bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history
Authors: Peng Bo , Wang Li-Li , Dou Li-Ping , Li Fei , Jin Xiang-Shu , Wang Lu , Jia Ming-Yu , Li Yan , Bo Jian , Zhao Yu , Zhu Hai-Yan , Huang Wen-Rong , Liu Dai-Hong
Published: June 2021

Background:

The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes.

Methods:

A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs).

Results:

The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88–40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84–27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84–27.62, P < 0.001).

Conclusions:

These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.
Cut-off values of lesion and vessel quantitative flow ratio in de novo coronary lesion post-drug-coated balloon therapy predicting vessel restenosis at mid-term follow-up
Authors: Meng Pei-Na , Liu Bin , Li Long-Bo , Yin De-Lu , Zhang Heng , Pan De-Feng , You Wei , Wu Zhi-Ming , Wu Xiang-Qi , Zhao Lei , Li Zhi-Bo , Wang Jin-Peng , Wang Zhi-Hui , Xu Tian , Huang Xiao-Yu , Gao Ruo-Nan , Ye Fei
Published: June 2021

Background:

Drug-coated balloons (DCBs) have emerged as potential alternatives to drug-eluting stents in specific lesion subsets for de novo coronary lesions. Quantitative flow ratio (QFR) is a method based on the three-dimensional quantitative coronary angiography and contrast flow velocity during coronary angiography (CAG), obviating the need for an invasive fractional flow reserve procedural. This study aimed to assess the serial angiographic changes of de novo lesions post-DCB therapy and further explore the cut-off values of lesion and vessel QFR, which predict vessel restenosis (diameter stenosis [DS] ≥50%) at mid-term follow-up.

Methods:

The data of patients who underwent DCB therapy between January 2014 and December 2019 from the multicenter hospital were retrospectively collected for QFR analysis. From their QFR performances, which were analyzed by CAG images at follow-up, we divided them into two groups: group A, showing target vessel DS ≥50%, and group B, showing target vessel DS <50%. The median follow-up time was 287 days in group A and 227 days in group B. We compared the clinical characteristics, parameters during DCB therapy, and QFR performances, which were analyzed by CAG images between the two groups, in need to explore the cut-off value of lesion/vessel QFR which can predict vessel restenosis. Student's t test was used for the comparison of normally distributed continuous data, Mann-Whitney U test for the comparison of non-normally distributed continuous data, and receiver operating characteristic (ROC) curves for the evaluation of QFR performance which can predict vessel restenosis (DS ≥50%) at mid-term follow-up using the area under the curve (AUC).

Results:

A total of 112 patients with 112 target vessels were enrolled in this study. Group A had 41 patients, while group B had 71. Vessel QFR and lesion QFR were lower in group A than in group B post-DCB therapy, and the cut-off values of lesion QFR and vessel QFR in the ROC analysis to predict target vessel DS ≥50% post-DCB therapy were 0.905 (AUC, 0.741 [95% confidence interval, CI: 0.645, 0.837]; sensitivity, 0.817; specificity, 0.561; P < 0.001) and 0.890 (AUC, 0.796 [95% CI: 0.709, 0.882]; sensitivity, 0.746; specificity, 0.780; P < 0.001).

Conclusions:

The cut-off values of lesion QFR and vessel QFR can assist in predicting the angiographic changes post-DCB therapy. When lesion/vessel QFR values are <0.905/0.890 post-DCB therapy, a higher risk of vessel restenosis is potentially predicted at follow-up.
Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China
Authors: Hu Nan , Wang Kun , Zhang Li , Liu Zuo-Jing , Jin Zhu , Cui Rong-Li , Zhang He-Jun , He Zhong-Hu , Ke Yang , Duan Li-Ping
Published: June 2021

Background:

Functional dyspepsia (FD) has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma (ESCC). This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia (OD) in such a population.

Methods:

A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC. All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire, and they underwent gastroscopy. After exclusion of gastroesophageal reflux disease, uninvestigated dyspepsia (UID) was divided into OD and FD for further analyses.

Results:

A total of 2916 participants were enrolled from July 2013 to March 2014 in China. We detected 166 UID cases with questionnaires, in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy. OD cases presented as reflux esophagitis (RE), ESCC, and duodenal ulcer. Heartburn (52.94%) and reflux (29.41%) were common in OD, but no symptomatic differences were found between FD and OD. Male sex, low education level, and liquid food were the risk factors for OD, while frequent fresh vegetable consumption was a protective factor. FD included 56 (37.58%) cases of postprandial distress syndrome (PDS), 52 (34.89%) of epigastric pain syndrome (EPS), nine (6.04%) of PDS + EPS, and 32 (21.48%) of FD + functional esophageal disorders. The Helicobacter pylori infection rate in FD patients was not higher than that in the control group (34.23% vs. 42.26%, P = 0.240). Frequent spicy food consumption was associated with PDS (odds ratio [OR]: 2.088, 95% confidence interval [CI]: 1.028–4.243), while consumption of deep well water was protective for PDS (OR: 0.431, 95% CI: 0.251–0.741).

Conclusions:

The prevalence of FD was 5.11% in the studied population. Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire.

Trial Registration:

ClinicalTrials.gov, NCT01688908; https://clinicaltrials.gov/ct2/show/record/NCT01688908.
The Impact of Body Mass Index on Freedom From Therapeutic Intervention and Quality of Life in Active Surveillance Prostate Cancer Patients
Authors: Merrick Gregory S. , Galbreath Robert , Fiano Ryan , Scholl Whitney , Bennett Abbey , Butler Wayne M. , Kurko Brian , Adamovich Edward
Published: June 2021

Objective:

The objective of this study was to evaluate the impact of body mass index (BMI) on overall survival, freedom from distant metastases, rates of therapeutic intervention (TI), and quality of life (QOL) in active surveillance (AS) prostate cancer patients.

Materials and Methods:

Three hundred forty consecutive, prospectively evaluated AS patients underwent a staging transperineal template-guided mapping biopsy before AS enrollment and were stratified by BMI (<25, 25 to 29.9, 30 to 34.9, and >35 kg/m2). Evaluated outcomes included overall survival, freedom from distant metastases, TI, QOL to include urinary, bowel, sexual function and depression and serial postvoid residual urine measurements. The relationship between BMI and anterior prostate cancer distribution was evaluated. Repeat biopsy was based on prostate specific antigen kinetics, abnormal digital rectal examination and patient preference.

Results:

Of the 340 patients, 323 (95%) were Gleason 3+3 and 17 patients (5.0%) were Gleason 3+4. The median follow-up was 5.2 years (range: 1 to 14 y). At 10 years, TI was instituted in 4.7%, 2.2%, 9.5%, and 25.0% of patients in BMI cohorts <25, 25 to 29.9, 30 to 34.9, and ≥35 (P=0.075). No patient has developed distant metastases. The median time to TI was 4.86 years. In multivariate analysis, TI was most closely predicted by prostate specific antigen density (P=0.071). At 8 years, no statistical differences in urinary function, bowel function, depression or postvoid residual were noted. However, a trend for erectile dysfunction was identified (P=0.106).

Conclusion:

At 10 years, BMI did not statistically predict for TI, geographic distribution of prostate cancer or QOL parameters.
Transversus abdominis plane block versus local anaesthetic wound infiltration for analgesia after caesarean section
Authors: Grape Sina , Kirkham Kyle Robert , Albrecht Eric
Published: June 2021

BACKGROUND

Transversus abdominis plane (TAP) block and local anaesthetic wound infiltration are used to relieve pain after caesarean section.

OBJECTIVES

To determine whether TAP block or local anaesthetic wound infiltration is the better analgesic option after caesarean section.

DESIGN

Systematic review and meta-analysis with trial sequential analysis.

DATA SOURCES

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

ELIGIBILITY CRITERIA

We retrieved randomised controlled trials comparing TAP block with wound infiltration after caesarean section. Primary outcome was pain score during rest (analogue scale, 0 to 10) at 2 h postoperatively, analysed according to the TAP block technique (ultrasound-guided/landmark-guided), anaesthetic strategy (spinal/general), intrathecal fentanyl (yes/no) and multimodal analgesia (yes/no). Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, and total intravenous morphine consumption at 2, 12 and 24 h. We sought rates of block complications, including postoperative infection, haematoma, visceral injury and local anaesthetic systemic toxicity.

RESULTS

Seven trials, totalling 475 patients, were identified. There was no difference in pain score during rest at 2 h between groups. Subgroup analyses revealed no differences related to TAP block technique (P = 0.64), anaesthetic strategy (P = 0.53), administration of intrathecal fentanyl (P = 0.59) or presence of multimodal analgesia (P = 0.57). Pain score during rest at 12 h and intravenous morphine consumption at 2 and 12 h were identical in both groups. Data were insufficient to compare block complications. Overall quality of evidence was moderate.

CONCLUSION

There is moderate level evidence that TAP block and wound infiltration provide similar postoperative analgesia after caesarean section.

TRIAL REGISTRY NUMBER

PROSPERO CRD42020208046.
Curcumin-mediated Photodynamic Therapy Inhibits the Phenotypic Transformation, Migration, and Foaming of Oxidized Low-density Lipoprotein-treated Vascular Smooth Muscle Cells by Promoting Autophagy
Authors: Wang Gailan , Zhu Ying , Li Kaiting , Liao Bo , Wang Fang , Shao Lan , Huang Liyi , Bai Dingqun
Published: June 2021

Vascular smooth muscle cells (VSMCs) are becoming a hot spot and target of atherosclerosis research. This study aimed to observe the specific effects of curcumin (CUR)-mediated photodynamic therapy (CUR-PDT) on oxidized low-density lipoprotein (ox-LDL)-treated VSMCs and confirm whether these effects are mediated by autophagy. In this study, the mouse aortic smooth muscle cell line and A7r5 cell lines were used for parallel experiments. VSMC viability was evaluated by Cell Counting Kit-8 assay. VSMCs were treated with ox-LDL to establish a model of atherosclerosis in vitro. The autophagy level and the expression of proteins related to phenotypic transformation were detected by western blotting. The migration ability of the cells was detected by using transwell assay. The presence of intracellular lipid droplets was detected by Oil Red O staining. The results showed that VSMCs transformed from the contraction phenotype to the synthetic phenotype when stimulated by ox-LDL, during which autophagy was inhibited. However, CUR-PDT treatment significantly promoted the level of autophagy and inhibited the process of phenotypic transformation induced by ox-LDL. In addition, ox-LDL significantly promoted VSMC migration and increased the number of lipid droplets, whereas CUR-PDT treatment significantly reduced the ox-LDL-induced increase in the migration ability of, and lipid droplet numbers in, VSMCs. When the VSMCs were pretreated with the autophagy inhibitor 3-methyladenine for 24 hours, the effects of CUR-PDT were reversed. Therefore, our study indicated that CUR-PDT can inhibit the phenotypic transformation, migration, and foaming of ox-LDL–treated VSMCs by inducing autophagy.
Evaluation of 6 biometers based on different optical technologies
Authors: Montés-Micó Robert
Published: June 2021

Purpose:

To evaluate repeatability and agreement between various biometric parameters using 6 biometers based on different optical technologies.

Setting:

University of Valencia, Spain.

Design:

Prospective, comparative case series.

Methods:

150 eyes were measured using the Aladdin, AL-Scan, Argos, IOLMaster700, Lenstar LS900, and OA-2000 biometers. Keratometry (K1 and K2), J0 and J45, central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), axial length (AL), white to white (WTW), and pupil size (PS) were measured 5 times with each device. Intrasubject SD, coefficient of variability (CoV), coefficient of repeatability, intraclass correlation coefficient, and Bland -Altman graphs were analyzed.

Results:

CoV values were <0.30% for K1, K2, and AL and up to 1.61% for CCT, ACD, LT, and WTW. PS values were higher (from 4.2% to 7.68%). There was statistically significant differences between biometers for all parameters evaluated (P < .001), and these differences varied as a function of the parameter analyzed. The limit of agreement (LoA) width of some comparisons for K1 and the majority for K2 were >0.50 diopter. A similar pattern was found for J0/J45. For CCT, many comparisons showed LoA width values of >25 μm. The LoA width for ACD ranged from 0.366 mm to 0.175 mm and for LT was about 0.2 mm. AL showed a highest LoA width of 0.225 mm. The LoA width for WTW was, in most cases, about ≥0.50 mm. The LoA width for PS ranged from 1.578 mm to 3.541 mm.

Conclusions:

The 6 biometers provided repeatable measurements for the different parameters analyzed. The LoA obtained for each comparison should be analyzed carefully to consider the interchangeability of these devices.
Concordance of keratoconus in monozygotic twins before and after combined corneal crosslinking/photorefractive keratectomy (Athens Protocol) using Scheimpflug and OCT tomography
Authors: Vingopoulos Filippos , Zisimopoulos Athanasios , Kanellopoulos Anastasios John
Published: June 2021

Purpose:

To describe the concordance of keratoconus (KC) expression in 2 pairs of monozygotic twins before and after a combined corneal crosslinking (CXL)/photorefractive keratectomy (PRK) procedure.

Setting:

Private ambulatory eye surgery unit.

Design:

Retrospective interventional twin study.

Methods:

Two pairs of male monozygotic twins with KC were studied retrospectively. Improvement of flattest (K1) and steepest (K2) keratometry, index of height decentration (IHD), and corneal thickness at the thinnest point and corneal epithelial thickness measured by anterior segment optical coherence tomography and Scheimpflug tomography was compared between respective eyes of monozygotic twin siblings 1 to 5 years after the application of combined CXL and topography-guided PRK of part of the refractive error (the Athens Protocol).

Results:

Significant improvement was noted in all the keratometric indices of all 8 eyes after the combined CXL/PRK procedure. The difference in K1, K2, IHD, corneal thickness at the thinnest point, and corneal epithelial thickness percentage improvement between the right eyes of each pair of twins was statistically significant 1 year and 5 years postoperatively (P < .05). Statistically significant discordance in the aforementioned parameters percentage improvement was similarly observed between the left eyes of each pair of twins (P < .05).

Conclusions:

Although a genetic predisposition in KC is well documented, the discordance in keratometric indices improvement after a CXL/PRK procedure between respective eyes of monozygotic twins suggests that environmental influences may contribute to the disease expression as well. Variable degree of synergy in a combined CXL/PRK procedure may also explain the aforementioned discordant improvement.
Femtosecond laser–assisted descemetorhexis for Descemet membrane endothelial keratoplasty: cell-based and tissue-based ex vivo analysis of precision and safety
Authors: Feldhaus Lukas , Dirisamer Martin , Ohlmann Andreas , Luft Nikolaus , Kassumeh Stefan , Shajari Mehdi , Priglinger Siegfried G. , Mayer Wolfgang J.
Published: June 2021

Purpose:

To analyze precision and safety of femtosecond laser–assisted descemetorhexis and postoperative corneal wound healing in human ex vivo specimens.

Setting:

Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany.

Design:

Experimental ex vivo study.

Methods:

4 donor corneas underwent femtosecond laser–assisted descemetorhexis. The descemetorhexis was performed using the LDV Z8 femtosecond laser, followed by live/dead staining, phase contrast microscopy, and scanning electron microscopy. The descemetorhexis parameters were set using a modified optical coherence tomography image capturing of 8 segments within a focus of 100 μm at the posterior corneal stroma (reversed capsulotomy program).

Results:

Live/dead sample staining analysis demonstrated that the femtosecond laser had minimal impact on the vitality of surrounding endothelial cells. Phase contrast microscopy and scanning electron microscopy evaluation showed that the laser produced precise, clear-cut edges, leaving no stromal tissue bridges.

Conclusions:

Femtosecond laser–assisted descemetorhexis could serve as a safe and precise technique with only minimal endothelial cell damage. To minimize stromal damage, further laser energy profile adjustments are necessary to optimize corneal treatment within different stages of corneal tissue swelling.
Association between
SLC17A7
gene polymorphisms and venlafaxine for major depressive disorder in a Chinese Han population: a prospective pharmacogenetic case-control study
Authors: Liu Liangjie , Ren Decheng , Yuan Fan , Bi Yan , Guo Zhenming , Ma Gaini , Xu Fei , Hou Binyin , Ji Lei , Chen Zhixuan , An Lin , Zhang Naixin , Yu Tao , Li Xingwang , Yang Fengping , Sun Xueli , Dong Zaiquan , Yu Shunying , Yi Zhenghui , Xu Yifeng , He Lin , Wu Shaochang , Zhao Longyou , Cai Changqun , He Guang , Shi Yi
Published: June 2021

Objective:

Venlafaxine is a common antidepressant and its therapeutic effect varies among people with different genetic backgrounds. The aim of this study was to investigate whether single nucleotide polymorphisms (SNPs) in the
SLC17A7
gene are associated with the treatment outcome of venlafaxine in a Chinese Han population with major depressive disorder.

Methods:

This prospective pharmacogenetic case-control study that involved genotyping of four SNPs of
SLC17A7
was conducted on 175 major depressive disorder patients of Chinese Han origin, aged 18 to 65 years, participated in the study from April 2005 to September 2006. Comparisons of allele and genotype frequencies of all SNPs were performed between the responder/remission group and the nonresponder/nonremission group. This study was approved by the Institutional Ethics Committee of Sichuan University (approval No. 20151112-265).

Results:

The allele and genotype frequencies of the four candidate SNPs in
SCL17A7
showed no significant difference between responders and nonresponders. Meanwhile, no significant difference was detected in the four investigated
SLC17A7
SNPs between patients who did and did not exhibit remission. Although one of the investigated
SLC17A7
variants (rs1578944) demonstrated a significant association (
P
=0.022) with a response to venlafaxine after 6 weeks of treatment in the survival analysis, the association was unclear after a Bonferroni multiple comparisons test was conducted.

Conclusion:

No significant association exists between the four candidate SNPs (rs1043558, rs1320301, rs1578944, and rs74174284) in
SLC17A7
and venlafaxine treatment in the Chinese Han population.
Race Moderates the Relationship Between Perceived Social Support and Self-care Confidence in Patients With Heart Failure
Authors: Cousin Lakeshia , Bugajski Andrew , Buck Harleah , Lennie Terry , Chung Misook Lee , Moser Debra K.
Published: June 2021

Background

African Americans are at the highest risk of developing heart failure (HF) compared with other races and are hospitalized at 7 to 8 times the rate of Whites. Poor overall self-care, low self-care confidence, and lower levels of perceived social support are factors related to increased risk for hospitalizations in HF. Yet, limited evidence is available regarding the factors that may differentially impact self-care confidence by race in patients with HF.

Objective

The aim of this study was to examine to what extent race moderates the relationship between perceived social support and self-care confidence.

Method

This is a secondary analysis of cross-sectional data from African American and White patients with HF in North America (n = 429). Patients completed the Multidimensional Scale of Perceived Social Support and the Self-Care Confidence Scale of the Self-Care of Heart Failure Index. A moderation analysis was conducted using hierarchal linear regression.

Results

Sample mean age was 60.8 ± 11.5 years, 22.4% were African American, and 54.7% were in New York Heart Association class I or II. Moderation analyses yielded a significant interaction of perceived social support and race, showing White patients, not African Americans, have significantly different self-care confidence scores depending on level of social support: White, b = 0.224, 95% confidence interval [0.046–0.094], t = 5.65, and P < .001; African American, b = −0.776, 95% confidence interval [−0.049 to 0.060], t = 0.212, and P = .832.

Conclusions

Our findings show a variable effect of perceived social support on self-care confidence as a function of race, suggesting the need for further research to develop and test interventions tailored to race and levels of social support in HF.
Effect of Ventricular Assist Device Self-care Simulation-Based Mastery Learning on Driveline Exit Site Infections
Authors: Wilcox Jane E. , Harap Rebecca S. , Stosor Valentina , Cohen Elaine R. , Grady Kathleen L. , Cameron Kenzie A. , Scholtens Denise M. , Wayne Diane B. , Shanklin Kerry B. , Nonog Gretchen P. , Schulze Lauren E. , Jirak Alison M. , Magliola Grace C. , Barsuk Jeffrey H.
Published: June 2021

Background

Ventricular assist device simulation-based mastery learning (SBML) results in better patient and caregiver self-care skills compared with usual training.

Objective

The aim of this study was to evaluate the effect of SBML on driveline exit site infections.

Methods

We compared the probability of remaining infection free at 3 and 12 months between patients randomized to SBML or usual training.

Results

The SBML-training group had no infections at 3 months and 2 infections at 12 months, yielding a Kaplan-Meier estimate of the probability of remaining infection free of 0.857 (95% confidence interval [CI], 0.692–1.00) at 12 months. The usual-training group had 6 infections at 3 months with no additional infections by 12 months. Kaplan-Meier estimates of remaining infection free at 3 and 12 months were 0.878 (95% CI, 0.758–1.00) and 0.748 (95% CI, 0.591–0.946), respectively. Time-to-infection distributions for SBML versus usual training showed a difference in 12-month infection rates of 0.109 (P = .07).

Conclusions

Ventricular assist device self-care SBML resulted in fewer 12-month infections.
Facilitators and Challenges to Exergaming
Authors: Cacciata Marysol C. , Stromberg Anna , Klompstra Leonie , Jaarsma Tiny , Kuriakose Mebin , Lee Jung-Ah , Lombardo Dawn , Evangelista Lorraine S.
Published: June 2021

Background

Few investigators have explored challenges and facilitators to exergaming, essential factors to exergaming adherence, among patients with heart failure.

Objectives

In this qualitative study, we explored facilitators and challenges using a home-based exergame platform, the Nintendo Wii Sports, in patients with heart failure.

Methods

Semistructured face-to-face interviews were conducted in 13 participants given a diagnosis of heart failure (age range, 34–69 years). Participants were asked about their experiences with exergaming. Transcribed interviews were analyzed with content analysis.

Results

The following 4 facilitators were identified: (1) enjoyment and competition motivated gaming, (2) accessibility at home gave freedom and lowered participants' barriers to exercise, (3) physical benefits when decreasing sedentary lifestyle, and (4) psychosocial benefits on stress, mood, and family interactions. Challenges included (1) diminished engagement over time due to boredom playing similar games and (2) frustrations due to game difficulty and lack of improvement.

Conclusion

Exergaming can increase individuals' physical activity because of easy accessibility and the fun and motivating factors the games offer. Participants initially found exergaming enjoyable and challenging. However, engagement diminished over time because of boredom from playing the same games for a period of time. Participants' preferences and capacities, participants' past experiences, and social support must be considered to avoid boredom and frustrations. Future studies are warranted to determine adherence to exergaming among patients with heart failure and, ultimately, increased overall well-being and healthcare delivery in this patient population.
Ethical Issues Encountered by Forensic Psychiatric Nurses in Japan
Authors: Tsunematsu Kayoko , Fukumoto Yuko , Yanai Keiko
Published: June 2021

Background

Criminals in Japan with mental disorders face penal servitude in prison or treatment under the Medical Treatment and Supervision Act, depending on their ability to take responsibility for their criminal acts. Forensic psychiatric nurses caring for this group may face various ethical issues.

Objective

This study aimed to identify ethical issues forensic psychiatric nurses in Japan encountered.

Method

We used the Ethical Issues Scale to conduct a survey among forensic healthcare ward nurses and analyzed the data using descriptive statistics. We also conducted semistructured interviews with individual nurses who provided signed consent and responded to the initial survey on ethical issues they encountered. These data were analyzed using Berelson's content analysis.

Results

Of 175 nurses, 131 answered our survey. The most frequently encountered ethical issue was “protecting patients' rights and human dignity,” and the most disturbing ethical issue was “providing nursing care with possible health risks.” Seventy-seven percent of the nurses chose to discuss with peers when resolving the ethical issues. Seventeen nurses who were interviewed described these forensic psychiatric nursing-related ethical distresses and conflicts: difficulty in discharge management, prevention of violence and self-harm, compulsory treatment, patient care, and negative emotions toward patient.

Conclusion

Forensic psychiatric nurses in Japan face difficulties regarding respecting patients' rights. They strive to respect patients' rights by using their expertise as nurses while sharing their difficulties with colleagues. It is important to develop a support system for social reintegration to solve ethical issues.
Dosing Tissue Plasminogen Activator on a Mobile Stroke Unit: Comparison Between Estimated and Hospital-Measured Weights
Authors: Jacob Asha P. , Wang Mengxi , Okpala Munachi , Yamal Jose-Miguel , Grotta James C. , Parker Stephanie A.
Published: June 2021

BACKGROUND: Prehospital tissue plasminogen activator dosing in a mobile stroke unit (MSU) is estimated by the paramedic and nurse. We aimed to determine the accuracy of the estimated weight method compared with the actual weight of patients treated with tissue plasminogen activator on the MSU. METHODS: We prospectively collected the estimated weight used on the MSU for treatment and the first-documented hospital-measured weight (bed scale) within 24 hours of hospital arrival. Median absolute and percent difference in weights were calculated; less than 10% of difference in weights was considered acceptable. To compare the estimated and measured weights, we conducted a Wilcoxon signed rank test and Fisher exact test to explore the association between weight difference of greater than 10% and patient outcomes. RESULTS: Among 337 patients, median estimated and hospital-measured weights were 79.0 kg (interquartile range [IQR], 66.0–94.5) and 78.5 kg (IQR, 65.0–91.7), respectively. The median of the absolute value of the difference in estimated versus measured weight was 2.7 kg (IQR, 0.6–7.6; P < .0001). The median percent difference in weight was 3.6% (IQR, 0.8%–9.4%). The median difference between the tissue plasminogen activator dosage administered on the MSU and the recommended dose based on the actual weight was 1.3 mg (IQR, 0.06–4.8) in absolute value. In 56 patients (16.6% of the entire sample) with overestimation of weight by greater than 10%, there were no symptomatic intracerebral hemorrhages. There was no association between weight difference and discharge modified Rankin score (P = .59). CONCLUSION: Weight estimation on an MSU can lead to similar tissue plasminogen activator dosing for 83.4% of subjects compared with if dosing were determined based on actual weight. Weight overestimation or underestimation had no detected impact on tissue plasminogen activator outcomes.
Effectiveness of a Nurse-Delivered Intervention on Illness Perceptions and Quality of Life in Patients With Injury
Authors: FANN Wen-Chih , HUNG Chang-Chiao , CHABOYER Wendy , LEE Bih-O
Published: June 2021

Background

Research has shown that nursing interventions are able to affect short-term outcomes in patients with injury. However, evidence based on a comprehensive nurse-led intervention may be beneficial for trauma care.

Purpose

This study was designed to assess the effect of a nursing intervention on the illness perceptions and quality of life of patients with injury.

Methods

A two-group experimental design and a follow-up period of 12 months were used. Ninety-four patients were randomly assigned to either the experimental group or the control group. A nurse-led cognitive behavioral therapy intervention was used to improve outcomes.

Results

The illness perception variables of “personal control” and “treatment control” were found to be significantly improved in the experimental group at 3 months after discharge, whereas “emotional perception” was significantly improved at 6 months after discharge. The intervention was also shown to improve “social quality of life” at 6 and 12 months after injury.

Conclusions

This study adds new knowledge related to nursing interventions for patients with injury in terms of the intervention achieving longer-term effects than the interventions examined in previous studies. The results highlight the importance of providing interprofessional collaborative care. However, the intervention protocol should be tested further in future studies.
Working From Home During a Pandemic
Authors: Guler Mehmet Akif , Guler Kutay , Guneser Gulec Meryem , Ozdoglar Elif
Published: June 2021

Objective:

To determine ergonomic problems when working from home during the COVID-19 pandemic with regard to musculoskeletal pain, sleep conditions, physical activity, resting, equipment, and productivity.

Methods:

In this cross-sectional study, office workers who switched to working from home during the COVID-19 pandemic participated in an online survey (n = 194). The data were interpreted using descriptive and multivariate regression analysis.

Results:

A significant increase in back pain was revealed (P < 0.001). Significant weight gain was observed (P < 0.001) connected to a decrease in physical activity and an increase in the consumption of junk food. Despite the negative health impact, participants self-reported an increase in productivity.

Conclusion:

The self-reported productivity was higher during the working from home, but a declining trend in employee health can be observed including low back pain and weight gain.
Association Between Business Travel, Health-Related Behaviors, and Adiposity
Authors: Bergquist Sharon H. , Marcus Michele , Meng Qi , Fei Teng , Robichaux Chad , Roberts David L. , Moore Reneé H.
Published: June 2021

Objective:

To evaluate the associations between frequency of business travel and health behaviors and adiposity.

Methods:

Retrospective cross-sectional analysis of de-identified electronic medical records from 795 corporate physical exams.

Results:

Business travel frequency demonstrates a curvilinear relationship with body mass index and body composition in men and women, with domestic and international travel. Linear and quadratic term beta coefficients indicate stronger associations between the sum of domestic and international travel and BMI, body fat percentage, and visceral adipose tissue in women than men, after accounting for age, exercise, and sleep. Based on our male sample population, international travel frequency has a greater influence on adiposity than summed (mostly domestic) travel.

Conclusions:

Frequent business travel adversely affects body composition, with differences by gender and type of travel.
Silica Dust Exposure Increases Risk for Rheumatoid Arthritis
Authors: Wrangel Oscar , Graff Pål , Bryngelsson Ing-Liss , Fornander Louise , Wiebert Pernilla , Vihlborg Per
Published: June 2021

Objective:

Rheumatoid arthritis (RA) is an inflammatory disease with unknown etiology. This study examines if silica dust exposure increases the risk for seropositive and seronegative RA.

Methods:

A nationwide registry case–control study was conducted that included all cases of RA in Sweden between 2005 and 2016. In total, 31,139 cases with two matched controls were included. A JEM was used to estimate exposure.

Results:

Silica dust exposure was associated with a statistically significant increase in odds ratio (OR) for seropositive (OR 1.22, 95% CI 1.05 to 1.40) and seronegative (OR 1.23, 95% CI 1.04 to 1.46) RA among men.

Conclusion:

This study found an increased OR for RA in silica-exposed men. The OR was equal for seropositive and seronegative RA. These findings further support the hypothesis that silica dust may be a trigger for RA.
Investigating the Impact of Job Loss and Decreased Work Hours on Physical and Mental Health Outcomes Among US Adults During the COVID-19 Pandemic
Authors: Guerin Rebecca J. , Barile John P. , Thompson William W. , McKnight-Eily Lela , Okun Andrea H.
Published: June 2021

Objective:

To investigate associations between adverse changes in employment status and physical and mental health among US adults (aged 18 years or older) during the COVID-19 pandemic.

Methods:

Data from participants (N = 2565) of a national Internet panel (June 2020) were assessed using path analyses to test associations between changes in self-reported employment status and hours worked and physical and mental health outcomes.

Results:

Respondents who lost a job after March 1, 2020 (vs those who did not) reported more than twice the number of mentally unhealthy days. Females and those lacking social support had significantly worse physical and mental health outcomes. Participants in the lowest, pre-pandemic household income groups reported experiencing worse mental health.

Conclusions:

Results demonstrate the importance of providing economic and social support services to US adults experiencing poor mental and physical health during the COVID-19 pandemic.
Institutional Protocol Evolution for Screening Surgical Patients During the COVID-19 Pandemic
Authors: Dibbs Rami P. , Ferry Andrew M. , Mehl Steven C. , Dunn James J. , Enochs Joyce A. , Ferguson Susannah M. , Archer Nakeisha M. , Ward Amanda A. , Winebar Janet M.
Published: June 2021

The provisions of healthcare have significantly changed globally as a result of the impact of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Consequently, SARS-CoV-2 has required hospitals to create institution-specific preoperative screening protocols to minimize nosocomial transmission. Nursing leadership at our institution has served an important role in the evolving screening process. Over 260,000 people have been infected with SARS-CoV-2 within Harris County, significantly impacting healthcare systems within the greater Houston area. Institutional surgical screening protocols have thus been designed to improve patient and provider safety while delivering optimal care in accordance with our institution's guidelines and the Centers for Disease Control and Prevention recommendations. Implementation of screening protocols has helped limit transmission of SARS-CoV-2 infection while maintaining high standards of patient care. Through this experience, perioperative nursing personnel have effectively helped design and implement surgical screening protocols while also safely and properly screening patients. In addition, nurses have shown flexibility in response to the evolving nature of the coronavirus disease 2019 pandemic.
The Male Athlete Triad—A Consensus Statement From the Female and Male Athlete Triad Coalition Part II: Diagnosis, Treatment, and Return-To-Play
Authors: Fredericson Michael , Kussman Andrea , Misra Madhusmita , Barrack Michelle T. , De Souza Mary Jane , Kraus Emily , Koltun Kristen J. , Williams Nancy I. , Joy Elizabeth , Nattiv Aurelia
Published: June 2021

The Male Athlete Triad is a medical syndrome most common in adolescent and young adult male athletes in sports that emphasize a lean physique, especially endurance and weight-class athletes. The 3 interrelated conditions of the Male Athlete Triad occur on spectrums of energy deficiency/low energy availability (EA), suppression of the hypothalamic–pituitary–gonadal axis, and impaired bone health, ranging from optimal health to clinically relevant outcomes of energy deficiency/low EA with or without disordered eating or eating disorder, functional hypogonadotropic hypogonadism, and osteoporosis or low bone mineral density with or without bone stress injury (BSI). Because of the importance of bone mass acquisition and health concerns in adolescence, screening is recommended during this time period in the at-risk male athlete. Diagnosis of the Male Athlete Triad is best accomplished by a multidisciplinary medical team. Clearance and return-to-play guidelines are recommended to optimize prevention and treatment. Evidence-based risk assessment protocols for the male athlete at risk for the Male Athlete Triad have been shown to be predictive for BSI and impaired bone health and should be encouraged. Improving energetic status through optimal fueling is the mainstay of treatment. A Roundtable on the Male Athlete Triad was convened by the Female and Male Athlete Triad Coalition in conjunction with the 64th Annual Meeting of the American College of Sports Medicine in Denver, Colorado, in May of 2017. In this second article, the latest clinical research to support current models of screening, diagnosis, and management for at-risk male athlete is reviewed with evidence-based recommendations.
CK syndrome: a rare cause of developmental delay in a young boy
Authors: Garg Meenal , Kulkarni Shilpa D. , Sayed Rafat , Hegde Anaita Udwadia
Published: June 2021

CK syndrome is a rare disorder caused by mutation in the NSDHL (NAD(P) dependent steroid dehydrogenase-like) gene at the Xq28 locus. It has expanded the spectrum of disorders associated with X-linked mental retardation and defects in sterol metabolism. There are only a few reports defining the phenotypic spectrum of this rare disorder. We describe a new patient from the Indian subcontinent who presented with dysmorphism, global developmental delay and epilepsy. We also add left ventricular concentric hypertrophy and sensory neuropathy, which have not been reported previously. Our report suggests that CK syndrome may be unrecognized due to limited clinical knowledge and restricted availability of genetic testing. The expansion of the phenotype may also lead to a better understanding of biochemical anomalies and management approaches.
Improving Medication Tolerance
Authors: Ballou Sarah , Iturrino Johanna , Rangan Vikram , Cheng Vivian , Kelley John M. , Lembo Anthony , Kaptchuk Ted J. , Nee Judy
Published: June 2021

Objectives:

Tricyclic antidepressants (TCAs) are commonly used to treat disorders of gut-brain interaction (DGBI). However, these medications are often associated with side effects that lead to early treatment discontinuation. Research in other chronic medical conditions suggests that many TCA side effects may be caused by nocebo (negative placebo) effects. The current study tests a brief, verbal intervention aimed at improving tolerance of TCAs in DGBI by providing education about nocebo effects.

Materials and Methods:

This pilot randomized controlled trial was performed in a tertiary care gastroenterology clinic. Participants with DGBI were randomized “standard information,” describing the benefits and risks of TCAs, or “augmented information,” which included an additional <30-second education about nocebo effects. Two weeks after their visit, participants were emailed a survey evaluating the number and bothersomeness of side effects, adequate relief, global improvement, and treatment satisfaction.

Results:

Thirty-one patients were randomized and 22 responded to the survey. The average age was 40% and 59% were women. Although not statistically significant, the augmented group attributed nominally fewer symptoms to TCAs than the standard group, with a medium effect size (1.5 vs. 4.2, effect size d=0.56, P=0.212) and reported being significantly less bothered by those symptoms (13.4 vs. 38.1, P=0.037). A nominally larger percentage of the augmented group reported adequate relief of symptoms after 2 weeks of treatment compared with the standard group (55% vs. 27%, respectively).

Conclusions:

This pilot study demonstrates that a brief (≈30 s) clinical intervention addressing nocebo effects may improve tolerance of TCAs. These findings provide support for future, fully powered studies to evaluate the impact of framing on clinical outcomes, especially in chronic conditions.
Optimal management of functional anorectal pain: a systematic review and network meta-analysis
Authors: Byrnes Kevin Gerard , Sahebally Shaheel Mohammad , McCawley Niamh , Burke John Patrick
Published: June 2021

Functional anorectal is idiopathic and characterised by severe and potentially intractable anorectal pain. The current review aims to appraise available evidence for the management of functional anorectal pain and synthesise reported outcomes using network meta-analysis. PubMed, CENTRAL and Web of Science databases were searched for studies investigating treatments for functional anorectal pain. The primary outcome was clinical improvement of symptoms and the secondary outcome was pain scores reported during follow-up. A Bayesian network meta-analysis of interventions was performed. A total of 1538 patients were included from 27 studies. Intramuscular injection of triamcinolone, sacral neuromodulation (SNM) and biofeedback were most likely to be associated with improvement in symptoms [SUCRA (triamcinolone) = 0.79; SUCRA (SNM) = 0.74; SUCRA (Biofeedback) = 0.61]. Electrogalvanic stimulation (EGS), injection of botulinum toxin A and topical glyceryl trinitrate (GTN) were less likely to produce clinical improvement [SUCRA (EGS) = 0.53; SUCRA (Botox) = 0.30; SUCRA (GTN) = 0.27]. SNM and biofeedback were associated with the largest reductions in pain scores [mean difference, range (SNM) = 4.6–8.2; (Biofeedback) = 4.6–6]. As biofeedback is noninvasive and may address underlying pathophysiology, it is a reasonable first-line choice in patients with high resting pressures or defecation symptoms. In patients with normal resting pressures, SNM or EGS are additional options. Although SNM is more likely to produce a meaningful response compared to EGS, EGS is noninvasive and has less morbidity. Whilst triamcinolone injection is associated with symptomatic clinical improvement, the magnitude of pain reduction is less.
Dementia Diagnosis Disparities by Race and Ethnicity
Authors: Lin Pei-Jung , Daly Allan T. , Olchanski Natalia , Cohen Joshua T. , Neumann Peter J. , Faul Jessica D. , Fillit Howard M. , Freund Karen M.
Published: June 2021

Background:

Dementia is often underdiagnosed and this problem is more common among some ethnoracial groups.

Objective:

The objective of this study was to examine racial and ethnic disparities in the timeliness of receiving a clinical diagnosis of dementia.

Research Design:

This was a prospective cohort study.

Subjects:

A total of 3966 participants age 70 years and above with probable dementia in the Health and Retirement Study, linked with their Medicare and Medicaid claims.

Measures:

We performed logistic regression to compare the likelihood of having a missed or delayed dementia diagnosis in claims by race/ethnicity. We analyzed dementia severity, measured by cognition and daily function, at the time of a dementia diagnosis documented in claims, and estimated average dementia diagnosis delay, by race/ethnicity.

Results:

A higher proportion of non-Hispanic Blacks and Hispanics had a missed/delayed clinical dementia diagnosis compared with non-Hispanic Whites (46% and 54% vs. 41%, P<0.001). Fully adjusted logistic regression results suggested more frequent missed/delayed dementia diagnoses among non-Hispanic Blacks (odds ratio=1.12; 95% confidence interval: 0.91–1.38) and Hispanics (odds ratio=1.58; 95% confidence interval: 1.20–2.07). Non-Hispanic Blacks and Hispanics had a poorer cognitive function and more functional limitations than non-Hispanic Whites around the time of receiving a claims-based dementia diagnosis. The estimated mean diagnosis delay was 34.6 months for non-Hispanic Blacks and 43.8 months for Hispanics, compared with 31.2 months for non-Hispanic Whites.

Conclusions:

Non-Hispanic Blacks and Hispanics may experience a missed or delayed diagnosis of dementia more often and have longer diagnosis delays. When diagnosed, non-Hispanic Blacks and Hispanics may have more advanced dementia. Public health efforts should prioritize racial and ethnic underrepresented communities when promoting early diagnosis of dementia.