bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-effectiveness analysis of noninvasive tests to identify advanced fibrosis in non-alcoholic fatty liver disease
Authors: Gruneau Lina , Kechagias Stergios , Sandström Per , Ekstedt Mattias , Henriksson Martin
Published: June 2023

Background:

Advanced fibrosis is associated with end-stage liver disease (ESLD) and mortality in NAFLD. As treatments specifically targeted at NAFLD are lacking, patient management focuses on surveillance for early detection of complications related to end-stage liver disease. Although current and emerging diagnostic tools for the detection of advanced fibrosis are crucial for surveillance, their added value is unclear. The aim of this study was to evaluate the costs and health outcomes of noninvasive tests in patient management strategies for diagnosing advanced fibrosis in NAFLD patients.

Method:

A decision analytical model was developed to evaluate 13 patient management strategies, including a no-testing strategy and 12 diagnostic algorithms with noninvasive tests (fibrosis 4- score, enhanced liver fibrosis, vibration controlled transient elastography), and liver biopsy. Model inputs were synthesized from the literature and Swedish registries. Lifetime health care costs, life years, quality-adjusted life years, clinical outcomes, and incremental cost-effectiveness ratios were calculated for a cohort of 55-year-old patients diagnosed with NAFLD.

Result:

The cost per quality-adjusted life year was above €50 000 for all diagnostic algorithms compared to no-testing. The cost per quality-adjusted life year of the most promising diagnostic algorithm (fibrosis 4- score, enhanced liver fibrosis, vibration controlled transient elastography, and liver biopsy) was ∼ €181 000 compared with no testing. Sensitivity analysis indicated that if treatment slowed down disease progression, the value of testing increased.

Conclusion:

The result questions the overall value of comprehensive diagnostic testing in a broad NAFLD population in current routine clinical care. The role of noninvasive tests may change if evidence-based treatments to slow down disease progression emerge.
Emerging Epigenetic and Posttranslational Mechanisms Controlling Resistance to Glucocorticoids in Acute Lymphoblastic Leukemia
Authors: Borin Cristina , Pieters Tim , Serafin Valentina , Ntziachristos Panagiotis
Published: June 2023

Glucocorticoids are extensively used for the treatment of acute lymphoblastic leukemia as they pressure cancer cells to undergo apoptosis. Nevertheless, glucocorticoid partners, modifications, and mechanisms of action are hitherto poorly characterized. This hampers our understanding of therapy resistance, frequently occurring in leukemia despite the current therapeutic combinations using glucocorticoids in acute lymphoblastic leukemia. In this review, we initially cover the traditional view of glucocorticoid resistance and ways of targeting this resistance. We discuss recent progress in our understanding of chromatin and posttranslational properties of the glucocorticoid receptor that might be proven beneficial in our efforts to understand and target therapy resistance. We discuss emerging roles of pathways and proteins such as the lymphocyte-specific kinase that antagonizes glucocorticoid receptor activation and nuclear translocation. In addition, we provide an overview of ongoing therapeutic approaches that sensitize cells to glucocorticoids including small molecule inhibitors and proteolysis-targeting chimeras.
Combination of iris vessel area density and surgery interval as the predictor of perceived pain during consecutive second-eye cataract surgery
Authors: Cui Lipu , Ma Yingyan , Wang Yulan , Luo Qin , Ding Qi , Ge Ling , Lu Shiheng , Miao Yuyu , Sun Qian , Zou Haidong , Jin Huiyi
Published: June 2023

Purpose:

To explore clinical indicators to predict perceived pain during second-eye phacoemulsification surgery in patients with bilateral cataracts.

Setting:

Shanghai General Hospital, China.

Design:

A case‒control study and a prospective cohort study.

Methods:

Patients with age-related cataract who underwent first-eye or second-eye uneventful phacoemulsification surgery were enrolled. Before surgery, ocular examination results, including vessel area density (VAD) and vessel skeleton density (VSD), obtained by optical coherence tomography angiography examination of the iris were performed. Patients completed a visual analog scale pain survey 3 times postoperatively: 1 hour, 3 hours, and 24 hours postoperatively.

Results:

70 patients were enrolled in the case‒control study, and the pain scores of the second-eye surgery group under local anesthesia were significantly greater than those of the first-eye surgery group (P = .0005). Preoperative iris VAD in the second-eye group affected perioperative pain scores (P = .0047). The optimal cutoff value of VAD was 0.2167 with a specificity of 76% and a sensitivity of 62%. In the prospective cohort study, 124 patients were included in the second-eye group. Preoperative iris VAD (P = .0361) and the time interval (P = .0221) were independent factors for second-eye surgery pain. Combined with preoperative iris VAD and surgical interval, the negative predictive value and positive predictive value were 0.95 and 0.29 for predicting moderate pain or above, the sensitivity and specificity were 0.97 and 0.23, respectively.

Conclusions:

The combination of iris VAD and the time interval between both eye surgeries can be an effective method to predict the timing of the second-eye cataract surgery and to avoid intraoperative pain.
Practice of debriefing of critical events: a survey-based cross-sectional study of Portuguese anesthesiologists
Authors: Teles Daniel , Silva Mariana , Berger-Estilita Joana , Pereira Helder
Published: June 2023

Background:

Debriefing is an essential procedure for identifying medical errors, improving communication, reviewing team performance, and providing emotional support after a critical event. This study aimed to describe the current practice and limitations of debriefing and gauge opinions on the best timing, effectiveness, need for training, use of established format, and expected goals of debriefing among Portuguese anesthesiologists.

Methods:

We performed a national cross-sectional online survey exploring the practice of anesthesiologists' debriefing practice after critical events in Portuguese hospitals. The questionnaire was distributed using a snowball sampling technique from July to September 2021. Data were descriptively and comparatively analyzed.

Results:

We had replies from 186 anesthesiologists (11.3% of the Portuguese pool). Acute respiratory event was the most reported type of critical event (96%). Debriefing occurred rarely or never in 53% of cases, 59% of respondents needed more training in debriefing, and only 4% reported having specific tools in their institutions to carry it out. There was no statistical association between having a debriefing protocol and the occurrence of critical events (P=.474) or having trained personnel (P=.95). The existence of protocols was associated with lower frequencies of debriefing (P=.017).

Conclusions:

Portuguese anesthesiologists know that debriefing is an essential process that increases patient safety, but among those surveyed, there is a need for an adequate debriefing culture or practice.

Trial registration:

Research registry 7741 (https://www.researchregistry.com/browse-the-registry#home).
Intraoperative fluoroscopic radiation in orthopedic trauma: correlation with surgery type and surgeon experience
Authors: Fabião Luís , Ribau Ana , Lemos Carolina , Rodrigues-Pinto Ricardo
Published: June 2023

Background:

While fluoroscopy is widely used in orthopedic trauma surgeries, it is associated with harmful effects and should, therefore, be minimized. However, reference values for these surgeries have not been defined, and it is not known how surgeon experience affects these factors. The aims of this study were to analyze the radiation emitted and exposure time for common orthopedic trauma surgeries and to assess whether they are affected by surgeon experience.

Methods:

Data from 1842 trauma orthopedic procedures were retrospectively analyzed. A total of 1421 procedures were included in the analysis. Radiation dose and time were collected to identify reference values for each surgery and compared for when the lead surgeon was a young resident, a senior resident, or a specialist.

Results:

The most performed surgeries requiring fluoroscopy were proximal femur short intramedullary nailing (n = 401), ankle open reduction and internal fixation (ORIF) (n = 141), distal radius ORIF (n = 125), and proximal femur dynamic hip screw (DHS) (n = 114). Surgeries using higher radiation dose were proximal femur long intramedullary nailing (mean dose area [DAP]): 1361.35 mGycm2), proximal femur DHS (1094.81 mGycm2), and proximal femur short intramedullary nailing (891.41 mGycm2). Surgeries requiring longer radiation time were proximal humerus and/or humeral shaft intramedullary nailing (02 mm:20 ss), proximal femur long intramedullary nailing (02 mm:04 ss), and tibial shaft/distal tibia intramedullary nailing (01 mm:49 ss). Senior residents required shorter radiation time when performing short intramedullary nailing of the proximal femur than young residents. Specialists required more radiation dose than residents when performing tibial nailing and tibial plateau ORIF and required longer radiation time than young residents when performing tibial nailing.

Conclusions:

This study presents mean values of radiation dose and time for common orthopedic trauma surgeries. Orthopedic surgeon experience influences radiation dose and time values. Contrary to expected, less experience is associated with lower values in some of the cases analyzed.
Effect of a Japanese Version of the Burns Wean Assessment Program e-Learning Materials on Ventilator Withdrawal for Intensive Care Unit Nurses
Authors: KIMURA Rika , HAYASHI Naoko , UTSUNOMIYA Akemi
Published: June 2023

Background

No assessment tool for predicting ventilator withdrawal success is currently available in Japan. Thus, an accessible and valid assessment tool to address this issue is needed. The Burns Wean Assessment Program (BWAP) has been validated as a reliable predictor of ventilator withdrawal outcomes. However, nurses must be familiar with this tool to ensure its efficient utilization in clinical settings.

Purpose

This study was designed to examine the effect of a 26-item Japanese version of BWAP (J-BWAP) e-learning materials on ventilator withdrawal in a sample of intensive care unit nurses in Japan.

Methods

The BWAP was translated into Japanese, checked, and verified as the J-BWAP. Nonrandomized intensive care unit nurses from six hospitals were assigned to three groups, including Intervention Group 1 (e-learning in one session), Intervention Group 2 (e-learning over three sessions during 1 week), and the control group. The participants underwent pretests and posttests using web-based, simulated patients. The primary outcome measure was the difference in online pretest and posttest total scores among the two intervention groups and the control group. The feasibility of the J-BWAP and its e-learning materials was evaluated using four frameworks: acceptability, demand, implementation, and adaptation.

Results

Of the 48 participants in the study, 32 completed the posttest and were included in the analysis (dropout rate: 33.3%). The difference between pretest and posttest scores was significantly higher in the intervention groups than the control group (2 vs. −1, p = .0191) and in Intervention Group 2 than the control group (2.0 vs. −0.5, p = .049). The feasibility frameworks for the J-BWAP and its e-learning materials were mostly positive.

Conclusions/Implications for Practice

The development of the J-BWAP and training nurses using e-learning were shown to be feasible in this study. The J-BWAP contents are appropriate for predicting the outcome of mechanical ventilation withdrawal. The J-BWAP has the potential to become a common tool among Japanese medical professionals after the contents are further simplified for daily application in clinical practice. Subsequent studies should verify the reliability and validity of this tool and test the real-world utility of the J-BWAP using randomized controlled trials in Japanese clinical settings.
An Exploration of Doctor of Physical Therapy Students' Belongingness in Clinical Education: A Validation Study
Authors: Poole Ashley K. , Hibbard Susan T. , Bell Karla A. , Brown Dawn S. , Condran Chris , Covington Kyle
Published: June 2023

Introduction.

The aim of this study was to adapt and validate the Belongingness Scale-Clinical Placement Experience (BES-CPE) for Doctor of Physical Therapy (DPT) students in the United States.

Review of Literature.

Belongingness is vital to one's mental, emotional, and physical health. Research has shown that belongingness is positively correlated with students' academic performance and achievement. An absence of belongingness may hinder students' full participation in clinical experiences and compromise clinical achievement.

Subjects.

Respondents were current or former DPT students at least 18 years of age who had either completed the midterm evaluation of their final terminal full-time clinical education experience (TCE) in their DPT program or were no more than 1 year from the completion of their final TCE.

Methods.

The BES-CPE was adapted for DPT students, and the scale was completed electronically by those who met the inclusion criteria. Principal component analysis with promax rotation and Cronbach's α were used to determine construct validity and reliability.

Results.

One hundred fifty-nine respondents completed all items on the BES-CPE and demographic survey. A 3-component structure was identified (esteem, connectedness, and efficacy), which was aligned to the original BES-CPE scale. One item was discarded, and the final version of the BES-CPE for DPT students is a 33-item scale with satisfactory internal consistency.

Discussion and Conclusion.

This study adapted and provided evidence for validity of the first known scale to measure belongingness in DPT students during their clinical education experiences (CEEs) in the United States. The 33-item BES-CPE provided valid and reliable measures of belongingness in DPT students during CEEs that can be used to provide a better understanding of the student experience in the clinical learning environment.
Early surgical treatment of closed reduction and internal fixation for a 30-day old intertrochanteric fracture with hemiplegia after acute stroke: A case report
Authors: Zhang Zeng-Li , Li Xu-Song , Zhao Wei-Qiang , Huang Jie-Feng , Zhu Ya-Hong
Published: June 2023

Rationale:

Currently, there are no clear guidelines to determine whether and when to perform surgical hip repair in patients with acute stroke and hip fracture.

Patient concerns:

In this case report, we report a case of 75-year-old woman admitted with left hip pain and limited mobility for 1 month.

Diagnoses:

Patient had a history of acute cerebral infarction 42 days ago, and diagnosed with a left intertrochanteric fracture at another hospital 30 days ago.

Intervention:

Patient was treated with closed reduction and internal fixation with proximal femoral nail anti-rotation.

Outcomes:

At 2-year follow-up, the patient’s basic function was restored. The fracture healed well, and the Harris hip score was 75.

Lessons:

Without consistent guidelines, individualized treatment strategies including surgical methods and timing of surgery should be made to weigh the risks and benefits for patients with acute stroke and intertrochanteric fractures.
High expression of MORC2 predicts worse neoadjuvant chemotherapy efficacy in triple negative breast cancer
Authors: Liao Xiaohong , Liu Chao , Ding Zhenluo , Wang Chen , He Jing , Wu Shugui
Published: June 2023

Tumor infiltrating lymphocytes (TILs) are closely related to the patients’ prognosis. Recently, Microrchidia 2 (MORC2) has been documented as a prognostic and predictive biomarker in triple negative breast cancer (TNBC). To compare whether MORC2 is a better predictor than TILs, as well as clinicopathological parameters, in predicting the efficacy of neoadjuvant chemotherapy (NAC) in TNBC, we detected the expression of MORC2 on neoplastic cells through immunohistochemistry and quantified the stromal TILs through Hematoxylin-eosin staining on core biopsies from 50 locally advanced TNBC patients who underwent standard NAC. Among all the 50 patients, 28 (56%) cases had residual tumors, while the other 22 (44%) achieved pathologic complete response (pCR). In these studied patients, age and T-stage showed no correlation with pCR rate, while percentage of TILs, nodal involvement and expression of MORC2 on tumor cells showed significant association with pCR rate. Positive nodal involvement was correlation with worse pathologic response at multivariate analysis (P = .0036), and high TILs levels (≥50%) was positively associated with better NAC efficacy at univariate analysis (P = .002). Whereas high expression of MORC2 was statistically associated with worse pCR rate both at univariate (P < .001) and multivariate (P = .036) analysis. Our results indicate that MORC2 expression has a better predictive role in predicting the efficacy of NAC than TILs in TNBC patients.
Medical intestinal rehabilitation
Authors: Segovia Maria C.
Published: June 2023

Purpose of review

Medical intestinal rehabilitation is a part of the very complex management of patients with intestinal failure. The goal is to achieve enteral autonomy and minimize need for parenteral nutrition and hydration. In this manuscript, we will review the strategies to achieve this goal with dietary optimization and pharmacologic interventions.

Recent findings

We will review the most updated recommendations on medical management of patients with intestinal failure.

Medical intestinal rehabilitation is just a portion of a multistep strategy that aims to minimize need of parenteral support in patients with intestinal failure, with the ultimate goal of achieving enteral autonomy. This needs to be done by a multidisciplinary team via dietary and pharmacologic optimization.
The spread of retzius-sparing robotic prostatectomy: an update after 10 years
Authors: Galfano Antonio , Secco Silvia , Olivero Alberto , Bocciardi Aldo Massimo , Dell’Oglio Paolo
Published: June 2023

Purpose of review

Objective of our work is to provide an update of the state of the art concerning Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and to give a possible vision on the future developments of this new approach.

Recent findings

A nonsystematic literature review has been conducted, finding 27 comparative studies and 24 reviews published up to April 15, 2023. Most of these studies confirm the advantages of RS-RARP relative to standard RARP mainly on early continence recovery. Conversely, discordant findings are reported for the benefit of RS-RARP on late continence recovery. Uncertainty is still present on the impact on positive surgical margins (PSMs), but this statement is based on low level of evidence. Several data concerning the learning curve have shown the safety of RS-RARP, but the need of adequate tutoring. Recent studies also confirmed the feasibility of RS-RARP in the setting of high-risk prostate cancer (PCa), large prostate volume, patients with an history of benign prostatic hyperplasia surgery and patients with a transplanted kidney. Atypical advantages can be also seen in the reduction of risk of postoperative inguinal hernias and in case of concomitant rectal resection.

Retzius-sparing RARP has been confirmed to be one of the standard approaches for the treatment of PCa, with well documented advantages and uncertainty on PSMs.
Patient Blood Management as an Emerging Concept in Quality
Authors: Ozawa Sherri , Ozawa-Morriello Joshua , Rock Rebecca , Sromoski MaryAnn , Walbolt Sarah , Hall Tiffany , Pearse Bronwyn Louise
Published: June 2023

Background:

Transfusion of blood components has long been considered lifesaving therapy. While blood transfusion may be clinically indicated as a treatment option for some patients, the benefits of transfusion in asymptomatic, hemodynamically stable patients are questionable.

Problem:

Blood component transfusion is routinely used as a default therapy when not clinically indicated, increasing the risk of poor patient outcomes, adverse events, pressures on blood supply and availability, and increased health care costs.

Approach:

Nurses have the responsibility to advocate for patients and reduce/avoid unnecessary blood transfusion through the implementation of patient blood management (PBM). The PBM paradigm includes treatment of anemia, minimizing blood loss and bleeding, optimization of coagulation, and employing true patient-centered decision making.

Conclusions:

PBM should become the standard of care with the goal of improving health care quality and patient outcomes while using the multidisciplinary team for its implementation. As advocates for their patients, nurses can play a major role in the development, implementation, and promotion of PBM.
Cancer Hospice Caregivers' Self-care Behaviors
Authors: Tay Djin L. , Reblin Maija , Iacob Eli , Cloyes Kristin G. , Thomas Hebdon Megan C. , Reynaga Miranda , Mooney Kathi , Ellington Lee
Published: June 2023

Cancer hospice family caregivers provide intensive support for patients at the end of life, sometimes at the expense of self-care. This secondary analysis examined the role of caregiving burden, activities of daily living, and mental health on self-care behaviors among cancer hospice family caregivers. Logistic regression models were adjusted for sociodemographic and caregiver characteristics, and model fit was evaluated with Hosmer-Lemeshow tests. Participants (N = 86) were mostly women (n = 62, 72.09%), White (n = 76, 88.37%), and spousal caregivers (n = 44, 51.16%). Almost half reported not getting enough rest (47.67%), time to exercise (47.67%), or time to slow down and rest when feeling ill (46.51%). Caregivers with better mental health reported being more likely to have enough time to exercise (adjusted odds ratio [ORadj], 1.15, [1.05, 1.26]; P = .004), rest (ORadj, 1.11, [1.01, 1.22]; P = .031), and slow down when ill (ORadj, 1.16, [1.04, 1.30]; P = .010). Controlling for sociodemographic and caregiver characteristics, men caregivers had 88% lower odds of being able to rest when ill (ORadj, 0.12, [0.03, 0.52]; P = .005) compared with women. Number of care tasks, not caregiving burden, was associated with self-care behaviors. Findings provide a preliminary understanding of factors related to caregiver self-care and have implications for increased assessment of caregiver mental health and self-care needs to better support family-oriented hospice care.
Interindividual Variability in Self-Monitoring of Blood Pressure Using Consumer-Purchased Wireless Devices
Authors: Zheng Yaguang , Zhang Yanfu , Huang Heng , Tison Geoffrey H. , Burke Lora E. , Blecker Saul , Dickson Victoria Vaughan , Olgin Jeffrey E. , Marcus Gregory M. , Pletcher Mark J.
Published: June 2023

Background

Engagement with self-monitoring of blood pressure (BP) declines, on average, over time but may vary substantially by individual.

Objectives

We aimed to describe different 1-year patterns (groups) of self-monitoring of BP behaviors, identify predictors of those groups, and examine the association of self-monitoring of BP groups with BP levels over time.

Methods

We analyzed device-recorded BP measurements collected by the Health eHeart Study—an ongoing prospective eCohort study—from participants with a wireless consumer-purchased device that transmitted date- and time-stamped BP data to the study through a full 12 months of observation starting from the first day they used the device. Participants received no instruction on device use. We applied clustering analysis to identify 1-year self-monitoring, of BP patterns.

Results

Participants had a mean age of 52 years and were male and White. Using clustering algorithms, we found that a model with three groups fit the data well: persistent daily use (9.1% of participants), persistent weekly use (21.2%), and sporadic use only (69.7%). Persistent daily use was more common among older participants who had higher Week 1 self-monitoring of BP frequency and was associated with lower BP levels than the persistent weekly use or sporadic use groups throughout the year.

Conclusion

We identified three distinct self-monitoring of BP groups, with nearly 10% sustaining a daily use pattern associated with lower BP levels.
Change in Functional Status During Hospital Admission and Long-Term Health-Related Quality of Life Among Pediatric Septic Shock Survivors
Authors: Workman Jennifer K. , Reeder Ron W. , Banks Russell K. , Zimmerman Jerry J. , Meert Kathleen L. , Keenan Heather T.
Published: June 2023

OBJECTIVES:

To investigate whether change in functional status from pre-hospitalization baseline to hospital discharge is associated with long-term health-related quality of life (HRQL) among children surviving septic shock.

DESIGN:

Secondary analysis of Life After Pediatric Sepsis Evaluation (LAPSE), a prospective cohort study of children with community-acquired septic shock, enrolled from January 2014 to June 2017.

SETTING:

Twelve U.S. academic PICUs.

PATIENTS:

Children, 1 month to 18 years, who survived to hospital discharge and had follow-up data for HRQL at 3 and/or 12 months.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Functional Status Scale (FSS) was assessed around enrollment to ascertain baseline status (pre-hospitalization) and at 28 days or hospital discharge. Two measures of HRQL were utilized: children with significant development delay were measured with the Functional Status II-R (FSII-R); typically, developing children were measured with the Pediatric Quality of Life Inventory (PedsQL). Each group was analyzed separately with multivariable regression modeling to determine the association between change in FSS from baseline to day 28 and HRQL at 3 and 12 months from PICU admission. Of the original 389 LAPSE participants, 224 (58%) are included. Among children with developmental delay (n = 88), worsened FSS was associated with lower FSII-R at 3 months from PICU admission (–2.02; 95% CI, –3.34 to –0.0.71; p = 0.003), but not 12 months. Among developmentally typical children (n = 136), worsened FSS was associated with lower PedsQL at both 3 and 12 months. Developmentally typical children with a neurologic insult during the PICU stay had the largest decrement in PedsQL at 12 months (–14.04 mo; 95% CI, –22.15 to –5.94 mo; p < 0.001). However, worsened FSS remained associated with poor HRQL-PedsQL at 3 and 12 months, after controlling for neurologic events (both p < 0.001).

CONCLUSIONS:

Change in FSS during hospitalization for septic shock is associated with long-term reductions in HRQL and could serve as a useful tool for identifying children at risk for this sequela.
Systematic review and quantitative and qualitative comparative analysis of interventions to address HIV-related stigma and discrimination
Authors: Ferguson Laura , Gruskin Sofia , Bolshakova Maria , Rozelle Mary , Yagyu Sachi , Kasoka Kasoka , Oraro-Lawrence Tessa , Motala Aneesa , Stackpool-Moore Lucy , Hempel Susanne
Published: June 2023

A strong global commitment exists to eliminate HIV-related stigma and discrimination, and multiple strategies to reduce or eliminate stigma and discrimination have been tried. Using a PICOTS framework and applying the GRADE criteria, we undertook a systematic review to determine the success of interventions aiming to address internalized stigma, stigma and discrimination in healthcare, and at the legal or policy level, and to identify their critical success factors. Random effects meta-analyses summarized results where possible. We carried out a component analysis to identify and characterize successful interventions. Internalized stigma interventions were diverse: across all studies, we found a reduction of stigma but it was not statistically significant (SMD 0.56; CI 0.31, 1.02; 17 studies). For interventions to address stigma and discrimination in healthcare settings, effect estimates varied considerably but most studies showed positive effects (SMD 0.71; CI 0.60, 0.84, 8 studies). Boosted regression analyses found that a combined approach comprising education, counseling, community participation, support person, and access to a HIV specialist often yielded success. Studies of efforts to address stigma and discrimination through law and policy documented, mostly qualitatively, the effect of court cases and directives. Across a range of settings and populations, promising interventions have been identified that, through diverse pathways, have positively impacted the types of stigma and discrimination studied. This evidence base must be built upon and brought to scale to help reach global HIV-related targets and, most importantly, improve the health and quality of life of people living with HIV.
Brief Report: Hepatitis B Infection or Reactivation After Switch to 2-Drug Antiretroviral Therapy: A Case Series, Literature Review, and Management Discussion
Authors: Vasishta Shilpa , Dieterich Douglas , Mullen Michael , Aberg Judith
Published: June 2023

Background:

Two-drug antiretroviral therapy (ART) without hepatitis B virus (HBV) activity is prescribed for persons with HIV as simplified or salvage therapy. Although two-drug regimens are not recommended for persons with chronic HBV infection, guidelines do not address their use in those with HBV susceptibility and/or core antibody reactivity. We present a case series of individuals with HBV infection or reactivation following switch to two-drug, non-HBV-active ART.

Setting:

HIV primary care clinics of an academic medical center in New York, NY.

Methods:

Case surveillance was conducted to identify persons with HBV surface antigenemia and viremia following two-drug ART switch. Clinical characteristics and outcomes were ascertained through chart review.

Results:

Four individuals with HBV infection or reactivation after ART switch were identified. Two had HBV susceptibility, 1 had core antibody reactivity, and 1 had surface antigen reactivity preswitch. All eligible persons had received HBV vaccination: 2 with low-level antibody response and 1 with persistent nonresponse. Two presented with fulminant hepatitis, with 1 required liver transplantation.

Conclusion:

Two-drug ART switch may pose risk of HBV infection or reactivation. We propose careful patient selection and monitoring through the following: (1) assessment of HBV serologies before switch and periodically thereafter, (2) vaccination and confirmation of immunity before switch, (3) risk stratification and counseling about HBV reactivation for those with core antibody, (4) preemptive HBV DNA monitoring for those at the risk of reactivation, (5) continuation of HBV-active prophylaxis when above measures are not feasible, and (6) continuation of HBV-active therapy and surveillance for chronic HBV infection.
Characterizing Network-Based HIV Testing Interventions to Guide HIV Testing and Contact Tracing at STI Clinics in Lilongwe, Malawi
Authors: Maierhofer Courtney N. , Powers Kimberly A. , Matoga Mitch M. , Chen Jane S. , Jere Edward , Massa Cecilia , Mmodzi Pearson , Bhushan Nivedita L. , Phiri Sam , Hoffman Irving F. , Lancaster Kathryn E. , Miller William C. , Rutstein Sarah E.
Published: June 2023

Background:

Understanding heterogeneity across patients in effectiveness of network-based HIV testing interventions may optimize testing and contact tracing strategies, expediting linkage to therapy or prevention for contacts of persons with HIV (PWH).

Setting:

We analyzed data from a randomized controlled trial of a combination intervention comprising acute HIV testing, contract partner notification (cPN), and social contact referral conducted among PWH at 2 STI clinics in Lilongwe, Malawi, between 2015 and 2019.

Methods:

We used binomial regression to estimate the effect of the combination intervention vs. passive PN (pPN) on having any (1) contact, (2) newly HIV-diagnosed contact, and (3) HIV-negative contact present to the clinic, overall and by referring participant characteristics. We repeated analyses comparing cPN alone with pPN.

Results:

The combination intervention effect on having any presenting contact was greater among referring women than men [prevalence difference (PD): 0.17 vs. 0.10] and among previously vs. newly HIV-diagnosed referring persons (PD: 0.20 vs. 0.11). Differences by sex and HIV diagnosis status were similar in cPN vs. pPN analyses. There were no notable differences in the intervention effect on newly HIV-diagnosed referrals by referring participant characteristics. Intervention impact on having HIV-negative presenting contacts was greater among younger vs. older referring persons and among those with >1 vs. ≤1 recent sex partner. Effect differences by age were similar for cPN vs. pPN.

Conclusion:

Our intervention package may be particularly efficacious in eliciting referrals from women and previously diagnosed persons. When the combination intervention is infeasible, cPN alone may be beneficial for these populations.
Development and Validation of the Hospital-to-Home-Health Transition Quality (H3TQ) Index: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality
Authors: Arbaje Alicia I. , Hsu Yea-Jen , Keita Maningbe , Greyson Sylvan , Wang Jiangxia , Werner Nicole E. , Carl Kimberly , Hohl Dawn , Jones Kate , Bowles Kathryn H. , Chan Kitty S. , Marsteller Jill A. , Gurses Ayse P. , Leff Bruce
Published: June 2023

Background:

Patients requiring skilled home health care (HH) after hospitalization are at high risk of adverse events. Human factors engineering (HFE) approaches can be useful for measure development to optimize hospital-to-home transitions.

Objective:

To describe the development, initial psychometric validation, and feasibility of the Hospital-to-Home-Health-Transition Quality (H3TQ) Index to identify patient safety risks.

Methods:

Development: A multisite, mixed-methods study at 5 HH agencies in rural and urban sites across the United States. Testing: Prospective H3TQ implementation on older adults' hospital-to-HH transitions. Populations Studied: Older adults and caregivers receiving HH services after hospital discharge, and their HH providers (nurses and rehabilitation therapists).

Results:

The H3TQ is a 12-item count of hospital-to-HH transitions best practices for safety that we developed through more than 180 hours of observations and more than 80 hours of interviews. The H3TQ demonstrated feasibility of use, stability, construct validity, and concurrent validity when tested on 75 transitions. The vast majority (70%) of hospital-to-HH transitions had at least one safety issue, and HH providers identified more patient safety threats than did patients/caregivers. The most frequently identified issues were unsafe home environments (32%), medication issues (29%), incomplete information (27%), and patients' lack of general understanding of care plans (27%).

Conclusions:

The H3TQ is a novel measure to assess the quality of hospital-to-HH transitions and proactively identify transitions issues. Patients, caregivers, and HH providers offered valuable perspectives and should be included in safety reporting. Study findings can guide the design of interventions to optimize quality during the high-risk hospital-to-HH transition.
Comparison of Oral and IV 18F-NaF PET/CT Administration in the Assessment of Bone Metastases in Patients With Breast or Prostate Cancers
Authors: Rocha Nelisa Helena , Zacchi Samara Riguete , Sado Heitor Naoki , Buchpiguel Carlos Alberto , Duarte Paulo Schiavom , Sapienza Marcelo Tatit
Published: June 2023

Purpose

The aim of this study was to compare oral and IV administrations of 18F-NaF PET/CT for detection of suspicious bone metastatic lesions of breast and prostate cancers.

Patients and Methods

Thirty-six patients with breast (n = 23) or prostate (n = 13) cancers and high risk for bone metastases were prospectively evaluated. All patients underwent 2 PET/CT studies after IV and oral 18F-NaF administration within a 2 to 23 days interval between them. The maximum SUVs from the same suspicious lesions (≤5 index lesions per patient) in both studies were measured. The target-to-background ratio (TBR), defined as the relation between the lesion maximum SUV and the whole skeletal mean SUV, was calculated for each lesion. The TBRs in the same lesion calculated using the 2 administration routes were compared. The agreements between 2 physicians in the definition of the number of lesions in both studies were also assessed using weighted κ.

Results

One hundred thirty-four pairs of lesions were analyzed. There was no significant statistical difference between the median TBRs (P = 0.212) for IV (10.33) and oral (10.85). Excellent intraobserver agreement was observed between IV and oral routes: weighted κ of 1.0 (95% confidence interval, 0.92–1.0) and 0.92 (95% confidence interval, 0.81–0.99) for physicians 1 and 2, respectively. The interobserver coefficients were 0.82 and 0.87 for “oral versus oral” and “IV versus IV,” respectively.

Conclusions

18F-NaF PET/CT studies using oral and IV routes present comparable performance; thus, it is possible to use oral route in patients with difficult venous access.
Bilateral Pulmonary Enteric Adenocarcinoma on FDG PET/CT
Authors: Su Hengyu , Yang Lixiang , Shen Guohua , Tian Rong
Published: June 2023

Pulmonary enteric adenocarcinoma(PEAC) is a rare variant of pulmonary adenocarcinoma. We herein report FDG PET/CT findings of PEAC in a 76-year-old woman. The images showed widespread opacities in both lungs with intense FDG uptake. The pathology revealed pulmonary enteric adenocarcinoma.
Prospective Comparison of the Imaging Value of 99mTc-MDP Bone Scan and 68Ga-FAPI-04 PET/CT in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome
Authors: Xu Tingting , Ding Haoyuan , Fan Dongmei , Shu Qingxue , Liu Guangfu , Zhang Shumao , Chen Yue
Published: June 2023

Purpose

This study aimed to explore the imaging value of 68Ga-FAPI-04 PET/CT in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and compare it with that of 99mTc-MDP bone scan.

Methods

Nineteen participants with SAPHO syndrome underwent 68Ga-FAPI-04 PET/CT and 99mTc-MDP bone scan. Demographic data and clinical features were recorded, SAPHO imaging features were analyzed, and the osteoarticular lesion detection rate in both methods was calculated.

Results

This prospective study recruited 4 men and 15 women aged 52.4 ± 8.6 years. The anterior chest wall was involved in all participants (100%). Palmoplantar pustulosis was the most common (36.8%) skin symptom. 99mTc-MDP bone scan and 68Ga-FAPI-04 PET/CT together detected 84 osteoarticular lesions, of which 91.7% (77/84) were detected by the former and 96.4% (81/84) by the latter. Furthermore, 68Ga-FAPI-04 PET/CT detected 5 cases of knee and hip joint synovitis.

Conclusions

68Ga-FAPI-04 PET/CT was more sensitive than 99mTc-MDP bone scan when evaluating osteoarticular lesions in SAPHO syndrome and could also evaluate synovial lesions. 68Ga-FAPI-04 PET/CT could be a good imaging method for SAPHO syndrome but requires further verification in a more extensive research cohort.
Saccade Analysis in Patients With Orbital-Wall Fractures Without Diplopia
Authors: Kakeue Ken , Yunoki Tatsuya , Mihara Miharu , Hayashi Atsushi
Published: June 2023

Purpose:

This study aimed to analyze saccades in patients with orbital-wall fractures with little or no ocular motor impairment.

Methods:

We included 7 eyes of 7 patients with unoperated orbital-wall fractures (3 cases of orbital-floor fractures and 4 cases of medial orbital-wall fractures) with mild or no diplopia who presented to our hospital between August 2019 and March 2021. Eye movements were assessed at the first visit and after 1 month using the Hess area ratio according to the Hess screen test, binocular single vision (BSV) scores (total 59 points) obtained using Goldman perimetry, and maximum velocity and amplitude of saccades within 15 degrees obtained using an eye tracker system.

Results

Hess area ratio and BSV scores at the first visit and after 1 month were 88.6±8.2% and 97.4±3.6% and 49.6±8.5 points and 53.5±6.6 points, respectively, with no significant change (Hess area ratio, P=0.06; BSV, P=0.44). Next, the authors compared the velocity and amplitude of the saccades between the first visit and 1 month later and found no significant changes in any of the 4 directions (adduction, abduction, upgaze, and downgaze). Similarly, no significant differences were observed between the velocity and amplitude of the saccades between the injured and noninjured eyes, both at the first visit and after 1 month.

Conclusions:

In patients with orbital-wall fractures with little or no eye movement impairment, eye tracker-based saccade analysis showed that the saccade velocity and amplitude did not change during the natural course of healing of the fracture.
The Physiological Function of Deglutition and Swallowing in Patients With Maxillary Protrusion After Mandibular Advancement
Authors: Kaku Masato , Kagawa Haruka , Yamamoto Taeko , Kojima Shotoku , Kamiya Takashi , Shimoe Saiji , Mine Yuichi , Murayama Takeshi , Yamamoto Ichiro , Tanimoto Kotaro
Published: June 2023

The objective of this study was to determine the tongue-palatal contact changes in patients with skeletal maxillary protrusion after sagittal split ramus osteotomy (SSRO) during swallowing. In this study, 15 patients with maxillary protrusion and 10 normal subjects participated. Before and 3 months after surgery, tongue-palatal contact patterns during swallowing of patients with maxillary protrusion as well as controls were evaluated by electropalatography. The electrode contact number in the alveolar, palatal, and velar parts was examined. The swallowing duration of each phase was also evaluated. In the lateral area of the velar part, incomplete electrode contact was shown at 0.3 seconds in patients with maxillary protrusion. The electrode contact number in the velar part at 0.3 seconds before tongue-palatal complete contact was significantly less in the preoperative patients compared with the controls (P < 0.05). A small increase in the electrode contact number of the velar part was shown in the postoperative patients at 0.3 and 0.2 seconds before tongue-palatal complete contact (P < 0.05). The pharyngeal phase duration was significantly larger in the patients with maxillary protrusion before SSRO compared with the controls (P < 0.05). After SSRO, the pharyngeal phase duration was significantly shortened. It was shown that the tongue-palatal contact pattern during swallowing in patients with maxillary protrusion improved after orthognathic surgery, and the pharyngeal phase duration was also shortened. It is suggested that the changes in the mesiodistal mandibular position by orthognathic surgery can improve tongue posture and movement during swallowing.
Cariprazine: an augmentation strategy for treatment-resistant schizophrenia with pro-cognitive and anti-hostility effects
Authors: Boydstun Chelsea , Lynch Sean , DiGenova Patrick
Published: June 2023

Schizophrenia is a chronic mental health condition treated with antipsychotics. A significant number of patients fail to respond to standard treatment and develop treatment-resistant schizophrenia (TRS). The only current treatment for TRS is clozapine, which has significant side effects and may only be effective in 40% of cases. We describe two cases of patients with TRS who have failed multiple antipsychotic trials and have had extensive hospitalization history due to aggression/hostility. Both patients responded to dual antipsychotic therapy with a long-acting injectable antipsychotic plus cariprazine. Both patients demonstrated improvement in hostility and cognition/memory. Cariprazine’s novel mechanism of action may allow it to be uniquely effective in dual antipsychotic therapy for TRS. Cariprazine has a higher affinity than dopamine for D3 receptors and has a 10-fold higher affinity for D3 than D2. This may contribute to its pro-cognitive and anti-hostility effects. Further studies are warranted to determine the role of cariprazine in TRS.
Selective direct motor cortical influence during naturalistic climbing in mice
Authors: Koh Natalie , Ma Zhengyu , Sarup Abhishek , Kristl Amy C. , Agrios Mark , Young Margaret , Miri Andrew
Published: June 2023

It remains poorly resolved when and how motor cortical output directly influences limb muscle activity through descending projections, which impedes mechanistic understanding of cortical movement control. Here we addressed this in mice performing an ethologically inspired all-limb climbing behavior. We quantified the direct influence of forelimb primary motor cortex (caudal forelimb area, CFA) on muscle activity across the muscle activity states that occur during climbing. We found that CFA instructs muscle activity pattern, mainly by selectively activating certain muscles while exerting much smaller, bidirectional effects on their antagonists. From Neuropixel recordings, we identified linear combinations (components) of motor cortical activity that covary with these effects, finding that these components differ partially from those that covary with muscle activity and differ almost completely from those that covary with kinematics. Collectively, our results reveal an instructive direct motor cortical influence on limb muscles that is selective within a motor behavior and reliant on a distinct neural activity subspace.
How ready is the health care system in North East India for surgical delivery? A mixed methods study on surgical capacity and need
Authors: Virk Amrit , King Rebecca , Heneise Michael , Brown Julia , Jayne David , Ensor Tim
Published: June 2023

Background

Surgical services are scarce with persisting inequalities in access across populations and regions globally. As the world’s most populous county, India’s surgical need is high and delivery rates estimated to be sub-par to meet need. There is a dearth of evidence particularly sub-regional data on surgical provisioning and need to aid planning.

Aim and method

This mixed methods study examines the state of surgical care in Northeast India, specifically health care system capacity and barriers to surgical delivery. It involved a facility based census and semi-structured interviews with surgeons and patients across four states in the region.

Results

Abdominal conditions constituted a large portion of the overall surgeries across public and private facilities in the region. Workloads varied among surgical providers across facilities. Task-shifting occurred, involving non-specialist nursing staff assisting doctors on surgical procedures or surgeons’ taking on anaesthetic tasks. Structural factors dis-incentivised facility level investment in suitable infrastructure. Patients’ care pathways were shaped by facility level shortages as well as personal preferences influenced by cost and distance to facilities.

Discussion and conclusion

skewed workloads across facilities and regions indicate uneven surgical delivery, with potentially variable care quality and provider efficiency. A systemic approach to referral coordination and human resource management are evident. Existing task shifting practices, along with incapacities induced by structural factors signal the direction of possible policy action.