bluuebunny/crossref_metadata_2025_split huggingface dataset:
More than the sum of its parts—A constructivist grounded-theory study on specialist palliative care during crises like the COVID pandemic
Authors: Wikert Julia , Bausewein Claudia , Hodiamont Farina 
Published: January 2024

Background: The COVID pandemic is an example of a crisis challenging healthcare systems worldwide. The impact of the pandemic on providing high-quality palliative care calls for a deeper understanding of specialist services during crises. This is essential in preparation for further crises. Aim: To develop a conceptual understanding of the impact of the pandemic on specialist palliative care as an example for arising future crises. Design: Qualitative interview study across Germany, following a constructivist grounded theory methodology. Setting/participants: Eleven semi-structured interviews with experts with overarching knowledge of structures and processes in specialist palliative care between 05–07/2020 and between 02–06/2021, 23 semi-structured interviews with healthcare professionals working in a specialist palliative care setting. Results: The complex system of palliative care provision during crises has properties that cannot be understood as separated parts of the care process. The pandemic led to unique structural and processual challenges characterized by interconnectedness, uncertainty, dynamic, underlying dilemmas, and unclear long-term goal. In response to the pandemic, teams experienced different phases, which enhanced adaption, innovation, and progress within complex care situations. Creative strategy approaches and dynamic responsiveness facilitated innovative development and could lead to long-lasting improvement within services. Availability of information, transparent communication, comprehensible instructions, participation in decision-making, and search for solutions contributed to teams’ proactive development throughout the pandemic. Conclusion: Addressing the complex problems in specialist palliative care caused by crises requires system thinking and a learning mindset. This can facilitate teams to overcome the crisis and move forward rather than bounce back to normal.
Trichomoniasis and retesting in Durham County, North Carolina, United States, 2021 - 2022
Authors: Jenks Jeffrey D. , Ryan Emily , Stancil Candy , Harris Kimberly , Hester Lizeth , Carrico Savannah , Mortiboy Marissa , Zitta John-Paul 
Published: January 2024

Background The Centers for Disease Control and Prevention recommends universal retesting within 3 months after treatment of Trichomonas vaginalis infection given high rates of persistent infection or reinfection, or if this is not possible, within 12 months following treatment. Data is lacking on how often this is actually done. Methods We analyzed the demographic and clinical characteristics, rate of return for the recommended retesting, concordance between wet prep and nucleic acid amplification testing, and percent positivity for T. vaginalis on repeat vaginal specimens at a local public health department in Durham, North Carolina, United States. Results Of 193 females treated for trichomoniasis between March 1, 2021 – May 31, 2022, 83% were Black or African American and 44% between the ages of 20 and 29 years. Of these individuals, 32% had retesting performed within 3 months and 50% within 365 days after treatment. Females between the ages of 20 and 29 years were more likely to return for retesting than those between the ages of 30 and 39 years. Of those who returned for retesting, 10% were positive on repeat testing. Conclusion In this study, 50% of females diagnosed with trichomoniasis completed retesting within 365 days. Improved scheduling of clients at the time of trichomoniasis treatment and improved identification in our electronic health record of individuals diagnosed with trichomoniasis within the prior year would likely improve retesting rates. Given the high prevalence of trichomoniasis, expanded screening of asymptomatic females in settings where this is feasible may be warranted.
Numerical modelling of ventilation strategies for mitigating cough particles transmission and infection risk in hospital isolation rooms
Authors: Korany Hussein Zein , Almhafdy Abdulbasit , AlSaleem Saleem S , Cao Shi-Jie 
Published: January 2024

This study used numerical modelling to analyze air velocity, cough particle distribution and infection risks in an isolation room. It investigated air change rates, inlet/outlet vent positioning and assessed various ventilation rates and outlet configurations for reducing infection risks. Quantitative assessments revealed different particle escape timings. In Case 1, smaller particles (2–4 μm) took 8.2 s to escape, while in Case 2, this time extended to 22.7 s. At 48 ACH, there were significant improvements in removing particles of various sizes, particularly those sized 2–4 μm, 16–24 μm and 40–50 μm, reducing the infection risk. The use of the Wells-Riley model highlighted considerable reductions in infection probabilities with higher ACH. Specifically, infection risks were reduced to 5% in Case 1 and 17% in Case 2, underscoring the marked advantage of Case 1 in reducing infection probabilities, particularly for smaller particles. Furthermore, escalated ACH values consistently correlated with decreased infection probabilities across all particle sizes, highlighting the pivotal role of ventilation rates in mitigating infection risks. The study comprehensively investigated the distribution of air velocity, dynamics of cough particles and infection risk associated with different ventilation strategies in isolation rooms.
Metal allergy and neurovascular stenting: A systematic review
Authors: Vaishnav Dhrumil , Essibayi Muhammed Amir , Toma Aureliana , Liriano Genesis , Perkash Raja Sandeep , Stock Ariel , Holland Ryan , Dmytriw Adam A , Wolfe Stacey Q , Al Kasab Sami , Spiotta Alejandro , Haranhalli Neil , Altschul David J 
Published: January 2024

Background Intracranial stents and flow diverters contain significant amounts of metals, notably nickel, which can cause allergic reactions in a considerable portion of the population. These allergic responses may lead to complications like in-stent stenosis (ISS) and TIA/Stroke in patients receiving stents or flow diverters for intracranial aneurysms. Methods We conducted a systematic review of studies from inception until July 2023, which reported outcomes of patients with metal allergy undergoing neurovascular stenting. The skin patch test was used to group patients into those with positive, negative, or absent patch test results but with a known history of metal allergy. Results Our review included seven studies with a total of 39 patients. Among them, 87% had a history of metal allergy before treatment. Most aneurysms (89%) were in the anterior circulation and the rest (11%) were in the posterior circulation. Skin patch tests were performed in 59% of patients, with 24% showing positive results and 33% negative. Incidental ISS was observed in 18% of patients, and the rate of TIA/Stroke was reported in 21%. The pooled rates of ISS and TIA/Stroke were higher in the first group (43% and 38%) compared to the second (18% and 9%) and third groups (15% and 15%), but these differences were not statistically significant. Conclusions The current neurosurgical literature does not provide a conclusive association between metal allergy and increased complications among patients undergoing neurovascular stenting. Further studies are necessary to gain a more comprehensive understanding of this topic.
Prevalence of Scarpa’s ganglion enhancement on high-resolution MRI imaging
Authors: Siminski Clayton , Benson John C , Carlson Matthew L , Lane John I 
Published: January 2024

Background and Purpose The vestibular ganglion, or Scarpa’s ganglion, is a cluster of afferent vestibular neurons within the internal auditory canal (IAC). There is minimal literature describing enhancement of this region on magnetic resonance imaging (MRI) and its correlation to clinical symptoms. Here, we sought to find the prevalence of enhancement at Scarpa’s ganglion, and determine whether such enhancement correlates with demographics or clinical symptoms. Materials and Methods A retrospective review was performed of consecutive patients with an MRI of the IAC between 3/1/2021 and 5/20/2021. Two neuroradiologists independently reviewed for T1 and FLAIR enhancement of the Scarpa’s ganglion on post-contrast fat-saturated T1 and post-contrast FLAIR images. Discrepancies were agreed upon by consensus. Clinical variables (hearing loss, vestibular symptoms, tinnitus, and MRI indication) were gathered from a retrospective chart review. Results Eighty-nine patients were included (51 female); the mean age was 58 (range 19–85). The most common MRI indication was hearing loss ( n = 53). FLAIR enhancement was present on the right in 7 patients, on the left in 7 patients, and bilaterally in 6 patients. No enhancement was seen on post-contrast T1 images. There was no statistically significant correlation between consensus FLAIR on at least one side and age ( p = .74), gender ( p = .29), hearing loss ( p = .32), hearing loss side ( p = .39), type of hearing loss ( p = .87), vestibular symptoms ( p = .71), or tinnitus ( p = .81). Conclusions Enhancement is present in the minority of patients on post-contrast FLAIR images. If seen, it should be considered an uncommon but not unexpected finding with no clinical significance.
Assessing the financial impact of cancer drug list (CDL) implementation on patients receiving chemotherapy in an ambulatory cancer centre in Singapore
Authors: Lee Darren , Lim Li Qing , Leow Jo Lene , Chew Lita 
Published: January 2024

Background On 1st September 2022, the Cancer Drug List (CDL) was implemented to ensure the long-term affordability of chemotherapy and insurance premiums. This project aimed to determine the financial impact of CDL on out-of-pocket expenses (OOPE), acceptability and financial toxicity (FT) after CDL implementation. Methods A cross-sectional study was conducted at National Cancer Center Singapore. We analyzed OOPE before and after implementation of CDL by reviewing billing transactions in Aug-Sept 2022. Acceptability and FT were determined using theoretical framework of acceptability (TFA) and COmprehensive Score for financial Toxicity (COST) tool respectively via survey. Results Of the 314 patients finalized bills examined, majority (68.8%) experienced no change in their OOPE, and 69.1% had no OOPE. Most patients (72.6%) were unaware of implementation of CDL. Among patients aware of CDL, majority (61.9%) were accepting, but unsure on how it benefits them. FT was reported as low (mean COST score = 22.4 ± 9.9), and patients ≥65 years old or have at least pre-university education were less likely to experience FT. Conclusion Despite best efforts from policymakers, it is challenging to achieve a one-size fits funding or subsidy framework that can cater to the needs of all patients. Some groups of patients would inevitably still experience high OOPE and FT due to their personal or clinical circumstances. Patients can be better empowered to seek financial assistance or resources.
Gluten-free diet on video platforms: Retrospective infodemiology study
Authors: Ye Chen , Fang Yuehui , Lian Yiyao , He Yuna 
Published: January 2024

Background Video platform is an important approach for individuals to access and adopt health information. Online information on gluten-free diet (GFD) videos remains underinvestigated. Methods GFD videos were identified by hashtag-based searching strategy. Videos' basic information, engagement metrics, and content were recorded. Mann-Kendall test was performed to examine time trends of submitting videos and engagement metrics. Video quality was evaluated by the DISCERN instrument and the HONcode. Results A total of 822 videos were included in the analysis, with the majority focusing on gluten-free food recipes. The number of videos related to GFD was showing an upward trend. Engagement metrics varied between platforms and video types, with non-recipe videos receiving higher user engagement. The average DISCERN score was 50.20 out of 80 and the average HONcode score was 1.93 out of 8. Videos submitted by health professionals demonstrated better quality compared to those submitted by patients or general users. Conclusion There was a rise in the number of videos related to GFD on Chinese video platforms. The overall quality of these videos was poor, most of them were not rigorous enough. Highlighting using social media as a health information source has the potential risk of disseminating one-sided messages and misleading. Efforts should be made to enhance the transparency of advertisements and establish clear guidelines for information sharing on social media platforms.
“Becoming a Person Who Does Self-Care”: How Health Care Trainees Naturalistically Develop Successful Self-Care Practices
Authors: Campoli Jessica , Cummings Jorden A 
Published: January 2024

OBJECTIVES Self-care is an ethical imperative for health professionals as it can mitigate the adverse effects of stress on professional functioning and health. Yet, there tends to be a lack of self-care among healthcare trainees and an insufficient focus on self-care in medical education. The objective of this study was to develop a grounded theory of how health trainees become successful self-care users. METHODS Semi-structured interviews were conducted with 17 students in a variety of healthcare disciplines. Data were analyzed using grounded theory methodology. RESULTS Health trainees underwent 4 iterative phases to become successful at self-care: Having a Wake-Up Call, Building Skills, Gaining Confidence, and Building an Identity. Our model also explained why some trainees were unsuccessful at developing self-care practices. CONCLUSION We offer the first theory to explain how health trainees develop effective self-care habits. Understanding how self-care practices naturalistically develop has critical implications for developing interventions and curricula: By basing curricula about self-care on knowledge of what works, we have an opportunity to be more successful as educators. Indeed, other researchers have noted a lack of success in self-care and anti-burnout interventions for healthcare professionals. We conclude by discussing implications and recommendations for medical training and curriculum for health professions, including augmenting naturally occurring processes, linking self-care to personalized values, providing opportunities for deliberate practice, focusing on persistence with self-care, and faculty promotion and acceptance of trainee self-care.
Descriptive before-and-after study of the introduction of a ‘Leave Behind’ take-home naloxone dispensing/distribution program by the ambulance service in Western Australia
Authors: Tohira Hideo , Brits Rudolph , Lenton Simon , Agramunt Seraina , Brink Deon , Naylor Curtis , Belcher Jason , Ball Stephen , Finn Judith 
Published: January 2024

Objective To describe changes observed in case characteristics and patient outcomes before and after ambulance service participation in a ‘Leave Behind’ take-home naloxone (THN) dispensing/distribution program. Methods This before-and-after study included emergency ambulance attendances for patients experiencing an opioid overdose one year before 1 October 2021 (pre-participation phase: 1 October 2020–30 September 2021) when St John Western Australia (SJWA) participated in the THN program and those one year after the date (post-participation phase: 1 October 2021–30 September 2022). Results There were 945 and 1240 opioid overdoses among 221,451 and 222,480 emergency ambulance attendances in the pre- and post-participation phases (0.43% vs 0.56%, p < 0.001). The number of ambulance attendances for overdose in the post-participation phase was not significantly different from that predicted based on the ambulance attendances in the pre-participation phase. No statistically significant differences in patient age, sex, and geographical location were identified between the two phases. Compared to the pre-participation phase, more patients had naloxone administered prior to ambulance arrival (10.7% vs 15.1%, p = 0.003), and more patients were discharged at the scene (21.2% vs 29.8%, p < 0.001) in the post-participation phase. No difference was found in mortality within one day (3.4% in the pre-participation phase vs 3.5% in the post-participation phase, p = 0.30). Conclusions After implementation of a ‘Leave Behind’ take-home naloxone dispensing/distribution program, more patients had naloxone administered prior to ambulance arrival, and the likelihood of discharging a patient at the scene significantly increased without affecting patient survival rates.
How I treat long-term survivors of childhood acute leukemia
Authors: Saultier Paul , Michel Gérard 
Published: January 2024

Abstract
The population of survivors of childhood leukemia who reach adulthood is growing due to improved therapy. However, survivors are at risk of long-term complications. Comprehensive follow-up programs play a key role in childhood leukemia survivor care. The major determinant of long-term complications is the therapeutic burden accumulated over time. Relapse chemotherapy, central nervous system irradiation, hematopoietic stem cell transplantation, and total body irradiation are associated with greater risk of long-term complications. Other parameters include clinical characteristics such as age and sex as well as environmental, genetic, and socioeconomic factors, which can help stratify the risk of long-term complications and organize follow-up program. Early diagnosis improves the management of several late complications such as anthracycline-related cardiomyopathy, secondary cancers, metabolic syndrome, development defects, and infertility. Total body irradiation is the treatment associated with worse long-term toxicity profile with a wide range of complications. Patients treated with chemotherapy alone are at a lower risk of long-term complications, although the optimal long-term follow-up remains unclear. Novel immunotherapies and targeted therapy are generally associated with a better short-term safety profile but still require careful long-term toxicity monitoring. Advances in understanding genetic susceptibility to long-term complications could enable tailored therapeutic strategies for leukemia treatment and optimized follow-up programs.
CPX-351 exploits the gut microbiota to promote mucosal barrier function, colonization resistance, and immune homeostasis
Authors: Renga Giorgia , Nunzi Emilia , Stincardini Claudia , Pariano Marilena , Puccetti Matteo , Pieraccini Giuseppe , Di Serio Claudia , Fraziano Maurizio , Poerio Noemi , Oikonomou Vasileios , Mosci Paolo , Garaci Enrico , Fianchi Luana , Pagano Livio , Romani Luigina 
Published: January 2024

Abstract
CPX-351, a liposomal combination of cytarabine plus daunorubicin, has been approved for the treatment of adults with newly diagnosed, therapy-related acute myeloid leukemia (AML) or AML with myelodysplasia-related changes, because it improves survival and outcome of patients who received hematopoietic stem cell transplant compared with the continuous infusion of cytarabine plus daunorubicin (referred to as “7 + 3” combination). Because gut dysbiosis occurring in patients with AML during induction chemotherapy heavily affects the subsequent phases of therapy, we have assessed whether the superior activity of CPX-351 vs “7 + 3” combination in the real-life setting implicates an action on and by the intestinal microbiota. To this purpose, we have evaluated the impact of CPX-351 and “7 + 3” combination on mucosal barrier function, gut microbial composition and function, and antifungal colonization resistance in preclinical models of intestinal damage in vitro and in vivo and fecal microbiota transplantation. We found that CPX-351, at variance with “7 + 3” combination, protected from gut dysbiosis, mucosal damage, and gut morbidity while increasing antifungal resistance. Mechanistically, the protective effect of CPX-351 occurred through pathways involving both the host and the intestinal microbiota, namely via the activation of the aryl hydrocarbon receptor–interleukin-22 (IL-22)–IL-10 host pathway and the production of immunomodulatory metabolites by anaerobes. This study reveals how the gut microbiota may contribute to the good safety profile, with a low infection-related mortality, of CPX-351 and highlights how a better understanding of the host-microbiota dialogue may contribute to pave the way for precision medicine in AML.
A randomized phase 2 trial of oral vitamin A for graft-versus-host disease in children and young adults
Authors: Khandelwal Pooja , Langenberg Lucille , Luebbering Nathan , Lake Kelly E. , Butcher Abigail , Bota Kylie , Ramos Kristie N. , Taggart Cynthia , Choe Hannah , Vasu Sumithira , Teusink-Cross Ashley , Koo Jane , Wallace Gregory , Romick-Rosendale Lindsey , Watanabe-Chailland Miki , Haslam David B. , Lane Adam , Davies Stella M. 
Published: January 2024

Abstract
Vitamin A plays a key role in the maintenance of gastrointestinal homeostasis and promotes a tolerogenic phenotype in tissue resident macrophages. We conducted a prospective randomized double-blinded placebo-controlled clinical trial in which 80 recipients of hematopoietic stem cell transplantation (HSCT) were randomized 1:1 to receive pretransplant high-dose vitamin A or placebo. A single oral dose of vitamin A of 4000 IU/kg, maximum 250 000 IU was given before conditioning. The primary end point was incidence of acute graft-versus-host disease (GVHD) at day +100. In an intent-to-treat analysis, incidence of acute GVHD was 12.5% in the vitamin A arm and 20% in the placebo arm (P = .5). Incidence of acute gastrointestinal (GI) GVHD was 2.5% in the vitamin A arm (P = .09) and 12.5% in the placebo arm at day +180. Incidence of chronic GVHD was 5% in the vitamin A arm and 15% in the placebo arm (P = .02) at 1 year. In an “as treated” analysis, cumulative incidence of acute GI GVHD at day +180 was 0% and 12.5% in recipients of vitamin A and placebo, respectively (P = .02), and cumulative incidence of chronic GVHD was 2.7% and 15% in recipients of vitamin A and placebo, respectively (P = .01). The only possibly attributable toxicity was asymptomatic grade 3 hyperbilirubinemia in 1 recipient of vitamin A at day +30, which self-resolved. Absolute CCR9+ CD8+ effector memory T cells, reflecting gut T-cell trafficking, were lower in the vitamin A arm at day +30 after HSCT (P = .01). Levels of serum amyloid A-1, a vitamin A transport protein with proinflammatory effects, were lower in the vitamin A arm. The vitamin A arm had lower interleukin-6 (IL-6), IL-8, and suppressor of tumorigenicity 2 levels and likely a more favorable gut microbiome and short chain fatty acids. Pre-HSCT oral vitamin A is inexpensive, has low toxicity, and reduces GVHD. This trial was registered at www.ClinicalTrials.gov as NCT03202849.
The contemporary management of spontaneous pneumothorax in adults
Authors: Shorthose Matthew , Barton Eleanor , Walker Steven 
Published: January 2024

Spontaneous pneumothorax is a common presentation, and there has been a recent surge of research into the condition. With the recent publication of the new British Thoracic Society guidelines and the upcoming European Respiratory Society guidelines, we provide a concise up-to-date summary of clinical learning points. In particular we focus on the role of conservative or ambulatory management, as well as treatment options for persistent air leak and guidance for when to refer to thoracic surgeons for the prevention of the recurrence of pneumothorax.Educational aimsTo give up-to-date guidance on the acute management of spontaneous pneumothorax, including the role of conservative or ambulatory managementTo discuss the different treatment options for persistent air leak.To guide physicians on when to refer patients to thoracic surgeons for the prevention of the recurrence of pneumothorax.