bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transvesical blockade of the obturator nerve to prevent adductor contraction in transurethral resection of urinary bladder tumor
Authors: Choudhury Sunirmal , Ahmed Shahbaaz , Bose Anjana Ghosh Dastidar , Ghosh Debasish 
Published: July 2024

Introduction: Urinary bladder tumors are one of the most common urological malignancies. Traditionally, it has been managed with trans-urethral resection of urinary bladder tumor (TURBT) for both diagnostic and therapeutic purposes. During TURBT of lateral wall tumors, there is risk of obturator nerve reflex (ONR), which can lead to serious complications such as inadvertent bleeding and urinary bladder perforation. To prevent this, obturator nerve block is given after spinal anesthesia. In this study, we have used the transvesical approach to block the obturator nerve. Materials and methods: In total, 60 patients were included in the study. In 30 of them, TURBT was performed under only SA and transvesical obturator nerve block (ONB). In the other 30 patients, TURBT was performed under SA and peripheral nerve stimulator (PNS) guided obturator nerve block (performed by anesthetists) was given. The patients underwent TURBT using conventional monopolar cautery. The procedure time and peri-operative complications were studied. In all patients, informed consent was taken. Results: In this study, 30 ONBs (all bilateral) were performed transvesically. After confirming the location of the obturator nerve, transvesical ONB was given using local anesthetic. Two patients (6.67%) experienced adductor jerk during the operation. In the 30 patients who underwent peripheral nerve stimulator (PNS) guided ONB, 6 of the patients (20%) experienced adductor jerk during the operation and 1 of those (3.33%) suffered from urinary bladder perforation which was managed conservatively. Conclusion: Transvesical ONB is an easy method to prevent adductor jerk during TURBT of lateral wall tumors. The learning curve is less and it has a high success rate.
The Pathways to Community Living Initiative (PCLI) for older adults: implementation and outcomes
Authors: Kellett Rowena , Findlay Lillian , Lubbe Sean , Wand Anne PF 
Published: July 2024

Objective To describe implementation of the Pathways to Community Living Initiative (PCLI) within an Older People’s Mental Health (OPMH) service. Method A retrospective observational study was conducted. Implementation comprised partnership with a specialist Residential Aged Care Facility (RACF). Data were obtained from Clinical Advisory Committee (CAC) discussion and minutes, the PCLI database, and consumer medical records. Results Eighteen consumers were accepted onto the program between April 2019 and March 2023. Their PCLI and rating scale outcomes alongside interventions facilitating placements are described. Interventions included OPMH case management, wide-reaching liaison, and inservices. Challenges included communication, confusion regarding roles, and differing views on capacity to accommodate complex consumers. Solutions included streamlining communication, including clinical updates in the CAC, facility appointment of a lead PCLI-nurse, and targeted RACF education. Conclusions Considered interventions strengthened the OPMH and specialist RACF partnership over time. Clarification of professional roles and intersection with other services was crucial. Successful placement for PCLI consumers required consideration of personalised needs and existing resident mix, liaison with stakeholders, and targeted staff training. These strategies may apply to other health services implementing similar initiatives supporting community placements for OPMH consumers with complex needs.
Review of Subcutaneous Insulin Regimens in the Management of Diabetic Ketoacidosis in Adults and Pediatrics
Authors: Ibarra Francisco , Bae Ryan , Haghighat Bardya 
Published: July 2024

Objective: Summarize the studies evaluating the use of subcutaneous (SQ) insulin in the management of diabetic ketoacidosis (DKA) in adults and pediatrics. Data Sources: A PubMed literature search was conducted for articles published between 2000 and the end of May 2024 which contained the following terms in their title: (1) subcutaneous, glargine, or basal and (2) ketoa*. Study selection and data extraction: Review articles, guidelines, meta-analysis, commentaries, studies not related to the acute management of DKA, studies evaluating continuous SQ insulin, animal studies, if the time to DKA resolution was not clearly defined, and studies where basal insulin was administered greater than 6 hours after the insulin infusion was started were excluded. Data synthesis: The electronic search identified 58 articles. Following the initial screening 38 articles were excluded and 3 were added after bibliography review. Of the 23 articles assessed for eligibility, 7 were excluded. Sixteen articles were included. Five studies compared SQ rapid/short-acting insulin and intravenous (IV) insulin infusions in adults, 4 compared SQ rapid/short-acting insulin and IV insulin infusions in pediatrics, 4 evaluated IV insulin infusions with or without SQ basal insulin in adults, and 3 evaluated IV insulin infusions with or without SQ basal insulin in pediatrics. Relevance to patient care and clinical practice: In comparison with IV insulin infusions, rapid/short-acting SQ insulin regimens were associated with reduced ICU admission rates, hospital length of stay, and hospitalization costs. IV insulin infusion regimens that included a single SQ basal insulin dose upon therapy initiation were associated with reduced concurrent IV insulin infusion durations. Conclusion: Studies reviewed suggest that SQ insulin regimens may be as effective and safe as IV insulin infusions in the management of DKA and are associated with the conservation of resources. Providers may refer to this review when establishing or modifying their DKA management protocols.
Dostarlimab: A promising new PD-1 inhibitor for cancer immunotherapy
Authors: Farzeen Zubaria , Khan Rana Rashad Mahmood , Chaudhry Ayoub Rashid , Pervaiz Muhammad , Saeed Zohaib , Rasheed Shahzad , Shehzad Behram , Adnan Ahmad , Summer Muhammad 
Published: July 2024

Objective Dostarlimab, a humanized monoclonal PD-1 blocking antibody, is being tested as a cancer therapy in this review. Specifically, it addresses mismatch repair failure in endometrial cancer and locally progressed rectal cancer patients. Data Sources A thorough database search found Dostarlimab clinical trials and studies. Published publications and ongoing clinical trials on Dostarlimab's efficacy as a single therapy and in conjunction with other medicines across cancer types were searched. Data Summary The review recommends Dostarlimab for endometrial cancer mismatch repair failure, as supported by GARNET studies. The analysis also highlights locally advanced rectal cancer findings. In the evolving area of cancer therapy, immune checkpoint inhibitors including pembrolizumab, avelumab, atezolizumab, nivolumab, and durvalumab were discussed. Conclusions Locally advanced rectal cancer patients responded 100% to Dostarlimab. Many clinical trials, including ROSCAN, AMBER, IOLite, CITRINO, JASPER, OPAL, PRIME, PERLA, and others, are investigating Dostarlimab in combination treatment. This research sheds light on Dostarlimab's current and future possibilities, in improving cancer immunotherapy understanding.
Peripheral Coagulation Parameters and Prostate Cancer Association: A Retrospective Study and Mendelian Randomization
Authors: Liu Feifan , Song Yufeng , Wu Fei , Wang Jianyu , Wang Delin , Zhao Zhenlin , Wu Haihu , Lyu Jiaju , Ning Hao 
Published: July 2024

Background: The limitations of prostate-specific antigen (PSA) in diagnosing prostate cancer (PCa) necessitate the exploration of novel biomarkers. Recent studies suggest a potential link between coagulation markers, particularly fibrinogen and D-dimer, and PCa. Methods: A retrospective single-center analysis on 466 biopsy-undergone patients was conducted, categorized into PCa and benign prostatic hyperplasia (BPH) groups. Baseline and coagulation parameter levels were analyzed. Utilizing a Mendelian randomization (MR) approach, we investigated the causative relationship between D-dimer and PCa risk. Results: Individuals with PCa, compared with those with BPH, exhibited significantly higher D-dimer levels ( P < .001), total PSA ( P < .001), and PSA density ( P < .001). Fibrinogen levels did not exhibit significant differences ( P = .505). The MR analysis suggested a probable causal link between elevated D-dimer levels and an increased risk of PCa (odds ratio: 1.81, 95% confidence interval: 1.48-2.21, P = 7.4 × 10−9). Conclusions: This research highlights D-dimer as a potential biomarker for diagnosing PCa, supported by clinical and MR analyses. The study paves the way for future large-scale, multi-center research to corroborate these findings and further explore the relationship between coagulation markers and PCa mechanisms.
Older adults in major trauma centre psychology provision
Authors: Moorhouse Jaswinder , Holt Bethany , Dixon Lili , Baggaley Jessica , Wilson Georgia , Johnson Louise 
Published: July 2024

Introduction Older adults (OAs) comprise a significant proportion of the Major Trauma (MT) population and the mean age of major trauma patients is rising. Over recent years increasing focus has been directed towards ensuring that the physical health needs of older MT patients are met and managed in a timely and appropriate manner during their acute care. This study aims to explore whether the psychological needs of older adults in major trauma centres are also being appropriately recognised and whether this population is appropriately referred for timely psychological support. The paper also briefly outlines the psychological needs identified in this group during their inpatient admission. The implications for major trauma teams and major trauma psychology services are discussed. Methods Retrospective review of referral data captured over a 6 month period as part of the routine service practice for new referrals. Demographic differences were analysed using chi-squared. Results There is a statistically significant relationship between major trauma patients’ age and their referral status to Clinical Psychology, with older adults receiving fewer referrals for psychological support. Conclusion The current literature understanding the impact of MT for OAs is sparse. Further exploration is needed with both staff and patients to better understand the service gaps and barriers for OAs accessing psychological support following MT.
LGBTQ+ Faculty Members' Perceptions of Diversity Policies and Practices in Higher Education
Authors: Mauldin Sage A. 
Published: July 2024

Problem The career development and professional growth of LGBTQ+ faculty members in higher education is an under researched topic in the field of human resource development (HRD); particularly as it relates to ways that exclusionary diversity policies and practices can hinder well-being and perpetuate marginalization of this group. While current diversity policies and practices in higher education acknowledge and address race and ethnicity, gender identity and sexuality have tended to receive far less attention. This issue is particularly problematic within the HRD career development paradigm. The reinforcement of cisheteronormativity leads to feelings of marginalization and exclusion among LGBTQ+ faculty members, highlighting systemic barriers that hinder their professional growth. Solution The purpose of this study was to explore six LGBTQ+ faculty members’ perceptions of diversity policies and practices at their respective institutions, investigating how the language and implementation of them contribute to a sense of marginalization and exclusion. The role of critical human resource development (CHRD) in challenging the social injustices emanating from exclusionary diversity policies and practices is discussed. Implications for positive career development outcomes from implementing and enforcing inclusive diversity policies and practices are highlighted. Stakeholders The stakeholders are higher education institutions (HEIs), human resource development (HRD) practitioners who may work with them, and diversity, equity, and inclusion (DEI) executives.
Single Access and X-Over Reversed Iliac Extension Technique in a PAD Patient Needing Complex Endovascular Aortic Aneurysm Repair
Authors: Nana Petroula , Kölbel Tilo , Panuccio Giuseppe , Torrealba José I. , Rohlffs Fiona 
Published: July 2024

Purpose: To describe the X-over reversed iliac extension technique in a patient with severe peripheral arterial disease (PAD) scheduled for inner branched endovascular aortic repair (iBEVAR). Technique: A multimorbid 62-year-old male patient was planned for iBEVAR due to a 58 mm suprarenal aortic aneurysm. The patient had a previous right femoropopliteal bypass and stenting of the left iliac axis. At admission, he presented with recent onset severe left limb claudication, which was attributed to left iliac stent occlusion. To avoid the postoperative compression of the right common femoral artery (CFA) and preserve the patency of the bypass, a single left CFA access, followed by left iliac artery recanalization, was decided. The right iliac axis was catheterized with a Lunderquist wire using X-over access from the left CFA. An iliac extension (ZISL, 24–59, Cook Medical, Bloomington, USA) was reversed and resheathed on back-table and implanted in the right common iliac artery using the X-over technique. The left CFA access was used to complete the remaining steps of the procedure. The predischarge computed tomography angiography confirmed bilateral iliac artery and femoropopliteal bypass patency. Conclusion: The X-over reversed iliac extension technique may be applied in selected PAD patients, when undergoing complex endovascular aortic repair. Clinical Impact As the number of patients with peripheral arterial disease (PAD) is expected to increase the upcoming decades, out of the box solutions may be needed to assist complex endovascular aortic management. The X over technique, which consist of the contralateral advancement of an on-table reversed iliac limb, was successfully applied in a patient with severe PAD and numerous previous peripheral interventions, who was managed with branched endovascular aortic repair . The X Over technique may provide an additional alternative in well-selected patients with demanding vascular access undergoing complex endovascular aortic procedures.
Compassion fatigue and loneliness at work in nurses – the mediating role of resilience: a cross-sectional study
Authors: Kiratli Didem , Duran Songul 
Published: July 2024

Background: Heavy workload, job stress and lack of colleague support can lead to loneliness and burnout in nurses. Caring for a patient with constant pain can cause compassion fatigue. Loneliness at work and compassion fatigue also negatively affect the quality of patient care. Aim: This study aims to determine the effect of resilience on loneliness at work and compassion fatigue in nurses. Method: This is a descriptive cross-sectional study. The study was conducted with a total of 214 nurses. Results: A statistically significant negative relationship was found between the level of loneliness at work and resilience, and between resilience and compassion fatigue in nurses. The mediating role of resilience was found to be significant in the effect of loneliness at work on compassion fatigue in nurses. Conclusions: The results of this study suggest empowering nurses who have loneliness at work and compassion fatigue. Compassion fatigue is seen as occupational deformation. Nurses need to learn how to manage compassion fatigue, develop coping skills and receive support to ensure job satisfaction. In addition, nurse managers should create a reasonable workload for nurses. These efforts can increase the job satisfaction and patient care quality of nursing departments.
Lifelog-based daily step counts, walking speed, and metabolically healthy status
Authors: Lim Ga-Young , Park Eunkyo , Song Ji-Young , Kwon Ria , Kang Jeonggyu , Cho Yoosun , Jung Se Young , Chang Yoosoo , Ryu Seungho 
Published: July 2024

Objective Optimal metabolically healthy status is important to prevent various chronic diseases. This study investigated the association between lifelog-derived physical activity and metabolically healthy status. Methods This cross-sectional study included 51 Korean adults aged 30–40 years with no history of chronic diseases. Physical activity data were obtained by the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Lifelog-derived physical activity was defined by step counts and walking speed for 1 week, as recorded by the Samsung Health application on both the Samsung Galaxy Fit2 and mobile phones. Participants without metabolic syndrome components were categorized as the metabolically healthy group ( n = 31) and the remaining participants as the metabolically unhealthy group ( n = 20). Prevalence ratios and 95% confidence intervals were estimated using Poisson regression models. The predictive ability of each physical activity measure was evaluated according to the area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) values. Results Among the physical activity measures, lifelog-derived walking speed was significantly inversely associated with prevalent metabolically unhealthy status. The lifelog component model including walking speed, age, and sex had the highest AUC value for metabolically unhealthy status. Adding lifelog-derived step counts to the IPAQ-SF-derived metabolic equivalent (MET) model (including age, sex, and IPAQ-SF-METs) yielded 37% and 13% increases in the NRI and IDI values, respectively. Incorporating walking speed into the IPAQ-SF-derived MET model improved metabolically unhealthy status prediction by 42% and 21% in the NRI and IDI analyses, respectively. Conclusions Slow walking speed derived from the lifelog was associated with a higher prevalence of metabolically unhealthy status. Lifelog-derived physical activity information may aid in identifying individuals with metabolic abnormalities.
Reliability of Angle Measurements Based on the Epiphyseal Scar for Knee Osteotomy: An International Multicenter Radiographic Study
Authors: Schippers Philipp , Peras Matthieu , de Geofroy Bernard , Drees Philipp , Gercek Erol , Junker Marius , Micicoi Lolita , Gonzalez Jean-François , Micicoi Grégoire 
Published: July 2024

Background: The proximal tibial epiphyseal inclination can be used as a prognostic factor for good results after knee osteotomy and measured using the tibial bone varus angle (TBVA). This angle depends on the visibility of the epiphyseal plate, which has shown poor reproducibility when measured on standard radiographs by conventional methods. Purpose: To evaluate the measurement reliability of the TBVA and other angles based on the epiphyseal scar using a digital image display. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 100 whole-leg radiographs were analyzed twice by 3 orthopaedic surgeons from 2 countries in a blinded and randomized manner. Observers measured the hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, and TBVA. The growth plate–tibial plateau (GPTP) angle, defined as the angle between the epiphyseal scar and tibial plateau, was measured; this angle has not yet been described for osteotomy. In addition, a modified version of the TBVA (mTBVA), defined as that between the epiphyseal scar, its center, and the center of the talus, was measured. The Ahlbäck score for osteoarthritis and a 3-grade score for epiphyseal scar visibility were also determined. The reliability of the angle measurements and scoring was evaluated using the Fleiss kappa and intraclass correlation coefficient (ICC). Results: The scores for epiphyseal scar visibility showed fair interobserver (Fleiss kappa correlation coefficient [κ] = 0.29-0.35) and strong intraobserver (Fleiss κ = 0.62-0.69) reliability. TBVA, GPTP angle, and mTBVA measurements showed good interobserver reliability (ICC, 0.76-0.77), while the GPTP angle achieved excellent intraobserver reliability (ICC, >0.9). Conclusion: Using digital image display, angles that depend on the epiphyseal scar—such as TBVA, GPTP angle, and mTBVA—can achieve acceptable measurement reliability despite the low agreement on the visibility of the epiphyseal scar.
Safeguarding Accuracy: The Impact of Interventions on Reducing Blood Culture Contamination
Authors: Adnan Fareeha , Khursheed Nazia , Khan Moiz Ahmed , Parveen Nazia 
Published: July 2024

Introduction: Blood culture is the gold standard for diagnosing bacteremia and direct the physicians to select appropriate antimicrobials. In hospitals, blood culture contamination (BCC) is a common problem that has a detrimental effect on patient outcomes. Hence, we implemented strategies in our tertiary care setup, for training phlebotomists and nurses in proper blood sampling techniques, and assessed their effectiveness in reducing BCC rates. Methods: This interventional study was conducted at the Indus Hospital, Karachi, Pakistan from 1st January 2021 to 30th June 2023. All blood cultures received from different departments of the hospital were included. The 2.5-year study period was divided into pre-intervention and intervention periods, with monthly monitoring of BCC. The BCC data between 1st January 2021 and 31st December 2021 was taken as the baseline pre-intervention period and the next 1.5 years comprised the intervention period (1st January 2022-30th June 2023). To improve compliance, various strategies were implemented, such as regular training sessions, didactic sessions, and re-competencies. Results: A total of 86 774 Blood cultures were received from all departments of the hospital, out of which n = 30 672 were received in the pre-intervention period whereas, n = 56 102 were received in the intervention period. Mean BCC rate in the pre-intervention period was found to be 4.6%. However, after the implementation of different measures to reduce BCC, the contamination rate decreased to a mean of 3.1% by the end of the intervention period. Emergency department accounted for the highest proportion of BCC in the pre-intervention and intervention periods. Conclusion: We decreased BCC in our tertiary care setup by implementing a simple and inexpensive collaborative intervention, and came to the conclusion that the higher incidence of BCC was probably caused by factors unique to the emergency department and provided measures to successfully address them.