bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of Rotational Thromboelastometry in Patients with Acute Promyelocytic Leukemia
Authors: Sabljic Nikica , Pantic Nikola , Virijevic Marijana , Bukumiric Zoran , Novakovic Tina , Pravdic Zlatko , Rajic Jovan , Vidovic Ana , Suvajdzic Nada , Jaradeh Mark , Fareed Jawed , Antic Darko , Mitrovic Mirjana
Published: August 2022

Introduction

Hemorrhagic early death (HED) remains a major cause of treatment failure among patients with acute promyelocytic leukemia (APL). We aimed to investigate the prognostic potential of rotational thromboelastometry (ROTEM) for bleeding in patients with APL.

Materials and Methods

31 newly-diagnosed APL patients (median age of 40 years; 14 female/17 male) that underwent treatment at the Clinic of Hematology UCCS from 2016-2020 with all-trans retinoic acid and anthracyclines were recruited. CBCs (complete blood count), conventional coagulation tests (CCTs), and ROTEM parameters obtained before treatment initiation were evaluated.

Results

All patients demonstrated at least one ROTEM parameter out of the reference range. ROTEM parameters associated with significant hemorrhage were EXTEM clotting time (CT) (P = 0.041) and INTEM amplitude 10 (A10) (P = 0.039), however, only EXTEM CT (P = 0.036) was associated with HED. Among CBCs and CCTs, only platelets were associated with significant bleeding (P = 0.015), while D-dimer was associated with both bleeding and HED (P = 0.001 and P = 0.002, respectively).

Conclusion

Our results indicate that ROTEM parameters may reveal hypocoagulability in APL patients and have the potential to improve current hemorrhage prognostic methods. Additionally, these results suggest the combination of ROTEM and CCTs might be useful in identifying patients at risk for HED.
Compassion Satisfaction and Burnout Are Related to Psychiatric Nurses’ Antipathy Towards Nonsuicidal Self-Injury (NSSI)
Authors: Streeto Courtney , Phillips Kathryn E.
Published: August 2022

Objective:

Many psychiatric patients engage in nonsuicidal self-injury (NSSI). Despite this, studies show that psychiatric nurses display a stigma toward patients who engage in self-harm, often due to the fact that nurses report a lack of understanding about the behavior. In addition, nurses can struggle with professional quality of life (ProQOL). The purpose of this study was to provide an educational intervention on NSSI and measure its effects on antipathy as well as to determine if ProQOL has an impact on overall antipathy.

Methods:

A sample of psychiatric nurses was recruited and randomly assigned to either the educational intervention or control group. Both groups took the Self-Harm Antipathy Scale (SHAS) and ProQOL-V; the intervention group was asked to repeat the SHAS immediately following an educational video, and the control was asked to repeat the SHAS at least 2 weeks later. Qualitative data were also collected.

Results:

The ProQOL-V CS subscale and pretest SHAS total scores ( n = 23, r = −0.432, p = .039) and SHAS Needs Function (NF) ( n = 23, r = −0.454, p = .029) showed a significant moderate negative correlation. There was also a significant moderate positive correlation between the ProQOL-V Burnout subscale and SHAS NF pretest scores ( n = 23, r = 0.483, r = 0.02).

Conclusions:

A relationship between high compassion satisfaction and low antipathy, as well as between high burnout and high antipathy, particularly in the area of understanding the reasons patients self-harm (NF) was found. Educating nurses on the reasons for NSSI may reduce their antipathy. It may also be beneficial to support nurses to prevent burnout.
A rebound in nature-based tourism intentions during the COVID-19 era
Authors: Jeong Ji Youn , Lee Kyung-Yur
Published: August 2022

Nature-based tourism (NBT) intentions that changed due to the COVID-19 pandemic are different from those not only before the COVID-19 but also during the COVID-19 period. We recruited 558 American participants over two time periods in 2020 and 2021 and compared their NBT intentions by adopting the health belief model (HBM). The results for 2020 indicated that intrapersonal barriers negatively influence attitudes and NBT intentions; however, they did not exert significant effects on the attitudes of the 2021 batch, partially confirming changes in the relationship between study variables. Moreover, NBT intentions increased in 2021 compared to those in 2020, but the extent of the increase differed by demographic variables. NBT intentions were higher among those who were under 40 years of age, married, and highly educated. This study is novel as it used HBM to elucidate NBT intentions as a protective behaviour during the ongoing pandemic and offered valuable contributions to the implementation of expeditious marketing strategies to promote NBT to potential tourists.
Processing instruction with structured/unstructured output: Does it make any changes in automatic/non-automatic explicit grammar knowledge?
Authors: Aghaei Aghdam Bita , Saeidi Mahnaz , Farrokhi Farahman
Published: August 2022

Research has underscored the separate role of output to promote processing instruction (PI) effects in language learning. Yet, there is a need to scrutinize the interplay between structured output (SO) and unstructured output (USO) within PI to understand how innovative combinations may enhance ultimate educational attainment. The present quasi-experimental study investigated the possible effects of PI with/without SO and USO on learners’ short-term and long-term automatic and non-automatic explicit knowledge of English passive structure. A homogeneous sample of 115 Intermediate learners of English as a foreign language (EFL) in intact groups was selected and randomly assigned to four experimental groups (PI, PI+SO, PI+USO, and PI+SO+USO). We administered parallel timed and untimed grammaticality judgment tests (GJT) to measure learning. Kruskal–Wallis, Mann–Whitney, Friedman, and Wilcoxon Signed Rank Tests revealed that the PI+SO+USO group outperformed the other groups. The findings underscore the significance of adding SO and USO to PI in promoting grammar knowledge and offer several pedagogical implications.
The Missing Voice: Incorporating the Hindu Community in Developing Inclusive Chaplaincy
Authors: Patel Rushil V.
Published: August 2022

This manuscript highlights potential barriers hospitalized Hindu patients and caregivers living in the United States encounter while accessing chaplaincy care. Community-based participatory research is suggested to foster partnerships between chaplains and the Hindu community in developing evidence-based, inclusive models of pastoral care.
The Altmetric Attention Score Is Associated With Citation Rates and May Reflect Academic Impact in the Total Joint Arthroplasty Literature
Authors: Kunze Kyle N. , Vadhera Amar S. , Polce Evan M. , Higuera Carlos A. , Siddiqi Ahmed , Chahla Jorge , Piuzzi Nicolas S.
Published: August 2022

Background: Given the increasing interest and potential use of social media for the promotion of orthopedic literature, there is a need to better understand Altmetrics. Purposes: We sought to determine the relationship between the Altmetric Attention Score (AAS) and the number of citations for articles on total joint arthroplasty (TJA) published in orthopedics journals. We also sought to determine the predictors of greater social media attention for these articles. Methods: Articles on TJA published in Bone and Joint Journal (BJJ), Journal of Bone and Joint Surgery (JBJS), Clinical Orthopedics and Related Research (CORR), Journal of Arthroplasty, Journal of Knee Surgery, Hip International, and Acta Orthopaedica in 2016 were extracted ( n = 498). One-way analysis of variance with Bonferroni corrections was used to compare AAS and citations across journals. Multivariate regressions were used to determine predictors of social media attention and number of citations. Results: The mean AAS and number of citations were 7.5 (range: 0–289) and 16.7 (range: 0–156), respectively. Significant between-group effects were observed according to journal for AAS and number of citations. Publishing an article in JBJS was the strongest predictor of higher number of citations. Publishing an article in BJJ was the only independent predictor of higher AAS, while publishing an article in JBJS or CORR trended toward statistical significance. A higher AAS was a significant predictor of a higher number of citations. Number of citations and number of study references were positive predictors of greater social media attention on Twitter and Facebook. Conclusions: In articles on TJA published in 7 journals in 2016, a higher AAS was a associated with a higher number of citations. Various bibliometric characteristics were found to be significantly associated with greater social media attention; the most common influences were number of citations and number of references. Researchers in orthopedics can use this information when considering how to assess the impact of their work.
Progress in Traditional Chinese Medicine on Treatment of Diabetic Retinopathy
Authors: Li Wencan , Li Wei , Xing Qichang , Liu Zheng , Hu Yixiang , Liu Xiang , Zhang Jiani
Published: August 2022

Diabetic retinopathy (DR), a common and blinding diabetic microvascular complication, is a harmful metabolic effect caused by persistent hyperglycemia. Owing to the complex pathogenesis of DR, various clinical treatment methods cannot completely prevent its development and are accompanied by various complications. Therefore, there is an urgent need to identify new therapeutic drugs or complementary and alternative therapies. Traditional Chinese medicine (TCM) has the unique advantages of multi-level, multi-target, and minimal side effects. Accumulating evidence has proven that TCM may help delay or prevent the progression of DR. This paper reviews the effect and mechanism of representative TCMs (including extracts, identified compounds, and compound formulas) on DR in recent years and provides evidence for new drug development and clinical efficacy.
Prevalence of chronic kidney disease and associated factors among patients visiting renal unit of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: A cross-sectional study design
Authors: Sertsu Addisu , Worku Teshager , Fekadu Gelana , Tura Abera Kenay
Published: August 2022

Objective:

This study aimed to assess the magnitude of chronic kidney disease among patients attending the renal unit of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Methods:

Institution-based cross-sectional study was conducted among 620 randomly selected patients who visited St. Paul’s Hospital Millennium Medical College renal unit from 1 January to 31 December, 2019. Data on sociodemographic characteristics, clinical conditions, behavioral risk factors, electrolytes, and renal function tests were extracted from patients’ medical records. To enter and analyze data, EpiData 3.1 and SPSS 22 were used, respectively. Bivariable and multivariable logistic regression analyses were conducted to see the association between predictor variables and chronic kidney disease. Adjusted odds ratio at 95% confidence interval was used to describe significant association. A p-value <0.05 was considered to declare an association between chronic kidney disease and independent variables.

Results:

Of 620 patients, 139 (22.4%; 95% confidence interval: 19.2, 25.6) and 61 (9.8%; 95% confidence interval: 7.4, 12.3) had chronic kidney disease using cut-off value of 90 and 60 ml/min/1.73 m2, respectively. Having urinary tract obstruction (adjusted odds ratio = 2.32; 95% confidence interval: 1.32, 4.06), hypertension (adjusted odds ratio = 4.06; 95% confidence interval: 2.50, 6.59), diabetes mellitus (adjusted odds ratio = 2.80; 95% confidence interval: 1.62, 4.85), cardiovascular disease (adjusted odds ratio = 2.54; 95% confidence interval: 1.60, 4.01), and age (adjusted odds ratio = 1.83; 95% confidence interval: 1.44, 3.57), family history of chronic kidney disease (adjusted odds ratio = 2.26; 95% confidence interval: 1.36, 3.75) were factors positively associated with having chronic kidney disease.

Conclusion:

Nearly, one out of five and one out of ten patients who visited the renal unit had chronic kidney disease using the two thresholds as a cut value. Patients with concomitant urinary tract obstruction, age, hypertension, diabetes mellitus, cardiovascular disease, and a family history of chronic kidney disease were more likely to develop chronic kidney disease. Regular screening for chronic kidney disease, optimal blood sugar, and blood pressure management should be practiced.
Influence of Financial Social Agents and Attitude Toward Money on Financial Literacy: The Mediating Role of Financial Self-Efficacy and Moderating Role of Mindfulness
Authors: Riaz Sheza , Khan Hadi Hassan , Sarwar Bilal , Ahmed Wahab , Muhammad Noor , Reza Sajjida , Ul Haq Sheikh Muhammad Nabeel
Published: August 2022

This study examines the relationship between the financial socialization agents, attitude toward money, and financial literacy with the mediating role of financial self-efficacy and the moderating role of mindfulness. The self-administered questionnaire was used for data collection from higher education institutions using the convenience sampling method because the sampling frame was not available. The data were tested using partial least square structural equation modeling (PLS-SEM) in smart PLS. The results indicated a positive relationship between financial self-efficacy, financial socialization agents, attitude toward money, mindfulness, and financial literacy. The finding of mediation analysis suggests the significant mediation effect of financial self-efficacy between attitude toward money and financial social agents with financial literacy. The mediation of financial self-efficacy between attitude toward money and financial literacy has the greatest impact which indicates that students with positive attitude and self-efficacy create high financial literacy. Whereas mindfulness positively moderates the relation of attitude toward money and financial literacy and negatively moderates the relation of financial self-efficacy and financial literacy while mindfulness does not moderate the relation of financial socialization agents and financial literacy. The findings of this research are of use to different stakeholders who are users or regulators of financial institutions because enhancing financial literacy has become a priority.
Examining Consumers’ Adoption of Smart Wearable Payments
Authors: Hidayat-ur-Rehman Imdadullah , Ahmad Arshad , Akhter Fahim , Ziaur Rehman Mohd
Published: August 2022

Smart wearable (SW) devices have attracted the users’ attention and their utility has been increasingly employed in different arenas of life. Of late, it is expected that wearable payments will be the norm of mobile payments soon. Recognizing the SW payments as an emerging innovation, this study investigates the consumers’ adoption of SW payments. A survey method was used to collect data from SW devices users in Saudi Arabia. For this purpose, online questionnaires were distributed and a total of 269 responses were received within that 243 operational cases were used for data analysis. Partial least squares structural equation modeling (PLS-SEM) technique was employed to analyze the data. The statistical tools employed for data analysis are SmartPLS 3.0 and SPSS23. The findings show that all hypothesized relationships were supported except the compatibility and perceived ease of use relationship which was found insignificant. Additionally, the moderating role of personal innovativeness on behavioral intention and actual use relationship was also confirmed. Although TAM is an established robust model of technology adoption, however, the integration of technological features like (perceived esthetics, compatibility, and convenience) make it a more vigorous model for adoption of the smart wearable device.
Linguistic Synesthesia in Korean: Universality and Variation
Authors: Jo Charmhun
Published: August 2022

It has long been argued that linguistic synesthesia has a universal linear-hierarchical directionality tendency, which is mostly grounded in Indo-European language data. This study explores linguistic synesthesia in Korean to verify the cross-linguistic generalizability of the universality hypothesis of linguistic synesthesia. Based on synesthetic data from the Sejong Corpus and gustatory adjectives, this study found that Korean synesthesia shows language-bound variations with three different types of mappings (i.e., unidirectional, reciprocal, and biased), which are frequency- and rule-based. This finding challenges the cross-linguistic universality of the mapping directionality of linguistic synesthesia. As for the mapping mechanism of linguistic synesthesia, this study supports the embodiment theory in terms of language-specific variation. Additionally, it has been proposed that linguistic synesthesia is a special type of metaphor based on both rules and frequency. Finally, this study suggests that linguistic synesthesia displays universal directionality at a general level and language-bound variation at a specific level.
Role of Triarchic Traits in Relations of Early Resting Heart Rate With Antisocial Behavior and Broad Psychopathology Dimensions in Later Life
Authors: Bertoldi Bridget M. , Tuvblad Catherine , Joyner Keanan J. , Ganley Colleen , Raine Adrian , Baker Laura , Latvala Antti , Oskarsson Sofi , Patrick Christopher J.
Published: August 2022

Low resting heart rate (HR) is a known risk indicator for the development of antisocial behavior (ASB) and other clinical problems. Stimulation seeking and fearlessness have been explored as factors underlying the HR/ASB relationship, but these have often been conflated, which has complicated interpretation. We examined HR’s associations with ASB and other outcomes in terms of biobehavioral traits described by the triarchic model of psychopathy using data ( N = 710) from a longitudinal study of ASB risk. Low resting HR in childhood was related to adult ASB, and covariance between ASB and traits of disinhibition and boldness largely accounted for this association. In addition, low childhood HR was related to greater externalizing problems and fewer internalizing problems in adulthood; disinhibition accounted for the former association, and boldness accounted for the latter. Findings indicate a role for both disinhibition and boldness in associations between early HR and later clinical outcomes and have implications for theory and practice.
Paradoxical Exudative Retinopathy and Macular Star Formation After Treatment Initiation in Coats Disease
Authors: Kalavar Meghana , Ashkenazy Noy , Acon Ramirez Dhariana , Berrocal Audina
Published: August 2022

Purpose: This work describes a unique clinical feature in Coats disease. Methods: A retrospective series of 2 cases is reported. Results: Two pediatric patients receiving treatment for Coats disease were included. In both cases, vision worsened secondary to paradoxically increased exudation and macular star formation following standard treatment with intravitreal bevacizumab, sub-Tenon triamcinolone acetonide, and laser photocoagulation. After serial treatments under general anesthesia, the exudates in both cases consolidated. Conclusions: A paradoxical exudative retinopathy can occur in some patients when initiating standard treatment of Coats disease. Longitudinal follow-up with continued intravitreal antivascular endothelial growth factor agents, laser photocoagulation, and corticosteroids might help control persistent exudation in these cases.
The epistemic tensions of nuclear waste siting in a nuclear landscape
Authors: Bell Marissa
Published: August 2022

Canada's siting process for spent nuclear fuel, led by the Nuclear Waste Management Organization (NWMO), is frequently held within nuclear industry spheres as an exemplary siting process, designed to be inclusive, participatory, and “community-driven.” Drawing from ethnographic observations of the process as it unfolded in Southern Ontario, Canada, this paper focuses on the epistemic issues of how diverse knowledges are treated in the process, whose knowledge is valued, how such knowledges are understood, and whose knowledges are excluded. In particular, I make sense of how epistemic tensions in the process are produced by being situated within a nuclear landscape, informed by local nuclear-dominant socio-technical relations and epistemic regimes, which exceptionalize pro-nuclear Western scientific knowledges. This socio-technical constellation, I suggest, leads to careful but sometimes paradoxical negotiations of the expert/lay divide that subsequently reveals cracks in the policy foundation for inclusion of diverse forms of knowledge. While the NWMO policy framework discursively values diverse knowledges, critical lay community knowledges are often delegitimized and dismissed. Similarly, there are scalar issues in the ways Indigenous knowledges are homogenized and devalued through discursive separation. These epistemic tensions, between how knowledges should be treated in policy, and how knowledges are actually treated in practice, demonstrate clear issues of recognition justice, participatory fairness, and inclusion of diverse knowledges. The implications of this work shed light on understanding the complexities of landscape-based knowledge politics and how they might inform siting practices and technological decision-making more broadly.
The early career researcher collaboration mindset
Authors: Wagers Scott S.
Published: August 2022

Everyone knows that science is about collaboration, but the degree to which one embraces collaboration can have an outsized impact on the value one derives from collaboration. In this article, different aspects of collaboration are discussed and a list of action-oriented principles is presented to help readers understand what can be done to develop more of a collaboration mindset to get the maximal value out of collaboration.
Paramedic management of back pain: a scoping review
Authors: Vella Simon P. , Chen Qiuzhe , Maher Chris G. , Simpson Paul M. , Swain Michael S. , Machado Gustavo C.
Published: August 2022

Background

Research examining paramedic care of back pain is limited.

Objective

To describe ambulance service use and usual paramedic care for back pain, the effectiveness and safety of paramedic care of back pain, and the characteristics of people with back pain who seek care from paramedics.

Methods

We included published peer-reviewed studies of people with back pain who received any type of paramedic care on-scene and/or during transport to hospital. We searched MEDLINE, EMBASE, CINAHL, Web of Science and SciELO from inception to July 2022. Two authors independently screened and selected the studies, performed data extraction, and assessed the methodological quality using the PEDro, AMSTAR 2 and Hawker tools. This review followed the JBI methodological guidance for scoping reviews and PRISMA extension for scoping reviews.

Results

From 1987 articles we included 26 articles (25 unique studies) consisting of 22 observational studies, three randomised controlled trials and one review. Back pain is frequently in the top 3 reasons for calls to an ambulance service with more than two thirds of cases receiving ambulance dispatch. It takes ~ 8 min from time of call to an ambulance being dispatched and 16% of calls for back pain receive transport to hospital. Pharmacological management of back pain includes benzodiazepines, NSAIDs, opioids, nitrous oxide, and paracetamol. Non-pharmacological care is poorly reported and includes referral to alternate health service, counselling and behavioural interventions and self-care advice. Only three trials have evaluated effectiveness of paramedic treatments (TENS, active warming, and administration of opioids) and no studies provided safety or costing data.

Conclusion

Paramedics are frequently responding to people with back pain. Use of pain medicines is common but varies according to the type of back pain and setting, while non-pharmacological care is poorly reported. There is a lack of research evaluating the effectiveness and safety of paramedic care for back pain.
Comparing evolvement of visual field defect in neuromyelitis optica spectrum disorder-optic neuritis and idiopathic optic neuritis: a prospective study
Authors: Liang Jiaqi , Zhang Yuxin , Liu Kaiqun , Xu Xiaoyu , Zhao Xiujuan , Qiu Wei , Zhang Xinyu , Yang Hui
Published: August 2022

Purpose

To compare the evolvement of visual field (VF) defect in neuromyelitis optica spectrum disorder-optic neuritis (NMOSD-ON) and idiopathic optic neuritis (IDON).

Methods

This prospective study involved 104 optic neuritis (ON) patients followed up for ≥ 6 months (33 patients with NMOSD-ON and 71 patients with IDON). The pattern and recovery pattern of VF defect, mean defect (MD) and pattern standard deviation (PSD) of VF, as well as BCVA at onset, 1 month (1 m), 3 months (3 m), and ≥ 6 months (6 m) after onset were compared between two groups. Analysis of these indicators in first episode patients was also done.

Results

Diffuse abnormalities and nerve fiber bundle abnormalities were the two most common patterns in both groups. The percentage of neurologic abnormality of VF defect in NMOSD-ON was higher than that of IDON. Compared with the IDON group, the MD and PSD of NMOSD-ON group were significantly worse at each follow-up. While a positive correlation in BCVA was found between 1 m and ≥ 6 m in the NMOSD-ON group only, a positive correlation was found between 1 m and ≥ 6 m in MD and PSD of both groups. A positive correlation was found between 3 m and ≥ 6 m in MD, PSD and BCVA of both groups. The quadrant recovery pattern was the most common pattern in both groups (57.1% in NMOSD-ON and 57.4% in IDON). The analysis of the first episode subgroup further confirmed the observation above.

Conclusions

The NMOSD-ON patients tended to suffer more severe VF damage, VF irregularity and worse prognosis than that of IDON patients. Diffuse abnormalities and nerve fiber bundle abnormalities were the two most common types in both groups, while neurologic abnormality more common in NMOSD-ON and central scotoma more common in IDON. The visual functions of 1 m in NMOSD-ON and 3 m in IDON were related to its prognosis.
A case series describing the risk of periodontal disease in Marfan syndrome patients harboring a possible aortic aneurysm or dissection
Authors: Umezawa Kouta , Kajiwara Takako , Ishii Kyoko , Hasegawa Tatsuya , Suzuki Shigeto , Nakano Masato , Sawaguchi Mayu , Venkataiah Venkata Suresh , Yahata Yoshio , Ito Koki , Saiki Yoshikatsu , Saito Masahiro
Published: August 2022

Background

Marfan syndrome (MFS) is a systemic disorder of connective tissues caused by insufficient elastic fiber formation that leads to structural weakness and results in various tissue disorders, including cardiovascular and periodontal disease. Notably however, the risk of periodontal disease in MFS patients affected by an aortic aneurysm or dissection has not yet been clarified.

Methods

We investigated the periodontal condition in the following three groups: MFS patients diagnosed with an aortic aneurysm or dissection with a planned aortic surgery (MFS surgery), MFS patients who had already undergone aortic surgery (MFS post-surgery) and healthy control patients (Healthy). The periodontal condition of all of these patients was evaluated at their first visit, reassessed again at two-month after the first visit, and evaluated again at a six-month follow-up after the reassessment.

Results

A total of 14 participants, 3 MFS surgery patients, 4 MFS post-surgery patients and 7 healthy control volunteers were examined. Saliva examinations revealed no significant differences between any of the groups at the first visit, reassessment, or follow-up. Interestingly, the MFS surgery cases showed a higher BOP and PISA at the first visit and follow-up compared with the other groups. In contrast, the MFS surgery patients showed an improvement in their LVDd and EF values, both markers of cardiac function, at the reassessment and follow-up compared with the first visit.

Conclusions

MFS associated with an aortic aneurysm or dissection leads to a higher risk of periodontal disease, indicating the need for more frequent oral hygiene maintenance in these patients. In addition, MFS patients who undergo frequent professional cleaning of their teeth show a lower onset of cardiovascular disease, suggesting that professional oral hygiene in these cases contributes to a healthier condition.
Development of a core outcome set for informed consent for therapy: An international key stakeholder consensus study
Authors: Convie Liam J. , Clements Joshua M. , McCain Scott , Campbell Jeffrey , Kirk Stephen J. , Clarke Mike
Published: August 2022

Background

300 million operations and procedures are performed annually across the world, all of which require a patient’s informed consent. No standardised measure of the consent process exists in current clinical practice. We aimed to define a core outcome set for informed consent for therapy.

Methods

The core outcome set was developed in accordance with a predefined research protocol and the Core OutcoMes in Effectiveness Trials (COMET) methodology comprising systematic review, qualitative semi structured interviews, a modified Delphi process and consensus webinars to ratify outcomes for inclusion in the final core outcome set. (Registration—https://www.comet-initiative.org/Studies/Details/1024). Participants from all key stakeholder groups took part in the process, including patients and the public, healthcare practitioners and consent researchers.

Results

36 outcome domains were synthesised through systematic review and organised into a consent taxonomy. 41 semi-structured interviews were performed with all consent stakeholders groups. 164 participants from all stakeholder groups across 8 countries completed Delphi Round 1 and 125 completed Round 2. 11 outcomes met the ‘consensus in’ criteria. 6 met ‘consensus in’ all stakeholder groups and were included directly in the final core outcome set. 5 remaining outcomes meeting ‘consensus in’ were ratified over two consensus webinars. 9 core outcomes were included in the final core outcome set: Satisfaction with the quality and amount of information, Patient feeling that there was a choice, Patient feeling that the decision to consent was their own, Confidence in the decision made, Satisfaction with communication, Trust in the clinician, Patient satisfaction with the consent process, Patient rated adequacy of time and opportunity to ask questions.

Conclusion

This international mixed-methods qualitative study is the first of its kind to define a core outcome set for informed consent for intervention. It defines what outcomes are of importance to key stakeholders in the consent process and is a forward step towards standardising future consent research.
Epstein-Barr virus infection-associated cholangiocarcinoma: a report of one case and the review of literature
Authors: Zhang Xinchun , Wang Ning , Wei Wenyan , Li Yangsheng
Published: August 2022

The clinical data of a patient with Epstein-barr virus (EBV) associated with cholangiocarcinoma was reported in this paper: a case of a 36-year-old female presented with abdominal pain and systemic skin yellowing combined with skin itching. Laboratory studies showed increase in alanine aminotransferase 242 U/L, aspartate aminotransferase 404 U/L, r-glutamyltransferase 1516 U/L, total bilirubin 308.2 µmol/L and CA199 (101.0 U/ml). AFP (4.5 ng/ml) was normal. CT revealed multiple space-occupying lesions in the liver. PET-CT revealed liver malignant tumor and lymph node metastasis. Liver puncture pathology revealed infiltrative growth of significant heterocyst nests in the liver tissue, which was morphologically consistent with malignant tumors, considering poorly differentiated carcinoma. Pathology suggestion: combining liver puncture with morphology, immunohistochemistry, and EBV in situ hybridization results, it was consistent with EB virus-associated poorly differentiated carcinoma, therefore, consider EBV infection-associated poorly differentiated cholangiocarcinoma (CCA) (LELC morphology). The patient underwent liver transplantation in Hangzhou Shulan Hospital on June 8, 2021 successfully. After surgery, the patient orally took tacrolimus for anti-rejection, entecavir for antiviral therapy, gemcitabine 1.2 g + cis-platinum 30 mg for chemotherapy. After following up for more than 5 months post liver transplantation, the condition of the patient deteriorated. The patient subsequently died. Based on the case of our patient and the review of existing literature, when the patient's serum CA199 increased, AFP did not change significantly, and there was no previous history of hepatitis B. CT revealed a low-density mass in the liver, ring enhancement in the arterial phase, and heterogeneous enhancement of the tumor in the delayed phase. Ring enhancement of the liver lesion mass was observed on MRI. Consider the might possibility of hepatic CCA. When patients showed recurrent tonsillitis at an early age, EBV virus infection should be vigilant and oropharyngeal tissue should persist, diagnosis of EBV-associated liver cancer should be considered. In particular, EBV infection-related liver cancer is relatively rare, the clinician should improve the recognition of the disease to strive for early diagnosis and therapy.
Clinical sepsis phenotypes in critically ill COVID-19 patients
Authors: Bruse Niklas , Kooistra Emma J. , Jansen Aron , van Amstel Rombout B. E. , de Keizer Nicolette F. , Kennedy Jason N. , Seymour Christopher , van Vught Lonneke A. , Pickkers Peter , Kox Matthijs
Published: August 2022

Background

A greater understanding of disease heterogeneity may facilitate precision medicine for coronavirus disease 2019 (COVID-19). Previous work identified four distinct clinical phenotypes associated with outcome and treatment responses in non-COVID-19 sepsis patients, but it is unknown if and how these phenotypes are recapitulated in COVID-19 sepsis patients.

Methods

We applied the four non-COVID-19 sepsis phenotypes to a total of 52,274 critically ill patients, comprising two cohorts of COVID-19 sepsis patients (admitted before and after the introduction of dexamethasone as standard treatment) and three non-COVID-19 sepsis cohorts (non-COVID-19 viral pneumonia sepsis, bacterial pneumonia sepsis, and bacterial sepsis of non-pulmonary origin). Differences in proportions of phenotypes and their associated mortality were determined across these cohorts.

Results

Phenotype distribution was highly similar between COVID-19 and non-COVID-19 viral pneumonia sepsis cohorts, whereas the proportion of patients with the δ-phenotype was greater in both bacterial sepsis cohorts compared to the viral sepsis cohorts. The introduction of dexamethasone treatment was associated with an increased proportion of patients with the δ-phenotype (6% vs. 11% in the pre- and post-dexamethasone COVID-19 cohorts, respectively, p < 0.001). Across the cohorts, the α-phenotype was associated with the most favorable outcome, while the δ-phenotype was associated with the highest mortality. Survival of the δ-phenotype was markedly higher following the introduction of dexamethasone (60% vs 41%, p < 0.001), whereas no relevant differences in survival were observed for the other phenotypes among COVID-19 patients.

Conclusions

Classification of critically ill COVID-19 patients into clinical phenotypes may aid prognostication, prediction of treatment efficacy, and facilitation of personalized medicine.
Aedes aegypti and Ae. albopictus microbiome/virome: new strategies for controlling arboviral transmission?
Authors: Gómez Marcela , Martinez David , Muñoz Marina , Ramírez Juan David
Published: August 2022

Aedes aegypti and Aedes albopictus are the main vectors of highly pathogenic viruses for humans, such as dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV), which cause febrile, hemorrhagic, and neurological diseases and remain a major threat to global public health. The high ecological plasticity, opportunistic feeding patterns, and versatility in the use of urban and natural breeding sites of these vectors have favored their dispersal and adaptation in tropical, subtropical, and even temperate zones. Due to the lack of available treatments and vaccines, mosquito population control is the most effective way to prevent arboviral diseases. Resident microorganisms play a crucial role in host fitness by preventing or enhancing its vectorial ability to transmit viral pathogens. High-throughput sequencing and metagenomic analyses have advanced our understanding of the composition and functionality of the microbiota of Aedes spp. Interestingly, shotgun metagenomics studies have established that mosquito vectors harbor a highly conserved virome composed of insect-specific viruses (ISV). Although ISVs are not infectious to vertebrates, they can alter different phases of the arboviral cycle, interfering with transmission to the human host. Therefore, this review focuses on the description of Ae. aegypti and Ae. albopictus as vectors susceptible to infection by viral pathogens, highlighting the role of the microbiota-virome in vectorial competence and its potential in control strategies for new emerging and re-emerging arboviruses.

Graphical Abstract
Assessing the accuracy of [18F]PSMA-1007 PET/CT for primary staging of lymph node metastases in intermediate- and high-risk prostate cancer patients
Authors: Ingvar Jacob , Hvittfeldt Erland , Trägårdh Elin , Simoulis Athanasios , Bjartell Anders
Published: August 2022

Background

[18F]PSMA-1007 is a promising tracer for integrated positron emission tomography and computed tomography (PET/CT).

Objective

Our aim was to assess the diagnostic accuracy of [18F]PSMA-1007 PET/CT for primary staging of lymph node metastasis before robotic-assisted laparoscopy (RALP) with extended lymph node dissection (ePLND).

Design, Setting and Participants

The study was a retrospective cohort in a tertiary referral center. Men with prostate cancer that underwent surgical treatment for intermediate- or high-risk prostate cancer between May 2019 and August 2021 were included.

Interventions

[18F]PSMA-1007 PET/CT for initial staging followed by RALP and ePLND.

Outcome measurements and statistical analyses

Sensitivity and specificity were calculated both for the entire cohort and for patients with lymph node metastasis ≥ 3 mm. Positive (PPV) and negative (NPV) predictive values were calculated.

Results and limitations

Among 104 patients included in the analyses, 26 patients had lymph node metastasis based on pathology reporting and metastases were ≥ 3 mm in size in 13 of the cases (50%). In the entire cohort, the sensitivity and specificity of [18F]PSMA-1007 were 26.9% (95% confidence interval (CI); 11.6–47.8) and 96.2% (95% CI; 89.2–99.2), respectively. The sensitivity and specificity of [18F]PSMA-1007 to detect a lymph node metastasis ≥ 3 mm on PET/CT were 53.8% (95% CI; 25.1–80.8) and 96.7% (95% CI; 90.7–99.3), respectively. PPV was 70% and NPV 93.6%.

Conclusions

In primary staging of intermediate- and high-risk prostate cancer, [18F]PSMA-1007 PET/CT is highly specific for prediction of lymph node metastases, but the sensitivity for detection of metastases smaller than 3 mm is limited. Based on our results, [18F]PSMA-1007 PET/CT cannot completely replace ePLND.

Patient summary

This study investigated the use of an imaging method based on a prostate antigen-specific radiopharmaceutical tracer to detect lymph node prostate cancer metastasis. We found that it is unreliable to discover small metastasis.
A systematic review of economic evaluations of cervical cancer screening methods
Authors: Sefuthi Thatohatsi , Nkonki Lungiswa
Published: August 2022

Objective

The aims of this systematic review were to (1) identify primary- and model-based economic evaluations of cervical cancer screening methods and to (2) provide a contextual summary of valuation outcomes associated with three types of cervical cancer screening tests: visual inspection with acetic acid, human papillomavirus deoxyribonucleic acid, and Papanicolaou smear.

Introduction

Cervical cancer screening is an important public health priority with the potential to improve the detection of precancerous lesions in high-risk females for early intervention and disease prevention. Test performance and cost-effectiveness differ based on the specific screening method used across different platforms. There is a need to appraise existing economic evaluations of cervical cancer screening methods.

Methods

This review considered primary-based and model-based full economic evaluations of cervical cancer screening methods. The evaluation methods of interest included cost-effectiveness analysis, cost-utility analysis, cost-minimization analysis, cost–benefit analysis, and cost-consequence analysis. We searched Scopus, PubMed, National Health Economic Evaluation Database (NH EED), Cochrane, and the Health Economic Evaluation Database for full economic evaluations of cancer screening methods. No formal date restrictions were applied. Model-based and primary-based full economic evaluations were included. A critical appraisal of included studies was performed by the main investigator, while a second independent reviewer assessed critical appraisal findings for any inconsistencies. Data were extracted using a standardised data extraction tool for economic evaluations. The ultimate outcomes of costs, effectiveness, benefits, and utilities of cervical cancer screening modalities were extracted from included studies, analysed, and summarised.

Results

From a total of 671 screened studies, 44 studies met the study inclusion criteria. Forty-three studies were cost-effectiveness analyses, one study reported both cost-utility and cost-effectiveness outcomes, and another study reported cost utilities of cervical cancer screening methods only. Human papillomavirus (HPV) DNA testing was reported as a dominant stand-alone screening test by 14 studies, while five studies reported visual inspection with acetic acid (VIA) as a dominant stand-alone screening test. Primary HPV screening strategies were dominant in 21 studies, while three studies reported cytology-based screening strategies as the dominant screening method.

Conclusions

Existing evidence indicates that HPV-based and VIA testing strategies are cost-effective, but this is dependent on setting. Our review suggests the limited cost-effectiveness of cytology-based testing, which may be due in part to the need for specific infrastructures and human resources.

Systematic review registration

PROSPERO CRD42020212454.
Explaining adults’ mental health help-seeking through the lens of the theory of planned behavior: a scoping review
Authors: Adams Claire , Gringart Eyal , Strobel Natalie
Published: August 2022

Background

Despite evidence-based efficacy, mental health services are underutilized due to low rates of help-seeking, leaving unmet mental health needs a global concern. The Theory of Planned Behavior (TPB) has been applied to understand the help-seeking process and in the development of behavior change interventions. The aim of this scoping review was to map the literature on the TPB as applied to mental health help-seeking in adults aged >18 years.

Methods

This scoping review was conducted based on the methodology presented by Arksey and O’Malley (2005). Six databases (CINAHL, PsycINFO, MEDLINE, ProQuest Health and Medicine, ProQuest Dissertations and Theses, Web of Science) and two grey literature sources (OpenGrey, Google Scholar) were systematically searched in February 2018 and updated in March 2020. Studies that explicitly discussed the TPB in the context of mental health help-seeking were initially selected; only studies that explored formal help-seeking for mental health problems and were published in English were retained. Data were extracted using Microsoft Excel.

Results

Initially, 8898 records were identified. Of these, 49 met the selection criteria and were included: 32 were journal articles and 17 were theses. Forty-three papers reported on non-intervention studies and seven articles reported on TPB-based interventions. Most studies (n = 39) identified predictors of help-seeking intentions. Attitudes and perceived behavioral control were significant predictors of intentions in 35 and 34 studies, respectively. Subjective norms were a significant predictor of intentions in 23 studies. Few studies aimed to predict help-seeking behavior (n = 8). Intentions and perceived behavioral control were significant predictors of behavior in seven and six studies, respectively. Only six TPB-based interventions were identified, all used digital technology to influence help-seeking, with mixed results.

Conclusions

The present scoping review identified a considerable evidence base on the TPB for predicting mental health help-seeking intentions. Attitudes and perceived behavioral control were frequently found to be significant predictors of help-seeking intentions. Knowledge on the TPB for predicting mental health help-seeking behavior, and on TPB-based interventions, is limited. Thus, the role of the TPB in developing help-seeking interventions remains unclear. Recommendations are presented to address such research gaps and inform policy and practice.
Focal amyloid and asymmetric tau in an imaging-to-autopsy case of clinical primary progressive aphasia with Alzheimer disease neuropathology
Authors: Martersteck Adam , Ayala Ivan , Ohm Daniel T. , Spencer Callen , Coventry Christina , Weintraub Sandra , Bigio Eileen H. , Mesulam M. -Marsel , Geula Changiz , Rogalski Emily
Published: August 2022

Quantification of in vivo amyloid and tau PET imaging relationships with postmortem measurements are critical for validating the sensitivity and specificity imaging biomarkers across clinical phenotypes with Alzheimer disease neuropathologic change (ADNC). This study examined the quantitative relationship between regional binding of in vivo 18F-florbetapir amyloid PET and 18F-flortaucipir tau PET with postmortem stereological counts of amyloid plaques and neurofibrillary tangles (NFT) in a case of primary progressive aphasia (PPA) with ADNC, where neurodegeneration asymmetrically targets the left hemisphere. Beginning 2 years prior to death, a 63-year-old right-handed man presenting with agrammatic variant PPA underwent a florbetapir and flortaucpir PET scan, and neuropsychological assessments and magnetic resonance imaging sessions every 6 months. Florbetapir and flortaucpir PET standard uptake value ratios (SUVRs) were quantified from 8 left and right hemisphere brain regions with stereological quantification of amyloid plaques and NFTs from corresponding postmortem sections. Pearson’s correlations and measures of asymmetry were used to examine relationships between imaging and autopsy measurements. The three visits prior to death revealed decline of language measures, with marked progression of atrophy. Florbetapir PET presented with an atypical focal pattern of uptake and showed a significant positive correlation with postmortem amyloid plaque density across the 8 regions (r = 0.92; p = 0.001). Flortaucipir PET had a left-lateralized distribution and showed a significant positive correlation with NFT density (r = 0.78; p = 0.023). Flortaucipir PET and NFT density indicated a medial temporal lobe sparing presentation of ADNC, demonstrating that AD does not always target the medial temporal lobe. This study adds additional evidence, in a non-amnestic phenotype of ADNC, that there is a strong correlation between AD PET biomarkers, florbetapir and flortaucipir, with quantitative neuropathology. The atypical and focal presentation of plaque density and florbetapir PET uptake suggests not all amyloid pathology presents as diffuse across neocortex.