bluuebunny/crossref_metadata_2025_split huggingface dataset:
Providing Legal Assisted Dying and Euthanasia Services in a Global Pandemic: Lessons for Ensuring Service Continuity
Authors: Oliver Pam , Wilson Michael , McLaren Cameron , Jonquiere Rob 
Published: April 2022

Background & objectives: Identifying the impacts of COVID-19 on patients’ and practitioners’ access to legal assisted dying and euthanasia (AD&E) services is vital to informing service continuity in an ongoing pandemic. Methods: An anonymous online survey collected qualitative and quantitative data from health practitioners and agencies providing legal AD&E services ( n = 89), complemented by semi-structured interviews with 18 survey respondents who volunteered. Results: Following governments’ responses to the dynamic pandemic context, rates of AD&E inquiries and requests fluctuated across and within jurisdictions, based on a complex interaction of factors affecting patient access to AD&E agencies and assessors as services were disrupted. Service flexibility and nimbleness became key elements in continuing service availability and included calculated ‘rule-breaking’ considered justifiable to adhere to established bioethics. Making innovative adjustments to usual practice led to reviewing the effectiveness of AD&E services and laws, resulting in providers now improving services and lobbying for legislative change.
The development and psychometric properties of a measure to assess the written submission of an admissions application
Authors: Stier Jill , Cameron Jill , Nowrouzi-Kia Behdin , Brammer Chantel , Asher Sara , Lipszyc Deborah 
Published: April 2022

Introduction Health care programs evaluate prospective applicants using cognitive and non-cognitive criteria. The aim of this research was to develop and evaluate the psychometric properties of a measure to evaluate the non-cognitive criteria of admissions applications. Method A Masters of Occupational Therapy Written Submission Measure (MOTWSM) was developed and evaluated over 3 phases, using applicants’ written statements, resumes, and reference letters. Participants included 50 students who completed an occupational therapy program for determination of internal consistency and test-retest reliability. Additionally, 195 written submissions selected from the applicants who were admitted, waitlisted, and not admitted to the program were evaluated to determine inter-rater reliability using a two-way ANOVA. Analysis of 195 submissions using a one-way ANOVA determined the measure’s discriminative validity. Findings Results indicated test-retest reliability of 0.95 and internal consistency reliability of 0.76. Inter-rater reliability reported a Cronbach’s alpha coefficient of 0.86 using a horizontal scoring method. Good discriminative validity was established. Conclusion The MOTWSM is a reliable and valid measure that can be used to evaluate the non-cognitive criteria of admissions applications in health profession programs. Use of this measure can facilitate selection of the highest caliber of students.
Evaluation of Low-Dose Aspirin use among Critically Ill Patients with COVID-19: A Multicenter Propensity Score Matched Study
Authors: Al Harthi Abdullah F. , Aljuhani Ohoud , Korayem Ghazwa B. , Altebainawi Ali F. , Alenezi Raghdah S. , Al Harbi Shmeylan , Gramish Jawaher , Kensara Raed , Hafidh Awattif , Al Enazi Huda , Alawad Ahad , Alotaibi Rand , Alshehri Abdulaziz , Alhuthaili Omar , Vishwakarma Ramesh , bin Saleh Khalid , Alsulaiman Thamer , Alqahtani Rahaf Ali , Hussain Sajid , Almazrou Saja , Al Sulaiman Khalid 
Published: April 2022

Background Aspirin is widely used as a cardioprotective agent due to its antiplatelet and anti-inflammatory properties. The literature has assessed and evaluated its role in hospitalized COVID-19 patients. However, no data are available regarding its role in COVID-19 critically ill patients. This study aimed to evaluate the use of low-dose aspirin (81-100 mg) and its impact on outcomes in critically ill patients with COVID-19. Method A multicenter, retrospective cohort study of all critically ill adult patients with confirmed COVID-19 admitted to intensive care units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were classified into two groups based on aspirin use during ICU stay. The primary outcome was in-hospital mortality, and other outcomes were considered secondary. Propensity score matching was used (1:1 ratio) based on the selected criteria. Results A total of 1033 patients were eligible, and 352 patients were included after propensity score matching. The in-hospital mortality (HR 0.73 [0.56, 0.97], p = 0.03) was lower in patients who received aspirin during stay. Conversely, patients who received aspirin had a higher odds of major bleeding than those in the control group (OR 2.92 [0.91, 9.36], p = 0.07); however, this was not statistically significant. Additionally, subgroup analysis showed a possible mortality benefit for patients who used aspirin therapy prior to hospitalization and continued during ICU stay (HR 0.72 [0.52, 1.01], p = 0.05), but not with the new initiation of aspirin (HR 1.22 [0.68, 2.20], p = 0.50). Conclusion Continuation of aspirin therapy during ICU stay in critically ill patients with COVID-19 who were receiving it prior to ICU admission may have a mortality benefit; nevertheless, it may be associated with an increased risk of significant bleeding. Appropriate evaluation for safety versus benefits of utilizing aspirin therapy during ICU stay in COVID19 critically ill patients is highly recommended.
Exploring the Changes in Code Status During the COVID-19 Pandemic and the Implications for Future Pandemic Care
Authors: Katamreddy Adarsh , Ye Alexander M. , Vorchheimer David A. , Hardoon Isaac , Faillace Robert T. , Taub Cynthia C. 
Published: April 2022

Objective: We aim to explore patterns of inpatient code status during the COVID-19 pandemic compared with a similar timeframe the previous year, as well as utilization of palliative care services. Methods: This is a retrospective cohort study using data from the Montefiore Health system of all inpatient admissions between March 15-May 31, 2019 and March 15-May 31, 2020. Univariate logistic regression was performed with full code status as the outcome. All statistically significant variables were included in the multivariable logistic regression. Results: The total number of admissions declined during the pandemic (16844 vs 11637). A lower proportion of patients had full code status during the pandemic (85.1% vs 94%, P < .001) at the time of discharge/death. There was a 20% relative increase in the number of palliative care consultations during the pandemic (12.2% vs 10.5%, P < .001). Intubated patients were less often full code (66.5% vs 82.2%, P < .001) during the pandemic. Although a lower portion of COVID-19 positive patients had a full code status compared with non-COVID patients (77.6% vs 92.4%, P<.001), there was no statistically significant difference in code status at death (38.3% vs 38.3%, P = .96). Conclusions: The proportion of full code patients was significantly lower during the pandemic. Age and COVID status were the key determinants of code status during the pandemic. There was a higher demand for palliative care services during the pandemic.
The Effect of Nursing Management of Patients Undergoing Interventional Therapy for Liver Cancer Compared with Standard Care on Patient-Reported Outcomes
Authors: Wang Xiu-Bei , Sun Ling-Fang , Niu Mei-E , Cai Jian-Zheng , Wang Hai-Fang 
Published: April 2022

Background: To investigate the efficacy of individualized symptom management based on patients’ self-reports during interventional therapy (IT) for liver cancer. Methods: Patients with liver cancer who recieved IT from April to August 2019 were assigned to either the intervention ( n=70) or control group ( n=70). The control group received routine nursing care and the intervention group received a nursing management program. The severity of specific symptoms, as measured by the Karnofsky Performance Scale (KPS), and satisfaction with nursing care, were analyzed. Results: Compared to the control group, patients given individualized management experienced significantly less severe pain, nausea, anxiety, and fatigue ( p < .05). The scores for KPS and satisfaction with care were both significantly improved in the intervention group than in the control group ( p < .05). Conclusion: This high-quality nursing management program predicated on patients’ self-reports is worthy of clinical application and popular adoption.
Evaluation of macular function and morphology following accelerated collagen cross-linking in progressive keratoconus
Authors: Dettoraki M , Droutsas K , Lazaridis A , Moschos MM 
Published: April 2022

Purpose To assess any changes in macular function and morphology in patients with progressive keratoconus undergoing accelerated corneal cross-linking (CXL). Methods This prospective case series included 9 eyes of 8 patients with progressive keratoconus undergoing CXL using a high intensity accelerated protocol (9 mW/cm2 for 14 min) with a total surface dose of 7.5 J/cm2. Visual acuity assessment, slit lamp biomicroscopy, dilated fundoscopy, corneal tomography, multifocal electroretinography (mfERG) and spectral domain optical coherence tomography scan were performed at baseline, 2 weeks and 6 weeks postoperatively. Results Uncorrected and corrected distance visual acuity did not change significantly at 2 weeks and 6 weeks following accelerated CXL compared to baseline. Retinal response density (RRD) of mfERG significantly decreased at 2 weeks postoperatively compared to baseline (p = 0.008) but did not differ from the baseline value at 6 weeks postoperatively in the fovea (ring 1) (p = 0.95). Similarly, P1 latency significantly decreased at 2 weeks (p = 0.04) but did not change at 6 weeks (p = 1.00) postoperatively compared to baseline in the fovea. No changes in RRD or P1 latency were observed in the retinal rings surrounding the fovea (rings 2 to 5). Central foveal thickness did not change at 2 weeks and 6 weeks postoperatively compared to baseline (p = 0.53 and p = 0.93, respectively). Conclusions A short-term reversible decrease in macular electrical activity without any structural changes seems to occur after accelerated CXL in patients with progressive keratoconus. The return of macular response to the preoperative values shows the safety of the CXL protocol.
Bilateral macular retinitis in patients with presumed rift valley fever from Sudan: A case series
Authors: Fouad Yousef A. , Mekkawy Mahmood O. , Sallam Ahmed B. 
Published: April 2022

Background Epidemic retinitis occurs seasonally following febrile infections in endemic regions. Rift valley fever (RVF) is endemic to Sudan, with a recent outbreak starting in 2019. Methods Retrospective case series of 3 patients travelling from Sudan with post-febrile retinitis, and with a history and clinical picture suggestive of RVF retinitis. Results The three patients were adult males with underlying medical conditions and underwent fundus fluorescein angiography that confirmed bilateral retinitis and occlusive vasculitis involving the posterior pole. Optical coherence tomography showed distortion of the macular layers. Case 2 presented 1 month following febrile illness and had retinal thinning, with optical coherence tomography angiography showing marked reduction in vessel density. Conclusion We present multimodal imaging data of three cases with presumed RVF retinitis from a recent outbreak in Sudan. The unavailability of standardized methods of testing for RVF, as is the case for most epidemic retinitis-causing pathogens, makes the diagnosis challenging.
Sodium hyaluronate 0.30% ocular gel versus sodium hyaluronate 0.18% eye drop in the treatment of moderate to severe dry eye disease
Authors: Calonge Margarita , Sahyoun Marwan , Baillif Stéphanie , Gain Philippe , Paw Ewa , Mearza Ali , Cochener Béatrice 
Published: April 2022

Purpose Compare 0.30% sodium hyaluronate (0.30%HA) ocular gel with 0.18%HA eye drops in terms of improvement of ocular signs and symptoms, in patients with moderate to severe dry eye disease (DED). Methods This was a multicentric, randomized, investigator-masked, non-inferiority, comparative study conducted over 84 days. Three visits were scheduled, testing fluorescein corneal and conjunctival staining (Oxford and Van Bijsterveld scores), tear film break-up time (TBUT), Schirmer test, DED symptoms, 5-Item-Dry-Eye-Questionnaire (5-DEQ), patient and investigator satisfaction and frequency of instillation. Results At Day 35 (D35) and Day 84 (D84), both groups (n = 35 each) had a significant improvement in corneal staining (p < 0.001) with no inter-group difference. Van Bijsterveld score improved earlier (D35) for 0.30%HA suggesting a faster effect on conjunctival epithelium healing. There was no difference between the two concentrations in terms of TBUT or Schirmer improvements; however, the Schirmer test increase was only significant for 0.30%HA at D35 (p = 0.040). At D35 and D84, both groups showed similar improvements of DED symptoms and DEQ-5 score. Furthermore, treatment satisfaction was similar for the 2 formulations suggesting that daily use of 0.30%HA do not cause gel-related blurred vision disturbances. Frequency of instillation was similar for both groups. Conclusion Our study demonstrates the non-inferiority of 0.30%HA gel compared to 0.18%HA solution in patients with moderate to severe DED. Because of its gel formulation and higher HA concentration providing prolonged comfort without causing visual disturbances, 0.30%HA gel might be adapted for bedtime use or during the day in more severe conditions.
Effects of anxiety on sedation among pediatric patients undergoing esophagogastroduodenoscopy
Authors: Choi You Jin , Park Eun Jin , Lee Yoo Min , Kim Soon Chul , Kang Ben , Lee Kyung Jae , Jang Hyo-Jeong , Lee Eun Hye , Kim Ju Young , Choi So Yoon , Jin Kim Hyun , Kang Yunkoo , Choe Byung-Ho , Lee Jeewon , Yi Dae Yong 
Published: April 2022

We investigated whether the severity of anxiety among children undergoing endoscopy could affect sedation. We prospectively recruited patients under 18 years of age who were scheduled to undergo esophagogastroduodenoscopy (EGD). Baseline anxiety was evaluated using the Spence Children’s Anxiety Scale (SCAS). Our analysis considered the type and dose of sedative drugs, degree of sedation, and complications associated with sedation according to the scale score. The mean total SCAS T-scores and each subscale score were significantly higher in the 6–12-year age group. The mean T-score among patients who exhibited irritability during EGD was higher than that among other patients, with significant differences in the Total, Obsessive Disorder, Panic Agoraphobia and General Anxiety subscales. The midazolam doses of children exhibiting irritability were more likely to need higher ( p = 0.006). Other sedation-related complications were not associated with the T-scores in each subscale. Total sleep time was not associated with any T-score subscales. Anxiety levels were significantly higher among 6–12-year-olds and children exhibiting irritability. Anxiety was often associated with irritability, difficulties achieving adequate sedation during EGD, and additional sedative drug administration. We recommend higher doses or more potent drugs to facilitate endoscopy for children with high anxiety levels.
Flow-noise characteristics of turbocharger compressors with rotational balance cuttings
Authors: Kim Sang Hyun , Park Tae Seon 
Published: April 2022

To correct the balance of the rotating assembly of a turbocharger, some parts of the compressor wheel are removed by cutting. A numerical investigation of the turbulent flows and flow noises produced by compressor wheels modified with such cutting parts was performed by a turbulence model and detached-eddy simulations. For the 6-cutting case, 0, 2, 4, and 6 circular cuttings and two additional—rectangular and triangular—shapes were used. To investigate the effects of the balance cuttings in a compressor wheel, the evaluation process using computational fluid dynamics was tried. It was found that the fluid forces due to the various wheel shapes have the potential to restore the eccentricity by approximately 50%. Severe variations of velocity, pressure, and turbulent kinetic energy in the interspace between the wheel and volute were observed. In particular, the wavelike patterns of pressure and turbulent kinetic energy were intensified for the modified wheels. The turbulent kinetic energy of the 6-cutting case had a dominant frequency at approximately 3000 Hz. The spectrum of the sound-pressure level of the modified compressor wheels exhibited the features of buzz-saw noise. The flow fields suggested that this feature of the sound pressure is related to the tip-clearance flow affected by the balance cuttings. In addition, the acoustic pressure and flow characteristics of the different types of modified compressor wheels were discussed and the resulting acoustic power was evaluated.
Right-Sided Chylothorax: A Case Report of an Uncommon Manifestation After Cervical Debranching Thoracic Endovascular Aneurysm Repair
Authors: Sasaki Hanae , Kowatari Ryosuke , Kondo Norihiro , Taguchi Ryo , Minakawa Masahito 
Published: April 2022

A 70-year-old man was admitted to our hospital with a thoracic aortic aneurysm. He underwent elective thoracic endovascular aneurysm repair with left common carotid artery-left subclavian artery bypass via the left supraclavicular approach. During the bypass, the thoracic duct was injured and ligated. On postoperative day 3, the patient complained of dyspnea. Chest radiography revealed a massive right-sided pleural effusion. On postoperative day 5, he was diagnosed with right-sided chylothorax and underwent chest tube insertion. The next day, a left-sided chylothorax was noted, and chest tube drainage was performed. Conservative management, including nil per os and subcutaneous octreotide (300 μg/day) injection, was carried out for 2 weeks; subsequently, the chylothorax improved. This report highlights the diagnostic challenge of right-sided chylothorax after debranching thoracic endovascular aneurysm repair.
Participants’ Perspectives of Their Involvement in Medical Device Trials: A Focus Groups Study
Authors: Kitchen William R. , Downey Candice L. , Brown Julia M. , Jayne David G. , Randell Rebecca 
Published: April 2022

Background Medical technologies have the potential to improve quality and efficiency of healthcare. The design of clinical trials should consider participants’ perspectives to optimise enrolment, engagement and satisfaction. This study aims to assess patients’ perceptions of their involvement in medical device trials, to inform the designs of future medical technology implementation and evaluation. Methods Four focus groups were undertaken with a total of 16 participants who had participated in a study testing hospital inpatient remote monitoring devices. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. Results Four main themes emerged: patients’ motivations for participating in medical device research; patients’ perceptions of technology in medicine; patients’ understanding of trial methodology; and patients’ perceptions of the benefits of involvement in medical device trials. The appeal of new technology is a contributing factor to the decision to consent, although concerns remain regarding risks associated with technology in healthcare settings. Perceived benefits of participating in device trials include extra care, social benefits and comradery with other participants seen using the devices, although there is a perceived lack of confidence in using technology amongst older patients. Conclusion Future device trials should prioritise information sharing with participants both before and after the trial. Verbal and written information alongside practical demonstrations can help to combat a lack of confidence with technology. Randomised trials and those with placebo- or sham-controlled arms should not be considered as barriers to participation. Study results should be disseminated to participants in lay format as soon as possible, subject to participant permission.
Endovascular Thrombectomy With or Without Intravenous Thrombolysis: A Meta-Analysis of Randomized Controlled Trials
Authors: Ishfaq Muhammad F. , Gulraiz Sana , Huang Wei , Lobanova Iryna , Martin Renee H. , French Brandi R. , Siddiq Farhan , Gurkas Erdem , Aytac Emrah , Gomez Camilo R. , Qureshi Adnan I. 
Published: April 2022

Background We performed this meta-analysis of randomized clinical trials to compare the outcomes in patients treated with endovascular thrombectomy who receive prior intravenous thrombolysis with those who do not receive such treatment. Recently, one randomized trial reported outcomes to address this issue, so timely update of meta-analysis is needed to determine the value of administering intravenous thrombolysis before endovascular thrombectomy. Materials and methods Four randomized clinical trials are included in our meta-analysis. We calculated pooled odds ratios and 95% CIs using random-effects models. The primary efficacy endpoint was a favorable outcome defined by a modified Rankin Scale score of 0 (no symptoms), 1 (no significant disability), or 2 (slight disability) at 90 days post-randomization. Secondary endpoints analyzed were any intracerebral hemorrhage, symptomatic intracerebral hemorrhage, and mortality. Results Of the 1633 patients randomized, the proportion of patients who achieved a favorable outcome was similar between endovascular thrombectomy alone and combined approach with intravenous thrombolysis and endovascular thrombectomy (1631 patients analyzed; odds ratio 1.02; CI 0.84–1.25; p = 0.83). Risk of any intracerebral hemorrhage was significantly lower among those randomized to endovascular thrombectomy alone (1633 patients analyzed; odds ratio 0.75; CI 0.57–0.99; p = 0.04). Rates of symptomatic intracerebral hemorrhage (p = 0.36) and mortality (p = 0.62) were not significantly different between the two groups. Conclusions Compared with endovascular thrombectomy preceded by intravenous thrombolysis, endovascular thrombectomy resulted in similar rates of favorable outcome with a lower rate of intracerebral hemorrhage. A large phase 3 trial is required to conclusively demonstrate equivalency of both approaches to guide future practice.