bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of work willingness and its influencing factors of mental illness prevention and control personnel of grassroots institutions in China: a cross-sectional study
Authors: Qin Lulu , Li Sheng , Chen Yiwei , Chen Si , Fan Xuelong , Luo Bangan , Liu Jiahe
Published: February 2022

Background

In China, there are many studies focusing on the willingness of general practitioners and special medical personnel to work. However, there is a lack of studies on the working willingness of mental illness prevention and control staff.

Methods

This is a cross-sectional study. In this study we selected mental illness prevention and control personnel in the grassroots health service institutions in Hunan Province, China as our subjects. The χ2 test and binary logistic regression analysis were used to explore their work willingness and related influencing factors.

Results

The work willingness of mental illness prevention and control staff of grassroots institutions in China was 55.6% (502/903). The influencing factors were age (odds ratio [OR] 0.753 [95% confidence interval {CI} 0.638 to 0.888]), educational background (OR 1.342 [95% CI 1.092 to 1.648]) and major (OR 1.083 [95% CI 1.009 to 1.162]).

Conclusions

The work willingness of the mental illness prevention and control staff of grassroots institutions in China was at a low level. The job of preventing and controlling mental illness in grassroots areas needs the competence of workers with strong specialty and professional competence and workers who are willing to work in these communities. Work willingness is the result of multiple factors, especially healthcare investments.
COVID-19 in cancer patients
Authors: Seneviratne Suranjith L , Wijerathne Widuranga , Yasawardene Pamodh , Somawardana Buddhika
Published: February 2022

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has currently affected >220 million individuals worldwide. The complex interplay of immune dysfunction, active malignancy, the effect of cancer treatment on the immune system and additional comorbidities associated with cancer and COVID-19 all affect the outcomes of COVID-19 in patients with cancer. We have discussed the published findings (through the end of September 2021) on the effects of cancer on the morbidity and mortality of COVID-19, common factors between cancer and COVID-19, the interaction of cancer and COVID-19 treatments, the impact of COVID-19 on cancer clinical services, immune test findings in cancer patients with COVID-19 and the long-term effects of COVID-19 on cancer survivors.
Civil Resistance
Authors: Chenoweth Erica
Published: February 2022

This chapter considers civil resistance as a form of collective action that seeks to affect the
political, social, or economic status quo without using violence or the threat of violence
against people to do so. It describes civil resistance as organized, public, and explicitly
nonviolent in its means and ends. It also outlines some of the main takeaways from history about
the ways that civil resistance campaigns have formed, strategized, organized, and mobilized. The
chapter introduces the impressive history of civil resistance over the millennia and reveals
some of the key controversies that persist regarding how to define civil resistance and how to
understand its impact on the world. It defines the term civil resistance that best captures the
historical legacy out of which people have developed and refined the technique.
Civil Resistance and Violence from within the Movement
Authors: Chenoweth Erica
Published: February 2022

This chapter takes on the complicated question of violence from within a movement. It reviews
recent research findings that address how fringe violence from within a movement affects the
political situation for those pushing for change. It also determines whether civil resistance
movements win more quickly and decisively if, on their fringes, some participants use violence
and recounts how movements have debated whether to take up arms. The chapter traces how the
debate has roiled the abolition movement, the labor movement, the civil rights movement, the
1960s antiwar movement, and various other movements in the United States over the past fifty
years. In the 1960s and 1970s, the American left split over whether even occasional violence was
either wise or necessary- a split that was so divisive that liberal, progressive, and radical
groups went their separate ways.
The Future of Civil Resistance
Authors: Chenoweth Erica
Published: February 2022

This chapter discusses the long-term effects of civil resistance on different societies, noting
whether successful civil resistance campaigns tend to leave societies better or worse off. It
explores how civil resistance campaigns have changed over the past decade, particularly with the
emergence of digital activism. It also considers how movements have persisted in the face of
rising authoritarianism, global economic crises, and the global coronavirus pandemic. The
chapter points out that more people today turn to nonviolent civil resistance than to violence
as a way to remedy dire circumstances, which has become increasingly true over the past fifty
years. According to comprehensive data on revolutionary campaigns-nonviolent and violent- 627
mass campaigns sought to overthrow dictatorships or achieve independence from 1900 to 2019.
Gender 101
Authors: Erickson-Schroth Laura , Davis Benjamin
Published: February 2022

This chapter provides an overview of gender. It also
considers the gender binary, gender nonconformity, transgender people, and sexuality.
Gender and sex are terms that are often used
interchangeably and can have different meanings in different contexts. Sex is usually assigned
at birth as either male or female depending on the appearance of the genitals. There are also
many people who are intersex, meaning that their bodies do not fully match expectations of
either male or female. Some people talk about gender as a social construction,
something that is created by society. Given such wide variation in gender expression—appearance,
clothing, and behavior—across the world, it is clear that many aspects of gender are learned.
However, there is controversy over the relative contributions of “nature” and “nurture” to
gender identity—one’s internal sense of their own gender. While gender roles and gender
expression may depend heavily on social influences, there is building evidence that gender
identity may have biological components, such as genetic or hormonal influences. If gender
identity is in some part biologically based, then the line between sex and gender becomes even
more complex.
Gender, Society, and Behavior
Authors: Erickson-Schroth Laura , Davis Benjamin
Published: February 2022

This chapter discusses the social construction of
gender. As a society, people have created gender roles that they agree on and perceive as
“real,” despite their not necessarily being based on objective differences between women and
men. Comparing men and women across the globe today, one can see that what is considered
masculine or feminine is not universally accepted. The chapter then considers how language and
culture shape the way people think about gender. It also looks at how different major religions
understand gender. While some religions remain strictly divided along gender lines, a number of
religious groups now permit women to become religious leaders. Some allow their leaders to
officiate same-sex marriages, while others have banned these unions from their grounds. The
chapter also introduces the use of gender-neutral titles and pronouns, traces the history of
gender equality under the law, defines gender-based violence, and identifies the legal
protections for transgender people in the United States.
Early tracheostomy: on the cutting edge, some benefit more than others
Authors: Craven Jack , Slaughter Ashley , Potter Kenneth F.
Published: February 2022

Purpose of review

The decision to undergo early tracheostomy in critically ill patients has been the subject of multiple studies in recent years, including several meta-analyses and a large-scale examination of the National in-patient Sampling (NIS) database. The research has focused on different patient populations, and identified common outcomes measures related to ventilation. At the crux of the new research is the decision to undergo an additional invasive procedure, mainly tracheostomy, rather than attempt endotracheal tube ventilation with or without early extubation. Notably, recent research indicates that neurological and SARS-CoV-2 (COVID-19) patients seem to have an exaggerated benefit from early tracheostomy.

Recent findings

Recent studies of patients undergoing early tracheostomy have shown decreases in ventilator associated pneumonia, ventilator duration and duration of ICU stay. However, these studies have shown mixed data with respect to mortality and length of hospitalization. Such advantages only become apparent with large-scale examination. Confounding the overall discussion is that the research has focused on heterogeneous groups, including neurosurgical ICU patients, general ICU patients, and most recently, intubated COVID-19 patients.

Specific populations such as neurosurgical and COVID-19 patients have clearly defined benefits following early tracheostomy. Although the benefit is less pronounced, there does seem to be an advantage in general ICU patients with regards to ventilator-free days and lower incidence of ventilator-associated pneumonia. In these patients, large-scale examination points to a clear mortality benefit.
The Analgesic Effect of Ultrasound-guided Bilateral Pectointercostal Fascial Plane Block on Sternal Wound Pain After Open Heart Surgeries
Authors: Hamed Mohamed A. , Abdelhady Mahdy A. , Hassan Alyaa A.S.M. , Boules Maged L.
Published: February 2022

Objectives:

We aimed to evaluate the analgesic efficacy of ultrasound-guided bilateral pectointercostal fascial plane block after open heart surgeries.

Methods:

Seventy patients aged above 18 years and scheduled for on-pump coronary artery bypass grafting or valve replacement or both through median sternotomy were enrolled in this study. Patients were randomly allocated into 2 groups of 35 (block group or control group). The block group had the block performed through 20 ml of a solution of 0.25% bupivacaine plus epinephrine (5 mcg/mL), and the control group received dry needling. The primary outcome was the 24-hour cumulative morphine consumption. The secondary outcomes were time to the first analgesic request, pain score, quality of oxygenation, intensive care unit stays, and hospital stay.

Results:

The cumulative morphine consumption in the first 24 hours was significantly lower in the block group, with a mean difference of −3.54 (95% confidence interval=−6.55 to −0.53; P=0.015). In addition, the median estimate time to the first analgesic request was significantly longer in the block group than in the control group. Finally, during the postoperative period (4 to 24 h), mean sternal wound objective pain scores were, on average, 0.58 units higher in the block group.

Conclusion:

pectointercostal fascial block is an effective technique in reducing morphine consumption and controlling poststernotomy pain after cardiac surgeries. Also, it may have a role in better postoperative respiratory outcomes.
Do Patient Demographics and Socioeconomic Status Influence Severity and Time to Diagnosis in Children With Stable Slipped Capital Femoral Epiphysis?
Authors: Loder Randall T. , Sun Seungyup , Gunderson Zachary J.
Published: February 2022

Background:

The time to diagnosis in stable slipped capital femoral epiphysis (SCFE) is often several months because of nebulous history, symptoms of knee/thigh pain, and Medicaid insurance. This study examined the impact of socioeconomic status and demographics on the time to diagnosis and SCFE severity in Indiana children.

Methods:

A retrospective review of all patients at a tertiary children’s hospital with SCFE from January 2010 through March 2021 was performed. Standard demographic data and type of insurance was collected. Neighborhood Atlas Mapping was used to determine the state decile of the area deprivation index (ADI), a measure of socioeconomic status using 17 variables related to income, employment, education, and housing. Statistical analyses consisted of standard univariate and bivariate analyses; logistic regression analysis was used to determine predictors of a mild SCFE. A P<0.05 was considered statistically significant.

Results:

There were 142 patients; 81 male and 61 female. The average age was 12.2±1.7 years, lateral epiphyseal shaft angle of 35±19 degrees, and symptom duration of 4.5±5.0 months. There was no correlation between ADI state deciles and lateral epiphyseal shaft angle (r
2=0.008) or symptom duration (r
2=0.019). Insurance status and race differed by ADI deciles. In the first decile (least disadvantaged), 44% had government insurance and 89% were White; in the 10th decile (most disadvantaged), 95% had government insurance and 38% were White. Predictors of a mild SCFE were female sex [odds ratio (OR): 3.2 [1.5, 7.0]; P=0.004], symptom duration <3 months [OR: 5.3 (2.4, 11.7); P=0.00004], and White race [OR: 2.4 (1.3, 6.2); P=0.01]. Insurance status and ADI were not significant.

Conclusions:

Contrary to other studies, neither insurance or socioeconomic status were associated with a delay in diagnosis or SCFE severity. The symptom duration in children with SCFE does not appear to be decreasing over the last several decades. Further investigation is required as to why.

Level of Evidence:

Level III—retrospective comparative study.
“In-house” Design and Use of 3-dimensional Printed Patient-specific Bone Tumor Resection Guides for Geometric Osteotomies in Sarcoma Surgery
Authors: Kendal Joseph K. , Wong Murray , Montgomery Spencer J. , Benavides Brent , Monument Michael J. , Puloski Shannon K.T.
Published: February 2022

Three-dimensional printing technology has rapidly advanced as a promising technology for preoperative planning, education, and surgical execution in orthopedic surgery. Use of patient-specific instrumentation in orthopedic oncology sarcoma cases can streamline complex osteotomies while providing safe margins based on predetermined osteotomy levels. We describe use of an “in-house” protocol to create patient-specific bone tumor resection guides for use in orthopedic oncology cases. The described protocol bypasses expensive outsourcing options and facilitates use of preoperative surgical simulation and intimate involvement of the surgical team in the guide design. We report on the successful design and use of three-dimensional printed patient-specific bone tissue resection guides in a case of proximal tibial parosteal osteosarcoma resection and reconstruction with a size-matched allograft, and in a case of a secondary pelvic chondrosarcoma resection.
Association of Arterial pH With Hemodynamic Response to Vasopressin in Patients With Septic Shock: An Observational Cohort Study
Authors: Bauer Seth R. , Sacha Gretchen L. , Siuba Matthew T. , Lam Simon W. , Reddy Anita J. , Duggal Abhijit , Vachharajani Vidula
Published: February 2022

OBJECTIVES:

Vasopressin is reported to retain vasoconstrictive activity in the setting of acidemia, but preclinical models are inconsistent and studies have not evaluated the clinical effectiveness of vasopressin based on arterial pH. This study sought to determine the association between arterial pH and blood pressure after vasopressin initiation in septic shock.

DESIGN:

This retrospective, multicenter, observational cohort study evaluated the association of arterial pH at the time of vasopressin initiation with hemodynamic response to vasopressin and change in catecholamine dose after vasopressin initiation. Hemodynamic response was defined as a catecholamine dose decrease with mean arterial pressure greater than or equal to 65 mm Hg at 6 hours after vasopressin initiation.

SETTING:

Patients from eight hospitals in a health system were evaluated.

PATIENTS:

Patients with septic shock initiated on vasopressin as a catecholamine adjunct between January 2012 and November 2017 were screened for inclusion.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 1,350 patients were included. At the time of vasopressin initiation patients were severely ill with arterial pH 7.28 ± 0.13, Sequential Organ Failure Assessment 14.1 ± 3.5, lactate 5.6 ± 4.6 mmol/L, and norepinephrine-equivalent catecholamine dose 32.3 ± 25.4 µg/min. After adjusting for lactate and Sequential Organ Failure Assessment with multivariable logistic regression, lower arterial pH was independently associated with lower odds of hemodynamic response to vasopressin (for each 0.1 unit arterial pH was below 7.40, response odds ratio 0.79; 95% CI, 0.72–0.87). For each 0.1 unit the pH was below 7.40 at vasopressin initiation, the norepinephrine-equivalent catecholamine dose increased by 1.5 µg/min (95% CI, 0.5–2.5 µg/min) at 1 hour, and increased by 2.5 µg/min (95% CI, 1.4–3.5 µg/min) at 6 hours after vasopressin initiation.

CONCLUSIONS:

Compared with higher arterial pH, patients with septic shock and low arterial pH had lower odds of vasopressin response and higher catecholamine doses after vasopressin initiation. Similar to other vasopressors, the clinical effectiveness of vasopressin appears to be impaired in the setting of acidemia.
Lifestyle and dietary factors associated with serologically detected gastric atrophy in a Caucasian population in the GISTAR study
Authors: Razuka-Ebela Danute , Polaka Inese , Daugule Ilva , Parshutin Sergei , Santare Daiga , Ebela Inguna , Rudzite Dace , Vangravs Reinis , Herrero Rolando , Young Park Jin , Leja Marcis
Published: February 2022

Objective

To identify dietary and lifestyle factors associated with decreased pepsinogen levels indicative of gastric atrophy.

Methods

Participants aged 40 to 64 from the “Multicentric randomized study of H. pylori eradication and pepsinogen testing for prevention of gastric cancer mortality (GISTAR study)” in Latvia tested for serum pepsinogen, as well as for Helicobacter pylori infection by 13C-urea breath test or serology were included. Data on sex, age, education, employment, diet, smoking, alcohol and proton pump inhibitor use were obtained by survey and compared for participants with and without serologically detected gastric atrophy defined as pepsinogen I/pepsinogen II ≤ 2 and pepsinogen I ≤ 30 ng/mL.

Results

Of 3001 participants (median age 53, interquartile range, 11.0, 36.9% male) 52.8% had H. pylori and 7.7% had serologically detected gastric atrophy. In multivariate analysis, increasing age, consumption of alcohol, coffee, and onions were positively, while H. pylori, former smoking, pickled product and proton pump inhibitor use were inversely associated with gastric atrophy. Pepsinogen values were higher in smokers and those with H. pylori. Pepsinogen ratio was lower in those with H. pylori. When stratifying by H. pylori presence, significantly higher pepsinogen levels remained for smokers without H. pylori.

Conclusion

Several dietary factors and smoking were associated with serologically detected gastric atrophy. Pepsinogen levels differed by smoking and H. pylori status, which may affect the serologic detection of gastric atrophy. There seems to be a complicated interaction between multiple factors. A prospective study including atrophy determined by both serology and histology is necessary.
Brief Communication PD1-related Nephrotoxicity: Optimizing Its Clinical Management Through Histopathologic Features
Authors: Di Giacomo Anna M. , Guarnieri Andrea , Tripodi Sergio A. , Maccari Marta , Mancianti Nicoletta , Guido Garosi , Rossi Giulia , Daffinà Maria Grazia , Calabrò Luana , Valente Monica , Maio Michele
Published: February 2022

Immune-related nephrotoxicity (ir-N) is a rare adverse event of immune-checkpoint(s) inhibitors (ICI) therapy and its clinical management is still debated. Among 501 consecutive ICI-treated patients at our Institution, 6 who developed an ir-N with clinical signs suggestive for an acute kidney injury underwent kidney biopsy. Histology showed an acute tubule-interstitial nephritis, simulating the scenario of acute T-cell–mediated kidney transplant rejection. Thus, the management of allograft kidney rejection routinely utilized at our clinic was implemented, leading to rapid renal function improvement. Histologic features supporting the definition of an immune-mediated acute kidney injury in ICI-treated patients may help optimizing the clinical management of ir-N.
The analgesic efficacy of transversus abdominis plane block vs. wound infiltration after inguinal and infra-umbilical hernia repairs
Authors: Grape Sina , Kirkham Kyle R. , Albrecht Eric
Published: February 2022

BACKGROUND

Both transversus abdominis plane (TAP) block and wound infiltration with local anaesthetic have been used to relieve pain after inguinal or infra-umbilical hernia repair.

OBJECTIVES

To determine whether TAP block or local anaesthetic infiltration is the best analgesic option after inguinal or infra-umbilical hernia repair.

DESIGN

Systematic review and meta-analysis with trial sequential analysis.

DATA SOURCES

MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science, up to June, 2020.

ELIGIBILITY CRITERIA

We retrieved randomised controlled trials comparing TAP block with wound infiltration after inguinal or infra-umbilical hernia repair. Primary outcome was rest pain score (analogue scale 0 to 10) at 2 postoperative hours. Secondary pain-related outcomes included rest pain score at 12 and 24 h, and intravenous morphine consumption at 2, 12 and 24 h. Other secondary outcomes sought were block-related complications such as rates of postoperative infection, haematoma, visceral injury and systemic toxicity of local anaesthetic.

RESULTS

Seven trials including 420 patients were identified. There was a significant difference in rest pain score at 2 postoperative hours in favour of TAP block compared with wound infiltration, with a mean (95% confidence interval) difference of −0.8 (−1.3 to -0.2); I
2 = 85%; P 
= 0.01. Most secondary pain-related outcomes were also significantly improved following TAP block. No complication was reported. The overall quality of evidence was moderate.

CONCLUSION

There is moderate level evidence that TAP block provides superior analgesia compared with wound infiltration following inguinal or infra-umbilical hernia repair.

TRIAL REGISTRY NUMBER

PROSPERO CRD42020208053.
Self-identified Black Race as a Risk Factor for Intraocular Pressure Elevation and Iritis Following Prophylactic Laser Peripheral Iridotomy
Authors: Adetunji Modupe O. , Meer Elana , Whitehead Gideon , Hua Peiying , Badami Avni , Addis Victoria , Gorry Thomasine , Lehman Amanda , Sankar Prithvi S. , Miller-Ellis Eydie , Ying Gui-Shuang , Cui Qi N.
Published: February 2022

Précis:

In primary angle closure suspects (PACS), self-identified Black race was a risk factor for intraocular pressure (IOP) elevation and iritis following laser peripheral iridotomy (LPI). Laser type was not associated with either immediate post-LPI IOP elevation or iritis in multivariate analysis.

Purpose:

The aim was to determine the impact of laser type and patient characteristics on the incidence of IOP elevation and iritis after LPI in PACS.

Materials and Methods:

The electronic medical records of 1485 PACS (2407 eyes) who underwent either neodymium-doped yttrium-aluminum-garnet or sequential argon and neodymium-doped yttrium-aluminum-garnet LPI at the University of Pennsylvania between 2010 and 2018 were retrospectively reviewed. Average IOP within 30 days before LPI (baseline IOP), post-LPI IOP within 1 hour, laser type, laser energy, and the incidence of new iritis within 30 days following the procedure were collected. Multivariate logistic regression accounting for intereye correlation was used to assess factors associated with incidence of post-LPI IOP elevation and iritis, adjusted by age, sex, surgeon, and histories of autoimmune disease, diabetes, and hypertension.

Results:

The incidence of post-LPI IOP elevation and iritis were 9.3% (95% confidence interval: 8.1%-10.5%) and 2.6% (95% CI: 1.9%-3.2%), respectively. In multivariate analysis, self-identified Black race was a risk factor for both IOP elevation [odds ratio (OR): 2.08 compared with White; P=0.002] and iritis (OR: 5.07; P<0.001). Higher baseline IOP was associated with increased risk for post-LPI IOP elevation (OR: 1.19; P<0.001). Laser type and energy were not associated with either post-LPI IOP elevation or iritis (P>0.11 for all).

Conclusions:

The incidence of immediate IOP elevation and iritis following prophylactic LPI was higher in Black patients independent of laser type and energy. Heightened vigilance and increased medication management before and after the procedure are suggested to help mitigate these risks.
Comparison of Antimicrobial Stewardship and Infection Prevention and Control Activities and Resources Between Low-/Middle- and High-income Countries
Authors: Villanueva Paola , Coffin Susan E. , Mekasha Amha , McMullan Brendan , Cotton Mark F. , Bryant Penelope A.
Published: February 2022

Background:

The growth of antimicrobial resistance worldwide has led to increased focus on antimicrobial stewardship (AMS) and infection prevention and control (IPC) measures, although primarily in high-income countries (HIC). We aimed to compare pediatric AMS and IPC resources/activities between low- and middle-income countries (LMIC) and HIC and to determine the barriers and priorities for AMS and IPC in LMIC as assessed by clinicians in those settings.

Methods:

An online questionnaire was distributed to clinicians working in HIC and LMIC healthcare facilities in 2020.

Results:

Participants were from 135 healthcare settings in 39 LMIC and 27 HIC. Formal AMS and IPC programs were less frequent in LMIC than HIC settings (AMS 42% versus 76% and IPC 58% versus 89%). Only 47% of LMIC facilities conducted audits of antibiotic use for pediatric patients, with less reliable availability of World Health Organization Access list antibiotics (29% of LMIC facilities). Hand hygiene promotion was the most common IPC intervention in both LMIC and HIC settings (82% versus 91%), although LMIC hospitals had more limited access to reliable water supply for handwashing and antiseptic hand rub. The greatest perceived barrier to pediatric AMS and IPC in both LMIC and HIC was lack of education: only 17% of LMIC settings had regular/required education on antimicrobial prescribing and only 25% on IPC.

Conclusions:

Marked differences exist in availability of AMS and IPC resources in LMIC as compared with HIC. A collaborative international approach is urgently needed to combat antimicrobial resistance, using targeted strategies that address the imbalance in global AMS and IPC resource availability and activities.
Dying in the emergency service: nurses’ attitudes before and after the first critical period of COVID-19
Authors: Cardoso Maria Filomena Passos Teixeira , Martins Maria Manuela Ferreira Pereira da Silva , Ventura-Silva João Miguel Almeida , Mota Paulo Emílio , Costa Paula Cristina Rodrigues , Ribeiro Olga Maria Pimenta Lopes
Published: February 2022

Background:

Death is an increasingly frequent event in hospitals, and nurses are the health professionals who live with this reality the most. The pandemic caused by COVID-19 made this event more present, showing that nurses’ attitudes toward death may influence the care provided to people at the end of life. The objective of this study was to analyze the attitudes of nurses in the emergency service toward death, before and after the first critical period of the pandemic by COVID-19 in Portugal.

Methods:

A quantitative, comparative, and cross-sectional study was conducted in a hospital in Northern Portugal at 2 different moments: the first in February 2018 and the second in May 2020, after the first critical period of the pandemic by COVID-19. In both moments, data were collected using a self-completion questionnaire, which included the Death Attitude Profile Assessment Scale.

Results:

The attitudes fear, avoidance, closeness, and escape did not show significant differences. In neutral/neutral acceptance, differences were found between the first and second moments of data collection (P 
= .01), with a lower mean after the critical period of the pandemic.

Conclusions:

The results obtained in 2018 and 2020 showed slight changes in attitudes toward death. The need to invest in the training and preparation of nurses who deal directly with death and the dying process was evident. Nurse managers should promote spaces for reflection and team training on death, aiming to reduce the professionals’ suffering and anxiety.
AlergiaPT: A Portuguese media campaign to inspire people with allergies to make a positive change in their life
Authors: Moreira André , Mendes Francisca de Castro , Rama Tiago , Mota Diogo , Silva Diana , Pádua Inês , Abreu Cristina , Vasconcelos Maria João , Farraia Mariana , Paciência Inês , Rufo João , Barros Renata , Padrão Patrícia , Moreira Pedro , Seabra Diana , Barros Henrique
Published: February 2022

Allergic diseases comprise a significant cause of morbidity worldwide and a substantial burden on the health and medical systems of both developed and emerging economies. Although highly prevalent, relatively severe, and largely impactful on the quality of life of patients, allergic diseases are commonly trivialized. Increasing awareness of the relevance of allergic diseases as a major public health problem might lead to an improved acknowledgment by governments and health authorities. Based on the positive impact that media campaigns might have on health-related behaviors, as well as the large use of social media by different types of users, social media might be used as a powerful tool for spreading awareness and education even more effective than traditional face-to-face communication. Therefore, we aimed to develop a social media-based communication program, the AlergiaPT, reaching all stakeholders, to increase the awareness of allergic diseases tackling the causes, prevention, control, and economic impact. The AlergiaPT will provide user-generated and interactive content toward engagement, include both long-form and short-form video productions toward education, as well as stories and time-sensitive content toward empowerment. It will be targeted to all populations, engaging different stakeholders. Contents will address the 5 campaign goals: i) allergy health is promoted; ii) tolerance is actively reinforced, and avoidance reduced; iii) treatment control and guided self-management of patients of asthma, rhinitis, food allergy, and atopic eczema are strengthened; iv) recognition and treatment of severe allergy and anaphylaxis are improved, and v) indoor air quality is promoted. Engagement on the campaign will be promoted through stepwise educational takeaways meetings using different social media, and targeting all audience groups, by promoting the organization of resources for common goals and the involvement of social media to improve public awareness. The impact of AlergiaPT will be assessed through google analytics.
Environments of professional nursing practice in the context of the COVID-19 pandemic
Authors: Ribeiro Olga Maria Pimenta Lopes , Trindade Letícia de Lima , de Sousa Clemente Neves , Teles Paulo João Figueiredo Cabral , Cardoso Maria Filomena Passos Teixeira , da Rocha Carla Gomes , Barros Sónia Cristina Costa , Ventura-Silva João Miguel Almeida
Published: February 2022

Background:

Although COVID-19 attracted attention to the environments of professional nursing practice, triggering a series of responses to address some of the most pressing problems, it is important to identify the size and scope of other weaknesses that have emerged.

Methods:

In an observational and cross-sectional study, using the Scale for the Evaluation of the Environment of Professional Nursing Practice, 752 nurses from a Portuguese university hospital, provided socio-demographic and professional data about the components structure, process and outcome of their professional nursing environment. Data collection took place from June 1–30, 2020, immediately after the first critical period of the COVID-19 pandemic in Portugal.

Results:

In the analysed environment of professional nursing practice, Process factors were favourable to the quality of care, while the Structure and Outcome factors had a moderately favourable effect. Structure factors related to work contexts (P < .001) and nursing functions in patient care areas with COVID-19 (P = .001). Process factors related significantly to work contexts (P < .001). A significant association was found between Outcome factors and work contexts (P < .001) and nursing functions in patient care areas with COVID-19 (P = .005).

Conclusion:

The environments of professional nursing practice in the hospital under study are moderately favourable to the quality of care. However, the need to invest in nurses’ participation, involvement and professional qualification is clear. Maintenance of a sustainable nursing workforce requires attention to be given to ensuring that practice environments are conducive to the quality of care and geared to promoting professional involvement and job satisfaction among nurses.
Sugar-sweetened beverages, effects on appetite and public health strategies to reduce the consumption among children: a review
Authors: Costa Daniela , Warkentin Sarah , Oliveira Andreia
Published: February 2022

Sugar-sweetened beverages (SSBs) consumption have been of public health concern and a target of interventions due to their high consumption and burden in health-related consequences, particularly in children and adolescents. SSBs provide high energy intake with low nutritional value and are a major contributor for added and free sugars intake of Portuguese in all age-groups, especially adolescents. Despite its recognized effect on weight gain, it might also disrupt appetite regulation. Research on the effect of SSBs on appetitive traits is still scarce and unclear, and the current knowledge of these potential effects will be discussed in this review. This review also aims to describe public health strategies implemented to decrease SSBs consumption among children, particularly in Portugal, such as: (i) implemented taxation measures and its impact in sales and in preventable cases of disease and death, (ii) marketing regulations applied to children and adolescents, and ultimately (iii) the intention of application of a single Front-of-Package labeling system in all countries, aiming to increase consumers’ food literacy.
Use of biologics for the treatment of moderate-to-severe asthma: the age of personalized medicine
Authors: Mustafa S. Shahzad , Patrawala Sara , Khurana Sandhya
Published: February 2022

Purpose of review

There are multiple FDA-approved biologics to treat poorly controlled moderate-to-severe asthma. Given the heterogeneity of asthma and the lack of head-to-head data between biologics, selecting the best biologic for a patient can be difficult. This review summarizes the key literature to date, in hopes of facilitating an evidence-based approach to selecting the most appropriate biologic for patients with asthma.

Recent findings

In addition to unique mechanisms of action, there is increasing literature on predictors of response to each biologic, such as sensitizations to aeroallergens, peripheral eosinophil count, total serum IgE, and exhaled nitric oxide. Biologics available for asthma are also being increasingly studied in comorbid conditions with asthma, and this may facilitate selecting the most appropriate biologic for a patient. In the absence of head-to-head studies, there is literature of switching between biologics whenever necessary.

The authors outline an approach to selecting a biologic based on various considerations, and hope this suggested approach facilitates selecting the biologic most suitable for each individual with poorly controlled moderate-to-severe asthma.
A clinical review of long-COVID with a focus on the respiratory system
Authors: Daines Luke , Zheng Bang , Pfeffer Paul , Hurst John R. , Sheikh Aziz
Published: February 2022

Purpose of review

Persistence of symptoms after acute coronavirus disease 2019 (COVID-19), often described as long- COVID, is common and debilitating. In this article, we review the epidemiology, clinical features, and research priorities for long-COVID focusing on the respiratory system.

Recent findings

Breathlessness, cough and chest pain were the most commonly reported respiratory symptoms associated with long-COVID. In hospitalised patients, abnormalities on lung function testing or chest imaging were observed less commonly at 12 months compared to six months since discharge. Clinical assessment of patients with persisting symptoms after acute COVID-19 requires a comprehensive evaluation to exclude other possible causes for symptoms. With no robust current evidence for interventions to treat long-COVID respiratory symptoms, symptomatic treatment, supported self-management and pulmonary rehabilitation should be considered to help individuals with respiratory symptoms associated with long-COVID.

Long-COVID is a debilitating syndrome that often includes persisting respiratory symptoms and to a lesser degree, abnormalities in lung physiology or imaging. Respiratory features of long-COVID may reduce over time, yet resolution is not seen in all cases. Future research is needed to understand the natural history of long-COVID, identify factors associated with spontaneous improvement/persistence, investigate mechanisms for persisting symptoms, and test interventions to prevent and treat long-COVID.
Mean arterial pressure drop is an independent risk factor of hepatorenal syndrome in patients with HBV-ACLF
Authors: Zheng Xingrong , Lian Yunwen , Wang Peipei , Zheng Lihua , Wu Hewei , Lin Jiaxin , Chen Xiyao , Gao Zhiliang , Peng Liang , Xie Chan
Published: February 2022

Background/aims

In patients with acute-on-chronic liver failure (ACLF), type 1 hepatorenal syndrome (HRS) is a critical organ failure complication that resulted in rapid mortality. There are no efficient parameters to predict HRS in hepatitis B virus (HBV)-related ACLF. To assess HBV-ACLF risk factors and evaluate the association between mean arterial pressures (MAP), HRS and survival in patients with HBV-ACLF.

Methods

A total of 420 ACLF patients were screened from June 2015 to June 2016, and 57 HBV-ACLF patients were included in the study. Clinical data and MAP measurements of these patients were collected. Multivariate analyses, Cox proportional hazards regression and receiver operator characteristic (ROC) curves were used to analyze.

Results

In a 30-day study period, 43 (75.44%) patients survived. Patients in the HRS group were older and had higher Model for End-Stage Liver Disease (MELD) scores than patients in the non-HRS group. A MAP drop of ≥9.5 mmHg was an independent predictor of HRS with a sensitivity and specificity of 92.86 and 69.77%, respectively. The baseline MELD score was also an independent risk factor of HRS. MAP drop (OR, 1.582; P = 0.000), prothrombin time, HRS, MELD and FIB were independent prognostic factors for 30-day mortality. The area under the ROC curve of MAP drop was 0.808 (P = 0.001).

Conclusion

A decrease in MAP was a valuable predictor of HRS in patients with HBV-related ACLF. MAP drop ≥9.5 mmHg may be useful for predicting patient prognosis and exploring new treatment measures in patients with HBV-related ACLF.
Residual and sound limb hip strength distinguish between sedentary and nonsedentary adults with transtibial amputation
Authors: Seth Mayank , Pohlig Ryan T , Beisheim-Ryan Emma H , Stauffer Samantha J , Horne John R , Hicks Gregory E , Sions Jaclyn Megan
Published: February 2022

Following a transtibial amputation (TTA), physical activity has known benefits for health and quality of life. Adults post-TTA, however, demonstrate reduced physical activity, predisposing them to adverse health outcomes. Identifying adults at the risk of sedentarism post-TTA via commonly used, objective clinical measures may enhance clinical decisions, including prosthesis prescription. The study’s purpose was to determine whether residual and sound limb hip strength distinguishes between sedentary and nonsedentary adults post-TTA. A secondary analysis of a cross-sectional dataset (n = 44) was conducted. Participant residual and sound limb hip flexion, extension, abduction and adduction strength were assessed via handheld dynamometry. Physical activity was monitored for 7 days and participants were classified as sedentary (<5000 steps/day; n = 13) or nonsedentary (≥5000 steps/day; n = 31). Receiver operating curves revealed that residual and sound limb hip extension, abduction and adduction strength distinguished between sedentary and nonsedentary adults post-TTA (P < 0.050). Preliminary cut-points for hip strength measures to classify adults at the risk of sedentarism were determined. A hip strength composite score (0–6) estimates a 2.2× increased odds of being sedentary with each additional hip strength deficit. Post-TTA, residual and sound limb hip strength can help identify adults at risk of sedentarism to aid clinical decision making, including prosthesis prescription.
Accuracy of Weight Estimation in Children Using the Broselow, PAWPER XL, PAWPER XL-MAC, and Mercy Tapes
Authors: Cosmos Yakubu Rafiuk , Ayi-bisah Nedda , Nguah Samuel Blay
Published: February 2022

Objectives

Quick and accurate estimate of a child’s weight is often required for medical interventions like drug dose calculation when scale measured weights cannot be obtained safely. Length-based methods of weight estimation are more accurate than age-based methods, with the most accurate being the length-based, habitus-modified methods. This study sought to determine and compare the accuracies of the 2017 Broselow tape, Paediatric Advanced Weight Prediction in the Emergency Room Extra-Long (PAWPER XL) tape, Paediatric Advanced Weight Prediction in the Emergency Room Extra-Long Mid-Arm Circumference (PAWPER XL-MAC) tape, and the 2-dimensional (2D) Mercy tape in Ghanaian children.

Methods

A cross-sectional study was conducted at the Tamale Teaching Hospital in Ghana. Eight hundred forty children between 2 months and 13 years had their weights estimated by the 2017 Broselow, PAWPER XL, PAWPER XL-MAC, and 2D Mercy tapes. Accuracy of the methods was determined by percentage of weight estimated to within 10% and 20% of actual weight. Mean percentage error and the Bland-Altman analysis were used to assess bias and precision.

Results

The proportion of weight estimates within 10% and 20% of actual weight for Broselow tape were 47.5% and 82.3%, for 2D Mercy tape were 73.1% and 96.3%, for PAWPER XL-MAC were 77.6% and 97.5%, and for PAWPER XL were 81.7% and 96.8%, respectively. The Broselow tape had the greatest bias and least precision among the 4 methods. The Mercy, PAWPER XL-MAC, and PAWPER XL tapes had similar performance, but all performed significantly better than the Broselow tape in pairwise comparison. The best weight estimation method overall was the PAWPER XL tape as it also had the least bias and greatest precision.

Conclusions

The Mercy, PAWPER XL-MAC, and PAWPER XL tapes were more accurate than the 2017 Broselow tape and should be used in preference in Ghana and countries with similar population structure.
Implementation of an Integrated Total Quality Management System in a Pulmonary Function Laboratory
Authors: Sánchez-Jerónimo Patricia , Silva-Cerón Mónica , López-López Miriam , Hernández-Morales Víctor , Gochicoa-Rangel Laura
Published: February 2022

Background and Objectives:

A worldwide objective in the area of health is to offer high-quality services supported by certification strategies that contribute to improving standards for processes commonly used in medicine. However, few pulmonary function test laboratories (PFTLs) follow official standards in their daily operations or are organized around an integrated total quality management system (ITQMS) focused on their established processes. The aim was to determine the feasibility of implementing an ITQMS to accredit the International Organization for Standardization (ISO) 9001:2015 standard in a high-demand PFTL where 13 respiratory function tests are routinely performed together with teaching and research activities.

Methods:

This project was conducted at the PFTL of the Instituto Nacional de Enfermedades Respiratorias in Mexico City from November 2014 to August 2017 and involved the implementation of an ITQMS guided by ISO 9001:2015 in 5 phases: (1) the establishment of a work team; (2) the elaboration of situational diagnoses; (3) the development of guidelines for the ITQMS; (4) the implementation of the ITQMS model; and (5) the evaluation of the ITQMS.

Results:

Upon completing the 5 phases, an evaluation of the system by an internal audit identified 3 minor cases of nonconformity (NC), while additional observations and an external audit found 5 minor cases of NC. These issues were addressed through a root-cause analysis to establish an action plan for each one. At the end of the process, the institution was granted the ISO 9001:2015 certification for its 3 processes: medical attention in support of diagnoses, teaching, and research.

Conclusions:

It is possible to implement an ISO quality management system as a routine operating methodology in a high-demand PFTL.
Hyperglycemia Management Prior to Admission in an Urban Emergency Department
Authors: Benbrahim Meissane , Cashman Lauri , Baker William E. , Gendron Bryan J. , Lookabill Sara , Farrell Natalija
Published: February 2022

Background and Objectives:

The aim of this quality improvement project was to decrease the percentage of emergency department (ED) patients admitted with blood glucose (BG) level above 250 mg/dL to less than 20%.

Methods:

A work group comprised physicians, pharmacists, and endocrinologists collaborated to standardize management of ED hyperglycemia. Plan-Do-Study-Act cycles included education, monitoring of patients with BG level above 200 mg/dL, and development of an ED-specific insulin protocol.

Results:

Following the initiative, 24.8% fewer patients were admitted with BG level above 250 mg/dL. The average admission BG level was reduced by 65.8 mg/dL, creating a significant shift toward improved average BG level. No difference was seen in hospital mortality, hospital length of stay, ED length of stay, hypoglycemia, or inhospital diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome.

Conclusion:

Implementation of a standardized hyperglycemia treatment protocol along with pharmacist interventions reduced average admission BG and the percentage of patients with BG level above 250 mg/dL on admission.