bluuebunny/crossref_metadata_2025 huggingface dataset:
A public health value-based healthcare paradigm for HIV
Authors: Vermeersch Sebastian , Demeester Rémy P. , Ausselet Nathalie , Callens Steven , De Munter Paul , Florence Eric , Goffard Jean-Christophe , Henrard Sophie , Lacor Patrick , Messiaen Peter , Libois Agnès , Seyler Lucie , Uurlings Françoise , Vandecasteele Stefaan J. , Van Wijngaerden Eric , Yombi Jean-Cyr , Annemans Lieven , De Wit Stéphane
Published: January 2022

Background

HIV patients face considerable acute and chronic healthcare needs and battling the HIV epidemic remains of the utmost importance. By focusing on health outcomes in relation to the cost of care, value-based healthcare (VBHC) proposes a strategy to optimize quality of care and cost-efficiency. Its implementation may provide an answer to the increasing pressure to optimize spending in healthcare while improving patient outcomes. This paper describes a pragmatic value-based healthcare framework for HIV care.

Methods

A value-based HIV healthcare framework was developed during a series of roundtable discussions bringing together 16 clinical stakeholder representatives from the Belgian HIV reference centers and 2 VBHC specialists. Each round of discussions was focused on a central question translating a concept or idea to the next level of practical implementation: 1) how can VBHC principles be translated into value-based HIV care drivers; 2) how can these value-based HIV care divers be translated into value-based care objectives and activities; and 3) how can value-based HIV care objectives and activities be translated into value-based care indicators. Value drivers were linked to concrete objectives and activities using a logical framework approach. Finally, specific, measurable, and acceptable structure, process and outcomes indicators were defined to complement the framework.

Results

Our framework identifies 4 core value areas where HIV care would benefit most from improvements: Prevention, improvement of the cascade of care, providing patient-centered HIV care and sustaining a state-of-the-art HIV disease management context. These 4 core value areas were translated into 12 actionable core value objectives. For each objective, example activities were proposed. Indicators are suggested for each level of the framework (outcome indicators for value areas and objectives, process indicators for suggested activities).

Conclusions

This framework approach outlines how to define a patient- and public health centered value-based HIV care paradigm. It proposes how to translate core value drivers to practical objectives and activities and suggests defining indicators that can be used to track and improve the framework’s implementation in practice.
A qualitative analysis of the barriers and enablers faced by Australian rural general practitioners in the non-pharmacological management of congestive heart failure in community dwelling patients
Authors: Kwan Trevor , Chua Benjamin , Pires David , Feng Olivia , Edmiston Natalie , Longman Jo
Published: January 2022

Background

Congestive heart failure (CHF) is a significant health problem in Australia, and disproportionately affects rural Australians. Management of CHF in Australia is heavily centred around the general practitioner (GP). Australian and international literature indicates there is a gap between current and best practice in CHF management. There is little known about the non-pharmacological aspects of management, or CHF management in a rural Australian context. This study aimed to identify what Australian GPs practicing in the Northern Rivers Region of New South Wales, Australia, perceived were the barriers and enablers in the non-pharmacological management of CHF amongst community dwelling patients, to inform healthcare access, resourcing and delivery in Australian rural environments.

Methods

Qualitative study involving a realist thematic analysis of data collected from semi-structured face-to-face interviews.

Results

Fifteen GPs and GP trainees participated. Four interlinked key themes underpinning GPs’ experiences with non-pharmacological management of CHF were interpreted from the interview data: (1) resources, (2) complexity of heart failure, (3) relationships, and (4) patient demographics, priorities and views affect how patients engage with non-pharmacological management of CHF.

Conclusion

Rural Australian GPs face considerable barriers to non-pharmacological management of CHF. The data suggests that increased rural Australian health services and community transportation, multidisciplinary management, and stronger professional networks have the potential to be invaluable enablers of CHF management. Further research exploring non-pharmacological management of CHF in other rural contexts may provide additional insights to better inform rural healthcare access and resourcing.
The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis
Authors: Boutcher Faith , Berta Whitney , Urquhart Robin , Gagliardi Anna R.
Published: January 2022

Background

Middle Managers (MMs) are thought to play a pivotal role as knowledge brokers (KBs) in healthcare organizations. However, the role of MMs who function as KBs (MM KBs) in health care is under-studied. Research is needed that contributes to our understanding of how MMs broker knowledge in health care and what factors influence their KB efforts.

Methods

We used a critical interpretive synthesis (CIS) approach to review both qualitative and quantitative studies to develop an organizing framework of how MMs enact the KB role in health care. We used compass questions to create a search strategy and electronic searches were conducted in MEDLINE, CINAHL, Social Sciences Abstracts, ABI/INFORM, EMBASE, PubMed, PsycINFO, ERIC and the Cochrane Library. Searching, sampling, and data analysis was an iterative process, using constant comparison, to synthesize the results.

Results

We included 41 articles (38 empirical studies and 3 conceptual papers) that met the eligibility criteria. No existing review was found on this topic. A synthesis of the studies revealed 12 MM KB roles and 63 associated activities beyond existing roles hypothesized by extant theory, and we elaborate on two MM KB roles: 1) convincing others of the need for, and benefit of an innovation or evidence-based practice; and 2) functioning as a strategic influencer. We identified organizational and individual factors that may influence the efforts of MM KBs in healthcare organizations. Additionally, we found that the MM KB role was associated with enhanced provider knowledge, and skills, as well as improved organizational outcomes.

Conclusion

Our findings suggest that MMs do enact KB roles in healthcare settings to implement innovations and practice change. Our organizing framework offers a novel conceptualization of MM KBs that advances understanding of the emerging KB role that MMs play in healthcare organizations. In addition to roles, this study contributes to the extant literature by revealing factors that may influence the efforts and impacts of MM KBs in healthcare organizations. Future studies are required to refine and strengthen this framework.

Trial registration

A protocol for this review was not registered.
Prevalence of and factors associated with dental service utilization among early elderly in Lithuania
Authors: Drachev Sergei N. , Puriene Alina , Aleksejuniene Jolanta , Stankeviciene Indre , Stangvaltaite-Mouhat Lina
Published: January 2022

Background

There is no recent information about dental service utilization (DSU) among elderly in Lithuania. We examined DSU and its associated factors in Lithuanian early elderly based on the Andersen’s behavioural model.

Methods

The cross-sectional study conducted in 2017–2019 included a nationally representative stratified sample of 370 Lithuanian early elderly aged 65–74 years (response rate of 54.5%). Information on predisposing factors (age, sex, nationality and education), enabling factor (residence), need-based factors (status of teeth, oral pain or discomfort, and dry mouth), general health, personal health practices and perceived stress was obtained from a structured, self-administered questionnaire. Clinically-assessed need-based factors included number of missing teeth and dental treatment need. Multivariable Poisson regression with robust variance estimates was used.

Results

A total of 239 study participants (64.6%) reported a dental visit during the last year and 338 (91.4%) needed dental treatments. A higher level of education (adjusted prevalence ratio [aPR] = 1.21, 95% confidence interval [CI]:1.04–1.40), pain or discomfort in teeth/mouth (aPR = 1.35, 95%CI: 1.13–1.62) and lower number of missing teeth (aPR = 0.99, 95%CI: 0.98–1.00) were associated with DSU.

Conclusions

Even though majority of early elderly needed dental treatments, only two-thirds visited a dentist during the last year. Predisposing and need-based factors were significant predictors of having a dental visit in the last year. A national oral health program for Lithuanian elderly with the focus on regular preventive dental check-ups is needed. More studies, both quantitative and qualitative, are warranted to investigate in depth the barriers for DSU among elderly in Lithuania.
Co-development of a transitions in care bundle for patient transitions from the intensive care unit: a mixed-methods analysis of a stakeholder consensus meeting
Authors: Rosgen Brianna K. , Plotnikoff Kara M. , Krewulak Karla D. , Shahid Anmol , Hernandez Laura , Sept Bonnie G. , Morrissey Jeanna , Robertson Kristin , Fraser Nancy , Niven Daniel J. , Straus Sharon E. , Leigh Jeanna Parsons , Stelfox Henry T. , Fiest Kirsten M.
Published: January 2022

Background

Intensive care unit (ICU) patients undergoing transitions in care are at increased risk of adverse events and gaps in medical care. We evaluated existing patient- and family-centered transitions in care tools and identified facilitators, barriers, and implementation considerations for the application of a transitions in care bundle in critically ill adults (i.e., a collection of evidence-based patient- and family-centred tools to improve outcomes during and after transitions from the intensive care unit [ICU] to hospital ward or community).

Methods

We conducted a concurrent mixed methods (quan + QUAL) study, including stakeholders with experience in ICU transitions in care (i.e., patient/family partners, researchers, decision-makers, providers, and other knowledge-users). First, participants scored existing transitions in care tools using the modified Appraisal of Guidelines, Research and Evaluation (AGREE-II) framework. Transitions in care tools were discussed by stakeholders and either accepted, accepted with modifications, or rejected if consensus was achieved (≥70% agreement). We summarized quantitative results using frequencies and medians. Second, we conducted a qualitative analysis of participant discussions using grounded theory principles to elicit factors influencing AGREE-II scores, and to identify barriers, facilitators, and implementation considerations for the application of a transitions in care bundle.

Results

Twenty-nine stakeholders attended. Of 18 transitions in care tools evaluated, seven (39%) tools were accepted with modifications, one (6%) tool was rejected, and consensus was not reached for ten (55%) tools. Qualitative analysis found that participants’ AGREE-II rankings were influenced by: 1) language (e.g., inclusive, balance of jargon and lay language); 2) if the tool was comprehensive (i.e., could stand alone); 3) if the tool could be individualized for each patient; 4) impact to clinical workflow; and 5) how the tool was presented (e.g., brochure, video). Participants discussed implementation considerations for a patient- and family-centered transitions in care bundle: 1) delivery (e.g., tool format and timing); 2) continuity (e.g., follow-up after ICU discharge); and 3) continuous evaluation and improvement (e.g., frequency of tool use). Participants discussed existing facilitators (e.g., collaboration and co-design) and barriers (e.g., health system capacity) that would impact application of a transitions in care bundle.

Conclusions

Findings will inform future research to develop a transitions in care bundle for transitions from the ICU, co-designed with patients, families, providers, researchers, decision-makers, and knowledge-users.
Co-establishing an infrastructure for routine data collection to address disparities in infant mortality: planning and implementation
Authors: Fareed Naleef , Swoboda Christine M. , Lawrence John , Griesenbrock Tyler , Huerta Timothy
Published: January 2022

Background

Efforts to address infant mortality disparities in Ohio have historically been adversely affected by the lack of consistent data collection and infrastructure across the community-based organizations performing front-line work with expectant mothers, and there is no established template for implementing such systems in the context of diverse technological capacities and varying data collection magnitude among participating organizations.

Methods

Taking into account both the needs and limitations of participating community-based organizations, we created a data collection infrastructure that was refined by feedback from sponsors and the organizations to serve as both a solution to their existing needs and a template for future efforts in other settings.

Results

By standardizing the collected data elements across participating organizations, integration on a scale large enough to detect changes in a rare outcome such as infant mortality was made possible. Datasets generated through the use of the established infrastructure were robust enough to be matched with other records, such as Medicaid and birth records, to allow more extensive analysis.

Conclusion

While a consistent data collection infrastructure across multiple organizations does require buy-in at the organizational level, especially among participants with little to no existing data collection experience, an approach that relies on an understanding of existing barriers, iterative development, and feedback from sponsors and participants can lead to better coordination and sharing of information when addressing health concerns that individual organizations may struggle to quantify alone.
Co-designing implementation strategies for the WALK-Cph intervention in Denmark aimed at increasing mobility in acutely hospitalized older patients: a qualitative analysis of selected strategies and their justifications
Authors: Kirk Jeanette Wassar , Nilsen Per , Andersen Ove , Powell Byron J. , Tjørnhøj-Thomsen Tine , Bandholm Thomas , Pedersen Mette Merete
Published: January 2022

Background

Selecting appropriate strategies to target barriers to implementing interventions represents a considerable challenge in implementation research and practice. The aim was to investigate what categories of implementation strategies were selected by health care practitioners and their managers in a co-design process and how they justified these strategies aimed at facilitating the implementation of the WALK-Cph intervention.

Methods

The study used a qualitative research design to explore what implementation strategies were selected and the justifications for selecting these strategies. Workshops were used because this qualitative method is particularly well suited for studying co-design processes that involve substantial attention to social interaction and the context. Data were 1) analyzed deductively based on the Proctor et al. taxonomy of implementation strategies, 2) categorized in accordance with the ERIC compilation of implementation strategies by Powell et al., and 3) analyzed to examine the justification for the selected strategies by the Proctor et al. framework for justifications of implementation strategies.

Results

Thirteen different types of implementation strategies were chosen across two hospitals. The deductive analysis showed that selection of implementation strategies was based on pragmatic and theoretical justifications. The contents of the two types of justifications were thematized into nine subthemes.

Conclusion

This study contributes with knowledge about categories and justification of implementation strategies selected in a co-design process. In this study, implementation strategies were selected through pragmatic and theoretical justifications. This points to a challenge in balancing strategies based on practice-based and research-based knowledge and thereby selection of strategies with or without proven effectiveness.
Evaluating Organizational Performance of Public Hospitals using the McKinsey 7-S Framework
Authors: Chmielewska Malgorzata , Stokwiszewski Jakub , Markowska Justyna , Hermanowski Tomasz
Published: January 2022

Background

This study examined non-financial aspects of the organizational performance of public hospitals from the perspective of hospital physicians; the obtained results were analyzed to identify the necessary improvements in organizational performance.

Methods

This was a cross-sectional study of multidisciplinary public hospitals on a group of 249 randomly selected physicians from 22 in-patient departments or clinics operating in the Warsaw region. The study data was collected using the structured World Health Organization questionnaires (to be filled out by respondents) assessing the hospital’s organizational performance variables qualified according to the McKinsey 7-S Framework.

Epidata software version 3.1 was used for data entry, and the analysis was carried out in the SPSS software, version 19. The results of the organization evaluation are presented in the McKinsey 7-S Framework diagram. Key elements of the performance factors were grouped into ‘stens’, and the sten values were expressed as arithmetic means. Normal distribution of the stens was validated with the Kolmogorov–Smirnov test. 95% confidence intervals were calculated. The significance of differences between the analyzed stens was compared with the paired Student t-test. The interdependence of the variables was determined using the Pearson’s correlation coefficient.

Results

The results revealed a significant difference (p <0.05) in the respondents’ assessment of social (a mean score of 2.58) and technical (a mean score of 2.80) organizational aspects of the hospital operation. Scores for all variables were low. The social elements of an organization with the lowest score included ‘staff’, and in it the aspect – ‘efforts are made to inspire employees at the lowest levels of the organization’, ‘skills’ involving the learning style followed by the management/managerial staff, and ‘management style’ (average scores of 2.38, 2.56, 2.61, respectively).

Conclusion

Consistently with the existing literature, social factors were shown to play a more significant role in the management and they therefore deserve careful attention and more recognition when identifying and improving the key aspects affecting the organizational performance of public hospitals. Technical elements (strategy, structure, system) are important, but were demonstrated to have limited effect on the organizational operations geared towards ensuring effective functioning of a public hospital.
Stevia and Uncaria extract (GlucoMedix®) reduces glucose levels and the need for medications in type 2 diabetes: an open label case series of six patients
Authors: Dooley Thomas P. , Pérez Johnny Martín Paredes , Rodriquez Carlos Rengifo
Published: January 2022

Background

GlucoMedix® is an all-natural phytotherapy consisting of a hydro-alcoholic extract of Stevia rebaudiana (Bertoni) Bertoni and pentacyclic chemotype Uncaria tomentosa (Willd. Ex Schult.) DC. The nutraceutical product has potential for the treatment of hyperglycemia in type 2 diabetes and Metabolic Syndrome.

Methods

Six adult Hispanic type 2 diabetic patients were included in an outpatient retrospective open label physician-sponsored case series study. GlucoMedix® extract of Stevia plus pentacyclic chemotype Uncaria was administered orally at doses of 2 ml, diluted in water, two or three times daily. The patients’ blood glucose levels were recorded historically, at baseline, and thereafter while taking GlucoMedix® orally.

Results

When treated with GlucoMedix®, with or without coincident advice to modify diet, all six patients manifested reductions in blood glucose levels. At baseline four of the six patients were administering one or more prescription treatments for hyperglycemia, e.g., Glibenclamide, Metformin, Vildagliptin, or Insulin. Two patients displayed substantial reductions in glucose of 50 and 70 mg/dl, and in conjunction with the removal of their prior drug treatments of Glibenclamide plus Metformin or of Vildagliptin. An Insulin-treated patient experienced a 50 mg/dl reduction while ceasing Metformin and was subsequently able to reduce the dose of Insulin by half. Thus, in three patients GlucoMedix® abrogated in whole or in part the requirement for pharmaceutical or biologic therapies to achieve substantial beneficial reductions in glycemic levels.

Conclusions

In this proof-of-principle study oral GlucoMedix® was an effective treatment for hyperglycemia in type 2 diabetic individuals. This all-natural phytotherapy can be used beneficially in conjunction with existing pharmaceutical or biological therapy regimens, and in some cases can replace in whole or in part the requirement for pharmaceutical or biologic therapies. These in-life results suggest that this natural product approach can serve as an alternative to prescription monotherapies or multimodal therapies for the regulation of hyperglycemia.
A projection-domain iterative algorithm for metal artifact reduction by minimizing the total-variation norm and the negative-pixel energy
Authors: Zeng Gengsheng L.
Published: January 2022

Metal objects in X-ray computed tomography can cause severe artifacts. The state-of-the-art metal artifact reduction methods are in the sinogram inpainting category and are iterative methods. This paper proposes a projection-domain algorithm to reduce the metal artifacts. In this algorithm, the unknowns are the metal-affected projections, while the objective function is set up in the image domain. The data fidelity term is not utilized in the objective function. The objective function of the proposed algorithm consists of two terms: the total variation of the metal-removed image and the energy of the negative-valued pixels in the image. After the metal-affected projections are modified, the final image is reconstructed via the filtered backprojection algorithm. The feasibility of the proposed algorithm has been verified by real experimental data.
What Is Asia to Me? Looking East from Africa
Authors: Thiong’o Ngũgĩ wa
Published: January 2022

Abstract: The following essay was inspired by the interview with Satya P. Mohanty (“Literature to Combat Chauvinism”) published in Frontline in April 2012. It was written for the new Global South Cultural Dialogue Project (see sidebar on page 18) for which WLT has agreed to be a participating journal.
Comics, War, and Ordinary Miracles
Authors: Mahmutović Adnan , Durneen Lucy
Published: January 2022

Abstract: After meeting at a short-fiction conference, Adnan Mahmutović and Lucy Durneen began talking to one another about his childhood love of comics and his efforts to preserve them during the Bosnian War (1992–95). Durneen encouraged Mahmutović to write an essay about these experiences and, inspired by their conversation, wrote a connected though independent story of her own. Here they join the two, creating a hybrid essay that braids together their two histories. Ultimately the two connect through friendship and the importance of preserving our most miraculous stories. To hear them read their essays, visit WLT's website.
A Girl in Litland: The 2016 Neustadt Prize Lecture
Authors: Ugrešić Dubravka
Published: January 2022

Abstract: After watching the world premiere of the staged adaptation of her story “Who Am I?” along with several hundred attendees, Ugrešić delivered the following keynote to the rapt audience.
How I Stopped Worrying and Learned to Trivas with Words
Authors: Mahmutović Adnan
Published: January 2022

Abstract: A Bosnian Swedish writer considers how extreme nuances and barely perceptible differences, which signify no change in the core meaning of a word, still evoke connotations that widen gaps between us rather than allowing us to trivas with words.
When arts and science meet: Digital technology in artistic research
Authors: Caruso Giusy , Nijs Luc
Published: January 2022

In recent decades, advancements in digital technologies have become a rich source of inspiration for artists, who seek to leave the trodden paths and find novel ways of expression. In addition, digital technologies are increasingly implemented in the development of artistic skills, providing new means to develop the artists’ reflection on their own development. As such, they hold great potential to shape artistic research. Moreover, digital technologies offer possibilities to capture the learning process based on quantitative measurement, thereby becoming a potential interface between artistic and scientific approaches to investigating artistic growth. This contribution presents two artistic projects illustrating the potentialities of the art–science encounter. Embedded in the research paradigm of embodied music cognition, both projects explore the role of the body in music performance (interpretation and improvisation). The first project investigates the relation between gesture and interpretative intentions in a contemporary piano composition. The second project concerns the development of one’s musical language through kinemusical improvisation. A mixed methodology and the use of technology as ‘an augmented mirror’ to monitor artistic practice were applied. Both projects illustrate how the implementation of digital technologies may boost the evolution in artistic research and facilitate novel approaches to music teaching and learning.
Evaluating the use of LoLa in European conservatoires: The SWING project
Authors: Redman Benjamin
Published: January 2022

The research presented in this article reports on the SWING project, a qualitative case study initiated by The Association Européenne des Conservatoires, Académies de Musique et Musikhochschulen (AEC) into the use of LoLa (low-latency audio-visual streaming) for instrumental music teaching between conservatoires. LoLa is a software package that allows musicians to perform and interact together synchronously in real-time with high-quality audio, something not currently possible with standard videoconferencing platforms. LoLa is a relatively new technology and there is limited research available on how effective it is when used for instrumental music teaching. Trials of LoLa technology were conducted in three conservatoires in Austria, Italy and Slovenia in early 2019. Follow-up interviews were conducted with music teachers, students and technicians to understand their experiences of using the technology, what changes took place in the teaching, and to determine the potential and limitations of LoLa for teaching in conservatoires. Participants in the trials reported overall satisfaction with the system, with many being surprised at the high quality. The findings showed that LoLa can expand the possibilities for artistic development by facilitating synchronous interaction between teachers and students in different conservatoires. These possibilities include one-to-one lessons, group masterclasses, examinations, and opportunities to rehearse and perform synchronously with musicians from other institutions. This aligns with current research which calls for a reappraisal of the traditional one-to-one conservatoire studio lesson.
Digital audio technology in music teaching and learning: A preliminary investigation
Authors: Kladder Jonathan
Published: January 2022

The inclusion of digital audio technology for sampling, editing, mixing and producing music in formal music classrooms has been considered a needed area of expansion across the music teaching and learning landscape. Current research suggests that music technology, defined broadly, is often disregarded in many music classrooms. However, the ubiquity of music technology suggests its relevancy in the digital age, especially for sampling editing, mixing and producing music. The purpose of this research was to survey the current climate of music education across all levels of instruction, with a special focus on teaching digital audio technology using MIDI controllers and audio production techniques. A researcher-developed survey was distributed to a population of music teachers across the United States (N=83). Results found that participants taught few digital audio technology concepts, used Garageband extensively, were self-taught, relied on out-of-date hardware and used a variety of MIDI controllers. Implications for music education and considerations for additional research are provided in conclusion.
Aglaya Play: Designing a software solution for group compositions in the music classroom
Authors: Murillo Adolf , Elena Riaño María , Tejada Jesús
Published: January 2022

This article details the design for Aglaya Play, a proposed software system that aims to meet three basic needs in the music classroom: the incorporation of creative processes, the adoption of collaborative-cooperative strategies and the reduction of reading–writing- and theory-based learning in the early stages of music education. The text contextualizes the needs that the software intends to meet and describes its phases of construction from a design-based research perspective. Finally, a full description of the system is offered based on its functions, and suggestions for its didactic implementation are provided.
Using DAWs as modelling tools for learning design sound-based applications in education
Authors: Boon Hussein
Published: January 2022

This article discusses a proposed design and sound tool teaching and learning approach, with interesting solution-based challenges not immediately associated with traditional DAW instruction. By stepping outside of the usual boundaries of DAW use, music production teaching is presented with a number of novel learning challenges. There is potential for DAWs, especially in educational settings, to be used to enhance the discipline, encourage experimentation and stimulate design-based ideas that promote DAW use beyond the mixing and engineering type contexts. By shifting DAWs into areas of sound-based music, as proposed by Landy, this innovative approach, facilitates deeper, experiential learning where sound is treated as the basic musical unit, therefore allowing for a potentially greater range of designed outputs.
What Can Legacy Patient-Reported Outcome Measures Tell Us About Participation Bias in Patient-Reported Outcomes Measurement Information System Scores Among Lumbar Spine Patients?
Authors: Lynch Conor P. , Cha Elliot D.K. , Jadczak Caroline N. , Mohan Shruthi , Geoghegan Cara E. , Singh Kern
Published: January 2022

Objective: Patient-Reported Outcomes Measurement Information System (PROMIS) is a validated tool for assessing patient-reported outcomes in spine surgery. However, PROMIS is vulnerable to nonresponse bias. The purpose of this study is to characterize differences in patient-reported outcome measure scores between patients who do and do not complete PROMIS physical function (PF) surveys following lumbar spine surgery.Methods: A prospectively maintained database was retrospectively reviewed for primary, elective lumbar spine procedures from 2015 to 2019. Outcome measures for Patient Health Questionnaire-9 (PHQ-9), visual analogue scale (VAS) back & leg, Oswestry Disability Index (ODI), and 12-item Short Form health survey physical composite summary (SF-12 PCS) were recorded at both preoperative and postoperative (6 weeks, 12 weeks, 6 months, 1 year, 2 years) timepoints. Completion rates for PROMIS PF surveys were recorded and patients were categorized into groups based on completion. Differences in mean scores at each timepoint between groups was determined.Results: Eight hundred nine patients were included with an average age of 48.1 years. No significant differences were observed for all outcome measures between PROMIS completion groups preoperatively. Postoperative PHQ-9, VAS back, VAS leg, and ODI scores differed significantly between groups through 1 year (all p < 0.05). SF-12 PCS differed significantly only at 6 weeks (p = 0.003).Conclusion: Patients who did not complete PROMIS PF surveys had significantly poorer outcomes than those that did in terms of postoperative depressive symptoms, pain, and disability. This suggests that patients completing PROMIS questionnaires may represent a healthier cohort than the overall lumbar spine population.
Higher American Society of Anesthesiologists Classification Does Not Limit Safety or Improvement Following Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Lynch Conor P. , Cha Elliot D.K. , Geoghegan Cara E. , Jadczak Caroline N. , Mohan Shruthi , Singh Kern
Published: January 2022

Objective: The American Society of Anesthesiologists (ASA) physical status classification has been used to risk stratify surgical candidates. Our study compares outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) procedures based on preoperative ASA physical status classification.Methods: A surgical registry was reviewed for primary, single-level MIS TLIF patients. Patients were categorized by preoperative ASA physical status classification: ASA I, ASA II, ASA III+. Perioperative complications were compared among groups. Patient-reported outcome measures (PROMs) for back pain, leg pain, physical function, and disability were recorded preoperatively and at 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. PROM improvement from baseline (ΔPROM) and minimum clinically important difference (MCID) achievement was calculated for each timepoint and compared among groups. MCID achievement was determined as ΔPROMs that surpassed previously established MCID values.Results: Of the 487 patients, 64 had an ASA classification of I, whereas 336 had an ASA of II, and 87 had an ASA of III or greater. Rates of complications were not associated with ASA classification (all p > 0.050). Neither mean PROM scores nor ΔPROM scores were significantly associated with ASA classification at any timepoint (all p > 0.050). MCID achievement was significantly associated with ASA classification for back pain at 1 year only (p = 0.041). Overall MCID achievement was not significantly associated with ASA classification for any PROM (p > 0.050).Conclusion: While ASA classification has been commonly used to risk stratify surgical candidates for spinal procedures, patients with an ASA of III or greater may be able to achieve similar long-term outcomes following MIS TLIF given proper selection criteria.
Location Distribution of Fistulas and Surgical Strategies for Spinal Extradural Meningeal Cysts: A Retrospective Analysis of 30 Cases at a Single Center
Authors: Jian Qiang , Song Gang , Liu Zhenlei , Duan Wanru , Guan Jian , Jian Fengzeng , Chen Zan
Published: January 2022

Objective: This study aimed to illustrate the features of fistula location distribution, surgical strategies, and outcomes in spinal epidural meningeal cysts (SEMCs).Methods: The authors searched and reviewed the medical records for cases of SEMCs. Imaging features, operative reports, and media were reviewed to accurately describe the surgical techniques employed. We recorded the level and laterality of the fistula according to the operative report and the media. Consistency analysis was performed on the dominant laterality of the cyst on preoperative axial magnetic resonance imaging and laterality of the fistula in the operative media or report. When cyst and fistula lateralities were the same, they were considered consistent. Finally, the Japanese Orthopedic Association (JOA) score was used to obtain patient-reported results at each follow-up.Results: Thirty patients with SEMCs were identified. Fistula repair was performed in all patients. Two patients experienced cyst recurrence after surgery and were repaired during the second surgery. Based on imaging findings, SEMCs mostly occurred in the thoracolumbar junction. Most of the fistulas (87.88%) were at the T12 or L1 levels. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst rather than in the middle level of the cyst. A fistula laterality of 72.72% was consistent with cyst laterality. The JOA improvement rate was 61.84% ± 26.63%.Conclusion: Most fistulas were always located at the T12–L1 level as well as the middle level of the cyst, which is always consistent with cyst laterality. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst. Cleft closure is key to healing SEMCs.
Evaluation of Procalcitonin and Interleukin-6 as a Marker of Bacterial Urinary Tract Infection
Authors: Darogha Suhaila N. , Azeez Sarhang H. , Abdullah Zhian G.
Published: January 2022

Urinary tract infection (UTI) is a major clinical problem in a wide age range that is associated with a high morbidity rate. Due to issues such as low specificity and the inability to differentiate between different types of infection in current diagnostic methods, there is a need to introduce novel UTI markers. The present study was conducted to evaluate the utility of Procalcitonin (PCT) and interleukin-6 (IL-6) as a marker of bacterial urinary tract infection. For this purpose, a cross-sectional study was conducted between November 2020 and February 2021 among 125 patients and 60 healthy volunteers (control) in Erbil Teaching Hospital. The concentration of PCT and IL-6 was quantified using the ELISA cloud immunoassay test. Between-group comparisons were assessed for the variables with analysis of variance. The results revealed that there was a significant difference between PCT levels in UTI patients (104.6±6.07) and control groups (54±2.24) (p <0.0001). The differences in IL-6 concentration in UTI patients (55.74±4.2) and control groups (24.56±2.4) were also significant (p <0.0001), implying that the level of both PCT and IL-6 increased due to bacterial infection in the urinary tract. As a whole, the findings of this study provide
A systematic ethnobotanical review of Adhatoda vasica (L.), Nees.
Authors: Shoaib Ambreen
Published: January 2022

Adhatoda vasica (L.), Nees belonging to the family Acanthaceae is a shrub with opposite ascending branches. The plant has been used in the indigenous system of medicine in India for near about 2500 years. It is a well-known plant as a drug in Ayurvedic and Unani medicines. Traditionally it was used for the treatment of various acute and chronic diseases and showed strong pharmacological activity particularly for bronchial infections, cough, bacterial infections, reproductive disorders, cardiac diseases and many more. Various phytochemicals like alkaloids, flavonoids, tannins, etc. were obtained from Adhatoda vasica (A. vasica). The active constituent of the plant is vasicine, l-vasicinone, deoxyvasicine, maiontone, vasicinolone and vasicinol etc. This review consists of updated information on the phyto-constituents isolated from A. vasica and their potential role in the treatment of various ailments traditionally and medically. Based on the critical review it was concluded that there is not sufficient scientifically strong evidence to explain that A. vasica extract, could be harmful to human beings especially in pregnant women. Major data on traditional uses as well as toxicological studies, evaluated various correctness, relevance, importance, and reliability for the overall evaluation of A. vasica safety. Numerous clinical trials are conducted around the globe on the herbal formulations of vasaka. This review includes strong data about phytochemical and ethnopharmacological studies that indicate that A. vasica is a versatile native plant of the Indian subcontinent having a commercial reputation and thus can be encouraged for diversified applications like medicinal and other potential uses.
Study of ultrasound-guided ropivacaine combined with butorphanol continuous paravertebral block to prevent pain syndrome by evaluating ccl2 gene expression after radical mastectomy
Authors: Ji Xiaochen , Cui Wenbin , Shan Shiqiang , Liu Xiaomeng , Wang Lixian , Zhang Boya
Published: January 2022

This study aimed to investigate the clinical effect of ultrasound-guided ropivacaine combined with butorphanol continuous paravertebral block in preventing postoperative pain syndrome of breast cancer. For this purpose, 100 women treated for breast cancer from April 2018 to July 2019 were enrolled as research objects. Surgical procedures included local sentinel lymph node biopsy, mastectomy, sentinel lymph node biopsy for mastectomy, modified radical mastectomy, and implantation. The selected patients were randomly divided into two groups: control group (routine operation anesthesia; n = 50) and observation group (ultrasound-guided thoracic paravertebral block before induction of ropivacaine+butorphanol anesthesia; n = 50). The Real-time PCR technique was performed to evaluate CCL2 gene expression. VAS scores were recorded during the postoperative period. Compared with the control group, the observation group had lower VAS scores at six h, 24h, and 48h (P<0.05). The pain effect of the observation group was less than that of the control group. The observation group had better analgesic effects after anesthesia. The observation group had a lower incidence of pain syndrome at the 6th, 8th, and 12th months (P<0.05), and the incidence of pain syndrome in the two groups decreased with the extension of time. The observation group had lower levels of related factors (P<0.05), and the observation group had lower traumatic stress responses. The protein expression of IL-6, IL-17, and CRP in the observation group was lower than that in the control group (P<0.05). The results of CCL2 gene expression also showed that gene expression in the control group increased significantly (P=0.0047). Since the expression of this gene is one of the factors that stimulate pain signals in the body, the method used in the present study was able to reduce the amount of pain significantly. Therefore, the combination of ropivacaine combined with butorphanol ultrasound-assisted paravertebral block can reduce the intensity of postoperative pain in patients with breast cancer surgery, decrease the incidence of pain syndrome, and increase pain tolerance.
Analysis of the clinical efficacy of leuprolide acetate in the treatment of obese patients with endometriosis and its role on the expression of MIF gene
Authors: Zhang Jing , Dong Liang , Zhang Shuzhen , Wang Lei
Published: January 2022

Endometriosis is an invasive but benign disease of women that develops in endometrial glands outside the endometrium and uterine muscle. It affects about 15-20% of women of childbearing age. One effective way to treat endometriosis is to use GnRH agonists, which inhibit estrogen production. However, one of the possible side effects of this treatment is obesity and BMI increasing, which is a concern for some patients. This study investigated the role of leuprolide acetate in treating overweight patients (BMI≥30) and their comparison with non-overweight patients (BMI<30) for six months. Also, the effect of this medicine was evaluated on the expression of the MIF gene, which is an effective gene in obesity. For this purpose, a clinical trial was performed on 75 women with endometriosis aged 18 to 35 years. These patients were divided into two groups. The first group consisted of 38 patients with BMI<30. The second group consisted of 37 patients with BMI≥30. Both groups were treated with leuprolide acetate at a dose of 3.75 mg/month (intramuscularly) for six months. In addition to clinical evaluations, the expression of the MIF gene was assessed by the real-time PCR technique. The results showed that treatment with leuprolide acetate during six months in both groups reduced dysmenorrhea, dyspareunia, and chronic pelvic pain (P<0.05). Although this decrease was greater in the BMI <30 group, the difference was not significant. Also, after collecting the side effects of the medication, it was found that hypoestrogenism, such as cramps and spotting, was more in the first group; Endogenous complications such as oily skin, acne, and hirsutism were also more common in the second group. The results of MIF gene expression showed that the expression level before and after the start of the experiment in the second group (BMI≥ 30) is higher than the first group (BMI <30). The results also showed that the two groups increased the expression of the MIF gene after treatment with leuprolide acetate. This increase was statistically significant in the second group (P = 0.042). Generally, it was found that this medication causes more weight gain in obese people and increases the risk of obesity-related diseases among these patients. Therefore, it is recommended that this treatment be used with caution in obese patients with endometriosis.
Pneumococcal Surface Protein A: A Promising Candidate for the Next Generation of Pneumococcal Vaccines
Authors: Alghamdi Saad , Sahibzada Muhammad Umar Khayam , Shesha Nashwa T. , Aslam Akhmed , Kabrah Ahmed , Atwah Banan , Khidir Elshiekh B. , Alsafi Radi , Farash Shouq Z , Mazhar Abdulbari A. , Kiran Myle Akshay , Alenzi Faris Q.
Published: January 2022

Streptococcus pneumoniae is the bacterium that causes pneumococcal disease which often results in pneumonia, meningitis, otitis media, septicemia and sinusitis. Pneumonia, particularly, is a significant cause of worldwide morbidity and a global health burden as well. Treatment often relies on antimicrobials, to which the pathogen is frequently mutating and rendering infective. Consequently, vaccination is the most effective approach in dealing with pneumococcal antimicrobial resistance (AMR). Unfortunately, the current pneumococcal polysaccharide and conjugate vaccines have a narrow serotype coverage. Therefore, the current need for vaccines with a broader serotype coverage cannot be overstated. Pneumococcal Surface Protein A and C are potential vaccine candidate antigens present in over 90% of the strains from clinical isolates as well as laboratory non-encapsulated strains. Pneumococcal Surface Protein A is an active virulent factor that pneumococci use to evade complement-mediated host immune responses and has been shown to elicit immune responses against pneumococcal infections. This review explores the potential utilization of Pneumococcal Surface Protein A to immunize against S. pneumoniae.
Study on PI3k gene expression in breast cancer samples and its association with clinical factors and patient survival
Authors: Lin Jiang , Ding Qi , Zhang Guoying , Yin Xiling
Published: January 2022

Breast cancer is the most common cancer among women in the world. The phosphatidylinositol 3-Kinase (PI3k), which regulates various cellular signaling pathways, is often elevated in human cancers. This study aimed to evaluate the expression of the PI3k gene in breast cancer. In this case-control study, 40 paraffin-embedded tissues of breast cancer and 40 adjacent non-tumor tissues were examined. After total RNA extraction and cDNA synthesis, the relative expression of the gene was obtained using the real-time-PCR method and evaluated by the 2-ΔΔCT method. Also, the association of gene expression with clinical factors and survival rate was investigated. Data analysis was performed by SPSS statistical software (version 22), t-test, and ANOVA. A p-value of less than 0.05 was considered significant. The results showed that PI3k expression was significantly increased in breast tumor tissues compared to non-tumor tissues (p = 0001). Consistent with these results, PI3k expression was associated with metastasis (p = 0.008) and high tumor grade (p = 0.01). In addition, increasing PI3k expression decreased overall survival compared to its low expression (p = 0.03). In general, PI3k plays a tumor-enhancing role in the progression of breast cancer. In addition, increased PI3k expression is associated with metastasis and poor prognosis of cancer, so that PI3k may be useful in the diagnosis, treatment, and prognosis of people with the disease. However, further investigation is needed to substantiate this claim.