bluuebunny/crossref_metadata_2025 huggingface dataset:
Medication-Related Fall (MRF) screening and scoring tool: consensus Delphi validation
Authors: Saeed D , Miller R , Darcy C , Miller K , Madden K , McKee H , Agnew J , Crawford P , Carter G , Parsons C
Published: April 2022

Introduction

Falls are associated with negative health outcomes such as injury and mortality, as well as increased healthcare usage and costs. Risk factors for falls are multifactorial and include polypharmacy and the use of certain medications (1).

Aim

To develop and validate a medication-related fall (MRF) screening and scoring tool.

Methods

The MRF tool was developed from medication classes associated with falling in the Polypharmacy Guidance Realistic Prescribing 2018 (2), and additional medications identified and categorised by specialist and consultant pharmacists and physicians across a region of the United Kingdom. Medication classes were categorised as high-risk (three points), moderate-risk (two points) or low-risk (one point) in their ‘potential to cause falls’. The overall medication-related fall risk for the patient was determined by summing the scores for all medications. The MRF was validated using Delphi consensus methodology, whereby three iterative rounds of online surveys were conducted using SurveyMonkey®. Delphi panel experts were defined as individuals with recognised expertise in geriatric medicine and pharmacotherapy in older people. Twenty-two experts determined their agreement with the falls risk associated with each medication on a 5-point Likert scale with accompanying written feedback. Only medications with at least 75% of respondents agreeing or strongly agreeing were retained in the next round. Following the first validation round, any proposed criteria that did not meet retention requirements were removed. The second and third rounds of the survey were created based on the panel comments from the previous round.

Results

Consensus was reached for 19 medications/medication classes to be included in the final version of the MRF tool (table) and to reject eight medications/medication classes. Consensus was not reached regarding eight medications and they were not included in the final version of the tool.

Conclusion

The MRF tool is simple and feasible to use in healthcare settings to evaluate and optimise medications as a standalone screening instrument or as part of a multidisciplinary intervention to reduce fall risk and negative fall-related outcomes. The score from the MRF tool has potential for use as a clinical parameter to evaluate prescribing appropriateness.

References

(1) Public Health England (2020) Falls: applying All Our Health. Available at https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health Guidance Falls: applying All Our Health. (Accessed: 4th April 2020)

(2) Scottish Government Polypharmacy Model of Care Group (2018). Polypharmacy Guidance, Realistic Prescribing. 3rd Edition.
Assessing the impact on workflow of placing a pharmacy team in an emergency department
Authors: Sinclair A G , Mitchell A , Bhagwanji S
Published: April 2022

Introduction

The ED in our tertiary referral Hospital was working at capacity and invited pharmacy to send a team for a period to assess the impact they might have on workflow and doctor time, by carrying out detailed (level 2) medicine reconciliations and resolving medicine related issues at the outset.

Aim

To assess the impact that allocating an experienced pharmacist (Independent prescriber) together with a pharmacy technician might have on workflow and patient safety in ED.

Methods

The pharmacy team were directed to managing patients’ medicines carrying out the more comprehensive level 2 (1) medicines reconciliation (MR). This is a more thorough level of MR than that usually carried out on admission by a doctor (Level 1 MR). The time taken to conduct each MR was recorded. Interventions made were categorised by the clinical pharmacist using the MERP index. Five doctors were surveyed and asked how long they usually took to conduct a level 1 MR.

Results

132 MRs were carried out over 5 days. The pharmacist conducted 65 MRs mean time per MR 13.8 minutes SD 6.84 CI 90% (+/- 0.11) and the technician conducted 67 MRs mean time 23.73 minutes SD 11.07 CI 90% (+/- 0.17). The doctor group took 15 minutes (estimated) to conduct a level 1 MR SD 34.85 CI 90% (+/- 0.81). 1013 interventions were made, 15 were judged to be significant in terms of harm or potential harm and a further 128 related to non-prescribing of critical items (see table). A 90% Confidence interval was used reflecting the significant variance in time that a medicine reconciliation can take.

Conclusion

This project had limitations; it was brief, and the number of doctors surveyed few. However, it was adjudged to be a success in terms of doctor time saved (33 hours) and patient safety identifying 14 harm or potential harm occurrences and 128 critical medicines omissions at the outset of the patient journey. Following the project, the trust recognised the impact the team had and has subsequently funded an ED pharmacy team.

References

(1) Improving the Quality of Meds Reconciliation: A Best Practice Resource and Toolkit: V1.1 June 17 Specialist Pharmacy Service. Accessed Oct 2021 Medicines_Reconciliation_Best_Practice_Standards_Toolkit_Vs1.1_June-15-links-updated-Aug-17.pdf (sps.nhs.uk)

(2) Types of Medication Errors | NCC MERP, accessed 7/10/2021. https://www.nccmerp.org/types-medication-errors
Effect of maternal dietary starch-to-fat ratio and daily energy intake during late pregnancy on the performance and lipid metabolism of primiparous sows and newborn piglets
Authors: Wang Wenhui , Wang Zijie , Ming Dongxu , Huang Caiyun , Xu Song , Li Zhe , Wang Zhenyu , Liu Hu , Zeng Xiangfang , Wang Fenglai
Published: April 2022

The present study evaluated the effects of maternal dietary energy intake and starch-to-fat ratio during late gestation on the performance and lipid metabolism of sows and their offspring. On day 84 of gestation, 80 Landrace × Yorkshire primiparous sows were assigned to 2 × 2 factorial arrangements according to body weight following a randomized complete block design. The factors were daily energy intake (8,375 kcal ME/d [CE] vs. 9,600 kcal ME/d [HE]) and dietary starch-to-fat ratio (10:1 [CR] vs. 15:1 [HR]). All sows were fed one of four diets from day 85 of gestation until farrowing. Data were analyzed using the GLM procedure in SPSS. High energy intake increased the body weight of sows on day 110 of gestation (P = 0.031) as well as the weight of piglets at birth (P = 0.018). Increased energy intake elevated the plasma triglyceride concentrations in sows (P = 0.027) and piglets (P = 0.044). Maternal high energy intake altered the liver metabolome of newborn piglets in terms of metabolites related to carbohydrate and linoleic acid metabolism. Moreover, maternal high energy intake increased hepatic total cholesterol (P = 0.023) and triglyceride (P = 0.026) concentration in newborn piglets. Furthermore, maternal high energy intake significantly increased the transcript abundance of fatty acid synthase (FAS; P = 0.001) and protein abundance of phosphorylated protein kinase B (P =0.001) in the liver of newborn piglets. A high starch-to-fat ratio reduced low-density lipoprotein cholesterol (LDL-C) concentration in the plasma of sows (P = 0.044) and newborn piglets (P = 0.048) as well as in the liver of newborn piglets (P = 0.015). Furthermore, maternal high starch-to-fat ratio increased the transcript abundances of FAS (P = 0.004) in newborn piglets. In conclusion, high daily energy intake of sows increased the birth weight of newborn piglets. Moreover, maternal high daily energy intake and high dietary starch-to-fat ratio improved the lipid metabolism of newborn piglets.
Evolution of the long-period pulsar GLEAM-X J162759.5–523504.3
Authors: Gençali A A , Ertan Ü , Alpar M A
Published: April 2022

The long-period (P = 1091 s) of the recently discovered pulsar GLEAM-X J162759.5–523504.3 can be attained by neutron stars evolving with fallback discs and magnetic dipole moments of a few 1030 G  cm3 at ages greater than ∼2 × 105 yr consistently with the observational upper limits to the period derivative, $\dot{P}$, and the X-ray luminosity, LX, of the source. The current upper limits for $\dot{P}$ allow two alternative present states: (1) The disc is still active with ongoing accretion at a low rate such that the accretion luminosity is much less than the neutron star’s cooling luminosity, which in turn is below the upper limit for LX. In this scenario, the spin-down will continue at $\dot{P}\sim 10^{-10}$ s s−1 until the disc becomes inactive; the final period will be P ∼ a few 103 s. (2) The disc is already inactive, there is no accretion. In this case, the period evolution has levelled off to the observed value in the final period range. The remaining, very weak, dipole torque sustains asymptotic spin-down at $\dot{P}\sim 4 \times 10^{-18}$ s s−1. Long periods P ∼ a few 103 s were predicted for the final states of soft gamma repeaters and anomalous X-ray pulsars with relatively strong dipole fields in earlier work with the fallback disc model.
Local Government
Authors: Lotta Gabriela , Oliveira Vanessa Elias de
Published: April 2022

In the 1970s, local governments all over the world began to undergo a far-reaching decentralization process. Lately, however, that process has begun to reverse and there is a recentralization movement in both federated and non-federated countries in and out of the Americas. This chapter considers local government in Latin American democracies. It starts with a discussion of two-way decentralization and recentralization movements. Then follows an analysis of how they have affected and reconfigured local autonomy in some countries in the region, namely, Mexico, Brazil, Argentina, Chile, Peru, and Colombia. Finally, it discusses the cases as a set endeavouring to identify similarities and differences in regard to the role of local governments in municipal public policy production and the inter-governmental relations that process leads to.
Right to Information and Transparency
Authors: Ugarte Ramiro Álvarez
Published: April 2022

This chapter first describes the legal history of the right to information—its theoretical basis and the historical context in which it appeared as a goal of a social movement. It argues that the right to information in Latin America presents a case of legal transplant, inspired by regulations abroad which were carried beyond the national borders by well-funded activists and organizations. It then discusses how the main path through which this transplant occurred was the Organization of American States, a place where formal and informal processes of legal consolidation take place in Latin America. It describes the general principles adopted at this regional level as a result of some sort of jurisprudential dialogue between different jurisdictions. Finally, the chapter maps new trends in the freedom of information movement landscape, the challenges it still faces, and the weaknesses which limit it as a path towards democratic accountability.
Historical and Modern Evidence for the Role of Reward Circuitry in Emergence
Authors: Heshmati Mitra , Bruchas Michael R.
Published: April 2022

Increasing evidence supports a role for brain reward circuitry in modulating arousal along with emergence from anesthesia. Emergence remains an important frontier for investigation, since no drug exists in clinical practice to initiate rapid and smooth emergence. This review discusses clinical and preclinical evidence indicating a role for two brain regions classically considered integral components of the mesolimbic brain reward circuitry, the ventral tegmental area and the nucleus accumbens, in emergence from propofol and volatile anesthesia. Then there is a description of modern systems neuroscience approaches to neural circuit investigations that will help span the large gap between preclinical and clinical investigation with the shared aim of developing therapies to promote rapid emergence without agitation or delirium. This article proposes that neuroscientists include models of whole-brain network activity in future studies to inform the translational value of preclinical investigations and foster productive dialogues with clinician anesthesiologists.
Constrained Functional Connectivity Dynamics in Pediatric Surgical Patients Undergoing General Anesthesia
Authors: Puglia Michael P. , Vlisides Phillip E. , Kaplan Chelsea M. , Jewell Elizabeth S. , Therrian Megan , Mashour George A. , Li Duan
Published: April 2022

Background

Functional connectivity in cortical networks is thought to be important for consciousness and can be disrupted during the anesthetized state. Recent work in adults has revealed dynamic connectivity patterns during stable general anesthesia, but whether similar connectivity state transitions occur in the developing brain remains undetermined. The hypothesis was that anesthetic-induced unconsciousness is associated with disruption of functional connectivity in the developing brain and that, as in adults, there are dynamic shifts in connectivity patterns during the stable maintenance phase of general anesthesia.

Methods

This was a preplanned analysis of a previously reported single-center, prospective, cross-sectional study of healthy (American Society of Anesthesiologists status I or II) children aged 8 to 16 yr undergoing surgery with general anesthesia (n = 50) at Michigan Medicine. Whole-scalp (16-channel), wireless electroencephalographic data were collected from the preoperative period through the recovery of consciousness. Functional connectivity was measured using a weighted phase lag index, and discrete connectivity states were classified using cluster analysis.

Results

Changes in functional connectivity were associated with anesthetic state transitions across multiple regions and frequency bands. An increase in prefrontal–frontal alpha (median [25th, 75th]; baseline, 0.070 [0.049, 0.101] vs. maintenance 0.474 [0.286, 0.606]; P < 0.001) and theta connectivity (0.038 [0.029, 0.048] vs. 0.399 [0.254, 0.488]; P < 0.001), and decrease in parietal–occipital alpha connectivity (0.171 [0.145, 0.243] vs. 0.089 [0.055, 0.132]; P < 0.001) were among those with the greatest effect size. Contrary to the hypothesis, connectivity patterns during the maintenance phase of general anesthesia were dominated by stable theta and alpha prefrontal–frontal and alpha frontal–parietal connectivity and exhibited high between-cluster similarity (r = 0.75 to 0.87).

Conclusions

Changes in functional connectivity are associated with anesthetic state transitions but, unlike in adults, connectivity patterns are constrained during general anesthesia in late childhood and early adolescence.

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Patient-Specific Instruments for Resection and Reconstruction of Osteoblastoma in the Talus
Authors: Gerstner Juan B. , Funes Tito L. , Lores Carlos A. , Gerstner-Saucedo Jochen
Published: April 2022

Osteoblastoma of the talus is a rare and challenging pathology both to diagnose and treat successfully. Treatment of an inadequate osteoblastoma resection is usually a wide resection, however, achieving the desired margins in the foot and ankle bones can lead to complications such as fractures or joint loss. We present a case of an incomplete talar neck Osteoblastoma resection and a novel technique that was followed for 3 years after surgery.

Level of Evidence: Diagnostic Level V—technique description. See Instructions for Authors for a complete description of levels of evidence.
Development of Communication Skills Through Virtual Reality on Nursing School Students
Authors: Mayor Silva Luis Iván , Caballero de la Calle Raquel , Cuevas-Budhart Miguel Angel , Martin Martin José Oliver , Blanco Rodriguez José María , Gómez del Pulgar García Madrid Mercedes
Published: April 2022

Multiple studies demonstrate benefits of virtual simulations as recreation of reality in the development of instrumental skills, but few randomized studies prove its efficacy in the development of communication and interpersonal relationships skills. The objective was to develop a virtual reality simulator to improve communication skills and compare its results with a traditional workshop based on cases and theoretical content explained through video. This is a randomized and controlled clinical trial, with a pretest and a posttest. Participants were first-year students from the Faculty of Nursing, Complutense University of Madrid, Spain (n = 100). The sample was divided into two groups: the intervention group (n = 50) was provided a virtual reality simulation teaching process as a novel resource, whereas the control group was provided with a case-based traditional workshop. Because data followed a normal distribution, it was analyzed with Student t test for independent samples, the group sample comparison, and analysis of variance, to find differences among age subgroups. Significant changes were observed at the time of evaluating the skills for the intervention group (P < .01) in comparison with the control group. Both interventions are effective after the first evaluation; however, virtual reality–based intervention stands above the usual method and showed better results in older students.
Outcomes of a Stroke Response Team on the Emergent Management of Intracerebral Hemorrhage
Authors: Ashcraft Susan , Jones Amber T.
Published: April 2022

Background

Spontaneous intracerebral hemorrhage results in high patient mortality or poor functional outcomes. Early access to specialty care allows for rapid implementation of evidence-based strategies that improve the patient's long-term outcomes.

Objectives

The aim of this study was to determine the impact of a dedicated stroke response team on timeliness of blood pressure control, administration of anticoagulation reversal agents, and emergency department arrival to a critical care bed.

Methods

A stroke response team was developed from the neuro intensive care unit that compliments the hospital's current rapid response team. Development of an algorithm guides the implementation of key interventions for intracerebral hemorrhages. Widespread education targeting care of patients with hemorrhagic stroke provided the stroke response team and emergency department staff with knowledge to implement the plan of care.

Results

Baseline time interval data were collected on 70 consecutive patients with intracerebral hemorrhage. After implementation of a dedicated stroke response team, time interval data on 70 consecutive patients with intracerebral hemorrhage were collected for comparison with the baseline measurement. A significant decrease was seen in the time to control the patient's systolic blood pressure (median of 130 to 56 minutes, P = .000) and emergency department arrival to a critical care bed (240 to 132 minutes, P = .000). Patient arrival to anticoagulation reversal agent administration decreased from a mean of 98 to 72 minutes (P = .32).

Discussion

Implementation of a stroke response team increased the knowledge of the care team, improved the timeliness of blood pressure control, and decreased the time for emergency department arrival to a critical care bed, and to anticoagulation reversal agent administration.
Steroid Use for Management of Vasoactive Resistant Shock in Pediatric Cardiac Intensive Care Patients
Authors: Diller Christin N. , Hartwell Lauren , Connor Jean A.
Published: April 2022

Background

Although a variety of doses and duration of hydrocortisone have been reported as a treatment modality for congenital heart surgery patients with refractory hypotension, there remains a lack of understanding of the clinical use in pediatric cardiac programs.

Objectives

The aim of this study was to describe the current practice of steroid use for refractory hypotension in postoperative congenital heart surgery patients.

Method

Survey participants were recruited from the Consortium of Congenital Cardiac Care–Measurement of Nursing Practice. The survey focused on 4 areas: diagnosis, intervention, duration of therapy, and clinical decision making. Data were summarized using descriptive statistics.

Results

Among the programs, 24 of 31 (77%) responded, with 21 (95%) using hydrocortisone as a treatment modality. Most, 20 (83%), reported no written clinical guideline for the use of hydrocortisone. Variation in dosing existed as 3 centers (14%) use 50 mg/m2/d, 6 (29%) use 100 mg/m2/d, and 8 (38%) indicated that dosing varies by provider.

Discussion

Nearly all centers reported using hydrocortisone for the treatment of hypotension refractory to fluid resuscitation and vasoactive medications. Substantial variation in practice exists in areas of diagnosis, dosing, and duration of hydrocortisone. More research is needed to develop a clinical practice guideline to standardize practice.
New cerebral microbleeds in AF patients on non-vitamin K oral anticoagulants or warfarin
Authors: Zhuang Liying , Zhai Lihao , Qiao Song , Hu Xiaofeng , Lai Qilun , Fu Fengli , Cheng Lin , Liu Lu , Liu Xiaoli , Wang Junjun
Published: April 2022

Anticoagulant treatment increases the risk of intracerebral hemorrhage (ICH), but whether the treatment, more specifically non-vitamin K oral anticoagulants (NOACs), increases the risk of cerebral microbleeds (CMBs) remains uncertain. We performed this study to investigate the development of new CMBs due to NOACs or warfarin treatment in patients with atrial fibrillation (AF).

We prospectively recruited AF patients before anticoagulation from June 2016 to June 2018. We performed susceptibility-weighted imaging (SWI) examinations on all enrolled AF patients and re-examined SWI 1 year later. We compared demographic features and new CMBs between the NOACs group and the warfarin group. Univariate analysis of clinical factors was performed according to the development of new CMBs; and age, a HAS-B(L)ED score, warfarin use, and the presence of baseline CMBs were then selected for inclusion in the multivariate logistic regression model.

A total of 72 AF patients were recruited, 29 of whom were assigned to the NOACs group and 43 to the warfarin group. Finally, 1 patient in the NOACs group (3.4%) and 9 patients (20.9%) in the warfarin group developed new CMBs after 1 year follow-up (P = .08). Univariate analysis showed that age, a HAS-B(L)ED score ≥4, the presence of baseline CMBs were associated with the development of new CMBs (P < .05). And multivariate regression analysis showed baseline CMBs (P = .03, odds ratio = 6.37, 95% confidence interval 1.15–35.36) was independently related to the increase in new CMBs.

AF patients treated with NOACs may have a decreased trend in the development of new CMBs compared with those treated with warfarin. Baseline CMBs increased the frequency of new CMBs during anticoagulant treatment. The development of new CMBs in AF patients with anticoagulation requires further longitudinal studies with longer follow-up in larger samples.
A group-based mental health intervention for Tanzanian youth living with HIV
Authors: Hosaka Kalei R.J. , Mmbaga Blandina T. , Shayo Aisa M. , Gallis John A. , Turner Elizabeth L. , O’Donnell Karen E. , Cunningham Coleen K. , Boshe Judith , Dow Dorothy E.
Published: April 2022

Background:

Youth living with human immunodeficiency virus (YLWH) are vulnerable to incomplete adherence to antiretroviral therapy in the context of stigma, decreased hope for future, and mental health challenges. Despite these challenges, few mental health interventions have been developed to support YLWH. Previous randomized results from the Sauti ya Vijana (SYV; “The Voice of Youth”) mental health intervention were indicative of the intervention's benefits in promoting virologic suppression.

Methods:

SYV is a group-based mental health and life skills intervention (pilot, individually randomized group treatment trial) developed alongside YLWH. SYV was comprised of 10, 90-minute sessions based on evidence-based treatment models designed to improve coping, social support, and hope for future as a pathway to improved adherence and virologic suppression. At baseline, YLWH 12 to 24 years of age were randomized to SYV or standard of care. Participants included in this secondary analysis were enrolled in SYV's crossover waves due to either being randomized to standard of care or inability to attend an earlier group, and therefore delayed intervention exposure. Measured outcomes included self-reported mental health measures, self-reported human immunodeficiency virus measures (stigma and adherence), and human immunodeficiency virus ribonucleic acid. Data was collected at baseline, preintervention, and postintervention timepoints. Participants were included if they attended a crossover wave and had data at all 3 timepoints.

Results:

Twenty-one crossover participants met inclusion criteria. Mean scores of self-reported mental health questionnaires were in an asymptomatic range both pre- and postintervention. Viral suppression was N = 15 (71%) preintervention compared to N = 17 (81%) postintervention. The participants who became virologically suppressed had no change in antiretroviral therapy.

Conclusions:

Despite the small sample size, findings from this study demonstrate that mental wellbeing may be an important pathway to improved HIV outcomes for YLWH. The same trend toward virologic suppression pre- to postintervention was demonstrated in the randomized pilot trial and suggests that SYV holds promise to improve HIV outcomes. Data from this analysis support the fully powered trial that is now underway.
The predictors of necrotizing enterocolitis in newborns with low birth weight
Authors: Tan Xuerong , Zhou Yunxia , Xu Lan , Zhang Li , Wang Jiaying , Yang Wenqiong
Published: April 2022

There are needs to investigate the influencing factors of necrotizing enterocolitis (NEC) in low birth weight (LBW) newborns, to provide insights into the clinical management of NEC.

This study was a retrospective cohort study. Infants admitted to our hospital from January 1, 2019 to June 30, 2021 were selected. The clinical characteristics of NEC and no-NEC infants were evaluated. Logistic regression analyses were conducted to assess the risk factors of NEC in LBW infants.

A total of 192 LBW infants were included, the incidence of NEC in LBW infants was 35.42%. There were significant differences in the congenital heart disease, sepsis, breastfeeding, blood transfusion and probiotics feeding between NEC and no-NEC group (all P < .05), and there were no significant differences in birth weight, gestational age, mother's pregnancy-induced hypertension, premature rupture of fetal membrane, amniotic fluid pollution, fetal asphyxia, neonatal respiratory distress syndrome and mechanical ventilation between NEC and no-NEC group (all P > .05). Congenital heart disease (OR: 2.128, 95% CI: 1.103–3.511), sepsis (OR: 1.630, 95% CI: 1.022–2.549), and blood transfusion (OR: 1.451, 95% CI: 1.014–2.085) were the independent risk factors for NEC in LBW infants, and breastfeeding (OR: 0.494, 95% CI: 0.023–0.928), probiotics feeding (OR: 0.816, 95% CI: 0.782–0.982) were the protective factors for the NEC in LBW infants. The prognosis of NEC infants undergone surgery treatment was better than that of infants undergone conservative treatments (P = .043).

The incidence of NEC in LBW is high, which is affected by many factors, and comprehensive interventions targeted on the risk and protective factors should be made to improve the prognosis of LBW infants.
Two cases of fatal methemoglobinemia caused by self-poisoning with sodium nitrite
Authors: Mun Sung Hoon , Park Gwan Jin , Lee Ji Han , Kim Young Min , Chai Hyun Seok , Kim Sang Chul
Published: April 2022

Rationale:

Sodium nitrite intoxication reportedly causes severe methemoglobinemia. Recent studies reported that most clinically significant cases resulted from intentional exposure in suicidal attempts. We describe 2 cases of severe methemoglobinemia secondary to intentional sodium nitrite intoxication in suicidal attempts.

Patients concerns:

A 26-year-old man and 20-year-old woman attempted suicide by taking sodium nitrite, and were brought to the emergency department.

Diagnosis:

The male patient collapsed at the scene. He ingested approximately 18 g of sodium nitrate, and his methemoglobin level was 90.3%. The female patient was conscious, but was cyanotic. She ingested approximately 12.5 g of sodium nitrite, and her methemoglobin level was 54.6%.

Interventions:

The male patient received advanced cardiac life support in the emergency department. Methylene blue was immediately administered for the female patient.

Outcomes:

The male patient died despite aggressive resuscitation. The female patient's cyanosis resolved, and her methemoglobin level decreased to 1.2% 3 hours later.

Lessons:

The immediate administration of methylene blue in severe methemoglobinemia patients prevented fatal consequences. The public should be informed about the accessibility and toxicity of sodium nitrite.
Membranous nephropathy without vacuolated podocytes in Fabry disease treated with agalsidase-β and carbamazepine
Authors: Kanai Takahiro , Ito Takane , Aoyagi Jun , Yamagata Takanori
Published: April 2022

Rationale:

Vacuolated podocytes are the most common form of renal damage in Fabry disease, but other types of renal damage have been reported, such as membranous nephropathy (MN) or IgM nephropathy. Enzyme replacement therapy (ERT) is effective at preventing renal damage, but the nephropathies require appropriate treatment to prevent renal damage.

Patient concerns:

A 22-year-old male with Fabry disease presented with proteinuria during ERT with agalsidase-β and carbamazepine. He had received the treatment for 10 years and maintained normal plasma globotryaosylceramide levels.

Diagnosis:

Renal biopsy revealed MN without vacuolated podocytes. Immunofluorescent staining of the IgG subclass revealed granular patterns of IgG1, G2, G4, and C3 deposition in the glomerular basement membrane.

Interventions:

The carbamazepine dose was reduced from 600 mg/day to 200 mg/day (serum concentration 10.0-11.0–4.0–5.0 μg/mL).

Outcomes:

After reducing the carbamazepine dose, proteinuria was negative, and the patient has had a normal urinalysis for 17 months. Plasma globotryaosylceramide levels have also remained normal.

Lessons:

This report is a reminder of the co-existence of MN without vacuolated podocytes in Fabry disease during ERT with agalsidase-β and carbamazepine.

Physicians should be aware of this form of renal damage in Fabry disease, even during treatment.
The effectiveness of acupoint herbal patching for constipation after stroke
Authors: Yuan Yue , Gao Ying , Ding Zihui , Qiao Ying , Xu Sanpeng , Tang Zhe , Liao Ying , Li Ping
Published: April 2022

Background:

Constipation is one of the common problems in stroke patients, which seriously affects the life quality of patients and even leads to the recurrence of cerebrovascular disease. The clinical trials of acupoint herbal patching (AHP) in the adjuvant treatment of constipation after stroke (CAS) is currently in progress. However, there is no systematic review or meta-analysis to evaluate the effects of AHP on CAS.

Methods:

We will search articles in 8 electronic databases including the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, Wanfang Database, and the Chinese Scientific Journal Database for randomized controlled trials of CAS treated by AHP from their inception to November 1, 2021. The primary outcome measures will be clinical effective rate, defecation frequency, improvement of clinical symptoms including complete spontaneous bowel movements. The data meeting the inclusion criteria were analyzed by RevMan V.5.4 software. Two authors evaluated the study using the Cochrane collaborative risk bias tool. We will use a scoring method to assess the overall quality of evidence supporting the main results.

Results:

This study will analyze the clinical effective rate, defecation frequency, improvement of clinical symptoms including complete spontaneous bowel movements after stroke.

Conclusion:

The findings of this systematic review will provide evidence to evaluate the effectiveness and safety of AHP for CAS.

INPLASY registration number:

INPLASY202210065.
Improvement in social anxiety following a return-to-work intervention for patients with depression
Authors: Okamoto Yoko , Takanashi Rieko , Sutoh Chihiro , Domon Yuki , Yamada Mayuko , Baba Yoko , Aya Chiaki , Yamanouchi Naoto , Sasaki Hajime , Shimizu Eiji
Published: April 2022

Purpose:

To retrospectively examine depression and social anxiety improvement in patients on sick leave due to depression who participated in a return-to-work intervention (RTW-I) program.

Methods:

Patients visited a psychiatric outpatient clinic simulating workplaces to learn recurrence prevention skills through RTW-Is, including group cognitive behavioral therapy, from April 1, 2013, to September 30, 2017. The Beck Depression Inventory-Second Edition (BDI-II), Social Adaptation Self-Evaluation Scale (SASS), and Liebowitz Social Anxiety Scale (LSAS) scores of 112 patients were analyzed before and after the intervention program. Missing postprogram data were substituted using the last observation carried forward scores. Next, 45 patients who responded to the work continuity survey 1 year after RTW-I were categorized into Group A (patients who continued working: 37) and Group B (those who did not continue: 8).

Results:

The mean BDI-II scores significantly decreased from preintervention 19.4 to postintervention 7.9 (t = 13.303, P < .001). The mean SASS scores significantly increased from preintervention 31.9 to postintervention 36.0 (t = −5.953, P < .001). The mean LSAS scores significantly decreased from preintervention 54.7 to postintervention 37.0 (t = 8.682, P < .001), and all scores demonstrated an improvement. Patients who continued working showed improved depressive and social anxiety symptoms. The BDI-II and SASS scores showed no significant differences between the groups, but the postintervention LSAS scores were significantly different (P = .041). LSAS score changes: Group A = −26.2; Group B = −9.8; estimated difference: −17.920, 95% CI: −32.181 to −3.659, P = .015.

Conclusions:

The RTW-I program improved depressive and social anxiety symptoms. Patients with improved scores continued working for 1 year after the intervention.

Trial registration: This trial was retrospectively registered with the UMIN Clinical Trial Registry (UMIN-CTR) (ID: UMIN000037662) on August 10, 2019.
Diagnostic significance of long non-coding RNAs expression in tuberculosis patients
Authors: Zhong Xiaoling , Guo Qin , Zhao Jing , Li Yinyue , Li Xue , Ren Min , Shu Min
Published: April 2022

Objectives:

It is crucial to identify effective diagnostic biosignatures of tuberculosis (TB) to optimize its treatment. Herein, we conducted a systematic review to elucidate the diagnostic efficacy of long noncoding RNA (lncRNAs) as TB biomarkers.

Methods:

We searched Medline, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, VIP, and China Biology Medicine disc databases up to February 18, 2020. These studies focusing on lncRNAs as diagnosis markers of TB were collected. STATA 12.0 and Meta-disc1.4 software were used to analyze the data extracted from eligible studies.

Results:

We included 8 articles with 1058 TB patients, and 1896 healthy controls in our study. The values of pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.63, 0.86, 4.48, 0.43, and 10.31, respectively. Additionally, we plotted the summary receiver operating characteristic curve to evaluate the diagnostic accuracy, and the area under the curve was 0.80.

Conclusion:

The present study is the first meta-analysis to assess the diagnostic accuracy of lncRNAs in TB patients. We found that lncRNAs might constitute potential biomarkers for the diagnosis of TB patients. More population-based high-quality research should be conducted to validate the efficacy lncRNAs in TB patients.
The effectiveness of Tuina in managing chronic non-specific low back pain
Authors: Zhou Xuan , Yang Juan , Ma Qing-yu , Guo Yu , He Ke-jie , Shen Long-bin , Fan Qiao , Philip Cheong Kwok Chee , Keng Tay Boon , Celia Tan Ia Choo , Bauer Brent A. , Chen Jia-xu
Published: April 2022

Background:

Chronic non-specific low back pain (CNLBP) is a common complaint about medical care and carries a heavy social burden. The efficacy of Tuina (TN) or physiotherapy (PT) for CNLBP has been evaluated in previous systematic reviews. However, there is no high-quality evidence to support the efficacy of Tuina. Therefore, this study aims to conduct a large-scale, multicenter, high-quality clinical trial to provide evidence for Tuina to treat CNLBP.

Methods:

This is a multicenter, assessor-, and analyst-blinded, randomized controlled trial with 3 parallel arms: TN, PT, and TN combined with PT (Tuina combined with physiotherapy) group. Six hundred twelve eligible CNLBP patients will be randomly assigned to the groups in a 1:1:1 ratio in 3 centers. The TN intervention includes 9-step routine techniques, while the PT intervention includes a physiotherapy treatment plan based on a patient's symptoms. The interventions for both groups will last for 30 minutes and will be carried out for 6 sessions in 8 weeks. The primary outcome will be the visual analog scale pain score. And the secondary outcomes will include the Oswestry Disability Index, spinal range of motion, 36-item short-form health survey. Safety evaluation will be recorded during the whole study. All data in this randomized controlled trial will be analyzed by SAS 9.4.

Discussion:

The results of this trial will provide evidence to evaluate the efficacy of Tuina's value as a treatment for CNLBP.

Trial registration:

Chinese Clinical Trial Registry (ChiCTR2000040288, November 27, 2020).
Efficacy and safety of rt-PA intravenous thrombolysis in patients with wake-up stroke
Authors: Liu Hongfa , Hu Weihua , Zhang Fang , Gu Wei , Hong Jiankun , Chen Jianping , Huang Ying , Pan Huoying
Published: April 2022

Background

: Recombinant tissue plasminogen activator (rt-PA) is one of the most effective therapies for patients with acute ischemic stroke. However, wake-up stroke (WUS) is typically excluded from intravenous thrombolytic therapy because of the unclear time of symptom onset. Therefore, we aimed to assess the efficacy and safety of rt-PA intravenous thrombolysis in patients with WUS by meta-analysis.

Methods

: We completed a systematic literature search of PubMed, Embase, the Cochrane Library, and SinoMed and included relevant studies of WUS patients covering rt-PA thrombolysis and nonthrombolysis (published from January 1, 2000, to February 28, 2021, with no language restrictions). The primary outcomes included safety outcomes and functional outcomes. Safety outcomes were measured according to the incidence of symptomatic intracranial hemorrhage and mortality within 90 days. The efficacy outcomes were measured based on 90-day modified Rankin Scale scores. We assessed pooled data using either a random-effects model (when P < .10, I
2 > 50%) or a fixed-effects model (when P > .10, I
2 < 50%).

Results

: A total of 913 patients from 9 studies were included in the meta-analysis. All patients had ischemic stroke confirmed by computed tomography or magnetic resonance imaging. The incidence of modified Rankin Scale 0 to 2 was significantly higher in the rt-PA thrombolysis group compared with the nonthrombolysis group. And rt-PA thrombolytic WUS patients did not differ significantly from nonthrombolytic WUS patients in terms of 90-day mortality. However, the incidence of Symptomatic intracranial hemorrhage was also significantly higher in the rt-PA thrombolysis group than that in the nonthrombolysis group.

Conclusions

: Patients with WUS who received rt-PA thrombolysis had a significant positive effect within 90 days. In addition, although there was no significant increase in mortality, we need to be aware of the risk of intracranial hemorrhage transformation associated with rt-PA thrombolysis despite no obvious increase in mortality. The safety of rt-PA intravenous thrombolysis should be closely monitored in patients with WUS.
The influence of weightlifting belts and wrist straps on deadlift kinematics, time to complete a deadlift and rating of perceived exertion in male recreational weightlifters
Authors: Fong Shirley S.M. , Chung Louisa M.Y. , Gao Yang , Lee Jeff Chak Wai , Chang Tak Ching , Ma Ada W.W.
Published: April 2022

Both weightlifting belts and wrist straps are commonly used weightlifting training aids but their effects on deadlift kinematics and performance were still not known. This study examined the effects of weightlifting belts and wrist straps on the kinematics of the deadlift exercise, time to complete a deadlift and rating of perceived exertion (RPE) in male recreational weightlifters.

This study used a repeated-measures, within-subjects design. Twenty male healthy recreational weightlifters (mean age ± standard deviation = 23.1 ± 2.5 years) were recruited from 2 local gyms and the Education University of Hong Kong between January and April 2021. All participants used various combinations of belt and straps during a conventional deadlift. The hip and knee flexion, cervical lordosis, thoracic kyphosis and lumbar lordosis angles and time to complete a deadlift were measured using video analysis software. RPE was also recorded.

Wearing both a belt and wrist straps was found to reduce knee flexion angle (P < .001), but not hip flexion angle (P > .05), during the setup phase of the deadlift compared to wearing no aid. Wearing straps alone exaggerated thoracic kyphosis in the lockout phase of the deadlift compared to wearing a belt alone (P < .001). No changes were seen in cervical and lumbar lordosis angles when using any or both of the weightlifting aids. Additionally, the participants completed deadlifts faster when wearing both a belt and straps (P = .008) and perceived less exertion when wearing a belt and/or straps (P < .001).

Weightlifting belts and wrist straps, when using together, have positive effects on the kinematics of deadlift, time to complete a deadlift and RPE in male recreational weightlifters. Trainers should recommend the use of a belt and straps together, but not straps alone, to recreational weightlifters when performing deadlift training.
Observer experience and accuracy of 18F-sodium-fluoride PET/CT for the diagnosis of bone metastases in prostate cancer
Authors: Zacho Helle D. , Ravn Søren , Ejlersen June A. , Fledelius Joan , Dolliner Peter , Nygaard Sofie T. , Holdgaard Paw C. , Lauridsen Jeppe F. , Haarmark Christian , Hendel Helle W. , Petersen Lars J.
Published: April 2022

Objective

To evaluate the diagnostic accuracy of observers with different levels of experience in reading 18F-sodium fluoride (NaF) PET/CT images for the diagnosis of bone metastases in prostate cancer (PCa) patients.

Methods

Nine observers with varying NaF PET/CT experience, ranging from no experience to 2000+ examinations, evaluated 211 NaF PET/CT scans from PCa patients participating in one of four prospective trials. Each observer evaluated each NaF PET/CT on a patient level using a trichotomous scale: M0 (no bone metastases), Me (equivocal for bone metastases) and M1 (bone metastases). Subsequently, a dichotomous evaluation was conducted (M0/M1). The final diagnosis was retrieved from the original study. For each observer, ROC curves and the diagnostic accuracy were calculated based on dichotomous and trichotomous scales; in the latter case, Me was first regarded as M1 and then M0.

Results

Across all experience levels, the sensitivity, specificity and accuracy using the dichotomous scale ranged from 0.81 to 0.89, 0.93 to 1.00 and 0.91 to 0.94, respectively. Employing the trichotomous scale, novice and experienced observers chose Me in up to 20 vs. 10% of cases, respectively. Considering Me as M0, the sensitivity, specificity and accuracy ranged from 0.78 to 0.89, 0.95 to 1.00 and 0.91 to 0.95, respectively. Considering Me as M1, the sensitivity, specificity and accuracy ranged from 0.86 to 0.92, 0.71 to 0.96 and 0.77 to 0.94, respectively.

Conclusion

Novice observers used the equivocal option more frequently than observers with NaF PET/CT experience. However, on the dichotomous scale, all observers exhibited high and satisfactory accuracy for the detection of bone metastases, making NaF PET/CT an effective imaging modality even in unexperienced hands.
Effect of dual-task training on gait and balance in stroke patients: A updated meta-analysis
Authors: Shu Yue , Bi Meng meng , Zhou Tian tian , Liu Lin , Zhang Chao
Published: April 2022

Objective

The main purpose of this meta-analysis was to evaluate the effect of dual-task training on gait and balance improvement in stroke patients.

Design

The PubMed, EMBASE, Cochrane Library, MEDLINE, CINAHL, CNKI, Wan Fang, and VIP databases were searched from inception to January 28, 2021, for randomized controlled trials (RCTs) investigating the effect of dual-task training on gait and balance intervention in stroke patients.

Results

A total of seventeen studies with 575 stroke patients that compared the efficacy and safety of dual-task training to conventional physical therapy or single-task training were included in this meta-analysis. The meta-analysis showed that the data were as follows under the dual-task training: step length [MD (Mean Difference) =2.7, 95%CI(1.33, 4.08), P = 0.0001]; cadence [MD = 5.06, 95%CI(3.37, 6.75), P < 0.00001]; stride length [MD = 7.34, 95%CI (5.47, 9.22), P < 0.00001]; Ten-meter walk test times (10MWT) [MD = -2.36, 95%CI(-3.70, -1.02), P = 0.0006]; Berg Balance Scale (BBS) [MD = 3.8, 95% CI (0.04, 7.55), P = 0.05]; Fugl-Meyer motor assessment of lower extremities (FMA-LE) [MD = 2.27, 95% CI (-1.04, 5.59), P = 0.18].

Conclusions

This meta-analysis showed that dual-task training can improve stroke patients’ step length, cadence, stride length, and ten-meter walk test, However, possible advantages in improving balance function need further exploration.