bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Depression Is Associated With Increased Complications Following Distal Radius Fracture Surgery
Authors: Broggi Matthew S. , Runge William O. , Hurt John T. , Dawes Alexander A. , Toston Roy J. , Ojemakinde Akinade A. , Cooke Hayden L. , Gottschalk Michael B. , Wagner Eric R.
Published: November 2023

Background:

Depression is a known risk factor for inferior outcomes after orthopedic procedures, but its specific relationship with distal radius fractures remains unknown. This study investigates the relationship between preoperative diagnosed depression and common postoperative complications occurring within the first year after open reduction internal fixation (ORIF) for distal radius fractures.

Methods:

This retrospective study used Truven MarketScan database and the Current Procedural Terminology (CPT) codes to identify distal radius fracture patients who underwent ORIF in the United States between January 1, 2009, and December 31, 2019. International Classification of Diseases (ICD) codes were used to identify patients with and without a diagnosis of preoperative depression. Univariate, multivariate, t test, and χ2 analyses were performed to determine the association between preoperative depression and postoperative complications following a distal radius fracture surgery.

Results:

Of the 75 098 eligible patients, 9.9% had at least one ICD code associated with preoperative depression. Preoperative depression was associated with increased odds for surgical site infection (odds ratio [OR] 1.25, confidence interval [CI] 1.14-1.37), emergency department visits for postoperative pain (OR 1.28, CI 1.15-1.36), hardware complication (OR 1.18, CI 1.07-1.30), removal of hardware within 1 year (OR 1.16, CI 1.09-1.27), wound complication (OR 1.17, CI 1.08-1.27), and 30-day readmission (OR 1.21, CI 1.07-1.31).

Conclusions:

Preoperative diagnosed depression is associated with increased complications following distal radius fracture surgery. These results can help guide preoperative and postoperative protocols in these higher risk patients. More research is needed to investigate if depression is a modifiable risk factor, as depression treatment could potentially improve postsurgical outcomes.
Raising the Bar: A Qualitative Study of a Co-Produced Model for Promoting research Partnerships in Mental Health
Authors: River Jo , Bellingham Brett , Isobel Sophie , Gill Katherine , Boydell Katherine , Conlon Liam , Goodhew Mark , Cutler Natalie , Kemp Holly
Published: November 2023

Internationally, lead agencies and consumer movements emphasise the need for high-level research participation in mental health. However, evidence suggests that people with lived experience tend to be recruited as subjects rather than as active agents in research, or are consulted in tokenistic ways. Although participatory research has the potential to rectify epistemic disparities, few studies have grappled with how to move from exclusion and tokenism to high-level research participation. This paper describes a qualitative co-evaluation of a co-produced model of research partnership, Raising the Bar, which involved deliberate establishment and facilitation of six participatory research teams, comprising 28 lived experience and ‘conventional' mental health researchers. Findings indicate that the theoretical elements of the model set the bar high from the outset, supporting research teams to address inconsistencies in knowledge about participation. It also provided researchers with the competencies and resources to undertake participatory research in egalitarian team structures, and to negotiate new forms of non-traditional research outputs - thereby challenging whom research might be for and how it might be made accessible. Finally, the model shifted collective meanings about research, lending credibility to participatory practices, which came to be seen as essential for meeting the needs of affected communities. Nonetheless, systemic barriers to participatory research remain, and need to be recognised and acted upon to promote a culture that supports high-level research participation.
Positioning Stakeholder Perspectives in COPD End-of-Life Care Using Critical Theory and Actor-Network Theory: A Methodological Approach
Authors: Landers Amanda , Pitama Suzanne G. , Palmer Suetonia C. , Beckert Lutz
Published: November 2023

Background

Meaningful engagement with stakeholders in the provision of healthcare and services is recommended by the World Health Organisation. Culturally specific evaluation may enable deeper exploration of the critical views of people living with advanced long-term conditions, their support people, and healthcare providers.

Aim and design

This article describes how critical theory and Actor-Network theory involved all stakeholders including patients with severe chronic obstructive pulmonary disease as expert voices during the evaluation of end-of-life care services.

Results

We describe how critical theory and Actor-Network theory informed the methodologies for focus groups and how stakeholders spoke as critical experts about and in the system. An analytical sample of the focus group study is presented to demonstrate how the frameworks were applied to identify cohesive themes that were inclusive of all stakeholders.

Conclusions

This paper highlights how the evaluation of health systems can include a critical methodological approach to include the values and perspectives of all stakeholders. The outcomes may be used by those who design health systems to develop high-quality services.
Virtual Synchronous Qualitative Data Collection Methods Used in Health and Social Sciences: A Scoping Review of Benefits, Challenges and Practical Insights
Authors: Dubé Marc-Olivier , Meziane Rabia Sabah , Hudon Anne , Cavallo Sabrina , Verduyckt Ingrid , Zidarov Diana
Published: November 2023

In recent years, we have seen the use of virtual synchronous qualitative data-collection methods grow exponentially, especially within the context of the COVID-19 pandemic. Although several recommendations for researchers conducting in-person interviews and focus groups are available in the scientific literature, they are not necessarily suited for application in a virtual context. To gain a better understanding of current practices and recommendations in virtual synchronous qualitative data collection, we conducted a scoping review. Information obtained from the 70 articles included in this review highlights the main benefits and challenges of virtual data-collection methods in research, compares differences with in-person means of data collection, and provides readers with practical insights for before, during, and after data collection. This comprehensive overview of the existing literature allowed us to outline the theoretical contributions and practical implications of our work as well as provide perspectives for future research. This scoping review can serve as a tool to inform researchers about how best to conduct virtual synchronous qualitative data collection based on other researchers’ prior experiences and the recommendations currently available in the literature.
Storytelling in Focus Group Discussions: A Narrative Approach to Phenomena With Temporal Dimensions in Medical Education Research
Authors: Gjessing Sofie , Kristensen Jette Kolding , Risør Torsten
Published: November 2023

People can express experiences, opinions, and perspectives in stories. In a story, the experiences can be relived and discovered independently of time and place. In medical education, it is a fundamental premise that time progresses, and it is within this temporal space that students learn, acquire competencies, and form identity. It is also within this space that much qualitative research is conducted. However, qualitative examinations at one point in time will result in only a snapshot of a dynamic phenomenon that evolves over time. Existing approaches to qualitative research are often inadequate to accommodate this dynamic development without applying a time- and cost-consuming design such as longitudinal investigations. The purpose of this paper is to present storytelling as a useful research approach to include temporal dimensions in cross-sectional qualitative data collection. We describe the background for the approach, argue for its use, and provide a practical example of storytelling with the use of a fictional character in online focus group discussions to explore a dynamic phenomenon in medical education research. Overall, storytelling offers a narrative approach to qualitative research that allows the researcher to explore phenomena across time and space. The approach has the advantage that it can be used in different formats both oral and written, digital or physical.
The association between inpatient rehabilitation intensity and outcomes after stroke in Ontario, Canada
Authors: MacDonald Shannon L , Linkewich Elizabeth , Bayley Mark , Jeong Irene JH , Fang Jiming , Fleet Jamie L
Published: November 2023

Background:

Several studies have demonstrated improved outcomes poststroke when higher intensity rehabilitation is provided. Canadian Stroke Best Practice Recommendations advise patients receive 180 min of therapy time per day; however, the exact amount required to reach benefit is unknown.

Aims:

The primary aim of this study was to determine the association between rehabilitation intensity (RI) and total Functional Independence Measure (FIM) Instrument change. Secondary aims included determining the association between RI and discharge location, 90-day home time, rehabilitation effectiveness, and motor and cognitive FIM change.

Methods:

A retrospective cohort study was conducted using available administrative databases of acute stroke patients discharged to inpatient rehabilitation facilities in Ontario, Canada, from January 2017 to December 2021. RI was defined as number of minutes per day of direct therapy by all providers divided by rehabilitation length of stay. The association between RI and the outcomes of interest were analyzed using regression models with restricted cubic splines.

Results:

A total of 12,770 individuals were included. Mean age of the sample was 72.6 years, 46.0% of individuals were female, and 87.6% had an ischemic stroke. Mean RI was 74.7 min (range: 5–162 min) per day. Increased RI was associated with an increase in mean FIM change. However, there was diminishing incremental increase after reaching 95 min/day. Increased RI was positively associated with motor and cognitive FIM change, rehabilitation effectiveness, 90-day home time, and discharge to preadmission setting. Higher RI was associated with a lower likelihood of discharge to long-term care.

Conclusions:

None of the patients met the recommended RI of 180 min/day based on the Canadian Stroke Best Practice Recommendations. Despite this, higher intensity was associated with better outcomes. Given that most positive associations were observed with a RI ⩾95 min/day, this may be a more feasible target.
Development and validation of a machine learning model for differential diagnosis of malignant pleural effusion using routine laboratory data
Authors: Wei Ting-Ting , Zhang Jia-Feng , Cheng Zhuo , Jiang Lei , Li Jiang-Yan , Zhou Lin
Published: November 2023

Background:

The differential diagnosis of malignant pleural effusion (MPE) and benign pleural effusion (BPE) presents a clinical challenge. In recent years, the use of artificial intelligence (AI) machine learning models for disease diagnosis has increased.

Objective:

This study aimed to develop and validate a diagnostic model for early differentiation between MPE and BPE based on routine laboratory data.

Design:

This was a retrospective observational cohort study.

Methods:

A total of 2352 newly diagnosed patients with pleural effusion (PE), between January 2008 and March 2021, were eventually enrolled. Among them, 1435, 466, and 451 participants were randomly assigned to the training, validation, and testing cohorts in a ratio of 3:1:1. Clinical parameters, including age, sex, and laboratory parameters of PE patients, were abstracted for analysis. Based on 81 candidate laboratory variables, five machine learning models, namely extreme gradient boosting (XGBoost) model, logistic regression (LR) model, random forest (RF) model, support vector machine (SVM) model, and multilayer perceptron (MLP) model were developed. Their respective diagnostic performances for MPE were evaluated by receiver operating characteristic (ROC) curves.

Results:

Among the five models, the XGBoost model exhibited the best diagnostic performance for MPE (area under the curve (AUC): 0.903, 0.918, and 0.886 in the training, validation, and testing cohorts, respectively). Additionally, the XGBoost model outperformed carcinoembryonic antigen (CEA) levels in pleural fluid (PF), serum, and the PF/serum ratio (AUC: 0.726, 0.699, and 0.692 in the training cohort; 0.763, 0.695, and 0.731 in the validation cohort; and 0.722, 0.729, and 0.693 in the testing cohort, respectively). Furthermore, compared with CEA, the XGBoost model demonstrated greater diagnostic power and sensitivity in diagnosing lung cancer-induced MPE.

Conclusion:

The development of a machine learning model utilizing routine laboratory biomarkers significantly enhances the diagnostic capability for distinguishing between MPE and BPE. The XGBoost model emerges as a valuable tool for the diagnosis of MPE.
Assessing Congressional Institutionalization and Political Elites’ Renewal in Latin America Through Legislative Amateurism
Authors: Levita Gabriel , Márquez Romo Cristian
Published: November 2023

Legislative experience, one of the various indicators of both congressional institutionalization and political elites’ renewal, has been mostly measured by either turnover or reelection. However, in regions such as Latin America, with more volatile and less institutionalized party systems, where most careers are not stable and ambitions are not mostly static, turnover and reelection may not be accurate measures of legislative experience. This paper aims to fill this gap by assessing parliamentary experience in Latin America by means of a more accurate indicator: legislative amateurism. Using a novel dataset comprising eighteen national single or lower-chamber legislatures over almost three decades, we find that legislative amateurism is a consequence of party system institutionalization, electoral volatility, and newly implemented gender quotas. Overall, our findings suggest that weak political parties and certain electoral rules may become fertile ground for amateur legislatorś landing in Congress.
Assessing the reliability and feasibility of frailty screening tools among hospitalised older adults
Authors: Lim Siew Hoon , Malhotra Rahul , Østbye Truls , Ang Shin Yuh , Ng Xin Ping , Agus Nurliyana , Binte Sunari Raden Nurheryany , Aloweni Fazila
Published: November 2023

Background

The 29-item Frail-Physical, Psychological and Social (Frail-PPS) and the 14-item Frailty Assessment Measure (FAM) were developed in Singapore to identify risk of frailty among community dwelling older adults and validated for use among hospitalised older adults.

Objectives

This study aimed to establish the interrater reliability and feasibility of the two screening tools ‒ FAM and Frail-PPS, for assessing frailty among hospitalized older adults.

Methods

The FAM and Frail-PPS were administered during the initial nursing assessment by nurses to 62 patients aged 65 years and older within 24 h of admission. Interrater reliability, convergent validity and intraclass correlation coefficients (ICCs) were established. Feasibility was determined by the time of administration.

Results

ICCs for Frail-PPS and FAM were 0.95 and 0.95 respectively. A positive correlation was established (r = 0.97). The administration time for Frail-PPS averaged 6.7 min, and 3.3 min for FAM.

Conclusions

The FAM, with its high reliability and convergent validity, as well as shorter administration time, may be the preferred screening tool for use in acute care settings.
A rare presentation of vanishing bile duct syndrome in Hodgkin lymphoma: Case report
Authors: Patodiya Bharat , Ramani Vinod K , Rao Padaki Nagaraja , Sharma Mithun , Patodiya Shalini , Reddy D Nageshwar
Published: November 2023

In this report, we present the case of vanishing bile duct syndrome in the setting of classical Hodgkin lymphoma. Vanishing bile duct syndrome was diagnosed retrospectively in this patient with Hodgkin lymphoma, who initially presented with a hepatic abnormality presumed to be drug induced. Vanishing bile duct syndrome is characterized by the disappearance of bile ducts, with the progressive damage resulting in cholestasis. Thus, nivolumab therapy was initiated for Hodgkin lymphoma, in place of the standard ABVD (Doxorubicin, bleomycin, vinblastine, dacarbazine) regimen, which resulted in autoimmune hemolytic anemia. Alternatively, GDP (gemcitabine, dexamethasone, and carboplatin) chemotherapy with protocol modification resulted in better tolerance and remission of Hodgkin lymphoma. Granulocyte colony-stimulating factor support and romiplostim supplement were provided to prevent chemotherapy-induced neutropenia and thrombocytopenia, respectively. Due to the deranged liver function in our case, we initially suspected the etiology as drug-induced cholestatic injury. While hepatic failure is the leading cause of mortality among patients with Hodgkin lymphoma-related vanishing bile duct syndrome, our case report suggests a complete remission of vanishing bile duct syndrome following an adequate treatment of Hodgkin lymphoma and an improvement in the hepatic function. To conclude, our report describes the rare case of vanishing bile duct syndrome which heralded the diagnosis of Hodgkin lymphoma, and the effective management of Hodgkin lymphoma which precedes the improvement of hepatic abnormality.
DWELL: Design for WELLness. A pilot study of an online Facebook intervention to improve perceptions of knowledge, engagement, and self-efficacy in the creation of healthy home environments
Authors: Aperman-Itzhak Tal , Prilleltensky Isaac , Rosen Laura
Published: November 2023

Background

Many factors in the environment influence healthy behaviors. Designing user-friendly environments, by changing the way choices are presented in the environment, may result in behavioral changes and promote the well-being.

Objectives

To run a pilot study to evaluate the feasibility and acceptability of DWELL (Design for WELLness), which is an online Facebook intervention to improve perceptions of knowledge, engagement, and self-efficacy in the creation of healthy home environments.

Methods

Both quantitative and qualitative methods were used to evaluate this 7.5-week pilot study. The intervention was conducted during the first wave of COVID-19 lockdown in Israel. Participants answered an online questionnaire at the beginning and end of the pilot. Afterwards, eleven semi-structured telephone interviews were conducted with some of the participants.

Results

There were 36 mothers who participated in the study. The overall DWELL index increased by 15.43 points ( p < 0.001) from the beginning of the pilot [Mean(SD) = 48.14(17.91)] to the end [Mean(SD) = 63.57(11.98]. There were significant increases in all 5 items of DWELL ( p < 0.05). Positive feedback was obtained from interviewees about their experience with the program, including being interested with the posts and having a mutual learning experience with other members. The intervention was found to be beneficial to most families during COVID-19 lockdown time.

Conclusions

DWELL was found to be a promising intervention for improving perceptions regarding designing home environments for wellness. These results justified the continuation of the program toward its next phase of the RCT.
Targeted Social Media Harassment: A Comparative Analysis of Toxicity Directed at Men and Women Sports Reporters
Authors: Johnson Rich G. , Al-khateeb Samer , Forbes Ali , Cupido Kyran
Published: November 2023

Scholars and professionals have discussed that women working in sports media are often targeted by hateful rhetoric on social media. Through the lenses of hegemonic masculinity and online toxicity theories, this study examines X (formerly known as Twitter) mentions directed at both men and women sports reporters, comparing how men and women are harassed and how often. The study also uses a network analysis to examine toxic behaviors and communities directed at sports journalists. The sample of nearly 350,000 mentions was gathered over a 12-year period. Results show that while toxic posts directed at women were no more common than those that were directed at men, the content of the toxic posts were markedly different. The toxic posts directed toward men contained many sports-related themes, such as coaches, games, or team names. The toxic posts toward women were more likely to contain discussions of gender, sex, and sexual assault.
Zimbabwe’s Command Agriculture: Problems of Planning Under Neoliberalism
Authors: Mazwi Freedom , Yeros Paris
Published: November 2023

This article examines the impacts of Zimbabwe’s Command Agriculture (CA) program, a state-driven cereal production model implemented since 2016. In the context of the neglect of cereal crops by African states generally under the accumulation strategies of international and domestic capital, and in the face of persisting neoliberal strategies led by international agencies such as the World Bank, the Zimbabwe experience continues to provide insights into the problems and prospects of planning under neoliberalism. In the case of CA, the Government of Zimbabwe intervened to bolster maize production, which had remained underfunded. The study shows a distinct correlation between national food self-sufficiency and, to some extent, economic stability and growth under state intervention and planning. This suggests that the CA program, as well as other planning initiatives, can stimulate economic growth and development if well managed. It illuminates how farmers were recruited and mobilized under CA and attempts to identify the weaknesses and challenges of the program. We posit that state planning in cereal production poses a threat to neoliberalism and the hierarchical international food system, and is an important step toward attaining national sovereignty.
The Role of Internal Communication on Employee Outcomes: A Review and Direction
Authors: Sinitsyna Elena , Anand Amitabh , Dumazert Jean-Pierre , Kazakov Sergey
Published: November 2023

Despite the importance of internal communication (IC) in organization and management studies, its role or impact on employee outcomes (specifically employee loyalty, commitment and citizenship behaviour) remains understudied. To address the preceding gap, this article systematically reviews the role of IC and its impact on employee outcomes. Our analysis reveals four critical themes, crisis events, culture/climate, organizational change and managers’ roles, where IC effectively influences the discussed employee outcomes. By summarizing the findings, we propose an integrated framework for researchers to move the conversation on the part of IC on employee outcomes forward.
Rectal Tropism: An Extremely Rare Case of Prostate Cancer Recurrence With Metastasis to the Rectum Postradical Prostatectomy
Authors: Trivedi Aakash , Bathobakae Lefika , Shenasan Pasha , Yuridullah Ruhin , Akmal Amer , El-Sedfy Abraham
Published: November 2023

Prostate cancer is the most common noncutaneous cancer affecting men in the United States. It is a slow-growing tumor that can be missed during the nascent phase. Prostate cancer commonly metastasizes to the bones and nearby lymph nodes. However, cases of metastatic prostate cancer to the rectum are exceptionally rare. Such metastases may cause obstructive or malabsorption symptoms similar to those observed in primary rectal carcinoma. We present a very rare case of prostate cancer recurrence with rectal metastasis in an elderly male with a history of castration-resistant prostate carcinoma status postradical prostatectomy.
Pain in the Gut: An Intriguing Case of Toothpick Ingestion Causing Gastric Perforation
Authors: Bathobakae Lefika , Mahmoud Anas , Wilkinson Tyler , Melki Gabriel , Cavanagh Yana , Siau Keith
Published: November 2023

Toothpick ingestion is a medical emergency requiring urgent intervention. Swallowed toothpicks can cause intestinal perforation, bleeding, or damage to the surrounding organs. Herein, we describe a unique case of a geriatric patient with a history of peptic ulcer disease who presented to the emergency department for the evaluation of abdominal pain and nausea. Gastric wall thickening concerning for a gastric neoplasm was observed on a computed tomography (CT) scan of the abdomen and pelvis. An esophagogastroduodenoscopy (EGD) revealed an embedded toothpick with a contained gastric perforation, and the foreign body was retrieved with a grasper device. Given the rare presentation, nonspecific symptoms, inability to recall, and often inconclusive imaging, a high index of suspicion is needed for early diagnosis and treatment of toothpick ingestion.
Listening Preferences of New Adult Hearing Aid Users: A Registered, Double-Blind, Randomized, Mixed-Methods Clinical Trial of Initial Versus Real-Ear Fit
Authors: Almufarrij Ibrahim , Dillon Harvey , Adams Benjamin , Greval Aneela , Munro Kevin J
Published: November 2023

Hearing aid verification with real-ear measurement (REM) is recommended in clinical practice. Improvements, over time, in accuracy of manufacturers’ initial fit mean the benefit of routine REM for new adult users is unclear. This registered, double-blinded, randomized, mixed-methods clinical trial aimed to (i) determine whether new adult hearing aid users prefer initial or real-ear fit and (ii) investigate the reasons for preferences. New adult hearing aid users ( n = 45) were each fitted with two programs: the initial fit and real-ear fit, both with adjustments based on immediate feedback from the patient. Participants were asked to complete daily paired-comparisons of the two programs with a magnitude estimation of the preference, one for each of clarity/comfort in quiet/noise as well as overall preference. The results revealed gain adjustment requests were low in number and small in magnitude. Deviation from NAL-NL2 targets (after adjustment for a 65 dB SPL input) was close to zero, except at high frequencies where real-ear fits were around 3 dB closer to target. There was no difference in clarity ratings between programs, but comfort ratings favored initial fit. Overall, 10 participants (22%) expressed a preference for real-ear fit. Reasons for preference were primarily based on comfort with the initial fit and clarity with real-ear fit. It may be acceptable to fit new adult users with mild-to-moderate hearing loss without the need for REMs, if the primary outcome of interest is user preference. It remains to be seen if the findings generalize to other fitting software, other outcome measures and more severe hearing loss.
The Involvement of Listening Effort in Explaining Bilingual Listening Under Adverse Listening Conditions
Authors: Bsharat-Maalouf Dana , Degani Tamar , Karawani Hanin
Published: November 2023

The current review examines listening effort to uncover how it is implicated in bilingual performance under adverse listening conditions. Various measures of listening effort, including physiological, behavioral, and subjective measures, have been employed to examine listening effort in bilingual children and adults. Adverse listening conditions, stemming from environmental factors, as well as factors related to the speaker or listener, have been examined. The existing literature, although relatively limited to date, points to increased listening effort among bilinguals in their nondominant second language (L2) compared to their dominant first language (L1) and relative to monolinguals. Interestingly, increased effort is often observed even when speech intelligibility remains unaffected. These findings emphasize the importance of considering listening effort alongside speech intelligibility. Building upon the insights gained from the current review, we propose that various factors may modulate the observed effects. These include the particular measure selected to examine listening effort, the characteristics of the adverse condition, as well as factors related to the particular linguistic background of the bilingual speaker. Critically, further research is needed to better understand the impact of these factors on listening effort. The review outlines avenues for future research that would promote a comprehensive understanding of listening effort in bilingual individuals.
Development and Assessment of Simulation-Based Point-of-Care Ultrasound Curriculum in Undergraduate Medical Education
Authors: Hagood Nancy L. , Klaybor Monica , Srivastava Romik , McManigle William , Huggins John Terrill , Shah Pranav V. , Heincelman Marc E. , Thomas Meghan K.
Published: November 2023

OBJECTIVES

Implementation barriers and lack of standardized point-of-care ultrasound (POCUS) curricula make the development of effective POCUS curricula and methods of assessment challenging. The authors aim to develop a longitudinal POCUS curriculum through staged intervention. In the first stage, the authors hypothesized that the use of high-fidelity ultrasound simulation during the Internal Medicine clerkship would improve POCUS confidence and knowledge among medical students, minimizing the need for trained faculty.

METHODS

A quasi-experimental study of third-year students on the Internal Medicine clerkship at a large academic medical center in the United States was performed assessing the efficacy of ultrasound simulation use. The control group consisted of students who received baseline POCUS education during teaching rounds but did not have access to the ultrasound simulator. The experimental group consisted of students who, in addition to baseline POCUS education, had access to a high-fidelity ultrasound simulator throughout the clerkship for a minimum of 1 hour per week. Students in both the control and experimental groups completed a pre- and post-intervention confidence survey and knowledge-based examination.

RESULTS

Eighty-two percent (50/61) of students completed pre- and post-tests, with the control group demonstrating no significant difference in POCUS confidence or knowledge. After exposure to the ultrasound simulator, the experimental group demonstrated statistically significant improvement in POCUS confidence and overall POCUS knowledge ( p < .01).

CONCLUSION

The use of high-fidelity ultrasound simulation can improve POCUS confidence and knowledge among medical students while addressing common barriers to the implementation of a POCUS curriculum. Despite showing statistically significant improvement in overall knowledge, the results did not appear to hold educational significance. Additional POCUS educational methods are necessary to overcome cognitive bias and potential overconfidence. The next stage of curriculum development will include resident-led POCUS workshops to supplement simulation.
A Ramayana for Our Times: Superheroes, Science Fiction and Myth
Authors: Chatterji Roma
Published: November 2023

Recent retellings of Indian epics draw upon science fiction. This article discusses an Indian superhero comic based on the Ramayana in which Rama, the central figure in the epic, is portrayed as the superhero Nagraj. The story uses the figure of the avatara (reincarnated one) to align the world of the epics with the contemporary world by incorporating science-fiction elements into their stories. It may seem that these retellings are drawing on strategies within science fiction to update the epics for the present so as to make mythic figures equivalent to superheroes. However, these strategies are not new. Parallel compositional techniques within folk epics prefigure these science-fictional strategies. This is borne out by the fact that Nagraj is an avatara of Rama, said to be reborn in the dark Kali age to fulfil unfulfilled desires from the past. In other words, instead of being for the sake of the present, superheroes are in the present to complete a quest from another time, drawing the present within the ambit of the mythic. There is a juxtaposition of a cyclical view of time associated with myth with the eventful linear time of superheroes, reorganising assumptions about chronicity in both superhero comics and epics.
Gendered Reflections on the Hindu Code Bill
Authors: Menon Shailaja
Published: November 2023

Women were always portrayed as self-sacrificing and demure, prisoner of various orthodox traditions and devoted to their family. 1 Her behaviour should be modelled on various religious texts, and she would be severely punished if any moral code were violated. However, at the socio-economic and political levels, she was rendered invisible. It was during the colonial phase of India’s historical trajectory that the gender question attained centre stage and serious efforts were undertaken to alleviate the situation of Indian women. This greater generalization of patriarchal controls and the pativrata ideals (Doniger & Smith, 1991, The laws of Manu, p. 198) throughout the caste hierarchy was a major factor in the increasing number of widows seen in the colonial period, and a gradually declining sex ratio, leaving India as one of the most patriarchal societies in the world when counting the number of ‘missing women’—an estimated 35-40 million women would have been alive were it not for the systematic discrimination (Dreze & Sen, 1995, India: Economic development and social opportunity, OUP Delhi). Nonetheless, the various debates on gender reforms either painted women as victims or heroines thereby denying them any agency.
Impact of Industrial Development on Land and Spatial Form in Small Industrial Towns in India: A Case of Morbi, Gujarat, India
Authors: Karmakar Satorupa , Bharti Madhu
Published: November 2023

Studying the interrelationships between industrial development and urban form is key to understanding land development and spatial dynamics in any industrial region. Taking Morbi (Gujarat, India), as a case study, this research examines how the development of the ceramic industry has influenced urban morphology over the years. For this research, a mix of qualitative and quantitative approaches has been undertaken, followed by situation assessment through a series of interviews of the local stakeholders. The findings demonstrate that a haphazard and steady increase of industrial units has exerted strong impacts on the urban form of Morbi town. Based on population projections and forecast of land requirements for the horizon year 2031, the study has identified critical urban issues and suggested possible interventions using zoning and proper regulations. Morbi town serves as a case study to understand the linkages of industrial development and urban growth in small industrial towns in India. The study will be useful to supplement decisions regarding spatial planning and advocacy.
Best step-up treatments for children with uncontrolled asthma: a systematic review and network meta-analysis of individual participant data
Authors: Cividini Sofia , Sinha Ian , Donegan Sarah , Maden Michelle , Rose Katie , Fulton Olivia , Culeddu Giovanna , Hughes Dyfrig A. , Turner Stephen , Tudur Smith Catrin
Published: November 2023

Background

There is uncertainty about the best treatment option for children/adolescents with uncontrolled asthma despite inhaled corticosteroids (ICS) and international guidelines make different recommendations. We evaluated the pharmacological treatments to reduce asthma exacerbations and symptoms in uncontrolled patients age <18 years on ICS.

Methods

We searched MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Web of Science, National Institute for Health and Care Excellence Technology Appraisals, National Institute for Health and Care Research Health Technology Assessment series, World Health Organization International Clinical Trials Registry, conference abstracts and internal clinical trial registers (1 July 2014 to 5 May 2023) for randomised controlled trials of participants age <18 years with uncontrolled asthma on any ICS dose alone at screening. Studies before July 2014 were retrieved from previous systematic reviews/contact with authors. Patients had to be randomised to any dose of ICS alone or combined with long-acting β2-agonists (LABA) or combined with leukotriene receptor antagonists (LTRA), LTRA alone, theophylline or placebo. Primary outcomes were exacerbation and asthma control. The interventions evaluated were ICS (low/medium/high dose), ICS+LABA, ICS+LTRA, LTRA alone, theophylline and placebo.

Results

Of the 4708 publications identified, 144 trials were eligible. Individual participant data were obtained from 29 trials and aggregate data were obtained from 19 trials. Compared with ICS Low, ICS Medium+LABA was associated with the lowest odds of exacerbation (OR 0.44, 95% credibility interval (95% CrI) 0.19–0.90) and with an increased forced expiratory volume in 1 s (mean difference 0.71, 95% CrI 0.35–1.06). Treatment with LTRA was the least preferred. No apparent differences were found for asthma control.

Conclusions

Uncontrolled children/adolescents on low-dose ICS should be recommended a change to medium-dose ICS+LABA to reduce the risk for exacerbation and improve lung function.
Asthma and incident coronary heart disease: an observational and Mendelian randomisation study
Authors: Valencia-Hernández Carlos A. , Del Greco M Fabiola , Sundaram Varun , Portas Laura , Minelli Cosetta , Bloom Chloe I.
Published: November 2023

Background

Observational studies suggest asthma is a risk factor for coronary heart disease (CHD) and sex modifies the risk, but they may suffer from methodological limitations. To overcome these, we applied a “triangulation approach”, where different methodologies, with different potential biases, were leveraged to enhance confidence in findings.

Methods

First, we conducted an observational study using UK medical records to match asthma patients 1:1, by age, sex and general practitioner (GP) practice, to the general population. We measured the association between asthma and incident CHD (myocardial infarction: hospitalisation/death) by applying minimal sufficient adjustment: model 1, smoking, body mass index, oral corticosteroids, atopy and deprivation; model 2, additionally adjusting for healthcare behaviour (GP consultation frequency). Second, we conducted a Mendelian randomisation (MR) study using data from the UK Biobank, Trans-National Asthma Genetic Consortium (TAGC) and Coronary Artery Disease Genome-wide Replication and Meta-analysis consortium (CARDIoGRAM). Using 64 asthma single nucleotide polymorphisms, the effect of asthma on CHD was estimated with inverse variance-weighted meta-analysis and methods that adjust for pleiotropy.

Results

In our observational study (n=1 522 910), we found asthma was associated with 6% increased risk of CHD (model 1: HR 1.06, 95% CI 1.01–1.13); after accounting for healthcare behaviour, we found no association (model 2: HR 0.99, 95% CI 0.94–1.05). Asthma severity did not modify the association, but sex did (females: HR 1.11, 95% CI 1.01–1.21; males: HR 0.91, 95% CI 0.84–0.98). Our MR study (n=589 875) found no association between asthma and CHD (OR 1.01, 95% CI 0.98–1.04) and no modification by sex.

Conclusions

Our findings suggest that asthma is not a risk factor for CHD. Previous studies may have suffered from detection bias or residual confounding.
Prevalence and patterns of multimorbidity among linguistic groups of patients receiving home care in Ontario: a retrospective cohort study
Authors: Batista Ricardo , Reaume Michael , Roberts Rhiannon , Seale Emily , Rhodes Emily , Sucha Ewa , Pugliese Michael , Kendall Claire E. , Bjerre Lise M. , Bouchard Louise , Prud’homme Denis , Manuel Douglas G. , Tanuseputro Peter
Published: November 2023

Background

Prior studies have demonstrated the negative impact of language barriers on access, quality, and safety of healthcare, which can lead to health disparities in linguistic minorities. As the population ages, those with multiple chronic diseases will require increasing levels of home care and long-term services. This study described the levels of multimorbidity among recipients of home care in Ontario, Canada by linguistic group.

Methods

Population-based retrospective cohort of 510,685 adults receiving home care between April 1, 2010, to March 31, 2018, in Ontario, Canada. We estimated and compared prevalence and characteristics of multimorbidity (2 or more chronic diseases) across linguistic groups (Francophones, Anglophones, Allophones). The most common combinations and clustering of chronic diseases were examined. Logistic regression models were used to explore the main predictors of ‘severe’ multimorbidity (defined as the presence of five or more chronic diseases).

Results

The proportion of home care recipients with multimorbidity and severe multimorbidity was 92% and 44%, respectively. The prevalence of multimorbidity was slightly higher among Allophones (93.6%) than among Anglophones (91.8%) and Francophones (92.4%). However, Francophones had higher rates of cardiovascular and respiratory disease (64.9%) when compared to Anglophones (60.2%) and Allophones (61.5%), while Anglophones had higher rates of cancer (34.2%) when compared to Francophones (25.2%) and Allophones (24.3%). Relative to Anglophones, Allophones were more likely to have severe multimorbidity (adjusted OR = 1.04, [95% CI: 1.02–1.06]).

Conclusions

The prevalence of multimorbidity among Ontarians receiving home care services is high; especially for whose primary language is a language other than English or French (i.e., Allophones). Understanding differences in the prevalence and characteristics of multimorbidity across linguistic groups will help tailor healthcare services to the unique needs of patients living in minority linguistic situations.
Association between chronic obstructive pulmonary disease and 28-day mortality in patients with sepsis: a retrospective study based on the MIMIC-III database
Authors: Chen Yubiao , Lu Lifei , Li Xicong , Liu Baiyun , Zhang Yu , Zheng Yongxin , Zeng Yuan , Wang Ke , Pan Yaru , Liang Xiangning , Wu Zhongji , Fu Yutian , Huang Yongbo , Li Yimin
Published: November 2023

Background

Sepsis is a common cause of mortality in critically ill patients, and chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in septic patients. However, the impact of COPD on patients with sepsis remained unclear. Therefore, the purpose of this study aimed to assess the effect of COPD on the prognosis of septic patients based on Medical Information Mart for Intensive Care (MIMIC-III) database.

Methods

In this retrospective study based on the (MIMIC)-III database version 1.4 (v1.4), we collected clinical data and 28-day all-cause mortality from patients with sepsis in intensive care unit (ICU) and these patients met the diagnostic criteria of Sepsis 3 on ICU admission between 2008 and 2012. International Classification of Diseases (ICD-9) (4660, 490, 4910, 4911, 49120, 49121, 4918, 4919, 4920, 4928, 494, 4940, 4941, 496) was used to identified COPD. We applied Kaplan–Meier analysis to compare difference of 28-day all-cause mortality between septic patients with and without COPD. Cox proportional-hazards model was applied to explore the risk factor associated with 28-day all-cause mortality in patients with sepsis.

Results

Six thousand two hundred fifty seven patients with sepsis were included in this study, including 955 (15.3%) patients with COPD and 5302 patients without COPD (84.7%). Compared with patients without COPD, patients with COPD were older (median: 73.5 [64.4, 82.0] vs 65.8 [52.9, 79.1], P < 0.001), had higher simplified acute physiology score II (SAPSII) (median: 40.0 [33.0, 49.0] vs 38.0 [29.0,47.0], P < 0.001) and greater proportion of mechanical ventilatory support (MV) (55.0% vs 48.9%, P = 0.001). In our study, septic patients with COPD had higher 28-day all-cause mortality (23.6% vs 16.4%, P < 0.001) than patients without COPD. After adjusting for covariates, the results showed that COPD was an independent risk factor for the 28-day all-cause mortality of patients with sepsis (HR 1.30, 95%CI: 1.12–1.50, P = 0.001).

Conclusions

COPD was an independent risk factor of 28-day all-cause mortality in septic patients. Clinically, septic patients with COPD should be given additional care.
Home care nurses facilitating planned home deaths. A focused ethnography
Authors: Sørstrøm Anne Kristine , Ludvigsen Mette Spliid , Kymre Ingjerd Gåre
Published: November 2023

Background

Home care nurses provide complex palliative care for patients who want to die in their own homes. This study aimed to explore home care nurses’ facilitation of planned home death to better understand nursing practices.

Methods

Data were collected between March 2019 and March 2020 using participant observations and semi-structured interviews. In addition, the number of planned home deaths was recorded. The analysis was guided by Roper and Shapira`s framework on focused ethnography.

Results

Twenty home care nurses (three men) in eight home care areas in two Norwegian municipalities met the inclusion criteria. Eight home deaths were registered, seven participatory observations were performed, and 20 semi-structured interviews were completed. Home care nurses find facilitating planned home deaths to be rewarding work, to the point of going above and beyond. At the same time, they describe facilitating planned home deaths as demanding work due to organizational stressors such as staff shortages, heavy workloads, and time restraints. While they tend to patients’ needs, they also express concern for the wellbeing of the next of kin. They find it challenging to juggle the needs of the patients with the needs of next of kin, as these are not always correlated.

Conclusion

Home care nurses are pushing the boundaries of their practice when facilitating planned home deaths while compensating for a fragile system by going above and beyond for patients and their next of kin. Providing insights into the work of home care nurses providing palliative care in patients’ homes can impact recruiting and retaining nurses in the workforce and influence local practices and policies.