bluuebunny/crossref_metadata_2025 huggingface dataset:
Bioengineered vascular grafts with a pathogenic
TGFBR1
variant model aneurysm formation in vivo and reveal underlying collagen defects
Authors: Yang Ying , Feng Hao , Tang Ying , Wang Zhenguo , Qiu Ping , Huang Xihua , Chang Lin , Zhang Jifeng , Chen Yuqing Eugene , Mizrak Dogukan , Yang Bo
Published: May 2024

Thoracic aortic aneurysm (TAA) is a life-threatening vascular disease frequently associated with underlying genetic causes. An inadequate understanding of human TAA pathogenesis highlights the need for better disease models. Here, we established a functional human TAA model in an animal host by combining human induced pluripotent stem cells (hiPSCs), bioengineered vascular grafts (BVGs), and gene editing. We generated BVGs from isogenic control hiPSC-derived vascular smooth muscle cells (SMCs) and mutant SMCs gene-edited to carry a Loeys-Dietz syndrome (LDS)–associated pathogenic variant (

TGFBR1
A230T

). We also generated hiPSC-derived BVGs using cells from a patient with LDS (

Patient
A230T/+

) and using genetically corrected cells (

Patient
+/+

). Control and experimental BVGs were then implanted into the common carotid arteries of nude rats. The

TGFBR1
A230T

variant led to impaired mechanical properties of BVGs, resulting in lower burst pressure and suture retention strength. BVGs carrying the variant dilated over time in vivo, resembling human TAA formation. Spatial transcriptomics profiling revealed defective expression of extracellular matrix (ECM) formation genes in

Patient
A230T/+

BVGs compared with

Patient
+/+

BVGs. Histological analysis and protein assays validated quantitative and qualitative ECM defects in

Patient
A230T/+

BVGs and patient tissue, including decreased collagen hydroxylation. SMC organization was also impaired in

Patient
A230T/+

BVGs as confirmed by vascular contraction testing. Silencing of collagen-modifying enzymes with small interfering RNAs reduced collagen proline hydroxylation in SMC-derived tissue constructs. These studies demonstrated the utility of BVGs to model human TAA formation in an animal host and highlighted the role of reduced collagen modifying enzyme activity in human TAA formation.
A phase 2 randomized trial with autologous polyclonal expanded regulatory T cells in children with new-onset type 1 diabetes
Authors: Bender Christine , Wiedeman Alice E. , Hu Alex , Ylescupidez Alyssa , Sietsema William K. , Herold Kevan C. , Griffin Kurt J. , Gitelman Stephen E. , Long S. Alice ,   on behalf of the T-Rex Study Group†, Gottlieb Peter A. , Strock Ruthie , Chesshir Lexie , Redondo Maria J. , Williams Christopher , Clements Mark A. , Moore Wayne V. , DiMeglio Linda A. , Legge Megan , Mullen Maureen , Sanchez Juan , Spall Maria , Woerner Stephanie , Gaglia Jason L. , Resnick Brittany , Bryant Nora , Krishfield Suzanne , Turley Jeanne , Koshy Nisha , Mackey Mikayla , Guttmann-Bauman Ines , Fitch Rebecca , Bartholow Lynn , Shelso John H. , Al Nofal Alaa , Hanisch Karen , Casas Luis , Thurlow Brenda , Gottschalk Michael , Hashiguchi Marla , Paglia Lisa , Lam Angela , Sanda Srinath , Torok Christine , Wesch Rebecca , Moore Daniel J. , Russell William E. , Smith Tyler Jordan , Brown Anne , Brendle Faith , Haller Michael J. , Cintron Miriam , Baidal David A. , Matheson Della , Blaschke Carlos , Moran Antoinette , Pappensus Elizabeth , Leschyshyn Janice , Street Anne
Published: May 2024

CD4
+
CD25
hi
CD127
lo/−
FOXP3
+
regulatory T cells (T
regs
) play a key role in preventing autoimmunity. In autoimmune type 1 diabetes (T1D), adoptive transfer of autologous polyclonal T
regs
has been shown to be safe in adults in phase 1 clinical trials. We explored factors contributing to efficacy of autologous polyclonal expanded T
regs
(expT
regs
) in a randomized phase 2 multi-center, double-blind, clinical trial (Sanford/Lisata Therapeutics T-Rex phase 2 trial,
ClinicalTrials.gov
NCT02691247). One hundred ten treated children and adolescents with new-onset T1D were randomized 1:1:1 to high-dose (20 × 10
6
cells/kilogram) or low-dose (1 × 10
6
cells/kilogram) treatments or to matching placebo. Cytometry as well as bulk and single-cell RNA sequencing were performed on selected expT
regs
and peripheral blood samples from participants. The single doses of expT
regs
were safe but did not prevent decline in residual β cell function over 1 year compared to placebo (
P
= 0.94 low dose,
P
= 0.21 high dose), regardless of age or baseline C-peptide. ExpT
regs
were highly activated and suppressive in vitro. A transient increase of activated memory T
regs
was detectable 1 week after infusion in the high-dose cohort, suggesting effective transfer of expT
regs
. However, the in vitro fold expansion of expT
regs
varied across participants, even when accounting for age, and lower fold expansion and its associated gene signature were linked with better C-peptide preservation regardless of T
reg
dose. These results suggest that a single dose of polyclonal expT
regs
does not alter progression in T1D; instead, T
reg
quality may be an important factor.
Phage K exposure generates phage-neutralizing activity in a rabbit model—humoral receptiveness may impact efficacy of phage therapy
Authors: Herren Sebastian C. , Karau Melissa J. , Koscianski Christina A. , Christensen Trace A. , Granger Dane , Bergan Nathanial G. , Mandrekar Jay , Holmes David R. , Patel Robin
Published: May 2024

Phage therapy has not been established in the clinical routine, in part due to uncertainties concerning efficacy and immunogenicity. Here, three rabbits were immunized against staphylococcal phage K to assess viral potency in the presence of immunized serum. Three rabbits received weekly intramuscular injections of ~10
10±1
pfu/mL phage K. Phage K-specific IgG formation was measured by an enzyme-linked immunosorbent assay (ELISA); phage inactivation was assessed by calculating K-rates. Using transmission electron microscopy (TEM) and immunogold labeling, antibody binding to phage K was visualized. This was numerically assessed by objective imaging analysis comparing the relative distances of each gold particle to the nearest phage head and tail structure. Immunization led to a strong IgG response, plateauing 7 days after the last phage injection. There was no significant correlation between K-rate and antibody titer over time. TEM showed IgG binding to the head structure of phage K. Image analysis showed a significant reduction in relative distances between antibodies and phage head structures when comparing samples from day 0 and day 28 (
P
< 0.0001). These results suggest that while individual serum analysis for antibodies against therapeutic phage bears consideration prior to and with prolonged therapy, during phage application, the formation of specific antibodies against phage may only partially explain decreased phage potency in the presence of immunized serum. Instead, other factors may contribute to an individual’s “humoral receptiveness” to phage therapy. Future investigations should be directed toward the identification of the humoral factors that have the most significant predictive value on phage potency
in vivo
.
Complete genome sequences of three
Porphyromonas gingivalis
strains, isolated from patient with esophageal squamous cell carcinoma and healthy individual in China
Authors: Gu Bianli , Ma Lixia , Chen Pan , Qi Yijun , Zhao Qi , Gao Shegan
Published: May 2024

Here, we report the complete genome sequences of three
Porphyromonas gingivalis
, one from patient with esophageal cancer (LyEC01), and the other two from periodontally healthy individuals (LyG-1 and LyG-2) in 2021 and 2023. The genome sizes of LyEC01, LyG-1, and LyG-2 were 2,408,275, 2,411,440, and 2,411,481 bp, respectively.
Supplemental Material: Late Oligocene–Miocene evolution of deep-water circulation in the abyssal South China Sea: Insights from Nd isotopes of fossil fish teeth
Authors: Shu Wei , Colin Christophe , Liu Zhifei , al. et
Published: May 2024

Geological and oceanographic background, materials and analytical methods, Figures S1–S3, Tables S1–S2, and references.  
Persistent omphalomesenteric duct in an infant with trisomy 21
Authors: Aghababaie Arameh , Ho Jennifer , Kelay Arun , Salt Penny
Published: May 2024

We present the case of a term newborn with trisomy 21 who presented to the paediatric emergency department with periumbilical flare and green-brown discharge from a clamped umbilical cord, initially suspected to be omphalitis. However, it was noticed later, that when the infant strained or cried, a thick, bubbling and offensive green-brown discharge came out of the clamped umbilical cord with umbilical flatus. An ultrasound abdomen and umbilical cord confirmed the presence of a persistent omphalomesenteric duct (POMD). He was then transferred to the paediatric surgical unit. There, he underwent a laparotomy and surgical resection of the POMD and was discharged home 2 days later.
Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study
Authors: Rikin Sharon , Bauman Laurie , Arnaoudova Ivelina , DiPalo Katherine , Suda Nisha , Gupta Sonali , Deng Yuting , Golestaneh Ladan
Published: May 2024

Introduction

We hypothesized that multidisciplinary, proactive electronic consultation (MPE) could overcome barriers to prescribing guideline-directed medical therapies (GDMTs) for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).

Research design and methods

We conducted an efficacy-implementation pilot study of MPE for T2D and CKD for primary care provider (PCP)–patient dyads at an academic health system. MPE included (1) a dashboard to identify patients without a prescription for sodium-glucose cotransporter-2 inhibitors (SGLT2i) and without a maximum dose prescription for renin–angiotensin–aldosterone system inhibitors (RAASi), (2) a multidisciplinary team of specialists to provide recommendations using e-consult templates, and (3) a workflow to deliver timely e-consult recommendations to PCPs. In-depth interviews were conducted with PCPs and specialists to assess feasibility, acceptability, and appropriateness of MPE and were analyzed using an iterative qualitative analysis approach to identify major themes. Prescription data were extracted from the electronic health record to assess preliminary effectiveness to increase GDMT.

Results

20 PCPs agreed to participate, 18 PCPs received MPEs for one of their patients with T2D and CKD, and 16 PCPs and 2 specialists were interviewed. Major themes were as follows: appropriateness of prioritization of GDMT for T2D and CKD, acceptability of the content of the recommendations, PCP characteristics impact experience with MPE, acceptability and appropriateness of multidisciplinary collaboration, feasibility of MPE to overcome patient-specific barriers to GDMT, and appropriateness of workflow. At 6 months postbaseline, 7/18 (39%) patients were newly prescribed an SGLT2i, and 7/18 (39%) patients were either newly prescribed or had increased dose of RAASi.

Conclusions

MPE was an acceptable and appropriate health system strategy to identify and address gaps in GDMT among patients with T2D and CKD. Adopting MPE could enhance GDMT, though PCPs raised feasibility concerns which could be improved with program enhancements, including follow-up e-consults for reinforcement, and administrative support for navigating system-level barriers.
Adaptation and validation of the EPIC-Norfolk food frequency questionnaire for assessing dietary intake in Ukrainian adults
Authors: Shatylo Sofiia , Solovyova Galyna
Published: May 2024

Introduction

Currently, there are no validated food frequency questionnaires (FFQs) for evaluating nutrient intake in Ukrainian adults. This study aimed to adapt and validate the European Prospective Investigation into Cancer Food Frequency Questionnaire (EPIC-Norfolk FFQ) for this population group.

Methods

Adults aged 18–54 years (n=90) living in different regions of Ukraine completed the new Ukrainian version of the EPIC-Norfolk FFQ and provided information about their 24-hour dietary recall. Raw and energy-adjusted data were analysed using Spearman’s correlation coefficients, Wilcoxon signed-ranks test, cross-classification method, weighted kappa and Bland-Altman analysis.

Results

Correlations ranged from 0.0738 (retinol equivalents) to 0.458 (total energy and phosphorus) and were statistically significant for all nutrients except cholesterol and vitamin A (as retinol and retinol equivalents). The percentage of participants classified into the same and adjacent quartiles ranged from 61.11% (vitamin A as retinol equivalents) to 81.11% (vitamin D). Gross misclassification into the opposite quartile ranged from 3.33% (magnesium) to 10% (cholesterol, vitamin A as retinol and retinol equivalents). Using the weighted kappa, most nutrients had a fair agreement (ĸ=0.21–0.40). Energy adjustment did not affect the results for most nutrients. Bland-Altman plots confirmed overestimation of the absolute intake of most nutrients and appeared to underestimate total sugars intake by FFQ; nevertheless, there was good agreement between the two methods.

Conclusion

The new Ukrainian version of the FFQ demonstrated reasonable relative validity for ranking an individual’s nutrient intake. The overestimation of the absolute intake of most nutrients is comparable to or even less than that in other FFQ validation studies. We cannot recommend the current Ukrainian version of the FFQ for the assessment of vitamin A (as retinol and retinol equivalents) consumption because of significant differences in results between the two methods.
Defining national research priorities for prostate cancer in Zambia: using the Delphi process for comprehensive cancer policy setting in sub-Saharan Africa
Authors: Lombe Dorothy Chilambe , Mwamba Monde , Simwinga Musonda , Bond Virginia , Ssemata Andrew Sentoogo , Muhumuza Richard , Seeley Janet , Lishimpi Kennedy , Mapulanga Victor , Kachimba John , Aggarwal Ajay , Msadabwe Susan
Published: May 2024

Objectives

Locally led research on cancer is needed in sub-Saharan Africa to set feasible research priorities that inform national policy. The aim of this project was to develop a research agenda for national cancer control planning, using a nationally driven approach, focused on barriers to diagnosis and high-quality treatment for prostate cancer in Zambia.

Methods and analysis

This was a Delphi process. 29 stakeholders were scored barriers on feasibility, the proportion of patients affected, the impact on patient outcomes and if there was a potential to address health systems barriers meaningfully. There were three rounds (R) to the process: (R1 and R2) by electronic survey and (R3) in-person meeting. In R1 statements scoring above 15 from over 70% of participants were prioritised immediately for R3 discussion. Those scoring below 30% were dropped and those in between were re-surveyed in R2.

Results

22 and 17 of the 29 stakeholders responded to R1 and R2. 14 stakeholders attended R3. National priority research areas for prostate cancer in Zambia were identified as prostate cancer awareness; building affordable high-quality diagnostic capacity; affordability of specialist cancer treatments; supporting better access to medicines; delivery and coordination of services across the pathway and staff training.

Conclusion

The suggested seven priority areas allow for the development of the prostate cancer control programme to be conducted in a holistic manner. The expectation is with this guidance international partners can contribute within the frameworks of the local agenda for sustainable development to be realised.
Association between indoor air pollution and depression: a systematic review and meta-analysis of cohort studies
Authors: Zhang Xiaona , Ding Linlin , Yang Fen , Qiao Guiyuan , Gao Xiaolian , Xiong Zhenfang , Zhu Xinhong
Published: May 2024

Objectives

Incomplete combustion of solid fuel and exposure to secondhand smoke (SHS) are the primary causes of indoor air pollution (IAP), potentially leading to detrimental effects on individual mental health. However, current evidence regarding the association between IAP and depression remains inconclusive. This study aims to systematically investigate the evidence regarding the association between IAP and the risk of depression.

Design

Systematic review and meta-analysis of cohort studies.

Data sources

Two independent reviewers searched PubMed, the Cochrane Library, Web of Science and EMBASE for available studies published up to 13 January 2024.

Eligibility criteria

We included all cohort studies published in English that aimed to explore the relationship between IAP from solid fuel use and SHS exposure and the risk of depression.

Data extraction and synthesis

Two independent reviewers extracted data and assessed the risk of bias. The association between IAP and depression was calculated using pooled relative risk (RR) with 95% CIs. Heterogeneity was assessed using the I2value, and the effect estimates were pooled using fixed-effects or random-effects models depending on the results of homogeneity analysis.

Results

We included 12 articles with data from 61 217 participants. The overall findings demonstrated a significant association between IAP exposure and depression (RR=1.22, 95% CI: 1.13 to 1.31), although with substantial heterogeneity (I2=75%). Subgroup analyses based on pollutant type revealed that IAP from solid fuel use was associated with a higher risk of depression (RR=1.20, 95% CI: 1.13 to 1.26; I2=62%; 5 studies, 36 768 participants) than that from SHS exposure (RR=1.11, 95% CI: 0.87 to 1.41; I2=80%; 7 studies, 24 449 participants). In terms of fuel use, the use of solid fuel for cooking (RR: 1.23, 95% CI: 1.16 to 1.31; I2=58%; 4 studies, 34 044 participants) and heating (RR 1.15, 95% CI: 1.04 to 1.27; I2=65%; 3 studies, 24 874 participants) was associated with increased depression risk.

Conclusions

The findings from this systematic review and meta-analysis of cohort studies indicated an association between exposure to IAP and depression.

PROSPERO registration number

CRD42022383285.
Impact of androgenic anabolic steroid use on cardiovascular and mental health in Danish recreational athletes: protocol for a nationwide cross-sectional cohort study as a part of the Fitness Doping in Denmark (FIDO-DK) study
Authors: Buhl Laust Frisenberg , Lehmann Christensen Louise , Diederichsen Axel , Lindholt Jes Sanddal , Kistorp Caroline Michaela , Glintborg Dorte , Andersen Marianne , Frystyk Jan
Published: May 2024

Introduction

The use of androgenic anabolic steroids (AASs) among recreational athletes is steadily increasing. However, knowledge regarding the potentially harmful effects of AAS primarily originates from case reports and small observational studies. This large-scale study aims to investigate the impact of AAS use on vascular plaque formation, preclinical coronary disease, cardiac function, circulating cardiovascular risk markers, quality of life (QoL) and mental health in a broad population of illicit AAS users.

Methods and analyses

A nationwide cross-sectional cohort study including a diverse population of men and women aged ≥18 years, with current or previous illicit AAS use for at least 3 months. Conducted at Odense University Hospital, Denmark, the study comprises two parts. In part A (the pilot study), 120 recreational athletes with an AAS history will be compared with a sex-matched and age-matched control population of 60 recreational athletes with no previous AAS use. Cardiovascular outcomes include examination of non-calcified coronary plaque volume and calcium score using coronary CT angiography, myocardial structure and function via echocardiography, and assessing carotid and femoral artery plaques using ultrasonography. Retinal microvascular status is evaluated through fundus photography. Cardiovascular risk markers are measured in blood. Mental health outcomes include health-related QoL, interpersonal difficulties, body image concerns, aggression dimensions, anxiety symptoms, depressive severity and cognitive function assessed through validated questionnaires. The findings of our comprehensive study will be used to compose a less intensive investigatory cohort study of cardiovascular and mental health (part B) involving a larger group of recreational athletes with a history of illicit AAS use.

Ethics and dissemination

The study received approval from the Regional Committee on Health Research Ethics for Southern Denmark (S-20210078) and the Danish Data Protection Agency (21/28259). All participants will provide signed informed consent. Research outcomes will be disseminated through peer-reviewed journals and scientific conferences.

Trial registration number

NCT05178537.
Person-centred care (PCC) research in Ghana: a scoping review protocol
Authors: Amoh Gordon Kwasi Ampomah , Addo Alex Kweku , Odiase Osamuedeme , Tahir Peggy , Getahun Monica , Aborigo Raymond A , Essuman Akye , Yawson Alfred Edwin , Essuman Vera Adobea , Afulani Patience A
Published: May 2024

Introduction

Person-centred care (PCC) is provision of care that is respectful of and responsive to individual patient preferences, needs and values, and ensures that patient values guide all clinical decisions. While there is a large body of evidence on the benefits of PCC in high-income countries, little research exists on PCC in Ghana and Sub-Saharan Africa at large. Most studies on PCC have focused on maternity care as part of the global movement of respectful maternity care. The few studies on patient experiences and health system responsiveness beyond maternal health also highlight gaps in patient experience and satisfaction as well as discrimination in health facilities, which leads to the most vulnerable having the poorest experiences. The protocol for this scoping review aims to systematically map the extent of literature focused on PCC in Ghana by identifying patient expectations and preferences, barriers and facilitators, and interventions.

Methods and analysis

The protocol will be guided by the Arksey and O’Malley methodological framework and recommendations by Levacet al. A comprehensive search strategy will be used to search for published articles in PubMed, EMBASE, Web of Science and the African Journals Online from their inception to August 2022. Grey literature and reference lists of included studies will also be searched. Two independent reviewers will perform the literature search, eligibility assessments and study selection. Any disagreements will be resolved through discussion with a third reviewer. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for the scoping reviews will be used to outline the study selection process. Extracted data from the included articles will be synthesised and reported under key concepts derived from the outcomes of the scoping review.

Ethics and dissemination

This scoping review does not require ethical approval. The findings will be disseminated through publications and conference presentations.

Scoping review registration

OSF Registration DOI 10.17605/OSF.IO/ZMDH9.
Identifying factors that can be used to assess a country’s readiness to deploy a new vaccine or improve uptake of an underutilised vaccine: a scoping review
Authors: Bhatt Aomesh , Monk Vaneesha , Bhatti Alexandra , Eiden Amanda L , Hermany Lindsay , Hansen Natasha , Connolly Mark P , Baxter Luke , Vanderslott Samantha , Mitrovich Rachel , Slater Rebeccah
Published: May 2024

Objectives

Identifying whether a country is ready to deploy a new vaccine or improve uptake of an existing vaccine requires knowledge of a diverse range of interdependent, context-specific factors. This scoping review aims to identify common themes that emerge across articles, which include tools or guidance that can be used to establish whether a country is ready to deploy a new vaccine or increase uptake of an underutilised vaccine.

Design

Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines.

Data sources

Embase, CINAHL, Cochrane Library, Google Scholar, MEDLINE, PsycINFO and Web of Science were searched for articles published until 9 September 2023. Relevant articles were also identified through expert opinion.

Eligibility criteria

Articles published in any year or language that included tools or guidance to identify factors that influence a country’s readiness to deploy a new or underutilised vaccine.

Data extraction and synthesis

Two independent reviewers screened records and performed data extraction. Findings were synthesised by conducting a thematic analysis.

Results

38 articles met our inclusion criteria; these documents were created using methodologies including expert review panels and Delphi surveys and varied in terms of content and context-of-use. 12 common themes were identified relevant to a country’s readiness to deploy a new or underutilised vaccine. These themes were as follows: (1) legal, political and professional consensus; (2) sociocultural factors and communication; (3) policy, guidelines and regulations; (4) financing; (5) vaccine characteristics and supply logistics; (6) programme planning; (7) programme monitoring and evaluation; (8) sustainable and integrated healthcare provision; (9) safety surveillance and reporting; (10) disease burden and characteristics; (11) vaccination equity and (12) human resources and training of professionals.

Conclusions

This information has the potential to form the basis of a globally applicable evidence-based vaccine readiness assessment tool that can inform policy and immunisation programme decision-makers.
Insomnia symptom prevalence in England: a comparison of cross-sectional self-reported data and primary care records in the UK Biobank
Authors: de Lange Melanie A , Richmond Rebecca C , Eastwood Sophie V , Davies Neil M
Published: May 2024

Objectives

We aimed to use a large dataset to compare self-reported and primary care measures of insomnia symptom prevalence in England and establish whether they identify participants with similar characteristics.

Design

Cross-sectional study with linked electronic health records (EHRs).

Setting

Primary care in England.

Participants

163 748 UK Biobank participants in England (aged 38–71 at baseline) with linked primary care EHRs.

Outcome measures

We compared the percentage of those self-reporting ‘usually’ having insomnia symptoms at UK Biobank baseline assessment (2006–2010) to those with a Read code for insomnia symptoms in their primary care records prior to baseline. We stratified prevalence in both groups by sociodemographic, lifestyle, sleep and health characteristics.

Results

We found that 29% of the sample self-reported having insomnia symptoms, while only 6% had a Read code for insomnia symptoms in their primary care records. Only 10% of self-reported cases had an insomnia symptom Read code, while 49% of primary care cases self-reported having insomnia symptoms. In both primary care and self-reported data, prevalence of insomnia symptom cases was highest in females, older participants and those with the lowest household incomes. However, while snorers and risk takers were more likely to be a primary care case, they were less likely to self-report insomnia symptoms than non-snorers and non-risk takers.

Conclusions

Only a small proportion of individuals experiencing insomnia symptoms have an insomnia symptom Read code in their primary care record. However, primary care data do provide a clinically meaningful measure of insomnia prevalence. In addition, the sociodemographic characteristics of people attending primary care with insomnia were consistent with those with self-reported insomnia, thus primary care records are a valuable data source for studying risk factors for insomnia. Further studies should replicate our findings in other populations and examine ways to increase discussions about sleep health in primary care.
Autologous concentrated bone marrow injection for precollapse osteonecrosis of the femoral head concurrent with contralateral total hip arthroplasty: protocol for a clinical trial
Authors: Homma Yasuhiro , Yamasaki Takuma , Tashiro Ken , Okada Yoshiki , Shirogane Yuichi , Watari Taiji , Hayashi Koju , Baba Tomonori , Nagata Kazufumi , Yanagisawa Naotake , Ohtsu Hiroshi , Fujiwara Naho , Ando Jun , Yamaji Ken , Tamura Naoto , Ishijima Muneaki
Published: May 2024

Introduction

The femoral head contralateral to the collapsed femoral head requiring total hip arthroplasty (THA) often manifests in the precollapse stage of osteonecrosis of the femoral head (ONFH). It is not yet demonstrated how autologous concentrated bone marrow injection may prevent collapse of the femoral head concurrent with contralateral THA. The primary objective is to evaluate the efficacy of autologous concentrated bone marrow injection for the contralateral, non-collapsed, femoral head in patients with bilateral ONFH, with the ipsilateral collapsed femoral head undergoing THA.

Methods and analysis

This is a multicentre, prospective, non-randomised, historical-data controlled study. We will recruit patients with ONFH who are scheduled for THA and possess a non-collapsed contralateral femoral head. Autologous bone marrow will be collected using a point-of-care device. After concentration, the bone marrow will be injected into the non-collapsed femoral head following the completion of THA in the contralateral hip. The primary outcome is the percentage of femoral head collapse evaluated by an independent data monitoring committee using plain X-rays in two directions 2 years after autologous concentrated bone marrow injection. Postinjection safety, adverse events, pain and hip function will also be assessed. The patients will be evaluated preoperatively, and at 6 months, 1 year and 2 years postoperatively.

Ethics and dissemination

This protocol has been approved by the Certified Committee for Regenerative Medicine of Tokyo Medical and Dental University and Japan’s Ministry of Healthy, Labour and Welfare and will be performed as a class III regenerative medicine protocol, in accordance with Japan’s Act on the Safety of Regenerative Medicine. The results of this study will be submitted to a peer-review journal for publication. The results of this study are expected to provide evidence to support the inclusion of autologous concentrated bone marrow injections in the non-collapsed femoral head in Japan’s national insurance coverage.

Trial registration number

jRCTc032200229.
Where does physical activity fit into preschool postpandemic? A qualitative exploration with parents, teachers and administrators
Authors: Zulauf-McCurdy Courtney , Tessema Betelehem , Tang Rachel , Almeida Saniya , Tandon Pooja S.
Published: May 2024

Objectives

During the preschool years, children depend on adult caregivers to provide opportunities for physical activity (PA). Research has focused on measuring PA in preschool, as well as barriers and facilitators to children’s PA but caregiver perceptions remain largely unknown especially in light of the COVID-19 pandemic. This study aims to understand the value of PA in preschool following the pandemic from three types of adult caregivers, parents of a young child (n=7), preschool teachers (n=7) and preschool administrators (n=7).

Methods

In-depth qualitative interviews were conducted to explore the following research questions: (a) how do caregivers describe the importance of PA in preschool postpandemic? (b) how do caregivers support and prioritise PA in preschool postpandemic and what challenges do they face in doing so? and (c) how do caregivers interact with one another to promote PA? Qualitative answers were coded using a codebook developed to answer the research questions of interest.

Results

Parents, teachers and administrators all described valuing PA for preschoolers, but each caregiver type described a different way of promoting it. All the caregivers listed barriers that inhibit their ability to prioritise and promote PA, some heightened postpandemic. Lastly, there were limited caregiver interactions when it came to promoting PA, with the burden largely falling on teachers.

Conclusion

Our findings indicate that one particularly important area for intervention is supporting parents, teachers and preschool administrators in creating a shared understanding of the importance of PA for young children and ways to collaborate to promote it.
Quality improvement initiative: improving obstetric triaging practices in a rural maternal hospital in central India
Authors: Ranade Mihir , Jain Shuchi , Shivkumar Poonam Varma , Gupta Subodh , Jain Manish
Published: May 2024

Triaging of obstetric patients by emergency care providers is paramount. It helps provide appropriate and timely management to prevent further injury and complications. Standardised trauma acuity scales have limited applicability in obstetric triage. Specific obstetric triage index tools improve maternal and neonatal outcomes but remain underused. The aim was to introduce a validity-tested obstetric triage tool to improve the percentage of correctly triaged patients (correctly colour-coded in accordance with triage index tool and attended to within the stipulated time interval mandated by the tool) from the baseline of 49% to more than 90% through a quality improvement (QI) process.

A team of nurses, obstetricians and postgraduates did a root cause analysis to identify the possible reasons for incorrect triaging of obstetric patients using process flow mapping and fish bone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles to address issues identified.

The interventions included introduction and application of an obstetric triage index tool, training of triage nurses and residents. We implemented these interventions in eight PDSA cycles and observed outcomes by using run charts. A set of process, output and outcome indicators were used to track if changes made were leading to improvement.

Proportion of correctly triaged women increased from the baseline of 49% to more than 95% over a period of 8 months from February to September 2020, and the results have been sustained in the last PDSA cycle, and the triage system is still sustained with similar results. The median triage waiting time reduced from the baseline of 40 min to less than 10 min. There was reduction in complications attributable to improper triaging such as preterm delivery, prolonged intensive care unit stay and overall morbidity. It can be thus concluded that a QI approach improved obstetric triaging in a rural maternity hospital in India.
Understanding patient safety in dentistry: evaluating the present and envisioning the future—a narrative review
Authors: Padmanabhan Vivek , Islam Md Sofiqul , Rahman Muhammed Mustahsen , Chaitanya Nallan CSK , Sivan Padma Priya
Published: May 2024

Background

Patient safety is crucial in dentistry, yet it has received delayed recognition compared with other healthcare fields. This literature review assesses the current state of patient safety in dentistry, investigates the reasons for the delay, and offers recommendations for enhancing patient safety in dental practices, dental schools, and hospitals.

Methods

The review incorporates a thorough analysis of existing literature on patient safety in dentistry. Various sources, including research articles, guidelines and reports, were reviewed to gather insights into patient safety definitions, challenges and best practices specific to dentistry.

Results

The review underscores the importance of prioritising patient safety in dentistry at all levels of healthcare. It identifies key definitions and factors contributing to the delayed focus on patient safety in the field. Additionally, it emphasises the significance of establishing a patient safety culture and discusses approaches such as safety plans, incident management systems, blame-free cultures and ethical frameworks to enhance patient safety.

Conclusion

Patient safety is vital in dentistry to ensure high-quality care and patient well-being. The review emphasises the importance of prioritising patient safety in dental practices, dental schools and hospitals. Through the implementation of recommended strategies and best practices, dental organisations can cultivate a patient safety culture, enhance communication, mitigate risks and continually improve patient safety outcomes. The dissemination of knowledge and the active involvement of all stakeholders are crucial for promoting patient safety and establishing a safe dental healthcare system.
Regional perspectives on patient safety policies and initiatives: a focus group study with patient safety leaders in the Middle East and Asian regions
Authors: O'Brien Niki , Soomro Marium , Shaw Alexandra , Latif Kanwal , Wu Yiwen , Ahmed Zakiuddin , Durkin Mike
Published: May 2024

Preventing and reducing risks and harm to patients is of critical importance as unsafe care is a leading cause of death and disability globally. However, the lack of consolidated information on patient safety policies and initiatives at regional levels represents an evidence gap with implications for policy and planning. The aim of the study was to answer the question of what patient safety policies and initiatives are currently in place in the Middle East and Asian regions and what were the main strengths, weaknesses, opportunities and threats in developing these. A qualitative approach using online focus groups was adopted. Participants attended focus groups beginning in August 2022. A topic guide was developed using a strengths, weaknesses, opportunities and threats framework analysis approach. The Consolidated Criteria for Reporting Qualitative Research checklist was used to ensure the recommended standards of qualitative data reporting were met. 21 participants from 11 countries participated in the study. Current patient safety policies identified were categorised across 5 thematic areas and initiatives were categorised across a further 10 thematic areas. Strengths of patient safety initiatives included enabling healthcare worker training, leadership commitment in hospitals, and stakeholder engagement and collaboration. Weaknesses included a disconnect between health delivery and education, implementation gaps, low clinical awareness and buy-in at the facility level, and lack of leadership engagement. Just culture, safety by design and education were considered opportunities, alongside data collection and reporting for research and shared learning. Future threats were low leadership commitment, changing leadership, poor integration across the system, a public–private quality gap and political instability in some contexts. Undertaking further research regionally will enable shared learning and the development of best practice examples. Future research should explore the development of policies and initiatives for patient safety at the provider, local and national levels that can inform action across the system.
Exploring the impact of compassion and leadership on patient safety and quality in healthcare systems: a narrative review
Authors: Ahmed Zakiuddin , Ellahham Samer , Soomro Marium , Shams Sohaima , Latif Kanwal
Published: May 2024

Background

Patient safetyandhealthcare qualityare considered integral parts of the healthcare system that are driven by a dynamic combination of human and non-human factors. This review article provides an insight into the two major human factors that impact patient safety and quality including compassion and leadership. It also discusses how compassion is different from empathy and explores the impact of both compassion and leadership on patient safety and healthcare quality. In addition, this review also provides strategies for the improvement of patient safety and healthcare quality through compassion and effective leadership.

Methods

This narrative review explores the existing literature on compassion and leadership and their combined impact on patient safety and healthcare quality. The literature for this purpose was gathered from published research articles, reports, recommendations and guidelines.

Results

The findings from the literature suggest that both compassion and transformational leadership can create a positive culture where healthcare professionals (HCPs) prioritise patient safety and quality. Leaders who exhibit compassion are more likely to inspire their teams to deliver patient-centred care and focus on error prevention.

Conclusion

Compassion can become an antidote for the burnout of HCPs. Compassion is a behaviour that is not only inherited but can also be learnt. Both compassionate care and transformational leadership improve organisational culture, patient experience, patient engagement, outcomes and overall healthcare excellence. We propose that transformational leadership that reinforces compassion remarkably improves patient safety, patient engagement and quality.
Comprehensive assessment of pediatric acute and inpatient care at a tertiary referral hospital in Malawi: opportunities for quality improvement
Authors: Fitzgerald Elizabeth , Ciccone Emily Jane , Mvalo Tisungane , Chiume Msandeni , Mgusha Yamikani , Mkaliainga Treasure B , Tilly Alyssa Evelyn , Chen Jane , Bell Griffin , Crouse Heather , Robison Jeff A , Eckerle Michelle
Published: May 2024

Background

Despite the reduction in global under-5 mortality over the last decade, childhood deaths remain high. To combat this, there has been a shift in focus from disease-specific interventions to use of healthcare data for resource allocation, evaluation of performance and impact, and accountability. This is a descriptive analysis of data derived from a prospective cohort study describing paediatric admissions to a tertiary referral hospital in Malawi for the purpose of process evaluation and quality improvement.

Methods

Using a REDCap database, we collected data for patients admitted acutely to Kamuzu Central Hospital, a tertiary referral centre in the central region. Data were collected from 17 123 paediatric inpatients from 2017 to 2020.

Results

Approximately 6% of patients presented with either two or more danger signs or severely abnormal vital signs. Infants less than 6 months, who had the highest mortality rate, were also the most critically ill on arrival to the hospital. Sepsis was diagnosed in about 20% of children across all age groups. Protocols for the management of high-volume, lower-acuity conditions such as uncomplicated malaria and pneumonia were generally well adhered to, but there was a low rate of completion for labs, radiology studies and subspecialty consultations required to provide care for high acuity or complex conditions. The overall mortality rate was 4%, and 60% of deaths occurred within the first 48 hours of admission.

Conclusion

Our data highlight the need to improve the quality of care provided at this tertiary-level centre by focusing on the initial stabilisation of high-acuity patients and augmenting resources to provide comprehensive care. This may include capacity building through the training of specialists, implementation of clinical processes, provision of specialised equipment and increasing access to and reliability of ancillary services. Data collection, analysis and routine use in policy and decision-making must be a pillar on which improvement is built.
Comparing the healthy development of youth Australian Rules Footballers across talent development and community settings
Authors: Graeme Liam G , Hall Kate , Olive Lisa S , Greenwood Christopher J , Couston Nicky , Mattingley Sophie , Francis Lauren M , Hoare Erin , Rice Simon , Bos Jason , Harris Emma , Youssef George J
Published: May 2024

Objectives

This study aimed to compare talent development athletes to community-level athletes in Australian Rules Football across various markers of healthy youth development.

Methods

Survey data were collected from 363 youth athletes (126 women, 232 men, 5 not reported; Mage=18.69 years, SDage=2.62 years, age range 16–25 years) playing Australian Rules Football at a talent development (recruited from Australian Football League Talent Pathway, n=220) or community (n=143) level. Measures included markers of physical health (eg, general health, risk-taking behaviours), psychological and emotional well-being (eg, mental health symptoms, life satisfaction), family and social relationships (eg, social support, relationship status), educational and occupational attainment/engagement (eg, career satisfaction, education), ethical behaviour (eg, moral self-image), civic engagement, life skills (eg, self-mastery, coping), and demographics.

Results

Based on regression models, relative to community-level athletes, talent development athletes reported better physical health (d=0.51), lower injury rates (OR=0.50) and less problematic drug use (d=−0.46). Talent development athletes also reported better psychological and emotional well-being, evidenced by lower stress (d=−0.30), higher life satisfaction (d=0.47) and less problematic gambling (d=−0.34). Additionally, talent development athletes reported higher family support (d=0.49), lower likelihood of poor educational outcomes (less than expected educational stage; OR=0.37), lower intention to complete less than year 12 education (OR=0.18), higher career satisfaction (d=0.42), higher self-mastery (d=0.37) and higher perfectionistic striving (d=0.59).

Conclusion

Findings demonstrate markers of healthier development within talent development athletes relative to community athlete peers. Investment in community-level sports may be warranted to improve healthy development. However, further causal evidence is required.
Maximising neuromuscular performance in people with pain and injury: moving beyond reps and sets to understand the challenges and embrace the complexity
Authors: Murphy Myles Calder , Rio Ebonie Kendra , Whife Casey , Latella Christopher
Published: May 2024

Rehabilitative practice is often criticised for being non-individualised, monotonous and not well aligned with foundational principles that drive continued physiological adaptation(s). However, our understanding of neuromuscular physiology is rapidly increasing and the way we programme rehabilitation is improving. This viewpoint highlights some of the potential considerations around why the adaptations achieved during rehabilitation programmes may be suboptimal. We provide basic, clinician-focused discussion about potential confounding physiological factors, and put forward several exercise-based programming recommendations and novel approaches to consider in contemporary rehabilitative practice. Specifically, we outline several potential mechanisms contributing to poor muscle activation and function that might be present following musculoskeletal injury. However, clinicians require strategies capable of attenuating these impairments to restore proper function. Therefore, we also provide an overview of recommended strength and conditioning guidelines, and novel strategies (such as external pacing and electrical stimulation techniques) that clinicians can consider to potentially improve the efficacy of musculoskeletal rehabilitation.