bluuebunny/crossref_metadata_2025 huggingface dataset:
A QUALITY IMPROVEMENT PROJECT TO REDUCE THE USE OF COMBINATION OPIOID/ACETAMINOPHEN MEDICATIONS WITHIN A LARGE HEALTH SYSTEM
Authors: Trivedi Sunny , Shea Kevin , Chadwick Whitney , Gaskari Shabnam , Wang Ellen , Caruso Thomas
Published: April 2020

Background:

Combination analgesics are among the most commonly prescribed pain medications in pediatric orthopedic patients. However, combined analgesics do not allow for individual medication titration, which can increase the risk of opioid misuse and hepatoxicity from acetaminophen. Increasingly, the risks of combined analgesics associated with opioid misuse and hepatotoxicity are recognized by the FDA and other organizations. Given these risks, consideration should be made for independent administration of acetaminophen and opioids.

Hypothesis/Purpose:

The primary aim was to alter the prescribing habits of pediatric orthopedic providers at our institution from postoperative combined opioid/acetaminophen medicines to independent opioids and acetaminophen.

Methods:

The study took place at a children’s hospital level one trauma center. A multidisciplinary team of health professionals utilized lean methodology to develop a project plan. Guided by a key driver diagram, (1) combination oxycodone/acetaminophen products were removed from hospital formulary, (2) a revised inpatient and outpatient electronic order set was implemented, and (3) multiple education efforts (emails, in person meetings) were conducted. Outcomes included inpatient and outpatient percent combined opioid/acetaminophen orders by surgical providers over twenty-seven months. Statistical process control charts were used to measure combination opioid prescribing practices for orthopedic and other surgical specialties.

Results:

Prior to intervention, inpatient combination opioid/acetaminophen products were prescribed for an average of 46% of all opioid prescriptions for orthopedic patients. After intervention and multiple educational efforts, the percent of combined opioid/acetaminophen products dropped to 31% and then to 3% by end of the investigational period. For outpatient prescriptions, the combined products accounted for 88% prior to intervention and dropped to 15% at project completion.

Conclusion:

By removing combined oxycodone/acetaminophen products from hospital formulary, educating the medical staff, and employing electronic order sets, the inpatient/outpatient prescribing practice of pediatric orthopedic surgeons changed from the common use of combined opioid/acetaminophen products to independent medications. This project demonstrates that changing medication prescription practice can be accomplished with 3 steps within a hospital system. Reducing the use of combination opioid/acetaminophen products may have further positive impacts on opioid misuse and hepatoxicity.
ANKLE BRACE USE AND RISK OF ACUTE LOWER EXTREMITY INJURY AMONG FEMALE HIGH SCHOOL VOLLEYBALL PLAYERS
Authors: Kliethermes Stephanie , McGuine Timothy , Biese Kevin , Bell David , Watson Andrew , Brooks M. Alison , Post Eric , Lang Pamela
Published: April 2020

Background:

Lower extremity injuries (LEIs), particularly ankle sprains, are the most common injury reported among female volleyball players. Many athletes wear ankle braces to help prevent injury; however, it is unknown whether ankle brace use reduces the rate and severity of ankle and LEI in these athletes.

Hypothesis/Purpose:

Determine if ankle brace use is associated with a reduced rate and severity of LEIs and ankle injuries among female high school volleyball players.

Methods:

2073 female volleyball players from 78 high schools were prospectively followed for injury, including acute LEI, during their fall 2018 volleyball season. Baseline data was collected on each participant including ankle brace use and type worn. Brace type was classified as soft- (e.g. fabric) or hard-shell. Injury severity was measured as days lost from sport. Incidence rates are reported per 1000 athlete exposures.

Results:

210 acute LEIs were observed during the season, of which 122 (58%) were ankle injuries. 76% of non-contact LEIs were due to jumping/landing or rotating around a planted foot. Similarly, 76% of contact LEIs were due to the floor or a teammate. The rate of LEI for athletes wearing soft-shell(SS) braces was 1.14 (95% CI: 0.76, 1.72), compared to 0.53 (95% CI: 0.25, 1.10) for those wearing hard-shells (HS) and 0.52 (95% CI: 0.37, 0.71) for those not wearing braces (NONE). The rate of a LEI for athletes wearing SS was 2.22 (95% CI: 1.31, 3.74) times as high as that for NONE (p=0.003). No association was found between LEI risk in athletes wearing HS versus NONE (IRR: 1.02, 95% CI: 0.45, 2.30). Similarly, the rates of ankle injury for HS, SS and NONE were 0.08 (95% CI: 0.01, 0.530), 0.40 (95% CI: 0.20, 0.79), and 0.16 (95% CI: 0.09, 0.28), respectively. The rate of ankle injury was 2.5 times as great in participants wearing SS compared to NONE (p=0.04). No association was detected for HS braces (p=0.48). No difference in median days lost for LEI (HS: 2[IQR 1,13], SS: 4[1, 10] None: 3[1,9]) or ankle injury (HS: 7[IQR 2,13], SS: 5[1, 11] None: 3[1,10]) was detected by brace use (p=0.99, p=0.79, respectively).

Conclusion:

The use of SS braces resulted in an increased risk of LEI and ankle injury among female high-school volleyball players; moreover, HS braces were not found to be associated with injury risk nor did ankle brace use affect severity of LEI and ankle injury in this population.
COMPARISON OF BONE-PATELLA TENDON-BONE (BTB) AND QUADRICEPS AUTOGRAFT FOR ACL RECONSTRUCTION IN PATIENTS UNDER 18 YEARS OF AGE
Authors: Sherman Seth L. , Hogan Daniel W. , Geeslin Derek W. , Rund Joseph M. , Burch M. Benjamin , Ma Richard , Gray Aaron D.
Published: April 2020

Background:

Graft choice for ACL reconstruction in patients under 18 years old remains controversial. BTB autograft has long been considered for young athletes who are at or near skeletal maturity. Quadriceps autograft has emerged as an alternative graft choice in the young patient population. However, there remains a paucity of comparative outcomes.

Hypothesis/Purpose:

Our purpose is to compare subjective outcomes and complications of ACL reconstruction in patients under 18 years old using either BTB or quadriceps autograft. Our hypothesis is that there will be no difference in subjective outcome or complication between groups.

Methods:

Following IRB approval, retrospective review of prospectively collected data identified consecutive cohorts of patients under 18 years old undergoing ACL reconstruction with either BTB or quadriceps autograft. Surgery was performed by a single sports fellowship trained surgeon between 2011-2019. Patients undergoing concomitant osteotomies, cartilage restoration, and other ligament reconstruction procedures were excluded. Pre- and post-surgical patient reported outcomes (PROs) including IKDC, KOOS, PROMIS, SANE, Tegner, and Marx were compared between groups. Complications requiring re-operation (i.e., infection, stiffness, reconstruction failure) were recorded. Results were analyzed statistically.

Results:

71 patients met inclusion criteria. There were 41 BTB and 30 quadriceps autografts. Mean age was 16.5 years in the BTB group and 14.5 in the quadriceps group (p=0.0000006). 27 of 41 (66%) BTB and 13 of 30 (43%) quadriceps were female. There were no significant differences in PROs between groups. At minimum 6-month follow-up (range 6-25.7 months), patients in both quadriceps and BTB autograft cohorts reported statistically significant improvements in IKDC scores (31.10%, p=0.0009; 34.25%, p=0.00000008), all KOOS domains, SANE (41.80%, p=0.0000006; 42.42%, p=0.000000002), and Tegner scores (2.99%, p=0.0002; 3.35%, p=0.000004). Post-operative PROs were not significantly different between groups (p>0.05). Complications were low and not significant between groups. Both quadriceps and BTB autograft cohorts required 3 post-operative re-operations (10% and 7%, p=0.7), each group including 2 revision reconstructions (7% and 5%, p=0.8) and 1 procedure for stiffness (3% and 2%, p=0.8).

Conclusion:

For ACL reconstruction in patients under 18 years old, both BTB and quadriceps autografts demonstrated significant subjective improvements and low rates of complications requiring re-operation. Quadriceps autograft appears to be a safe and effective alternative to BTB autograft in this challenging patient population.

[Table: see text][Table: see text]
How I treat pain in hematologic malignancies safely with opioid therapy
Authors: Geyer Holly L. , Gazelka Halena , Mesa Ruben
Published: April 2020

The field of malignant hematology has experienced extraordinary advancements with survival rates doubling for many disorders. As a result, many life-threatening conditions have since evolved into chronic medical ailments. Paralleling these advancements have been increasing rates of complex hematologic pain syndromes, present in up to 60% of patients with malignancy who are receiving active treatment and up to 33% of patients during survivorship. Opioids remain the practice cornerstone to managing malignancy-associated pain. Prevention and management of opioid-related complications have received significant national attention over the past decade, and emerging data suggest that patients with cancer are at equal if not higher risk of opioid-related complications when compared with patients without malignancy. Numerous tools and procedural practice guides are available to help facilitate safe prescribing. The recent development of cancer-specific resources directing algorithmic use of validated pain screening tools, prescription drug monitoring programs, urine drug screens, opioid use disorder risk screening instruments, and controlled substance agreements have further strengthened the framework for safe prescribing. This article, which integrates federal and organizational guidelines with known risk factors for cancer patients, offers a case-based discussion for reviewing safe opioid prescribing practices in the hematology setting.
Epo receptor signaling in macrophages alters the splenic niche to promote erythroid differentiation
Authors: Chen Yuanting , Xiang Jie , Qian Fenghua , Diwakar Bastihalli T. , Ruan Baiye , Hao Siyang , Prabhu K. Sandeep , Paulson Robert F.
Published: April 2020

Anemic stress induces stress erythropoiesis, which rapidly generates new erythrocytes to restore tissue oxygenation. Stress erythropoiesis is best understood in mice where it is extramedullary and occurs primarily in the spleen. However, both human and mouse stress erythropoiesis use signals and progenitor cells that are distinct from steady-state erythropoiesis. Immature stress erythroid progenitors (SEPs) are derived from short-term hematopoietic stem cells. Although the SEPs are capable of self-renewal, they are erythroid restricted. Inflammation and anemic stress induce the rapid proliferation of SEPs, but they do not differentiate until serum erythropoietin (Epo) levels increase. Here we show that rather than directly regulating SEPs, Epo promotes this transition from proliferation to differentiation by acting on macrophages in the splenic niche. During the proliferative stage, macrophages produce canonical Wnt ligands that promote proliferation and inhibit differentiation. Epo/Stat5-dependent signaling induces the production of bioactive lipid mediators in macrophages. Increased production of prostaglandin J2 (PGJ2) activates peroxisome proliferator-activated receptor γ (PPARγ)-dependent repression of Wnt expression, whereas increased production of prostaglandin E2 (PGE2) promotes the differentiation of SEPs.
The transcription factor ETS1 is an important regulator of human NK cell development and terminal differentiation
Authors: Taveirne Sylvie , Wahlen Sigrid , Van Loocke Wouter , Kiekens Laura , Persyn Eva , Van Ammel Els , De Mulder Katrien , Roels Juliette , Tilleman Laurentijn , Aumercier Marc , Matthys Patrick , Van Nieuwerburgh Filip , Kerre Tessa C.C. , Taghon Tom , Van Vlierberghe Pieter , Vandekerckhove Bart , Leclercq Georges
Published: April 2020

Natural killer (NK) cells are important in the immune defense against tumor cells and pathogens, and regulate other immune cells by cytokine secretion. Whereas murine NK cell biology has been extensively studied, knowledge about transcriptional circuitries controlling human NK cell development and maturation is limited. By generating ETS1-deficient human embryonic stem cells (hESC) and by expressing the dominant-negative ETS1 p27 isoform in cord blood (CB) hematopoietic progenitor cells (HPCs), we show that the transcription factor ETS1 is critically required for human NK cell differentiation. Genome-wide transcriptome analysis determined by RNA-sequencing combined with chromatin immunoprecipitation-sequencing (ChIP-seq) analysis reveals that human ETS1 directly induces expression of key transcription factors that control NK cell differentiation, i.e. E4BP4, TXNIP, TBET, GATA3, HOBIT and BLIMP1. In addition, ETS1 regulates expression of genes involved in apoptosis and NK cell activation. Our study provides important molecular insights into the role of ETS1 as an important regulator of human NK cell development and terminal differentiation.
Functional and phylogenetic alterations in gut microbiome are linked to graft-versus-host disease severity
Authors: Payen Mathilde , Nicolis Ioannis , Robin Marie , Michonneau David , Delannoye Johanne , Mayeur Camille , Kapel Nathalie , Berçot Béatrice , Butel Marie-José , Le Goff Jérôme , Socié Gérard , Rousseau Clotilde
Published: April 2020

Acute graft-versus-host disease (aGVHD) is the main complication of hematopoietic stem cell transplantation (HSCT). Changes in gut microbiota composition have been associated with subsequent aGVHD, and reconstitution of healthy microbiota is currently being explored as a therapeutic approach. However, the specific actors in the intestinal ecosystem involved in the pathologic process at the time of aGVHD onset are not yet fully known. We prospectively collected stool samples from patients who underwent allogeneic HSCT. Patients sampled at aGVHD onset were compared with non-GVHD patients. To identify phylogenetic and functional signatures of the disease process, we determined fecal short-chain fatty acid (SFCA) profiles and used high-throughput DNA sequencing and real-time quantitative polymerase chain reaction to assess the microbiota composition. Microbiota alterations were highly specific of gastrointestinal (GI) aGVHD severity. Bacterial biomass and α-diversity were lower in severe aGVHD. We identified several bacterial signatures associated with severe aGVHD at disease onset; a negative correlation was observed with anaerobic bacteria of the Lachnospiraceae, especially the Blautia genus, and Ruminococcaceae families. In parallel, in severe aGVHD patients, we showed a dramatic decrease in the levels of the main SFCAs: acetate (75.8%), propionate (95.8%), and butyrate (94.6%). Mild aGVHD patients were characterized by conserved levels of propionate and Blautia propionate producers. Butyrate was significantly decreased in all GI aGVHD stages, representing a potential diagnostic marker of the disease. Specific microbiota and metabolic alterations were thus associated with aGVHD severity and may be useful for diagnostic and pathophysiologic purposes.
A scoping review of pre-hospital technology to assist ambulance personnel with patient diagnosis or stratification during the emergency assessment of suspected stroke
Authors: Lumley Hannah A , Flynn Darren , Shaw Lisa , McClelland Graham , Ford Gary A , White Phil M , Price Christopher I
Published: April 2020

Background

Pre-hospital identification of key subgroups within the suspected stroke population could reduce delays to emergency treatment. We aimed to identify and describe technology with existing proof of concept for diagnosis or stratification of patients in the pre-hospital setting.

Methods

A systematic electronic search of published literature (from 01/01/2000 to 06/06/2019) was conducted in five bibliographic databases. Two reviewers independently assessed eligibility of studies or study protocols describing diagnostic/stratification tests (portable imaging/biomarkers) or technology facilitating diagnosis/stratification (telemedicine) used by ambulance personnel during the assessment of suspected stroke. Eligible descriptions required use of tests or technology during the actual assessment of suspected stroke to provide information directly to ambulance personnel in the pre-hospital setting. Due to study, intervention and setting heterogeneity there was no attempt at meta-analysis.

Results

2887 articles were screened for eligibility, 19 of which were retained. Blood biomarker studies (n = 2) were protocols of prospective diagnostic accuracy studies, one examining purines and the other a panel of known and novel biomarkers for identifying stroke sub-types (versus mimic). No data were yet available on diagnostic accuracy or patient health outcomes. Portable imaging studies (n = 2) reported that an infrared screening device for detecting haemorrhages yielded moderate sensitivity and poor specificity in a small study, whilst a dry-EEG study to detect large vessel occlusion in ischaemic stroke has not yet reported results. Fifteen evaluations of pre-hospital telemedicine were identified (12 observational and 3 controlled comparisons) which all involved transmission of stroke assessment data from the pre-hospital setting to the hospital. Diagnosis was generally comparable with hospital diagnosis and most telemedicine systems reduced time-to-treatment; however, it is unknown whether this time saving translated into more favourable clinical outcomes. Telemedicine systems were deemed acceptable by clinicians.

Conclusions

Pre-hospital technologies to identify clinically important subgroups amongst the suspected stroke population are in development but insufficient evidence precludes recommendations about routine use in the pre-hospital setting. Multi-centre diagnostic accuracy studies and clinical utility trials combining promising technologies are warranted.
Views of patients with multi-morbidity on what is important for patient-centered care in the primary care setting
Authors: Kuipers Sanne Jannick , Nieboer Anna Petra , Cramm Jane Murray
Published: April 2020

Background

Patient-centered care (PCC) has been proposed as the way forward in improving primary care for patients with multi-morbidity. However, it is not clear what PCC exactly looks like in practice for patients with multi-morbidity. A better understanding of multi-morbid patients’ views on what PCC should look like and which elements are most important may help to improve care delivery for this vulnerable population. The present study thus aimed to identify views of patients with multi-morbidity on the relative importance of PCC aspects in a Dutch primary care setting.

Methods

Interviews were conducted with 16 patients with multi-morbidity using Q-methodology, which combines quantitative and qualitative analyses. The participants ranked 28 statements about the eight dimensions of PCC (patients’ preferences, information and education, access to care, emotional support, family and friends, continuity and transition, physical comfort, and coordination of care) by relative importance. By-person factor analysis using centroid factor extraction and varimax rotation were used to reveal factors that represent viewpoints. Qualitative interview data were used to interpret the viewpoints.

Results

The analyses revealed three factors representing three distinct viewpoints of patients with multi-morbidity on what is important for patient-centered care in the primary care setting. Patients with viewpoint 1 are prepared proactive patients who seem to be well-off and want to be in charge of their own care. To do so, they seek medical information and prefer to be supported by a strongly coordinated multidisciplinary team of healthcare professionals. Patients with viewpoint 2 are everyday patients who visit GPs and require well-coordinated, respectful, and supportive care. Patients with viewpoint 3 are vulnerable patients who are less resourceful in terms of communication skills and finances, and thus require accessible care and professionals taking the lead while treating them with dignity and respect.

Conclusion

The findings of this study suggest that not all patients with multi-morbidity require the same type of care delivery, and that not all aspects of PCC delivery are equally important to all patients.
Lithium induced reversible Splenial lesion in neuroleptic malignant syndrome like symptoms: two case reports
Authors: Ryu Han Uk , Chung Ji Yeon , Shin Byoung-Soo , Kang Hyun Goo
Published: April 2020

Background

Lithium is primarily used to treat bipolar disorder and is known to cause several acute neurological complications. Reversible splenial lesions (RSLs) may be evident in antiepileptic drug toxicity or withdrawal, infections, and other phenomena. We report two cases of RSL presenting as neuroleptic malignant syndrome-like symptoms (NMSLS) with lithium associated neurotoxicity.

Case presentation

A 28-year-old woman was admitted after taking increased dosages of lithium for schizophrenia. She experienced generalized tremor, rigidity, dysarthria, high fever, and tachycardia. Symptoms and brain lesion recovered 2 weeks after discontinuation of lithium. The second case involved a 59-year-old woman who was receiving treatment for bipolar disorder since 1988. When lithium was administered for impatience and aggressive behavior, her mental state deteriorated and fever developed, along with generalized tremor in the extremities. Brain magnetic resonance imaging (MRI) in both patients showed a reversible oval-shaped lesion localized to the splenium of the corpus callosum. Both patients were defined as neuroleptic malignant syndrome-like symptoms (NMSLS) based on the DSM-5 diagnostic criteria for neuroleptic malignant syndrome. The suspected etiology of our cases was lithium associated neurotoxicity according to their clinical course and medical information. Our patients fully recovered in 10–14 days after the discontinuation of lithium.

Conclusions

The patients experienced similar clinical courses and had similar radiological findings of RSL. Manifestations in both cases were related to lithium associated neurotoxicity and this should be considered in patients with RSL and NMSLS.
Identifying opportunities to support patient-centred care for ductal carcinoma in situ: qualitative interviews with clinicians
Authors: Nyhof Bryanna B. , Wright Frances C. , Look Hong Nicole J. , Groot Gary , Helyer Lucy , Meiers Pamela , Quan May Lynn , Baxter Nancy N. , Urquhart Robin , Warburton Rebecca , Gagliardi Anna R.
Published: April 2020

Background

Women with ductal carcinoma in situ (DCIS) report poor patient-clinician communication, and long-lasting confusion and anxiety about their treatment and prognosis. Research shows that patient-centred care (PCC) improves patient experience and outcomes. Little is known about the clinician experience of delivering PCC for DCIS. This study characterized communication challenges faced by clinicians, and interventions they need to improve PCC for DCIS.

Methods

Purposive and snowball sampling were used to recruit Canadian clinicians by specialty, gender, years of experience, setting, and geographic location. Qualitative interviews were conducted by telephone. Data were analyzed using constant comparison. Findings were mapped to a cancer-specific, comprehensive PCC framework to identify opportunities for improvement.

Results

Clinicians described approaches they used to address the PCC domains of fostering a healing relationship, exchanging information, and addressing emotions, but do not appear to be addressing the domains of managing uncertainty, involving women in making decisions, or enabling self-management. However, many clinicians described challenges or variable practices for all PCC domains but fostering a healing relationship. Clinicians vary in describing DCIS as cancer based on personal beliefs. When exchanging information, most find it difficult to justify treatment while assuring women of a good prognosis, and feel frustrated when women remain confused despite their efforts to explain it. While they recognize confusion and anxiety among women, clinicians said that patient navigators, social workers, support groups and high-quality information specific to DCIS are lacking. Despite these challenges, clinicians said they did not need or want communication interventions.

Conclusions

Findings represent currently unmet opportunities by which to help clinicians enhance PCC for DCIS, and underscore the need for supplemental information and supportive care specific to DCIS. Future research is needed to develop and test communication interventions that improve PCC for DCIS. If effective and widely implemented, this may contribute to improved care experiences and outcomes for women diagnosed with and treated for DCIS.
Measures for the integration of health and social care services for long-term health conditions: a systematic review of reviews
Authors: Kelly Laura , Harlock Jenny , Peters Michele , Fitzpatrick Ray , Crocker Helen
Published: April 2020

Background

As people are living longer with higher incidences of long-term health conditions, there is a move towards greater integration of care, including integration of health and social care services. Integrated care needs to be comprehensively and systematically evaluated if it is to be implemented widely. We performed a systematic review of reviews to identify measures which have been used to assess integrated care across health and social care services for people living with long-term health conditions.

Methods

Four electronic databases (PUBMED; MEDLINE; EMBASE; Cochrane library of systematic reviews) were searched in August 2018 for relevant reviews evaluating the integration of health and social care between 1998 and 2018. Articles were assessed according to apriori eligibility criteria. A data extraction form was utilised to collate the identified measures into five categories.

Results

Of the 18 articles included, system outcomes and process measures were most frequently identified (15 articles each). Patient or carer reported outcomes were identified in 13 articles while health outcomes were reported in 12 articles. Structural measures were reported in nine articles. Challenges to measuring integration included the identification of a wide range of potential impacts of integration, difficulties in comparing findings due to differences in study design and heterogeneity of types of outcomes, and a need for appropriate, robust measurement tools.

Conclusions

Our review revealed no shortage of measures for assessing the structures, processes and outcomes of integrated care. The very large number of available measures and infrequent use of any common set make comparisons between schemes more difficult. The promotion of core measurement sets and stakeholder consultation would advance measurement in this area.
Correction to: The French glioblastoma biobank (FGB): a national clinicobiological database
Authors:   FGB network, Clavreul Anne , Soulard Gwénaëlle , Lemée Jean-Michel , Rigot Marion , Fabbro-Peray Pascale , Bauchet Luc , Figarella-Branger Dominique , Menei Philippe
Published: April 2020

An amendment to this paper has been published and can be accessed via the original article.
Correction to: A novel role of glutathione S-transferase A3 in inhibiting hepatic stellate cell activation and rat hepatic fibrosis
Authors: Chen Haihua , Gan Qixin , Yang Congying , Peng Xiongqun , Qin Jiao , Qiu Sisi , Jiang Yanzhi , Tu Sha , He Ying , Li Shenglan , Yang Huixiang , Tao Lijian , Peng Yu
Published: April 2020

An amendment to this paper has been published and can be accessed via the original article.
The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network’s first protocol: deep phenotyping in three sub-Saharan African countries
Authors:   the PRECISE Network, von Dadelszen Peter , Flint-O’Kane Meriel , Poston Lucilla , Craik Rachel , Russell Donna , Tribe Rachel M. , d’Alessandro Umberto , Roca Anna , Jah Hawanatu , Temmerman Marleen , Koech Etyang Angela , Sevene Esperança , Chin Paulo , Lawn Joy E. , Blencowe Hannah , Sandall Jane , Salisbury Tatiana T. , Barratt Benjamin , Shennan Andrew H. , Makanga Prestige Tatenda , Magee Laura A.
Published: April 2020

Background

The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network is a new and broadly-based group of research scientists and health advocates based in the UK, Africa and North America.

Methods

This paper describes the protocol that underpins the clinical research activity of the Network, so that the investigators, and broader global health community, can have access to ‘deep phenotyping’ (social determinants of health, demographic and clinical parameters, placental biology and agnostic discovery biology) of women as they advance through pregnancy to the end of the puerperium, whether those pregnancies have normal outcomes or are complicated by one/more of the placental disorders of pregnancy (pregnancy hypertension, fetal growth restriction and stillbirth). Our clinical sites are in The Gambia (Farafenni), Kenya (Kilifi County), and Mozambique (Maputo Province). In each country, 50 non-pregnant women of reproductive age will be recruited each month for 1 year, to provide a final national sample size of 600; these women will provide culturally-, ethnically-, seasonally- and spatially-relevant control data with which to compare women with normal and complicated pregnancies. Between the three countries we will recruit ≈10,000 unselected pregnant women over 2 years. An estimated 1500 women will experience one/more placental complications over the same epoch. Importantly, as we will have accurate gestational age dating using the TraCer device, we will be able to discriminate between fetal growth restriction and preterm birth. Recruitment and follow-up will be primarily facility-based and will include women booking for antenatal care, subsequent visits in the third trimester, at time-of-disease, when relevant, during/immediately after birth and 6 weeks after birth.

Conclusions

To accelerate progress towards the women’s and children’s health-relevant Sustainable Development Goals, we need to understand how a variety of social, chronic disease, biomarker and pregnancy-specific determinants health interact to result in either a resilient or a compromised pregnancy for either mother or fetus/newborn, or both. This protocol has been designed to create such a depth of understanding. We are seeking funding to maintain the cohort to better understand the implications of pregnancy complications for both maternal and child health.
The contribution of qualitative research within the PRECISE study in sub-Saharan Africa
Authors:   the PRECISE Network, Daniele Marina A. S. , Martinez-Alvarez Melisa , Etyang Angela Koech , Vidler Marianne , Salisbury Tatiana , Makanga Prestige Tatenda , Musitia Peris , Flint-O’Kane Meriel , Brown Tanya Wells , Diallo Brahima Amara , Boene Helena , Stones William , von Dadelszen Peter , Magee Laura A. , Sandall Jane
Published: April 2020

The PRECISE Network is a cohort study established to investigate hypertension, fetal growth restriction and stillbirth (described as “placental disorders”) in Kenya, Mozambique and The Gambia. Several pregnancy or birth cohorts have been set up in low- and middle-income countries, focussed on maternal and child health. Qualitative research methods are sometimes used alongside quantitative data collection from these cohorts. Researchers affiliated with PRECISE are also planning to use qualitative methods, from the perspective of multiple subject areas. This paper provides an overview of the different ways in which qualitative research methods can contribute to achieving PRECISE’s objectives, and discusses the combination of qualitative methods with quantitative cohort studies more generally.

We present planned qualitative work in six subject areas (health systems, health geography, mental health, community engagement, the implementation of the TraCer tool, and respectful maternity care). Based on these plans, with reference to other cohort studies on maternal and child health, and in the context of the methodological literature on mixed methods approaches, we find that qualitative work may have several different functions in relation to cohort studies, including informing the quantitative data collection or interpretation. Researchers may also conduct qualitative work in pursuit of a complementary research agenda. The degree to which integration between qualitative and quantitative methods will be sought and achieved within PRECISE remains to be seen. Overall, we conclude that the synergies resulting from the combination of cohort studies with qualitative research are an asset to the field of maternal and child health.
Survey of UK pet owners quantifying internal parasite infection risk and deworming recommendation implications
Authors: Pennelegion Christopher , Drake Jason , Wiseman Scott , Wright Ian
Published: April 2020

Background

Dogs and cats in the UK are exposed to many internal parasites which can pose risks to the health of both the pet and their owners. By understanding these endemic parasites and the risks they pose, we can assess the lifestyle of pets and recommend the correct deworming frequency. Studies identifying risk factors were discussed in the European Scientific Counsel Companion Animal Parasites (ESCCAP) guidelines. To this date, there has been very little information on how pet owners in the UK deworm their pets and if the protocols they follow align with ESCCAP recommendations. The objective of this study was to look at the current deworming protocols of UK cat and dog owners in conjunction with their lifestyle and risk.

Methods

An online survey was conducted in the UK targeting pet owners who own at least one dog and/or cat and were responsible for product purchase, the pet’s health care and veterinary visits. These survey results were analysed against the ESCCAP guidelines and each pet placed into a risk category. By comparing the current deworming frequency with that recommended for their risk category, the compliance of UK pet owners with ESCCAP recommendations was evaluated.

Results

A total of 500 dog owners and 500 cat owners completed surveys. Overall, the study found none of the pets fell into risk group A, with all pets meeting the risk level for at least deworming four times a year (risk group B and above). The majority of animals fell into the highest risk category D with 97% of dogs and 68% of cats. The average deworming per year in the UK was 3.1 for dogs and 3.1 cats, below the minimum recommended by ESCCAP.

Conclusions

For both felines and canines, the dosing frequencies are lower than recommended to both reduce zoonotic risk for reducing Toxocara spp. egg-shedding and improve pet health. This research highlights the need for improved education around dog and cat patient risk assessments and greater adherence to recommended deworming aligned with the ESCCAP guidelines.
Drinking or smoking while breastfeeding and later developmental health outcomes in children
Authors: Gibson Louisa , Porter Melanie
Published: April 2020

Objectives

Prenatal intake of alcohol and tobacco have been associated with negative outcomes in children. Consumption of alcohol while breastfeeding has also been associated with dose-dependent decreases in abstract reasoning ability and academic scores in children at later ages. Using longitudinal data from The Growing Up in Australia Study, the current study aimed to investigate whether intake of alcohol or tobacco while breastfeeding was related to later developmental health outcomes in children.

Results

Multivariable linear regression analyses were performed on a sample of 2008 babies who were actively breastfeeding at study entry and 4679 babies who had been breastfed at any time (actively breastfed babies combined with babies who had been previously breastfed). Only a diagnosis of Autism spectrum disorder and Attention deficit disorder were associated with lower developmental health outcomes. Neither maternal alcohol consumption nor tobacco smoking while breastfeeding were associated with developmental health outcomes at 6–7 years old or 10–11 years old for either sample group. A relationship between maternal consumption of alcohol or tobacco smoking while breastfeeding and later developmental health outcomes in children was not identified.
Self-directed behaviors differentially explain associations between emotion dysregulation and eating disorder psychopathology in patients with or without objective binge-eating
Authors: Monell Elin , Clinton David , Birgegård Andreas
Published: April 2020

Background

Emotion dysregulation and negative self-directed behaviors are key characteristics of eating disorders (EDs), but their interaction in relation to ED psychopathology is insufficiently explored, and empirically robust and clinically relevant models are needed.

Methods

This study examined whether the association between emotion dysregulation and ED psychopathology was mediated by different negative self-directed behaviors in 999 ED patients divided into two sub-samples based on absence or presence of objective binge-eating episodes (OBE). Several simple and extended mediation models were examined using the Difficulties in Emotion Regulation Scale (DERS) as independent variable, the Structural Analysis of Social Behavior (SASB) as mediator, and the Eating Disorder Examination Questionnaire (EDE-Q) as dependent variable.

Results

An associational pathway was found where higher emotion dysregulation was associated with more negative self-directed behaviors, which in turn was associated with higher ED psychopathology. Self-directed behaviors of importance differed between patient groups. In participants without OBE, lower self-love and higher self-attack were influential, whereas in participants with OBE, lower self-affirmation and higher self-blame were influential.

Conclusions

Self-directed behaviors may help to explain the association between emotion dysregulation and ED psychopathology. Our findings have both theoretical and clinical implications that are pathology-specific. Addressing specific self-directed behaviors could be an important way of helping patients deal with their emotions in relation to ED psychopathology.
Metallic allergy requiring removal of iliac stent: report of a case
Authors: Guntani Atsushi , Kawakubo Eisuke , Yoshiga Ryosuke , Mii Shinsuke
Published: April 2020

Background

The use of metallic stents, which are predominantly composed of nickel, in the treatment of patients with nickel allergy has not been well studied.

Case presentation

A patient who suffered from contact dermatitis due to implantation of an iliac stent was successfully treated by removing the stent that caused nickel allergy. The patient has exhibited no symptoms of claudication or severe pruritic rash in the 2-year follow-up period after iliac stent removal.

Conclusions

We herein report a case of nickel allergy in which a metallic iliac stent that was predominantly composed of nickel was removed. The patient showed a marked recovery from her contact dermatitis. In cases of suspected metallic allergy, it is necessary to consider revascularization without using a metal device.
Overweight & obese Australian adults and micronutrient deficiency
Authors: McKay Jenny , Ho Suleen , Jane Monica , Pal Sebely
Published: April 2020

Background

Micronutrients have been implicated as an important factor in regulating various metabolic processes and thus playing a role in the aetiology of obesity. Many studies have been conducted worldwide that clearly show a direct link between obesity and micronutrient deficiencies. The aim of this study was to assess the nutritional status of overweight and obese Australian adults to see if there were any associations between BMI and serum micronutrient levels.

Methods

Baseline serum micronutrient data of overweight and obese individuals with a body mass index (BMI) between 25 and 40 kg/m2 and aged between 18 and 65 years was compared to the clinical micronutrient reference ranges for associations between BMI and micronutrient status.

Results

There were significant negative associations between BMI and serum vitamin D (p = 0.044), folate (p = 0.025), magnesium (p = 0.010) and potassium (p = 0.023).

Conclusions

Overweight and obesity appears to impact on the bioavailability and utilisation of micronutrients with absorption, excretion, storage/distribution (fat sequestering, tissue dispersion), metabolism (catabolic losses, possibly oxidative), increased physiologic requirements, and lower absolute total dietary intake being the current theory for observed differences. While vitamins D, folate, magnesium and potassium showed a negative relationship to BMI, other micronutrients did not. This may be explained by the fortification of certain processed foods, or the possibility of overweight and obese people eating more to satisfy their nutritional requirements.
Improving social function with real-world social-cognitive remediation in schizophrenia: Results from the RemedRugby quasi-experimental trial
Authors: Dubreucq Julien , Gabayet Franck , Ycart Bernard , Faraldo Megane , Melis Fanny , Lucas Thierry , Arnaud Benjamin , Bacconnier Mickael , Bakri Motassem , Cambier Gentiane , Carmona Florian , Chereau Isabelle , Challe Titaua , Morel Sophie , Pires Sylvie , Roussel Celine , Lamy Philippe , Legrand Guillaume , Pages Emmanuelle , Pommier Romain , Rey Romain , Souchet Yohan , Llorca Pierre-Michel , Massoubre Catherine ,   the RemedRugby Group
Published: April 2020

Background.

Functional capacity (FC) has been identified as a key outcome to improve real-world functioning in schizophrenia. FC is influenced by cognitive impairments, negative symptoms, self-stigma and reduced physical activity (PA). Psychosocial interventions targeting FC are still under-developed.

Methods.

we conducted a quasi-experimental study evaluating the effects of an exercise-enriched integrated social cognitive remediation (SCR) intervention (RemedRugby [RR]) compared with an active control group practicing Touch Rugby (TR). To our knowledge, this is the first trial to date evaluating the effectiveness of such a program provided in a real-life environment.

Results.

Eighty-seven people with schizophrenia were included and allocated to either the RR group (n= 57) or the TR group (n= 30) according to the routine clinical practice of the recruiting center. Outcomes were evaluated at baseline and post-treatment in both groups and after 6 months of follow-up in the RR group using standardized scales for symptom severity, social functioning, self-stigma, and a large cognitive battery. After treatment we observed moderate to large improvements in social function (Personal and Social Performance Scale [PSP],p< 0.001,d= 1.255), symptom severity (Positive and Negative Syndrome Scale [PANSS] negative,p< 0.001,d= 0.827; PANSS GP,p< 0.001,d= 0.991; PANSS positive,p= 0.009,d= 0.594), verbal abstraction (p= 0.008,d= 0.554), aggression bias (p= 0.008,d= 0.627), and self-stigma (stereotype endorsement,p= 0.019,d= 0.495; discrimination experiences,p= 0.047;d= 0.389) that were specific to the RR group and were not observed in participants playing only TR. Effects were persistent over time and even larger between post-treatment and follow-up.

Conclusions.

Exercise-enriched integrated SCR appears promising to improve real-life functioning in schizophrenia. Future research should investigate the potential effects of this intervention on neuroplasticity and physical fitness.
Lean Lobectomy: Streamlining Video-Assisted Lobectomy to Increase the Value of Lung Cancer Care
Authors: Yeo Jane H. , Shariati Nazly M. , Pelz Geoffrey B. , Dozier Jordan M. , Rizk Nabil P.
Published: April 2020

PURPOSE:

A review of the outcomes of patients who received our video-assisted thoracic surgery (VATS) lung lobectomy in 2015 revealed long lengths of stay, inefficient care transitions, and overuse of resources. Focused process redesign offers a proven method for instituting improvement and changes in health care. We sought to use systems process improvement to streamline VATS lobectomies at our institution, and we targeted cost drivers to optimize quality of care and minimize overuse of resources.

METHODS:

We performed a retrospective review of perioperative practices between January 2015 and March 2016 for patients undergoing VATS lobectomy that helped establish a value stream map, used a granular cost database, and performed real-time analysis. We used an outcomes database, which allowed us to identify cost drivers, practice variability, and rent seeking. We implemented process redesign with constant review and formal value stream reanalysis at 6-month intervals over a 2-year period.

RESULTS:

We ultimately experienced an overall 187% reduction of time in the operating room (297 v 159 minutes). Our process redesign also resulted in significantly fewer chest x-rays per patient (mean, 6.7 v 2), laboratory draws (100% v 5.7%), and consultations (100% v 5.7%), which resulted in a 234% reduction in mean length of stay (4.4 v 1.88 days) and an overall cost reduction of 40%. These changes did not have a detrimental effect on patient outcomes: pulmonary complications (16.9% v 8.6%), cardiac complications (13.2% v 8.6%), and readmission rates (13.6% v 2.9%) all decreased.

CONCLUSION:

By using value stream analysis and process redesign methodologies, closely paired with highly granular cost and outcomes data, we were able to achieve significant improvements in patient outcomes and use of resources.
Electric field effect on spin waves: Role of magnetic moment current
Authors: Basso Vittorio , Ansalone Patrizio
Published: April 2020

We show that a static electric field E

x
gives rise to a shift of the spin wave dispersion relation

in the direction of the wave number q

y
of the quantity

. This effect is caused by the magnetic moment current carried by the spin wave itself which generates an additional phase proportional to the electric field, as in the Aharonov-Casher effect. This effect is independent of the possibly present magneto-electric effects of insulating ferromagnets and superimposes to them.
Effect of Spacer Length in Naphthobispyrazine-Based π-Conjugated Polymers on Properties, Thin Film Structures, and Photovoltaic Performances
Authors: Mikie Tsubasa , Teshima Yoshikazu , Okamoto Kenta , Osaka Itaru
Published: April 2020

Incorporation of an electron-deficient building unit based on a large π-system into the polymer backbone is a powerful strategy for the development of high-performance π-conjugated polymers. The naphthobispyrazine (NPz) tetracyclic π-electron system is a promising electron-deficient building unit but its use in π-conjugated polymers has seldom been investigated. Here, we synthesized four NPz-based π-conjugated polymers with different donor units, namely thiophene (P1), bithiophene (P2), terthiophene (P3), and quaterthiophene (P4), and systematically studied their structure-property relationships. The absorption range was significantly red-shifted when the spacer length was longer than bithiophene due to the decreased steric hindrance between the NPz moieties. Furthermore, the crystallinity in the polymer thin films was dramatically improved when the spacer length was longer than terthiophene. These results clearly affect the efficiency of polymer/fullerene-based solar cells, with the maximum efficiency of 4.4% obtained using P3. This study may be helpful for the design of NPz-based π-conjugated polymers with improved performance.