bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘We tend to get pad happy’: a qualitative study of health practitioners’ perspectives on the quality of continence care for older people in hospital
Authors: Percival John , Abbott Katharine , Allain Theresa , Bradley Rachel , Cramp Fiona , Donovan Jenny L , McCabe Candy , Neubauer Kyra , Redwood Sabi , Cotterill Nikki 
Published: April 2021

BackgroundBladder and bowel control difficulties affect 20% and 10% of the UK population, respectively, touch all age groups and are particularly prevalent in the older (65+ years) population. However, the quality of continence care is often poor, compromising patient health and well-being, increasing the risk of infection, and is a predisposing factor to nursing and residential home placement.ObjectiveTo identify factors that help or hinder good continence care for patients aged 65 years and over in hospital medical ward settings. Medical care, not surgical, was our exclusive focus.MethodsWe conducted 27 qualitative interviews with nursing, medical and allied health practitioners in three hospitals. We used a purposive sample and analysed data thematically, both manually and with the aid of NVivo software.ResultsInterviews revealed perspectives on practice promoting or inhibiting good quality continence care, as well as suggestions for improvements. Good continence care was said to be advanced through person-centred care, robust assessment and monitoring, and a proactive approach to encouraging patient independence. Barriers to quality care centred on lack of oversight, automatic use of incontinence products and staffing pressures. Suggested improvements centred on participatory care, open communication and care planning with a higher bladder and bowel health profile. In order to drive such improvements, hospital-based practitioners indicate a need and desire for regular continence care training.ConclusionsFindings help explain the persistence of barriers to providing good quality care for patients aged 65 years and over with incontinence. Resolute continence promotion, in hospitals and throughout the National Health Service, would reduce reliance on products and the accompanying risks of patient dependency and catheter-associated gram-negative bacteraemia. Robust assessment and care planning, open communication and regular continence care training would assist such promotion and also help mitigate resource limitations by developing safer, time-efficient continence care.
Chronic breathlessness in advanced cardiorespiratory disease: patient perceptions of opioid use
Authors: Moran Thomas , Zentner Dominica , Wong James , Philip Jennifer , Smallwood Natasha 
Published: April 2021

ObjectiveLow-dose oral opioids may improve severe chronic breathlessness in advanced cardiorespiratory diseases. Prescription of opioids for breathlessness occurs infrequently however, with little known about patients’ attitudes towards their use in this setting. The aim of this qualitative study was to explore patients’ perceptions regarding opioids for the management of severe chronic breathlessness in people with advanced cardiorespiratory disease.MethodsA cross-sectional, qualitative study was undertaken using outpatients with severe chronic breathlessness due to either severe chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF). Indepth, semistructured interviews were audio-recorded, transcribed verbatim and coded. Thematic analysis was undertaken to extrapolate recurring ideas from the data.ResultsTwenty-four participants were purposively sampled from three different groups: opioid-naïve patients with COPD (n=7), opioid-naïve patients with CHF (n=7) and patients with COPD using opioids currently or previously for severe chronic breathlessness (n=10). Four major themes were shared by both theopioid-naïveandopioid-experiencedcohorts: (1) stigmatised attitudes and beliefs regarding opioids, (2) limited knowledge and information-seeking behaviour regarding opioids, (3) the impact of the relationships with health professionals and continuity of care, and (4) the significance of past experiences with opioids. An additional theme that was unique to the opioid-experienced cohort was (5) the perception of benefit and improved quality of life.ConclusionLack of knowledge regarding the role of opioids in managing severe chronic breathlessness, opioid misinformation and social stigmas are major barriers to opioid therapy that may be overcome by accurate information from trusted health professionals.
The analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: a systematic review and meta-analysis with trial sequential analysis
Authors: Dinges Hanns-Christian , Wiesmann Thomas , Otremba Berit , Wulf Hinnerk , Eberhart Leopold H , Schubert Ann-Kristin 
Published: April 2021

Background/ImportanceLiposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection anesthesia. To this day, the benefit of the new substance on relevant end points is discussed controversial.ObjectiveThe objective was to determine whether there is a difference in postoperative pain scores and morphine consumption between patients treated with LB and bupivacaine hydrochloride in a systematic review and meta-analysis.Evidence reviewRandomized controlled trials (RCT) were identified in Embase, CENTRAL, MEDLINE and Web of Science up to May 2020. Risk of bias was assessed using Cochrane methodology. Primary end points were the mean pain score difference and the relative morphine equivalent (MEQ) consumption expressed as the ratio of means (ROM) 24 and 72 hours postoperatively.Findings23 RCTs including 1867 patients were eligible for meta-analysis. The mean pain score difference at 24 hours postoperatively was significantly lower in the LB group, at −0.37 (95% CI −0.56 to −0.19). The relative MEQ consumption after 24 hours was also significantly lower in the LB group, at 0.85 (0.82 to 0.89). At 72 hours, the pain score difference was not significant at −0.25 (−0.71 to 0.20) and the MEQ ratio was 0.85 (0.77 to 0.95).ConclusionThe beneficial effect on pain scores and opioid consumption was small but not clinically relevant, despite statistical significance. The effect was stable among all studies, indicating that it is independent of the application modality.
Invasive placebos in research on peripheral nerve blocks: a follow-up study
Authors: Laing Sarah , Bolt Dana L , Burgoyne Laura L , Fahy Cormac J , Wake Pauline B , Cyna Allan M 
Published: April 2021

IntroductionThe Serious Harm and Morbidity “SHAM” grading system has previously been proposed to categorize the risks associated with the use of invasive placebos in peripheral nerve block research. SHAM grades range from 0 (no potential complications, eg, using standard analgesia techniques as a comparator) through to 4 (risk of major complications, eg, performing a sub-Tenon’s block and injecting normal saline). A study in 2011 found that 52% of studies of peripheral nerve blocks had SHAM grades of 3 or more.MethodsWe repeated the original study by allocating SHAM grades to randomized controlled studies of peripheral nerve blocks published in English over a 22-month period. Documentation was made of the number of study participants, age, number of controls, body region, adverse events due to invasive placebos and any discussion regarding the ethics of using invasive placebos. We compared the proportion of studies with SHAM grades of 3 or more with the original study.ResultsIn this current study, 114 studies fulfilled the inclusion criteria, 5 pediatric and 109 adult. The SHAM grade was ≥3 in 38 studies (33.3%), with 1494 patients in these control groups collectively. Several studies discussed their reasons for choosing a non-invasive placebo. No pediatric studies had a SHAM grade of ≥3.ConclusionsThe use of invasive placebos that may be associated with serious risks in peripheral nerve block research has decreased in contemporary peripheral nerve block research.
Radiation reaction from quantum electrodynamics and its implications for the Unruh effect
Authors: Tulipánt Zoltán 
Published: April 2021

AbstractThe Abraham–Lorentz–Dirac theory predicts vanishing radiation reaction for uniformly accelerated charges. However, since an accelerating observer should detect thermal radiation, the charge should be seen absorbing photons in the accelerated frame which, if nothing else occurs, would influence its motion. This means that either there is radiation reaction seen in an inertial frame or there should be an additional phenomenon seen in the accelerated frame countering the effect of absorption. In this paper I rederive the Abraham–Lorentz–Dirac force from quantum electrodynamics, then I study the case of a uniformly accelerated charge. I show that in the accelerated frame, in addition to the absorption of photons due to the Unruh effect there should also be stimulated emission. The net effect of these phenomena on the motion of the charge is found to be zero.
Ex-anteImpact Assessment of Urban Interventions: The Sustainability Check at the Example of the City of Bottrop, Germany
Authors: Fuchs Marisa , Schnittfinke Tanja , Ohlmeyer Kristina , Gruehn Dietwald , Greiving Stefan 
Published: April 2021

The effects of climate change and associated extreme weather events such as heat, storms and heavy rainfall lead to considerable damage to property and personal injury worldwide. To counteract the causes and consequences of climate change, many states, regions and cities worldwide declared the status of climate emergency in 2019. As a result, scientists and urban planners intensified their efforts to develop appropriate mechanisms and measures to mitigate and adapt to climate change and its consequences.This paper presents an informal systematic and user-driven governance instrument, which examines the ecological, social and economic effects of urban interventions – the ‘Sustainability Check’. As a target-based assessment tool, it provides decision-makers with information about the extent to which a planned intervention corresponds with future-oriented urban development. The check results from the research project ZUKUR (‘Future of the Urban Region Ruhr’), in which researchers and practitioners from the City of Bottrop (Germany) worked together in a real-world laboratory. The Sustainability Check is novel because it combines elements of an impact assessment tailored to user needs and links sustainable urban development goals with resilient and environmentally just urban development at the local level. Based on the first application, we conclude that the Sustainability Check significantly contributes to developing a future-oriented city. Adapted to the local and context-specific needs of a city, it offers systematic consideration of the requirements of sustainable, resilient and environmentally just urban development in an efficient manner and at the early-stage.
Cardiac Late Sodium Channel Current Is a Molecular Target for the Sodium/Glucose Cotransporter 2 Inhibitor Empagliflozin
Authors: Philippaert Koenraad , Kalyaanamoorthy Subha , Fatehi Mohammad , Long Wentong , Soni Shubham , Byrne Nikole J. , Barr Amy , Singh Jyoti , Wong Jordan , Palechuk Taylor , Schneider Chloe , Darwesh Ahmed M. , Maayah Zaid H. , Seubert John M. , Barakat Khaled , Dyck Jason R.B. , Light Peter E. 
Published: April 2021

Background:

SGLT2 (sodium/glucose cotransporter 2) inhibitors exert robust cardioprotective effects against heart failure in patients with diabetes, and there is intense interest to identify the underlying molecular mechanisms that afford this protection. Because the induction of the late component of the cardiac sodium channel current (late-
I
Na
) is involved in the etiology of heart failure, we investigated whether these drugs inhibit late-
I
Na
.

Methods:
Electrophysiological, in silico molecular docking, molecular, calcium imaging, and whole heart perfusion techniques were used to address this question.

Results:

The SGLT2 inhibitor empagliflozin reduced late-
I
Na
in cardiomyocytes from mice with heart failure and in cardiac Nav1.5 sodium channels containing the long QT syndrome 3 mutations R1623Q or ΔKPQ. Empagliflozin, dapagliflozin, and canagliflozin are all potent and selective inhibitors of H
2
O
2
-induced late-
I
Na
(half maximal inhibitory concentration = 0.79, 0.58, and 1.26 µM, respectively) with little effect on peak sodium current. In mouse cardiomyocytes, empagliflozin reduced the incidence of spontaneous calcium transients induced by the late-
I
Na
activator veratridine in a similar manner to tetrodotoxin, ranolazine, and lidocaine. The putative binding sites for empagliflozin within Nav1.5 were investigated by simulations of empagliflozin docking to a three-dimensional homology model of human Nav1.5 and point mutagenic approaches. Our results indicate that empagliflozin binds to Nav1.5 in the same region as local anesthetics and ranolazine. In an acute model of myocardial injury, perfusion of isolated mouse hearts with empagliflozin or tetrodotoxin prevented activation of the cardiac NLRP3 (nuclear-binding domain-like receptor 3) inflammasome and improved functional recovery after ischemia.

Conclusions:

Our results provide evidence that late-
I
Na
may be an important molecular target in the heart for the SGLT2 inhibitors, contributing to their unexpected cardioprotective effects.
Novel Approach to Risk Stratification in Left Ventricular Non‐Compaction Using A Combined Cardiac Imaging and Plasma Biomarker Approach
Authors: Ramchand Jay , Podugu Pooja , Obuchowski Nancy , Harb Serge C. , Chetrit Michael , Milinovich Alex , Griffin Brian , Burrell Louise M. , Wilson Tang W. H. , Kwon Deborah H. , Flamm Scott D. 
Published: April 2021

Background
Left ventricular non‐compaction remains a poorly described entity, which has led to challenges of overdiagnosis. We aimed to evaluate if the presence of a thin compacted myocardial layer portends poorer outcomes in individuals meeting cardiac magnetic resonance criteria for left ventricular non‐compaction .

Methods and Results

This was an observational, retrospective cohort study involving individuals selected from the Cleveland Clinic Foundation cardiac magnetic resonance database (N=26 531). Between 2000 and 2018, 328 individuals ≥12 years, with left ventricular non‐compaction or excessive trabeculations based on the cardiac magnetic resonance Petersen criteria were included. The cohort comprised 42% women, mean age 43 years. We assessed the predictive ability of myocardial thinning for the primary composite end point of major adverse cardiac events (composite of all‐cause mortality, heart failure hospitalization, left ventricular assist device implantation/heart transplant, ventricular tachycardia, or ischemic stroke). At mean follow‐up of 3.1 years, major adverse cardiac events occurred in 102 (31%) patients. After adjusting for comorbidities, the risk of major adverse cardiac events was nearly doubled in the presence of significant compacted myocardial thinning (hazard ratio [HR], 1.88 [95% CI, 1.18‒3.00];
P
=0.016), tripled in the presence of elevated plasma B‐type natriuretic peptide (HR, 3.29 [95% CI, 1.52‒7.11];
P
=0.006), and increased by 5% for every 10‐unit increase in left ventricular end‐systolic volume (HR, 1.01 [95% CI, 1.00‒1.01];
P
=0.041).

Conclusions
The risk of adverse clinical events is increased in the presence of significant compacted myocardial thinning, an elevated B‐type natriuretic peptide or increased left ventricular dimensions. The combination of these markers may enhance risk assessment to minimize left ventricular non‐compaction overdiagnosis whilst facilitating appropriate diagnoses in those with true disease.
Spontaneous Congenital Perilabyrinthine Cerebrospinal Fluid Fistulas
Authors: Lovin Benjamin D. , Appelbaum Eric N. , Makoshi Latifah , Whitehead William E. , Sweeney Alex D. 
Published: April 2021

Objectives: To report a recalcitrant spontaneous cerebrospinal fluid (CSF) fistula arising from multiple, anatomically-linked lateral skull base defects, and to review the available literature to determine optimal techniques for operative repair of congenital CSF fistulae. Methods: A patient with recurrent episodes of otologic meningitis was found to have a patent tympanomeningeal fissure, also known as a Hyrtl’s fissure, and internal auditory canal (IAC) diverticulum that communicated with the jugular bulb. A systematic review of the literature characterized all reports of spontaneous congenital perilabyrinthine CSF leaks, and all cases of Hyrtl’s fissures. Results: An 11-year-old female was referred for recurrent meningitis. Imaging demonstrated a fistulous connection between the middle ear and IAC diverticulum via the jugular foramen. Specifically, a Hyrtl’s fissure was identified, as well as demineralized bone around the jugular bulb. Obliteration of the fissure was initially performed, and a fistula reformed 4 months later. Multifocal CSF egress in the hypotympanum was identified on re-exploration, and middle ear obliteration with external auditory canal (EAC) overclosure was performed. A systematic review of the literature demonstrated 19 cases of spontaneous congenital perilabyrinthine CSF leaks. In total, 6 cases had multiple sources of CSF leak and 2 had history suggestive of intracranial hypertension. All of these noted cases demonstrated leak recurrence. Middle ear obliteration with EAC overclosure was successful in 4 recalcitrant cases. Conclusions: Repair of spontaneous congenital perilabyrinthine CSF leaks in cases demonstrating multiple sources of egress or signs of intracranial hypertension should be approached with caution. Middle ear obliteration with EAC overclosure may provide the most definitive management option for these patients, particularly if initial attempt at primary repair is unsuccessful.
TLM Outcomes in Elderly Patients with Glottic Pre-Malignancy and Early Malignancy; A 12-Year Retrospective Study
Authors: Jones Heidi , Ross Elizabeth , Jose Jemy 
Published: April 2021

Introduction: UK population ageing and associated cancer risk predicts an increase in the prevalence of laryngeal cancer in elderly patients. Whilst trans-oral laser microsurgery (TLM) has been demonstrated to achieve excellent control of early disease with few complications, data specifically related to its safety and efficacy in older patients is lacking. We report the largest series to date. Objectives: To assess the safety and efficacy of TLM in elderly patients with glottic pre-malignancy and early malignancy. Methods: A retrospective review and statistical analysis of the clinical records of patients aged 70 or over undergoing TLM for early and premalignant glottic disease. Results: The records of 106 patients over the age of 70 were identified. Thirteen records were excluded, 4 due to failure to meet the inclusion criteria (stage I/II disease, primary site of lesion in the glottis) and 9 due to incomplete follow up data capture. Most surgeries (>70%) were performed as a day case or overnight admission, with only 2 admissions >2 days. One patient required hospital readmission with dysphagia, resulting in an altered diet. No patients required tracheostomy or tube feeding. No treatment related deaths or intensive care admissions were observed. Ten patients had recurrent disease within 5 years; 1 received radiotherapy, 1 underwent salvage laryngectomy, the remainder had further TLM without complication. Five-year disease specific survival rates were >90%. Conclusion: Our results demonstrate that TLM is safe and effective for elderly patients, with outcomes comparable to those reported in large, non-age selected cohorts. Although our patients underwent more conservative cordectomy types (I-III) than those with similar disease stages reported elsewhere, our recurrence rates were not higher. This supports the oncological effectiveness of surgery whilst reducing the risk of associated functional compromise.
Implementing Partnering for Change in Québec: Occupational Therapy Activities and Stakeholders’ Perceptions
Authors: Camden Chantal , Campbell Wenonah , Missiuna Cheryl , Berbari Jade , Héguy Léa , Gauvin Cheyenne , Dostie Rosalie , Ianni Lina , Rivard L ,   GOLD Research Team, Anaby Dana 
Published: April 2021

Background. The occupational therapy school-based Partnering for Change (P4C) model has mostly been documented in Ontario. Purpose. This implementation study describes the implementation of P4C in two Québec elementary schools (P4C-Q), as well as therapy practices, their impacts, factors perceived to influence implementation, and recommendations. Method. A sequential mixed-methods design was applied. Therapists (n=2) completed daily journals, describing activities by P4C-Q level. Therapists and other school-stakeholders (n=11) participated in semi-structured interviews, analyzed through a content analysis framework. Findings. Daily journals illustrated that the majority of therapy time was spent on activities targeting the entire classroom, and on collaboration with educators. Interviews illustrated how coaching was used across different practices and the impact of these practices for schools (e.g., capacity-building) and children (e.g., increased functioning), and highlighted how relationship-building is key to facilitating the implementation of this model. Implications. Lessons learned may be helpful for others implementing P4C in their own contexts.
Governing healthcare in India: a policy capacity perspective
Authors: Bali Azad Singh , Ramesh M. 
Published: April 2021

After decades of neglect, in 2008, the Indian government launched a national health insurance programme to address the needs of the bulk of the population that could not afford healthcare. This was followed by the launch of another national programme in 2018 that further expanded insurance coverage. These schemes envision a large single-payer, insurance-based system covering about 110 million families. The central objective of this article is to assess the government’s capacity to implement these ambitious programmes. We employ the policy capacity framework developed by Wu et al. to examine the types of capacities needed to achieve desired objectives in the health sector. The central argument of the article is that there are critical capacity deficits, especially along operational dimensions. Our conclusions are generalisable to other middle-income countries currently in the process of implementing similar prospective-payment health policy reforms. Points for practitioners This article highlights the need for governments to prioritise the capacity for implementing health policy reforms. Efforts to achieve and sustain universal healthcare are contingent not only on appropriate policy design, mobilising required resources and building political support, but also on overcoming capacity deficits in implementation. The framework presented in this article serves as a useful tool for governments to diagnose strengths and weaknesses in the specific types of capacities (analytical, operational, and political) needed for universal health coverage.