bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding how the Support Needs Approach for Patients (SNAP) enables identification, expression and discussion of patient support needs: A qualitative study
Authors: Gardener A Carole , Ewing Gail , Deaton Christi , Farquhar Morag 
Published: October 2021

Objectives To identify whether and how the support needs approach for patients enables patients with chronic progressive conditions to identify, express and discuss their unmet support needs. Methods Thirteen healthcare professionals trained in the Support Needs Approach for Patients (SNAP), recruited from three pilot sites in the East of England (across primary, community and secondary care) delivered SNAP to 56 patients with the exemplar condition chronic obstructive pulmonary disease over a 4-month period. Healthcare professionals participated in a mid-pilot semi-structured interview (pilot site representatives) and end-of pilot focus group (all healthcare professionals). Twenty patients who received SNAP were interviewed about their experiences (topic-guided). Transcripts analysed using a framework approach. Results There were differences in how healthcare professionals delivered SNAP and how patients engaged with it; analysing the interaction of these identified a continuum of care (from person-centred to healthcare professional-led) which impacted patient identification and expression of need and resulting responses. When delivered as intended, SNAP operationalised person-centred care enabling patient-led identification, expression and discussion of support needs. Discussion SNAP addresses the rhetoric within policy, good practice guidance and the person-centred care literature espousing the need to involve patients in identifying their needs and preferences by providing healthcare professionals with a mechanism for achieving holistic person-centred care in everyday practice.
Predictors of Mortality in Patients With Necrotizing Fasciitis: A Literature Review and Multivariate Analysis
Authors: Kjaldgaard Lindsey , Cristall Nora , Gawaziuk Justin P. , Kohja Zeenib , Logsetty Sarvesh 
Published: October 2021

Background: Necrotizing fasciitis (NF) is a life-threatening infectious disease that can result in significant morbidity and mortality. Previously identified factors have not been verified in a large population. The objective of this study is to further examine the relationship of patient factors in NF mortality. Methods: This study is a retrospective review on patients ≥18 years old diagnosed with NF at the provincial referral centres from 2004 to 2016. The following data were examined: demographics, comorbidities, laboratory values, length of stay, and inhospital mortality. Results: Three hundred forty patients satisfied the inclusion criteria: 297 survived and were discharged, 43 died in hospital. In multivariate analysis, a prognostic model for NF mortality identified age >60 years, elevated creatinine, abnormal blood platelets, and group A β-hemolytic Streptococcus (GABS) infection. Conclusions: Multiple factors were associated with mortality in NF. The strongest univariate association with mortality was age >60 years. In addition, a history of hypertension and/or dyslipidemia, renal disease, and the presence of GABS contributed to a predictive model for inhospital NF mortality.
Acetabular Morphology and Spinopelvic Characteristics: What Predominantly Determines Functional Acetabular Version?
Authors: DeVries Zachary , Speirs Andrew D. , Salih Saif , Beaulé Paul E. , Witt Johan , Grammatopoulos George 
Published: October 2021

Background: In addition to the relative size of the acetabular rim and how the pelvis is positioned in space, the plane in which the acetabular version is calculated also affects its measurement. Purpose: To determine the relative contribution of pelvic and acetabular characteristics on morphological version (measured relative to the anterior pelvic plane angle [APPA]) and functional version (measured relative to the horizontal table). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 50 acetabular dysplasia patients and 109 asymptomatic controls. Using image analysis software, morphological parameters of the pelvis and acetabulum were determined from 2-dimensional computed topography: pelvic incidence, pelvic tilt angle, sacral slope, APPA, morphological and functional acetabular versions, and subtended angles (measure of acetabular rim prominence relative to the femoral head center) around the acetabular clockface in 30° increments. Correlation and multivariable regression analyses were performed with morphological and functional version as dependent variables and spinopelvic and acetabular parameters as independent variables. Results: Morphological version was moderately associated with differences between anterior and posterior subtended angles ( R = 0.68 [ P < .001] and R = 0.57 [ P < .001] for differences at 165° and 15° and 135° and 45°, respectively). Functional version was moderately associated with pelvic tilt angle ( R = 0.56; P <.001) and the difference in subtended angles between anterior and posterior rims ( R = 0.61 [ P < .001] and R = 0.50 [ P < .001] for differences at 165° and 15° and 135° and 45°, respectively). Multivariate analysis revealed a good model for predicting morphological version ( R 2 = 0.44; P < .01) and functional version ( R 2 = 0.58; P < .01). Subtended angle difference between 165° and 15° ( B = 0.36 [95% CI, 0.24-0.49]; P < .001) was most strongly related to morphological version, and pelvic tilt angle ( B = 0.57 [95% CI, 0.46-0.68]; P < .001) was most strongly related to functional version. Conclusion: Functional acetabular version was influenced most strongly by pelvic tilt angle rather than the relative prominence of the acetabular rims. Before determining surgical management for version abnormalities, it would be prudent to assess pelvic mobility and characteristics in different functional positions. In patients with minimal pelvic tilt change dynamically, corrective osteotomy would be the treatment of choice to improve functional version.
Second-Look Arthroscopic Evaluation of Healing Rates After Arthroscopic Repair of Meniscal Tears: A Systematic Review and Meta-analysis
Authors: Dai Wenli , Leng Xi , Wang Jian , Hu Xiaoqing , Ao Yingfang 
Published: October 2021

Background: Evaluation of meniscal healing status after repair is important, as it allows the surgeon to inform patients whether they can increase their activities or return to sports. Purpose: To identify the healing rates after arthroscopic repair of meniscal tears via second-look arthroscopic evaluation. Study Design: Systematic review; Level of evidence, 4. Methods: Searches of PubMed, Embase, Scopus, and the Cochrane databases were conducted to identify relevant studies published before June 1, 2020. Studies were eligible for this meta-analysis if they provided data regarding healing status of the meniscus at second-look arthroscopy. Random-effects meta-analyses were generated to provide pooled meniscal healing estimates. We further performed subgroup analysis to investigate the healing rates of the meniscus under different situations. Results: A total of 41 studies with 1908 individuals were included in the study. The pooled analysis showed the complete healing rate was 74% (95% confidence interval [CI], 67%-80%), the partial healing rate was 10% (95% CI, 6%-16%), and the failure rate was 12% (95% CI, 10%-15%) for arthroscopic repair of meniscal tears via second-look arthroscopic evaluation. Sensitivity analysis demonstrated that no individual study affected the overall healing rate by >1%. Subgroup analysis found higher meniscal healing rates in patients with the following characteristics: age <40 years, male, body mass index <26, red-red tear location, tear in posterior horn, vertical tear, outside-in technique, repair concomitant with anterior cruciate ligament reconstruction, weight-restricted rehabilitation, and time interval from meniscal repair to second-look arthroscopy >12 months. Conclusion: In this systematic review, the complete healing rate was 74%, the partial healing rate was 10%, and the failure rate was 12% for arthroscopic repair of meniscal tears via second-look arthroscopic evaluation.
Bilateral Ischemic Retinopathy Associated With Upshaw-Schulman Syndrome: A Case Report
Authors: Cernichiaro-Espinosa Mariam , Meizner-Grezemkovsky Daniela , López-Santiago Norma , Borbolla-Pertierra Ana M. , Morales-Cantón Virgilio , Cernichiaro-Espinosa Linda A. 
Published: October 2021

Purpose: This is the first report to our knowledge of ischemic retinopathy in a pediatric patient with Upshaw-Schulman syndrome (USS). Methods: A 6-year-old girl previously diagnosed with USS was referred to our clinic with exodeviation of the left eye and a 2-month-long decrease in vision of both eyes. A dilated fundus examination showed a total vitreous hemorrhage in both eyes. The first course of action was conservative treatment, with the patient experiencing visual-acuity improvement in her right eye. Results: An ischemic retina and optic nerve atrophy was found once the left eye was cleared of the hemorrhage. Conclusions: We present a case of a vitreous hemorrhage, possibly secondary to an episode of severe thrombocytopenia. Following USS diagnosis, providers should perform dilated ophthalmologic examinations as part of initial and follow-up general evaluations. This case exemplifies that, in understudied and underdescribed pediatric retinal diseases, extreme therapeutic decisions—such as surgery—should not be rushed.
From wave to wave: a Dutch national study on the long-term impact of COVID-19 on well-being and family visitation in nursing homes
Authors: Backhaus Ramona , Verbeek Hilde , de Boer Bram , Urlings Judith H. J. , Gerritsen Debby L. , Koopmans Raymond T. C. M. , Hamers Jan P. H. 
Published: October 2021

Abstract
Background
To protect nursing home residents, many governments around the world implemented blanket visitor bans in March and April 2020. As a consequence, family caregivers, friends, and volunteers were not allowed to enter nursing homes, while residents were not allowed to go out. Up until now, little is known on the long-term consequences and effects of visiting bans and re-opening of nursing homes. The aim of the study was to assess the long-term effects of the pandemic on residents, family members, and staff, and their preparedness for the next coronavirus wave.

Methods
A mixed-methods approach was used, consisting of a questionnaire and analyses of documentation (local visiting protocols). Of the 76 nursing home locations that participated in a Dutch national pilot on welcoming visitors back into nursing homes, 64 participated in this follow-up study. Data were collected in September/October 2020. For each nursing home, one contact person completed the questionnaire. Descriptive statistics were calculated for quantitative questionnaire data. Data on open-ended questions, as well as data from the documentation, were analyzed thematically.

Results
The study demonstrated that the consequences of strict visiting bans do not disappear at the moment the visiting ban is lifted. Although in October 2020, daily life in nursing homes was more “back to normal,” more than one-third of the respondents indicated that they still applied restrictions. Compared to the situation before the pandemic, fewer volunteers were working in the nursing homes, grandchildren visited their relative less often, and visits differed.

Conclusions
Five months after the visiting ban in Dutch nursing homes had been lifted, it still had an impact on residents, family members, and staff. It is questionable whether nursing homes feel prepared for welcoming visitors in the case of new COVID-19 infections. Nursing homes indicated that they felt prepared for the next wave, while at the same time, they were particularly concerned about staff well-being and vitality. It seems wise to invest in staff well-being. In addition, it seems desirable to think about how to support nursing homes in seeking a balance between infection prevention and well-being of residents, family members, and staff.
The relationship between bone density and the oral function in older adults: a cross-sectional observational study
Authors: Hasegawa Yoko , Tsuji Shotaro , Nagai Koutatsu , Sakuramoto-Sadakane Ayumi , Tamaoka Joji , Oshitani Masayuki , Ono Takahiro , Sawada Takashi , Shinmura Ken , Kishimoto Hiromitsu 
Published: October 2021

Abstract
Background
Falls among older adults with a low bone density can lead to a bedridden state. Declining bone density increases the risk of falls resulting fractures in older adults. A person’s physical performance is known to be closely related to bone density, and a relationship between the physical performance and the oral function is also known to exist. However, there currently is a lack of evidence regarding the relationship between bone density and the oral function. We assessed the relationship between the bone density and the both the oral function and physical performance among older adults.

Patients and methods
754 older adults aged 65 years or older who independently lived in rural regions and who were not taking any medications for osteoporosis participated. We checked all participants for osteoporosis using an ultrasonic bone density measuring device. Regarding the oral function, we evaluated the following factors: remaining teeth, occlusal support, masticatory performance, occlusal force, and tongue pressure. We also evaluated body mass index (BMI) and skeletal muscle mass Index as clinical characteristics. The normal walking speed, knee extension force and one-leg standing test were evaluated as physical performance. For the statistical analyses, we used the Mann–Whitney U test, chi-square test, the Kruskal-Wallis, and a multiple regression analysis.

Results
Eighty-one percent of the females and 58% of the males had osteoporosis or a decreased bone mass. The occlusal force, masticatory performance and the tongue pressure showed significant association with the bone density. The participants physical performance showed a significant association with their bone states except for walking speed. According to a multiple regression analysis, clinical characteristics (sex, age, BMI), one-leg standing and occlusal force showed independent associations with the bone density. It was suggested that the bone density tends to increase if the occlusal force is high and/or the one-leg standing test results are good.

Conclusions
The bone density in the older adults showed a significant relationship not only with clinical characteristics or physical performance, but also with occlusal force. It may also be effective to confirm a good oral function in order to maintain healthy living for older adults.
Loneliness in older parents: marital transitions, family and social connections, and separate bedrooms for sleep
Authors: Chiao Chi , Lin Wen-Hsu , Chen Yu-Hua , Yi Chin-Chun 
Published: October 2021

Abstract
Objectives
This research innovatively analyzed the marital transitions (i.e., divorce and widowhood) of older Taiwanese parents, their sleep problems and spousal specific characteristics (i.e., separate bedrooms for sleep and marital relationships) as well as their social and family connections, all of which were simultaneously reflected in emotional and social domains of loneliness.

Methods
Data are from 1645 older parents from Northern Taiwan. Loneliness was assessed by a De Jong-Gierveld short scale with emotional and social domains. We conducted multivariate logistic regression to examine the associations of marital transitions and family/social connections regarding sleep problems and psychological well-being with loneliness in social and emotional domains. Besides sleep problems and individual socioeconomic status, we included data on couples’ sleeping arrangements and marital relationships.

Results
Social loneliness was significantly associated with being divorced (AOR = 1.80, 95% CI 1.13–2.86) and living alone (AOR = 1.50, 95% CI 1.02–2.23). In contrast, strong family cohesion and frequent weekly contact with friends were associated with lower social loneliness. Married parents who slept in separate bedrooms were more likely than bed-sharing couples to feel emotional and social loneliness, despite adjusting for their sleep problems. Furthermore, satisfactory spousal relationships significantly decreased the magnitude of associations in the social domain.

Discussion
Our findings support significant associations between loneliness in later life and major marital transitions, family and social connections and sleep problems which differ in social and emotional domains. Independent of relationship satisfaction, separate bedrooms relate to higher risks of emotional loneliness in older adults.
Langerhans cell histiocytosis misdiagnosed as cow protein allergy: a case report
Authors: Lv Xintong , Wang Libo , Pi Zhuang , Zhang Chunyan 
Published: October 2021

AbstractBackgroundLangerhans cell histiocytosis (LCH) is a heterogeneous disease with diverse clinical manifestations. Abdominal organ involvement is rare. Early diagnosis and active treatment are needed. The purpose of this article is to enable readers to have a better knowledge of LCH and prevent misdiagnosis.Case presentationA 2-month-old boy had diarrhea, hematochezia, and a rash, and was diagnosed as having a cow milk protein allergy (CMPA). He was given an amino acid-based formula, but there was no sign of improvement in his condition.The patient then had a skin biopsy and was diagnosed as having multisystem Langerhans cell histiocytosis (MS-LCH). The general condition of the child deteriorated after the first two doses of chemotherapy, and the child died.ConclusionsMS-LCH is a protracted and progressive condition with poor prognosis. Early diagnosis and treatment are essential for survival. If a child has chronic diarrhea and hematochezia in the presence of a characteristic rash, the pediatrician should consider the possibility of this disease to avoid misdiagnosis.
Subtypes of nurses’ mental workload and interaction patterns with fatigue and work engagement during coronavirus disease 2019 (COVID-19) outbreak: A latent class analysis
Authors: Wu Jing , Li Husheng , Geng Zhaohui , Wang Yanmei , Wang Xian , Zhang Jie 
Published: October 2021

Abstract
Background
Nurses play critical roles when providing health care in high-risk situations, such as during the COVID-19 outbreak. However, no previous study had systematically assessed nurses’ mental workloads and its interaction patterns with fatigue, work engagement and COVID-19 exposure risk.

Methods
A cross-sectional study was conducted via online questionnaire. The NASA Task Load Index, Fatigue Scale-14, and Utrecht Work Engagement Scale were used to assess nurses’ mental workload, fatigue and work engagement, respectively. A total of 1337 valid questionnaires were received and analyzed. Nurses were categorized into different subgroups of mental workload via latent class analysis (LCA). Cross-sectional comparisons, analysis of covariance (ANCOVA), and multivariate (or logistic) regression were subsequently performed to examine how demographic variables, fatigue and work engagement differ among nurses belonging to different subgroups.

Results
Three latent classes were identified based on the responses to mental workload assessment: Class 1 – low workload perception & high self-evaluation group (n = 41, 3.1%); Class 2 – medium workload perception & medium self-evaluation group (n = 455, 34.0%); and Class 3 – high workload perception & low self-evaluation group (n = 841, `62.9%). Nurses belonging into class 3 were most likely to be older and have longer professional years, and displayed higher scores of fatigue and work engagement compared with the other latent classes (p < 0.05). Multivariate analysis showed that high cognitive workload increased subjective fatigue, and mental workload may be positively associated with work engagement. Group comparison results indicated that COVID-19 exposure contributed to significantly higher mental workload levels.

Conclusions
The complex scenario for the care of patients with infectious diseases, especially during an epidemic, raises the need for improved consideration of nurses’ perceived workload, as well as their physical fatigue, work engagement and personal safety when working in public health emergencies.
Long-acting antimuscarinic therapy in patients with chronic obstructive pulmonary disease receiving beta-blockers
Authors: Chapman Kenneth R. , Wise Robert A. , Scirica Benjamin M. , Bhatt Deepak L. , Daoud Sami Z. , Lythgoe Dan , Gil Esther Garcia 
Published: October 2021

Abstract
Background
Beta-blocker therapies for cardiovascular comorbidities are often withheld in patients with chronic obstructive pulmonary disease (COPD) due to potential adverse effects on airway obstruction. We carried out a post hoc analysis to determine the efficacy and safety of aclidinium in patients with moderate-to-very severe COPD and increased cardiovascular risk receiving beta-blockers at baseline versus non-users.

Methods
ASCENT-COPD was a Phase 4, multicenter, double-blind, randomized, placebo-controlled, parallel-group study. Patients were randomized 1:1 to aclidinium or placebo twice-daily for up to 3 years. Outcomes included risk of (time to first) major adverse cardiovascular events (MACE), all-cause mortality, and lung function over 3 years, and exacerbations over 1 year.

Results
Of 3589 patients, 1269 (35.4%) used beta-blockers and 2320 (64.6%) were non-users at baseline. Aclidinium did not statistically increase the risk of MACE (beta-blocker user: hazard ratio 1.01 [95% CI 0.62–1.64]; non-user: 0.80 [0.51–1.24]; interaction P = 0.48) or all-cause mortality (beta-blocker user: 1.13 [0.78–1.64]; non-user: 0.89 [0.62–1.26]; interaction P = 0.35), in patients using beta-blockers. Aclidinium reduced annualized rate of moderate-to-severe COPD exacerbation (beta-blocker user: rate ratio 0.75 [95% CI 0.60–0.94, P = 0.013]; non-user: 0.79 [0.67–0.93, P = 0.005]), delayed time to first exacerbation, and improved lung function versus placebo. There was greater trough FEV1 benefit in beta-blocker users versus non-users (least squares mean difference at 52 weeks: 111 mL [95% CI 74 mL–147 mL] versus 69 mL [42 mL–97 mL]; interaction P = 0.041).

Conclusions
This post hoc analysis supports long-acting anti-muscarinic use with concomitant beta-blockers in patients with moderate-to-very severe COPD and cardiovascular comorbidity.
Trial registration: ClinicalTrials.gov, NCT01966107, Registered 16 October 2013, https://clinicaltrials.gov/ct2/show/NCT01966107.