bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of oral chemotherapy pharmacists on cost avoidance of oral oncolytics in an integrated health system
Authors: Nguyen Analia L
Published: August 2022

Background

While the impact of oncology pharmacist interventions on patient outcomes has been well-documented in previous studies, there is a scarcity of articles relating to oncology pharmacists’ impact on cost avoidance of oral oncolytics within an integrated health care system. Cost savings and cost avoidance studies are needed to help promote the expansion of clinical services provided by the oncology pharmacy department.

Objective

The primary objective of this study was to analyze interventions made by oncology pharmacists in the Oral Chemotherapy Treatment Program (OCTP) at the Kaiser Permanente—San Diego Service Area and determine the direct cost avoidance effects over one year. A secondary objective was to evaluate oncologists’ satisfaction with OCTP.

Methods

This was a retrospective, observational, single-arm study where the drug cost avoidance impact resulting from oncology pharmacists’ interventions was calculated. A report containing all documented oncology pharmacist interventions made in OCTP from 1 January to 31 December 2021 were reviewed for study inclusion. A retrospective chart review was conducted to verify that the interventions were made by the oncology pharmacists. The average wholesale price of drugs listed on Lexicomp as of 1 November 2021 was used to calculate drug cost avoidance values.

Results

A total of 238 OCTP oncology pharmacist interventions associated with direct drug cost avoidance values were identified, amounting to a total cost avoidance of $2,521,844 and an annual return on investment of 440%.
Hierarchical and fractal structured materials: Design, additive manufacturing and mechanical properties
Authors: Martínez-Magallanes Mario , Cuan-Urquizo Enrique , Crespo-Sánchez Saúl E , Valerga Ana P , Roman-Flores Armando , Ramírez-Cedillo Erick , Treviño-Quintanilla Cecilia D
Published: August 2022

Novel rationally designed structured materials (SMs) exhibit unconventional mechanical properties that cannot be found in common materials. Although most microarchitectures of the developed SMs are based on regular unit cell tessellation design, few studies have explored the potential of fractal geometry as a design tool for creating new SMs. A novel strategy for creating fractal-like aperiodic SMs based on Hilbert self-filling fractal curves synthetization is presented here. Families of continuous Hilbert structured cubes derived from two separate Hilbert curve iterations at three different matching relative densities were obtained, additionally, a method to decompose the Hilbert curve to obtain non-continuous Hilbert structured cubes is proposed. To obtain a broad overview of their mechanical response, samples were manufactured out of thermoplastic polyurethane via fused filament fabrication and tested under compression. An apparent model of elasticity has been proposed to classify their mechanical performance under low and high strain. Results showed that relative stiffness, energy absorption and deformation could be tuned by adjusting parameters of the Hilbert structured cubes. By iterating the Hilbert curve from n = 4 to n = 5, a 51% increase in stiffness was obtained. A significant increment of 82% and 148% on stiffness was observed on non-continuous Hilbert structured cubes for the first and second orders, respectively; besides, energy absorption capabilities and great shape recovery were observed.
Interstitial position or ‘bastard’ status? Interpreters at the French National Court of Asylum
Authors: PIAN Anaïk
Published: August 2022

This article, based on fieldwork conducted in 2016 at the French national Court of Asylum (CNDA), explores reflections on the role and position of interpreters in the examination of asylum applications. Interpreters occupy a position that is at once an interstitial position – that is, at the crossroads of the social worlds of judges and claimants – and a ‘bastard’position, in the sense that, although they are indispensable, their legitimacy is never fully established. To grasp the full ambiguity and complexity of their position, on the one hand, the article aims to shed light on the trajectories and working conditions of interpreters as actors in this system whose legitimacy is fragile, yet who play an essential bridging role between the institutions and the foreigners seeking their protection. On the other hand, it seeks to identify and explore other factors, beyond the codification of the role within highly standardized hearings, which may influence the ways interpreters carry out their missions in practice, in both speech and behavior.
Voltage-heating responsive and patternable solvatochromism display utilizing nickel complex-Nafion film composites
Authors: Wang Yanjie , Zhang Lei , Li Bo , Tang Gangqiang , Zhao Xin , Zhang Zeyu , Li Lijie
Published: August 2022

In this work, a voltage-heating actuated flexible solvatochromic film is developed using the composites of Nafion film-nickel complexes with spray-coated silver nanowires (AgNWs). The nickel complexes, inside Nafion film through ion exchange, serve as colorable components due to the coordination number change of water molecules in solvatochromism. The color-changing process of the composites was characterized experimentally by adjusting the water content in films, which exhibit distinct coloration properties from red to green with an absorbency shift (0.25–0.60 at 420–550 nm). To achieve an electrical actuation, the electrothermal joule effect of AgNWs is studied to accelerate the hydrolysis of the nickel complexes. A mask patterned spraying process is developed to increase the adhesion between AgNWs and Nafion film, which can be beneficial in a low (2–5 V) voltage-regulated coloration. This study provides a systematic investigation of flexible electrothermally responsive color-changing film of complex metal ions, the composite film prepared from flexible smart materials and well-adhered electrodes have potential applications in the fields of adaptive camouflage, wearable display devices and e-skins.
Enhancing mechanical properties of 3D printed thermoplastic polymers by annealing in moulds
Authors: Vorkapić Miloš , Mladenović Ivana , Ivanov Toni , Kovačević Aleksandar , Hasan Mohammad Sakib , Simonović Aleksandar , Trajković Isaak
Published: August 2022

Five series of specimens with two different print orientations (−45/45 and 0/90) and two print layer thicknesses (0.1 and 0.2 mm) were made. In total 60 specimens with 100% filament infill were made. One specimen series (20 pieces) was isolated as a reference or thermally untreated. Before the thermal treatment (annealing), two specimen moulding methods were used: NaCl powder (granulation 63 mm: 20 pieces) and Calcium Sulphate (Gypsum: 20 pieces). During the annealing, specimens immersed in NaCl powder were heated in a drying oven to the filament melting point (for PLA: 200°C, with a duration interval of 30 min), while the treatment of the heated specimens in gypsum was performed at a temperature of around 190°C, with duration interval of 3 h with the observed temperature inside the mould of about 100°C. An ultrasonic bath and a drying oven were used in the gypsum treatment. Temperature measurement and control during both annealing treatments were performed using a thermal imaging camera, while the temperature control inside the drying oven was performed using a digital thermometer. After treatment, the specimens in the moulds were cooled at room temperature, and the dimensions of annealing and untreated specimens were controlled. Surface morphology was characterised using scanning electron microscopy (SEM). The SEM analysis reveals improved internal structure after heat treatment of the PLA specimens. These results show that the investigated specimens after heat treatments had better structural properties than the referent specimens. Tensile testing on a universal testing machine in compliance with the ASTM D638 standard was also performed. The referent PLA specimen with −45/45 and layer thickness of 0.1 mm had the highest tensile stress value (64.08 MPa) while the specimen with minimal tensile stress value before fracture was 0/90, 0.2 mm (54.81 MPa). Heat treatment in gypsum showed the most significant increase in strength with −45/45 (0.1 mm) being the strongest (71.66 MPa) while the strongest specimen treated in sodium chloride was −45/45 (0.1 mm) with maximum tensile stress of 70.08 MPa. The mechanical characteristics of the PLA were characterised using the Vickers microhardness tester. The PLA microhardness value was calculated according to standards ASTM E384 and ISO 6507. The referent PLA specimen with −45/45 (0.2 mm) orientation shows the maximal microhardness value (125 MPa), and the minimal microhardness value was observed for the 0/90 (0.1 mm) orientation specimens (108 MPa). The heat treatment specimens in gypsum have a better hardness (185 MPa) than those treated in gypsum (165 MPa), with microhardness increasing by about 12%. The essence of the work is reflected in the additional filament processing to achieve a better structural and mechanical performance of the materials and reduce the anisotropy that is characteristic of 3D printing.
European-Australasian consensus on the management of advanced gastric and gastro-oesophageal junction cancer: current practice and new directions
Authors: Pavlakis Nick , Tincknell Gary , Lim Lisi Elizabeth , Muro Kei , Obermannova Radka , Lorenzen Sylvie , Chua Yu Jo , Jackson Chris , Karapetis Christos Stelios , Price Timothy , Chantrill Lorraine , Segelov Eva , Lordick Florian
Published: August 2022

Gastric carcinoma and gastro-oesophageal junction (GC/GEJ) carcinoma remain a significant global problem, with patients presenting with symptoms often found to have advanced or metastatic disease. Treatment options for these patients have broadened in recent years with new chemotherapy agents, agents targeting angiogenic pathways and the development of immune checkpoint inhibitors (ICIs). Most initial advances have occurred in the refractory setting, where it is important to balance treatment benefits versus toxicity and patient quality of life. In the first-line treatment of advanced/metastatic GC/GEJ, platinum- and fluoropyrimidine-based chemotherapy protocols remain the backbone of therapy (with or without HER2-targeted therapy), with the FOLFIRI regimen offering an alternative in patients deemed unsuitable for a platinum agent. Microsatellite instability-high or mismatch repair-deficient cancers have been shown to benefit most from ICIs. In unselected patients previously treated with doublet or triplet platinum- and fluoropyrimidine-based chemotherapy and second-line chemotherapy with irinotecan or taxanes have formed the backbone of therapy with or without the addition of the vascular endothelial growth factor receptor-2 inhibitor ramucirumab in addition to paclitaxel. Beyond this, efficacy has been demonstrated with oral trifluridine/tipiracil and with single-agent nivolumab, in selected refractory patients. In this review, we highlight the positive evidence from key trials that have led to our current practice algorithm, with particular focus on the refractory advanced disease setting, discussing the areas of active research and highlighting the factors, including biomarkers and the influence of ethnicity, that contribute to therapeutic decision-making.
A Study on Victims of Intimate Partner Violence Reported to Colombo North Teaching Hospital, Sri Lanka During 2019-2021
Authors: Muthulingam Thanushan , Edirisinghe Patikirige Anuruddhi Samanthika , Wijewardhane Handun Pathirannehelage , Thivaharan Yalini , Jayasundara Mudiyanselage Maleesha Sawaneeth , Borukgama Nirmal , Kulathunga Deshan Lakshitha , Alwis Dula Nuwanthi , Govinnage Pawanthi Samudini , Kitulwatte Indira Deepthi Gamage
Published: August 2022

Introduction:

Intimate partner violence (IPV) is a common issue in any society and the reported cases are just the tip of an iceberg as most of the victims are reluctant to come to the criminal justice system. Forensic experts are often encountering the victims who chose to seek justice. Evaluation of the nature, consequences, and underlying factors are needed in planning preventive measures.

Objectives:

To describe the patterns and associated factors of IPV among victims who reported to Office of the Judicial Medical Officer of Colombo North Teaching Hospital and to specifically describe the patterns prior and during the COVID-19 pandemic.

Methods:

A retrospective descriptive study based on 471 medicolegal records of the victims who had undergone medicolegal examination following IPV during last two years (March 2019 to February 2021).

Results:

Out of 471, 206 cases were reported prepandemic and 265 reported postpandemic periods. Even though majority were females there were 21 males. Types of abuse were complex and often interrelated. There were 463 who had experienced physical injuries while there were 20 who had been subjected to sexual violence. Face was the commonest target of assault (63%). Substance abuse was identified as the commonest predisposing factor (56%). Even though repeated abuse was common, 42.5% of the victims had never made any complaints to the police. Despite multiple complains, 39.7% had experienced repeated violence.

Conclusion:

Victims of IPV are silently suffering for many long years. Failure in the response from authorities was identified. COVID-19 pandemic has become an additional risk factor for IPV. Strengthening of legal and social responses is the need of the hour.
Carotid pseudoaneurysm in a kitten after accidental puncture with a needle
Authors: Sterman Allyson , Dickerson Vanna , Voges Andra , Milliron Sarai , Wiener Dominique , Thieman Mankin Kelley M
Published: August 2022

Case summary

A 3-month-old intact male domestic shorthair kitten’s cervical region was inadvertently punctured during routine subcutaneous fluid administration. A swelling rapidly developed on the left lateral neck and continued to grow, despite compression. An emergency facility evaluated the kitten 48 h later and the swelling was determined to be blood. Fine-needle aspiration of the swelling resulted in further swelling of the mass on the neck. The kitten began showing signs of systemic shock, necessitating a blood transfusion. The kitten was referred to a tertiary facility 24 h later for further diagnostics and treatment. CT of the head and neck revealed a large fluid-filled mass with progressive contrast enhancement noted during the filling phase, consistent with active hemorrhage. A carotid pseudoaneurysm was suspected and surgery was recommended. The left carotid artery was ligated proximal to the pseudoaneurysm; hemorrhage continued and the swelling was further explored. A small connection to the carotid artery within the medial aspect of the swelling was identified and ligated. The kitten required autotransfusion and massive allotransfusion during surgery due to blood loss. Recovery was uneventful. A head tilt and Horner’s syndrome were noted postoperatively and improved over the following months. Histopathology was consistent with pseudoaneurysm.

Relevance and novel information

This is the first reported case of pseudoaneurysm in a kitten that was treated surgically, with massive blood transfusion and minimal complications. Early surgical intervention can result in excellent prognosis. The need for blood product administration should be anticipated.
Effect of Intraoperative Tranexamic Acid on Perioperative Major Hemorrhage Requiring Transfusion in Patients Undergoing Elective Spine Surgery: A Propensity Score-Matched Analysis Using a National Inpatient Database
Authors: Honda Akira , Iizuka Yoichi , Michihata Nobuaki , Uda Kazuaki , Mieda Tokue , Takasawa Eiji , Ishiwata Sho , Kakuta Yohei , Tomomatsu Yusuke , Ito Shunsuke , Inomata Kazuhiro , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo , Chikuda Hirotaka
Published: August 2022

Study Design

Retrospective cohort study.

Objectives

This study aimed to examine whether the use of intravenous TXA in elective spine surgery is associated with reduced perioperative massive hemorrhage requiring transfusion.

Methods

We extracted all patients who underwent decompression with or without fusion surgery for the cervical, thoracic, and lumbar spine between April 2012 and March 2019. The primary outcome was the occurrence of massive hemorrhage requiring transfusion, defined as at least 560 mL of blood transfusion within 2 days of spine surgery or the requirement of additional blood transfusion from 3-7 days postoperatively. Secondary outcomes were the occurrence of thrombotic complications (pulmonary embolism, acute coronary syndrome, and stroke) and postoperative hematoma requiring additional surgery.

Results

We identified 83,821 eligible patients, with 9747 (12%) patients in the TXA group. Overall, massive hemorrhage requiring transfusion occurred in 781 (.9%) patients. Propensity score matching yielded 8394 pairs. In the matched cohort, the TXA group had a lower proportion of massive hemorrhage requiring transfusion than the control group (.7% vs 1.1%; P = .002). There was no significant difference in the occurrence of thrombotic complications and postoperative hematoma requiring additional surgery between both groups. The multivariable regression analysis also showed that the use of TXA was associated with significantly lower proportions of massive hemorrhage requiring transfusion (odds ratio, .62; 95% confidence interval, .43-.90; P = .012).

Conclusions

In this analysis using real-world data, TXA use in elective spinal surgery was associated with reduced perioperative massive hemorrhage requiring transfusion without increasing thrombotic complications.

Level of evidence

Prognostic Level Ⅲ
Utilizing the “One Health” Model to Study Human Aging in Urban Environments
Authors: Peterson Jennifer R. , Howell Britteny M. , Hahn Micah B.
Published: August 2022

The “One Health” concept has resulted in a rich research literature that integrates human and animal systems, with a focus on zoonotic diseases; however, this narrow focus is at the expense of one of the leading causes of global human mortality: non-infectious, chronic diseases. Here, we provide a viewpoint that applying the integrated One Health framework to public health issues such as the impact of stressful urban environments on the process of human aging has the potential to elucidate potential causal mechanisms that have previously gone unnoticed. Given the success of the One Health paradigm in studying human health in rural areas, we posit that this model would be a useful tool for studying human, animal, and environmental interactions in urban settings.
Impact of integrating out-of-hours services into Emergency Medical Services Copenhagen: a descriptive study of transformational years
Authors: Zinger Nienke D. , Blomberg Stig Nikolaj , Lippert Freddy , Krafft Thomas , Christensen Helle Collatz
Published: August 2022

Background

Many emergency medical services and out-of-hours systems are facing an increasing demand for primary, ambulance, and secondary care services caused by population aging and a higher prevalence of long-term and complex conditions. In order to ensure safety and efficiency for future demands, many systems are changing their dispersed healthcare services towards a more integrated care system. Therefore, an evaluation of the production and performance over time of such a unified system is desirable.

Methods

This retrospective quantitative study was performed with dispatch and financial accounting data of Copenhagen Emergency Medical Services for the period 2010–2019. Copenhagen Emergency Medical Services operates both an emergency number and a medical helpline for out-of-hours services. The number of calls to the emergency number, the centralized out-of-hours medical helpline, the number of dispatches, and the annual expenditure of the system are described for both the periods before and after the major reforms. Production of the emergency number and the centralized medical helpline were analyzed separately.

Results

The average number of dispatches increased from 328 per 10,000 inhabitants in 2010 to 361 per 10,000 inhabitants in 2019. The newly initiated medical helpline received 533 calls per 10,000 inhabitants in its first year and 5 years later 548 calls per 10,000 inhabitants. A cost increase of 10% was observed in the first year after the reforms, but it decreased again to 8% in the following year.

Conclusions

There is a population demand for a centralized telephone access point for (semi-)emergency medical services. A more integrated EMS system is promising for a sustainable healthcare provision for a growing population with complex healthcare demands and multi-morbidities.
Efficacy of pramipexole on quality of life in patients with Parkinson’s disease: a systematic review and meta-analysis
Authors: Li Tao , Zou Shuang , Zhang Zijuan , Liu Meiruo , Liang Zhanhua
Published: August 2022

Background

Quality of life (QoL) in patients with Parkinson’s disease (PD) is increasingly used as an efficacy outcome in clinical studies of PD to evaluate the impact of treatment from the patient’s perspective. Studies demonstrating the treatment effect of pramipexole on QoL remain inconclusive. This study aims to evaluate the effect of pramipexole on QoL in patients with PD by conducting a systematic review and meta-analysis of existing clinical trials.

Methods

A systematic literature search of PubMed, Embase and the Cochrane Library was performed from inception to 30 April 2022 to identify randomised, placebo-controlled trials of patients with idiopathic PD receiving pramipexole, who reported a change from baseline in their QoL as measured by the 39-item Parkinson’s Disease Questionnaire (PDQ-39). Risk of bias was independently assessed by two reviewers using the Cochrane Collaboration’s tool for bias assessment.

Results

Of 80 eligible articles screened, six trials consisting of at least 2000 patients with early or advanced PD were included. From the synthesis of all six selected trials, a significant mean change from baseline in the PDQ-39 total score of –2.49 (95% CI, –3.43 to –1.54;p < 0.0001) was observed with pramipexole compared with placebo. A trend toward improvement in QoL was consistently observed among patients who received optimal doses of pramipexole (≥ 80% of the study population on 1.5 mg dosage), regardless of disease severity (advanced versus early) or baseline QoL levels.

Conclusion

This meta-analysis provides evidence for the potential treatment benefit of pramipexole in improving QoL in patients with PD.
Characteristics of non-stenotic carotid plaque in embolic stroke of undetermined source compared with cardiogenic embolism: a retrospective cross-sectional observational study
Authors: Zhang Lihao , Guo Yikun , Zhou Wang , Zhu Shumin , Chen Zhuoyou , Dong Guanzhong , Cao Yin
Published: August 2022

Background

Non-stenotic carotid plaque is considered an important etiology of embolic stroke of undetermined source (ESUS). However, only a few previous studies included a negative control group, and the characteristics of non-stenotic carotid plaque in ESUS have yet to be investigated. The objective of this study is to explore the clinical characteristics of ESUS and the correlation between non-stenotic carotid plaque and ESUS.

Methods

This is a single-center, retrospective cross-sectional observational study conducted to compare differences in clinical information among ESUS, CE, and large-artery atherosclerosis (LAA), as well as the prevalence of non-stenotic carotid plaque and non-stenotic carotid plaque with low echo between patients with ESUS and CE in Changzhou No.2 People’s Hospital from January 2020 to January 2022. Ultrasound was used to evaluate the characteristics of non-stenotic carotid plaque and vulnerable carotid plaque was defined as plaque with low echo. The binary logistic regression model was used to analyze the relationship between the characteristics of non-stenotic carotid plaque and ESUS. The receiver-operating characteristic curve was used to evaluate the diagnostic efficiency of the characteristics of non-stenotic carotid plaque for ESUS.

Results

We had a final studying population of 280 patients including 81 with ESUS, 37 with CE, and 162 with LAA. There were no differences in clinical features between ESUS and LAA, but in the comparison of CE and ESUS, there were differences in age, smoking, hypertension, levels of triglyceride, total cholesterol, and low density lipoprotein cholesterol. In ESUS, the prevalence of non-stenotic carotid plaque was more common on the ipsilateral side of stroke than in CE [55 (67.90%) vs. 18 (48.65%), p = 0.046], so was the prevalence of non-stenotic carotid plaque with low echo [38 (46.91%) vs. 5 (13.51%), p < 0.001]. Logistic regression analysis showed that the prevalence of non-stenotic carotid plaque (OR: 4.19; 95% CI: 1.45–12.11; p = 0.008) and the prevalence of non-stenotic carotid plaque with low echo (OR: 5.12; 95% CI: 1.55–16.93; p = 0.007) were, respectively, the independent predictors of ESUS. The results receiver-operating characteristic (ROC) curve showed that the combination of age, hypertension, and ipsilateral non-stenotic carotid plaque with low echo had the best diagnostic efficiency for ESUS (0.811; 95%CI: 0.727–0.896; p < 0.001).

Conclusion

Our results suggest that ipsilateral vulnerable non-stenotic carotid plaque is associated with ESUS in anterior circulation infarction.
A non-randomized concurrent controlled trial of myofunctional treatment in the mixed dentition children with functional mouth breathing assessed by cephalometric radiographs and study models
Authors: Habumugisha Janvier , Cheng Bo , Ma Shu-Yu , Zhao Min-Yue , Bu Wen-Qing , Wang Gao-Li , Liu Qiong , Zou Rui , Wang Fei
Published: August 2022

Objectives

This study aimed to examine the clinical effects of myofunctional treatment on children with functional mouth breathing by cephalometric radiographs and study models.

Methods

A total of 224 children (6–10 years old; 114 males and 110 females; SNA°: 82.24 ± 1.67°; ANB°: 2.79 ± 0.80°, 28° < SN-GoGn° < 37°) formed three groups: MB-M group (mouth breathers with myofunctional treatment,n = 75); MB-N group (mouth breathers with no treatment,n = 70); NB group (nasal breathers with no treatment,n = 79). A blind evaluation of cephalometric radiographs and study models was conducted at T1(pre-study) and T2 (post-study), respectively.

Results

Two hundred four children (MB-M:66, MB-N:68, NB:70) completed the present study. At T1, MB-M and MB-N groups, compared to their NB counterpart, had greater anterior lower facial height(P < 0.01) and overjet(P < 0.001) but shorter overbite and maxillary canines width (P < 0.001). At T2, the MB-N group exhibited a higher ANB angle, anterior lower facial height, and overjet, but shorter overbite and maxillary canines width (P < 0.001). From T1 to T2, the anterior lower facial height increased, overbite and the maxillary canines width further decreased in the MB-N group (P < 0.001). However, in the MB-M group, the incisors were retracted, overbite increased (P < 0.001), anterior lower facial height increased insignificantly (P > 0.05), and maxillary canines width increased slightly (P < 0.05). In the NB and MB-M groups, the mandible showed a normal tendency to grow forward, whereas, in the MB-N group, the mandible showed a tendency to grow downward (P < 0.001).

Conclusions

Mouth breathers demonstrated increased anterior facial height and overjet but reduced overbite and maxillary arch width, which improved significantly following myofunctional treatment.

Trial registration

TCTR:TCTR20220401001. Registered 1stApril 2022-Retrospectively registered.
Health care utilization in young adults with childhood physical disabilities: a nationally representative prospective cohort study
Authors: Fergus Kirkpatrick B. , Zambeli-Ljepović Alan , Hampson Lindsay A. , Copp Hillary L. , Nagata Jason M.
Published: August 2022

Background

Young people with physical disabilities face barriers to accessing health care; however, few studies have followed adolescents with physical disabilities longitudinally through the transition of care into adulthood. The objective of this study was to investigate differences in health care utilization between adolescents with physical disabilities and those without during the transition period from adolescent to adult care.

Methods

We utilized the National Longitudinal Study of Adolescent to Adult Health, a prospective cohort study following adolescents ages 11–18 at baseline (1994–1995) through adulthood. Baseline physical disability status was defined as difficulty using limbs, using assistive devices or braces, or having an artificial limb; controls met none of these criteria. Health care utilization outcomes were measured seven years after baseline (ages 18–26). These included yearly physical check-ups, unmet health care needs, and utilization of last-resort medical care, such as emergency departments, inpatient hospital wards, and inpatient mental health facilities. Multiple logistic regression models were used to predict health care utilization, controlling for age, sex, race/ethnicity, insurance status, and history of depression.

Results

Thirteen thousand four hundred thirty-six participants met inclusion criteria, including 4.2% with a physical disability and 95.8% without. Half (50%) of the sample were women, and the average age at baseline was 15.9 years (SE = 0.12). In logistic regression models, those with a disability had higher odds of unmet health care needs in the past year (Odds Ratio (OR) 1.41 95% CI 1.07–1.87), two or more emergency department visits in the past five years (OR 1.34 95% CI 1.06–1.70), and any hospitalizations in the past five years (OR 1.36 95% CI 1.07–1.72). No statistically significant differences in preventive yearly check-ups or admission to mental health facilities were noted.

Conclusions

Young adults with physical disabilities are at higher risk of having unmet health care needs and using last-resort health care services compared to their non-disabled peers.
The impact of lockdown on young people with genetic neurodevelopmental disabilities: a study with the international participatory database GenIDA
Authors: Coutelle Romain , Boedec Morgane , Vermeulen Karlijn , Kummeling Joost , Koolen David A. , Kleefstra Tjitske , Fournier Camille , Colin Florent , Strehle Axelle , Geneviève David , Burger Pauline , Mandel Jean-Louis
Published: August 2022

Background

Previous publications suggested that lockdown is likely to impact daily living issues of individuals with intellectual disabilities. The authors notably suspected an intensification of behavioural, eating and sleep problems.

Methods

To test these hypotheses, we conducted an international online survey about the impact of COVID-19-associated first lockdown on people with genetic neurodevelopmental disorders. This survey was carried out using GenIDA, an international participatory database collecting medical information on genetic neurodevelopmental disorders. Patients’ relatives took part in this online survey from 30/04/2020 to 09/06/2020. This survey adapted from GenIDA standard questionnaire requested information on diagnosis, lifestyle and was based on yes/no answers to questions regarding behaviour, diet, and sleep, in the 6-months period before lockdown and during lockdown. We also asked relatives to evaluate the intensity of these problems by severity level. Finally, relatives could freely comment in open fields on the medical and/or quality of life problems they had encountered during lockdown.

Results

In total 199 participants—144 children and 45 adults—with neurodevelopmental disorders (intellectual disability (79.4%) and/or autism spectrum disorder (21.6%)) of various genetic origins, with near-equal male/female (96/103) contribution and originating mainly from Europe and Northern America, were included. The average lockdown duration at time of the survey was 57 days. We did not find differences in the frequency of behavioural, eating and sleep problems before and during lockdown. Moreover, there was no apparent difference in the intensity of eating and sleep disorders between both periods. However, for persons with behavioural problems at both periods, relatives reported an increase in aggressivity, self-aggressivity, depressiveness, stereotypies, and restricted interests during lockdown, all of which might be interpreted as consequences of a lack of stimulation or a reaction to unexpected changes in daily habits.

Conclusions

Our results support previous studies that suggest that the negative impact of lockdown does not depend on the intellectual disability per se but on the associated comorbidities such as behavioural disorders. This study addresses the need for prevention of behavioural disturbance in the vulnerable population with genetic neurodevelopmental disabilities.
Design and implementation of a health systems science curriculum at a large teaching hospital
Authors: Harcher Elizabeth , Fakolade Adeola , Gordon Dana , Nedorost Susan
Published: August 2022

Background

Physicians must increasingly lead change for improvement in the value of health care for individuals and populations. Leadership, stewardship, and population health competencies are not explicitly part of the Accreditation Council for Graduate Medical Education (ACGME) requirements and are best appreciated in the context of Health Systems Science (HSS).

HSS education is best approached at the institutional level, yet almost all graduate medical education (GME) curriculum is at the program level. We describe the process of designing and implementing an institutional HSS GME curriculum in a hospital-based sponsoring institution.

Methods

A group of diverse stakeholders drafted a curriculum to build competencies in leadership, stewardship, and population health, which was further refined by our Graduate Medical Education Committee (GMEC) and Resident Forum in the academic years 2015–2017. The refined curriculum was implemented at the institutional level of a large urban teaching hospital with over 80 ACGME accredited programs in the 2017–2018 academic year, participation was tracked and impact surveys were conducted.

Results

All programs participate in at least parts of the curriculum with sustained use. Annual surveys show a progression in assessment of our target competencies and/or opportunities to reflect and provide feedback. The annual program review meeting and GMEC meetings are used to troubleshoot and identify new curricular opportunities.

Conclusion

This innovative institutional curriculum has been sustained for over four years and we believe that other training institutions with similar goals will find our experience implementing an institutional curriculum translatable to their clinical learning environment.
Non-pharmacological delirium prevention practices among critical care nurses: a qualitative study
Authors: Liang Surui , Chau Janita Pak Chun , Lo Suzanne Hoi Shan , Zhao Jie , Liu Wenhui
Published: August 2022

Background

Delirium is common among critically ill patients, leading to increased mortality, physical dependence, and cognitive impairment. Evidence suggests non-pharmacological delirium prevention practices are effective in preventing delirium. However, only a few studies explore the actual implementation and its associated challenges among critical care nurses.

Aim

To explore critical care nurses’ perceptions of current non-pharmacological delirium prevention practices in adult intensive care settings, including delirium screening, early mobilisation, sleep promotion, family engagement, and sensory stimulation.

Methods

A qualitative design adopting a thematic analysis approach. Semi-structured interviews with 20 critical care nurses were conducted in ten acute hospitals in mainland China.

Results

Three themes emerged: (a) importance of family engagement; (b) influence of organisational factors, and (c) suggestions on implementation. The implementation of non-pharmacological delirium prevention practices was limited by a strict ICU visitation policy, lack of routine delirium screening and delirium training, light and noise disturbances during nighttime hours, frequent resuscitation and new admissions and strict visitation policy. Case-based training, adopting a sensory stimulation protocol, and family engagement may be enablers.

Conclusion

ICU care routine that lacks delirium assessment and the strict family visitation policy made it challenging to implement the complete bundle of non-pharmacological practices. Resource deficiency (understaffing, lack of training) and ICU environment (frequent resuscitation) also limited the implementation of non-pharmacological practices. Clinicians could implement case-based training and sensory-stimulation programs and improve communication with family caregivers by instructing family caregivers to recognise delirium symptoms and delirium prevention strategies.
Healthcare providers’ experiences in hospital resuscitation of patients with COVID-19: a qualitative study
Authors: Goodarzi Afshin , Khodaveisi Masoud , Abdi Alireza , Salimi Rasoul , Oshvandi Khodayar
Published: August 2022

Background

The COVID-19 epidemic has globally challenged medical practices, including cardiopulmonary resuscitation (CPR). Numerous challenges affect healthcare providers (HCPs) who are members of the resuscitation team and the resuscitation process in COVID-19 patients. As a result, HCPs may experience different dilemmas about CPR. Failure to recognize these experiences can harm both HCPs and patients. This study aimed to explore the HCP’s experiences of CPR in patients with COVID-19.

Methods

A qualitative study was conducted using semi-structured interviews with 26 participants in the emergency departments of Besat, Golestan, and Imam Reza hospitals (in the west of Iran) using the hermeneutic phenomenology approach. The data were analyzed using the 6-step Smith interpretative phenomenological analysis (IPA) method.

Results

The mean age of the participants was 38 years. Most of them (61.5%) were male and had a Bachelor’s degree in nursing (46.1%).The data analysis resulted in extracting four super-ordinate and nine sub-ordinate themes. “Human aspects of Care”, “Perceived Psychological Effects of Resuscitation in COVID-19”, “HCP’s perceptions of factors affecting the resuscitation process in COVID-19”, and “Perceived differences in COVID-19 resuscitation compared to non-COVID patients” were super-ordinate themes.

Conclusions

The participants experienced a wide range of difficult feelings and emotions while resuscitating the patients with COVID-19, suggesting the effect of the COVID-19 epidemic on HCPs and the resuscitation process. They experienced stress and fear, and the resuscitation process was influenced by their compassion, underlying patient conditions, resuscitation futility, and participants’ fatigue or lack of oxygen due to the use of personal protective equipment (PPE).
Validity and reliability study of clinician attitude towards rural health extension program in Ethiopia: exploratory and confirmatory factor analysis
Authors: Gebremedhin Merhawi , Gebrewahd Esie , Stafford Lauryn K.
Published: August 2022

Background

The Ethiopian health extension program (HEP) is an innovative community-based strategy aimed at disease prevention and health promotion. While health extension workers (HEWs) are its front-line workers, the involvement of clinicians remains an integral part. The goals of this study were to: (1) assess the correlation of clinician attitude with predictors and (2) assess the reliability and validity of the survey instrument.

Methods

A cross-sectional study design was utilized to collect data from a sample of 1239 clinicians using 28 items of attitude questions. Exploratory factor analysis (EFA) was applied to create the latent variables. Oblique Promax type rotation with factor loading (> 0.5) was used. Cronbach’s alpha was used to assess reliability, with a level of > 0.7 suggesting good reliability. Confirmatory factor analysis (CFA) was undertaken, with the values of Root Mean Square Error Administration (RMSEA) < 0.08, Standardized Root Mean Square Residual (SRMR) < 0.05, comparative fit index (CFI) 0.9–0.95, and Tucker-Lewis index (TLI) 0.9–0.95 suggesting acceptable model fit. A linear regression analysis was conducted.

Results

EFA produced two latent variables which explained 93.2% of the total variance. The latent variables were labeled as perceived attitude towards the skill of HEWs (F1), and perceived attitude towards the impact of HEP (F2). Internal reliability for the 28 items was reported with a Cronbach’s alpha of 0.94, and for F1 and F2 it was 0.91 and 0.90, respectively. CFA was done and RMSEA was reported at 0.04, SRMR was 0.03, and CFI and TLI were each 0.97. The value of clinician attitude increased by 3.5, 95% CI (1.5, 5.3), P-value < 0.001 for those who have been exposed to the HEP program than non-exposed. Similarly, clinician attitude was lower for degree holders compared to those with diplomas by − 2.7, 95% CI (− 4.4, − 0.94), P-value < 0.002.

Conclusion

Clinician attitude increased as exposure to HEP increased. Clinician attitude towards HEP has two latent variables. Furthermore, the assessment tool demonstrated good reliability and validity. In conclusion, it is worthy valued for clinicians to receive orientation about HEP, and researchers and program evaluators can use this assessment tool.
Papillary renal neoplasm with reverse polarity may be a novel renal cell tumor entity with low malignant potential
Authors: Yang Tong , Kang Enhao , Zhang Longxiao , Zhuang Jie , Li Yujun , Jiang Yanxia , Wang Han , Yu Wenjuan , Zhang Wei
Published: August 2022

Aims

This study retrospectively investigated the morphological, immunohistochemical and molecular genetic features of papillary renal neoplasm with reverse polarity (PRNRP), a recently described renal tumor.

Methods and results

Eleven cases of PRNRP were collected, and 16 cases of type I and 9 cases of type II papillary renal cell carcinoma were included as a control series. Pathological features were evaluated based on HE staining and immunohistochemistry. KRAS exon 2 and BRAF V600E mutations were detected by Real-time PCR and Sanger sequencing. Fluorescence in situ hybridization was conducted for identification of chromosomal abnormalities.

Hemosiderin deposition was found in a small amount of tumor cells in 6 cases. Multifocal or patchy necrosis (5/11), small focal invasion of the pseudocapsules or renal parenchyma (6/11), and breakthrough of renal capsule with nerve invasion (1/11) were revealed, inconsistent with the previous view that the tumor lacks necrosis and intercellular hemosiderin. Immunohistochemical staining (diffusely positive for CK7 and GATA3, negative for CD117 and vimentin, and negative to weakly positive for P504S) and high frequency of KRAS mutations in exon 2 (9/10) supported the identification and inclusion of our cases. Chromosome 7 trisomy (1/7), chromosome 17 trisomy (0/7) and chromosome Y deletion (0/5 male patients) were seldom detected in this tumor.

All patients were alive without metastasis or recurrence at the end of the follow-up.

Conclusion

Our findings may highlight the possibility of a low malignant potential of this emerging entity. We suggest that the tumor be classified as a novel renal cell tumor subtype independent of papillary renal cell carcinoma.
A double-blind clinical trial to compare the efficacy and safety of a multiple amino acid-based ORS with the standard WHO-ORS in the management of non-cholera acute watery diarrhea in infants and young children: “VS002A” trial protocol
Authors: Das Rina , Sobi Rukaeya Amin , Sultana Al-Afroza , Nahar Baitun , Bardhan Pradip Kumar , Luke Laura , Fontaine Olivier , Ahmed Tahmeed
Published: August 2022

Background

Diarrhea is the second deadliest disease for under-five children globally and the situation is more serious in developing countries. Oral rehydration solution (ORS) is being used as a standard treatment for acute watery diarrhea for a long time. Our objective is to compare the efficacy of amino acid-based ORS “VS002A” compared to standard glucose-based WHO-ORS in infants and young children suffering from acute non-cholera watery diarrhea.

Methods

It is a randomized, double-blind, two-cell clinical trial at Dhaka Hospital of icddr,b. A total of 312 male children aged 6–36 months old with acute non-bloody watery diarrhea are included in this study. Intervention arm participants get amino acid-based ORS (VS002A) and the control arm gets standard glucose-based WHO-ORS. The primary efficacy endpoint is the duration of diarrhea in the hospital.

Discussion

Oral rehydration therapy (ORT) with the present ORS formulation has certain limitations - it does not reduce the volume, frequency, or duration of diarrhea. Additionally, the failure of present standard ORS to significantly reduce stool output likely contributes to the relatively limited use of ORS by mothers as they do not feel that ORS is helping their child recover from the episode of diarrhea. Certain neutral amino acids (e.g., glycine, L-alanine, L-glutamine) can enhance the absorption of sodium ions and water from the gut. By using this concept, a shelf-stable, sugar-free amino acid-based hydration medicinal food named ‘VS002A’ that effectively rehydrates, and improves the barrier function of the bowel following infections targeting the gastrointestinal tract has been developed. If the trial shows significant benefits of VS002A use, this may provide evidence to support consideration of the use of VS002A in the present WHO diarrhea management guidelines. Conversely, if there is no evidence of benefit, these results will reaffirm the current guidelines.

Trial registration

ClinicalTrials.gov NCT04677296. Registered on December 21, 2020.