bluuebunny/crossref_metadata_2025 huggingface dataset:
Low BASDAI score alone is not a good predictor of anti-tumor necrosis factor treatment efficacy in ankylosing spondylitis: a retrospective cohort study
Authors: Nam Bora , Koo Bon San , Lee Tae-Han , Shin Ji-Hui , Kim Jin-Ju , Lee Seunghun , Joo Kyung Bin , Kim Tae-Hwan
Published: February 2021

Background

The purpose of this study was to determine the prevalence of high disease activity as measured using the Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS) patients who nonetheless have low Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores after anti-tumor necrosis factor (TNF) treatment. Its clinical impact on anti-TNF survival was also investigated.

Methods

We conducted a single-centre retrospective cohort study of AS patients having low BASDAI scores (< 4) and available ASDAS-C-reactive protein (CRP) data after 3 months of first-line anti-TNF treatment. Patients were grouped into high-ASDAS (≥ 2.1) and low-ASDAS (< 2.1) groups according to the ASDAS-CRP after 3 months of anti-TNF treatment. Their characteristics were compared. And survival analyses were carried out using Kaplan–Meier curves and log-rank test with the event being discontinuation of anti-TNF treatment due to lack/loss of efficacy.

Results

Among 116 AS patients with low BASDAI scores after 3 months of anti-TNF treatment, 38.8% were grouped into the high-ASDAS group. The high-ASDAS group tended to have greater disease activity after 9 months of treatment (BASDAI 2.9 ± 1.1 vs. 2.3 ± 1.4, p=0.007; ASDAS-CRP 1.8 ± 0.6 vs. 1.5 ± 0.7, p=0.079; proportion of high ASDAS-CRP 27.8% vs. 13.8%, p=0.094) and greater risk of discontinuing anti-TNF treatment due to lack/loss of efficacy than the low-ASDAS group (p=0.011).

Conclusions

A relatively high proportion of AS patients with low BASDAI scores had high ASDAS-CRP. These low-BASDAI/high-ASDAS-CRP patients also had a greater risk for discontinuation of anti-TNF treatment due to low/lack of efficacy than the low-ASDAS group. The use of the ASDAS-CRP alone or in addition to the BASDAI may improve the assessment of AS patients treated with anti-TNF agents.
Treatment of the fresh central slip avulsion of the extensor tendon by bone tunnel-tendon suture: a prospective cohort study
Authors: Wang Bin , Lu Yiming , Wang Tianliang , Gu Jiaxiang , Zhang Naichen
Published: February 2021

Background

The current evidence base for the management of central slip avulsions is limited from obtaining a best approach. The purpose of this study was to evaluate the clinical effect and feasibility of repairing the fresh central slip avulsion by bone tunnel-tendon suture.

Methods

Twenty-four cases of open and closed central slip avulsions were prospectively studied. They were treated by suturing the tendon to the pre-holed bone through two parallel bone tunnels. Follow-up was conducted at 1 month, 3 months, 6 months, 12 months and 18 months after the operation. Symptoms, degree of satisfaction with the appearance, complications, Crawford’s evaluation, DASH scores and the total active movement (TAM) were collected.

Results

The follow-up period was 6~18 months (mean 13 months). Finger function was assessed using the Crawford’s evaluation criteria: excellent in 12, good in 10, average in 2, with an excellent and good rate of 91.7%. DASH scores ranged from 37 to 47(mean 39). According to the Chinese Medical Association’s trial criteria for assessing the function of upper limbs, excellent, good and average cases were 9, 14 and 1 respectively. The range of motion gradually improved over time. Conclusions Good prognosis can be achieved through bone tunnel-tendon suture for the treatment of fresh central slip avulsion.
Lessons learned from successful autologous gastrointestinal reconstruction in patients with intestinal failure: a case series
Authors: Ashrafzadeh Kiarash , Shafiekhani Mojtaba , Azadeh Nazanin , Esmaeili Maryam , Nikoupour Hamed
Published: February 2021

Background

Intestinal failure (IF) is a rare but severe form of organ failure. The condition is defined as body’s inability to absorb adequate fluids, macronutrients and minerals for growth and development, so that intravenous supplementation is necessary. A broad spectrum of diseases, trauma and complications of surgery might eventually end up with intestinal failure. Nowadays, intestinal failure patients are preferably cared for in intestinal rehabilitation units (IRU). Autologous gastrointestinal reconstruction (AGIR) refers to non-transplant operative management of IF patients designed to improve enteral tolerance and gut absorptive capacity.

Case presentation

Herein we present five cases with complications of surgeries due to peptic ulcer bleeding, blunt abdominal trauma, obesity and gastric tumor. The surgeries were complicated by anastomotic leak, peritonitis and fistula formation. By adopting multidisciplinary decisions and special care for each complication, all the five patients were successfully managed and discharged.

Discussion and conclusions

As presented, re-anastomosis in presence of abdominal contamination will probably fail. In patients with intestinal failure, PN should start as soon as possible to increase the success rate of future surgeries and prevent potential need for intestinal transplantation. We suggest referring patients with complicated outcomes of gastrointestinal surgeries to the IRUs to reduce morbidity and mortality.
A modified Delphi study to develop a practical guide for selecting patients with prostate cancer for active surveillance
Authors: Merriel Samuel W. D. , Moon Daniel , Dundee Phil , Corcoran Niall , Carroll Peter , Partin Alan , Smith Joseph A. , Hamdy Freddie , Moore Caroline , Ost Piet , Costello Tony
Published: February 2021

Background

Active surveillance (AS) is a management option for men diagnosed with lower risk prostate cancer. There is wide variation in all aspects of AS internationally, from patient selection to investigations and follow-up intervals, and a lack of clear evidence on the optimal approach to AS. This study aimed to provide guidance for clinicians from an international panel of prostate cancer experts.

Methods

A modified Delphi approach was undertaken, utilising two rounds of online questionnaires followed by a face-to-face workshop. Participants indicated their level of agreement with statements relating to patient selection for AS via online questionnaires on a 7-point Likert scale. Factors not achieving agreement were iteratively developed between the two rounds of questionnaires. Draft statements were presented at the face-to-face workshop for discussion and consensus building.

Results

12 prostate cancer experts (9 urologists, 2 academics, 1 radiation oncologist) participated in this study from a range of geographical regions (4 USA, 4 Europe, 4 Australia). Complete agreement on statements presented to the participants was 29.4% after Round One and 69.0% after Round Two. Following robust discussions at the face-to-face workshop, agreement was reached on the remaining statements. PSA, PSA density, Multiparametric MRI, and systematic biopsy (with or without targeted biopsy) were identified as minimum diagnostic tests required upon which to select patients to recommend AS as a treatment option for prostate cancer. Patient factors and clinical parameters that identified patients appropriate to potentially receive AS were agreed. Genetic and genomic testing was not recommended for use in clinical decision-making regarding AS.

Conclusions

The lack of consistency in the practice of AS for men with lower risk prostate cancer between and within countries was reflected in this modified Delphi study. There are, however, areas of common practice and agreement from which clinicians practicing in the current environment can use to inform their clinical practice to achieve the best outcomes for patients.
Levan from Leuconostoc citreum BD1707: production optimization and changes in molecular weight distribution during cultivation
Authors: Han Jin , Feng Huafeng , Wang Xiaohua , Liu Zhenmin , Wu Zhengjun
Published: February 2021

Background

Levan is a well-known homopolymer of fructose composed predominantly of β-(2, 6) fructofuranosyl linkages in the backbone with occasional β-(2, 1) linkages in the branch chains with varied applications. However, high production cost due to low yield of microbial levan has become a bottleneck for its practical applications. Furthermore, factors affecting the molecular mass of the synthesized levan by Leuconostoc spp. during prolonged cultivation is not fully elucidated.

Methods

The cultivation condition for Leuconostoc citreum BD1707 to synthesize levan was optimized by single-factor experiments and subsequently with response surface methodology (RSM). The average molecular weight (Mw) of levan synthesized by the strain L.citreum BD1707 under the optimized cultivation conditions was monitored by high-performance size exclusion chromatography (HPSEC). Finally, the enzyme with levan-degrading activity was determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE).

Results

The levan yield of BD1707 reached 34.86 g/L with a corresponding productivity of 7.47 g/L/d under the optimal cultivation conditions deduced by RSM, i.e., cultivation at 26 °C and 200 rpm for 112 h in tomato juice supplemented with 172 g/L sucrose with an initial pH value of 6.12. The Mw of levan reached a peak value of 2.320 × 107 Da at 6 h of cultivation under the optimized cultivation conditions and then gradually decreased to 8.809 × 106 Da after 120 h of cultivation.

Conclusion

The levan yield of the strain L.citreum BD1707 could be sufficiently enhanced via cultivation condition optimization. The decrease in molecular mass of the synthesized levan was attributed predominantly to the hydrolytic activity of levansucrase secreted by L.citreum BD1707 during cultivation, with an estimated Mw of 130 KD by SDS-PAGE, while the effect of acid hydrolysis could be nearly neglected.
Correlation between microbial host factors and caries among older adults
Authors: Mittal Rakhi , Tan Kai Soo , Wong Mun Loke , Allen Patrick Finbarr
Published: February 2021

Background

There is little knowledge about factors which may affect oral health among older adults. The objective of this study was to determine the relationship between Streptococcus mutans (MS) and Lactobacilli (LB) counts and caries among older adults.

Methods

In this community-based observation study, 141 participants aged 60 years and above were recruited from the west district of Singapore. Alongside the clinical examination, saliva samples were collected to determine Streptococcus mutans (MS) and Lactobacilli (LB) counts, as well as to record salivary flow rate and buffering capacity of saliva.

Results

Of the 141 participants, 63.8% were female and 94.3% were of Chinese ethnicity. The mean DMFT was 11.08 (s.d. 8.27). 9.9% of participants had at least one decayed tooth, 52.5% had minimum one missing tooth and 86.5% had at least one filled tooth. 67.4% had MS counts of ≥ 105 while LB counts were ≥ 105 for 48.2%. 83.7% had normal salivary flow or hypersalivation (> = 1 mL/min), the buffering capacity of the saliva was alkaline in 61% of the participants. Multivariate analysis showed that participants who had high MS counts were less likely to have a DMFT < 12 [OR (95% CI), 0.29 (0.11–0.77)] whereas participants who had high LB counts were less likely to have a DMFT ≤ 14 [OR (95% CI), 0.45 (0.20–1.002)].

Conclusion

Our study showed a positive correlation between MS and LB counts and caries experience in older adults. The mean DMFT was on the low side in our sample despite having a relatively high MS count. This suggests that there are many other factors which vary according to host environment, physiological and biological conditions that may affect MS and LB counts in the oral cavity.

Clinical relevance

Our study supports the knowledge that the aetiology of dental caries among older adults is a complex process and it would be wrong to consider caries as a same problem with the same solution for all age groups.
Assessment of dental anxiety and dental phobia among adults in Lebanon
Authors: Kassem El Hajj Hiba , Fares Youssef , Abou-Abbas Linda
Published: February 2021

Background

Dental anxiety continues to be a widespread problem affecting adult populations. The primary aim of our study was to evaluate the psychometric properties of the Lebanese Arabic version of the Modified Dental Anxiety Scale (MDAS-A) and to identify the optimal cut-off for assessing dental anxiety and dental phobia among adults in Lebanon. In addition, we sought to assess dental anxiety and phobia as well as their correlates among Lebanese adult patients.

Methods

A cross-sectional study was carried out on a sample of 451 dental adult patients aged between 18 and 65 years old. Information about demographic characteristics, previous bad dental experience, trauma’s experience period, perception of a periodontal problem, sensation of nausea during dental treatment, the MDAS-A scale, and the Visual Analogue Scale for anxiety (VAS-A) were collected.

Results

MDAS-A exhibited evidence of adequate psychometric properties. The optimal cut-off was 12 for dental anxiety and 14 for dental phobia. Out of the total sample, 31.5% suffered from dental anxiety while 22.4% had a dental phobia. Multivariable analysis showed that the odds of dental anxiety and phobia were higher among females compared to males. Also, patients suffering from periodontal problem perceptions, bad dental experiences during childhood and adolescence, and the sensation of nausea during dental treatment were at a higher risk of developing dental anxiety and phobia compared to their counterparts. However, a higher level of education was found to be a protective factor against dental phobia among Lebanese adult patients.

Conclusion

The MDAS-A scale is a suitable tool for the routine assessment of dental anxiety and phobia among Lebanese adult patients. Identifying patients with dental anxiety at the earliest opportunity is of utmost importance for delivering successful dental care.
Oral health of aboriginal people with kidney disease living in Central Australia
Authors: Kapellas Kostas , Hughes Jaquelyne T. , Cass Alan , Maple-Brown Louise J. , Skilton Michael R. , Harris David , Askie Lisa M. , Hoy Wendy , Pawar Basant , McKenzie Kirsty , Sajiv Cherian T. , Arrow Peter , Brown Alex , Jamieson Lisa M.
Published: February 2021

Background

Associations between kidney disease and periodontal disease are not well documented among Aboriginal people of Australia. The purpose of this investigation was to report and compare demographic, oral health, anthropometric and systemic health status of Aboriginal Australians with kidney disease and to compare against relevant Aboriginal Australians and Australian population estimates. This provides much needed evidence to inform dental health service provision policies for Aboriginal Australians with kidney disease.

Methods

Sample frequencies and means were assessed in adults represented in six datasets including: (1) 102 Aboriginal Australians with kidney disease residing in Central Australia who participated in a detailed oral health assessment; (2) 312 Aboriginal participants of the Northern Territory’s PerioCardio study; (3) weighted estimates from 4775 participants from Australia’s National Survey of Adult Oral Health (NSAOH); (4) Australian 2016 Census (all Australians); (5) National Health Survey 2017–2018 (all Australians) and; (6) Australian Health Survey: Biomedical Results for Chronic Diseases, 2011–2012 (all Australians). Oral health status was described by periodontal disease and experience of dental caries (tooth decay). Statistically significant differences were determined via non-overlapping 95% confidence intervals.

Results

Aboriginal Australians with kidney disease were significantly older, less likely to have a tertiary qualification or be employed compared with both PerioCardio study counterparts and NSAOH participants. Severe periodontitis was found in 54.3% of Aboriginal Australians with kidney disease, almost 20 times the 2.8% reported in NSAOH. A higher proportion of Aboriginal Australians with kidney disease had teeth with untreated caries and fewer dental restorations when compared to NSAOH participants. The extent of periodontal attachment loss and periodontal pocketing among Aboriginal Australians with kidney disease (51.0%, 21.4% respectively) was several magnitudes greater than PerioCardio study (22.0%, 12.3% respectively) and NSAOH (5.4%, 1.3% respectively) estimates.

Conclusions

Aboriginal Australians with kidney disease exhibited more indicators of poorer oral health than both the general Australian population and a general Aboriginal population from Australia’s Northern Territory. It is imperative that management of oral health among Aboriginal Australians with kidney disease be included as part of their ongoing medical care.
Dignity of informal caregivers of migrant patients in the last phase of life: a qualitative study
Authors: de Voogd X. , Willems D. L. , Torensma M. , Onwuteaka-Philipsen B. D. , Suurmond J. L.
Published: February 2021

Background

A key aim of palliative care is to improve the quality of life of patients and their families. To help ensure quality of life for the families of patients with migrant backgrounds, this study sought insights into the dignity of informal caregivers in migrant communities. This could improve understanding of family-centered care for migrant patients.

Methods

Twenty semi-structured interviews with informal caregivers of Turkish, Moroccan, or Surinamese background living in the Netherlands were analyzed thematically.

Results

The dignity of the patient and that of their informal caregivers were found to be strongly interrelated. Most important for the dignity of caregivers was ensuring good care for their patients and preserving the patients’ dignity. Ensuring good care involved advocating for good and dignified care and for satisfaction of a patient’s wishes. For many informal caregivers, it also included delivering care to the patient by themselves or together with other family members, despite having to give up part of their own lives. Providing care themselves was part of maintaining a good relationship with the patient; the care was to cater to the patient’s preferences and help preserve the patient’s dignity, and it could be accompanied by valuable aspects such as times for good conversations. Positive interaction between an informal caregiver and a patient positively influenced the informal caregiver’s dignity. Informal caregiver and patient dignity were often compromised simultaneously; when informal caregivers felt healthcare professionals were undermining a patient’s dignity, their own dignity suffered. According to informal caregivers, healthcare professionals can help them preserve dignity by taking seriously their advice about the patient, keeping them informed about the prognosis of the disease and of the patient, and dealing respectfully with differences in values at the end of life.

Conclusion

The dignity of migrant patients’ informal caregivers in the last phase of a patient’s life is closely entwined with ensuring good care and dignity for the patient. Healthcare professionals can strengthen the dignity of informal caregivers by supporting their caregiving role.
Nutrition from the kitchen: culinary medicine impacts students’ counseling confidence
Authors: Magallanes Emily , Sen Ahana , Siler Milette , Albin Jaclyn
Published: February 2021

Background

Although a poor diet is the number one risk factor for early death in the United States and globally, physicians receive little to no training in dietary interventions and lack confidence counseling patients about lifestyle modifications. Innovative, interprofessional strategies to address these gaps include the emergence of culinary medicine, a hands-on approach to teaching the role of food in health outcomes. We sought to assess the impact of a culinary medicine elective on counseling confidence, awareness of an evidence-based approach to nutrition, and understanding of the role of interprofessional teamwork in dietary lifestyle change among medical students at one undergraduate medical school.

Methods

We administered pre- and post-course surveys to two cohorts of medical students (n = 64 at pre-test and n = 60 at post-test) participating in a culinary medicine enrichment elective. Chi-square analysis was used to assess the relationship between participation in the course and a positive response to each survey item.

Results

Compared with the baseline, students participating in culinary medicine were more likely to feel confident discussing nutrition with patients (29% vs 92%; p < 0.001), to feel familiar with the Mediterranean diet (54% vs. 97%; p < 0.001), and to understand the role of dietitians in patient care (37% vs. 93%; p < 0.001).

Conclusions

Culinary medicine shows promise as an impactful educational strategy among first-year medical students for increasing counseling confidence, promoting familiarity with evidence-based nutrition interventions, and augmenting understanding of the role of interprofessional engagement to address lifestyle-related disease.
Application and practice of a step-by-step method combined with case-based learning in Chinese otoendoscopy education
Authors: Wei Fanqin , Sun Qiyang , Qin Zili , Zhuang Huiwen , Jiang Guangli , Wu Xuan
Published: February 2021

Background

Standardized training allows more physicians to master otoendoscopic surgery. However, the lecture-based learning (LBL) applied in otoendoscopy teaching may not be conducive to training students in clinical thinking and surgical ability. It is necessary to explore innovative methods for otoendoscopy teaching. This study aimed to determine the effect of a step-by-step (SBS) method combined with case-based learning (CBL) in otoendoscopy teaching.

Methods

Fifty-nine physicians who participated in otoendoscopy training were selected as the study subjects and randomly divided into two groups (A and B). Group A underwent training with the SBS & CBL method, while Group B underwent training with the LBL & CBL method. The effects of these two methods for otoendoscopy training were compared by evaluation of professional skills and questionnaires before and after the training.

Results

Proficiency in otoendoscopic anatomy and grades for both professional knowledge and otoendoscopic skills were significantly higher in Group A than in Group B(P < 0.05). In terms of learning interest, surgical ability, acting capacity during surgery, reducing surgical complications, and satisfaction with learning experience, all responses from Group A were better than those from Group B(P < 0.05).

Conclusions

The SBS & CBL method may help to improve ability in otoendoscopic surgery and clinical thinking and appears suitable for endoscopy teaching.
The anatomy of electronic patient record ethics: a framework to guide design, development, implementation, and use
Authors: Jacquemard Tim , Doherty Colin P. , Fitzsimons Mary B.
Published: February 2021

Background

This manuscript presents a framework to guide the identification and assessment of ethical opportunities and challenges associated with electronic patient records (EPR). The framework is intended to support designers, software engineers, health service managers, and end-users to realise a responsible, robust and reliable EPR-enabled healthcare system that delivers safe, quality assured, value conscious care.

Methods

Development of the EPR applied ethics framework was preceded by a scoping review which mapped the literature related to the ethics of EPR technology. The underlying assumption behind the framework presented in this manuscript is that ethical values can inform all stages of the EPR-lifecycle from design, through development, implementation, and practical application.

Results

The framework is divided into two parts: context and core functions. The first part ‘context’ entails clarifying: the purpose(s) within which the EPR exists or will exist; the interested parties and their relationships; and the regulatory, codes of professional conduct and organisational policy frame of reference. Understanding the context is required before addressing the second part of the framework which focuses on EPR ‘core functions’ of data collection, data access, and digitally-enabled healthcare.

Conclusions

The primary objective of the EPR Applied Ethics Framework is to help identify and create value and benefits rather than to merely prevent risks. It should therefore be used to steer an EPR project to success rather than be seen as a set of inhibitory rules. The framework is adaptable to a wide range of EPR categories and can cater for new and evolving EPR-enabled healthcare priorities. It is therefore an iterative tool that should be revisited as new EPR-related state-of-affairs, capabilities or activities emerge.
Enhancing the ethical conduct of a longitudinal cluster-randomized trial of psychosocial stimulation intervention for children with complicated severe acute malnutrition through Rapid Ethical Assessment: a qualitative study
Authors: Tessema Tesfalem T. , Alamdo Andamlak G. , Mekonnen Eyoel B. , Debele Fanna A. , Bamud Juhar A. , Abessa Teklu G. , Lema Tefera Belachew
Published: February 2021

Background

Informed consent is a universally accepted precondition for scientific researches involving human participants. However, various factors influence the process of obtaining authentic informed consent, and researchers particularly working in resource-poor countries often face considerable difficulties in implementing the universally recommended procedures for obtaining informed consent. We have conducted this Rapid Ethical Assessment (REA) to accommodate the local cultural norms and to understand the relevant ethical issues in the Silti community before the conduct of a cluster-randomized controlled trial.

Methods

This REA was conducted in two purposively selected Woredas/Districts and Worabe Town administration of Silti Zone. Data were collected using in-depth interviews and focus group discussions. Purposive and convenient sampling techniques were used to select respondents. Five in-depth interviews and 15 Focus Group Discussions were conducted in the Amharic language. The collected data was transcribed, translated, and analyzed using a thematic approach.

Result

Most of the community members never heard about research and therapeutic misconception was common. In the area, the permission of people working in the formal and informal community administration is essential before approaching individuals. The male head of the household should also be involved in the decision before individual household members participate in research. Furthermore, sensitizing the community using public and religious gatherings was suggested before individual recruitment. In the consent process, delivering selected information particularly the purpose and benefits of the research was emphasized and the tendency of preferring verbal consent was documented despite the willingness of the individuals to sign on the consent form. Local health workers were identified as appropriate personnel to communicate information and the procedures of the research were found to be acceptable. However, the value of small incentives was suggested to motivate potential participants. Finally, involving all concerned stakeholders and respecting the cultural norm of the community was emphasized.

Conclusion

Through REA, we understand the research awareness of the community, their expectation, and the cultural norms relevant to the ethical conduct of research. It enabled us to devise culturally sensitive and scientifically sound strategies to secure authentic informed consent. The process of conducting REA was found to be feasible, quick, and efficient.
Prediction of adverse drug reactions based on knowledge graph embedding
Authors: Zhang Fei , Sun Bo , Diao Xiaolin , Zhao Wei , Shu Ting
Published: February 2021

Background

Adverse drug reactions (ADRs) are an important concern in the medication process and can pose a substantial economic burden for patients and hospitals. Because of the limitations of clinical trials, it is difficult to identify all possible ADRs of a drug before it is marketed. We developed a new model based on data mining technology to predict potential ADRs based on available drug data.

Method

Based on the Word2Vec model in Nature Language Processing, we propose a new knowledge graph embedding method that embeds drugs and ADRs into their respective vectors and builds a logistic regression classification model to predict whether a given drug will have ADRs.

Result

First, a new knowledge graph embedding method was proposed, and comparison with similar studies showed that our model not only had high prediction accuracy but also was simpler in model structure. In our experiments, the AUC of the classification model reached a maximum of 0.87, and the mean AUC was 0.863.

Conclusion

In this paper, we introduce a new method to embed knowledge graph to vectorize drugs and ADRs, then use a logistic regression classification model to predict whether there is a causal relationship between them. The experiment showed that the use of knowledge graph embedding can effectively encode drugs and ADRs. And the proposed ADRs prediction system is also very effective.
EMS utilization predictors in a Mobile Integrated Health (MIH) program
Authors: Pinet-Peralta Luis M. , Glos Lukas J. , Sanna Evan , Frankel Brian , Lindqvist Ernest
Published: February 2021

Background

The provision of unnecessary Emergency Medical Services care remains a challenge throughout the US and contributes to Emergency Department overcrowding, delayed services and lower quality of care. New EMS models of care have shown promise in improving access to health services for patients who do not need urgent care. The goals of this study were (1) to identify factors associated with EMS utilization (911) and (2) their effects on total EMS calls and transports in an MIH program.

Methods

The study sample included 110 MIH patients referred to the program or considered high-users of EMS services between November 2016 and September 2018. The study employed descriptive statistics and Poisson regressions to estimate the effects of covariates on total EMS calls and transports.

Results

The typical enrollee is a 60-year-old single Black male living with two other individuals. He has a PCP, takes 12 medications and is compliant with his treatment. The likelihood of calling and/or being transported by EMS was higher for males, patients at high risk for falls, patients with asthma/COPD, psychiatric or behavioral illnesses, and longer travel times to a PCP. Each prescribed medication increased the risk for EMS calls or transports by 4%. The program achieved clear reductions in 911 calls and transports and savings of more than 140,000 USD in the first month.

Conclusions

This study shows that age, marital status, high fall risk scores, the number of medications, psychiatric/behavioral illness, asthma/COPD, CHF, CVA/stroke and medication compliance may be good predictors of EMS use in an MIH setting. MIH programs can help control utilization of EMS care and reduce both EMS calls and transports.
Evolutionary dynamics and structural consequences of de novo beneficial mutations and mutant lineages arising in a constant environment
Authors: Kinnersley Margie , Schwartz Katja , Yang Dong-Dong , Sherlock Gavin , Rosenzweig Frank
Published: February 2021

Background

Microbial evolution experiments can be used to study the tempo and dynamics of evolutionary change in asexual populations, founded from single clones and growing into large populations with multiple clonal lineages. High-throughput sequencing can be used to catalog de novo mutations as potential targets of selection, determine in which lineages they arise, and track the fates of those lineages. Here, we describe a long-term experimental evolution study to identify targets of selection and to determine when, where, and how often those targets are hit.

Results

We experimentally evolved replicate Escherichia coli populations that originated from a mutator/nonsense suppressor ancestor under glucose limitation for between 300 and 500 generations. Whole-genome, whole-population sequencing enabled us to catalog 3346 de novo mutations that reached > 1% frequency. We sequenced the genomes of 96 clones from each population when allelic diversity was greatest in order to establish whether mutations were in the same or different lineages and to depict lineage dynamics. Operon-specific mutations that enhance glucose uptake were the first to rise to high frequency, followed by global regulatory mutations. Mutations related to energy conservation, membrane biogenesis, and mitigating the impact of nonsense mutations, both ancestral and derived, arose later. New alleles were confined to relatively few loci, with many instances of identical mutations arising independently in multiple lineages, among and within replicate populations. However, most never exceeded 10% in frequency and were at a lower frequency at the end of the experiment than at their maxima, indicating clonal interference. Many alleles mapped to key structures within the proteins that they mutated, providing insight into their functional consequences.

Conclusions

Overall, we find that when mutational input is increased by an ancestral defect in DNA repair, the spectrum of high-frequency beneficial mutations in a simple, constant resource-limited environment is narrow, resulting in extreme parallelism where many adaptive mutations arise but few ever go to fixation.
Pattern and trend of five major musculoskeletal disorders in China from 1990 to 2017: findings from the Global Burden of Disease Study 2017
Authors: Wu Dongze , Wong Priscilla , Guo Cui , Tam Lai-Shan , Gu Jieruo
Published: February 2021

Background

With increasing life expectancy in China, no large population-based studies have been done on the trend for musculoskeletal disorders in China. We have investigated the pattern and trend of five major musculoskeletal disorders in China from the Global Burden of Disease Study 2017 and its association with sociodemographic index (SDI).

Methods

The main outcome measures were incidence, prevalence, and disability-adjusted life years (DALYs) for rheumatoid arthritis, osteoarthritis, low back pain, neck pain, and gout. Average annual percent change (AAPC) and annual percent change (APC) between 1990 and 2017 were analyzed with Joinpoint regression.

Results

The age-standardized rate of incidence, prevalence, and DALYs for the five major musculoskeletal disorders increased with age. For SDI, the age-standardized rate of DALYs was zigzagged increasing for rheumatoid arthritis and curvilinear increasing for gout, curvilinear decreasing for low back pain, and reaching to the highest point for osteoarthritis and neck pain with an SDI value of 0.61. The AAPC in age-standardized rate of DALYs indicated an increasing trend for rheumatoid arthritis (0.20, 95% CI 0.07, 0.34), osteoarthritis (0.26, 95% CI 0.20, 0.31), neck pain (0.09, 95% CI 0.07, 0.12), and gout (0.25, 95% CI 0.23, 0.27), but a decreasing trend for low back pain (− 0.96, 95% CI − 0.98, − 0.93). The AAPC of risk factors indicated a decreasing trend in smoking (− 0.14, 95% CI − 0.24, − 0.04) for rheumatoid arthritis, smoking (− 0.22, 95% CI − 0.24, − 0.19) and occupational ergonomic factors (− 1.25, 95% CI − 1.29, − 1.21) for low back pain, and impaired kidney function (− 0.95, 95% CI − 1.00, − 0.90) for gout, but an increasing trend in high body-mass index for osteoarthritis (3.10, 95% CI 3.03, 3.17), low back pain (3.07, 95% CI 2.99, 3.14), and gout (3.12, 95% CI 3.04, 3.20). Comparing the burden of five musculoskeletal diseases in China with the 19 countries of G20, China ranked first to second in the number of DALYs, and 12th to 16th in age-standardized rate of DALYs.

Conclusion

There are remarkably complex temporal patterns in disease burden and risk factors for five major musculoskeletal disorders across past three decades. Population-wide initiatives targeting high body-mass index may mitigate the burden of musculoskeletal disorders.
Chemotherapeutic and targeted agents can modulate the tumor microenvironment and increase the efficacy of immune checkpoint blockades
Authors: Li Jun-Yan , Chen Yu-Pei , Li Ying-Qin , Liu Na , Ma Jun
Published: February 2021

The development of immune checkpoint blockade (ICB)-based immunotherapy has dramatically changed methods of cancer treatment. This approach triggers a durable treatment response and prolongs patients' survival; however, not all patients can benefit. Accumulating evidence demonstrated that the efficacy of ICB is dependent on a robust antitumor immune response that is usually damaged in most tumors. Conventional chemotherapy and targeted therapy promote the antitumor immune response by increasing the immunogenicity of tumor cells, improving CD8+ T cell infiltration, or inhibiting immunosuppressive cells in the tumor microenvironment. Such immunomodulation provides a convincing rationale for the combination therapy of chemotherapeutics and ICBs, and both preclinical and clinical investigations have shown encouraging results. However, the optimal drug combinations, doses, timing, and sequence of administration, all of which affect the immunomodulatory effect of chemotherapeutics, as well as the benefit of combination therapy, are not yet determined. Future studies should focus on these issues and help to develop the optimal combination regimen for each cancer.
Responsiveness of PROMIS and Patient Health Questionnaire (PHQ) Depression Scales in three clinical trials
Authors: Kroenke Kurt , Stump Timothy E. , Chen Chen X. , Kean Jacob , Damush Teresa M. , Bair Matthew J. , Krebs Erin E. , Monahan Patrick O.
Published: February 2021

Background

The PROMIS depression scales are reliable and valid measures that have extensive normative data in general population samples. However, less is known about how responsive they are to detect change in clinical settings and how their responsiveness compares to legacy measures. The purpose of this study was to assess and compare the responsiveness of the PROMIS and Patient Health Questionnaire (PHQ) depression scales in three separate samples.

Methods

We used data from three clinical trials (two in patients with chronic pain and one in stroke survivors) totaling 651 participants. At both baseline and follow-up, participants completed four PROMIS depression fixed-length scales as well as legacy measures: Patient Health Questionnaire 9-item and 2-item scales (PHQ-9 and PHQ-2) and the SF-36 Mental Health scale. We measured global ratings of depression change, both prospectively and retrospectively, as anchors to classify patients as improved, unchanged, or worsened. Responsiveness was assessed with standardized response means, statistical tests comparing change groups, and area-under-curve analysis.

Results

The PROMIS depression and legacy scales had generally comparable responsiveness. Moreover, the four PROMIS depression scales of varying lengths were similarly responsive. In general, measures performed better in detecting depression improvement than depression worsening. For all measures, responsiveness varied based on the study sample and on whether depression improved or worsened.

Conclusions

Both PROMIS and PHQ depression scales are brief public domain measures that are responsive (i.e., sensitive to change) and thus appropriate as outcome measures in research as well as for monitoring treatment in clinical practice.

Trial registrationClinicalTrials.gov ID: NCT01236521, NCT01583985, NCT01507688
Association of health checkups with health-related quality of life among public servants: a nationwide survey in Taiwan
Authors: Shih Dann-Pyng , Kuo Hsien-Wen , Liang Wen-Miin , Lin Ping-Yi , Tseng Pochang , Wang Jong-Yi
Published: February 2021

Background

Preventive health checkups have gained in importance over the last decade. The association of health checkups and the number of diseases with health-related quality of life (HRQoL), including physical and mental health, remains unclear. We sought to investigate the aforementioned association among Taiwanese public servants.

Methods

A cross-sectional survey was conducted using randomized and multistage stratified cluster sampling based on proportional probabilistic sampling. The questionnaires addressed demographics, job characteristics, health behaviors, health status, 3 types of health checkups during the preceding 3 years (government-paid health checkup [GPHC], self-paid health checkup [SPHC], and no health checkup [NOHC]), and physical component summary (PCS) and mental component summary (MCS) scores of the Short-Form Health Survey. In total 11,454 middle-aged public servants were analyzed. A multivariate general linear model (GLM) was used to estimate PCS and MCS scores by using least square means.

Results

Health checkup types were associated with a significant difference in PCS scores among the public servants. Scores of PCS and MCS were both significantly higher in the GPHC group than in the NOHC group for those with no chronic diseases (51.20 vs. 50.66 [P = 0.008] and 46.23 vs. 45.58 [P = 0.02], respectively). Compared with the NOHC group, both scores of GPHC and SPHC groups were significantly associated with higher PCS scores for public servants with ≥ 2 chronic diseases (46.93 vs. 45.13 [P = 0.002] and 46.52 vs. 45.13 [P = 0.009], respectively).

Conclusion

In Taiwan, public servants undergoing GPHCs are more likely to report higher PCS scores than are those undergoing SPHCs. It is crucial that encourage periodically using the health checkup to improve health status and HRQoL.
Understanding patient outcomes to develop a multimorbidity adapted patient-reported outcomes measure: a qualitative description of patient and provider perspectives
Authors: Sasseville Maxime , Chouinard Maud-Christine , Fortin Martin
Published: February 2021

Background

Multimorbidity is a complex health situation that requires interventions tailored to patient needs; the outcomes of such interventions are difficult to evaluate. The purpose of this study was to describe the outcomes of patient-centred interventions for people with multimorbidity from the patients’ and healthcare providers’ perspectives.

Methods

This study followed a qualitative descriptive design. Nine patients with multimorbidity and 18 healthcare professionals (nurses, general practitioners, nutritionists, and physical and respiratory therapists), participating in a multimorbidity-adapted intervention in primary care were recruited. Data were collected using semi-structured interviews with 12 open-ended questions. Triangulation of disciplines among interviewers, research team debriefing, data saturation assessment and iterative data collection and analysis ensured a rigorous research process.

Results

Outcome constructs described by participants covered a wide range of themes and were grouped into seven outcome domains: Health Management, Physical Health, Functional Status, Psychosocial Health, Health-related Behaviours, General Health and Health Services. The description of constructs by stakeholders provides valuable insight on how outcomes are experienced and worded by patients.

Conclusion

Participants described a wide range of outcome constructs, which were relevant to and observable by patients and were in line with the clinical reality. The description provides a portrait of multimorbidity-adapted intervention outcomes that are significant for the selection and development of clinical research outcome measures.
A low RENAL Nephrometry Score can avoid the need for the intraoperative insertion of a ureteral catheter in robot-assisted partial nephrectomy
Authors: Nishimura Kenichi , Sawada Yuichiro , Sugihara Naoya , Funaki Keisuke , Koyama Kanae , Noda Terutaka , Fukumoto Tetsuya , Miura Noriyoshi , Miyauchi Yuki , Kikugawa Tadahiko , Saika Takashi
Published: February 2021

Background

Intraoperative urinary collecting system entry (CSE) in robot-assisted partial nephrectomy (RAPN) may cause postoperative urinary leakage and extend the hospitalization. Therefore, identifying and firmly closing the entry sites are important for preventing postoperative urine leakage. In RAPN cases expected to require CSE, we insert a ureteral catheter and inject dye into the renal pelvis to identify the entry sites. We retrospectively analyzed the factors associated with intraoperative CSE in RAPN and explored the indications of intraoperative ureteral catheter indwelling in RAPN.

Methods

Of 104 Japanese patients who underwent RAPN at our institution from August 2016 to March 2020, 101 were analyzed. The patients were classified into CSE and non-CSE groups. The patients’ background characteristics, RENAL Nephrometry Score (RNS), and surgical outcomes were analyzed.

Results

Intraoperative CSE was observed in 41 patients (41%). The CSE group had a significantly longer operative time, console time, ischemic time, and hospital stay than the non-CSE group. In a multivariable analysis, the N-score (odds ratio [OR] = 3.9, P < 0.05) and RNS total score excluding the L-score (OR = 3.1, P < 0.05) were associated with CSE. In a logistic regression analysis, CSE showed a moderate correlation with the RNS total score excluding the L-score (AUC 0.848, cut-off 5, sensitivity 0.83, specificity 0.73).

Conclusion

A ureteral catheter should not be placed in patients with an RNS total score (excluding the L-score) of ≤ 4.
Non-invasive monitoring of pH and oxygen using miniaturized electrochemical sensors in an animal model of acute hypoxia
Authors: Pla Laura , Berdún Sergio , Mir Mònica , Rivas Lourders , Miserere Sandrine , Dulay Samuel , Samitier Josep , Eixarch Elisenda , Illa Miriam , Gratacós Eduard
Published: February 2021

Background

One of the most prevalent causes of fetal hypoxia leading to stillbirth is placental insufficiency. Hemodynamic changes evaluated with Doppler ultrasound have been used as a surrogate marker of fetal hypoxia. However, Doppler evaluation cannot be performed continuously. As a first step, the present work aimed to evaluate the performance of miniaturized electrochemical sensors in the continuous monitoring of oxygen and pH changes in a model of acute hypoxia-acidosis.

Methods

pH and oxygen electrochemical sensors were evaluated in a ventilatory hypoxia rabbit model. The ventilator hypoxia protocol included 3 differential phases: basal (100% FiO2), the hypoxia-acidosis period (10% FiO2) and recovery (100% FiO2). Sensors were tested in blood tissue (ex vivo sensing) and in muscular tissue (in vivo sensing). pH electrochemical and oxygen sensors were evaluated on the day of insertion (short-term evaluation) and pH electrochemical sensors were also tested after 5 days of insertion (long-term evaluation). pH and oxygen sensing were registered throughout the ventilatory hypoxia protocol (basal, hypoxia-acidosis, and recovery) and were compared with blood gas metabolites results from carotid artery catheterization (obtained with the EPOC blood analyzer). Finally, histological assessment was performed on the sensor insertion site. One-way ANOVA was used for the analysis of the evolution of acid-based metabolites and electrochemical sensor signaling results; a t-test was used for pre- and post-calibration analyses; and chi-square analyses for categorical variables.

Results

At the short-term evaluation, both the pH and oxygen electrochemical sensors distinguished the basal and hypoxia-acidosis periods in both the in vivo and ex vivo sensing. However, only the ex vivo sensing detected the recovery period. In the long-term evaluation, the pH electrochemical sensor signal seemed to lose sensibility. Finally, histological assessment revealed no signs of alteration on the day of evaluation (short-term), whereas in the long-term evaluation a sub-acute inflammatory reaction adjacent to the implantation site was detected.

Conclusions

Miniaturized electrochemical sensors represent a new generation of tools for the continuous monitoring of hypoxia-acidosis, which is especially indicated in high-risk pregnancies. Further studies including more tissue-compatible material would be required in order to improve long-term electrochemical sensing.