bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute myeloid leukaemia in patients we judge as being older and/or unfit
Authors: Lazarevic V. Lj.
Published: March 2021

The definition of older age in AML is arbitrary. In the context of the clinical studies, it starts with age ≥60 or ≥65 years and in recent years ≥70 or 75, depending on the selection of the studied population. In clinical practice, with older age, we often mean that the patient is unfit for intensive chemotherapy. Higher age overlaps with categories such as worse performance status, unfitness, comorbidities, poor‐risk cytogenetics, adverse mutation patterns, age‐related clonal haematopoiesis and specific disease ontogeny. Intensive induction therapy can result in prolonged overall survival, at least in a subset of elderly patients aged up to 75 years despite the reluctance of some physicians and patients to use treatment regimens perceived as toxic. Venetoclax and azacitidine combination is the new standard of comparison for persons unfit for intensive therapy. New oral hypomethylating agent CC‐486 as maintenance therapy led to a prolonged overall survival in a randomized trial of patients ≥55 years of age who were in first complete remission, but not eligible for allogeneic stem cell transplantation. Any therapy is better than no therapy, but a substantial proportion of older patients still receive only palliative care. Making a decision for AML diagnosed in older age should be individualized and shared through the dialog with the patient and relatives or cohabitants, considering medical issues and social factors including personal goals. Although we are witnesses of the advances in basic research and therapy, we are still a very long way from curing older patients with AML.
Reliability and validity of the Korean 12‐item Perception of Aggression Scale
Authors: Nam Sujin , Hong Soyun , Kim Heejung , Wong Janet Yuen Ha , Fong Daniel Yee Tak
Published: March 2021

Accessible Summary

What is known on the subject?

The importance of and interest in nurses’ attitudes towards and subjective experience with workplace violence in clinical settings is increasing.

The prevalence of patient‐perpetrated violence against Korean nurses in hospital settings is highly prevalent.

Only few instruments are available to measure the nurses’ perception of patient aggression in Korea.

What the paper adds to existing knowledge?

This is the first study to assess the linguistic and psychometric reliability and validity of an instrument that evaluates the attitude of Korean nursing staff towards patient‐perpetrated workplace violence.

What are the implications for practice?

This valid and reliable instrument could be used to assess and monitor the nurses’ attitudes towards aggressive tendencies in the workplace.

The results could contribute to the development of relevant interventions for coping with violence by patients towards nursing staff and the implementation of practical training to cultivate healthy perceptions towards patients to foster therapeutic nurse–patient relationships.

Introduction

Despite the high prevalence of patient‐perpetrated violence against Korean nurses globally, reliable and valid measures of patient aggression are lacking in Korean.

Aim

We translated the 12‐item Perception of Aggression Scale (POAS) into Korean and psychometrically assessed its utility in measuring nurses’ attitudes towards aggression.

Methods

The 12‐item Korean POAS was obtained through forward–backward translation and cognitive debriefing. It was administered online to 319 nurses (mean age = 32.64 years; females = 96.2%), of which 206 completed it again after two weeks. Confirmatory factor analysis validated the 3‐factor structure as hypothesized in the original version. The intra‐class correlation coefficient was used to assess the test–retest reliability.

Results

The originally hypothesized 3‐factor structure showed a good fit. The 3 dimensions: aggression as a dysfunctional or undesirable phenomenon, aggression as a functional or comprehensible phenomenon, and aggression as a protective measure had internal consistencies of 0.74, 0.86 and 0.90 and corresponding ICCs of 0.70, 0.86 and 0.90, respectively.

Discussion

The 12‐item Korean POAS is a valid and reliable scale that might aid investigating nurses’ attitudes towards patient aggression.

Implications for practice

The 12‐item Korean POAS can help Korean nurses adopt protective behaviours and develop interventions to cope with aggression.
Shifting Religious Influences on Attitudes Towards Same‐Sex Behavior and Civil Liberties: A Multilevel Across‐Time Analysis
Authors: Moore Laura M. , Adamczyk Amy , Ryan J. Michael , Ovadia Seth
Published: March 2021

Americans' acceptance of same‐sex sexual relations and their willingness to restrict the civil liberties of sexual minorities vary substantially across both time and place even as overall trends have been towards more liberalizing stances. Yet few quantitative studies have explored both the individual and contextual religious factors shaping Americans' views and none have applied such an analysis to examining attitudes over time. Using hierarchical ordered logistic modeling and time‐year interactions with 1973–2016 General Social Survey data, we examine whether the religious characteristics of residents and the contexts in which they reside moderated Americans' liberalizing attitudes over time. We find that more religiously engaged people, those who belonged to evangelical and Black protestant faiths, as well as those living in areas with higher overall levels of religious attendance changed their moral perspective about same‐sex relations at a lesser rate over time. However, we do not find similar moderating influences of religious factors for explaining Americans' willingness to restrict the civil liberties of individuals identifying as homosexual. We frame these findings relative to the morality and equality discourses permeating the culture and the concerted efforts of the Christian Right to influence public opinion and policy since the 1970s.
Going against the grain: An exploration of agency in medical learning
Authors: Watling Christopher , Ginsburg Shiphra , LaDonna Kori , Lingard Lorelei , Field Emily
Published: March 2021

Background

Learner‐centred medical education relies on learner agency. While attractive in principle, the actual exercise of agency is a complicated process, potentially constrained by social norms and cultural expectations. In this study, we explored what it means to be an agentic learner in medicine, and how individuals experience and harness agency in their learning.

Methods

Using a constructivist grounded theory approach, we interviewed 19 physicians or physicians‐in‐training who identified as ‘learning mavericks’; this strategy facilitated recruiting participants with a strong sense of themselves as agentic learners. We asked them about atypical learning choices they had made, about support and resistance they encountered and about how they managed to carve a distinct path for themselves. Data collection and analysis were concurrent and iterative, grounded in the constant comparative approach.

Results

We identified one overarching concept: agency is work. The work of exercising agency was compounded by a system of professional training that was perceived to promote conformity and to resist individual learner agency. Individuals’ capacity to exercise agency appeared to be bolstered by social capital, self‐knowledge and mentorship.

Discussion and Conclusions

Our work extends and elaborates the understanding of learner agency in medicine, highlighting the exercise of agency as a sometimes counter‐cultural act that requires learners to resist considerable pressure to conform to social and professional expectations. Agency may come more easily to strong learners who have established their ability to succeed within the system's expectations. Enhancing learner agency thus requires careful attention to learner support. Mentorship that both helps learners to identify appropriate learning paths and shields them from the pull of social expectations may be especially fruitful.
Efficiency of theCO2‐baited omni‐directionalFay‐Princetrap under semi‐field conditions and characterizing response behaviours for the yellow fever mosquito,Aedes aegypti
Authors: Amos Brogan A. , Cardé Ring T.
Published: March 2021

Aedes aegypti(L.) (Diptera: Culicidae) is a vector of several serious disease‐causing viruses including Dengue, Zika, chikungunya and yellow fever. Effective and efficient trapping methods are essential for meaningful mosquito population and disease‐presence surveillance and ultimately, vector control. The Fay‐Prince trap (FPT) was developed in the late 1960s as a daytime visual trap for maleAe. aegypti. Since then, its use has been expanded into the trapping of femaleAe. aegypti,Aedes albopictusSkuse, otherAe.spp., andCulexspp. The efficiency of the FPT alone and with CO2was tested under semi‐field conditions and the behaviour of responding femaleAe. aegyptiwas characterized. The mean capture efficiency of the FPT with CO2per 30 min in the greenhouse was 3.07% and the capture rate from the total number of mosquitoes in our semi‐field setup was slightly higher at 4.45%. Understanding the behaviours that mosquitoes exhibit during their encounter with particularly a visual trap may recommend trap improvements and contributes to our understanding of host‐seeking behaviour and how it might be exploited.
Validating a model for medication‐related dental outcomes in older people
Authors: Tan Edwin C. K. , Lexomboon Duangjai , Häbel Henrike , Fastbom Johan , Eriksdotter Maria , Johnell Kristina , Sandborgh‐Englund Gunilla
Published: March 2021

Objectives

To externally validate a model for medication‐related dental outcomes in (a) a general older population with dementia and (b) a matched population without dementia.

Subjects and Methods

This validation study used population‐based data from seven Swedish national registers (2008–2017). Individuals aged 60+ with dementia were matched to those without dementia on age, gender, and county of residence at the date of diagnosis (index date). The exposure was continuous use of xerogenic medications during the 3‐year period before index date. The primary outcome was the number of tooth extraction and restorative procedures within 3 years after index date.

Results

A total of 334,220 individuals were included in the final sample. In the dementia cohort, the use of urological drugs (incidence rate ratio [IRR] 1.08, 95% CI 1.03–1.13), respiratory medicines (IRR 1.10, 95% CI 1.04–1.17), and proton‐pump inhibitors (IRR 1.09, 95% CI 1.05–1.13) was associated with the primary outcome. In the non‐dementia cohort, respiratory medicines (IRR 1.03, CI 1.00–1.05), proton‐pump inhibitors (IRR 1.06, CI 1.04–1.08), opioids (IRR 1.05, CI 1.03–1.07), and antidepressants (IRR 1.06, CI 1.04–1.08) were associated with the primary outcome.

Conclusions

Although there were differences in prescription patterns, the model performed similarly in both those with and without dementia.
Allogeneic hematopoietic stem cell transplantation in patients with childhood cerebral adrenoleukodystrophy: A single‐center experience “Better prognosis in earlier stage”
Authors: Yalcin Koray , Çelen Suna S. , Daloglu Hayriye , Demir Mustafa Kemal , Öztürkmen Seda , Pasayev Dayanat , Zhumatayev Suleimen , Uygun Vedat , Hazar Volkan , Karasu Gulsun , Yesilipek Akif
Published: March 2021

Background

ALD is a rare X‐linked peroxisomal metabolic disorder with many distinct phenotypes of disease that emerge on a wide scale from adrenal insufficiency to fatal cALD which progresses to a vegetative state within a few years. Currently, HSCT is the only treatment method known to stabilize disease progression in patients with cALD. In this study, we aim to report our HSCT experience in patients with cALD and the factors that determine the success of HSCT, as a single‐center experience.

Methods

The study cohort involves 23 boys with cALD and three patients with ALD trait and new‐onset abnormal behavior who underwent allogeneic HSCT between January 2012 and September 2019 in our transplantation center. Loes scoring, NFS, scale and MFD were performed for evaluating the severity of the cerebral disease. The study cohort was divided into two groups according to baseline NFS and Loes score: early‐stage (NFS ≤ 1 and Loes score <9) and advanced stage (NFS > 1 or Loes score ≥9).

Results

The pretransplant stage of disease impacted both OS and MFD‐free survival. The estimated OS and MFD‐free survival at 3 years in patients with advanced disease were 46.1% (95% CI 19.0–73.2) and 23.1% (95% CI 0.2–46.0), respectively, and all patients with the early disease were alive (p: .004) and MFD‐free (p < .001) at 3 years.

Conclusion

This study demonstrated that early HSCT is vital in patients with cALD. The early‐stage disease had a significant survival advantage and free from disease progression after HSCT.
Surgical Scheduling with Constrained Patient Waiting Times
Authors: Zhou Yun , Parlar Mahmut , Verter Vedat , Fraser Shannon
Published: March 2021

We consider a surgical case scheduling problem with the objective of minimizing the expected time span of the schedule subject to a prespecified upper bound on the expected waiting time for each patient. The problem is challenging due to its combinatorial and nonlinear nature, and we focus on developing approximate methods to solve the problem. Specifically, we study two approximation methods. In the certainty equivalent method, we approximate the expected time span of the cases by assuming that the waiting time of each surgical case is a deterministic value. In the variance bounding method, we approximate the expected time span based on upper bounds on the variance of the surgical case waiting times. We show that the certainty equivalent method leads to a lower bound on the optimal expected time span, while the variance bounding method leads to an upper bound. Both methods suggest a simple sequencing rule, which is to sort the surgical cases in the ascending order of the surgical duration variability. Based on the upper and lower bounds, we derive a closed‐form, distribution‐free relative error bound for our sequencing rule, and show that it is uniformly bounded with respect to the number of cases. We also conduct a case study based on real‐life data on hernia repair procedures at the Jewish General Hospital in Montréal, to demonstrate our analytical models and their potential benefits for improving surgical scheduling. Finally, we conclude the paper by mentioning a few future research directions.
Eye movements are not mandatorily preceded by the N2pc component
Authors: Talcott Travis N. , Gaspelin Nicholas
Published: March 2021

Researchers typically distinguish between two mechanisms of attentional selection in vision: overt and covert attention. A commonplace assumption is that overt eye movements are automatically preceded by shifts of covert attention during visual search. Although the N2pc component is a putative index of covert attentional orienting, little is currently known about its relationship with overt eye movements. This is because most previous studies of the N2pc component prohibit overt eye movements. The current study assessed this relationship by concurrently measuring covert attention (via the N2pc) and overt eye movements (via eye tracking). Participants searched displays for a lateralized target stimulus and were allowed to generate overt eye movements during the search. We then assessed whether overt eye movements were preceded by the N2pc component. The results indicated that saccades were preceded by an N2pc component, but only when participants were required to carefully inspect the target stimulus before initiating the eye movement. When participants were allowed to make naturalistic eye movements in service of visual search, there was no evidence of an N2pc component before eye movements. These findings suggest that the N2pc component does not always precede overt eye movements during visual search. Implications for understanding the relationship between covert and overt attention are discussed.
Caring for patients with end‐stage renal disease during COVID‐19 lockdown: What (additional) challenges to family caregivers?
Authors: Sousa Helena , Frontini Roberta , Ribeiro Oscar , Paúl Constança , Costa Elísio , Amado Leonilde , Miranda Vasco , Ribeiro Fernando , Figueiredo Daniela
Published: March 2021

Introduction

Caring for a patient with end‐stage renal disease undergoing in‐centre haemodialysis can be a stressful experience, likely to involve significant burden. Within the context of the new coronavirus pandemic, these patients are highly vulnerable to infection by COVID‐19, which might increase the care demands and burden of family caregivers.

Aim

This study aimed to explore the subjective experiences of family caregivers of non‐COVID‐19 patients with end‐stage renal disease undergoing in‐centre haemodialysis during the COVID‐19 lockdown.

Study design

A qualitative study was performed with a purposive sample.

Methods

Semi‐structured telephone interviews were conducted with 19 family caregivers (50.7 ± 14 years old) of patients undergoing in‐centre haemodialysis in April 2020.

Findings

Four major themes were identified: (1) emotional distress; (2) changes in caregiving responsibilities; (3) educational and supportive needs; and (4) coping strategies to deal with the outbreak and with the lockdown.

Discussion

The findings suggest that family caregivers of patients undergoing in‐centre haemodialysis have to manage several additional care responsibilities due to COVID‐19 lockdown. The dialysis team should consider the development of educational and supportive interventions to meet family caregivers’ needs, mitigate emotional distress, fears and concerns, and prevent caregiver burden during the COVID‐19 pandemic.
Emulation‐based inference for spatial infectious disease transmission models incorporating event time uncertainty
Authors: Pokharel Gyanendra , Deardon Rob
Published: March 2021

Mechanistic models of infectious disease spread are key to inferring spatiotemporal infectious disease transmission dynamics. Ideally, covariate data and the infection status of individuals over time would be used to parameterize such models. However, in reality, complete data are rarely available; for example, infection times are almost never observed. Bayesian data‐augmented Markov chain Monte Carlo (MCMC) methods are commonly used to allow us to infer such missing or censored data. However, for large disease systems, these methods can be highly computationally expensive. In this paper, we propose two methods of approximate inference for such situations based on so‐called emulation techniques. Here, both methods are set in a Bayesian MCMC framework but replace the computationally expensive likelihood function by a Gaussian process‐based likelihood approximation. In the first method, we build an emulator of the discrepancy between summary statistics of simulated and observed epidemic data. In the second method, we develop an emulator of an importance sampling‐based likelihood approximation. We show how both methods offer substantial computational efficiency gains over standard Bayesian MCMC‐based method, and can be used to infer the transmission of complex infectious disease systems. We also show that importance sampling‐based methods tend to perform more satisfactorily.
Central‐local tensions in the decentralization of social policies: Street‐level bureaucrats and social practices in the Netherlands
Authors: Jansen Erik , Javornik Jana , Brummel Annica , Yerkes Mara A.
Published: March 2021

European welfare reforms often involve the decentralization of social care services. This potentially creates central‐local tensions for professionals implementing and delivering policies on the ground. Using the capability approach (CA) as a conceptual frame, this article compares local professionals' experiences in the decentralization of social work and care services in an urban and a rural mid‐sized municipality in the Netherlands. It offers a missing insiders' perspective on central‐local tensions, focusing on front‐line workers' capabilities to effectively implement policy on the ground. It finds that perfect policy implementation is hardly achievable locally and that policies are translated through implementation and on‐the‐ground delivery. This leads to central‐local tensions and the absence of reflective space for professionals to deal with normative dilemmas. We conclude that the CA is both useful for identifying these tensions as well as providing a normative framework to guide professionals in reflecting on and negotiating street‐level issues.
Conservation of Rh negative Low Titer O Whole Blood (LTOWB) and the need for a national conversation to define its use in trauma transfusion protocols
Authors: Troughton Marla , Young Pampee P.
Published: March 2021

Low‐titer group O whole blood (LTOWB) use is growing steadily in the United States. Although the percentage of O negative LTOWB use by Red Cross hospitals has remained steady at ~23% over the last 2 years, this elevated use rate is twice that of O negative RBC components. Given the more restricted group O donor pool, this level of use will make it difficult to expand the use of this product. Evaluation of hospital practices regarding females of childbearing potential show significant variability with some hospitals transfusing O positive, with others choosing to restrict this population to O negative LTOWB or only O negative RBC component therapy. To ensure access of LTOWB to all patients who may benefit and to maintain sufficient supplies, we recommend developing standardized practice recommendations for its use.
Bayesian spatial modelling of Ebola outbreaks in Democratic Republic of Congo through the INLA‐SPDE approach
Authors: Adegboye Oyelola , Gayawan Ezra , James Adewale , Adegboye Adedayo , Elfaki Faiz
Published: March 2021

Ebola virus (EBV) disease is a globally acknowledged public health emergency, endemic in the west and equatorial Africa. To understand the epidemiology especially the dynamic pattern of EBV disease, we analyse the EBV case notification data for confirmed cases and reported deaths of the ongoing outbreak in the Democratic Republic of Congo (DRC) between 2018 and 2019, and examined the impact of reported violence on the spread of the virus. Using fully Bayesian geo‐statistical analysis through stochastic partial differential equations (SPDE) allows us to quantify the spatial patterns at every point of the spatial domain. Parameter estimation was based on the integrated nested Laplace approximation (INLA). Our findings revealed a positive association between violent events in the affected areas and the reported EBV cases (posterior mean = 0.024, 95% CI: 0.005, 0.045) and deaths (posterior mean = 0.022, 95% CI: 0.005, 0.041). Translating to an increase of 2.4% and 2.2% in the relative risks of EBV cases and deaths associated with a unit increase in violent events (one additional Ebola case is associated with an average of 45 violent events). We also observed clusters of EBV cases and deaths spread to neighbouring locations in similar manners. Findings from the study are therefore useful for hot spot identification, location‐specific disease surveillance and intervention.
A Multimodal and Pragmatic Analysis of the Environmental-Friendly Corporate Identity of Apple
Authors: Xiong Zhe
Published: March 2021

As environmental problems become increasingly serious, people are more aware of the importance of the environmental protection. Accordingly, companies have realized the necessity and significance of constructing an environmental-friendly identity. Environmental-friendly corporate identity is currently receiving an increasing amount of attention in the literature on corporate identity construction. The present study has continued that focus by investigating the environmental-friendly corporate identity of Apple. The new product conference, which is held online by Apple in October, 2020 is chosen as the research material. The present study is different from previous research on new product conferences or corporate identities, for it offers a multimodal analysis of the data within the framework of the Relevance Theory. The purpose of the study is to explore how Apple constructed its environmental-friendly corporate identity while rationalizing its announcement in the new product conference. Findings from the study indicate that the environmental-friendly corporate identity of Apple is constructed in the new product conference through the interplay of main modes, such as language, visual images, gaze and gestures. The findings of the study not only contribute to prove the feasibility of multimodal analysis of the new product conference under the Relevance Theory, but also shed light on the studies of environmental-friendly corporate identity construction.
Postoperative lumbar paraspinal compartment syndrome
Authors: Saadat Niloufar , Rezania Kourosh
Published: March 2021

Lower lumbar paraspinal muscles constitute a compartment as they are surrounded by distinct fascial and bony boundaries. Lumbar paraspinal compartment syndrome is a rare entity, often caused by intense exercise, but also can be a postoperative complication. We present a 60-year-old man with low back pain, numbness in the left lower back and radicular pain in the left lower extremity, which started after a surgery that involved prolonged positioning on the left side 7 years before, and persisted to the day of evaluation. There was an immediate transient rise in the creatine kinase after surgery. Electromyography showed a left lower lumbar–sacral plexopathy and a lumbar spine MRI revealed fatty infiltration of the lower lumbar–sacral paraspinal muscles. The emergence of radicular lower limb pain was likely due to the compression of the proximal portion of lumbar–sacral plexus during the acute stage of rhabdomyolysis.
Bilobed tongue base associated with multiple branchial anomalies
Authors: Konstantinidou Sevasti , Wyatt Michelle , Butler Colin , Frauenfelder Claire
Published: March 2021

A bilobed tongue base was identified in an infant with multiple other head, neck and cardiac congenital anomalies. This anatomical variation of the posterior tongue is rare, with only two other cases identified in the literature. We report a case of a 5-month-old boy with a bilobed posterior tongue incidentally identified during workup for cardiac surgery.
Cumulative risk of compromised physical, mental and social health in adulthood due to family conflict and financial strain during childhood: a retrospective analysis based on survey data representative of 19 European countries
Authors: Santini Ziggi Ivan , Koyanagi Ai , Stewart-Brown Sarah , Perry Bruce D , Marmot Michael , Koushede Vibeke
Published: March 2021

Background

Childhood adversity (CA) has previously been linked to various health problems in adulthood. Investigations into the differential impact of distinct types of CA on a wide range of outcomes are scarce. This study aimed to assess the impact of self-reported childhood family conflict and/or financial strain on health and social functioning in adulthood among Europeans, while taking into account the mediating role of adulthood socioeconomic disadvantage (SED) in these associations.

Methods

Using the European Social Survey (ESS) collected in 2014, nationally representative cross-sectional data from 35 475 participants aged 15 years and older in 19 European countries were analysed. Logistic regressions were conducted to assess associations of retrospectively reported family conflict and/or financial strain in childhood with physical and mental health as well as health behaviours and social functioning in adulthood.

Results

A quarter of the European population reported having experienced family conflict, financial strain or both in childhood. Financial strain was reported more among older age groups and conflict more among younger age groups. A dose-response pattern with increased risk was demonstrated for almost all physical, behavioral, mental and social outcomes for these aspects of CA compared with no CA, with the highest risk observed in those who experienced both financial strain and family conflict. Adulthood SED mediated a significant proportion of the associations with financial strain (ranging from 5.4% to 72.4%), but did not mediate the associations with conflict.

Conclusion

Individuals reporting family conflict or financial strain during childhood are at increased risk of developing a wide range of health and social problems. Those who report financial strain in childhood are more likely to experience SED in adulthood, which in turn increases their risk of experiencing health and social problems. Reported family conflict during childhood conferred increased risk of health and social problems, but adulthood SED did not appear to operate as an indirect pathway.
Cost-effectiveness analysis of an intimate partner violence prevention intervention targeting men, women and couples in rural Ethiopia: evidence from the Unite for a Better Life randomised controlled trial
Authors: Leight Jessica , Deyessa Negussie , Sharma Vandana
Published: March 2021

Objectives

Experience of intimate partner violence (IPV) is associated with adverse health and psychosocial outcomes for women. However, rigorous economic evaluations of interventions targeting IPV prevention are rare. This paper analyses the cost-effectiveness of Unite for a Better Life (UBL), a gender-transformative intervention designed to prevent IPV and HIV risk behaviours among men, women and couples.

Design

We use an economic evaluation nested within a large-scale cluster randomised controlled trial, analysing financial and economic costs tracked contemporaneously.

Setting

UBL was implemented in rural southern Ethiopia between 2013 and 2015.

Participants

The randomised controlled trial included 6770 households in 64 villages.

Interventions

UBL is an intervention delivered within the context of the Ethiopian coffee ceremony, a culturally established forum for community discussion, and designed to assist participants to build skills for healthy, non-violent, equitable relationships.

Primary and secondary outcome measures

This paper reports on the unit cost and cost-effectiveness of the interventions implemented. Cost-effectiveness is measured as the cost per case of past-year physical and/or sexual IPV averted.

Results

The estimated annualised cost of developing and implementing UBL was 2015 US$296 772, or approximately 2015 US$74 per individual directly participating in the intervention and 2015 US$5 per person annually for each community-level beneficiary (woman of reproductive age in intervention communities). The estimated cost per case of past-year physical and/or sexual IPV averted was 2015 US$2726 for the sample of direct beneficiaries, and 2015 US$194 for the sample of all community-level beneficiaries.

Conclusions

UBL is an effective and cost-effective intervention for the prevention of IPV in a low and middle-income country setting. Further research should explore strategies to quantify the positive effects of the intervention across other domains.

Trial registration number

NCT02311699 (ClinicalTrials.gov); AEARCTR-0000211 (AEA Registry)
Comparative efficacy and acceptability of different antihypertensive drug classes for cardiovascular disease prevention: protocol for a systematic review and network meta-analysis
Authors: Jussil Heidi , Chaimani Anna , Carlberg Bo , Brunström Mattias
Published: March 2021

Introduction

Clinical practice guidelines differ in their recommendations on first-line antihypertensive drug classes. No adequately powered randomised controlled trial have assessed all major drug classes against each other, and previous meta-analyses have mainly relied on pairwise meta-analyses for treatment comparisons.

Methods and analysis

A systematic review and network meta-analysis will be carried out to assess the efficacy and acceptability of all major antihypertensive drug classes. PubMed and CENTRAL were searched on 21 February 2020 to identify randomised controlled trials with at least 1000 person-years of follow-up, assessing any antihypertensive agent against other agents or placebo. All trials fulfilling the inclusion criteria will be assessed for risk of bias using the second version of Cochrane’s risk of bias assessment tool. The study selection process, risk of bias assessment and data extraction are done by two authors in duplicate. Relative risks from individual trials will be combined in pairwise meta-analyses; in the absence of important intransitivity, random-effects network meta-analysis will be performed. The primary outcome for efficacy will be major adverse cardiovascular events, whereas the primary acceptability outcome will be treatment discontinuation for any reason. Additional outcomes include all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, heart failure and acute renal failure. The impact of differences within drug classes will be explored through alternative networks, including analysing thiazide-like and thiazide-type diuretics separately.

Ethics and dissemination

This review will only process aggregated study level data and does not require ethical approval. The findings will be published in a peer-reviewed medical journal.

PROSPERO registration number

CRD42020205482.
Evaluation of a ‘drop box’ doorstep assessment service to aid remote assessments for COVID-19 in general practice
Authors: Irving Greg , Lawson David , Tinsley Adele , Parr Helen , Whittaker Cheryl , Jones Hayley , Cox Stephen
Published: March 2021

COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed without obtaining objective recording of vital signs and face-to-face examination. Some regions have formed hot hubs to facilitate the review of suspected COVID-19 cases and keep their practice site ‘clean’ including the use of doorstep observations in avoiding the risk of face-to-face examination. To support the safe, effective and efficient remote assessment of suspected and confirmed patients with COVID-19, we established a doorstep assessment service to compliment telephone and video consultations. This allows physiological parameters such as temperature, pulse, blood pressure and oxygen saturation to be obtained to guide further triage. Quality improvement methods were used to integrate and optimise the doorstep assessment and measure the improvements made. The introduction of a doorstep assessment service increased the proportion of assessments for patients with suspected COVID-19 in routine care over weeks. At the same time we were able to dramatically reduce face-to-face assessment over a 6-week period by optimising through a range of measures including the introduction of a digital stethoscope. The majority of patients were managed by their own general practitioner following assessment supporting continuity of care. There were no adverse events during the period of observation; no staff absences related to COVID-19. Quality improvement methods have facilitated the successful integration of doorstep assessments into clinical care.
Improving peripherally inserted central catheter appropriateness and reducing device-related complications: a quasiexperimental study in 52 Michigan hospitals
Authors: Chopra Vineet , O'Malley Megan , Horowitz Jennifer , Zhang Qisu , McLaughlin Elizabeth , Saint Sanjay , Bernstein Steven J , Flanders Scott
Published: March 2021

Background

The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) provides evidence-based criteria for peripherally inserted central catheter (PICC) use. Whether implementing MAGIC improves PICC appropriateness and reduces complications is unknown.

Methods

A quasiexperimental study design to implement MAGIC in 52 Michigan hospitals was used. Data were collected from medical records by trained abstractors. Hospital performance on three appropriateness criteria was measured: short-term PICC use (≤5 days), use of multilumen PICCs and PICC placement in patients with chronic kidney disease. PICC appropriateness and device complications preintervention (January 2013 to December 2016) versus postintervention (January 2017 to January 2020) were compared. Change-point analysis was used to evaluate the effect of the intervention on device appropriateness. Logistic regression and Poisson models were fit to assess the association between appropriateness and complications (composite of catheter occlusion, venous thromboembolism (VTE) and central line-associated bloodstream infection (CLABSI)).

Results

Among 38 592 PICCs, median catheter dwell ranged from 8 to 56 days. During the preintervention period, the mean frequency of appropriate PICC use was 31.9% and the mean frequency of complications was 14.7%. Following the intervention, PICC appropriateness increased to 49.0% (absolute difference 17.1%, p<0.001) while complications decreased to 10.7% (absolute difference 4.0%, p=0.001). Compared with patients with inappropriate PICC placement, appropriate PICC use was associated with a significantly lower odds of complications (OR 0.29, 95% CI 0.25 to 0.34), including decreases in occlusion (OR 0.25, 95% CI 0.21 to 0.29), CLABSI (OR 0.61, 95% CI 0.46 to 0.81) and VTE (OR 0.40, 95% CI 0.33 to 0.47, all p<0.01). Patients with appropriate PICC placement had lower rate of complications than those with inappropriate PICC use (incidence rate ratio 0.987, 95% CI 0.98 to 0.99, p<0.001).

Conclusions

Implementation of MAGIC in Michigan hospitals was associated with improved PICC appropriateness and fewer complications. These findings have important quality, safety and policy implications for hospitals, patients and payors.
Effects of the combination of second-generation antipsychotics on serum concentrations of aripiprazole and dehydroaripiprazole in Chinese patients with schizophrenia
Authors: Jiang Ping , Sun Xiujia , Ren Juanjuan , Liu Hongmei , Lin Zhiguang , Liu Junwen , Fang Xinyu , Zhang Chen
Published: March 2021

Background

Aripiprazole (ARI) is often prescribed alone or in combination with other second-generation antipsychotics (SGAs) to treat patients with schizophrenia. However, this may increase the potential clinical significance of drug–drug interactions. Therapeutic drug monitoring (TDM) is an important and fundamental tool both when administering ARI alone and in combination with other SGAs to monitor ARI pharmacokinetics, adjust the dosage and thereby achieve more effective and safer treatment.

Aims

This study retrospectively investigated the effects of four SGA comedications (clozapine, risperidone, quetiapine (QTP) and olanzapine) and other potential factors (sex, age and ARI dose) on the serum concentrations of ARI and dehydroaripiprazole (DARI) in Chinese patients with schizophrenia using TDM data.

Methods

High-performance liquid chromatography was used to test the serum concentrations of ARI, DARI and ARI+DARI. In addition, steady-state dose-adjusted serum concentrations (ie, concentration-to-dose ratios, C:D ratios) of ARI, DARI and ARI+DARI; sex; age; ARI dose and SGA comedication dose between 299 inpatients with schizophrenia who received ARI or SGA comedication were all collected and analysed. Spearman’s correlation and multiple linear regression analysis were used to evaluate bivariate associations between ARI dose and serum ARI and DARI concentrations and describe the effect of independent variables on serum ARI and DARI concentrations, respectively.

Results

There were significant differences in the C:D ratios of ARI (χ2=−3.21, p=0.001) and ARI+DARI (χ2=−2.50, p=0.01) between the ARI and SGA groups, as well as in the C:D ratios of ARI (χ2=−3.59, p<0.001) and ARI+DARI (χ2=−3.10, p=0.002) between the female patients in the two groups. Of the four SGAs, only QTP had significant effects on the C:D ratios of ARI (Z=−4.12, p<0.001) and ARI+DARI (Z=−3.62, p<0.001) when compared with the ARI group in the whole sample and on the C:D ratios of ARI, DARI and ARI+DARI (Z=−3.96, p<0.001; Z=−2.22, p=0.03; Z=−3.75, p<0.001, respectively) in women when compared with their counterparts in the ARI group.

Conclusion

Comedication with SGAs resulted in lower C:D ratios of ARI and ARI+DARI compared with ARI monotherapy, and comedication with QTP resulted in lower C:D ratios of ARI and ARI+DARI than ARI monotherapy. Despite this statistical significance of our findings, whether the presently observed effect has clinical significance requires exploration by further research. TDM and dosage regulation of ARI should be performed in Chinese inpatients with schizophrenia who are receiving SGA comedication (especially QTP) to maintain a safe and effective dose-adjusted serum concentration of ARI and DARI.
Challenging of frozen diagnoses of small sclerosing pneumocytoma
Authors: Shang Zhanxian , Han Yuchen , Shao Jinchen , Zhu Lei , Teng Haohua , Zhang Jie
Published: March 2021

Aims

An increasing number of small pulmonary nodules are being screened by CT, and an intraoperative diagnosis is necessary for preventing excessive treatment. However, there is limited literature on the frozen diagnosis of small sclerosing pneumocytomas (SPs). In particular, tumours smaller than 1 cm are challenging for pathologists performing intraoperative frozen diagnosis.

Methods

In total, 230 cases of SP were surgically resected between January 2015 and March 2019 at Shanghai Chest Hospital, and of them, 76 cases were smaller than 1 cm. The histology and clinical information of these 76 cases (33.0%, 76/230) were reviewed retrospectively, 54 cases of which were diagnosed intraoperatively, and the pitfalls were summarised. All diagnoses were confirmed on permanent sections and immunohistochemical sections.

Results

Histologically, 78.9% (60/76) of the small SP was dominated by one growth pattern, and solid and papillary growth pattern were the most commonly misdiagnosed circumstances. The rate of intraoperative misdiagnosis of these SP smaller than 1 cm was 11.1% (6/54).

Conclusions

The main reason for misdiagnosis was failure to recognise the dual cell populations and the cellular atypia. Diagnostic clues include the gross morphology, the presence of dual-cell populations and a hypercellular papillary core, foam cell accumulation in glandular spaces and haemorrhage and haemosiderin on the periphery. In spite of awareness of pitfalls some cases may still be essentially impossible to diagnose on frozen section.
Educational disparities in ischaemic heart disease among 0.5 million Chinese adults: a cohort study
Authors: Chen Lu , Tan Yunlong , Yu Canqing , Guo Yu , Pei Pei , Yang Ling , Chen Yiping , Du Huaidong , Wang Xiaohuan , Chen Junshi , Chen Zhengming , Lv Jun , Li Liming
Published: March 2021

Background

The relationship between educational attainment and ischaemic heart disease (IHD) is limited in evidence in middle-income countries like China. Exploring lifestyle-related mediators, which might be not universal between socioeconomic status and health outcomes in diverse regions, can contribute to interventions targeted at the Chinese to narrow the educational gap in IHD.

Methods

Based on the China Kadoorie Biobank of 489 594 participants aged 30–79 years who did not have heart disease or stroke at baseline, this study examined the association of educational attainment with IHD. Total IHD cases were further divided into acute myocardial infarction (AMI) cases and non-AMI cases. The Cox proportional hazard model was performed to estimate the HRs and 95% CIs for mortality and incidence of IHD. Logistic regression was used to estimate the ORs and 95% CIs for case fatality.

Results

During the median follow-up period of 11.1 years, this study documented 45 946 (6668) incident IHD (AMI) cases and 5948 (3689) deaths altogether. Lower educational attainment was associated with increased risk of incident AMI as well as death and fatality of total IHD including its subtypes (ptrend<0.001). Although the risk of incident non-AMI was greater for participants with higher levels of education in the whole population (ptrend<0.001), an inverse association of education with its incidence was found in participants from <50 years age group and rural areas. Smoking and dietary habits were the two most potent mediating factors in the associations of education with mortality and AMI incidence; whereas, physical activity was the major mediating factor for non-AMI incidence in the whole population.

Discussion

Interventions targeting unhealthy lifestyles are ideal ways to narrow the educational gap in IHD while solving ‘upstream’ causes of health behaviours might be the most fundamental ones.
Testicular Sertoli cell tumour and potentially testicular Leydig cell tumour are features of DICER1 syndrome
Authors: Golmard Lisa , Vasta Lauren M , Duflos Valérie , Corsini Carole , Dubois d'Enghien Catherine , McMaster Mary L , Harney Laura A , Carr Ann G , Ling Alexander , Dijoud Frédérique , Gauthier Arnaud , Miettinen Markku , Cost Nicholas G , Gauthier-Villars Marion , Orbach Daniel , Irtan Sabine , Haouy Stéphanie , Schultz Kris Ann , Stoppa-Lyonnet Dominique , Coupier Isabelle , Stewart Douglas R , Sirvent Nicolas
Published: March 2021

DICER1 syndrome is a rare paediatric autosomal dominant inherited disorder predisposing to various benign and malignant tumours. It is caused by a germline pathogenic variant in DICER1, and the second hit for tumour development is usually a missense hotspot pathogenic variant in the DICER1 ribonuclease IIIb domain. While DICER1 predisposing variants account for about 60% of ovarian Sertoli-Leydig cell tumours, no DICER1-related testicular stromal tumours have been described. Here we report the first two cases of testicular stromal tumours in children carrying a DICER1 germline pathogenic variant: a case of Sertoli cell tumour and a case of Leydig cell tumour diagnosed at 2 and 12 years of age, respectively. A somatic DICER1 hotspot pathogenic variant was detected in the Sertoli cell tumour. This report extends the spectrum of DICER1-related tumours to include testicular Sertoli cell tumour and potentially testicular Leydig cell tumour. Diagnosis of a testicular Sertoli cell tumour should prompt DICER1 genetic testing so that patients with a DICER1 germline pathogenic variant can benefit from established surveillance guidelines. DICER1 genetic evaluation may be considered for testicular Leydig cell tumour. Our findings suggest that miRNA dysregulation underlies the aetiology of some testicular stromal tumours.