bluuebunny/crossref_metadata_2025 huggingface dataset:
Common Iliac Artery to Below-Knee Popliteal Artery Bypass via Obturator Foramen in a Third-Time Reoperative Groin for Limb Salvage in Chronic Limb-Threatening Ischemia
Authors: Pratt Brittaney , Thompson Jamie , Peshel Emanuela C. , Herur-Raman Aalap , Nguyen Bao-Ngoc , Lala Salim
Published: May 2023

This case report presents the management of a 69-year-old man with an extensive history of peripheral vascular disease including 2 previous failed right femoral to distal bypasses and a left above-the-knee amputation who presented with right lower extremity rest pain and non-healing shin ulcers. A redo bypass was performed for limb salvage via the obturator foramen to avoid his extensively scarred femoral region. The postoperative course was uneventful and the bypass remained patent in the early period. This case demonstrates the usefulness of the obturator bypass to provide revascularization and avoid amputation in a patient with chronic limb-threatening ischemia and multiple failed bypasses.
Feasibility of Robotic Mitral Valve Repair Using Barbed Nonabsorbable Sutures: A Preliminary Single-Center Experience
Authors: Round Kellen J. , Yost Colin C. , Rosen Jake L. , Haenen Filip W. N. , Komlo Caroline M. , Wong Daniella H. , Mandel Jenna L. , Prochno Kyle W. , Ott Nathan Y. , Guy T. Sloane
Published: May 2023

Objective:

Barbed nonabsorbable sutures have been widely adopted for tissue closure in noncardiac robotic surgery to improve intraoperative efficiency. Here, we examine the profile in robotic mitral valve repair (rMVR), which utilized barbed nonabsorbable sutures. To our knowledge, this is the first report to describe clinical outcomes for rMVR with barbed nonabsorbable sutures.

Methods:

A retrospective review identified 90 patients who underwent rMVR using barbed nonabsorbable sutures at our center between 2019 and 2021. The primary outcome measure was dehiscence, while other relevant outcomes included 30-day readmission and 30-day mortality.

Results:

In addition to fixation of the mitral annuloplasty band, barbed nonabsorbable sutures were employed commonly in concomitant pericardiectomy closure (100.0%, 90 of 90), atriotomy closure (100.0%, 90 of 90), and left atrial appendage closure (if eligible; 98.8%, 83 of 84). One patient who underwent mitral valve annuloplasty using only barbed nonabsorbable suture required reoperation for annuloplasty ring dehiscence. Immediate postoperative ring dehiscence was not observed in any patients after the routine reinforcement of barbed nonabsorbable sutures with everting pledgeted polyester sutures, and no additional patients required reoperation for suture-related complications. Clinical signs of dehiscence were not observed after pericardiectomy, atriotomy, or left atrial appendage closure with barbed nonabsorbable sutures. The 30-day readmission rate was 3.3% (3 of 90), and 30-day mortality was 0% (0 of 90).

Conclusions:

These data suggest the initial feasibility of barbed nonabsorbable sutures in robotic cardiac surgery, specifically within rMVR. Further research is necessary to explore the long-term safety and efficacy profile of such approach.
Acute carotid stenting plus aspirin during thrombectomy of tandem occlusions: A matched case-control study
Authors: Yahia Mohamed-Ismaël , Marnat Gaultier , Finitsis Stephanos , Sibon Igor , Olivot Jean-Marc , Pop Raoul , Anadani Mohammad , Richard Sébastien , Gory Benjamin
Published: May 2023

Background and purpose

Acute carotid artery stenting (CAS) for ischemic stroke patients with anterior circulation tandem occlusion requires periprocedural antiplatelet therapy to prevent stent thrombosis. However, due to the lack of randomized trials and inconsistent published results, there is no reliable information regarding the safety of additional antiplatelet treatment. Therefore, we compared the safety and functional outcomes of patients treated with acute CAS plus Aspirin during tandem occlusions thrombectomy with isolated intracranial occlusions patients treated with thrombectomy alone.

Methods

Two prospectively acquired mechanical databases from August 2017 to December 2021 were reviewed. Patients were included if they had carotid atherosclerotic tandem occlusions treated with acute CAS and Aspirin (intravenous bolus 250 mg) during thrombectomy. Any antiplatelet agent was added after thrombectomy and before the 24-h control imaging. This group was compared with a matched group of isolated intracranial occlusions treated with thrombectomy alone.

Results

A total of 1557 patients were included and 70 (4.5%) had an atherosclerotic tandem occlusion treated with acute CAS plus Aspirin during thrombectomy. In exact coarse matched weight adjusted analysis, the rate of symptomatic intracerebral hemorrhage was similar in both groups (OR, 3.06; 95% CI, 0.66–14.04; P = 0.150), parenchymal hematoma type 2 (OR, 1.15; 95% CI, 0.24–5.39; P = 0.856), any intracerebral hemorrhage (OR, 1.84; 95% CI, 0.75–4.53; P = 0.182), and 90-day mortality (OR, 0.79; 95% CI, 0.24–2.60; P = 0.708). Rates of early neurological improvement and 90-day modified Rankin Scale score 0–2 were comparable.

Conclusions

Acute CAS plus Aspirin during thrombectomy for tandem occlusion stroke appears safe. Randomized trials are warranted to confirm these findings.
Venous balloon test occlusion for pulsatile tinnitus assessment: A clinical feasibility study
Authors: Charbonnier Guillaume , Cancelliere Nicole Mariantonia , Rustici Arianna , Araújo André , Vanek Irene , Rutka John , Bengzon Diestro Jose Danilo , Marotta Tom , Spears Julian , Mendes Pereira Vitor
Published: May 2023

Background

Pulsatile tinnitus (PT) can have huge impact on the patients’ quality of life and can be associated with curable vascular anomalies. In the present study, we aim firstly to describe our protocol for venous BTO and secondly to report possible predictors for a positive BTO test.

Methods

All consecutive PT patients undergoing BTO for the purpose of determining eligibility for venous neuro-intervention were included. We recommend BTO for patients when there is uncertainty in the association of the venous pathology identified on non-invasive cross-sectional imaging (CTV or MRV) and the patient's symptoms.

Results

Between May 2016 and October 2022, we recorded 29 venous balloon test occlusions fulfilling our inclusions criteria. Over the 29 procedures scheduled, 8 finally did not lead to a successful balloon test occlusion. The main reason was that the patient did not hear the PT on the day the angiogram was performed. Two patients could not have the BTO due to difficulties in venous navigation. After BTO, only four patients of our cohort were scheduled for an endovascular treatment.

Conclusion

We describe a technique and present a single cohort of venous BTO in severe PT patients with unclear anatomical cause. This angiographic test was useful to exclude patients from endovascular surgery and discuss the most probable cause of the PT. Complexity of vascular PT should support a patient-based approach when discussing interventional treatment.
Optimal study of the Initial Track Tension for the track vehicle under soft ground based on multiple operating conditions
Authors: Weiwei Liu , Kai Cheng , Jiang Liu
Published: May 2023

The determination of Initial Track Tension (ITT) is an important issue for the moving performance of tracked vehicle under soft ground. At the present time, however, the selection of ITT only according to a moving performance or an operating condition under hard ground. Focus on this, a novel approach for determination of ITT without changing the basic vehicle parameters is proposed in this paper, which can improve the moving performance under soft ground comprehensively. Analytical models for predicting ground pressure under tracked vehicle on soft ground including ITT were used based on the track-soil coupling relationship, movement characteristics and turning characteristics of an articulated track vehicle, which applied to the straight driving condition, steering-driving condition and climbing condition. The intrinsic mechanisms between the ITT and the Mean Maximum Pressure (MMP) under roadwheels were revealed. The stresses produced by the action of track and sprocket, roadwheels, idle wheel, soil respectively were studied in consideration of the vehicle-soil mechanics theory and strength theory. The stress state and changes for an element of the track were investigated. What’s more, the relationship between the ITT and fatigue life of the track was explained in detail based on the Miner’s rule. On this basis, an optimal study for the ITT was performed taking advantage of NSGAII, which used the MMP under roadwheels and fatigue life of track as optimization objectives. And then, the determination principles of the ITT were presented, and it was identified by an articulated track vehicle. The results are significant to the prediction and control of the moving performance of track vehicle under soft ground.
Co-Administration of nalbuphine to improve morphine tolerance in mice with bone cancer pain
Authors: Ren Bingxu , Zhang Jiannan , Yang Xiaohu , Sun Dapeng , Sheng Duanyang , Fang Qiang , Ji Zhonghua
Published: May 2023

Background

Kappa-opioid receptor (KOR) agonists are known for having opposite and/or different effects compared with Mu-opioid receptor (MOR) agonists. This study is aimed at clarifying the analgesic effect and tolerance of nalbuphine combined with morphine, and quantifying the mRNA and protein expression of spinal MOR and KOR in a mouse bone cancer pain (BCP) model treated with nalbuphine and morphine.

Method

BCP model was prepared in C3H/HeNCrlVr Mice by implanting the sarcoma cells into the intramedullary space of the femur. The paw withdrawal thermal latency (PWL) measured by thermal radiometer was used to assess thermal hyperalgesia. PWL testing was performed after implantation and drug administration according to the protocol. Hematoxylin-eosin staining in the spinal cord and x-ray in the femoral intramedullary canal was detected. Real-time PCR and western blot analysis played a role in detecting spinal MOR and KOR expression changes.

Results

In tumor-implanted mice, the spinal MOR and KOR protein and mRNA expression was down-regulated when compared to that in sham-implanted mice ( p < 0.05). Morphine therapy can lead to a decrease in spinal μ receptor expression. Similarly, the nalbuphine therapy can lead to a decrease in the expression of κ receptor protein and mRNA at the spinal cord level ( p < 0.05). Morphine, nalbuphine, or nalbuphine co-administration with morphine all can extend the paw withdrawal thermal latency (PWL) to radiant thermal stimulation in tumor-implanted mice ( p < 0.05). Compared with the morphine treatment group, nalbuphine co-administration with morphine delayed the reduction of PWL value again ( p < 0.05).

Discussion

BCP itself may induce down-regulation of the spinal MOR and KOR expression. A low dose of nalbuphine co-administration with morphine led to the delayed emergence of morphine tolerance. The part of the mechanism may be due to the regulation of spinal opioid receptors expression.
Six years of the Angels Initiative: Aims, achievements, and future directions to improve stroke care worldwide
Authors: Caso Valeria , Martins Sheila , Mikulik Robert , Middleton Sandy , Groppa Stanislav , Pandian Jeyaraj Durai , Thang Nguyen Huy , Danays Thierry , van der Merwe Jan , Fischer Thomas , Hacke Werner
Published: May 2023

The rate of stroke-related death and disability is four times higher in low- and middle-income countries (LMICs) than in high-income countries (HICs), yet stroke units exist in only 18% of LMICs, compared with 91% of HICs. In order to ensure universal and equitable access to timely, guideline-recommended stroke care, multidisciplinary stroke-ready hospitals with coordinated teams of healthcare professionals and appropriate facilities are essential.

Established in 2016, the Angels Initiative is an international, not-for-profit, public–private partnership. It is run in collaboration with the World Stroke Organization, European Stroke Organisation, and regional and national stroke societies in over 50 countries. The Angels Initiative aims to increase the global number of stroke-ready hospitals and to optimize the quality of existing stroke units. It does this through the work of dedicated consultants, who help to standardize care procedures and build coordinated, informed communities of stroke professionals. Angels consultants also establish quality monitoring frameworks using online audit platforms such as the Registry of Stroke Care Quality (RES-Q), which forms the basis of the Angels award system (gold/platinum/diamond) for all stroke-ready hospitals across the world.

The Angels Initiative has supported over 1700 hospitals (>1000 in LMICs) that did not previously treat stroke patients to become “stroke ready.” Since its inception in 2016, the Angels Initiative has impacted the health outcomes of an estimated 7.46 million stroke patients globally (including an estimated 4.68 million patients in LMICs). The Angels Initiative has increased the number of stroke-ready hospitals in many countries (e.g. in South Africa: 5 stroke-ready hospitals in 2015 vs 185 in 2021), reduced “door to treatment time” (e.g. in Egypt: 50% reduction vs baseline), and increased quality monitoring substantially.

The focus of the work of the Angels Initiative has now expanded from the hyperacute phase of stroke treatment to the pre-hospital setting, as well as to the early post-acute setting. A continued and coordinated global effort is needed to achieve the target of the Angels Initiative of >10,000 stroke-ready hospitals by 2030, and >7500 of these in LMICs.
The relationship between neurological function trajectory, assessed by repeated NIHSS measurement, and long-term cardiovascular events, recurrent stroke, and mortality after ischemic stroke
Authors: Du Jigang , Wang Yan , Che Bizhong , Miao Mengyuan , Bao Anran , Peng Yanbo , Ju Zhong , Xu Tan , He Jiang , Zhang Yonghong , Zhong Chongke
Published: May 2023

Background:

Clinically significant changes in neurological deficits frequently occur after stroke onset, reflecting further neurological injury or neurological improvement. However, the National Institutes of Health Stroke Scale (NIHSS) score is only evaluated once in most studies, usually at stroke onset. Utilizing repeated measures of NIHSS scores to identify different trajectories of neurological function may be more informative and provide more useful predictive information. We determined the association of neurological function trajectories with long-term clinical outcomes after ischemic stroke.

Methods:

A total of 4025 participants with ischemic stroke from the China Antihypertensive Trial in Acute Ischemic Stroke were included. Patients were recruited from 26 hospitals across China between August 2009 and May 2013. A group-based trajectory model was used to identify distinct neurological function trajectories, as measured by NIHSS at admission, 14 days or hospital discharge, and 3 months. Study outcomes were cardiovascular events, recurrent stroke, and all-cause mortality during 3–24 months after ischemic stroke onset. Cox proportional hazards models were used to examine the associations of neurological function trajectories with outcomes.

Results:

We identified three distinct subgroups of NIHSS trajectories: persistent severe (persistent high NIHSS scores during the 3-month follow-up), moderate (NIHSS scores started at around 5 and gradually reduced), and mild (NIHSS scores always below 2). The three trajectory groups had different clinical profiles and different risk of stroke outcomes at 24-month follow-up. Compared to the mild trajectory group, patients in the persistent severe trajectory group had a higher risk of cardiovascular events (multivariable-adjusted hazard ratios (95% confidence intervals) = 1.77 (1.10–2.86)), recurrent stroke (1.82 (1.10–3.00)), and all-cause mortality (5.64 (3.37–9.43)). Those with moderate trajectory had an intermediate risk: 1.45 (1.03–2.04) for cardiovascular events and 1.52 (1.06–2.19) for recurrent stroke.

Conclusion:

Longitudinal neurological function trajectories derived from repeated NIHSS measurements during the first 3 months after stroke provide additional predictive information and are associated with long-term clinical outcomes. The trajectories characterized by persistent severe and moderate neurological impairment were associated with increased risk of subsequent cardiovascular events.
Reperfusion by endovascular thrombectomy and early cerebral edema in anterior circulation stroke: Results from the SITS-International Stroke Thrombectomy Registry
Authors: Thorén Magnus , Escudero-Martínez Irene , Andersson Tomas , Chen Shih-Yin , Tsao Nicole , Khurana Dheeraj , Beretta Simone , Peeters Andre , Tsivgoulis Georgios , Roffe Christine , Ahmed Niaz
Published: May 2023

Background:

A large infarct and expanding cerebral edema (CED) due to a middle cerebral artery occlusion confers a 70% mortality unless treated surgically. There is still conflicting evidence whether reperfusion is associated with a lower risk for CED in acute ischemic stroke.

Aim:

To investigate the association of reperfusion with development of early CED after stroke thrombectomy.

Methods:

From the SITS-International Stroke Thrombectomy Registry, we selected patients with occlusion of the intracranial internal carotid or middle cerebral artery (M1 or M2). Successful reperfusion was defined as mTICI ⩾ 2b. Primary outcome was moderate or severe CED, defined as focal brain swelling ⩾1/3 of the hemisphere on imaging scans at 24 h. We used regression methods while adjusting for baseline variables. Effect modification by severe early neurological deficits, as indicators of large infarct at baseline and at 24 h, were explored.

Results:

In total, 4640 patients, median age 70 years and median National Institutes of Health Stroke Score (NIHSS) 16, were included. Of these, 86% had successful reperfusion. Moderate or severe CED was less frequent among patients who had reperfusion compared to patients without reperfusion: 12.5% versus 29.6%, p < 0.05, crude risk ratio (RR) 0.42 (95% confidence interval (CI): 0.37–0.49), and adjusted RR 0.50 (95% CI: 0.44-0.57). Analysis of effect modification indicated that severe neurological deficits weakened the association between reperfusion and lower risk of CED. The RR reduction was less favorable in patients with severe neurological deficits, defined as NIHSS score 15 or more at baseline and at 24 h, used as an indicator for larger infarction.

Conclusion:

In patients with large artery anterior circulation occlusion stroke who underwent thrombectomy, successful reperfusion was associated with approximately 50% lower risk for early CED. Severe neurological deficit at baseline seems to be a predictor for moderate or severe CED also in patients with successful reperfusion by thrombectomy.
The perceived credibility of the Ethiopian private, federal and regional television channels
Authors: Wolde Bereket Wondimu , Woldearegay Amanuel Gebru
Published: May 2023

The detaining, arresting and holding of journalists for more than half a year without formal charges in addition to the war and conflict in Ethiopia between different ethnicities and regional states motivated these authors to explore rising issues of perceptions of media credibility in Ethiopia. The main focus of this study was to assess the audiences’ perceived credibility of the Ethiopian federal, regional and private television channels. The participants of this study were people living in two regional states and one capital city of Ethiopia (i.e. Amhara, Oromia and Addis Ababa). A total of 600 participants were chosen from the three places included in the survey, using snowball and convenience sampling techniques. The data were collected through the survey and analysed using non parametric statistics (Mann Whitney U Test, Wilcoxon Signed Rank Test, Kruskal Wallis Test and Wilcoxon Rank Sum Test) using SPSS version 26. Results indicated that the federal and private television channels enjoy more news and medium credibility than the regional television channels. However, the audiences’ perception of the credibility of journalists from the television channels of the federal, private and regional states showed no statistically significant difference. The results of the study suggest that the television organizations, journalists and policy designers need to work harder to bring credibility to the regional states television channels in addition to ensuring credibility to the federal and private television channels.
Viral Camus: Mapping cultural memory in the Covid era
Authors: Brutsche Vanessa
Published: May 2023

This article evaluates the place of The Plague in the emergent cultural memory of the COVID-19 pandemic, a time when the novel was said to have “gone viral” in popular culture. I ask what it means to reread The Plague in the current moment, a time characterized not just by a pandemic but by widespread unrest and social movements on both ends of the political spectrum. While rereadings of Camus in light of COVID-19 seem predicated on a turn away from the novel’s allegorical dimension, The Plague has taken on new metaphorical meanings in its Covid-era reception. Examining the proliferation of “readings” of the pandemic, in which the virus has been understood as a figure for collective social ills, this article highlights the place of Camus’s novel in the cultural memory of the crisis and proposes that it can illuminate some of the complex entanglements of our present.
Systematic review: efficacy of therapies for cholestatic pruritus
Authors: Ebhohon Ebehiwele , Chung Raymond T.
Published: May 2023

Background:

Pruritus is a symptom of several cholestatic liver diseases (CLDs) that can impair health-related quality of life (HRQoL). Despite evidence-based guideline therapy, managing cholestatic pruritus (CP) remains challenging, thus making the need for newer, more effective therapeutic agents more evident.

Objective:

Our study evaluated the efficacy of existing CP therapies.

Design:

Systematic review.

Data sources:

From inception until March 2023, we conducted a comprehensive search of MEDLINE, Cochrane, EMBASE, Scopus, ClinicalTrial.gov, and other sources, including pharmaceutical webpages and conference proceedings published in English that reported on CP interventions.

Methods:

Two reviewers independently conducted screening and full-text review of articles with extraction conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The methodological quality of studies included in our qualitative synthesis was assessed by using the Cochrane ROBINS-I and ROBINS-II tools for interventional studies and the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome assessed in our systematic review was the severity of CP after therapy.

Results:

Of 3293 screened articles, 92 studies were eligible for inclusion in the qualitative synthesis. Some patients’ HRQoL improved with evidence-based standard therapy. Others, particularly those with severe and refractory CP, often required conversion to or addition of experimental noninvasive (e.g., ondansetron) or extracorporeal liver support to alleviate CP. In addition, studies investigating a newer class drug, the ileal bile acid transporter inhibitor (IBATi), demonstrate its effectiveness in reducing serum bile acid and alleviating CP with sustained improvement noted in patients with the inherited childhood cholestatic disorders – progressive familial intrahepatic cholestasis and Alagille syndrome.

Conclusion:

Our findings consolidate data on the efficacy of guideline-based approaches and newer therapies for CP. While the initial findings are promising, additional clinical trials will be needed to determine the full extent of IBATi’s efficacy and potential use in treating other common CLDs. These results provide a foundation for future research and highlight the need for continued investigation into the management and treatment of CLDs.
The Role of Positron Emission Tomography for the Management of Sinonasal Malignancies: A Systematic Review
Authors: El-Adem David , Yang Nathan , Gudis David A.
Published: May 2023

Background

Positron emission tomography (PET) scan is a valuable imaging modality widely used in the management of cancers. Its usage is well defined for most head and neck malignancies. However, there is a lack of consensus regarding the utility of PET scan for sinonasal malignancies. This is highlighted by the latest international consensus statement on endoscopic skull base surgery.

Objective

This systematic review aims to clarify the role of PET scan in the management of sinonasal malignancies.

Methods

We conducted a comprehensive literature search using PubMed, MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane databases for research studies of interest. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) updated statement was used to guide the review.

Results

In total, 1807 articles were assessed for eligibility. Thirty-nine original papers, published between 2004 and 2021, met inclusion criteria. Seven articles focused on the role of PET scan for inverted papilloma, 23 for sinonasal carcinoma, 4 for melanoma, and 3 for lymphoma, and finally, 3 articles focused on the use of specific PET scan tracers for sinonasal malignancies. Qualitative summaries for each potential role of PET scans were provided. In general, included studies were retrospective in nature with low level of evidence.

Conclusions

In general, and across all types of sinonasal malignancies, PET scan yielded positive results regarding detection and initial staging. It was also considered as the modality of choice for detection of distant metastases, except in the case of sinonasal lymphoma. PET scan's main limit resides in its inability to detect lesions in or close to the metabolic activity of the brain.
Beyond the decolonial? Decolonial and Muslim feminist perspectives
Authors: Noxolo Patricia , Hamis Safiya
Published: May 2023

Sidaway's (2023) article article is provocative in its agenda to go beyond the decolonial. In this commentary, we consider the implications of this move in relation to decolonial geographies and Muslim feminism. We conclude by considering questions of identity and reflexivity that arise from decolonial and feminist perspectives.
Towards accountable digital geographies
Authors: Rivera Isaac
Published: May 2023

The proliferation and everywhereness of digital materialities, operations, and mediations require attention to the ways that colonial knowledge assumes access to Indigenous lands. In this commentary, I consider what an agenda for accountable digital geographies might look like. With the turn to (re)imagine the futures of geographical praxis, I invite a collective inquiry on how digital practices can work toward geographies of accountability and restitution on Indigenous lands with the aim of honoring the places, spaces, and communities in which geographical knowledge emerges. I suggest that decolonial and anticolonial methods redirect digital practices toward Land Back, re-orienting geographical knowledge to the affirmation of Indigenous life.
Medicinal cannabis for pain: Real-world data on three-month changes in symptoms and quality of life
Authors: O’Brien Kylie , Beilby Justin , Frans Michelle , Lynskey Michael , Barnes Michael , Jayasuriya Mihindu , Athanasiou-Fragkouli Alkyoni , Blair Philip , Nutt David
Published: May 2023

Background

Internationally, one of the most common conditions for which people seek medicinal cannabis (MC) is chronic pain. However, relatively little is known about the effectiveness of cannabis for reducing pain in Australia. Medicinal cannabis was made legally available in Australia in 2016. Project Twenty21 Australia is an observational study that follows patients prescribed MC for chronic pain, anxiety, PTSD and multiple sclerosis for up to 12 months. It commenced recruitment in February 2022. This paper describes some preliminary findings for a cohort of patients with chronic pain.

Method

Participants seeking treatment for chronic pain are prescribed MC from within a Project Formulary, and complete questionnaires at baseline then three monthly for up to 12 months. Pain severity and interference are assessed using the Brief Pain Index while standardised measures of quality of life, mood and sleep quality are also applied.

Results

By 30 November 2022, 55 participants with chronic pain had completed the first three-month follow-up. Patients reported a low quality of life and high levels of co-morbidity. Three-month data indicate that MC use was associated with significant reductions in self-reported pain intensity and pain interference (Effect sizes = 0.66 [95% CI = 0.34–0.98] and 0.56 [0.24–0.88], respectively). Additionally, there were significant improvements in quality of life, general health, mood/depression and sleep (Effect sizes = 0.53–0.63). One adverse reaction was reported which was mild in nature.

Conclusions

Preliminary evidence suggests that MC may be effective in reducing both pain severity and pain interference while also improving quality of life, general health, mood and sleep in patients with chronic pain. Increasing uptake of MC coupled with growing evidence of both the effectiveness and safety of these medications indicate a need both to make MC more widely available and to reduce financial costs associated with its use.
Prediction of therapeutic value of new drugs approved by health Canada from 2011−2020: A cross-sectional study
Authors: Lexchin Joel
Published: May 2023

Objectives

To examine whether a combination of three characteristics of new drugs – review type, outcome of premarket trials (surrogate or clinical) and first-in-class is associated with significant therapeutic value.

Design

Cross-sectional analysis of new drugs approved by Health Canada from January 1, 2011 to December 31, 2020.

Setting

Canada.

Participants

New drugs approved by Health Canada for which therapeutic evaluations, trial outcomes and first-in-class status was available.

Main outcome measures

Distribution of therapeutic value (major, moderate, little to no) depending on how many of the three characteristics were present for each drug.

Results

Health Canada approved 340 drugs of which 243 had data available for analysis. If all three characteristics were present 10 out of the 20 drugs had a major therapeutic rating. Conversely if none were present only 2 drugs out of 37 had a major therapeutic rating.

Conclusion

This study introduces a new evaluation method for determining whether new drugs will have major therapeutic value that appears to be more successful than relying only on the type of review that drugs receive.
Environmental determinants of infectious and chronic disease prevention behaviours: A systematic review and thematic synthesis of qualitative research
Authors: Thaivalappil Abhinand , Bhattacharyya Anit , Young Ian , Gosselin Sydney , Pearl David L , Papadopoulos Andrew
Published: May 2023

Regulatory health policies facilitate desired health behaviours in communities, and among them, smoke-free policies and COVID-19 restrictions have been widely implemented. Qualitative research studies have explored how these measures and other environmental influences shape preventive behaviours. The objective of this systematic review was to synthesize previously published qualitative research, generate across-study themes, and propose recommendations for behaviour change interventions. We used a comprehensive search strategy, relevance screening and confirmation, data extraction, quality assessment, thematic synthesis, and quality-of-evidence assessment. In total, 87 relevant studies were identified. Findings were grouped under six overarching themes and mapped under three categories: (i) the political environment, (ii) the sociocultural environment, and (iii) the physical environment. These findings provide insights into the environmental influences of behaviour and indicate future interventions may be more effective by considering moral norms, community norms, policy support, and group identity.
Investigating information needs and preferences regarding digital mental health services among medical and psychology students in Germany: A qualitative study
Authors: Braun Pia , Schwientek Ann-Kathrin , Angerer Peter , Guthardt Lisa , Icks Andrea , Loerbroks Adrian , Apolinário-Hagen Jennifer
Published: May 2023

Background

Since 2020, physicians and psychotherapists in Germany can prescribe digital mental health services (dMHSs). However, even future healthcare professionals (HCPs), such as medical and psychology students, remain reluctant to use dMHSs, although they are a risk group for mental health issues themselves. Reasons include scepticism and lacking awareness of dMHSs, which can be addressed by acceptance-facilitating interventions (AFIs) such as information strategies. To date, though, little is known about their information needs.

Methods

Semi-structured interviews with n = 21 students were conducted between August and September 2021. Students of legal age studying psychology or medicine at a German university could participate. Interview recordings were transcribed verbatim and content-analyzed according to Mayring, using deductive and inductive coding.

Results

Most students reported having little experience with dMHSs. Digital health has barely been raised in their study, even though it was perceived as crucial for personal needs as well as in preparation for their work as HCPs. Students favoured receiving information on and recommendations for dMHSs from their university via, e.g. social media or seminars. Among others, information about data safety, scientific evidence base and application scope were preferred. Additionally, information on costs as well as user reviews seemed to be essential components of information strategies because students were concerned that high costs or low usability would hinder uptake.

Conclusions

The results give first insights on how future HCPs would like to be informed on dMHSs. Future research should focus on systematic variations of AFIs' components mimicking real-world decision scenarios to increase the adoption of dMHSs.
The “Lazio ADVICE” telemedicine platform: First results of general practitioners’ usage, facilitators and barriers in the Local Health Authority Roma 1
Authors: Barbara Andrea , Villani Leonardo , Lombardo Paolo , Parente Paolo , Gemma Antonella , Angeletti Debora , Chiriaco Tiziana , Mastromattei Antonio , Akselrod Svetlana , Goletti Mauro , Rosa Enrico Di , De Vito Corrado
Published: May 2023

Background

Telemedical approaches represent a valuable tool for the management of coronavirus disease 2019 patients, allowing daily clinical assessment, monitoring of vital parameters, remote visits, and prescription of treatment or hospitalization in case of clinical worsening. This cross-sectional study aims to evaluate the use, barriers and facilitators of the “Lazio ADVICE” telemedical platform, a regional system for remote assistance for coronavirus disease 2019 patients at home, according to General Practitioners and Family Pediatricians of the Local Health Authority Roma 1, during the coronavirus disease 2019 pandemic.

Methods

An interview-based survey was performed between December 2020 and January 2021. The survey investigated the demographic information of General Practitioner and Family Pediatricians, the knowledge of the platform, frequency of utilization, usefulness, strengths and weaknesses, and hypothesis of future implementation proposed.

Results

We interviewed 214 physicians and 89 (41.6%) were classified as users and 125 (58.4%) as non-users. Older age and working in District 1, 14 and 15 (vs. District 13) significantly reduced the probability of using the platform physician. Among the 89 users, 19 (21.3%) used the platform every day or even several times a day, 40 (44.9%) several times a week but less than one access per day, 30 (33.7%) used the platform several times a month up to one entry per week. Most of them (92.3%) consider the platform useful. Barriers were poor integration with software and work routine (76.4%), and usability issues (53.9%). Among the 125 non-users, 14 (11.2%) didn’t know the existence of the platform, 60 (48.0%) never tried it and 51 (40.8%) tried to use it. Reported reasons for the interruption of use were not very user-friendly (45.1%), perceived useless (37.3%), non-optimal functioning (23.5%), and lack of time (19.6%).

Conclusion

The pandemic accelerated the implementation of telemedicine services around Lazio Region, starting a positive and continuous exchange of experiences, activities and best practices among physicians.
Management and Outcome of Elderly Patients With Patellar Fracture Treated With Novel Modified Cerclage Wiring
Authors: Li Lin , Zhang Qing , Tao Fulin , Wang Dawei , Dong Jinlei , Zhou Dongsheng , Song Wenhao
Published: May 2023

Introduction

The purpose of this study is to assess the efficacy and security of a fixation method for fixing patellar fractures in elderly patients utilizing modified cerclage wire.

Methods

From January 2015 to December 2020, 31 cases (age≥65 years old) of closed patellar fracture were treated by modified cerclage wiring. Patients in these instances ranged in age from 65 to 87 (73.7 ± 7.2 years), with 15 men and 16 women. 4 instances were type 34-C1 (transverse fracture) according to the AO/OTA classification, 27 cases (87%) were comminuted fractures, including 11 cases that were type 34-C2 (3 fragments), and 16 cases that were type 34-C3 (more than 3 fragments). Postoperative problems such as fragment re-displacement, nonunion, internal fixation loosening, infection, and internal fixation rupture were evaluated. The clinical grading systems of Böstman were used to assess the postoperative clinical outcomes.

Results

Thirty one patients in all were monitored for 14 to 31 months (22.2 ± 4.5 months). After the procedure, the fracture took 2.5-3.5 months (2.92 ± .25 months) to heal. There were no postoperative issues like infection, dislocation, implant breakage, uncomfortable hardware, or post-traumatic osteoarthritis. According to the clinical grading scales of Böstman, the average score of the final follow-up was 28.6 ± 1.1 (range 26-30). 29 (94%) of the patients had excellent results, whereas just 2 (6%) had good results. The patient’s knee flexion activity ranged from 110 to 140°, making for a favorable prognosis.

Conclusion

Most patella fractures in the elderly are comminuted. Elderly patients with patellar fractures may be successfully treated with modified cerclage wire, with good results and no noticeable side effects.
Job Satisfaction and Overcoming the Challenges of Teleworking in Times of COVID-19: A Pilot Study Among Iranian University Community
Authors: Ahmadi Fereshteh , Zandi Saeid , Khodayarifard Mohammad , Cetrez Önver A. , Akhavan Sharareh
Published: May 2023

The coronavirus pandemic changed the academic world in many ways, and most academic institutions continue operating through teleworking. The aim of the present study was to determine how satisfied the university community (faculty/staff members and students) in Iran has been with remote work, and the ways in which they have dealt with the lockdown and working from home during the coronavirus pandemic. A survey was conducted among 196 academics from different universities in Iran. The results show that a majority of our participants (54%) are very or somewhat satisfied with the current work-from-home arrangement. The most frequently used methods for managing the challenges of teleworking were social contacts with colleagues or classmates at a distance, solidarity and offering kindness and support to the people around them. The least used coping method was trusting state or local health authorities in Iran. The coping strategies that have the highest impact on overall teleworking satisfaction are “ Make myself busy with my working day because it makes me feel useful,”“ I care for my mental and physical health,” and “ Think about what I can do rather than what I can’t do.” The findings were discussed in detail, taking into consideration the theoretical approaches, as well as bringing forth more dynamic aspects of the culture.
Twenty years of assessment policies in China: A focus on assessing students’ holistic development
Authors: Luo Jiahui , Chan Cecilia KY
Published: May 2023

Over the past two decades, China has formulated a series of policies regarding how to assess students’ holistic development, aiming to transform its highly exam-oriented culture which traditionally emphasises knowledge transmission and book learning. Although the efforts have met with some success, various issues persist when bringing such policies into practice. This article has three goals — (1) to outline the 20 years of assessment policies of students’ holistic development under the holistic suzhi assessment scheme in China, (2) to explore how these policies have been translated into practice and the issues arose from practice, and (3) to discuss the potential implications for nurturing and assessing students’ holistic development in times of increasing uncertainties.
Opioid Use After Knee Arthroscopy in Adolescent Patients: A Prospective Evaluation
Authors: Steinmetz R. Garrett , Hamilton John M. , Moritz Brandon W. , Algan Sheila M.
Published: May 2023

Background:

There is a relative paucity of literature on how to best treat postoperative pain after knee arthroscopy in the adolescent population.

Purpose:

To evaluate the use of opioid medication after knee arthroscopy in adolescent patients.

Study Design:

Case series; Level of evidence, 4.

Methods:

We prospectively enrolled 50 patients aged 10 to 18 years who underwent 1 of the following procedures: diagnostic arthroscopy; plica excision; loose body removal; debridement; chondroplasty; meniscal repair; and/or partial meniscectomy. Patients already taking chronic pain medication and those undergoing revision knee arthroscopy, ligamentous reconstruction, or bony osteotomy procedures were excluded. Postoperatively, the patients were prescribed 15 tablets of hydrocodone/acetaminophen (5 mg/325 mg) every 6 hours as needed for pain. The patients were given a diary to record the number of postoperative opioid pills taken, days the pills were taken, pain level, and nonopioid pills taken. The data were collected and used to identify the mean number of opioid pills needed as well as the number of days opioid medication was needed postoperatively.

Results:

Of the 50 enrolled patients, 35 patients adequately completed the diary and were included in the study. The mean age in this cohort was 14.2 years. The total number of pills taken ranged from 0 to 14, with an overall mean of 5.41. Therefore, on average, patients utilized 36% of their postoperative prescriptions. In our cohort, 74.3% of patients had stopped taking opioids by postoperative day 3, with a mean of 3.8 pills, and 97.1% of patients had stopped taking opioids by postoperative day, 5 with a mean of 5.3 pills. No postoperative refills of opioid medication were necessary.

Conclusion:

After knee arthroscopy, the adolescents in our study consumed a mean of 5.41 opioid pills postoperatively, and over 97% of patients stopped opioid use by postoperative day 5. The results of this study should help in guiding physicians to avoid overprescribing opioid medication while treating postoperative pain after knee arthroscopy in this vulnerable patient population.
The US Immigration Courts, Dumping Ground for the Nation’s Systemic Immigration Failures: The Causes, Composition, and Politically Difficult Solutions to the Court Backlog
Authors: Kerwin Donald , Millet Evin
Published: May 2023

The US immigration court system seeks to “fairly, expeditiously, and uniformly administer and interpret US immigration laws” (DOJ 2022a). It represents the first exposure of many immigrants to due process and the rule of law in the United States, and occupies an integral role in the larger US immigration system. Yet it labors under a massive backlog of pending cases that undermines its core goals and objectives. The backlog reached 1.87 million cases in the first quarter of FY 2023 (Straut-Eppsteiner 2023, 6). This paper attributes the backlog to systemic failures in the broader immigration system that negatively affect the immigration courts, such as: Visa backlogs, United States Citizen and Immigration Services (USCIS) application processing delays, and other bottlenecks in legal immigration processes. The immense disparity in funding between the court system and the Department of Homeland Security (DHS) agencies that feed cases into the courts. The failure of Congress to pass broad immigration reform legislation that could ease pressure on the enforcement and court systems. The lack of standard judicial authorities vested in Immigration Judges (IJs), limiting their ability to close cases; pressure parties to “settle” cases; and manage their dockets. The absence of a statute of limitations for civil immigration offenses. Past DHS failures to establish and adhere to enforcement priorities and to exercise prosecutorial discretion (PD) throughout the removal adjudication process, including in initial decisions to prosecute. The location of the Executive Office for Immigration Review (EOIR), which oversees US immigration courts, within the nation’s preeminent law enforcement agency, the Department of Justice (DOJ). The misconception of many policymakers that the court system should primarily serve as an adjunct to DHS. A past record of temporary judge reassignments and government shutdowns.

The paper supports a well-resourced and independent immigration court system devoted to producing the right decisions under the law. Following a short introduction, a long section on “Causes and Solutions to the Backlog” examines the multi-faceted causes of the backlog, and offers an integrated, wide-ranging set of recommendations to reverse and ultimately eliminate the backlog. The “Conclusion” summarizes the paper’s topline findings and policy proposals.
The Relationship Between Social Interaction and Anxiety Regarding COVID-19 in Japanese Older Adults
Authors: Choe Hwang , Gondo Yasuyuki , Kasuga Ayaka , Masui Yukie , Nakagawa Takeshi , Yasumoto Saori , Ikebe Kazunori , Kamide Kei , Kabayama Mai , Ishizaki Tatsuro
Published: May 2023

While previous studies suggest that women have higher anxiety than men regarding COVID-19, underlying mechanisms remain unclear. This study tries to explain the mechanisms by gender difference in social interaction based on a theory of social amplification of risk framework (SARF). We surveyed older adults in Japan regarding their anxiety regarding COVID-19, as well as the frequencies of their direct and indirect social interaction in July 2020 ( N = 1,587, aged 78–99 years). To explore the way in which gender and anxiety regarding COVID-19 were mediated by these two types of social interactions, MODEL4 of SPSS’s Process MACRO was applied to the data. We found that older women interacted more directly and indirectly with others than did older men. And, direct social interaction was negatively and related, but indirect social interaction was positively related to older adults’ anxiety regarding COVID-19. Furthermore, direct social interaction was related to older women’s low anxiety regarding COVID-19, whereas indirect social interaction was related to older women’s high anxiety regarding COVID-19. The findings of our study suggest that the degree of anxiety regarding COVID-19 among older women may be dependent upon the types of social interaction they have with others.