bluuebunny/crossref_metadata_2025 huggingface dataset:
Workplace violence and risk factors for PTSD among psychiatric nurses: Systematic review and directions for future research and practice
Authors: Hilton N. Zoe , Addison Sonja , Ham Elke , C. Rodrigues Nicole , Seto Michael C.
Published: July 2021

Accessible Summary

What is known on the subject?

Trauma among psychiatric nurses and other healthcare workers is related to workplace violence, but other risk factors may also contribute, including those occurring before, during or after workplace violence.

What does this paper add to existing knowledge?

Most previously identified PTSD risk factors were not tested or supported in research with psychiatric nurses, although there is promising evidence for risk factors including severe or injurious assault, cumulative exposure, burnout, and other worker characteristics.

We identify directions for research needed to improve knowledge, including collecting data before nurses experience workplace violence, defining workplace risk factors consistently and conducting and reporting qualitative analysis.

What are the implications for practice?

Provide training in risk assessment and violence prevention to psychiatric nurses.

Offer mental health support to those exposed to violence, especially with cumulative exposure.

Introduction

Psychiatric nurses are at risk of workplace violence and post‐traumatic stress disorder (PTSD). There is limited understanding of pre‐trauma and post‐trauma risk factors.

Aim

Our aim was to review factors associated with workplace PTSD in psychiatric nurses.

Method

We searched quantitative and qualitative studies from 1980 to 2019 in 23 databases plus abstracts for studies on psychiatric hospital nursing staff, potentially traumatic workplace events, workplace factors and PTSD. Following duplicate abstract (n = 10,064) and full‐text (n = 199) screening, data were extracted in duplicate from 19 studies. Using best‐fit framework synthesis, we identified workplace violence, pre‐trauma and post‐trauma risk factors.

Results

Six variables yielded evidence in at least two empirical studies scoring at least 6/8 on a quality measure, or one such study plus more than one other study (“promising”: severe/injurious assault, cumulative exposure, burnout, poor mental health, low compassion satisfaction, neuroticism). Four were supported by at least one better quality study or at least two others (“suggestive”: gender, poor training, any physical aggression exposure, compassion fatigue).

Discussion

Pre‐trauma measures, consistent definitions of workplace exposures and thorough reporting of quantitative results are needed to improve research.

Implications for Practice

Violence prevention and mental health care for exposed nurses appear the most promising targets for PTSD prevention. Therefore, it is particularly important to understand workplace violence and mental health among nurses working in psychiatric hospitals.
Weekend working in 21st century Britain: Does it matter for the well‐being of workers?
Authors: Bryce Andrew M.
Published: July 2021

On any given weekend, over a fifth of the UK labour force is at work, while more than half of working adults report working at the weekend at least some of the time. This is despite the fact that weekends are conventionally set aside as rest days. The question that this paper addresses is: does this matter? This paper adds to the literature by using two large panel datasets to analyse the effects of weekend working on eight different measures of subjective well‐being in the UK. I find that weekend working has a significant impact on how satisfied people are with the amount of leisure time they have, with the results suggesting that avoiding weekend working is equivalent to working six fewer hours per week. Moreover, people working at the weekend report significantly lower happiness yesterday than non‐weekend workers. While weekend workers also experience lower levels of life satisfaction than non‐weekend workers, this difference disappears when controlling for unobserved heterogeneity between individuals. This suggests that there is no evidence that weekend working causes people to be worse off overall.
Vibrio fischeri imports and assimilates sulfate during symbiosis with Euprymna scolopes
Authors: Wasilko Nathan P. , Ceron Josue S. , Baker Emily R. , Cecere Andrew G. , Wollenberg Michael S. , Miyashiro Tim I.
Published: July 2021

Sulfur is in cellular components of bacteria and is, therefore, an element necessary for growth. However, mechanisms by which bacteria satisfy their sulfur needs within a host are poorly understood. Vibrio fischeri is a bacterial symbiont that colonizes, grows, and produces bioluminescence within the light organ of the Hawaiian bobtail squid, which provides an experimental platform for investigating sulfur acquisition in vivo. Like other γ‐proteobacteria, V. fischeri fuels sulfur‐dependent anabolic processes with intracellular cysteine. Within the light organ, the abundance of a ΔcysK mutant, which cannot synthesize cysteine through sulfate assimilation, is attenuated, suggesting sulfate import is necessary for V. fischeri to establish symbiosis. Genes encoding sulfate‐import systems of other bacteria that assimilate sulfate were not identified in the V. fischeri genome. A transposon mutagenesis screen implicated YfbS as a sulfate importer. YfbS is necessary for growth on sulfate and in the marine environment. During symbiosis, a ΔyfbS mutant is attenuated and strongly expresses sulfate‐assimilation genes, which is a phenotype associated with sulfur‐starved cells. Together, these results suggest V. fischeri imports sulfate via YfbS within the squid light organ, which provides insight into the molecular mechanisms by which bacteria harvest sulfur in vivo.
An integrated framework of plant form and function: the belowground perspective
Authors: Weigelt Alexandra , Mommer Liesje , Andraczek Karl , Iversen Colleen M. , Bergmann Joana , Bruelheide Helge , Fan Ying , Freschet Grégoire T. , Guerrero‐Ramírez Nathaly R. , Kattge Jens , Kuyper Thom W. , Laughlin Daniel C. , Meier Ina C. , van der Plas Fons , Poorter Hendrik , Roumet Catherine , van Ruijven Jasper , Sabatini Francesco Maria , Semchenko Marina , Sweeney Christopher J. , Valverde‐Barrantes Oscar J. , York Larry M. , McCormack M. Luke
Published: July 2021

Plant trait variation drives plant function, community composition and ecosystem processes. However, our current understanding of trait variation disproportionately relies on aboveground observations. Here we integrate root traits into the global framework of plant form and function. We developed and tested an overarching conceptual framework that integrates two recently identified root trait gradients with a well‐established aboveground plant trait framework. We confronted our novel framework with published relationships between above‐ and belowground trait analogues and with multivariate analyses of above‐ and belowground traits of 2510 species. Our traits represent the leaf and root conservation gradients (specific leaf area, leaf and root nitrogen concentration, and root tissue density), the root collaboration gradient (root diameter and specific root length) and the plant size gradient (plant height and rooting depth). We found that an integrated, whole‐plant trait space required as much as four axes. The two main axes represented the fast–slow ‘conservation’ gradient on which leaf and fine‐root traits were well aligned, and the ‘collaboration’ gradient in roots. The two additional axes were separate, orthogonal plant size axes for height and rooting depth. This perspective on the multidimensional nature of plant trait variation better encompasses plant function and influence on the surrounding environment.
Risk factors for, and molecular epidemiology and clinical outcomes of, carbapenem‐ and polymyxin‐resistant Gram‐negative bacterial infections in pregnant women, infants, and toddlers: a systematic review and meta‐analyses
Authors: Osei Sekyere John , Reta Melese Abate , Bernard Fourie Petrus
Published: July 2021

In the following systematic review and meta‐analyses, we report several conclusions about resistance to carbapenem and polymyxin last‐resort antibiotics for treating multidrug‐resistant bacterial infections among pregnant women and infants. Resistance to carbapenems and polymyxins is increasing, even in otherwise vulnerable groups such as pregnant women, toddlers, and infants, for whom therapeutic options are limited. In almost all countries, carbapenem‐/polymyxin–resistant Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii infect and/or colonize neonates and pregnant women, causing periodic outbreaks with very high infant mortalities. Downregulation of plasmid‐borne blaNDM, blaKPC, blaOXA‐48, blaIMP, blaVIM, blaGES‐5, and ompK35/36 in clonal strains accelerates the horizontal and vertical transmissions of carbapenem resistance among these pathogens. New Delhi metallo‐β‐lactamase (NDM)–positive isolates in infants/neonates have been mainly detected in China and India, while OXA‐48–positive isolates in infants/neonates have been mainly detected in Africa. NDM‐positive isolates in pregnant women have been found only in Madagascar. Antibiotic therapy, prolonged hospitalization, invasive procedures, mechanical ventilation, low birth weight, and preterm delivery have been common risk factors associated with carbapenem/polymyxin resistance. The use of polymyxins to treat carbapenem‐resistant infections may be selecting for resistance to both agents, restricting therapeutic options for infected infants and pregnant women. Currently, low‐ and middle‐income countries have the highest burden of these pathogens. Antibiotic stewardship, periodic rectal and vaginal screening, and strict infection control practices in neonatal ICUs are necessary to forestall future outbreaks and deaths.
Son Preference, Gender Discrimination, and Missing Girls in Rural Spain, 1750–1950
Authors: Marco‐Gracia Francisco J. , Beltrán Tapia Francisco J.
Published: July 2021

Relying on longitudinal microdata from a Spanish rural region between 1750 and 1950 (almost 35,000 life courses), this article provides evidence that discriminatory practices affected sex‐specific mortality during infancy and childhood. Although it is likely that families also discriminated against girls during the first year of life, female excess mortality was especially visible in the 1–5 age group. While breastfeeding seems to have temporarily mitigated the effects of gender discrimination, sex‐specific mortality rates behaved very differently once children were weaned. Parents, therefore, prioritized boys during infancy and childhood in the allocation of food and/or care in order to enhance their survival chances.
Reasons for never receiving a pap test among Brazilian women: National health survey
Authors: Rodrigues Claudia Fernandes , Coutinho José Victor Afonso , Muzi Camila Drumond , Guimarães Raphael Mendonça
Published: July 2021

Objective

To identify reasons among Brazilian women for never having a Pap test.

Design

We designed a cross‐sectional study that used data from the National Health Survey.

Sample

Two thousand four hundred and two women 25–64 years old who never had a pap test.

Measures

Variables were age, race, education, marital status, housing condition, primary health care access, health insurance, self‐perceived health, and social support network. We calculated the prevalence of different reasons and odds ratios for each.

Results

The most frequent reason for never having a test were linked to women thinking the test was unnecessary (42.3%) which had a significant association with marital status (OR = 1.52; 95% CI = 1.07–1.91), age (OR = 1.56; 95% CI = 1.21–1.99), area of residence (OR = 1.15; 95% CI = 1.02–1.39), having a health insurance (OR = 1.18; 95% CI = 1.01–1.36), and self‐perceived health (OR = 1.42; 95% CI = 1.28–1.56). The second most frequent reason was not knowing they needed a test (22.9%) which was associated with age (OR = 1.95; 95% CI = 1.74–2.16) and self‐perceived health (OR = 1.56; 95% CI = 1.33–1.80).

Conclusions

The findings suggest lack of knowledge about cervical cancer and its prevention among Brazilian women. We consider it essential that the health service can provide the test, as well as the necessary guidelines for raising the awareness of the target audience.
Multidisciplinary pharmacotherapy collaboration for home‐based older adults with dementia: a study focusing on physicians, pharmacists, and nursing professionals
Authors: Suwa Sayuri , Tsujimura Mayuko , Yumoto Akiyo , Iwata Naoko , Shimamura Atsuko
Published: July 2021

Background

It is imperative that a team consisting of a physician, pharmacist, and nursing professional provides pharmacotherapy support to achieve the optimal effect of pharmacotherapy for older adults with dementia. This study reviewed Japanese publications on the process of pharmacotherapy support practised by various professionals for home‐based older adults with dementia and investigated healthcare professionals' perceived importance and practice of pharmacotherapy support.

Methods

This study aimed to shed light on basic pharmacotherapy support for behavioural and psychological symptoms among home‐based older adults with dementia using multidisciplinary collaboration, through a literature review of Japanese publications. Based on the literature review, 13 items pertaining to basic pharmacotherapy support for home‐based older adults with dementia were extracted. A mail‐based, self‐administered, anonymous questionnaire survey was conducted with professionals including physicians, pharmacists, and nursing professionals who provide pharmacotherapy support to home‐based older adults with dementia. Participants rated 13 items on their perceived importance and practice of basic pharmacotherapy support using a four‐point Likert scale.

Results

The results indicated that participants recognised the importance of all 13 items. At least 80% of all professionals indicated that they practised seven out of 13 items. Less than 80% of all professionals indicated they practised the other six items that should be provided after the commencement of pharmacotherapy. A relatively high proportion of nursing professionals (70%) indicated they practised the remaining six items. The 13 items were indeed deemed important for characterising pharmacotherapy support. However, in Japan, suboptimal support is provided following the commencement of medication. This may be because appropriate modifications to dementia care are not made as the patient's condition progresses.

Conclusions

It is suggested that multidisciplinary collaboration focusing on the progression of dementia and the process of pharmacotherapy, especially after the commencement of pharmacotherapy, may help provide effective, continuous pharmacotherapy.
Estimation of Causal Quantile Effects with a Binary Instrumental Variable and Censored Data
Authors: Wei Bo , Peng Limin , Zhang Mei-Jie , Fine Jason P.
Published: July 2021

The causal effect of a treatment is of fundamental interest in the social, biological and health sciences. Instrumental variable (IV) methods are commonly used to determine causal treatment effects in the presence of unmeasured confounding. In this work, we study a new binary IV framework with randomly censored outcomes where we propose to quantify the causal treatment effect by the concept of complier quantile causal effect (CQCE). The CQCE is identifiable under weaker conditions than the complier average causal effect when outcomes are subject to censoring, and it can provide useful insight into the dynamics of the causal treatment effect. Employing the special characteristic of the binary IV and adapting the principle of conditional score, we uncover a simple weighting scheme that can be incorporated into the standard censored quantile regression procedure to estimate CQCE. We develop robust non-parametric estimation of the derived weights in the first stage, which permits stable implementation of the second stage estimation based on existing software. We establish rigorous asymptotic properties for the proposed estimator, and confirm its validity and satisfactory finite-sample performance via extensive simulations. The proposed method is applied to a bone marrow transplant data set to evaluate the causal effect of rituximab in diffuse large B-cell lymphoma patients.
Atypical oral viral coinfection after allogeneic hematopoietic stem cell transplantation: Diagnosis and treatment challenge
Authors: Schepanski Natalia , Machado Edina Fernanda Martins , Sola Caroline Bonamin , Percicote Ana Paula , de Araujo Melissa Rodrigues
Published: July 2021

Background

Viral reactivation in patients undergoing immunosuppressive therapy after hematopoietic stem cell transplantation (HSCT) is a serious complication associated with significant morbidity and mortality. Infections caused by human herpes viruses such as herpes simplex virus (HSV), cytomegalovirus (CMV), and Epstein‐Barr virus (EBV) can result in oral lesions.

Case Presentation

A 40‐year‐old male patient who had undergone HSCT presented with ulcerated lesions in different areas of the mouth, for 7 months. The lesions had evolved to painful exophytic nodules with an erythematous, ulcerated surface. They were present on the tongue margins and soft and hard palate. Histological, immunohistochemical (IHC), and polymerase chain reaction analyses were performed, and the results were compatible with HSV‐1 and ‐2 and CMV infections. Treatment comprised five sessions of antimicrobial photodynamic therapy (aPDT) and oral valganciclovir. Thirty days after combined antiviral therapy and aPDT, the lesions were completely resolved. Patient was followed up for 12 months without recurrence.

Conclusion

Diagnosis and treatment of atypical oral infections in immunosuppressed patients is challenging. Assessment of both clinical and laboratory findings is mandatory for a conclusive diagnosis. The use of local antimicrobial and systemic therapies contributes to positive clinical response in such cases.
Evaluating the respective weights of some facial signs on the perceived radiance/glow in differently aged women of six countries
Authors: Flament Frederic , Ye Chengda , Mercurio Daiane Garcia , Abric Aurelie , Sewraj Poonam , Velleman Damien , Yamamoto Sawako , Prunel Anne , Colomb Loic
Published: July 2021

Objectives

To evaluate the impact of Facial radiance or Glow on the perception of age (PA) and to assess which facial signs most influence PA.

Material and Methods

The faces of 1058 differently aged women (18‐80 years) of six different ethnicities/countries (China, Japan, Korea, India, South Africa, and Brazil) were photographed under standard conditions. These allowed to focus on 20 different facial signs that were further graded by experts, using referential Atlases dedicated to facial aging. In each of the six countries, 100 local women were recruited as naïve panels to express their perceptions on Glow and Age on each full‐face photograph (blind coded) of the local studied woman.

Results

A decreased Glow/Radiance appears clearly associated with an increased perceived age in all studied subjects, especially among Chinese, Japanese, and South African women. With regard facial signs, Skin texture (Wrinkles of all kinds), Ptosis/Sagging, and Pigmentation signs prevail in almost all women at the exception of South African women where Pigmentation signs and Cheek skin pores largely predominate in the perception of both Glow and PA. Pigmentation signs are of a very high weight among Chinese and Japanese women.

Conclusion

Despite some collective agreements, the present study shows some specificities within the women of the six ethnicities/countries. PA, a core index of antiaging strategies, goes along with facial Glow in almost all studied women. The duller the facial skin, the older it is perceived.
Multilevel Governance or Scalar Clashes: Finding the Right Scale for EU Energy Policy
Authors: Palle Angélique , Richard Yann
Published: July 2021

The European energy policy is based on two major pillars: integration (of infrastructure networks, markets, standards, and policies) and transition, as set out by European climate policies and by the upcoming Green Deal. The governance model for this common EU policy and the shared energy system it supports is mostly based on multilevel governance (MLG) theories, grounded in the principle of subsidiarity. This paper questions the possibility of MLG in the field of energy, in compliance with the European subsidiarity principle. The coexistence of diverse energy models promoting different scales of reference and actors may result in ‘scalar clashes’: this hybrid model creates a chaotic status quo, disrupting the EU's transition towards renewable energy sources. Building a common European energy policy that combines the dual objectives of transition and integration does not just require upscaling energy systems, but also setting the adequate scale(s) to implement this transition.
iPOTs: Internet of Things‐based pot system controlling optional treatment of soil water condition for plant phenotyping under drought stress
Authors: Numajiri Yuko , Yoshino Kanami , Teramoto Shota , Hayashi Atsushi , Nishijima Ryo , Tanaka Tsuyoshi , Hayashi Takeshi , Kawakatsu Taiji , Tanabata Takanari , Uga Yusaku
Published: July 2021

A cultivation facility that can assist users in controlling the soil water condition is needed for accurately phenotyping plants under drought stress in an artificial environment. Here we report the Internet of Things‐based pot system controlling optional treatment of soil water condition (iPOTs), an automatic irrigation system that mimics the drought condition in a growth chamber. The Wi‐Fi‐enabled iPOTs system allows water supply from the bottom of the pot, based on the soil water level set by the user, and automatically controls the soil water level at a desired depth. The iPOTs also allows users to monitor environmental parameters, such as soil temperature, air temperature, humidity, and light intensity, in each pot. To verify whether the iPOTs mimics the drought condition, we conducted a drought stress test on rice (Oryza sativa L.) varieties and near‐isogenic lines, with diverse root system architecture, using the iPOTs system installed in a growth chamber. Similar to the results of a previous drought stress field trial, the growth of shallow‐rooted rice accessions was severely affected by drought stress compared with that of deep‐rooted accessions. The microclimate data obtained using the iPOTs system increased the accuracy of plant growth evaluation. Transcriptome analysis revealed that pot positions in the growth chamber had little impact on plant growth. Together, these results suggest that the iPOTs system is a reliable platform for phenotyping plants under drought stress.
Pinching the cortex of live cells reveals thickness instabilities caused by myosin II motors
Authors: Laplaud Valentin , Levernier Nicolas , Pineau Judith , Roman Mabel San , Barbier Lucie , Sáez Pablo J. , Lennon-Duménil Ana-Maria , Vargas Pablo , Kruse Karsten , du Roure Olivia , Piel Matthieu , Heuvingh Julien
Published: July 2021

Magnetic beads are used as a caliper to measure the cortical layer of dendritic cells and its temporal variations.
Exendin-4 gene modification and microscaffold encapsulation promote self-persistence and antidiabetic activity of MSCs
Authors: Zhang Yuanyuan , Gao Shuang , Liang Kaini , Wu Zhaozhao , Yan Xiaojun , Liu Wei , Li Junyang , Wu Bingjie , Du Yanan
Published: July 2021

This study revealed the enhanced therapeutic effects and mechanisms of Exendin-4–engineered MSCs for type 2 diabetes treatment.
The m
6
A reader IMP2 directs autoimmune inflammation through an IL-17– and TNFα-dependent C/EBP transcription factor axis
Authors: Bechara Rami , Amatya Nilesh , Bailey Rachel D. , Li Yang , Aggor Felix E. Y. , Li De-Dong , Jawale Chetan V. , Coleman Bianca M. , Dai Ning , Gokhale Nandan S. , Taylor Tiffany C. , Horner Stacy M. , Poholek Amanda C. , Bansal Anita , Biswas Partha S. , Gaffen Sarah L.
Published: July 2021

The m6A “reader” IMP2 promotes cytokine-induced kidney autoimmunity by posttranscriptional control of C/EBPβ/δ transcription factors.
Supplemental Material: Translithospheric magma plumbing system of intraplate volcanoes as revealed by electrical resistivity imaging
Authors: Li Yabin , Weng Aihua , al. et
Published: July 2021

Details on the 3-D magnetotelluric inversion, sensitivity test of resistivity anomalies and melt fraction estimation, and Figures S1–S11.
Supplemental Material: South African speleothems reveal influence of high- and low-latitude forcing over the past 113.5 k.y.
Authors: Chase Brian M , al. et
Published: July 2021

Details of materials, methods and results relevant to the work presented.
Supplemental Material: Multiple melt source origin of the Line Islands (Pacific Ocean)
Authors: Pockalny Robert , al. et
Published: July 2021

Supplemental information, Figures S1 and S2, Tables S1–S3, and Videos S1–S4.
Supplemental Material: How carbonate dissolution facilitates sediment-hosted Zn-Pb mineralization
Authors: Liu Weihua , al. et
Published: July 2021

Details of the experiments, analysis, and modeling
Endometriosis of para-aortic node masquerading a malignancy: a rare occurrence
Authors: Christable Evangeline , Shivkumaran Sathyanarayan , Venkitaraman Balasubramanian , Kajamohideen Suhaildeen
Published: July 2021

Endometriosis is a benign estrogen-dependent disorder affecting women in their reproductive age group. Endometriosis means ‘abnormal growth of endometrial glands’ outside the uterus. Multiple theories on aetiopathogenesis of endometriosis have been postulated, Halban’s theory on ‘Benign Metastasis’ which proposed the presence of endometriotic cells in lymphatic vessels and lymph nodes provides the basis of this case report. Here, we report a case of 26-year-old nulliparous woman who presented with grossly elevated CA 125 with endometriosis in her para-aortic nodes mimicking as ovarian cancer.
Subclavian artery laceration following clavicle fracture, successfully treated with a combined endovascular and open surgical approach
Authors: Arnold Samuel , Gilroy Darina , Laws Peter , Kempthorne Josh
Published: July 2021

Subclavian artery injury is a rare complication of clavicle fracture. The fractured clavicle can lacerate the underlying subclavian artery. Life-threatening haemorrhage can occur secondary to arterial laceration, and if distal blood flow is impaired, upper limb ischaemia can develop. There is little discussion in the literature regarding combined (or ‘hybrid’) endovascular and open surgical management of acute subclavian injuries secondary to clavicle fracture. We report a case of subclavian artery laceration secondary to clavicle fracture, managed with a combined endovascular and open surgical approach. An endovascular balloon was used for proximal arterial control, while surgical exposure and primary repair of the subclavian artery was completed, followed by fixation of the clavicle. There was no sustained vascular or neurological impairment at follow-up. We suggest that select traumatic injuries of the subclavian artery can be safely and successfully managed with a combined endovascular and open surgical approach.
Avascular necrosis as a part of ‘long COVID-19’
Authors: Agarwala Sanjay R , Vijayvargiya Mayank , Pandey Prashant
Published: July 2021

‘Long COVID-19’ can affect different body systems. At present, avascular necrosis (AVN) as a sequalae of ‘long COVID-19’ has yet not been documented. By large-scale use of life-saving corticosteroids in COVID-19 cases, we anticipate that there will be a resurgence of AVN cases. We report a series of three cases in which patients developed AVN of the femoral head after being treated for COVID-19 infection. The mean dose of prednisolone used in these cases was 758 mg (400–1250 mg), which is less than the mean cumulative dose of around 2000 mg steroid, documented in the literature as causative for AVN. Patients were symptomatic and developed early AVN presentation at a mean of 58 days after COVID-19 diagnosis as compared with the literature which shows that it generally takes 6 months to 1 year to develop AVN post steroid exposure.
Progression of the atypical fibroxanthoma to pleomorphic dermal sarcoma in a heart transplant patient
Authors: Ripa Valeria , Singh Natasha , Star Allen E , Smith Franz
Published: July 2021

An 82-year-old man presented with a right scalp lesion which had been increasing in size. The patient’s medical history was significant for a heart transplant 25 years before, and he was on chronic immunosuppression. Biopsy of the lesion showed atypical fibroxanthoma. The patient underwent an excision of the lesion with split thickness skin graft. Pathology showed fibroxanthoma with negative margins. Over the next 9 months, the patient developed new lesions, which were also excised to negative margins. However, with each new lesion, the histology demonstrated increasing dysplasia and ultimately pleomorphic sarcoma. The patient had a metastatic workup with CT of the chest, which was negative, and he underwent a radical scalpectomy, split thickness skin graft placement and adjuvant radiation therapy. The patient has not developed any new scalp lesions and no evidence of metastasis.
Quality of life in patients with IBD during the COVID-19 pandemic in the Netherlands
Authors: de Bock Ellen , Filipe Mando D , Meij Vincent , Oldenburg Bas , van Schaik Fiona D M , Bastian Okan W , Fidder Herma F , Vriens Menno R , Richir Milan C
Published: July 2021

Objective

COVID-19 has put a strain on regular healthcare worldwide. For inflammatory bowel disease (IBD), gastrointestinal surgeries were postponed and changes in treatment and diagnostic procedures were made. As abrupt changes in treatment regimens may result in an increased morbidity and consequent well-being of patients with IBD, the aim of this study was to determine the effect of the COVID-19 pandemic on health-related quality of life (HRQoL) in patients with IBD.

Design

All patients with IBD who completed both Inflammatory Bowel Disease Questionnaire (IBDQ) and 36-Item Short Form Health Survey (SF-36) questionnaire between 31 August and 13 September 2020 were included in our cohort study. The primary end point was to determine the HRQoL in patients with IBD, measured by the IBDQ and SF-36 questionnaire. The secondary end point was determining which factors influence the HRQoL in patients with IBD.

Results

582 patients with IBD filled in the IBDQ and SF-36 questionnaire. The HRQoL in our study population was low according to the questionnaires on both physical and mental subscales. In addition, multivariate analysis showed that increased age, female sex and patients who underwent surgery had a significantly lower HRQoL, most frequently on the physical domains in both questionnaires.

Conclusion

Patients with IBD had an overall low HRQoL during the COVID-19 pandemic. Furthermore, older patients, women and patients who underwent surgical procedures had the lowest physical HRQoL.
Effects of SARS-CoV-2 pandemic on follow-up and pharmacological treatment of chronic diseases in undocumented migrants
Authors: Fiorini Gianfrancesco , Franchi Matteo , Corrao Giovanni , Tritto Roberta , Fadelli Sara , Rigamonti Antonello Emilio , Sartorio Alessandro , Cella Silvano Gabriele
Published: July 2021

Background

All over the world, the COVID-19 pandemic, not unlikely other epidemics, has hit harder people in low socioeconomic conditions.

In Western countries, undocumented migrants are a growing component of this disadvantaged segment of the population.

Their health conditions are frequently burdened by a number of chronic conditions, and they experience many difficulties in accessing public health services. Frequently, the only medical assistance they can get is provided by non-governmental organisations.

Methods

We studied the medical records (including pharmacological treatments) of all patients attending the outpatient clinics of Opera San Francesco (OSF; a big charity in Milano, Italy), in the first 5 months of 2020. These comprise the outbreak of the pandemic and the lockdown period. The 1914 patients (1814 undocumented migrants and 100 Italians) seen during the lockdown were compared with those seen in the same period of 2019 and with those seen in the preceding months of 2020. We especially focused on three chronic conditions: cardiovascular diseases, diabetes and psychiatric disorders.

Results

The number of consultations during the first 5 months of 2020 was much smaller than that of the same period of 2019. During the lockdown, we found 4048 consultations for 1914 patients, while they were 8051 in the same period of 2019 and 5681 in the first 2 months of 2020.

The quantity of medicines dispensed by OSF showed a marked decrease in the period of the study and mainly during the lockdown.

The decrease in consultations and dispensation of medicines was most evident for psychiatric patients and almost not existent for patients with diabetes. Female patients suffered a more pronounced reduction.

Conclusions

Western countries need strategies to better assist the very poor during epidemics.

Differences among different groups of disadvantaged persons should be taken into account when designing recovery plans.
Sustainability drivers and inhibitors for the health system performance improvement projects in selected health facilities in Kenya: a qualitative study
Authors: Chelagat Tecla , Kokwaro Gilbert , Onyango Joseph , Rice Jim
Published: July 2021

Objectives

To investigate the health managers perceived sustainability status of the health facilities institutional improvement projects and their experiences on factors that facilitated or constrained their maintenance, with intentions of informing relevant strategies or policies in Kenya’s health sector.

Methods

A qualitative study, nested within a quasi-experimental study. Thirty-three project-teams of health managers were purposively selected and interviewed based on their project implementation success rates post-training. The managers had previously undergone a 9-month leadership training, complimented with facility-based team coaching around the chosen projects. The training was funded by the US Agency for International Development; however, the implementation of the projects was based on how the participants could innovatively use the existing resource to create a positive change. The projects were housed within 20 public, 9 faith-based and 4 private health facilities in 19 counties in Kenya. The interviews explored the manager’s experiences in sustaining the successfully implemented projects within the (24–60 months post-training period). We asked managers to describe factors they perceived enabled or hindered the sustainability of the successfully implemented institutional improvement project. The digitally audio-recorded interviews were transcribed verbatim. Data on barriers and enablers were thematically analysed.

Results

Twenty-nine out of the 33 successfully implemented projects reported sustainability within periods ranging from 24 to 60 months post-training. Seven themes related to drivers of sustainability emerged, namely; programme design, stakeholder’s buy-in, board members, communication, coaching, presence of change champion, devolution and political good-will. Four sustainability inhibitors identified were: human resources constraints, policy implementation, misalignment of projects with daily operations, devolution and political interference.

Conclusions

The sustainability of institutional improvement strategies such as projects implemented post-leadership training in public and private health facilities depends on the quality of board members, communication management and institutionalisation of coaching culture. These findings are pertinent for planning and implementing similar health systems strengthening intervention in low-income countries.
Distribution and determinants of hospital efficiency and relative productivity in county-level hospitals in rural China: an observational study
Authors: Zhong Jing , Wang Wei , Wang Hongxi , Huang Jingjing , Li Tao , Chen Jingjing , Chen Wan , Yuan Jin , Chen Weirong
Published: July 2021

Background

Cataract surgery is very important to prevent blindness, but its productivity and efficiency in China are unknown. Our study aimed to evaluate the geographical distribution of cataract surgeons and prospectively identify the factors associated with the increased productivity in cataract surgery and efficiency in outpatient ophthalmic services in rural Chinese hospitals.

Methods

Data were prospectively collated from various hospital datasets and the census registered by the geographical unit county. Prior to mapping, the geographical location data of counties were cross-linked with the equivalent ophthalmologist and service output data to create categories and map multiple data attributes. Descriptive statistical analyses were performed to characterise the data stratified by county. Linear regression analyses were used to explore the factors associated with the increased productivity/efficiency.

Results

The ophthalmologists, surgical productivity of ophthalmologists and outpatient efficacy of ophthalmologists significantly varied across counties. During the period between 2016 and 2018, the median (IQR) change in surgical productivity of and outpatient efficacy of ophthalmologists were 31.627 (−3.33 to 29.94) and 118.08 (−132.30 to 740.89). In the simple regression analysis for predictors of a high productivity change, only the increased number of phaco machine had statistical significance (p=0.003). In addition, only the gross domestic product per capita in 2016 was associated with an increased improvement in efficiency of outpatient services (p=0.008).

Conclusions

This study demonstrated that the ophthalmologist productivity and the efficiency of outpatient services were unequally geographically distributed, and their predictors were identified. Further studies to elucidate the extent of the problem and improve the health service delivery models are required.
Phenotypes of atrial fibrillation diagnosed before-versus-after ischaemic stroke and TIA: study protocol for a systematic review and meta-analysis
Authors: Jimenez-Ruiz Amado , Vargas-Gonzalez Juan Camilo , Fridman Sebastian , Sposato Luciano A
Published: July 2021

Introduction

The underlying pathophysiology of atrial fibrillation (AF) detected after stroke (AFDAS) is relatively unknown. Preliminary evidence suggests AFDAS has a lower prevalence of cardiovascular comorbidities and higher incidence of insular cortex involvement than AF known to exist before stroke occurrence (KAF). This favours a neurogenic AF substrate (autonomic dysregulation) in which the presence of underlying heart disease is not necessary for AF to occur. The main objective of this systematic review and meta-analysis is to compare the prevalence of cardiovascular comorbidities and echocardiographic abnormalities in patients with AFDAS, KAF and no AF (NAF). Secondary objectives are to compare the proportion with insular cortex involvement, stroke recurrence and death in the three rhythm groups.

Methods and analysis

We will perform a systematic review including cross-sectional, case–control, cohort studies and clinical trials involving ≥18 years patients, with ischaemic stroke or transient ischaemic attack published between inception and 31 December 2020 in any language, and reporting the proportion of patients with AFDAS, KAF and NAF. We will search PubMed, EMBASE and Scopus by applying predefined search terms. Two reviewers will independently screen titles and abstracts and retrieve full texts, extract data in a predesigned form, and assess the risk of bias. We will perform a meta-analysis of all included studies and we will report the results of the main outcome as proportions. We will report results of secondary outcomes as risk ORs. We will estimate heterogeneity across studies by using t2, Q and I2measures. We will use funnel plots, Rosenthal’s Fail-Safe N and Egger’s regression intercept to assess publication bias.

Ethics and dissemination

This study will be based on published data and does therefore not require ethical clearance. The results will be published in peer-reviewed journals.

PROSPERO registration number

CRD42020202622.
Which older emergency patients are at risk of intracranial bleeding after a fall? A protocol to derive a clinical decision rule for the emergency department
Authors: de Wit Kerstin , Mercuri Mathew , Clayton Natasha , Worster Andrew , Mercier Eric , Emond Marcel , Varner Catherine , McLeod Shelley L , Eagles Debra , Stiell Ian , Barbic David , Morris Judy , Jeanmonod Rebecca , Kagoma Yoan , Shoamanesh Ashkan , Engels Paul T , Sharma Sunjay , Kearon Clive , Papaioannou Alexandra , Parpia Sameer
Published: July 2021

Introduction

Falling on level ground is now the most common cause of traumatic intracranial bleeding worldwide. Older adults frequently present to the emergency department (ED) after falling. It can be challenging for clinicians to determine who requires brain imaging to rule out traumatic intracranial bleeding, and often head injury decision rules do not apply to older adults who fall. The goal of our study is to derive a clinical decision rule, which will identify older adults who present to the ED after a fall who do not have clinically important intracranial bleeding.

Methods and analysis

This is a prospective cohort study enrolling patients aged 65 years or older, who present to the ED of 11 hospitals in Canada and the USA within 48 hours of having a fall. Patients are included if they fall on level ground, off a chair, toilet seat or out of bed. The primary outcome is the diagnosis of clinically important intracranial bleeding within 42 days of the index ED visit. An independent adjudication committee will determine the primary outcome, blinded to all other data. We are collecting data on 17 potential predictor variables. The treating physician completes a study data form at the time of initial assessment, prior to brain imaging. Data extraction is supplemented by an independent, structured electronic medical record review. We will perform binary recursive partitioning using Classification and Regression Trees to derive a clinical decision rule.

Ethics and dissemination

The study was initially approved by the Hamilton Integrated Research Ethics Committee and subsequently approved by the research ethics boards governing all participating sites. We will disseminate our results by journal publication, presentation at international meetings and social media.

Trial registration number

NCT03745755.
Prognostic factor analysis in patients with temporomandibular disorders after reversible treatment: study protocol for a prospective cohort study in China
Authors: Zhang Ling , Shi Wentao , Lu Shenji , Cai Bin , Fan Shuai , Yang Yang , Xu Lili
Published: July 2021

Introduction

Temporomandibular disorders (TMDs) are complex multifactorial disorders. Reversible treatment has been suggested for the initial management of TMD; however, comparable therapeutic effects of different reversible intervention modalities remain controversial. Various biopsychosocial factors, which may be putative prognostic factors that influence the response to reversible treatment for TMD, have been reported to increase the risk of developing first-onset TMD. However, there is a paucity of research that aims to identify prognostic factors associated with the clinical outcomes of reversible treatment in people with TMD. The objective of this prospective cohort study is to identify prognostic factors that are associated with clinical outcomes of reversible treatment in patients with TMD and to analyse the risk factors that influence the development of chronic TMD.

Methods and analysis

We plan to recruit 834 patients with TMD who meet the inclusion criteria. Once informed consent is obtained, baseline data, including anamnestic data, physical assessments and self-report questionnaires, will be collected from participants at their first clinic visit; subsequently, they will receive 1–4 weeks of reversible treatment. The primary treatment outcome measures will be a change in the anterior maximum mouth opening, worsening of TMD pain scores assessed using a visual analogue scale (VAS) and a reduction in characteristic pain intensity. A good outcome will be defined as an anterior maximal opening ≥35 mm and at least a 30% reduction in VAS scores 3 months after baseline. The association between candidate prognostic factors and clinical outcomes of reversible TMD treatment will be analysed.

Ethics and dissemination

The protocol has been approved by the Ethics Committee of Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, based on the guidelines outlined in the Declaration of Helsinki (SH9H-2019-T316-4). The results of this study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. The authors intend to publish the results in a peer-reviewed journal.

Trial registration number

ChiCTR2000033328.
Micro-phenomenological approach to explore the patient experience during an initial spirometry examination to diagnose COPD in general practice in France
Authors: Bremond Matthieu , Berthelot Anthony , Plantier Laurent , Breton Hervé , Pautrat Maxime
Published: July 2021

Objectives

To explore the patient experience of a spirometry test used to confirm chronic obstructive pulmonary disease (COPD) diagnosis in patients with suspected smoking-related COPD.

Design

This is a qualitative study, performed with open interviews in adults following a routine spirometry test to confirm COPD diagnosis. Data were analysed with a phenomenological-inspired micro-phenomenology approach.

Participants

Eligible patients were recruited through their general practitioner, 10 were interviewed.

Setting

Primary care in Centre-Val-De-Loire area, France, in 2018.

Results

Participants reported the spirometry test experience as being unfamiliar but gave meaning to the symptoms they experience. Participants expressed a desire to perform the test well and a willingness to confront their state of health. After the spirometry had been completed and the results announced, participants moved through stages of grief from their pre-spirometry self and symptom perception to a state of acceptance. Overall, participants expressed a narrative of an evolving cognitive and corporeal awareness during this spirometry experience. The verbatim quotes describe a cognitive rupture with their chronic illness usually considered as a ‘way of life’.

Conclusions

A spirometry test goes beyond a diagnostic value, providing patients with an opportunity to gain awareness of their own state of health, reframe their breathlessness-related limitations and thus begin to accept the disease. These awareness gains may be considered as small steps towards health behavioural change. Spirometry may have educative potential and support lifestyle changes.