bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased expression of IL1-RL1 is associated with type 2 and type 1 immune pathways in asthma
Authors: Xu Changyi , Du Lijuan , Chen Fengjia , Tang Kun , Tang Lu , Shi Jia , Xiao Lisha , Zeng Zhimin , Liang Yuxia , Guo Yubiao
Published: May 2022

Background

Asthma is a common chronic airway disease in the world. The purpose of this study was to explore the expression of IL1-RL1 in sputum and its correlation with Th1 and Th2 cytokines in asthma.

Methods

We recruited 132 subjects, detected IL1-RL1 protein level in sputum supernatant by ELISA, and analyzed the correlation between the expression level of IL1-RL1 and fraction of exhaled nitric oxide (FeNO), IgE, peripheral blood eosinophil count (EOS#), and Th2 cytokines (IL-4, IL-5, IL-10, IL-13, IL-33 and TSLP) and Th1 cytokines (IFN-γ, IL-2, IL-8). The diagnostic value of IL1-RL1 was evaluated by ROC curve. The expression of IL1-RL1 was further confirmed by BEAS-2B cell in vitro.

Results

Compared with the healthy control group, the expression of IL1-RL1 in sputum supernatant, sputum cells and serum of patients with asthma increased. The AUC of ROC curve of IL1-RL1 in sputum supernatant and serum were 0.6840 (p = 0.0034), and 0.7009 (p = 0.0233), respectively. IL1-RL1 was positively correlated with FeNO, IgE, EOS#, Th2 cytokines (IL-4, IL-5, IL-10, IL-13, IL-33 and TSLP) and Th1 cytokines (IFN-γ, IL-2, IL-8) in induced sputum supernatant. Four weeks after inhaled glucocorticoids (ICS) treatment, the expression of IL1-RL1 in sputum supernatant and serum was increased. In vitro, the expression of IL1-RL1 in BEAS-2B was increased after stimulated by IL-4 or IL-13 for 24 h.

Conclusion

The expression of IL1-RL1 in sputum supernatant, sputum cells and serum of patients with asthma was increased, and was positively correlated with some inflammatory markers in patients with asthma. IL1-RL1 may be used as a potential biomarker for the diagnosis and treatment of asthma.
Intraoperative low tidal volume ventilation and the risk of ICD-10 coded delirium and the use for antipsychotic medications
Authors: Karalapillai Dharshi , Weinberg Laurence , Neto Ary Serpa , Peyton Philip J. , Ellard Louise , Hu Raymond , Pearce Brett , Tan Chong , Story David , O’Donnell Mark , Hamilton Patrick , Oughton Chad , Galtieri Jonathan , Appu Sree , Wilson Anthony , Eastwood Glenn , Bellomo Rinaldo , Jones Daryl A.
Published: May 2022

Background

Low tidal volume (VT) ventilation and its associated increase in arterial carbon dioxide (PaCO2) may affect postoperative neurologic function. We aimed to test the hypothesis that intraoperative low VT ventilation affect the incidence of postoperative ICD-10 coded delirium and/or the need for antipsychotic medications.

Methods

This is a post-hoc analysis of a large randomized controlled trial evaluating low vs. conventional VT ventilation during major non-cardiothoracic, non-intracranial surgery. The primary outcome was the incidence of ICD-10 delirium and/or the use of antipsychotic medications during hospital stay, and the absolute difference with its 95% confidence interval (CI) was calculated.

Results

We studied 1206 patients (median age of 64 [55–72] years, 59.0% males, median ARISCAT of 26 [19–37], and 47.6% of ASA 3). ICD-10 coded delirium and /or antipsychotic medication use was diagnosed in 11.2% with similar incidence between low and conventional VT ventilation (11.1% vs. 11.3%; absolute difference, -0.24 [95%CI, -3.82 to 3.32]; p = 0.894). There was no interaction between allocation group and type of surgery.

Conclusion

In adult patients undergoing major surgery, low VT ventilation was not associated with increased risk of ICD-10 delirium and/or the use of antipsychotic medications during hospital stay.

Trial registration

ANZCTR Identifier: ACTRN12614000790640.
Delirium risk factors in hospitalized patient: a comprehensive evaluation of underlying diseases and medications in different wards of a large Urban Hospital Center in Iran
Authors: Arbabi Mohammad , Ziaei Elham , Amini Behnam , Ghadimi Hamidreza , Rashidi Fatemeh , Shohanizad Narges , Moradi Soroush , Beikmarzehei Alireza , Hasanzadeh Alireza , Parsaei Amirhossein
Published: May 2022

Background

Delirium is a neurobehavioral syndrome, which is characterized by a fluctuation of mental status, disorientation, confusion and inappropriate behavior, and it is prevalent among hospitalized patients. Recognizing modifiable risk factors of delirium is the key point for improving our preventive strategies and restraining its devastating consequences. This study aimed to identify and investigate various factors predisposing hospitalized patients to develop delirium, focusing mostly on underlying diseases and medications.

Method

In a prospective, observational trial, we investigated 220 patients who had been admitted to the internal, emergency, surgery and hematology-oncology departments. We employed the Confusion Assessment Method (CAM) questionnaire, The Richmond Agitation Sedation Scale (RASS), the General Practitioner Assessment of Cognition (GPCOG), demographic questionnaire, patient interviews and medical records. Multivariate logistic regression models were used to analyze the predictive value of medications and underlying diseases for daily transition to delirium.; demographics were analyzed using univariate analysis to identify those independently associated with delirium.

Results

Two hundred twenty patients were enrolled; the emergency department had the most incident delirium (31.3%), and the surgery section had the least (2.4%); delirium was significantly correlated with older ages and sleep disturbance. Among multiple underlying diseases and the medications evaluated in this study, we found that a history of dementia, neurological diseases and malignancies increases the odds of transition to delirium and the use of anticoagulants decreases the incident delirium.

Conclusion

Approximately 1 out of 10 overall patients developed delirium; It is important to evaluate underlying diseases and medications more thoroughly in hospitalized patients to assess the risk of delirium.
Sevoflurane concentration for cannulation in developmental disabilities
Authors: Kunihiro Naou , Tsukamoto Masanori , Taura Shiori , Hitosugi Takashi , Miki Yoichiro , Yokoyama Takeshi
Published: May 2022

Objective

The goal of this study was to compare the end-tidal sevoflurane concentration and time for intravenous cannulation at induction of anesthesia using sevoflurane with or without nitrous oxide in healthy children and in those with developmental disabilities.

Methods

Normal and developmentally disabled children were anesthetized by inhalation of sevoflurane with nitrous oxide or with nitrous oxide-free oxygen, and intravenous cannulae were introduced. Nitrous oxide was stopped after loss of consciousness. The following parameters were recorded for each patient: age, gender, height, weight, BMI, duration of intravenous cannulation, end-tidal concentration of sevoflurane at the completion of intravenous cannulation, and use of nitrous oxide.

For each parameter except gender,p-value were calculated by one-way analysis of variance (ANOVA). For gender,p-value were calculated using the Fisher method. Two-way ANOVA was performed to evaluate the effect of patient health status and nitrous oxide use on the end-tidal concentrations of sevoflurane and the time required for intravenous cannulation.

Results

The end-tidal sevoflurane concentrations at the completion of the intravenous cannulation had received a significant main effect of the factor "the use of nitrous oxide" (F(1,166) = 25.8,p < 0.001, η2 = 0.13) and a small effect of the factor "the patient health status" (F(1,166) = 0.259,p = 0.611, η2 = 0.001). However, the time required for intravenous cannulation was not significantly affected by either of the two factors, "the use of nitrous oxide" (F(1,166) = 0.454,p = 0.501, η2 = 0.003) and "the patient health status" (F(1,166) = 0.308,p = 0.579, η2 = 0.002).

Conclusions

Between the healthy children and the children with developmental disabilities, no significant differences in the time required for the intravenous cannulation from the beginning of anesthetic induction. However, the end-tidal sevoflurane concentrations at the completion of the intravenous cannulation was significantly different. Sevoflurane in alveoli might be diluted by nitrous oxide.
A novel intervention to reduce noninfectious and infectious complications associated with indwelling urethral catheters in hospitalized older patients: a quasi-experimental study
Authors: Hu Fang-Wen , Yeh Chun-Yin , Huang Chi-Chang , Cheng Hsiu-Chi , Lin Cheng-Han , Chang Chia-Ming
Published: May 2022

Background

Indwelling urethral catheters are widely used in clinical settings. Catheter-associated urinary tract infection has been recognized as a common adverse event in older patients. However, noninfectious complications are almost 5 times as common as infectious complications, and insufficient attention has been given to noninfectious complications. Given this importance, a novel intervention related to removing unnecessary catheters in a timely manner to promote, after removal, the recovery of self-voiding function is herein developed to reduce infectious and noninfectious complications associated with indwelling urethral catheters in hospitalized older patients.

Methods

A quasi-experimental study design was adopted. Patients aged 65 and older who had a urinary catheter placed within 24 h of hospital admission were included. All patients were allocated into either an intervention group, in which the novel intervention developed in the study was implemented, or a control group, who received care as usual. The outcomes of this study were to evaluate whether the novel intervention reduced the incidence of the following: catheter-associated urinary tract infections, catheter-associated noninfectious complications, decline in activities of daily living, and new nursing home admissions.

Results

Of 106 hospitalized older patients who consented to participate, 92 completed follow-up until discharge, including 49 in the control group and 43 in the intervention group. The patients in the intervention group were significantly older than those in the control group [83.72 ± 9.18 vs. 80.26 ± 7.66, p = 0.038], and no differences were found between the groups in other demographics or present health conditions. Multivariable logistic regression analysis showed that the control group was more likely to develop noninfectious complications [adjusted odds ratio: 3.01, 95% confidence interval: 1.32–6.81] and a decline in ADLs [adjusted odds ratio: 11.20, 95% confidence interval: 3.68–34.00].

Conclusions

A novel intervention can be effective as a means of reducing noninfectious complications associated with indwelling urethral catheters in hospitalized older patients. This approach will help to standardize urethral catheter care, and it highlights the fact that health care professionals can play a crucial role in preventing harm from urethral catheters.
Prevalence of multimorbidity and its correlates among older adults in Eastern Nepal
Authors: Balakrishnan Siva , Karmacharya Isha , Ghimire Saruna , Mistry Sabuj Kanti , Singh Devendra Raj , Yadav Om Prakash , Gudi Nachiket , Rawal Lal Bahadur , Yadav Uday Narayan
Published: May 2022

Background

The number of people with multimorbidity is surging around the world. Although multimorbidity has been introduced in policy and practice in developed countries, developing countries like Nepal have not considered it as a matter of public health urgency due to the lack of enough epidemiological data. Multimorbidity profoundly affects older adults’ wellbeing; therefore, it is crucial to estimate its prevalence and determinants. This study aimed to estimate the prevalence of multimorbidity among older adults in Eastern Nepal and identify its correlates.

Methodology

A community-based cross-sectional survey was conducted in three districts of Eastern Nepal. Data were collected between July and September 2020, among 847 Nepali older adults, aged 60 and older, where study participants were recruited through a multi-stage cluster sampling technique. Semi-structured interviews were conducted at the community settings to collect data. Logistic regression assessed correlates of multimorbidity. SAS 9.4 was used to run all statistical tests and analyses.

Results

More than half (66.5%) of the participants had at least one of the five non-communicable chronic conditions; hypertension (31.6%), osteoarthritis (28.6%), chronic respiratory disease (18.0%), diabetes (13.5%), and heart disease (5.3%). The prevalence of multimorbidity was 22.8%. In the adjusted model, increased age (for 70–79 years, OR: 3.11, 95% CI: 1.87–5.18; for 80 + years, OR: 4.19, 95% CI: 2.32–7.57), those without a partner (OR: 1.52, 95% CI: 1.00–2.30), residing in urban areas (OR: 1.71, 95% CI: 1.16–2.51), and distant from health center (OR: 1.66, 95% CI: 1.04–2.64) were significantly associated with multimorbidity.

Conclusions

This study found one in five study participants had multimorbidity. The findings will assist policymakers and stakeholders in understanding the burden of multimorbidity among the older population and identifying the groups in most need of health promotion intervention. Future interventions may include developing horizontal multimorbid approaches and multisectoral strategies specifically tailored to meet the needs of those populations.
Talaromyces marneffei infection associated with bronchiolitis obliterans in an HIV-negative child: a case report
Authors: Lin Lin , Fan Huifeng , Zhang Dongwei , Lu Gen
Published: May 2022

Background

Talaromyces marneffei is an opportunistic pathogen that infects immunodeficient and immunocompromised patients. We presented a pediatric patient with a diagnosis of T. marneffei infection who was followed up in the Guangzhou Women and Children’s Medical Centre.

Case presentation

The child was a 5-year-old girl with persistent cough and gasping over 2 months who was confirmed with T. marneffei infection by bronchoalveolar lavage fluid culture and high-throughput sequencing technology. Human immunodeficiency virus (HIV) was negative according to a serum-specific antibody test. She was treated with amphotericin B and itraconazole as antifungal agents, with good clinical response. At follow-up, high-resolution computed tomography showed a mosaic sign in the whole lung field with a diagnosis of post-infectious bronchiolitis obliterans (PIBO) as the sequela. She has a mutated COPA gene with uncertain pathogenic potential on whole-exome sequencing.

Conclusions

Clinicians should consider PIBO as a possible sequela in an HIV-negative paediatric patient with T. marneffei infection.
The accuracy and influencing factors of Doppler echocardiography in estimating pulmonary artery systolic pressure: comparison with right heart catheterization: a retrospective cross-sectional study
Authors: Lv Guang-jie , Li Ai-li , Tao Xin-cao , Zhai Ya-nan , Zhang Yu , Lei Jie-ping , Gao Qian , Xie Wan-mu , Zhai Zhen-guo
Published: May 2022

Background

Noninvasive assessment of pulmonary artery systolic pressure by Doppler echocardiography (sPAPECHO) has been widely adopted to screen for pulmonary hypertension (PH), but there is still a high proportion of overestimation or underestimation of sPAPECHO. We therefore aimed to explore the accuracy and influencing factors of sPAPECHO with right heart catheterization (RHC) as a reference.

Methods

A total of 218 highly suspected PH patients who underwent RHC and echocardiography within 7 days were included. The correlation and consistency between tricuspid regurgitation (TR)-related methods and RHC results were tested by Pearson and Bland–Altman methods. TR-related methods included peak velocity of TR (TR Vmax), TR pressure gradient (TR-PG), TR mean pressure gradient (TR-mPG), estimated mean pulmonary artery pressure (mPAPECHO), and sPAPECHO. With mPAP ≥ 25 mm Hg measured by RHC as the standard diagnostic criterion of PH, the ROC curve was used to compare the diagnostic efficacy of sPAPECHO with other TR-derived parameters. The ratio (sPAPECHO–sPAPRHC)/sPAPRHC was calculated and divided into three groups as follows: patients with an estimation error between − 10% and + 10% were defined as the accurate group; patients with an estimated difference greater than + 10% were classified as the overestimated group; and patients with an estimation error greater than − 10% were classified as the underestimated group. The influencing factors of sPAPECHO were analyzed by ordinal regression analysis.

Results

sPAPECHO had the highest correlation coefficient (r = 0.781, P < 0.001), best diagnostic efficiency (AUC = 0.98), and lowest bias (mean bias = 0.07 mm Hg; 95% limits of agreement, − 32.08 to + 32.22 mm Hg) compared with other TR-related methods. Ordinal regression analysis showed that TR signal quality, sPAPRHC level, and pulmonary artery wedge pressure (PAWP) affected the accuracy of sPAPECHO (P < 0.05). Relative to the good signal quality, the OR values of medium and poor signal quality were 0.26 (95% CI: 0.14, 0.48) and 0.23 (95% CI: 0.07, 0.73), respectively. Compared with high sPAPRHC level, the OR values of low and medium sPAPRHC levels were 21.56 (95% CI: 9.57, 48.55) and 5.13 (95% CI: 2.55, 10.32), respectively. The OR value of PAWP was 0.94 (95% CI: 0.89, 0.99). TR severity and right ventricular systolic function had no significant effect on the accuracy of sPAPECHO.

Conclusions

In this study, we found that all TR-related methods, including sPAPECHO, had comparable and good efficiency in PH screening. To make the assessment of sPAPECHO more accurate, attention should be paid to TR signal quality, sPAPRHC level, and PAWP.
SCARA3 inhibits cell proliferation and EMT through AKT signaling pathway in lung cancer
Authors: Kim Jeeho , You Ho Jin , Youn Chakyung
Published: May 2022

Background

Scavenger receptor class A member 3 (SCARA3) is decreased in prostate cancer and myeloma. However, functions of SCARA3 in various cancers remain unclear. In this study, we tried to evaluate the functional study of SCARA3 in lung cancer.

Methods

The expression level of SCARA3 in the TCGA-database, lung cancer tissue microarray and lung cancer cells and the prognosis of lung cancer patients were measured. Lung cancer tissue microarray was analyzed pathologically using immunohistochemistry, and quantitative analysis of SCARA3 in normal lung cells and lung cancer cells was analyzed using western blot analysis. Survival curves for lung cancer patients were prepared with the Kaplan-Meier method. Migration and invasion of SCARA3 overexpressed lung cancer cells were determined using a Transwell chamber system. Proliferation of lung cancer cells was determined based on cell viability assay using cell culture in vitro and a tumorigenicity model of BALB/C nude mouse in vivo.

Results

The expression of SCARA3 was abnormally reduced in TCGA-database, lung tissue microarray, and various lung cancer cells. However, overexpression of SCARA3 reduced the proliferation of lung cancer. The ability of SCARA3 to inhibit cancer cell proliferation was maintained even in vivo using a mouse xenograft model. In addition, overexpression of SCARA3 reduced migration and invasion ability of lung cancer cells and induced decreases of EMT markers such as β-catenin, vimentin, and MMP9. We aimed to prove the role of SCARA3 in the treatment of Lung cancer, and shown that the expression level of SCARA3 is important in cancer treatment using cisplatin. The enhancement of the effect of cisplatin according to SCARA3 overexpression is via the AKT and JNK pathways.

Conclusions

This study confirmed an abnormal decrease in SCARA3 in lung cancer. Overexpression of SCARA3 potently inhibited tumors in lung cancer and induced apoptosis by increasing sensitivity of lung cancer to cisplatin. These results suggest that SCARA3 is a major biomarker of lung cancer and that the induction of SCARA3 overexpression can indicate an effective treatment.
How paediatricians investigate early developmental impairment in the UK: a qualitative descriptive study
Authors: Atherton Mark , Hart Anthony R.
Published: May 2022

Background

Early developmental impairment (EDI) is common and has many aetiologies and, therefore, potential investigations. There are several published guidelines recommending aetiological investigations, and paediatricians’ views of them varies. Little is known on the thought processes underlying clinical decisions in investigating EDI. This study aimed to describe the thought processes affecting clinical decisions on the investigation of EDI within a nationalised health care system.

Methods

A qualitative descriptive study using semi-structured qualitative interviews performed in person or via video link with paediatricians who see children with EDI in England. As part of the interview, a case study of a fictional disease, Cavorite deficiency, modelled on biotinidase deficiency, was given to participants with the cost of testing, incidence and likelihood it would respond to treatment. This allowed exploration of cost without encumbrance from predisposing views and training on the condition. Thematic analysis was performed by iterative approach. Where participants stated they wanted to redirect money from investigations to treatment, were that even possible, we asked which services they would like to be better funded in their area.

Results

Interviews were conducted with 14 consultant paediatricians: 9 Community / Neurodisability, 2 General paediatricians, and 3 Paediatric Neurologists. Two themes were identified: the value of an aetiological diagnosis to families and managing risk and probability when investigating EDI. The latter contained 4 subthemes: ‘circumspection’ involved blanket investigations chosen irrespective of phenotype and high regard for guidelines; ‘accepting appropriate risk’ involved participants choosing investigations based on clinical phenotype, recognising some aetiologies would be missed; consultants found they ‘transitioned between practices’ during their career; and ‘improved practice’ was thought possible with better evidence on how to stratify investigations based on phenotype. Services that were most frequently reported to need additional funding were therapy services, early community developmental services, management of behaviour, sleep and mental health, and educational support.

Conclusions

There are many factors that influence paediatricians’ choice of aetiological investigation in EDI, but clinical factors are the most important. Paediatricians want better evidence to allow them to select the right investigations for each child without a significant risk of missing an important diagnosis.
Group treatment for complex dissociative disorders: a randomized clinical trial
Authors: Bækkelund Harald , Ulvenes Pål , Boon-Langelaan Suzette , Arnevik Espen Ajo
Published: May 2022

Background

Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment.

Methods

Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group–treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation. The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties.

Results

Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period.

Conclusion

In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning.

Trial registration

Clinical Trials (NCT02450617).
The spatiotemporal dynamics of lung cancer: 30-year trends of epidemiology across 204 countries and territories
Authors: Chen Xiang , Mo Shaoyan , Yi Bin
Published: May 2022

Background

It has been established that lung cancer is the leading cause of all cancer deaths. This study sought to analyze the epidemiological trends of lung cancer over the past 30 years worldwide.

Methods

Estimates, including the global, regional, national prevalence, incidence, and years lived with disability (YLDs) of lung cancer from 1990 to 2019, were extracted from the Global Burden of Disease Study 2019 to assess the spatiotemporal dynamics in cases and age-standardized rates (ASR). The estimated annual percentage change (EAPC) was calculated to evaluate the variation in ASR. Besides, estimates of age-sex specific prevalence, decomposition analysis for incident cases, and correlation analysis of the EAPC were conducted in our study.

Results

Globally, the ASR of lung cancer prevalence, incidence and YLDs in 2019 were 38.84/100,000 persons, 27.66/100,000 persons, and 6.62/100,000 persons, respectively. Over the past 30 years, the ASR of incidence (EAPC = -0.09) decreased, although that of prevalence (EAPC = 0.51) and YLDs (EAPC = 0.03) increased. The global prevalence counts was greater in males than females at all age groups and increased with age, peaking in the 65–69 age group for both sexes. The increase in incidence was mainly attributed to population aging. For YLDs, EAPC was negatively correlated with the human development index (p = 0.0008) and ASR (p < 0.0001) in 1990 across nation-level units.

Conclusions

Lung cancer remains a major public health issue globally, warranting the implementation of scientific and effective measures in different countries and territories to control it.
A team level participatory approach aimed at improving sustainable employability of long-term care workers: a study protocol of a randomised controlled trial
Authors: Heijkants Ceciel H. , van Hooff Madelon L. M. , Geurts Sabine A. E. , Boot Cécile R. L.
Published: May 2022

Background

Staff currently working in long-term care experience several difficulties. Shortage of staff and poor working conditions are amongst the most prominent, which pose a threat to staff’s sustainable employability. To improve their sustainable employability it is important to create working conditions that fulfil workers’ basic psychological need for autonomy, relatedness and competence in line with Self-Determination Theory. Since many long-term care organisations work with self-managing teams, challenges exist at team level. Therefore, there is a need to implement an intervention aimed at maintaining and improving the sustainable employability of staff on team level.

Methods

We developed a participatory workplace intervention, the Healthy Working Approach. In this intervention teams will uncover what problems they face related to autonomy, relatedness and competence in their team, come up with solutions for those problems and evaluate the effects of these solutions. We will evaluate this intervention by means of a two-arm randomized controlled trial with a follow-up of one year. One arm includes the intervention group and one includes the waitlist control group, each consisting of about 100 participants. The primary outcome is need for recovery as proxy for sustainable employability. Intervention effects will be analysed by linear mixed model analyses. A process evaluation with key figures will provide insight into barriers and facilitators of the intervention implementation. The Ethical Committee Social Sciences of the Radboud University approved the study.

Discussion

This study will provide insight in both the effectiveness, and the barriers/facilitators of the implementation process of the Healthy Working Approach. The approach is co-created with long-term care workers, focuses on team-specific challenges, and is rooted in the evidence-based participatory workplace approach and Self-Determination Theory. First results are expected in 2022.

Trial registration

Netherlands Trial Register, NL9627. Registered 29 July 2021 - Retrospectively registered.
Understanding the risk perception of visceral leishmaniasis exposure and the acceptability of sandfly protection measures among migrant workers in the lowlands of Northwest Ethiopia: a health belief model perspective
Authors: Berhe Resom , Spigt Mark , Schneider Francine , Paintain Lucy , Adera Cherinet , Nigusie Adane , Gizaw Zemichael , Tesfaye Yihenew Alemu , Elnaiem Dia-Eldin A. , Alemayehu Mekuriaw
Published: May 2022

Background

Visceral leishmaniasis (VL) is the leading cause of health concerns among Ethiopian migrant workers. Understanding risk perception and health-protective behavior are significant challenges in the prevention and eradication of the disease. As a result, studies are required to assess these important epidemiological factors, which will provide guidance on how to assist migrant workers in taking preventive measures against VL.

Method

We conducted qualitative research among migrant workers on seasonal agricultural farms in Northwest Ethiopia between June and November 2019 to assess their perception of the risk of contracting VL and their willingness to use protective measures against the disease. Seventeen focus group discussions and 16 key informant interviews were conducted to study migrant workers’ risk perception in relation to sandfly bite exposure and use of sandfly control measures. For analysis, all interviews were recorded, transcribed, and translated. ATLASti was used to perform qualitative content analysis on the data.

Result

Migrant workers are fearful of VL because of previous exposure and the disease’s prevalence in the area. They believe, however, that VL is a minor illness that is easily treated. While Insecticide Treated Nets (ITNs) are widely accepted as a protective measure, there are still reservations about using them due to the seasonality of the transmission, difficulties in hanging them on farm areas, and a preference for alternative traditional practices. Regardless of perceived self-efficacy, the central cues were the message delivered by the health workers and an increase in sandfly bite irritation. Based on the findings, three levels of intervention modalities are suggested: 1) increasing pre-arrival awareness through outdoor media (posters, stickers, billboards), 2) encouraging proper use of protective measures upon arrival at farm camps, and 3) informing departing workers on disease recognition and best practices for health-seeking continuous use of protective measures at home.

Conclusion

This finding suggests that VL prevention interventions should focus on individuals’ perceptions in order to promote consistent use of protective measures. The findings are highly useful in planning effective interventions against VL.
Unusual presentation of lepidic adenocarcinoma in a healthy female
Authors: Akhtar Zaheer , Laageide Leah , Robles Julian , Winters Christopher , Wall Geoffrey C. , Mallen James , Jawa Zeeshan
Published: May 2022

Background

Lepidic adenocarcinoma represents a histologic pattern of non-small cell lung cancer that characteristically arises in the lung periphery with tracking alongside pre-existing alveolar walls. Noninvasive and invasive variants of lepidic adenocarcinoma are dependent on parenchymal destruction, vascular, or pleural invasion. The lepidic-predominant lung malignancies are collectively recognized as slow growing with rare metastasis and excellent prognosis. The World Health Organization classification of lung malignancies depends on molecular and histopathological findings. CT findings most commonly include ground-glass characteristics, commonly mistaken for inflammatory or infectious etiology. These tumors are generally surgically resectable and associated with better survival given infrequent nodal and extrathoracic involvement. Rarely these tumors present with diffuse pneumonic-type involvement associated with worse outcomes despite lack of nodal and distant metastases.

Case presentation

A 63-year-old Caucasian athletic immunocompetent female presented with 2 months of progressive shortness of breath, fatigue, loss of appetite and 15 pound weight loss. History was only notable for well controlled essential hypertension and hypothyroidism. Contrast computed tomography angiogram and positron emission tomography revealed diffuse hypermetabolic interstitial and airspace abnormalities of the lungs without lymphadenopathy (or distant involvement) in addition to right hydropneumothorax and left pleural effusion. Baseline laboratory testing was unremarkable, and extensive bacterial and fungal testing returned negative. Bronchoscopy and video-assisted thoracoscopic surgery was subsequently performed with pleural fluid cytology, lung and pleural biopsies returning positive for lepidic adenocarcinoma with 2% programmed death ligand 1 expression and genomic testing positive for PTEN gene deletion. Prior to treatment, the patient perished on day 15 of admission.

Conclusion

We present a rare case of lepidic predominant adenocarcinoma with extensive bilateral aerogenous spread in the context of no lymphovascular invasion in a healthy, low risk patient. This case presentation may add to the body of knowledge regarding the different behavior patterns of lepidic predominant adenocarcinomas.
Regenerating and repairing degenerative intervertebral discs by regulating the micro/nano environment of degenerative bony endplates based on low-tension mechanics
Authors: Che Yan-Jun , Guo Jiang-Bo , Hao Yue Feng , Luo Zong-Ping
Published: May 2022

Background

Conservative treatment is the recommended first-line treatment for degenerative disc diseases. Traction therapy has historically been one of the most common clinical methods to address this, but the clinical effect remains controversial.

Methods

Forty-two six-month-old male Sprague-Dawley rats were randomly divided into six groups: the model group (Group A, four coccyx vertebrae (Co7-Co10) were fixed with customized external fixators, and the vertebral disc degeneration model was constructed by axial compression of the target segment Co8 - Co9 for 4 weeks), the experimental control group (Group B, after successful modeling, the external fixation device was removed and self-rehabilitation was performed) and four intervention groups (Groups C to F): Groups C and E: Co8 - Co9 vertebrae compressed for 4 weeks followed by two or 4 weeks of high tension traction (HTT), respectively, and Groups D and F: vertebrae compressed for 4 weeks followed by two or 4 weeks of low-tension traction (LTT), respectively. Imaging tests (X-ray and MRI) were performed to assess disc height and T2 signal intensity at each time point. After the experiment, the animals were euthanized, and the caudal vertebrae were collected for analysis of intervertebral disc histopathology, proteoglycan content, and micronanostructure of the annulus fibrosus, nucleus pulposus and bony endplate.

Results

Signs of tissue regeneration were apparent in all four intervention groups. After two to 4 weeks of intervention (HTT and LTT), the morphology of pores in the bony endplate, their number, and diameter had recovered significantly compared with those in Group A. The LTT group was superior to the HTT group, and the 4w in situ group was significantly superior to the 2w group. Meanwhile, the histological scores of discs, the mean fibril diameter and modulus of annulus fibrosus were significantly improved compared with the control groups, and the LTT group was superior to HTT group.

Conclusions

Low-tension traction better promotes active reconstruction of bony endplates and improves the elastic modulus and micro/nanostructure of the disc. Thus, it further promotes the regeneration and repair of intervertebral discs.
An undergraduate medical education framework for refugee and migrant health: Curriculum development and conceptual approaches
Authors: Gruner Douglas , Feinberg Yael , Venables Maddie J. , Shanza Hashmi Syeda , Saad Ammar , Archibald Douglas , Pottie Kevin
Published: May 2022

Background

International migration, especially forced migration, highlights important medical training needs including cross-cultural communication, human rights, as well as global health competencies for physical and mental healthcare. This paper responds to the call for a ‘trauma informed’ refugee health curriculum framework from medical students and global health faculty.

Methods

We used a mixed-methods approach to develop a guiding medical undergraduate refugee and migrant health curriculum framework. We conducted a scoping review, key informant interviews with global health faculty with follow-up e-surveys, and then, integrated our results into a competency-based curriculum framework with values and principles, learning objectives and curriculum delivery methods and evaluation.

Results

The majority of our Canadian medical faculty respondents reported some refugee health learning objectives within their undergraduate medical curriculum. The most prevalent learning objective topics included access to care barriers, social determinants of health for refugees, cross-cultural communication skills, global health epidemiology, challenges and pitfalls of providing care and mental health. We proposed a curriculum framework that incorporates values and principles, competency-based learning objectives, curriculum delivery (i.e., community service learning), and evaluation methods.

Conclusions

The results of this study informed the development of a curriculum framework that integrates cross-cultural communication skills, exploration of barriers towards accessing care for newcomers, and system approaches to improve refugee and migrant healthcare. Programs should also consider social determinants of health, community service learning and the development of links to community resettlement and refugee organizations.
Psychometric evaluation of a nursing competence assessment tool among nursing students: a development and validation study
Authors: Huang Sheng-Miauh , Fang Su-Chen , Hung Chia-Tai , Chen Yi-Heng
Published: May 2022

Background

Nursing competence refers to the core abilities that are required for fulfilling one’s role as a nurse. A specific instrument comprehensively measuring competence among nursing students has not yet been developed. The purpose of the study was to develop and validate a nursing competence instrument for nursing students in bachelor training.

Methods

A descriptive and explorative study design was used. Data were collected from students at one medical college in Taiwan in 2020 and 2021. A total of 241 nursing students participated in this study. We developed the initial instrument through systematic review, expert evaluations, and pilot versions. Its validity was then tested using confirmatory factor analysis (CFA) and criterion-related validity, while its reliability was tested using Cronbach’s alpha and test–retest analysis.

Results

The final fit indexes of CFA were as follows: chi-square = 860.1 (p < 0.01), normed chi-square = 2.24, SRMR = 0.04, RMSEA = 0.07, CFI = 0.94, and TLI = 0.94. Cronbach’s alpha values for the subscales observed ranged from 0.91 to 0.98. The test–retest reliability coefficient for the Nurse Competence Scale was 0.515 (n = 30, p < 0.01).

Conclusions

The instrument exhibited acceptable psychometric properties, thereby proving itself a valuable tool for evaluating nursing students’ competence at bachelor training. Further assessments of its reliability, validity, and generality from mentors’ and scholars’ views in different contexts and cultures are recommended.
Overview of ICD-11 architecture and structure
Authors: Chute Christopher G. , Çelik Can
Published: May 2022

Background

The International Classification of Diseases (ICD) has progressed from a short list of causes of death to become the predominant classification of human diseases, syndromes, and conditions around the world. The World Health Organization has now explored how the ICD could be revised to leverage the advances in computer science, ontology, and knowledge representation that had accelerated in the twentieth and early twenty-first centuries.

Methods

Many teams of clinical specialists and domain leaders worked to fundamentally revise the science and knowledge base of ICD-11. Development of the ICD-11 architecturally was a fundamental revision. The architecture for ICD-11 proposed in 2007 included three layers: a semantic network of biomedical concepts (Foundation), a traditional tabulation of hierarchical codes that would derive from that network (Linearization), and a formal ontology that would anchor the meaning of terms in the semantic network. Additionally, each entry in the semantic network would have an associated information model of required and optional content (Content Model).

Results

This paper describes the innovative architecture developed for ICD-11.

Conclusion

ICD11 is a revolutionary transformation of a century long medical classification that retains is historical rendering and interface while expanding the opportunity for multiple linearization and underpinning its content with a formally constructed semantic network. The new artifact can enable modern data science and analyses with content encoded with ICD11.
Study of Nightingale’s nursing professionalism: a survey of nurses and nursing students in China
Authors: Wang Qian , Wang Chen , Luo Dan , Li Jin , Duan Zhiguang
Published: May 2022

Background

Nursing professionalism is highly significant to the development of nursing. Florence Nightingale was the founder and leader of modern nursing, and Nightingale’s nursing professionalism has a significant impact on nursing in China and all over the world. In the new era, a new understanding of Nightingale’s nursing professionalism should be developed, and its positive role in nursing reshaped.

Methods

A total of 1,557 nurses and nursing students from 27 provincial administrative regions of China were surveyed using a customized questionnaire. Their recognitions of Nightingale’s nursing professionalism were evaluated based on scores, and statistical differences between and within the groups were analyzed using an Analysis of Variance (ANOVA). The elements of Nightingale’s nursing professionalism were extracted by the exploratory factor method and a principal component analysis.

Results

The Cronbach’s α of the questionnaire was 0.965, and the two groups did not differ significantly (p > 0.05). Based on the standard that the cumulative contribution rate of common factor should be > 85%, three common factors of Nightingale’s nursing professionalism, including professional emotion, professional ability and professional ethics, were extracted based on the Scree plot.

Conclusions

This study aimed to explore the connotation of Nightingale’s nursing professionalism. Our survey indicates that Nightingale’s nursing professionalism is highly recognized by nurses and nursing students in China. Its connotation includes professional emotion, ability and ethics. Nursing education and nursing management should fully utilize the leading role of Nightingale and guide the professional behaviors of nurses to be consistent with Nightingale’s nursing professionalism, thus, improving the degree of nurse professionalism.
Association between continuity of care (COC), healthcare use and costs: what can we learn from claims data? A rapid review
Authors: Nicolet Anna , Al-Gobari Muaamar , Perraudin Clémence , Wagner Joël , Peytremann-Bridevaux Isabelle , Marti Joachim
Published: May 2022

Objective

To describe how longitudinal continuity of care (COC) is measured using claims-based data and to review its association with healthcare use and costs.

Research design

Rapid review of the literature.

Methods

We searched Medline (PubMed), EMBASE and Cochrane Central, manually checked the references of included studies, and hand-searched websites for potentially additional eligible studies.

Results

We included 46 studies conducted in North America, East Asia and Europe, which used 14 COC indicators. Most reported studies (39/46) showed that higher COC was associated with lower healthcare use and costs. Most studies (37/46) adjusted for possible time bias and discussed causality between the outcomes and COC, or at least acknowledged the lack of it as a limitation.

Conclusions

Whereas a wide range of indicators is used to measure COC in claims-based data, associations between COC and healthcare use and costs were consistent, showing lower healthcare use and costs with higher COC. Results were observed in various population groups from multiple countries and settings. Further research is needed to make stronger causal claims.
Medical Dispute Committees in the Netherlands: a qualitative study of patient expectations and experiences
Authors: Dijkstra Rachel I. , Elbers Nieke A. , Friele Roland D. , Pemberton Antony
Published: May 2022

Background

Health care incidents, such as medical errors, cause tragedies all over the world. Recent legislation in the Netherlands has established medical dispute committees to provide for an appeals procedure offering an alternative to civil litigation and to meet the needs of clients. Dispute committees incorporate a hybrid procedure where one can file a complaint and a claim for damages resulting in a verdict without going to court. The procedure is at the crossroads of complaints law and civil litigation. This study seeks to analyze to what extent patients and family members’ expectations and experiences with dispute committees match the goals of the new legislation.

Methods

This qualitative, retrospective research includes in-depth, semi-structured, face-to-face interviews with patients or family members who filed a complaint with a dispute committee in the Netherlands. The researchers conducted an inductive, thematic analysis of the qualitative data.

Results

A total of 26 interviews were held with 30 patients and family members. The results showed that participants particularly felt the need to be heard and to make a positive impact on health care. Some wished to be financially compensated, for others money was the last thing on their mind. The results demonstrated the existence of unequal power relationships between participants and both the defendant and dispute committee members. Participants reported the added value of (legal) support and expressed the need for dialogue at the hearing. Participants sometimes experienced closure after the proceedings, but often did not feel heard or felt a lack of a practical outcome and a tangible improvement.

Conclusions

This study shows that participants’ expectations and experiences were not always met by the current set up of the dispute committee proceedings. Participants did not feel heard, while they did value the potential for monetary compensation. In addition, some participants did not experience an empowered position but rather a feeling of a power misbalance. The feeling of a power misbalance and not being heard might be explained by existing epistemic injustice, which is a concept that should be carefully considered in processes after health care incidents.