bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘It breaks a narrative of paramedics, that we’re lifesavers’: A qualitative study of health professionals’, bereaved family members’ and carers’ perceptions and experiences of palliative paramedicine
Authors: Juhrmann Madeleine L , Butow Phyllis N , Platts Cara M , Simpson Paul , Boughey Mark , Clayton Josephine M 
Published: July 2023

Background: Paramedic practice is diversifying to accommodate evolving global health trends, including community paramedicine models and growing expertise in palliative and end-of-life care. However, despite palliative care specific clinical practice guidelines and existing training, paramedics still lack the skills, confidence and clinical support to provide this type of care. Aim: To elicit paramedics’, palliative care doctors and nurses’, general practitioners’, residential aged care nurses’ and bereaved families and carers’ experiences, perspectives, and attitudes on the role, barriers and enablers of paramedics delivering palliative and end-of-life care in community-based settings. Design: A qualitative study employing reflexive thematic analysis of data collected from semi-structured online interviews was utilised. Setting/participants: A purposive sample of 50 stakeholders from all Australian jurisdictions participated. Results: Five themes were identified: positioning the paramedic (a dichotomy between the life saver and community responder); creating an identity (the trusted clinician in a crisis), fear and threat (feeling afraid of caring for the dying), permission to care (seeking consent to take a palliative approach) and the harsh reality (navigating the role in a limiting and siloed environment). Conclusion: Paramedics were perceived to have a revered public identity, shaped by their ability to fix a crisis. However, paramedics and other health professionals also expressed fear and vulnerability when taking a palliative approach to care. Paramedics may require consent to move beyond a culture of curative care, yet all participant groups recognised their important adjunct role to support community-based palliative care.
Preparation and in vitro characterization studies of astaxanthin-loaded nanostructured lipid carriers with antioxidant properties
Authors: Gu Liyuan , Wang Wenjuan , Wu Bi , Ji Suping , Xia Qiang 
Published: July 2023

The purpose of this study was to evaluate the astaxanthin-loaded nanostructured lipid carriers (ASX-NLC) prepared using a high-pressure homogenization transport system for local application of astaxanthin. Dynamic light scattering (DLS) and X-ray diffraction (XRD) were used to study the effect of microencapsulation on the properties of ASX-NLC. The mean size of ASX-NLC was about 108.43 ± 0.26 nm and PdI was 0.176 ± 0.002. The ASX-NLC had high encapsulation efficiency which was 95.69 ± 0.13%. Good light stability and temperature stability were shown at the ASX-NLC, indicating that the preparation process was feasible. The 2,2-diphenyl-1-pyridylohydrazinyl (DPPH) scavenging test showed that ASX-NLC could still play an antioxidant role. In vitro release studies showed that compared with an astaxanthin ethanol solution, an ASX-NLC could maintain astaxanthin release more effectively. In vitro permeation studies showed that ASX-NLC could increase astaxanthin retention in the skin. In conclusion, ASX-NLC could significantly enhance astaxanthin accumulation during dermal applications. The research results have important reference significance for local skin applications and provide a basis for the development of nanostructured lipid carriers. ASX-NLC might be suitable carriers for the local application of astaxanthin.
Assessing the Impact of Immersion on Learning in Medical Students: A Pilot Study Comparing Two-Dimensional and Three-Dimensional Virtual Simulation
Authors: Bray Lucy , Spencer Sebastian , Pearson Emma , Meznikova Katerina , Hepburn David 
Published: July 2023

Introduction Virtual simulation within health professions education can be categorized as two-dimensional or three-dimensional, dependent upon how users interact with the scenario. A core difference between these two categories is the degree of immersion experienced by the user. The importance of immersion for knowledge-based learning is unclear. Hence, this pilot study compares two virtual simulators to determine the impact of immersion on knowledge acquisition and retention and user experience. Methods This randomized crossover trial consisted of 25 fifth-year medical students attending two consecutive teaching sessions using two-dimensional and three-dimensional virtual simulation, respectively. Multiple-choice questions, completed immediately before and after, and one-month after the sessions, were employed to determine knowledge acquisition and retention. Questionnaires, consisting of Likert-scale and open-ended questions, evaluated user experience. Quantitative data was analyzed using a Student’s t-test and qualitative data was analyzed using thematic analysis. Results Both interventions demonstrated statistically significant levels of knowledge acquisition and retention, though there was no significant difference in the extent of learning between the simulators. The two interventions offered valuable and acceptable approaches to virtual simulation, though Likert-scale responses indicated that participants significantly preferred three-dimensional virtual simulation. Free-form responses revealed themes of education and technology, with subthemes of desirability, learning, curriculum integration, fidelity, hardware and software. Conclusions The findings indicate that higher levels of immersion do not appear to offer greater educational benefit, with two-dimensional simulation possibly offering an equally valuable learning experience to three-dimensional simulation. Participants appeared to significantly prefer three-dimensional virtual simulation, though potential uses for both simulators were identified.
Appraising the Quality of Reporting of Vascular Surgery Studies That Use the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database
Authors: Mirzaie Amin A. , Ueland Walker R. , Lambert Katherine A. , Delgado Amanda M. , Rosen Jordan W. , Valdes Carlos A. , Scali Salvatore T. , Huber Thomas S. , Upchurch Gilbert R. , Shah Samir K. 
Published: July 2023

Objective The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is an important data source for observational studies. While there are guides to ensure appropriate study reporting, there has been no evaluation of NSQIP studies in vascular surgery. We sought to evaluate the adherence of vascular-surgery related NSQIP studies to best reporting practices. Methods In January 2022, we queried PubMed for all vascular surgery NSQIP studies. We used the REporting of studies Conducted using Observational Routinely-collected Health Data (RECORD) statement and the JAMA Surgery (JAMA-Surgery) checklist to assess reporting methodology. We also extracted the Journal Impact Factor (IF) of each article. Results One hundred and fifty-nine studies published between 2002 and 2022 were identified and analyzed. The median score on the RECORD statement was 6 out of 8. The most commonly missed RECORD statement items were describing any validation of codes and providing data cleaning information. The median score on the JAMA-Surgery checklist was 2 out of 7. The most commonly missed JAMA-Surgery checklist items were identifying competing risks, using flow charts to help visualize study populations, having a solid research question and hypothesis, identifying confounders, and discussing the implications of missing data. We found no difference in the reporting methodology of studies published in high vs low IF journals. Conclusion Vascular surgery studies using NSQIP data demonstrate poor adherence to research reporting standards. Critical areas for improvement include identifying competing risks, including a solid research question and hypothesis, and describing any validation of codes. Journals should consider requiring authors use reporting guides to ensure their articles have stringent reporting methodology.
How Institution of the Sup-ER Protocol in a Clinic Changed Procedure Patterns in Upper Brachial Plexus (Erb’s Type) Birth Injuries
Authors: Wong Vanessa Choi Yin , Balumuka Darius , Tuen Young Ji , Bucevska Marija , Courtemanche Rebecca , Durlacher Kim , Bellows Doria , Hynes Sally , Verchere Cynthia 
Published: July 2023

Background: For children with upper brachial plexus birth injury (BPBI; C5, C6, ±C7 roots), most clinics first recommend nonsurgical treatment followed by primary and/or secondary surgical interventions in selected patients. Since 2008, we have used an infant shoulder repositioning protocol (supination-external rotation [Sup-ER]) designed to prevent shoulder internal rotation contracture and its potential effects on the shoulder joint. This study characterizes our clinic’s current choice, number, and timing of primary and secondary procedural interventions (including Botox) and compares Sup-ER protocol patients with those of our historical controls. Methods: The records of all patients with upper BPBI who underwent procedures from 2001 to 2018 were retrospectively reviewed and grouped into a historical (2001-2007, n = 20) and recent (2008-2018, n = 23) cohort. Patient demographics, procedure types and timing, and functional outcomes were collected and analyzed. Results: Since the 2008 institution of the Sup-ER protocol, fewer brachial plexus exploration and grafting (BPEG) surgeries were performed and none in later infancy, where nerve transfers were preferred. There were more and earlier Botox injections. There were fewer tendon transfers, and the preoperative indications were from a higher level of function. Conclusions: We now see fewer indications for BPEG surgeries overall. After the 3-month-age group, more direct nerve transfers are indicated instead of the BPEG surgery if nerve surgery is required at all. Shoulder tendon transfer rates have decreased. Humeral osteotomies are not seen in our recent group. Glenoid osteotomies within tendon transfers are rare in both groups.
The Suitability and Acceptability of the Think-Aloud Method to Aboriginal and Torres Strait Islander Adults
Authors: Gall Alana , Howard Kirsten , Anderson Kate , Diaz Abbey , Garvey Gail 
Published: July 2023

Background There is a long history of research being conducted on Aboriginal and Torres Strait Islander peoples that has offered questionable benefit but occasioned great distress and distrust. Using research methods that are suitable and acceptable to Aboriginal and Torres Strait Islander peoples is a critically important step towards restoring trust and improving the accessibility and relevancy of research that better addresses the needs of Aboriginal and Torres Strait Islander peoples. The current research aims to qualitatively evaluate Aboriginal and Torres Strait Islander peoples’ perceptions of the suitability and acceptability of engaging in a think-aloud interview embedded in an individual yarn; a think-aloud yarn. Methods We employed the think-aloud method as part of the larger What Matters 2Adults study. Aboriginal and Torres Strait Islander participants were engaged in a think-aloud yarn, then immediately following, a follow-up yarn to explore the acceptability of the think-aloud method. The follow-up yarns were audio recorded, transcribed verbatim, and analysed utilising reflexive thematic analysis with an Indigenous epistemological lens. Results A total of 17 Aboriginal and Torres Strait Islander adults participated in our study. Participants reported that taking part in the think-aloud yarn was acceptable, not difficult and was less onerous than writing down their thoughts. Engaging participants in a social yarn before the think-aloud research yarn ensured they were comfortable verbalising and assured them that the process was confidential. Thinking out loud gave participants the opportunity to reflect and to think critically about their responses. Some found that by thinking out loud they were able to better understand the statements in their own mind and felt they were therefore able to provide a more authentic response. Because of these benefits, participants conveyed that the think-aloud yarn is a vitally important component in testing items and developing measures for Aboriginal and Torres Strait Islander people. Conclusions Overall, our study found that the think-aloud yarn is acceptable to Aboriginal and Torres Strait Islander peoples and therefore a suitable method for use in studies that involve them.
SARS-CoV-2 breakthrough infections after COVID-19 vaccination in patients with inflammatory bowel disease: a systematic review and meta-analysis
Authors: van de Pol Natasja , Pan Qiuwei , Derikx Lauranne A. A. P. , Bakker Linda , van der Woude C. Janneke , de Vries Annemarie C. 
Published: July 2023

Background: Patients with inflammatory bowel disease (IBD) have an attenuated serologic response to COVID-19 vaccination. It is unclear whether an impaired immune response in vaccinated IBD patients impacts the susceptibility to SARS-CoV-2 infection and occurrence of severe COVID-19. Objectives: To evaluate SARS-CoV-2 breakthrough infection rates and the disease course of COVID-19 in vaccinated IBD patients. Design: A systematic literature search and meta-analysis was performed. Data sources and methods: The search was performed in Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and CINAHIL. The articles were independently screened and selected by two reviewers. A random-effects model was used to calculate the pooled relative risk for breakthrough infections in vaccinated IBD patients and controls. Results: A total of 16 studies were included, with study periods ranging from January 2020 to October 2021 and follow-up time from 3 weeks to 6 months. The breakthrough infection rates range from 0 to 37.4% in vaccinated IBD patients. The disease course of COVID-19 was generally mild, with low hospitalization and mortality rates (0–8.7% and 0–4.3%, respectively). Vaccinated IBD patients had a significantly lower relative risk of breakthrough infection rate compared to unvaccinated controls (risk ratio: 0.07, 95% CI: 0.03–0.18). No difference was observed between IBD patients and non-IBD controls, and between partially and fully vaccinated IBD patients. The impact of immunosuppressive therapy on breakthrough infection rates differs between studies. Most studies showed no impact from immunosuppressive treatment, anti-tumour necrosis factor alpha or corticosteroids and other biologics; one study reported higher rates for patients treated with infliximab versus vedolizumab. Conclusion: Vaccination is effective to prevent COVID-19 infections in patients with IBD. Breakthrough infections do occur, but the disease course is generally mild. Available data seem to suggest a declining trend of breakthrough infections during calendar time. Registration: The protocol was published in the PROSPERO database (CRD42021292853).
Standardized management of pediatric abdominal pain admissions improves patient outcomes – A quality improvement project
Authors: Lu Lok Hui , Arbab Hana , Cheng Choo Suet , Yin Ong Lin , Caroline Ong Choo Phaik 
Published: July 2023

Background Children commonly present at the emergency department with abdominal pain and it is challenging to identify urgent surgical conditions. An audit conducted at a tertiary children’s hospital showed that 70% of patients admitted to Department of Pediatric Surgery (PAS) for abdominal pain had non-surgical diagnoses and wide variation in management. Objective Our quality improvement (QI) project aimed to reduce length of stay (LOS) and unnecessary investigations performed for patients admitted to PAS with abdominal pain, without causing complications or delayed diagnosis of surgical conditions. Methods The QI project consists of a standardised management workflow with stringent discharge criteria. We reviewed outcome measures of LOS, number of investigations ordered, compliance to workflow and readmission within 1-week post discharge at the end of each Plan-Do- Study-Act (PDSA) cycle and iteratively improved the workflow following QI principles. Results 61% of patients were admitted to PAS for non-surgical abdominal pain throughout three PDSA cycles conducted. The third cycle showed improved compliance to workflow (80.7%) with reduced median LOS by 1 day, reduced median number of blood, stool and urine investigations by 1 and reduced range of investigations ordered. Readmission and CE attendance rate 1 week after discharge was 1.6% ( n = 3), which was comparable to audit at 2.3% ( n = 4), p = 0.709. Conclusion The workflow reduced LOS, number of unnecessary investigations and variability in investigations ordered, without causing misdiagnosis. It improved patient experience with sizeable cost savings for the patient and the hospital. QI projects can improve patient outcomes by introducing standard protocols that aid clinical management.
Designing a flow-controlled STA-MCA anastomosis based on the Hagen–Poiseuille law for preventing postoperative hyperperfusion in adult moyamoya disease
Authors: Hu Miao , Yu Jin , Zhang Jianjian , Chen Jincao 
Published: July 2023

Background: Technical improvements for preventing postoperative symptomatic cerebral hyperperfusion (CHP) during superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD) were seldom reported. Objectives: The aim of this study was to investigate the significance of application of a novel flow-controlled concept which voluntarily reduces the hemodynamic difference between the donor and recipient arteries based on the Hagen–Poiseuille law when performing direct anastomoses of recipient parasylvian cortical arteries (PSCAs) with anterograde hemodynamic sources from the MCA (M-PSCAs) in adult MMD. Design: This was a retrospective observational study. Methods: Direct anastomoses of recipient M-PSCAs were performed on 89 symptomatic hemispheres in 82 adult MMD patients in our hospital from January 2020 to June 2021. They were divided into the flow-controlled group (patients who received direct anastomosis under designed flow-controlled principles) and non-flow-controlled group (patients who received conventional direct anastomosis to obtain maximum flow). The patients’ basic characteristics and incidence of postoperative CHP were compared between the two groups. Risk factors for occurrence of postoperative CHP were analyzed. Results: Overall, 36 hemispheres were included in the non-flow-controlled group and 53 in flow-controlled group. The incidences of postoperative focal (22.6%) and symptomatic CHP (5.7%) in the flow-controlled group were significantly lower than those (focal, 52.8%; symptomatic, 25.0%) in the non-flow-controlled group ( p = 0.003 and 0.009, respectively). Multivariate analysis revealed that the flow-controlled concept was significantly associated with the development of focal ( p = 0.005) and symptomatic ( p = 0.012) CHP. Conclusion: The flow-controlled STA-MCA anastomosis can significantly decrease the incidence of postoperative CHP during direct anastomoses of recipient M-PSCAs in adult MMD.
Phase II randomised, placebo-controlled, clinical trial of interleukin-1 receptor antagonist in intracerebral haemorrhage: BLOcking the Cytokine IL-1 in ICH (BLOC-ICH)
Authors: Parry-Jones Adrian R , Stocking Katie , MacLeod Mary Joan , Clarke Brian , Werring David J , Muir Keith W , Vail Andy 
Published: July 2023

Purpose: Recombinant human interleukin-1 receptor antagonist (anakinra) is an anti-inflammatory with efficacy in animal models of stroke. We tested the effect of anakinra on perihaematomal oedema in acute intracerebral haemorrhage (ICH) and explored effects on inflammatory markers. Methods: We conducted a multicentre, randomised, double-blind, placebo-controlled trial in patients with acute, spontaneous, supratentorial ICH between May 2019 and February 2021. Patients were randomised to 100 mg subcutaneous anakinra within 8 h of onset, followed by five, 12-hourly, 100 mg subcutaneous injections, or matched placebo. Primary outcome was oedema extension distance (OED) on a 72 h CT scan. Secondary outcomes included plasma C-reactive protein (CRP) and interleukin-6 (IL-6). Findings: 25 patients (target = 80) were recruited, 14 randomised to anakinra, 11 to placebo. Mean age was 67 and 52% were male. The anakinra group had higher median baseline ICH volume (12.6 ml, interquartile range[IQR]:4.8–17.9) versus placebo (5.5 ml, IQR:2.1–10.9). Adjusting for baseline, 72 h OED was not significantly different between groups (mean difference OED anakinra vs placebo -0.05 cm, 95% confidence interval [CI]: −0.17–0.06, p = 0.336). There was no significant difference in area-under-the-curve to Day 4 for IL-6 and CRP, but a post-hoc analysis demonstrated IL-6 was 56% (95% CI: 2%–80%) lower at Day 2 with anakinra. There were 10 and 2 serious adverse events in anakinra and placebo groups, respectively, none attributed to anakinra. Conclusion: We describe feasibility for delivering anakinra in acute ICH and provide preliminary safety data. We lacked power to test for effects on oedema thus further trials will be required.
Notch signaling pathway: a new target for neuropathic pain therapy
Authors: Zhang Yan , Wang Tingting , Wu Sanlan , Tang Li , Wang Jia , Yang Jinghan , Yao Shanglong , Zhang Yan 
Published: July 2023

AbstractThe Notch gene, a highly evolutionarily conserved gene, was discovered approximately 110 years ago and has been found to play a crucial role in the development of multicellular organisms. Notch receptors and their ligands are single-pass transmembrane proteins that typically require cellular interactions and proteolytic processing to facilitate signal transduction. Recently, mounting evidence has shown that aberrant activation of the Notch is correlated with neuropathic pain. The activation of the Notch signaling pathway can cause the activation of neuroglia and the release of pro-inflammatory factors, a key mechanism in the development of neuropathic pain. Moreover, the Notch signaling pathway may contribute to the persistence of neuropathic pain by enhancing synaptic transmission and calcium inward flow. This paper reviews the structure and activation of the Notch signaling pathway, as well as its potential mechanisms of action, to provide novel insights for future treatments of neuropathic pain.