was also collected. Results indicated that this intervention decreased burnout, improved compassion satisfaction, and decreased secondary trauma for this team. Recommendations are to further investigate methods to further reduce burnout for this population of health care providers. Results from this pilot study demonstrate that professional development days should be expanded for those providers who are at a high risk for burnout in the hospital setting.
Identifying Obstetric Mistreatment Experiences in U.S. Birth Narratives
Authors: Tello Hannah J. , Téllez Dylan J. , Gonzales Joseph E.
Published: February 2022

Background:

Traumatic births are those resulting in feelings of distress that persist after the birth experience. Health care providers may play a role in these experiences through various forms of mistreatment. Analyses of global birth experiences have generated several domains of mistreatment. This study applies these evidence-based domains of mistreatment as an a priori coding scheme for analysis of 96 oral narratives of U.S.-based births to describe the nature of perceived mistreatment using participants' own descriptions of experiences.

Method:

Ninety-six transcripts of oral birth stories from 61 participants were coded using the domains of mistreatment experiences described by the Bohren et al.'s (2015) systematic review of obstetric mistreatment.

Results:

N = 131 individual experiences of perceived obstetric mistreatment were identified in 41 out of 96 narratives (42.7%). The most frequent types of experiences were Poor Rapport (90 incidences) and Failure to Meet Professional Standards of Care (29).

Clinical Implications:

Although most women in our study did not perceive any instances of obstetric mistreatment during their childbirth, over 40% of participants noted at least one event that fit one of the typologies we used as a framework for analysis. Visibility and review of the types of perceived mistreatment experiences that occur during birth enables health system leaders to implement prevention and accountability strategies. Most instances of perceived mistreatment during birth may be prevented through intentional implementation of individualized, respectful, supportive care during labor and birth.
Epidemiology of Herpes Simplex Virus Type 2 in Canada, Australia, and New Zealand: Systematic Review, Meta-Analyses, and Meta-Regressions
Authors: AlMukdad Sawsan , Farooqui Uzma S. , Harfouche Manale , Aldos Lana , Abu-Raddad Laith J.
Published: February 2022

Background

This study characterized the epidemiology of herpes simplex virus type 2 (HSV-2) infection in Canada, Australia, and New Zealand.

Methods

Cochrane and PRISMA guidelines were followed to systematically review, synthesize, and report HSV-2-related data up to January 21, 2021. Meta-analyses and meta-regressions were performed.

Results

In Canada, pooled mean seroprevalence was 10.0% (95% confidence interval [CI], 7.8–12.4%) among general populations, 44.5% (95% CI, 20.0–70.5%) among sexually transmitted infection clinic attendees and symptomatic populations, and 60.7% (95% CI, 49.8–71.1%) among human immunodeficiency virus (HIV)-positive individuals and individuals in HIV-discordant couples. In Australia and New Zealand, combined, pooled mean seroprevalence was 15.4% (95% CI, 9.6–22.2%) among general populations, 27.8% (95% CI, 12.0–47.2%) among men who have sex with men, and 37.2% (95% CI, 23.7–51.8%) among sexually transmitted infection clinic attendees and symptomatic populations. Men had 0.64-fold (95% CI, 0.47–0.86) lower seroprevalence compared with women. No evidence was found for a decline in seroprevalence over time. Pooled mean proportion of HSV-2 isolation in laboratory-confirmed genital herpes was 62.1% (95% CI, 53.8–70.1%) in Canada and 71.9% (95% CI, 64.2–78.9%) in Australia and New Zealand. Proportion of HSV-2 isolation in genital herpes declined by 0.98-fold (95% CI, 0.97–0.99) per year. Pooled mean proportion of HSV-2 isolation in genital ulcer disease was 17.4% (95% CI, 4.0–37.1%) in these countries.

Conclusions

Over 10% of adults in these countries are infected, with no evidence for declining seroprevalence, unlike other global regions. Over 60% of genital herpes cases are caused by HSV-2 in these countries, yet HSV-2's role is declining by 2% per year.
Incentive-Based Sexually Transmitted and Blood-Borne Infections Screening in High-Income Countries: A Systematic Review
Authors: Lambert Teresa , Finlay Jenise , Krahn Jessica , Meyer Garret , Singh Ameeta E. , Kennedy Megan , Caine Vera
Published: February 2022

Background

Despite increasing access to treatment and screening, rates of sexually transmitted and blood-borne infections (STBBI) continue to rise in high-income countries. The high cost of undiagnosed and untreated STBBI negatively affects individuals, health care systems, and societies. The use of monetary and nonmonetary incentives may increase STBBI screening uptake in high-income countries. Incentivized screening programs are most effective when developed specific to context and target population.

Methods

Our review was performed according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions. Inclusion criteria were as follows: English language, high-income countries, primary research studies, and older than 16 years. Study quality was assessed using Joanna Briggs Institute quality assessment tools.

Results

The search yielded 6219 abstracts. Thirteen articles met the inclusion criteria. Studies took place in the United States, the United Kingdom, and Australia. Populations screened included: postsecondary and tertiary students, parolees or probationers, youth, and inner-city emergency department patients. Incentivized STBBI screened were human immunodeficiency virus (n = 5), chlamydia (n = 7), and multiple infections (n = 1). Incentives offered were monetary (cash/gift cards/not specified) (n = 10), nonmonetary (n = 1), and mixed (n = 2). Both monetary and nonmonetary incentives enhance STBBI screening in high-income countries.

Conclusion

Incentivized screening programs are most effective when developed specific to context and target population. Further research is needed to analyze incentivized screening across similar study designs and to evaluate long-term effectiveness.
Contrast Sensitivity with Center-distance Multifocal Soft Contact Lenses
Authors: Nti Augustine N. , Gregory Hannah R. , Ritchey Eric R. , Wolffsohn James S. , Berntsen David A.
Published: February 2022

SIGNIFICANCE

The contrast sensitivity (CS) function provides a more detailed assessment of vision than visual acuity. It was found that center-distance multifocal contact lens designs that are increasingly being prescribed for myopia control reduce distance photopic and mesopic CS in nonpresbyopic patients across a range of spatial frequencies.

PURPOSE

This study aimed to determine the effect of center-distance multifocal soft contact lenses (MFCLs) on CS under photopic and mesopic conditions in nonpresbyopic patients.

METHODS

Twenty-five myopic, nonpresbyopic adults were fitted binocularly with three lenses: Biofinity single vision contact lens (SVCL), Biofinity Multifocal D +2.50 add, and NaturalVue Multifocal in random order. Contrast sensitivity was measured at distance (4 m) under photopic and mesopic conditions and at near under photopic conditions. Log CS by spatial frequency and area under the log contrast sensitivity function (AULCSF) were analyzed between lenses.

RESULTS

Distance photopic CS at each spatial frequency was higher with the SVCL than the MFCLs (P < .001), but there was no difference between the MFCLs (P = .71). Distance mesopic CS from 1.5 to 12 cycles per degree (cpd) was higher with the SVCL than the MFCLs (all P < .02); however, at 18 cpd, there was no difference in CS between NaturalVue and the SVCL (P = .76), possibly because of spurious resolution. Photopic AULCSF for the SVCL was roughly 10% greater than both MFCLs. Contrast sensitivity at near was generally similar between lenses, only slightly lower with the NaturalVue at 11 and 15.5 cpd, but AULCSF at near was not different between lenses (P > .05).

CONCLUSIONS

Multifocal contact lenses reduce distance contrast sensitivity under both photopic and mesopic conditions. There is no clinically significant difference in near CS among all three lenses. These data show that MFCLs have effects on vision that are not captured by standard high-contrast visual acuity testing.
Driving to Reduce Socioeconomic Barriers to Latent Tuberculosis Infection Care: A Mobile Pediatric Treatment Program
Authors: Swamy Padma , Duran Cassandra , Gupta Aditi , Misra Sanghamitra , Fredricks Karla , Cruz Andrea T.
Published: February 2022

Context:

Tuberculosis (TB) disease causes significant morbidity, mortality, and public health impacts. Prevention of latent tuberculosis infection (LTBI) in children reduces the burden of disease.

Program:

The Texas Children's Mobile Clinic Program's (TC-MCP's) mission is to provide high-quality health care to underresourced children within the community setting. The TC-MCP serves a large foreign-born pediatric population. The need for an LTBI treatment program arose when caring for this high-risk population.

Implementation:

The TC-MCP providers collaborated with nationally recognized pediatric TB experts as well as local health departments that provide medications free of cost. The TC-MCP placed tuberculin skin tests (TSTs) on patients with risk factors for TB. TST-positive patients had an interferon-γ release assay (IGRA) performed. IGRA-positive patients had a chest radiograph (CXR) obtained. Children with positive IGRA and normal CXR were included in the LTBI program, which consisted of TC-MCP outpatient visits and 12 once-weekly doses of isoniazid/rifapentine (3HP) provided by local health departments.

Results:

From January 2018 to March 2020, 785 TC-MCP patients received TSTs, of which 38 (4.8%) were positive. An additional 7 positive TSTs were identified from outside facilities. In addition to the 45 positive TSTs, 4 TC-MCP patients with follow-up difficulties had IGRAs done as the initial test. Of these 49 IGRAs done, 13 patients had a positive IGRA. An additional 6 patients with positive IGRAs from outside facilities were identified. Nineteen patients (36.5%) were diagnosed with LTBI; of whom, 18 completed 3HP therapy through the TC-MCP. Eighty-three percent (15/18) completed at least 2 in-person visits.

Discussion:

Underresourced children at higher risk for TB benefit from a mobile clinic's unique reach. By utilizing community partnerships, mobile clinics can successfully fill gaps in the health care system where marginalized populations may be missed.
Differences in Postacute Rehabilitation Recommendations by Ethnicity at an Urban Comprehensive Stroke Center
Authors: Chavez Audrie A. , Abraham Annie M. , Venkatachalam Aardhra M. , McCreary Morgan , Ifejika Nneka L.
Published: February 2022

Objective

The aim of this study was to investigate differences in postacute rehabilitation discharge recommendations, actual disposition, and rehabilitation duration by ethnicity at an urban Joint Commission Comprehensive Stroke Center.

Design

This was a retrospective cohort study of adult acute stroke hospital admissions between January 1, 2016, and December 31, 2019 (n = 1717) who were discharged to home with or without outpatient therapy, inpatient rehabilitation facility, or skilled nursing facility (SNF). Lognormal and multinomial regressions were used to create statistical models evaluating ethnicity-related differences in discharge recommendation and disposition as well as rehabilitation duration while controlling for age, stroke type and severity, insurance type, and medical comorbidities; non-Hispanic white (NHW) patients served as the comparison group.

Results

Hispanic patients were less likely to have therapy recommendations of SNF, with a trend toward significance (P = 0.06), yet statistically more likely to have the actual disposition of SNF (P = 0.01) than NHW patients. There were no statistically significant differences comparing disposition rates for black and Asian patients to NHW patients for both inpatient rehabilitation facility and SNF. There was no statistically significant difference in rehabilitation duration for black or Hispanic patients compared with NHW patients.

Conclusions

Hispanic patients were less likely to have therapy recommended SNF disposition, with a trend toward significance, but significantly more likely to have actual SNF disposition compared with NHW patients after acute stroke.
Analyzing and Discussing Human Factors Affecting Surgical Patient Safety Using Innovative Technology: Creating a Safer Operating Culture
Authors: van Dalen Anne Sophie Helena Maria , Jung James J. , Nieveen van Dijkum Els J.M. , Buskens Christianne J. , Grantcharov Teodor P. , Bemelman Willem A. , Schijven Marlies P.
Published: February 2022

Introduction

Surgical errors often occur because of human factor–related issues. A medical data recorder (MDR) may be used to analyze human factors in the operating room. The aims of this study were to assess intraoperative safety threats and resilience support events by using an MDR and to identify frequently discussed safety and quality improvement issues during structured postoperative multidisciplinary debriefings using the MDR outcome report.

Methods

In a cross-sectional study, 35 standard laparoscopic procedures were performed and recorded using the MDR. Outcome data were analyzed using the automated Systems Engineering Initiative for Patient Safety model. The video-assisted MDR outcome report reflects on safety threat and resilience support events (categories: person, tasks, tools and technology, psychical and external environment, and organization). Surgeries were debriefed by the entire team using this report. Qualitative data analysis was used to evaluate the debriefings.

Results

A mean (SD) of 52.5 (15.0) relevant events were identified per surgery. Both resilience support and safety threat events were most often related to the interaction between persons (272 of 360 versus 279 of 400). During the debriefings, communication failures (also category person) were the main topic of discussion.

Conclusions

Patient safety threats identified by the MDR and discussed by the operating room team were most frequently related to communication, teamwork, and situational awareness. To create an even safer operating culture, educational and quality improvement initiatives should aim at training the entire operating team, as it contributes to a shared mental model of relevant safety issues.
Use of Hospital Capacity Command Centers to Improve Patient Flow and Safety: A Scoping Review
Authors: Franklin Brian J. , Mueller Stephanie K. , Bates David W. , Gandhi Tejal K. , Morris Charles A. , Goralnick Eric
Published: February 2022

Objectives

Delayed emergency department (ED) and hospital patient throughput is recognized as a critical threat to patient safety. Increasingly, hospitals are investing significantly in deploying command centers, long used in airlines and the military, to proactively manage hospital-wide patient flow. This scoping review characterizes the evidence related to hospital capacity command centers (CCCs) and synthesizes current data regarding their implementation.

Methods

As no consensus definition exists for CCCs, we characterized them as units (i) involving interdisciplinary, permanently colocated teams, (ii) using real-time data, and (iii) managing 2 or more patient flow functions (e.g., bed management, transfers, discharge planning, etc.), to distinguish CCCs from transfer centers. We undertook a scoping review of the medical and gray literature published through April 2019 related to CCCs meeting these criteria.

Results

We identified 8 eligible articles (including 4 peer-reviewed studies) describing 7 CCCs of varying designs. The most common CCC outcome measures related to transfer volume (n = 5) and ED boarding (n = 4). Several CCCs also monitored patient-level clinical parameters. Although all articles reported performance improvements, heterogeneity in CCC design and evidence quality currently restricts generalizability of findings.

Conclusions

Numerous anecdotal accounts suggest that CCCs are being widely deployed in an effort to improve hospital patient flow and safety, yet peer-reviewed evidence regarding their design and effectiveness is in its earliest stages. The costs, objectives, and growing deployment of CCCs merit an investment in rigorous research to better measure their processes and outcomes. We propose a standard definition, conceptual framework, research priorities, and reporting standards to guide future investigation of CCCs.
Applying Healthcare Failure Mode and Effect Analysis and the Development of a Real-Time Mobile Application for Modified Early Warning Score Notification to Improve Patient Safety During Hemodialysis
Authors: Lin Chang-Hung , Ho Tsing-Fen , Chen Hui-Fen , Chang Hsin-Yi , Chien Ju-Huei
Published: February 2022

Objective

Patients undergoing hemodialysis are a high-risk population. This study identified possible errors by using a healthcare failure mode and effect analysis system to improve patient safety during hemodialysis.

Methods

A multidisciplinary collaborative team, including physicians, nurses, information technicians, and medical staff members, was assembled. A flow diagram was used to indicate each process of the hemodialysis procedure from evaluating patient condition to transporting the patient back to the ward from the hemodialysis center. We scored all possible failure modes using the hazard scoring method as a combination of the occurrence frequency and severity. These potential failure modes were used to identify and evaluate possible risks by using a risk scoring matrix.

Results

Thirty failure modes were identified across 6 processes, and their potential causes were explored. Four major strategies for addressing most of the failure modes were implemented: establishment of a mobile application that sends real-time automated alerts to the medical team based on the Modified Early Warning Score, design of a modified dialysis Identify-Situation-Background-Assessment-Recommendation checklist for dialysis, technician education and training, and internal auditing and monitoring of the implementation of the entire process. After the implementation of the strategies, the hazard scores of patients during dialysis dropped by 71.2% from 170 points to 49 points.

Conclusions

The healthcare failure mode and effect analysis system was useful for evaluating potential risk during dialysis. Using the mobile application reduced the occurrence of emergency resuscitation during hemodialysis and significantly improved the communication between medical personnel.
Patient Safety Culture in Dentistry Analysis Using the Safety Attitude Questionnaire in DKI Jakarta, Indonesia: A Cross-Cultural Adaptation and Validation Study
Authors: Juliawati Mita , Darwita Risqa R. , Adiatman Melissa , Lestari Fatma
Published: February 2022

Objectives

This study aimed to analyze a cross-cultural adaptation of the Safety Attitude Questionnaire (SAQ) for Indonesian dentists.

Methods

A cross-sectional study was conducted on 250 general dentists in health services in Jakarta, Indonesia. The first step included cultural adaptation and translation, which was followed by the development of the tested questionnaire through expert agreement and by validity and reliability analysis using Spearman correlation coefficient, Cronbach α, and interclass correlation coefficient. The SAQ consisted of 30 items and 6 dimensions (safety climate, teamwork climate, job satisfaction, stress recognition, perception of management, and working conditions).

Respondents were members of the Indonesian Dental Association who voluntarily filled out a Google-based questionnaire from September to October 2020.

Results

A total of 250 respondents with a response rate of 16.4% demonstrated a total Cronbach α value of 0.897, whereas the value per item ranged from 0.890 to 0.905, which suggested an acceptable and good to very good internal consistency. The interclass correlation coefficient value varied from 0.840 to 1.000, which meant almost perfect agreement. The correlation coefficient of 30 questions items resulted in a total SAQ score ranging from 0.422 to 0.699 (moderate to strong correlation) and between 6 dimensions to total SAQ score ranging from 0.648 to 0.772 (strong correlation).

Conclusions

The Indonesian version of the SAQ exhibited good validity and very good reliability and potential to be used for evaluating dentists’ patient safety culture in Indonesia.
Assessment of Culture and Laboratory Practices Related to Patient Safety in Brazilian Laboratories
Authors: Shcolnik Wilson , da Silva Duarte Alberto Jose
Published: February 2022

Objectives

This study aimed at the simultaneous assessment of culture and laboratory practices related to patient safety in Brazilian laboratories, and validation of the proposed questionnaire.

Methods

The questionnaire was based on the Hospital Survey on Patient Safety Culture, used by the 1.0 version of the Agency of Healthcare Research and Quality and other bibliographical references. The sample consisted of 1414 professionals from 51 different Brazilian clinical laboratories. Agency of Healthcare Research and Quality criteria were used to define “strengths and weaknesses” related to patient safety. The psychometric evaluation of the questionnaire included the analysis of reliability and validity.

Results

Patient safety in the laboratories was considered “excellent” (35.22%), “very good” (53.14%), “regular” (10.11%), “bad” (0.92%), and “very bad” (0.61%). The only dimension of culture with positivity less than 50% was “nonpunitive responses to errors” (30.74%). The dimensions on laboratory practices related to patient safety revealed positivity greater than 60%, with the “analytical” dimension (76.47%) being the highest. The psychometric evaluation revealed the reliability of the questionnaire, the applicability of 12 dimensions to assess culture, and 4 or 5 dimensions to assess laboratory practices related to patient safety.

Conclusions

The culture and practices related to patient safety in Brazilian laboratories were evaluated as good, although a punitive culture against the occurrence of errors was identified. The psychometric evaluation of the questionnaire confirmed its reliability and validity. Studies performed in a larger and more diverse sample of clinical laboratories are needed to confirm the results obtained.
Report of a Multimodal Strategy for Improvement of Hand Hygiene Compliance in a Latin American Hospital. How Far From Excellence?
Authors: González-González Ricardo , Huertas-Jiménez Martha Asunción , Ochoa-Hein Eric , Galindo-Fraga Arturo , Macías-Hernández Alejandro E. , De la Torre-Rosas Alethse
Published: February 2022

Objective

The aim of the study was to report the results of a multimodal strategy for improvement of hand hygiene (HH) compliance in a third-level hospital in Mexico.

Methods

This is an epidemiological study in a public, acute care, academic, tertiary referral center from 2009 to 2019. Healthcare worker (HCW) compliance with HH was assessed after implementation of the World Health Organization multimodal strategy that included permanent and widespread access to alcohol-based hand rubs; educational activities for staff, students, patients, and relatives; reminders in healthcare areas; patient empowerment; water quality surveillance; frequent evaluation of compliance; and feedback. The primary outcome was HH compliance rate (measured by direct observation). The association of HH with healthcare-associated infections was the secondary outcome.

Results

A total of 60,685 HH opportunities were evaluated. The HH compliance rate increased significantly from 39.83% (95% confidence interval [CI] = 38.83%–40.84%) to 64.81% (95% CI = 64.08%–65.54%), mostly due to HH compliance in World Health Organization moments 3 to 5 (r = 0.86, P = 0.001). A statistically significant inverse association was found between HH compliance rates and surgical site infection rates (incidence rate ratio = 0.9977, 95% CI = 0.9957–0.9997, P = 0.029).

Conclusions

A multimodal strategy in a Latin American setting showed an increase in HH compliance over 10 years of follow-up that should nonetheless be improved. An association between HH compliance and surgical site infection rates was noticed, but this did not occur with other healthcare-associated infections; this underscores the need for a comprehensive bundled approach in their prevention.