bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family carers' experiences and perceived roles in interprofessional collaborative practice in primary care: A constructivist grounded theory study
Authors: Davidson Alexandra R. , Zigori Bekhinkosi D. , Ball Lauren , Morgan Mark , Gala Devanshi , Reidlinger Dianne P. 
Published: July 2023

AbstractBackgroundChronic conditions can lead to physical, cognitive and social decline; thus, increasing an individual's dependence on family who assist with activities of daily living. Interprofessional collaborative practice (IPCP), involving two or more health professionals working with the patient and their family, is one model of care for the high‐quality management of individuals with chronic conditions in primary care. Nevertheless, family carers have reported a disconnect between themselves and healthcare providers in previous research. This study aimed to explore the experiences and perspectives of family carers for individuals with chronic conditions, regarding their involvement in IPCP.MethodsAspects of constructivist grounded theory methodology were used. Family carers of individuals with chronic conditions were invited to participate in a one‐on‐one, semistructured interview about their experiences with IPCP in the care of their loved one. Interview transcripts were analysed using Charmaz's four‐step iterative process: (1) line‐by‐line coding, (2) focused coding, (3) categorisation of codes and (4) potential theme and subtheme development with memo writing to support each phase of analysis. The research team collaborated on reflexivity exercises, the conceptualisation of categories and the development of themes.ResultsConstructivist data analysis of interviews (average 40 min) with 10 family carers resulted in two themes. (1) Stepping in for my loved one represents the notion that carers take on external roles on behalf of their loved ones (subthemes: working with interprofessional teams, supporting independence and learning as I go). (2) Taking on the carer role, represents the internal factors that influence the external roles described in theme 1 (subthemes: feeling obligated to be involved and changing relationship dynamics).ConclusionThis study outlines the external actions and internal influences on family carer involvement in an interprofessional team. The required knowledge and support to care for their loved ones is currently learned in an ad hoc manner, and carers' resources should be better promoted by health professionals. Additionally, the relationship dynamics between a carer and their loved one change as the carer becomes more involved in IPCP and influences how and the extent health professionals involve family carers.Patient or Public ContributionCarers were the study population involved in this qualitative study. Patient advocates who have chronic conditions, and are informal family carers, were involved in the creation and design of this study, including a review of the research question, participant information sheet and the interview guide.
Women's experiences of care after stillbirth and obstetric fistula: A phenomenological study in Kenya
Authors: Nendela Anne , Farrell Sarah , Wakasiaka Sabina , Mills Tracey , Khisa Weston , Omoni Grace , Lavender Tina 
Published: August 2023

AbstractBackgroundStillbirth and (obstetric) fistula are traumatic life events, commonly experienced together following an obstructed labour in low‐ and middle‐income countries with limited access to maternity care. Few studies have explored women's experiences of the combined trauma of stillbirth and fistula.AimTo explore the lived experiences of women following stillbirth and fistula.MethodsQualitative, guided by Heideggerian phenomenology. Twenty women who had experienced a stillbirth were interviewed while attending a specialist Hospital fistula service in urban Kenya. Data were analysed following Van Manen's reflexive approach.ResultsThree main themes summarised participants' experiences: ‘Treated like an alien’ reflected the isolation and stigma felt by women. The additive and multiplying impacts of stillbirth and fistula and the ways in which women coped with their situations were summarised in ‘Shattered dreams’. The impact of beliefs and practices of women and those around them were encapsulated in ‘It was not written on my forehead’.ConclusionThe distress women experienced following the death of a baby was intensified by the development of a fistula. Health professionals lacked an understanding of the pathophysiology and identification of fistula and its association with stillbirth. Women were isolated as they were stigmatised and blamed for both conditions. Difficulty accessing follow‐up care meant that women suffered for long periods while living with a constant reminder of their baby's death. Cultural beliefs, faith and family support affected women's resilience, mental health and recovery. Specialist services, staff training and inclusive policies are needed to improve knowledge and awareness and enhance women's experiences.Patient or Public ContributionA Community Engagement and Involvement group of bereaved mothers with lived experience of stillbirth and neonatal death assisted with the review of the study protocol, participant‐facing materials and confirmation of findings.
Validation of the Croatian version of the short form of the Burnout Assessment Tool: Findings from a nationally representative sample
Authors: Tomas Jasmina , Maslić Seršić Darja , Mikac Una , Rebernjak Blaž , Buško Vesna , De Witte Hans 
Published: August 2023

AbstractBurnout poses severe health‐related and financial risks. However, valid and reliable measurement of this occupational phenomenon has been impeded by the conceptual, psychometric and pragmatical shortcomings of the extant burnout instruments. The Burnout Assessment Tool (BAT) is a new measure of burnout that was developed to overcome these deficiencies. The purpose of this study was to validate the Croatian version of its short form, BAT‐12, using a representative sample of the Croatian working population. To do so, we examined the factor structure and measurement invariance of BAT‐12 across gender, age, and occupational type, as well as convergent and discriminant data on BAT‐12 vis‐à‐vis an alternative burnout measure, the Oldenburg Burnout Inventory, job resources, job demands and job outcomes. The results obtained on online survey data from 966 employees supported the hierarchical structure of BAT‐12, although with slight modifications. We also found comparable loading structure across age, gender, and occupational type, whereas the intercept invariance depended on the moderator. Convergent and discriminant validity was supported in relation to all examined variables. Therefore, the psychometric soundness of the Croatian version of BAT‐12 adds new evidence to the current validation process of the BAT‐12 and supports the application of this measure on the Croatian working population.
Responses of rice cultivars with different cold tolerance to chilling in booting and flowering stages: An experiment in Northeast China
Authors: Ma Haoyu , Zhu Xi , Cao Tiehua , Li Shanlong , Guo Erjing , Shi Yanyin , Guan Kaixin , Li E. , Sun Ridan , Wang Xi , Li Tao , Zhang Tianyi , Yang Xiaoguang 
Published: July 2023

AbstractClimate change has led to an increasing trend in the intensity of global extreme weather events, including chilling. Breeding cultivars with high cold tolerance could be an important pathway to mitigate the negative effects of climate change. For rice, few studies have been focusing on the responses of different cold‐tolerance cultivars on chilling stress. In this study, we selected four japonica rice cultivars and conducted a chilling treatment experiment (with three chilling temperatures and three chilling durations) at the booting and flowering stages in 2020 and 2021 in Northeast China. The results showed that chilling treatment at the booting stage affected the biomass allocation and yield traits more than the chilling treatment at the flowering stage did. Overall, the chilling treatment affected the cold‐sensitive cultivars more than the cold‐tolerant cultivars. Among all the study yield traits, chilling treatment affected spikelet fertility the most, followed by the number of grains per panicle. For every 10°C day increase in CDD at the booting (flowering) stage, the grain yield per plant and spikelet fertility decreased by 4.8–12.8% and 3.6–10.8% (2.1–5.3% and 2.2–4.9%), respectively. Even with the intense chilling treatment, the cold‐tolerant cultivars had relatively high number of effective spikes per plant, grain weight, and stable spikelet fertility, hence they maintained relatively high grain yield. Therefore, it is important to factor in the cold tolerance of the cultivars when assessing the chilling effects on biomass allocation and yield traits for rice. In order to combat the negative effects of extremely low temperature at the reproductive stage on rice grain yield, the future breeding technology could focus on improving the spikelet fertility, grain filling size, and number of spikes per plant.
Noninvasive ECG imaging of the intrinsic atrial pacemaker and atrial activation in surgically repaired or palliated congenital heart disease
Authors: Moore Benjamin M. , Al‐Kaisy Ahmed , Joshi Subodh B. , Lui Elaine , Grigg Leanne E. , Kalman Jonathan M. 
Published: August 2023

AbstractIntroductionSinus node location, function, and atrial activation are often abnormal in patients with congenital heart disease (CHD), due to anatomical, surgical, and acquired factors. We aimed to perform noninvasive electrocardiographic imaging (ECGI) of the intrinsic atrial pacemaker and atrial activation in patients with surgically repaired or palliated CHD, compared with control patients with structurally normal hearts.Methods and ResultsAtrial ECGI was performed in eight CHD patients with prespecified diagnoses (Fontan circulation, dextro transposition of the great arteries post Mustard/Senning, tetralogy of Fallot), and three controls. Activation and propagation maps were constructed in presenting rhythm. Wavefront propagation was analyzed to identify (1) intrinsic atrial pacemaker breakout site, (2) morphological right atrial (RA) activation pattern, (3) morphological left atrial (LA) breakout sites (i.e., interatrial connections), (4) LA activation pattern, and (5) putative lines of block. Physiologically appropriate atrial activation and propagation maps were able to be constructed. In the majority of patients, atrial breakouts were in keeping with the sinus node, observed in a crescent‐shaped distribution from the anterior superior vena cava to the posterior RA. Ectopic atrial pacemaker sites were demonstrated in the atriopulmonary (AP) Fontan patient (very diffuse posterolateral RA) and Mustard patient (very posterior RA competing with a low RA focus). RA propagation was laminar in controls, but suggested either a line of block or conduction slowing consistent with an atriotomy scar in the tetralogy of Fallot (TOF) patients. Putative lines of block were more complex and RA propagation more abnormal in the atrial switch and AP Fontan patients, compared with the TOF patients. RA activation in the extracardiac Fontan patients was relatively laminar. Earliest LA breakout was most commonly observed in the region of Bachmann's Bundle in both controls and CHD patients, except for posterior LA breakouts in two patients. LA activation was typically more homogeneous than RA activation in CHD patients.ConclusionECGI can be utilized to create a noninvasive mapping model of atrial activation in postsurgical CHD, demonstrating atrial pacemaker location, putative lines of block and interatrial connections. Once validated invasively, this may have clinical implications in predicting risk of sinus node dysfunction and atrial arrhythmias, or in guiding catheter ablation.
Adjunct posterior wall isolation reduces the recurrence of atrial fibrillation in patients undergoing cryoballoon ablation: A systematic review and meta‐analysis
Authors: Mumtaz Mishal , Jabeen Sidra , Danial Ahmad , Chaychi Muhammad Tayyab Muzaffar , Zaheer Muhammad Kashan , Mumtaz Aymen , Mumtaz Tayebah , Herweg Bengt 
Published: August 2023

AbstractBackgroundRecurrence rates of atrial fibrillation (AF) remain high even after complete wide area circumferential pulmonary vein isolation (PVI). In recent years adjunct posterior wall isolation (PWI) has been performed in patients with more persistent forms of AF but the benefits remain unclear.AimThe objective of this meta‐analysis was to evaluate the efficacy of adjunct posterior wall isolation in reducing recurrence rates of AF using cryoballoon ablation (CBA).MethodsWe searched PubMed, Google Scholar, Clinicaltrials.gov and Cochrane CENTRAL. We included studies comparing PVI to PVI + PWI in patients with either persistent or paroxysmal AF (PAF) undergoing CBA. After data extraction and quality assessment of the studies, we assessed recurrence rates of atrial tachy‐arrhythmias (AF, atrial flutter, and atrial tachycardia) as well as total ablation time and procedural adverse events. Risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) were calculated using Review Manager.ResultsConcomitant PWI exhibited a substantial reduction in the risk of AF recurrence (RR: 0.51; 95% CI: 0.42–0.63, p < .00001), as well as all atrial arrhythmias (RR: 0.58; 95% CI: 0.49–0.68, p < .00001). On subgroup analysis, in patients with only PAF, adjunct PWI resulted in significant reduction in recurrence risk of AF (RR: 0.56; 95% CI: 0.41–0.76, p = .0002) as well. There was no significant difference in adverse events between both groups (RR: 0.90; 95% CI: 0.44–1.86; p = .78), whereas total ablation time was significantly increased in PVI + PWI group (MD: 21.75; 95% CI: 11.13–32.37, p < .0001).ConclusionAdjunct PWI when compared to PVI alone decreases recurrence rates of atrial fibrillation after CBA of patients with persistent as well as paroxysmal atrial fibrillation.
miR‐221‐3p targets Ang‐2 to inhibit the transformation of HCMECs to tip cells
Authors: Yang Peng , Yang Qing , Yang Yiheng , Tian Qingshan , Zheng Zhenzhong 
Published: August 2023

AbstractPostembryonic angiogenesis is mainly induced by various proangiogenic factors derived from the original vascular network. Previous studies have shown that the role of Ang‐2 in angiogenesis is controversial. Tip cells play a vanguard role in angiogenesis and exhibit a transdifferentiated phenotype under the action of angiogenic factors. However, whether Ang‐2 promotes the transformation of endothelial cells to tip cells remains unknown. Our study found that miR‐221‐3p was highly expressed in HCMECs cultured for 4 h under hypoxic conditions (1% O2). Moreover, miR‐221‐3p overexpression inhibited HCMECs proliferation and tube formation, which may play an important role in hypoxia‐induced angiogenesis. By target gene prediction, we further demonstrated that Ang‐2 was a downstream target of miR‐221‐3p and miR‐221‐3p overexpression inhibited Ang‐2 expression in HCMECs under hypoxic conditions. Subsequently, qRT‐PCR and western blotting methods were performed to analyse the role of miR‐221‐3p and Ang‐2 on the regulation of tip cell marker genes. MiR‐221‐3p overexpression inhibited CD34, IGF1R, IGF‐2 and VEGFR2 proteins expression while Ang‐2 overexpression induced CD34, IGF1R, IGF‐2 and VEGFR2 expression in HCMECs under hypoxic conditions. In addition, we further confirmed that Ang‐2 played a dominant role in miR‐221‐3p inhibitors promoting the transformation of HCMECs to tip cells by using Ang‐2 shRNA to interfere with miR‐221‐3p inhibitor‐treated HCMECs under hypoxic conditions. Finally, we found that miR‐221‐3p expression was significantly elevated in both serum and myocardial tissue of AMI rats. Hence, our data showed that miR‐221‐3p may inhibit angiogenesis after acute myocardial infarction by targeting Ang‐2 to inhibit the transformation of HCMECs to tip cells.
Unveiling the interplay between evidence, values and cognitive biases. The case of the failure of the AstraZeneca COVID‐19 vaccine
Authors: Amoretti M. Cristina , Lalumera Elisabetta 
Published: July 2023

AbstractThis paper depicts a Covid science case, that of the AstraZeneca Vaxzevria vaccine, with specific focus on what happened in Italy. Given that we believe acknowledging the role of non‐evidential factors in medicine is an important insight into the recent philosophy of science, we illustrate how in the case of Vaxzevria, the interplay between facts, values (both epistemic and non‐epistemic) and cognitive biases may have possibly led to different institutional decisions based on the same evidence. The structure of the paper is as follows. First, we provide a glossary of the relevant terms involved, that is to say, epistemic values, non‐epistemic values and cognitive biases. Second, we sketch a timeline of Vaxzevria's approvals and suspensions by relevant institutional healthcare authorities with special focus on Italy and the Italian Medicines Agency. Then we show the interplay between the evidence base, epistemic as well as non‐epistemic values and cognitive biases using a narrative review of political decisions along with newspaper and social media content pertaining to Vaxzevria. We briefly compare Italy with other European countries to show that different political decisions were made on the basis of the same evidence.
Relative billing complexity of in‐person versus telehealth outpatient encounters
Authors: Chen Kevin , Zhang Christine , Jackson Hannah B. 
Published: July 2023

AbstractRationaleVideo visits became more widely available during the coronavirus disease (COVID‐19) pandemic. However, the ongoing role and value of video visits in care delivery and how these may have changed over time are not well understood.Aims and ObjectivesCompare the relative complexity of in‐person versus video visits during the COVID‐19 pandemic and describe the complexity of video visits over time.MethodsWe used billing data for in‐person and video revisits from non‐behavioural health specialities with the most video visit utilisation (≥50th percentile) at a large, urban, public healthcare system from 1 January 2021 to 31 March 2022. We used current procedural terminology (CPT) codes as a proxy for information gathering and decision‐making complexity and time spent on an encounter. We compared the distribution of CPT codes 99211–99215 between in‐person and video visits using Fisher's exact tests. We used Spearman correlation to test for trends between proportions of CPT codes over time for video visits.ResultsTen specialities (adult primary care, paediatrics, adult dermatology, bariatric surgery, paediatric endocrinology, obstetrics and gynaecologist, adult haematology/oncology, paediatric allergy/immunology, paediatric gastroenterology, and paediatric pulmonology) met inclusion criteria. For each speciality, proportions of each CPT code for in‐person visits and for video visits varied significantly, and patterns of variation differed by speciality. For example, in adult primary care, video visits had smaller proportions of moderate/high complexity visits (99214 and 99215) and greater proportions of lower complexity visits (99211–99213) compared with in‐person visits (p < 0.001), but in paediatric endocrinology, the opposite was seen (p < 0.001). Trends in CPT codes over time for video visits in each speciality were also mixed.ConclusionIn‐person and video visits had differing proportions of complexity codes (typically skewing towards lower complexity for video visits). The complexity of video visits changed over time in many specialities. Observed patterns for both phenomena varied by speciality.
Contrasting epistemologies: Biomedicine, narrative medicine and indigenous story medicine
Authors: Neilson Shane 
Published: August 2023

AbstractBackgroundNarrative Medicine (NM) and Indigenous Story Medicine both use narrative to understand and effect health, but their respective conceptualizations of narrative differ.AimsI contrast the concept of narrative in NM with that of Indigenous Story Medicine.Materials and MethodsThe article relies Western narrative theorists as well as Indigenous epistemologists to frame a discussion‐by‐contrast of the Judeo‐Christian creation myth with a Haundenosaunee Creation Story.ResultsI demonstrate that the deficiencies of Narrative Medicine exist because the latter's use of narrative is a mere application in an otherwise reductive field, whereas Indigenous epistemologies rely on story as medicine itself.DiscussionOMIT.ConclusionI call for more scholars to take up different narratives to further investigate the ethical space between NM and Indigenous Story Medicine.
Aggressive end‐of‐life care across gradients of cognitive impairment in nursing home patients with metastatic cancer
Authors: Koroukian Siran M. , Douglas Sara L. , Vu Long , Fein Hannah L. , Gairola Richa , Warner David F. , Schiltz Nicholas K. , Cullen Jennifer , Owusu Cynthia , Sajatovic Martha , Rose Johnie 
Published: July 2023

AbstractBackgroundStudies examining end‐of‐life (EOL) care in older cancer patients are scarce, and prior studies have not accounted for gradients of cognitive impairment (COG‐I). We examine EOL care patterns across COG‐I gradients, hypothesizing that greater COG‐I severity is associated with lower odds of receiving aggressive EOL care.MethodsUsing data from the linked Surveillance Epidemiology and End Results (SEER) ‐Medicare ‐Minimum Data Set (MDS) 3.0, we identified patients with nursing facility stays (NFS) and who died with metastatic cancer from 2013 to 2017. Markers of aggressive EOL care were: cancer‐directed treatment, intensive care unit admission, >1 emergency department visit, or >1 hospitalization in the last 30 days of life, hospice enrollment in the last 3 days of life, and in‐hospital death. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to evaluate the independent association between COG‐I severity and receipt of aggressive EOL care.ResultsOf the 40,833 patients in our study population, 49.2% were cognitively intact; 24.4% had mild COG‐I; 19.7% had moderate COG‐I; and 6.7% had severe COG‐I. The percent of patients who received aggressive EOL care was 62.6% and 74.2% among those who were cognitively intact and those with severe COG‐I, respectively. Compared with cognitively intact patients, those with severe COG‐I had 86% higher odds of receiving any type of aggressive EOL care (adjusted odds ratio (aOR): 1.86 (95% confidence interval: 1.70–2.04)), which were primarily associated with higher odds of in‐hospital death. The odds of in‐hospital death associated with severe COG‐I were higher among those with short‐ than with long‐term stays (aOR:2.58 (2.35–2.84) and aOR:1.40 (1.17–1.67), respectively).ConclusionsContrary to our hypothesis, aggressive EOL care in older metastatic cancer patients with NFS was highest among those suffering severe COG‐I. These findings can inform the development of interventions to help reduce aggressive EOL care in this patient population.