Using mixed methods for genetic counseling research

Mixed methods research encompasses methodological approaches that involve the collection, analysis, and integration of qualitative and quantitative data. Mixed methods are useful for complex research questions, applied research settings, and when end users value multiple forms of evidence, which makes mixed methods suitable for many areas of genetic counseling research. High-quality rigorous research methods are required to generate useful knowledge that can advance the field of genetic counseling. The goal of this paper was to provide an introduction to mixed methods research and discuss the rationale, research paradigms, study designs, methodological considerations, opportunities, and challenges in genetic counseling research.

Participation Rates in 11 National Dental Practice-Based Research Network Surveys 2014-2022

Surveys of health professionals typically have low response rates, which have decreased in recent years. We report on the methods used, participation rates, and study time for 11 national questionnaire studies of dentists conducted from 2014-2022. Participation rates decreased (87%-25%). Concurrent with this decrease was a decrease in the intensity with which the practitioners were recruited. Participation rates were higher when postal mail invitation and paper options were used (84% vs. 58%, p < .001). Completion rates were nearly twice as high in studies that recruited in waves than those that did not (61% vs. 35%, p = .003). Study time varied from 2.6 to 28.4 weeks. Study time was longest when postal mail and completion on paper were used (26.0 vs. 11.3 weeks, p = .01). Among studies using only online methods, study time was longer when invitations were staggered than when all invitations went out in one bolus (means 12.0 and 5.2, p = .04). Study time was positively correlated with participation rates (Spearman r = .80, p = .005). General dentists participated at an average of 12% higher rates than specialists. Recruitment methodology, such as recruiting in waves or stages, should be considered when designing surveys.

Reflecting realities: gauging the pulse of simulator-based training in medical minds-resonance of simulator-based ultrasound training in medical education

BACKGROUND

Simulator-based training (SBT) transforms medical education from traditional methods to technology-driven simulations for safer, complex scenario learning. This study examines perceptions, benefits, drawbacks, and challenges of such training, focusing on ultrasound simulations among medical students and physicians.

METHODS

The study surveyed 343 participants: 154 third-year medical students, 97 practical-year students, and 92 physicians across various specialties. A digital questionnaire was used to analyze their views on SBT, featuring main- and sub-items evaluated through a Likert scale and dichotomous questions.

RESULTS

Widespread exposure to SBT was evident, notably in ultrasound simulator usage, where over 60% of all respondent groups reported prior experience. Significant disparities in acceptance and assessment between students and physicians were noted, particularly highlighting inconsistent integration into mandatory education and a marked deficit in physicians' training (p < 0.001). All groups acknowledged the relevance of SBT for developing practical skills and patient safety. The interest in ultrasound simulator use showed variability across specialties (p < 0.001). While ultrasound pathology training was highly valued, doubts about simulators replacing hands-on patient experience persisted.

CONCLUSIONS

Our study highlights the necessity for enhanced integration of SBT within medical curricula. It highlights the significance of adaptive teaching methodologies and singles out ultrasound simulator training as essential for practical skill development. Future research should concentrate on creating comprehensive customized teaching strategies to elevate the quality of patient care.

Working Women Walking Program: A Sequential Multiple Assignment Randomized Trial

BACKGROUND

Different interventions have shown efficacy in improving physical activity in women. This study aimed to determine the most effective adaptive intervention combining 4 efficacious treatments (Fitbit, text messages, personal calls, and group meetings) for improving physical activity.

METHODS

The Working Women Walking program used a Sequential Multiple Assignment Randomized Trial (SMART) design with 3 phases: initial (weeks 1-8), augmented (weeks 9-34), and maintenance (weeks 35-50). Low-active women aged 18-70 working at an academic medical center were recruited. In the initial phase, participants were randomized to Fitbit or Fitbit + text messages. After 8 weeks, nonresponders were rerandomized to an augmented treatment (personal calls or group meetings). The primary outcomes (steps/day and minutes of moderate/vigorous physical activity [MVPA]/day via ActiGraph) were assessed at baseline and 8, 34, and 50 weeks.

RESULTS

The study had 301 women (age: 45.1 [11.6] y). During the initial phase, there were no differences by initial treatment for change in steps (P = .78) or MVPA (P = .60). During the augmented phase, there were no differences by augmented treatment among nonresponders for change in steps (P = .95) or MVPA (P = .78). A significant overall increase was seen in steps (752/d; P < .001, d = 0.56) and MVPA at 8 weeks (4.1 min/d; P < .001, d = 0.48), and this was sustained at 34 and 50 weeks.

CONCLUSIONS

Text messages, personal calls, and group meetings did not lead to increased physical activity. Using Fitbit and goal setting (a constant) appeared to have some benefit for many of the women in improving physical activity.

Evaluating the coverage of sexually transmitted infection prevention and control services in eight districts in Central Uganda: lot quality assurance sampling survey

INTRODUCTION

Sexually transmitted infections (STIs) are a major global public health problem, associated with infertility, adverse pregnancy outcomes, and significant social and economic burdens. These challenges are particularly severe in underprivileged communities. A 2024 World Health Organisation report highlighted a global surge in STIs, requiring intensified efforts to improve their control and management. In order to appropriately respond and reverse the status quo, it is important to understand the extent to which the current interventions have reached the beneficiaries. This study aimed to assess the coverage of sexually transmitted infection (STI) services using the Lot Quality Assurance Sampling (LQAS) approach in eight districts of Central Uganda.

METHODOLOGY

A household survey was conducted in eight districts, targeting four population groups: mothers of children aged 0-11 months, women aged 15-49 years, men aged 15 + years, and youth aged 15-25 years. LQAS was used, with each district stratified into five supervision areas (SAs). In each SA, 19 respondents were randomly sampled from each target group. The survey assessed key indicators related to STIs, including knowledge of STI symptoms, knowledge of actions to take when infected with an STI, and engagement in risky sexual behavior. The study also examined condom use during risky sex, circumcision acceptance and non-acceptance among men, including reasons for its acceptance or non-acceptance. Overall and district-specific coverage was calculated with 95% confidence intervals. Indicator coverage in the SAs was classified using LQAS decision rules (DRs) for each indicator, using the overall coverage as benchmark for setting the DR.

RESULTS

The findings revealed that mothers of children aged 0-11 months demonstrated superior knowledge of STIs and appropriate actions to take if one has an STI. Men (15 + years) and youth (15-24 years) reported engaging more in risky sexual behavior compared to women 15-49 years and mothers of children aged 0-11 months. Relatedly, men 15 + years reported higher condom use during risky intercourse. Youth were more likely to be circumcised than older men. Coverage for most indicators varied across SAs and districts. However, one in forty of the SAs fell short of average coverage in all the indicators. Personal hygiene was the leading motivator for circumcision acceptance while fear of pain was the leading driver for refusal to accept being circumcised.

CONCLUSIONS

The findings highlight vital disparities in STI knowledge and risky sexual behavior among different demographic groups. These findings inform public health strategies to address STI disparities and improve reproductive health outcomes. District and SA-specific bottleneck analysis is recommended in order to provide actionable solutions to improve low-indicator coverage in low-coverage districts and SAs.

Nurses' Knowledge, Attitude and Practice in Nutrition Management of Hospitalised Adults: A Mixed-Methods Study

AIM(S)

To examine nurses' knowledge, attitude and practice regarding nutrition management in hospitalised adults and explore their views on it.

DESIGN

A mixed-method approach combining cross-sectional and descriptive qualitative methods.

METHODS

379 enrolled/registered nurses working in acute or intensive units of a tertiary hospital were recruited between 24th August 2023 and 3rd December 2023. Participants completed a questionnaire on their sociodemographic profile, knowledge, attitude and practice (KAP) regarding nutrition management. Data analysis was conducted using R software, reporting levels of KAP and its associations with sociodemographic factors. Mann-Whitney U and Kruskal-Wallis tests were used for non-normally distributed knowledge and practice scores (reported as median and interquartile range). Two-sample t-tests and ANOVA were used for normally distributed attitude scores (reported as mean and standard deviation). 21 of the participants from the quantitative study were either purposively sampled or snowballed from the quantitative study to undergo semi-structured interviews (physically or virtually face-to-face), which were transcribed verbatim and analysed using content analysis.

RESULTS

The mean scores on KAP were 61.6, 19.4 and 22.8, respectively. Knowledge varied significantly by educational level (p < 0.001), while attitudes also differed based on education (p = 0.001) and years of employment (p = 0.019). Practice scores showed differences based on subspeciality (p = 0.032), nursing rank (p < 0.001) and years of employment (p = 0.004). Findings identified barriers to effective nutrition management, including prioritisation issues, varying professional roles, limited autonomy and resource shortages. It also emphasises nurses' roles in nutrition management and strategies such as nurses' autonomy and family members involvement to improve nutrition management.

CONCLUSION

Sociodemographic factors significantly influence nurses' KAP in nutrition management, revealing knowledge deficits, low prioritisation and time constraints. Tailored education and training, increased autonomy, resource expansion and greater family involvement can enhance nurses' KAP in nutrition management.

Rerouting therapeutic peptides and unlocking their potential against SARS-CoV2

The COVID-19 pandemic highlighted the potential of peptide-based therapies as an alternative to traditional pharmaceutical treatments for SARS-CoV-2 and its variants. Our review explores the role of therapeutic peptides in modulating immune responses, inhibiting viral entry, and disrupting replication. Despite challenges such as stability, bioavailability, and the rapid mutation of the virus, ongoing research and clinical trials show that peptide-based treatments are increasingly becoming integral to future viral outbreak responses. Advancements in computational modelling methods in combination with artificial intelligence will enable mass screening of therapeutic peptides and thereby, comprehending a peptide repurposing strategy similar to the small molecule repurposing. These findings suggest that peptide-based therapies play a critical and promising role in future pandemic preparedness and outbreak management.

Maxillary defects due to COVID-19 associated mucormycosis: Impact on quality of life after rehabilitation with an obturator

STATEMENT OF PROBLEM

Aggressive surgical debridement including maxillectomy in patients with coronavirus disease 2019 (COVID-19) associated mucormycosis of the maxilla alters facial appearance, function, and an individual's overall quality of life (QOL). These patients require rehabilitation of defects with obturators to help them recover from esthetic and functional disabilities and regain near-normal quality of life. Because COVID-19 associated with mucormycosis is a newer entity, less is known about the quality of life of these patients after rehabilitation with obturators. Hence, the effects of COVID-19 associated with mucormycosis, treatment, and rehabilitation need to be evaluated to assess QOL.

PURPOSE

The purpose of this clinical study was to assess the impact on QOL after rehabilitation with obturators for participants with COVID-19-associated mucormycosis who underwent maxillectomy.

MATERIAL AND METHODS

Oral health impact profile-14 (OHIP-14) and obturator functioning scale (OFS) questionnaires were administered to 26 participants with COVID-19-associated mucormycosis of the maxilla who underwent maxillectomy and required rehabilitation with obturators. Questionnaire responses were received on numerical Likert scales of 0 to 4 for OHIP-14 and 1 to 5 for OFS. The repeated measures analysis of variance (ANOVA) with pairwise post hoc Bonferroni tests were used to evaluate and compare mean scores of OHIP-14 and OFS at different preoperative and postoperative stages (α=.05).

RESULTS

A total of 26 participants who underwent maxillectomy were provided with obturators. A higher mean ±standard deviation OHIP score was observed before rehabilitation at T1 (51.0 ±9.6) followed by 1 week after fabrication of the surgical obturator at T2 (18.6 ±16.4), and 1 week after fabrication of the interim obturator at T3 (4.7 ±8.2). The lower mean scores ±standard deviation were seen 1 week after the fabrication of definitive obturators at T4 (2.9 ±7.2). Comparison of the scores at T1, T2, T3, and T4 found significant difference (P≤.001). Similarly, higher mean ±standard deviation OFS scores were seen 1 week after rehabilitation with surgical obturators at T2 (27.3 ±12.6) and at least 1 week after fabrication with definitive obturators at T4 (15.7 ±5.6). A comparison of the scores at T2, T3, and T4 found significant differences (P≤.001).

CONCLUSIONS

Considerable improvement was seen in QOL with the fabrication of surgical obturators in participants who had received maxillectomy/debridement for mucormycosis. This improvement had a linear relationship with the time elapsed and the consecutive fitting of the obturators with healing.

SPACO+: a mixed methods protocol to assessing the effectiveness of an educative intervention in patients with Long Covid

BACKGROUND

The management of many chronic diseases requires a multidisciplinary and holistic approach. Long Covid is a recent, poorly understood disease with several symptoms. Most recommendations suggest a multidisciplinary approach. While there are a few programs aimed to the management of Long Covid, to our knowledge very few were assessed. The SPACO + study therefore aims to evaluate an innovative program which combines the methods used in therapeutic education and in personalized multifactorial intervention for management of Long Covid. Here, we present the protocol of our study, which aims to evaluate the effectiveness of an educational intervention in terms of changes in quality of life at 6 months in comparison with standard clinical practice in patients suffering from Long Covid.

METHODS

To achieve our objectives, we have planned to carry out a prospective, multicentre, two-arm randomized controlled trial with a convergent parallel mixed methods design. Two countries are involved in this study: France and Cameroon. The study concerns patients aged 18 and over, who have been infected with Covid-19. They must also be diagnosed as having Long Covid in accordance with the WHO definition. The number of subjects required for the study is 400 individuals. Participants will be randomly assigned to either the intervention or control group using a dynamic randomization process to ensure balanced group characteristics. The SPACO + program is an educative intervention with individual follow-up by a nurse dedicated to the program. The SPACO + program offers five workshops, two of which are compulsories. Patients take part in the other workshops according to their needs. The program includes an 8 - 10 weeks intervention period. Each session lasts two hours and includes breaks (pacing). The main outcome measure will be quality of life, evaluated through the SF-36. Primary and secondary outcomes, with few exceptions, are assessed before the intervention ("T0"), at 8 weeks ("T1" corresponding to the end of SPACO + program's session period) and then 3 months later ("T2").

DISCUSSION

If the SPACO + program is effective and accepted by professionals and patients, it could be disseminated in other regions to assess its transferability. The medico-economic evaluation will also make it possible to assess the benefits provided.

TRIAL REGISTRATION

This trial is registered under the number NCT05787366 (March 24, 2023). Protocol Version N°3.0 (May 31, 2024).

Validation and application of a finite element model simulating failure thresholds of skin during blunt puncture with varying impactor geometries

Injuries caused by knives or other sharp tools such as scissors and screwdrivers are common in violent crimes and self-defense acts. The force thresholds of skin have been quantified based on the puncture instrument to assess degree of force in forensic cases, but limited studies have investigated blunt instruments and the effect of skin thickness. A finite element (FE) computational model was developed to simulate blunt puncture of skin. Curve fitting and manual optimization were performed to obtain Ogden material coefficients. The model was validated with experimental force-time curves for spherical impactors of diameter 3, 5, and 8 mm into thin, average, and thick skin at slow and fast loading rates (n = 18 total conditions), resulting in an average CORA score of 0.725. The average maximum principal stress at the time of experimental failure was 57.3 MPa with a coefficient of variance of 0.18, and the median value of 54.8 MPa was selected as the failure criterion. The validated model was applied to load seven spherical impactors, five Hex screwdrivers, and three Torx screwdrivers into skin with thicknesses ranging from 2 to 3 mm. Increased skin thickness resulted in greater force, displacement, and strain energy at failure. Cross-sectional area of the impactor and failure thresholds of skin expressed a linear relationship for normalized force (R2 ≥ 0.88), displacement (R2 ≥ 0.77), and normalized strain energy (R2 ≥ 0.92). The validated FE model may be used to determine the force required to penetrate skin with a case-specific blunt instrument.

Reorganization of work schedules for better distribution of work demands in home health care - a feasibility study

BACKGROUND

Given the home health care industry's growth, increasing demand for workers, and complex patient care needs, investigating initiatives to maintain home health care workers' health and ability to work is crucial. This study aims to assess the feasibility of an organizational intervention for equal distribution of physical and psychosocial work demands among home health care aides.

METHOD

We conducted a 7-week quasi-experimental feasibility study at a Danish home health care institution with 27 home health care aides. The 6SQuID framework was used to develop, test and evaluate the feasibility of the organizational intervention, inspired by the 'Goldilocks Work Principle'. The intervention consisted of three activities: (1) classification workshop, (2) individual dialogue with a schedule coordinator, and (3) reorganizing work schedules. Feasibility was assessed through: (1) acceptability evaluated by interview and questionnaire post-intervention, (2) fidelity assessed by documentation during intervention, and (3) potential effects on selected psychosocial factors and physical work demands evaluated pre-post intervention with technical measurements and questionnaire.

RESULTS

Nineteen home health care aides participated in the evaluation of the intervention. Most of the home health care aides (73.33%) reported to like or really like the intervention. The interviewees expressed general acceptance of both the intervention activities and the overall aim of the intervention. Most home health care aides (77.8%) participated in the Classification workshop and 124 citizens were classified. All home health care aides participated in the Individual dialogue. No significant changes were seen in the Reorganized work schedules (p > 0.05). Physical and emotional fatigue and physical exertion showed statistically significant change (p < 0.05), with a mean difference of 17 and 11 (100 point scale), and 1.7 (10 point scale) points respectively.

CONCLUSION

This study found components of the intervention to be feasible, but concludes that adaptions to enhance implementation addressing barriers related to time pressure, improving fidelity to the intervention, and ensuring practical applicability within the home health care context are critical for future success.

TRIAL REGISTRATION

The study was registered in the ISRCTN registry under registration number ISRCTN15131198 on August 8, 2023.

Understanding the perceptions, behavior, and attitudes of healthcare professionals, hospitalized children, and their parents toward hospital play services: A mixed-methods approach

INTRODUCTION

This study examined the perceptions, behavior, and attitudes of healthcare professionals, hospitalized children and their parents toward hospital play services.

METHODS

A two-phase mixed-methods study was conducted in Hong Kong. In phase one, a cross-sectional survey was administered to 182 healthcare professionals working with hospitalized pediatric patients. In phase two, qualitative interviews were conducted with 20 healthcare professionals, 15 hospitalized children, and 14 parents.

RESULTS

Most healthcare professionals valued hospital play services. They believed that hospital play specialists (HPS) could alleviate their workload, especially given the shortage of healthcare professionals. Hospitalized children and their parents reported that HPS help with stress coping and mood improvement, built excellent relationships with children, and facilitated communications between children and healthcare professionals.

DISCUSSION

The findings highlight the importance of play services and HPS in pediatric units to enhance healthcare for hospitalized children. The results provide implications for hospital authority to implement supportive measures.

The Burden of Adult X-Linked Hypophosphatemia on Carers and Family Members: A Mixed-Methods Study

Introduction: X-linked hypophosphatemia (XLH) is a rare, genetic disorder that severely impacts the health-related quality of life (HRQoL) of people living with the condition. This impact can also extend to carers and family members, described as a "spillover effect." Measurement of spillover effects can lead to greater understanding of disease burden and potentially to more equitable decision-making regarding adoption of treatments by health technology assessment (HTA) bodies. This study aimed to explore spillover effects among carers and family members of adults with XLH. Methods: This cross-sectional, mixed-methods study included carers and family members of adults diagnosed with XLH in the United Kingdom. Quantitative data included a background questionnaire, the EQ-5D-5L, and the Work Productivity and Activity Impairment Questionnaire (WPAI). Qualitative data were gathered through semi-structured interviews. Results: Twenty carers or family members of adults with XLH completed the study. Four (20%) had an XLH diagnosis themselves. Mean (SD) EQ-5D utility was 0.66 (0.33) for the total sample, and 0.20 (0.31) and 0.77 (0.21) for participants with and without a personal diagnosis of XLH, respectively. The WPAI activity impairment was 42% and overall work impairment was 28%. Interviews revealed 6 areas of participants' lives impacted by XLH: emotional wellbeing, daily activities, work, finances, social lives and relationships, and physical impacts. Conclusion: Findings of this study indicate a substantial health-related quality-of-life and productivity burden for carers and family members of adults with XLH. The magnitude of this burden highlights the importance of incorporating such spillover effects in HTAs and broader rare disease policies.

The Inflation Reduction Act and Drug Development: Potential Early Signals of Impact on Post-Approval Clinical Trials

BACKGROUND

The Inflation Reduction Act's (IRA) Drug Price Negotiation Program (DPNP) may reduce incentives for industry investments in post-approval clinical development. We aimed to explore the IRA's impact on the initiation of industry-sponsored, post-approval clinical trials.

METHODS

Using Citeline's Trialtrove database (7/2014-8/2024), we conducted an interrupted time series analysis (ITSA) to estimate the IRA's impact on the initiation of industry-sponsored Phase I-III trials in previously approved drugs, excluding all vaccines and COVID-19 treatments. We conducted an additional ITSA to examine post-IRA changes in government-funded trials, hypothesized to be unaffected by the IRA, and sensitivity analyses to explore potential exogenous confounding factors. Finally, we explored differences in the IRA's impact on post-approval industry-sponsored clinical trial initiation in small versus large molecule drugs.

RESULTS

Following the IRA's passage, the average monthly number of industry-sponsored trials on post-approval drugs decreased by 38.4%. The ITSA indicated that the IRA's passage was associated with an immediate drop of 11.1 industry-sponsored trials (p-value < 0.05) and an additional decrease by 0.9 trials per month (p-value < 0.01). The IRA's passage was not statistically associated with changes in government-funded trial initiation. Sensitivity analyses supported ITSA findings. Initiation of post-approval industry-sponsored trials decreased by 47.3% and 32.9% for small and large molecule drugs, respectively.

CONCLUSIONS

The IRA's passage was associated with reductions in industry-sponsored, but not government-funded, post-approval trials, with larger reductions for small molecule drugs. These findings provide early evidence supporting concerns around IRA-related reductions in incentives for post-approval clinical development.

Real-world evidence in gynecologic cancers presented at key oncology conferences in the United States: Distribution and factors related to high-tier acceptance

PURPOSE

To describe the distribution, trends, and characteristics of types of real-world evidence (RWE) abstracts presented at key oncology congresses.

METHODS

Data on gynecologic cancers (cervical, ovarian, endometrial, and multiple gynecologic/other) were extracted from the American Society of Clinical Oncology (ASCO) and the Society of Gynecologic Oncology (SGO) conference databases (2018-2020) to: a) identify the proportion of clinical trial (CT) versus RWE abstracts accepted; b) describe the distribution and tier of acceptance of RWE versus CTs; c) analyze the characteristics (authorship, data source, data type, study design, outcome[s], and presence of statistically significant results) associated with RWE acceptance.

RESULTS

Of 3163 abstracts screened, 2271 (77% RWE, 23% CTs) were included. RWE represented a higher proportion of work at SGO versus ASCO (70% vs 30%). Overall, more RWE studies versus CTs were accepted as posters (75% vs 60%), while fewer were accepted as oral presentations (4% vs 20%; p < 0.001 for both). Among RWE abstracts, 90% had academic author(s), 68% of studies were from North America, 45% used other clinical data sources, and nearly 32% reported statistically significant results. Approximately 60% of RWE were retrospective and 9% were prospective. The most common outcomes in RWE abstracts were molecular analyses (18%) and survival based on treatment efficacy (13%; p < 0.001).

CONCLUSION

RWE abstracts were accepted for presentation more frequently at SGO versus ASCO, and majority of them were presented as posters. While RWE abstracts are prevalent and provide valuable data for healthcare decision-making, they do not always achieve the visibility of CTs.

Health Care Providers' Experiences and Perceptions With Telehealth Tools in a Hospital-at-Home Program: Mixed Methods Study

Background

The growing demand for hospital-based care, driven by aging populations and constrained resources, has accelerated the adoption of telehealth tools such as teleconsultations and remote monitoring in hospital-at-home (HaH) programs. Despite their increasing use in delivering acute care at home, studies exploring health care providers' experiences and perceptions of these tools within HaH settings remain limited.

Objective

This study aimed to understand the experiences and perspectives of health care providers toward teleconsultations and vital signs monitoring systems within a HaH program in Singapore to optimize effectiveness and address challenges in future implementation.

Methods

A convergent mixed methods approach that combines qualitative in-depth interviews with an electronic survey designed based on the 5 domains (usefulness, ease of use, effectiveness, reliability, and satisfaction) of the Telehealth Usability Questionnaire was used.

Results

In total, 37 surveys and 20 interviews were completed. Participants responded positively to the use of both teleconsultation and vital signs monitoring with a mean total score of each method being 4.55 (SD 0.44) and 4.52 (SD 0.42), respectively. Significantly higher mean ratings were observed among doctors compared with other health care providers for usefulness (P=.03) and ease of use (P=.047) in teleconsultations. Health care providers with fewer years of clinical experience also perceived the use of vital signs monitoring to be more effective (P=.02) and more usable (P=.04) than those with more years of experience. Qualitative analysis identified four themes: (1) benefits of telehealth for health care providers such as improved work convenience, efficiency, and satisfaction; (2) challenges of telehealth implementation relating to communication and technology; (3) perspectives on telehealth impact; and (4) enablers for successful implementation. Comparing both datasets, qualitative findings were aligned with and confirmed quantitative results.

Conclusions

This study highlighted the benefits and usability of telehealth among health care providers. However, challenges relating to patient communication, technological issues, and delivery of care were also discussed along with enablers for successful implementation. These insights can inform strategies to optimize future implementation of telehealth in HaH.

Hypoglycemic and Gut Microbiota-Modulating Effects of Pectin from Citrus aurantium "Changshanhuyou" Residue in Type 2 Diabetes Mellitus Mice

To fully utilize the Citrus aurantium "Changshanhuyou" resource, the hypoglycemic effect and mechanisms of action of pectin from Changshanhuyou residue (HYP) were studied. HYP considerably inhibited α-glucosidase, suggesting its potent in vitro hypoglycemic activity. In streptozotocin-induced type 2 diabetes mellitus (T2DM) mice, HYP significantly increased the body weight, survival rate, hexokinase activity, and glycogen content and decreased fasting blood glucose, oral glucose tolerance, liver weight, and glycated serum protein levels. Furthermore, HYP remarkably improved glycolipid metabolism-related indices in both serum and liver, IL-6 and TNF-α levels in serum, and antioxidant enzyme activities in liver. HYP also modulated mRNA expression of the key factors (e.g., Akt, PI3K, IRS2, InsR, GLUT4, G6 Pase, PEPCK, AMPK, GS, and GSK-3β) and increased short chain fatty acid production and abundance of beneficial bacteria. Thus, the underlying hypoglycemic mechanism of HYP may involve the activation of PI3K/Akt, AMPK, and GS/GSK-3β signaling pathways and modulation of gut microbiota composition.

Digital, Personalized Clinical Trials Among Older Adults, Lessons Learned From the COVID-19 Pandemic, and Directions for the Future: Aggregated Feasibility Data From Three Trials Among Older Adults

BACKGROUND

The COVID-19 pandemic was extremely disruptive to clinical practice and research. Given older adults' increased likelihood of chronic health concerns, limited resources, and greater risk for adverse outcomes of COVID-19, access to research participation during this time was critical, particularly to interventions that may impact health conditions or behaviors. Fortunately, the implementation of personalized, digital research trials during the pandemic allowed for research and intervention delivery for older adults to continue remotely, resulting in feasibility findings that can benefit researchers, practitioners, and the broader older adult population.

OBJECTIVE

This study discusses 3 digital, remote, and personalized intervention trials implemented during the pandemic to increase physical activity (2 trials) or to reduce back pain (1 trial).

METHODS

We identified measures used for all 3 trials including Fitbit activity monitor use and self-reported participant satisfaction. Participant levels of Fitbit activity monitor use and satisfaction ratings of the digital trials were compared between younger (younger than 55 years) and older adults (older than 55 years). Differences between these cohorts were analyzed using chi-square tests for categorical outcomes and 2-tailed independent-sample t tests for continuous outcomes.

RESULTS

Across the 3 trials, the majority of participants reported high satisfaction with the usability of the trials' digital systems including SMS text message interventions and surveys (≥62% satisfied) and the use of wearable devices such as Fitbits (≥81% satisfied). In addition, the use of the Fitbit device was shown to be feasible, as older adults across all trials wore their Fitbits for the majority of the day (mean 20.3, SD 3.6 hours). Furthermore, consistent Fitbit wear was common; 100% of participants older than 55 years wore their Fitbit an average of 10 or more hours per day. These trials highlight that digital, remote intervention delivery may be successfully implemented among older adults by way of personalized trials. Across the 3 digital interventions, feasibility and acceptability were high among older adults, and comparable to younger adults.

CONCLUSIONS

Given the success of the current trials amid pandemic restrictions, we argue that these trials serve as a useful framework to aid in designing personalized, digital, remote interventions in other areas of clinical care among older adults and in planning for future disruptions including new pandemics.

Determinants of default from outpatient management of severe acute malnutrition among caregivers of children aged 6-59 months at Fortportal regional referral hospital, Southwestern Uganda: a mixed methods study

BACKGROUND

Successful outpatient management of severe acute malnutrition (SAM) significantly lowers the morbidity and mortality of patients. However, 29.5% of children under five years of age default from outpatient management of SAM in the Tooro subregion in southwestern Uganda, and little is known about the associated factors. This study assessed the determinants of default from the outpatient management of SAM among caregivers of children aged 6-59 months. It explored their experiences and perceptions of SAM and its management at Fort Portal Regional Referral Hospital in the Tooro subregion, Uganda.

METHODS

A mixed methods study was conducted among caregivers of children who received outpatient management between January 2018 and August 2022. Cases were selected purposively, whereas controls were randomly selected. Data was collected using a structured questionnaire and exported to STATA 14 for analysis. Logistic regression was used to identify the determinants of default from the outpatient management of SAM. Fourteen caregivers and five health workers were purposively selected and interviewed, with informed consent. The interviews were audio recorded, transcribed verbatim, and analysed using Atlas. Ti 9 software. Ethical approval was sought from the Makerere School of Public Health Research & Ethics Committee (Protocol ID: 087).

RESULTS

A total of 88 cases and 111 controls were recruited. Several factors, including being Protestant (AOR = 2.60; 95% CI: 1.12-5.90), being Orthodox/Seventh-day Adventist (AOR = 3.65; 95% CI: 1.47-9.10), high transport costs (AOR = 3.30; 95% CI: 1.59-6.80), lacking perceived susceptibility to other illnesses (AOR = 3.90; 95% CI: 1.84-8.30), lacking health education (AOR = 3.97; 95% CI: 1.1-14.30) and lacking self-efficacy (AOR = 0.33; 95% CI: 0.16-0.66), were significantly associated with default from the outpatient management of SAM. Most caregivers reported being afraid of the possible consequences of default and agreed that SAM management was beneficial. However, their confidence in adhering to management was undermined by several factors, including transport costs, distance to the health facility, and discrimination.

CONCLUSION

Being Protestant, Orthodox/Seventh-day Adventist, high transport costs, lack of perceived susceptibility to other illnesses, lack of health education, and lack of self-efficacy were essential determinants of default from outpatient management of SAM. To reduce the default rate, stakeholders must strengthen peripheral sites and community health workers to bring SAM management services closer to the community. Additionally, a closer examination of the role of religious beliefs in default from the outpatient management of SAM is needed.

Examining the efficacy of treatment outcomes for patients with pulmonary tuberculosis in Western China: A retrospective study in a region of high incidence

BACKGROUND

Guizhou, situated in western China, exhibits a high incidence of pulmonary tuberculosis (PTB) alongside comparatively challenging medical and economic conditions. Our objective was to investigate the determinants influencing successful PTB treatment and their scope, aiming to provide a scientific foundation for targeted interventions and enhancing treatment efficacy.

METHODS

Data encompassing all PTB cases registered in Guizhou's China Disease Prevention and Control Information System from 2017 to 2022 were analyzed. Using the successful treatment rate as the dependent variable, initial univariate analysis of independent variables was conducted, followed by multilevel binary logistic regression analysis to assess variables demonstrating statistically significant disparities.

RESULTS

A total of 139,414 patients (average age: 44 years) were included, with 64.41% male and 35.59% female. Among them, 47.57% were etiologically positive and 16.35% had comorbidities. The overall successful treatment rate was 95.77%, with a cure rate of 42.54%. Nine factors were identified to influence treatment success, including a higher proportion of females (OR = 1.178), students versus farmers (OR = 1.960), and etiologically negative cases (OR = 1.831). Initial treatment showed better success rates than retreatment (OR = 3.046), and patients without comorbidities had higher success rates than those with comorbidities (OR = 1.303). Fixed-dose combination therapy (FDC) also yielded better outcomes (OR = 1.296). Ethnic differences were noted, with the Miao group having lower success rates (OR = 0.874) and the Buyi group higher success rates (OR = 1.270) compared to Han. Age was another factor, with success rates decreasing in the 41-60 (OR = 0.731) and 61 + age groups (OR = 0.604).

CONCLUSIONS

Western China faces ongoing challenges in enhancing its PTB treatment capacity and should prioritize the promotion of FDC therapy. Risk factors that influence treatment outcomes for PTB include male gender, advanced age, belonging to the Miao ethnic group, occupation as a farmer, etiological positivity, retreatment status, and comorbidities such as diabetes and HIV/AIDS. Further investigation is warranted to explore the disparities in successful treatment rates among different ethnicities.

Quality of life among earthquake survivors living in prefabricated houses in Adıyaman: a cross-sectional study after the February 2023 earthquakes in Türkiye

Introduction

On February 6, 2023, two devastating earthquakes in Türkiye caused significant loss of life and widespread destruction, forcing many survivors into temporary housing. The earthquakes have the potential to significantly impact the quality of life of survivors, exacerbating various dimensions of their physical, emotional, and social well-being. This study aims to assess quality of life among earthquake survivors residing in prefabricated housing in Adıyaman, one of the most severely affected provinces, and to identify associated factors.

Methods

This cross-sectional study was conducted with 334 adult earthquake survivors residing in prefabricated housing in Adıyaman. Socio-demographic earthquake-related characteristics were recorded, and quality of life was assessed using the Short Form-36 (SF-36) through face-to-face interviews. The relationship between quality of life and independent variables was analyzed using the Mann-Whitney U test and multivariate logistic regression analysis.

Results

All eight domains of the SF-36 showed a decline in comparison to general population norms. The smallest decrease was observed in the 'physical functioning' domain (7.6% in men and 15.4% in women), while the largest decline occurred in the 'role limitations due to emotional problems' domain (32.1% in men and 45.6% in women). Female gender, loss of a relative, hospitalization due to the earthquake, being married, being over 35 years old and having an education level below high school were identified as risk factors for scoring below the general population norms in at least one domain of the SF-36.

Conclusion

Sixteen months after the earthquake, the quality of life among survivors remains significantly low, highlighting the critical need for the rapid implementation of targeted interventions, prioritizing high-risk groups.

Effects of smokeless tobacco on cancer incidence and mortality: a global systematic review and meta-analysis

INTRODUCTION

The prevalence of smokeless tobacco consumption remains high despite policies on reduction interventions. This study aims to quantify the associations between smokeless tobacco use with cancer incidence and mortality globally.

METHODS

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and PROSPERO protocol (ID: CRD42023390468). A comprehensive literature search was performed using PubMed, Web of Science, and Scopus databases, covering the period from January 1, 2000, to February 28, 2023. We included peer-reviewed observational studies, specifically case-control and cohort studies, where smokeless tobacco use was the primary exposure and cancer incidence, or mortality were the main outcomes. Three independent reviewers screened titles, abstracts, and full texts, and extracted data from the included studies. Risk of bias was assessed by the same three reviewers. Any disagreements were resolved through discussion with a fourth reviewer. We performed random-effects meta-analyses and assessed heterogeneity and publication bias to ensure the robustness of our findings.

RESULTS

Of the 3,611 articles identified, 80 were included in the final analysis. Increased risks were observed for cancer mortality [Risk Ratio (RR) 1.38, 95% Confidence Interval (CI) 1.22-1.56] and incidence [RR 1.17, 95% CI 1.08-1.27]. The specific cancer sites with increased mortality risk included head and neck cancers, as well as stomach cancer. For cancer incidence, associations were observed with head and neck, oral, esophageal, stomach, and pancreatic cancers. Significant heterogeneity (I2 statistic 65% to 90%) was observed among most cancer outcomes.

CONCLUSION

Our study found significant associations between smokeless tobacco use and cancer incidence and mortality. Targeted policy interventions, such as stricter regulations on smokeless tobacco use, are recommended to reduce its consumption and mitigate the associated cancer risks.

Unlocking the Mysteries of Rare Disease Drug Development: A Beginner's Guide for Clinical Pharmacologists

Clinical pharmacologists face unique challenges when developing drugs for rare diseases. These conditions are characterized by small patient populations, diverse disease progression patterns, and a limited understanding of underlying pathophysiology. This tutorial serves as a comprehensive guide, offering practical insights and strategies to navigate its complexities. In this tutorial, we outline global regulatory incentives and resources available to support rare disease research, describe some considerations for designing a clinical development plan for rare diseases, and we highlight the role of biomarkers, real-world data, and modeling and simulations to navigate rare disease challenges. By leveraging these tools and understanding regulatory pathways, clinical pharmacologists can significantly contribute to advancing therapeutic options for rare diseases.

Obstetrics and gynecology devices designed for low- and middle-income countries: A narrative review

There are many barriers contributing to poor health outcomes for women in low- and middle-income countries (LMICs), one of which is the lack of necessary medical devices. Presently, the development of various kinds of devices intended to improve women's health outcomes specifically in LMICs remains underrepresented in the literature; therefore, we performed a narrative review to understand this current state of literature. A literature search was conducted in Scopus and Overton between December 2023 to February 2024, and PubMed in October 2024 to broadly explore peer-reviewed publications focusing on understanding the development of devices used specifically in obstetrics and gynecology (OBGYN) care in LMICs. The initial search identified 132 published manuscripts: 114 non-duplicates from 1993 to 2024. After a two-research team member independent review, 22 manuscripts from 2011 to 2023 were included, and 18 devices identified. Nine devices focus on postpartum hemorrhage, four on general obstetrics, one on fetal monitoring, one on vaginal deliveries, one on gynecology hemorrhage, one on gynecology screening, and one on OBGYN anesthesia. This review provides recommendations for areas of improvement of key gaps affecting the development and implementation of OBGYN devices for use in LMICs. Recommendations are provided for various stages of the development to early commercialization phases. We believe future incorporation of these recommendations can aid in equitable and implementable medical device design for OBGYN care in LMICs.

Disclosure of positive HIV status to sexual partners among young people receiving treatment at an urban clinic, Kampala, Uganda

BACKGROUND

HIV/AIDS remains a public health threat globally. The disclosure rates of positive HIV status by young people living with HIV (YPLHIV) to their sexual partners vary and have been reported as low as 31%, despite the consequences of non-disclosure. Little is known about disclosure to sexual partners among YPLHIV in most of Sub-Saharan Africa, including Uganda. We assessed the prevalence, determinants, barriers and facilitators of HIV status disclosure to sexual partners among YPLHIV in care at an urban HIV clinic in Uganda.

METHODS

The study utilized a cross sectional design using a parallel-convergent mixed method approach. We conducted 281 structured interviews through random sampling and 16 purposively sampled in-depth interviews (IDIs) among YPLHIV (18 to 24 years). Descriptive analysis was done to obtain the frequency and percentage of HIV status disclosure to sexual partners of YPLHIV. Modified Poisson regression was used to determine associated factors at multivariate analysis and adjusted prevalence ratios, 95% CI and p values were obtained using STATA version 14. Verbatim transcription and thematic analysis using NVIVO version 12 was used to explore the barriers and facilitators of HIV status disclosure to sexual partners using the health belief model.

RESULTS

The prevalence of HIV status disclosure to sexual partners was 45.2%. Having a known HIV free partner (aPR = 0.6, P < 0.001), being a partial or complete orphan (aPR = 1.4, P = 0.022), knowing one's HIV status for > 1 year (aPR = 0.7, P < 0.001), and having 2 rather than 3 sexual partners (aPR = 1.7, P = 0.013) were among the determinants of HIV status disclosure. Facilitators of disclosure included; health worker/peer support, nature of relationship, protecting partners against HIV, need for social/financial support. Barriers to disclosure included; lack of confidence to disclose, fear of sexual partners' reaction, awareness of undetectable HIV viral load equated to none HIV transmission, influence by parents among others.

CONCLUSION

This study revealed a low HIV status disclosure prevalence to sexual partners among YPLHIV. Addressing potential barriers through comprehensive health education including the role of viral load in HIV transmission, and creating supportive environments to enhance their confidence, will improve disclosure rates among YPLHIV to their sexual partners.

Impact of the economic crisis in Sri Lanka on health and healthcare related to epilepsy

BACKGROUND

The economic crisis in Sri Lanka in 2022-23, has had a significant impact on its healthcare system, particularly with epilepsy, a condition demanding continuous care, facing heightened vulnerability amidst this turmoil.

OBJECTIVES

To assess the health impact of the economic crisis on people with epilepsy (PWE), their caregivers and healthcare providers and on the delivery of epilepsy-related healthcare services METHOD: A hospital-based cross-sectional study was conducted from June to August 2022 in the most populated province in Sri Lanka. The sample included 405 patients and their caregivers. A separate cross-sectional survey among all neurologists practicing in the national healthcare system was concurrently performed. Health outcomes were assessed by recall for before and after the economic crisis. Epilepsy control scales, mental well-being scales and questionnaires were used to measure health outcomes. Impact on healthcare services was evaluated through 1). a country-wide survey on availability of anti-seizure medication (ASM) and 2). neurologists' views on effects on healthcare services during the crisis.

RESULTS

Significant shifts in health outcomes such as increase in frequency of average number of seizures experienced (p < 0.001), number of emergency admissions(p < 0.01) and greater number of breakthrough seizures(p < 0.001) was reported. Psychological distress was reported by all three categories (PWEs, caregivers and care providers). Healthcare services were affected due to shortage of ASMs and other first-line medications. Healthcare providers reported management challenges, including medication shortages and increased patient burdens.

SIGNIFICANCE

The adverse impacts of the economic crisis in Sri Lanka extend to both health and epilepsy-related healthcare services. This study underscores the imperative for immediate collaborative efforts to address these challenges.

FUNDING

Self-funded by the authors.

Comparison of HIV prevention indicators among adolescent girls and young women in DREAMS and non-DREAMS intervention districts in Uganda

In sub-Saharan Africa, a significant number of new human immunodeficiency virus (HIV) infections occur among adolescent girls and young women (AGYW). The 2023 Uganda Annual Spectrum estimates indicated that about one-third of all new HIV infections are among AGYW. In 2016, the Ministry of Health in partnership with the United States President's Emergency Plan for AIDS Relief (PEPFAR) initiated the Determined, Resilient, Empowered, AIDS-Free, Mentored and Safe (DREAMS) program to reduce the vulnerability of AGYW to HIV by offering various direct and indirect HIV-related prevention services. These services influence the level of various HIV prevention indicators in the age group. This study aimed to compare these levels. The study was a secondary analysis of pooled Lot Quality Assurance Sampling (LQAS) survey data collected in DREAMS and non-DREAMS districts during 2021 and 2022. Fifteen HIV prevention indicators were independently compared between 8 DREAMS and 8 non-DREAMS districts. Chi-square tests were used to assess the significance in the differences. Of the 9,290 records of AGYW reviewed, 52.40% were of AGYW residing in DREAMS districts. Between DREAMS and non-DREAMS districts, significant differences in level of knowledge of HIV prevention methods (25.60% versus 14.63%, p < 0.001), condom use (58.99% versus 48.33%, p < 0.001), knowledge of HIV testing points (93.43% versus 92.38%, p = 0.049), having multiple sex partners (15.28% versus 10.11%, p < 0.001), condom use (58.99% versus 48.33%, p < 0.001), HIV testing (84.86% versus 82.00%, p < 0.001) and multiple sex partners (15.28% versus 10.11%, p < 0.001) among other indictors. AGYW in DREAMS districts had better outcomes for all indicators except multiple sex partners. Although this factor likely contributed to the initial selection of DREAMS-intervention districts, its persistence may continue to influence overall efforts towards the reduction of HIV prevalence. Moreover, this potentially mitigates the benefits from other better performing indicators.

Exploration of Rapid Adaptation of First Contact Physiotherapy Services During the COVID-19 Pandemic: A Three-Phase Sequential Mixed-Methods Study Protocol

Background

The COVID-19 pandemic significantly disrupted primary care and emergency departments globally, including the UK and Australia respectively, affecting services within these settings, such as first contact physiotherapy services (FCPS) for patients with musculoskeletal conditions. This disruption necessitated rapid adaptation to ensure continuity of care. Before this study, comprehensive adaptations across both primary care and emergency departments FCPS had not been documented. Additionally, the specific adaptation processes, strategies used, and experiences of both staff and patients during the COVID-19 pandemic were unclear. Variations in responses between the UK and Australia also remained unknown. Documenting these rapid adaptations and experiences is crucial for future preparedness, as it provides valuable insights to guide FCPS and similar services, preventing future disruptions and promoting continuity of care. Moreover, findings will contribute significant knowledge to the existing literature.

Aim

This study explores rapid adaptation of FCPS for patients with musculoskeletal conditions during the COVID-19 pandemic in the UK and Australia.

Methods

This is an ongoing three-phase sequential mixed-methods study. Phase 1 utilises a cross-sectional survey of physiotherapists in FCPS role in the UK and Australia to assess changes in healthcare delivery during the pandemic, as well as levels of readiness and responsiveness, highlighting similarities and differences. Phase 2 employs a case-study approach, including semi-structured interviews and a review of documents produced to direct the management and implementation of proposed changes in FCPS, to further understand the findings from Phase 1. In phase 3, mixed-methods integration facilitates the development of context specific recommendations for the rapid adaptation of FCPS and similar contexts. These recommendations will be presented to experts for feedback and further refinement.

Discussion

The mixed-methods research will provide contextually rich account of FCPS rapid adaptation, providing key learnings that could be applied to implement evidence-informed rapid adaptation in FCPS during public health emergencies.

Calling time on low-risk drinking guidelines: An evaluation of alternative methods to communicate risks of alcohol use to consumers

BACKGROUND

Current epidemiological analyses suggest there is no risk-free level of alcohol consumption. Awareness remains low and consumption levels high. There is limited research on the types of alcohol warning label (AWL) messages to address this concern.

AIMS

We tested alternative AWL messages with young adults to identify effective methods of communicating Canada's 2023 Guidance on Alcohol and Health.

METHODS

We recruited 332 young adults attending two Canadian universities who drank at least monthly. Participants' knowledge of health risks from alcohol was assessed. Six AWLs were developed to communicate (a) traditional "low risk" limits, (b) alcohol's cancer risk, (c) guidelines to keep mortality risk below 1 %, (d) reduced life expectancy in minutes per drink, (e) reduced life expectancy in months or (f) a "drink less" message. AWLs were rated for impact on purchasing, clarity, discomfort and degree of annoyance caused. Mixed regression was used to analyse the rated scores all compared with a control message which recommended consumers drink responsibly. T-tests were used to test for significance between the impact ratings of the AWLs. The AWLs were also discussed by a focus group.

RESULTS

Participants correctly identified liver cirrhosis (93.37 %) and pancreatitis (85.84 %) as caused by alcohol, fewer identified throat (38.25 %) or breast cancer (24.70 %). All six experimental AWLs were rated as significantly more impactful on purchasing behaviour than the control. The highest mean ratings were received for the 'Cancer Risk' (3.09, 95 % CIs: 2.95-3.25), the '5 Minutes of Life Lost per Drink' (3.01, 95 % CIs: 2.87-3.16) and 'Three Months of Life Lost' (2.96, 95 % CIs: 2.82-3.11) AWLs. Traditional drinking guideline messages and a '1 % mortality risk' message performed relatively poorly. These results were confirmed by qualitative analysis of the focus group discussion.

CONCLUSIONS

Health communications, including AWLs, may be more effective if they highlight specific, tangible risks from alcohol consumption such as cancer and potential impacts on life expectancy.

Long COVID Response to Classical Chinese Medicine

Background

Long COVID remains a significant burden for patients, clinicians, employers, and the U.S. healthcare system. Despite substantial resources and scientific studies directed at understanding and treating long COVID, its cause, and thus targeted treatment remains elusive. Conventional medicine focuses on symptom evaluation to rule out other etiologies. Intervention typically offers the patient current understanding and education and provides reassurance and context for their symptoms. Treatment is mostly supportive care directed at symptom management to improve quality of life, including occupational and physical therapy, breathing exercises, pulmonary rehabilitation, and mental health therapy. Classical Chinese Medicine (CCM) can help make sense of an individual's response to COVID-19 infection, as each pathophysiological change caused by COVID can be correlated with CCM principles, therefore a corresponding treatment approach is available.

Methods

A case series of four representative patients with long COVID treated with CCM is presented. Symptom complex, CCM diagnoses and treatment, and response to treatment are provided for each case, and the rationale for the selected therapy approach is explained.

Results

All four patients recovered fully from long COVID after treatment with CCM therapy. These cases are representative of 56 patients successfully treated thus far with CCM for long COVID.

Conclusion

There is no single treatment for long COVID in Western or Chinese medicine. Western medical treatment centers around reassurance and supportive care, whereas CCM treatment can be more directly targeted and individualized to underlying causes and increase the probability of recovery. These cases indicate the potential of CCM for treating long COVID. However, more research is needed to evaluate the effectiveness of this approach to long COVID recovery.

Diagnostic and Therapeutic Role of Peroneal Tenography in Chronic Peroneal Disorders: A Service Evaluation

Purpose The aims were to investigate if there was a diagnostic difference between peroneal tenography and MRI to guide the management of peroneal tendon disorders with the secondary aim to investigate the therapeutic effect of peroneal tenography. Methods A retrospective study was carried out over a 75-month period, including all patients over 18 years who presented with ankle injuries to identify patients with peroneal tendon disorders. Symptomatic patients were investigated using MRI and peroneal tenography. This was also compared with intraoperative findings of peroneal tendons. Fischer's exact test was used to determine the diagnostic difference between peroneal tenography as compared to MRI. The therapeutic effect of peroneal tenography was also calculated. Results The cohort consisted of 27 patients (20 females and 7 males), with the median age being 50 years and the mean BMI being 31.9. The follow-up period after the final management plan was 12 months before discharge from care. Findings from peroneal tenography were more likely to match intraoperative findings than MRI when compared with intraoperative findings (p=0.033). Fifteen out of the 27 patients who underwent peroneal tenography reported adequate pain relief following the procedure. Conclusion Peroneal tenography is more sensitive and specific in determining peroneal tendon disorders as compared to MRI and plays a role as a therapeutic intervention in ankle pain management for these patients.

Acceptability of a Web-Based Health App (PortfolioDiet.app) to Translate a Nutrition Therapy for Cardiovascular Disease in High-Risk Adults: Mixed Methods Randomized Ancillary Pilot Study

BACKGROUND

The Portfolio Diet is a dietary pattern for cardiovascular disease (CVD) risk reduction with 5 key categories including nuts and seeds; plant protein from specific food sources; viscous fiber sources; plant sterols; and plant-derived monounsaturated fatty acid sources. To enhance implementation of the Portfolio Diet, we developed the PortfolioDiet.app, an automated, web-based, multicomponent, patient-facing health app that was developed with psychological theory.

OBJECTIVE

We aimed to evaluate the effect of the PortfolioDiet.app on dietary adherence and its acceptability among adults with a high risk of CVD over 12 weeks.

METHODS

Potential participants with evidence of atherosclerosis and a minimum of one additional CVD risk factor in an ongoing trial were invited to participate in a remote web-based ancillary study by email. Eligible participants were randomized in a 1:1 ratio using a concealed computer-generated allocation sequence to the PortfolioDiet.app group or a control group for 12 weeks. Adherence to the Portfolio Diet was assessed by weighed 7-day diet records at baseline and 12 weeks using the clinical Portfolio Diet Score, ranging from 0 to 25. Acceptability of the app was evaluated using a multifaceted approach, including usability through the System Usability Scale ranging from 0 to 100, with a score >70 being considered acceptable, and a qualitative analysis of open-ended questions using NVivo 12.

RESULTS

In total, 41 participants were invited from the main trial to join the ancillary study by email, of which 15 agreed, and 14 were randomized (8 in the intervention group and 6 in the control group) and completed the ancillary study. At baseline, adherence to the Portfolio Diet was high in both groups with a mean clinical Portfolio Diet Score of 13.2 (SD 3.7; 13.2/25, 53%) and 13.7 (SD 5.8; 13.7/25, 55%) in the app and control groups, respectively. After the 12 weeks, there was a tendency for a mean increase in adherence to the Portfolio Diet by 1.25 (SD 2.8; 1.25/25, 5%) and 0.19 (SD 4.4; 0.19/25, 0.8%) points in the app and control group, respectively, with no difference between groups (P=.62). Participants used the app on average for 18 (SD 14) days per month and rated the app as usable (System Usability Scale of mean 80.9, SD 17.3). Qualitative analyses identified 4 main themes (user engagement, usability, external factors, and added components), which complemented the quantitative data obtained.

CONCLUSIONS

Although adherence was higher for the PortfolioDiet.app group, no difference in adherence was found between the groups in this small ancillary study. However, this study demonstrates that the PortfolioDiet.app is considered usable by high-risk adults and may reinforce dietitian advice to follow the Portfolio Diet when it is a part of a trial for CVD management.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02481466; https://clinicaltrials.gov/study/NCT02481466.

Immunohistochemical Expression of Glucose Transporter-1 in Oral Epithelial Dysplasia and Different Grades of Oral Squamous Cell Carcinoma

Background and Objectives: Glucose Transporter-1 (GLUT1) is the key target gene for hypoxia-inducible factor (HIF), which helps cells uptake glucose during cell division, malignant transformation, and nutrient depletion. Cancer hypoxia is a well-known condition caused by an oxygen imbalance in the cancer microenvironment. During chronic hypoxia, certain cancer cells can survive and adapt. These cellular alterations can make cancer more aggressive, causing invasion and metastasis. The study investigated the presence of GLUT1 in oral epithelial dysplasia (OED) and various histopathological grades of oral squamous cell carcinoma (OSCC) to assess the significance of GLUT1 as a prognostic indicator. Material and Methods: A total of 40 samples of tissue blocks, including 5 cases of normal oral mucosa, 5 cases of epithelial dysplasia, and 30 cases of OSCC with 10 cases each of well-differentiated, moderately differentiated, and poorly differentiated OSCCs, these cases were diagnosed using the Hematoxylin and Eosin (H&E) staining technique. GLUT1 expression was assessed using immunohistochemical staining, which involved evaluating the location of the stain and the percentage of staining. Results: The mean area percent was highest in poorly differentiated cases (47.37) and lowest in well-differentiated cases (13.42). In poorly differentiated cases, diffuse expression was observed in almost all malignant cells, exhibiting membrane, cytoplasmic and nuclear staining. A significant difference (p < 0.001) between all groups in regard to immunostaining was detected. Conclusions: GLUT1 expression increased from oral epithelial dysplasia to oral squamous cell carcinoma histological grades. GLUT1 in actively dividing cells may reflect the tumor's aggressiveness and treatment response. Hypoxia increases this marker's expression, indicating division and proliferation.

Cyclodextrin-based delivery systems for chemical and genetic drugs: Current status and future

Cyclodextrins (CDs) are cyclic polysaccharides characterized by their unique hollow structure, making them highly effective carriers for pharmaceutical agents. CD-based delivery systems are extensively utilized to enhance drug stability, increase solubility, improve oral bioavailability, and facilitate controlled release and targeted delivery. This review initially provides a concise overview of nano drug delivery systems, followed by a detailed introduction of the structural features and benefits of CDs. It further summarizes the applications of CD-based delivery systems and offers insights for the rational design of drug delivery systems. In this review, CD-based delivery systems are categorized into several types, such as covalently modified CD derivatives, non-modified CD inclusion complexes, poly-cyclodextrins and others. The application of CD-based systems for the delivery of genetic therapeutic agents and co-delivery of gene and drug is also presented. Finally, this review discusses potential challenges and opportunities that may arise in the future. With the development of nanotechnology and optimization of preparation process, CD-based drug delivery systems will provide a more effective, precise and safe approach to drug therapy.

Assessment of health risks of university professors through exposure to BTEX compounds from white board markers

This case-control study aimed to investigate the health risks faced by university professors as a result of using whiteboard markers. The study included 30 professors who used the whiteboard markers for teaching and 20 professors who used other teaching aids. Samples of urine and breathing air were collected from the participants, and then analyzed in the laboratory using gas chromatography (GC) to measure the concentrations of BTEX compounds. The carcinogenic and non-carcinogenic risks of these compounds were assessed using a probabilistic method. The mean concentrations (ug/L) of compounds in the urine differed significantly (p < 0.05) between the case and control groups for benzene (82.59 vs. 65.36), toluene (128.47 vs. 85.65), and ethylbenzene (9.09 vs. 25.16). The mean lifetime cancer risk (LTCR) for benzene (8.27 × 10-8) and ethylbenzene (9.38 × 10-8) as well as the non-carcinogenic risk of all compounds in the control group were below the acceptable limit. Due to the higher concentration of compounds in the urine of the case group compared to the control group, it is essential to utilize alternative teaching methods in educational settings instead of traditional whiteboards and chemical markers.

Oncology Provider and Patient Perspectives on a Cardiovascular Health Assessment Tool Used During Posttreatment Survivorship Care in Community Oncology (Results from WF-1804CD): Mixed Methods Observational Study

BACKGROUND

Most survivors of cancer have multiple cardiovascular risk factors, increasing their risk of poor cardiovascular and cancer outcomes. The Automated Heart-Health Assessment (AH-HA) tool is a novel electronic health record clinical decision support tool based on the American Heart Association's Life's Simple 7 cardiovascular health metrics to promote cardiovascular health assessment and discussion in outpatient oncology. Before proceeding to future implementation trials, it is critical to establish the acceptability of the tool among providers and survivors.

OBJECTIVE

This study aims to assess provider and survivor acceptability of the AH-HA tool and provider training at practices randomized to the AH-HA tool arm within WF-1804CD.

METHODS

Providers (physicians, nurse practitioners, and physician assistants) completed a survey to assess the acceptability of the AH-HA training, immediately following training. Providers also completed surveys to assess AH-HA tool acceptability and potential sustainability. Tool acceptability was assessed after 30 patients were enrolled at the practice with both a survey developed for the study as well as with domains from the Unified Theory of Acceptance and Use of Technology survey (performance expectancy, effort expectancy, attitude toward using technology, and facilitating conditions). Semistructured interviews at the end of the study captured additional provider perceptions of the AH-HA tool. Posttreatment survivors (breast, prostate, colorectal, endometrial, and lymphomas) completed a survey to assess the acceptability of the AH-HA tool immediately after the designated study appointment.

RESULTS

Providers (n=15) reported high overall acceptability of the AH-HA training (mean 5.8, SD 1.0) and tool (mean 5.5, SD 1.4); provider acceptability was also supported by the Unified Theory of Acceptance and Use of Technology scores (eg, effort expectancy: mean 5.6, SD 1.5). Qualitative data also supported provider acceptability of different aspects of the AH-HA tool (eg, "It helps focus the conversation and give the patient a visual of continuum of progress"). Providers were more favorable about using the AH-HA tool for posttreatment survivorship care. Enrolled survivors (n=245) were an average of 4.4 (SD 3.7) years posttreatment. Most survivors reported that they strongly agreed or agreed that they liked the AH-HA tool (n=231, 94.3%). A larger proportion of survivors with high health literacy strongly agreed or agreed that it was helpful to see their heart health score (n=161, 98.2%) compared to survivors with lower health literacy scores (n=68, 89.5%; P=.005).

CONCLUSIONS

Quantitative surveys and qualitative interview data both demonstrate high acceptability of the AH-HA tool among both providers and survivors. Although most survivors found it helpful to see their heart health score, there may be room for improving communication with survivors who have lower health literacy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03935282; http://clinicaltrials.gov/ct2/show/NCT03935282.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-https://doi-org.wake.idm.oclc.org/10.1016/j.conctc.2021.100808.

Causative Agents of Fungal Keratitis in Northeastern Iran: A 3-Year Tertiary Care Hospital Study

Infectious keratitis is a significant ocular disease that, if left untreated, can lead to blindness. Fungi are among the causative agents that can result in severe symptoms. Keratitis infections are prevalent globally, with a higher incidence reported in tropical and subtropical regions. The current research focused on the molecular diagnosis of fungal keratitis and its prevalence over a 3-year period in northeastern Iran. The study involved the collection of 38 corneal scraping specimens from the Eye Specialized Hospital of Khatam in Mashhad, northeastern Iran. These specimens were cultured on Sabouraud dextrose agar, and the isolates were identified using DNA-based techniques. Among the patients studied (n = 38), 22 (58%) cases were caused by Aspergillus species (A. flavus, n = 17, A. fumigatus, n = 3; A. terreus, n = 1; A. tubingensis, n = 1), seven (18%) by Neocosmospora species (N. falciformis, n = 4; N. solani, n = 3), three (7%) by Candida albicans, two (5%) by Fusarium annulatum, and one case each (2%) by Penicillium chrysogenum, Cladosporium cladosporioides, and Cytospora sp. In addition, one case had a combined infection of A. flavus and P. glabrum. The results indicate a higher incidence of fungal keratitis in males, particularly in the age range of 40-60 years. Aspergillus sp., and specifically A. flavus, had the highest prevalence. Cladosporium cladosporioides is reported for the first time in this area as causal agent of keratitis. Additionally, this is the first report of keratitis likely caused by Cytospora species.

Development of an AI-derived, non-invasive, label-free 3D-printed microfluidic SERS biosensor platform utilizing Cu@Ag/carbon nanofibers for the detection of salivary biomarkers in mass screening of oral cancer

Developing a non-invasive and reliable tool for the highly sensitive detection of oral cancer is essential for its mass screening and early diagnosis, and improving treatment efficacy. Herein, we utilized a label-free surface enhanced Raman spectroscopy (SERS)-based biosensor composed of Cu@Ag core-shell nanoparticle anchored carbon nanofibers (Cu@Ag/CNFs) for highly sensitive salivary biomarker detection in oral cancer mass screening. This SERS substrate provided a Raman signal enhancement of up to 107 and a detection limit as low as 10-12 M for rhodamine 6G molecules. Finite-difference time-domain (FDTD) simulation studies on Cu@Ag/CNFs indicated an E-field intensity enhancement factor (|E|2/|E0|2) of 250 at the plasmonic hotspot induced between two adjacent Cu@Ag nanoparticles. The interaction of this strong E-field along with the chemical enhancement effects was responsible for such huge enhancement in the Raman signals. To realize the real capability of the developed biosensor in practical scenarios, it was further utilized for the detection of oral cancer biomarkers such as nitrate, nitrite, thiocyanate, proteins, and amino acids with a micro-molar concentration in saliva samples. The integration of SERS substrates with a 3D-printed 12-channel microfluidic platform significantly enhanced the reproducibility and statistical robustness of the analytical process. Moreover, AI-driven techniques were employed to improve the diagnostic accuracy in differentiating the salivary profiles of oral cancer patients (n1 = 56) from those of healthy controls (n2 = 60). Principal component analysis (PCA) was utilized for dimensionality reduction, followed by classification using a random forest (RF) algorithm, yielding a robust classification accuracy of 87.5%, with a specificity of 92% and sensitivity of 88%. These experimental and theoretical findings emphasize the real-world functionality of the present non-invasive diagnostic tool in paving the way for more accurate and early-stage detection of oral cancer in clinical settings.

A Network Pharmacology Study and In Vitro Evaluation of the Bioactive Compounds of Kadsura coccinea Leaf Extract for the Treatment of Type 2 Diabetes Mellitus

Kadsura coccinea is a traditional Chinese medicine whose roots have long been used to treat various ailments, but little is known about the efficacy of its leaves. In this study, the antidiabetic activity of K. coccinea leaf extract (KCLE) was determined, the main components of KCLE were identified using UPLC-TOF-MS, and network pharmacology and molecular docking were integrated to elucidate the antidiabetic mechanism of KCLE. The results showed that KCLE effectively increased the glucose consumption of IR-HepG2 cells through pyruvate kinase (PK) and hexokinase (HK), promoted glycogen synthesis, and inhibited α-glucosidase and α-amylase activities. KCLE also improves diabetes by regulating AKT1, TNF, EGFR, and GSK3β. These targets (especially AKT1 and TNF) have a high binding affinity with the main active ingredients of KCLE (rutin, luteolin, demethylwedelolactone, maritimetin, and polydatin). Pathway enrichment analysis showed that the antidiabetic effect of KCLE was closely related to the PI3K-Akt signaling pathway, MAPK signaling pathway, AGE-RAGE signaling pathway, and FoxO signaling pathway. These findings provide a theoretical basis for promoting the pharmacodynamic development of K. coccinea and its application in treating diabetes.

Lip and oral cavity cancer in Iran from 1990 to 2019 based on the global burden of disease study

The global burden of disease (GBD) provides valid and reliable assessments of the burden of various diseases. The present study aimed to evaluate the trends of incidence, mortality, and morbidity of lips and oral cavity cancers (LOCC) in Iran from 1990 to 2019 according to GBD 2019 data. Indicators including prevalence, incidence, death, years of life lost (YLL), years lived with disability (YLD), disability adjusted life years (DALY), and mortality-to-incidence ratio (MIR) for two genders and three age groups including 15-49 years, 50-69 years, and 70 + years in Iran were extracted from GBD 2019/calculated. The annual percentage changes of different indicators were analyzed. A joinpoint regression analysis was used to examine the pattern of changes. LOCC incidence in Iran has increased during the studied period, in both genders and all age groups. The average annual percent change (AAPC) of incidence increase was much higher in women (1.36) than in men (0.007), while the highest growth was observed in middle-aged women from 2010 to 2015 (6.9). The general trend (AAPC (Confidence interval (CI)) of YLL in total patients (-0.20 (-0.23, -0.17)), and DALY in total patients (-0.17 (-0.21, -0.14)) had a significant decrease. However, YLL in women (0.48 (0.44, 0.50)) and DALY in women (0.51 (0.48, 0.54)) significantly increased. Moreover, MIR has been declining during the studied period except for the time range of 2002 to 2010, in each of the two sexes (-0.46 in men and - 0.64 in women) and both together (-0.53). A declining trend of YLL/DALY/MIR, and an improvement in screening/diagnosis/treatment/patient care of LOCC in Iran has happened that still needs to be improved. Due to the increase in incidence/mortality/morbidity of LOCC in Iranian women, risk factors exposure and disease screening should be followed seriously.

Fostering Adherence to Evidence-Based Care in the Management of Musculoskeletal Shoulder Pain: A Mixed-Methods Study

OBJECTIVE

The objective was to identify the priorities of individuals with musculoskeletal shoulder pain and their health care providers (HCPs) that are perceived to foster multistakeholder adherence to evidence-based recommendations.

METHODS

The study used a mixed-methods design, informed by concept mapping. Patients with shoulder pain (ie, ≥6 weeks) and HCPs involved in their care (recruited via social media, email, etc) were invited to complete an initial survey to identify perceived priorities to foster adherence to evidence-based recommendations. Preliminary data sorting resulted in a final priority list, with a subset (n = 20) of respondents rating their importance using a Likert scale. A public and patient involvement (PPI) panel (N = 8) assisted in this rating phase, further sorting of priorities based on thematic similarities (ie, into categories and then domains), analysis, interpretation, and developing a concept map illustrating relationships between them.

RESULTS

One hundred and fifty-four participants (HCPs = 133; patients = 21) responded to the initial survey, generating 77 priorities, grouped into 13 categories, and then into 3 domains: (1) Education, (2) Patient-centered care, and (3) Health care communication. Patients prioritized categories relating to the provision of a specific diagnosis, the establishment of a strong therapeutic relationship, and the need for education on progress and recovery timelines, as well as treatment options. HCPs prioritized these same educational categories, also prioritizing the need for tailoring exercise therapy and providing a unified message on best management. PPI panelists identified education on treatment options coupled with a strong therapeutic alliance and a unified message on best management to be of pivotal importance in fostering adherence. Panelists also stressed that future knowledge translation resources must provide tailored education.

CONCLUSION

HCPs and patients agree on the need to prioritize education related to progress and recovery timelines as well as treatment options, with a strong therapeutic alliance and a unified message on best management also considered of pivotal importance for adherence to evidence-based recommendations.

IMPACT

To the knowledge of the authors, this is the first study, including a broad range of stakeholder groups spanning across 11 different countries, to explore the priorities that stakeholders perceived to support stricter adherence to evidence-based recommendations for musculoskeletal shoulder pain, with the relationship between these priorities visually illustrated using a concept map. Patients and HCPs were united in their prioritization of education relating to expected progress and recovery timelines, as well as treatment options and supporting evidence. Stakeholders also identified the need for greater emphasis to be placed on establishing a therapeutic relationship and on integrating shared decision-making into clinical practice to further facilitate adherence. Education relating to treatment options and supporting evidence, a strong therapeutic relationship, and a unified message on best management were perceived by the PPI panel as being pivotal in facilitating adherence to evidence-based treatment. The findings of this study highlight the need for improved tailoring of educational resources for shoulder pain, as well as more cohesive messaging from health care providers, both assisting in supporting first-line treatments, such as exercise therapy, for musculoskeletal shoulder pain.

Identifying the panorama of potential pandemic pathogens and their key characteristics: a systematic scoping review

The globe has recently seen several terrifying pandemics and outbreaks, underlining the ongoing danger presented by infectious microorganisms. This literature review aims to explore the wide range of infections that have the potential to lead to pandemics in the present and the future and pave the way to the conception of epidemic early warning systems. A systematic review was carried out to identify and compile data on infectious agents known to cause pandemics and those that pose future concerns. One hundred and fifteen articles were included in the review. They provided insights on 25 pathogens that could start or contribute to creating pandemic situations. Diagnostic procedures, clinical symptoms, and infection transmission routes were analyzed for each of these pathogens. Each infectious agent's potential is discussed, shedding light on the crucial aspects that render them potential threats to the future. This literature review provides insights for policymakers, healthcare professionals, and researchers in their quest to identify potential pandemic pathogens, and in their efforts to enhance pandemic preparedness through building early warning systems for continuous epidemiological monitoring.

The Epidemiological Profile of Tuberculosis Patients and Risk Factors for Poor Treatment Outcomes in Sarpang District, Bhutan: A 17 Years Retrospective Study

Tuberculosis (TB) is one of the major public health issues in Bhutan. This study aimed to evaluate epidemiology of TB and predictors of poor treatment outcomes in Sarpang District, Bhutan. A retrospective cohort study was conducted using TB case-based surveillance data of Sarpang District from 2005 to 2021. The outcome of interest was poor treatment outcome. The potential predictors were analyzed using logistic regression. A total of 1704 TB cases were analyzed in this study. The poor outcome in this study was 6.6% with 2.6% deaths due to TB. The patients older than 65 years (adjusted odds ratio [AOR] = 3.58) and sputum non-conversion in the second month with acid-fast bacilli results of scanty (AOR = 3.08), 1+ (AOR = 7.12), and 2+ (AOR = 21.05) were the significant predictors of poor treatment outcome. Therefore, older age and sputum non-conversion in the second month should be given priority.

Exploring the Extent and Nature of Disordered Eating Among Canadian Adolescents and Young Adults With Spina Bifida and Hydrocephalus

BACKGROUND

Adolescents and young adults (AYA) with spina bifida and/or hydrocephalus (SBH) are at a higher risk for disordered eating, poor body image and body dissatisfaction. Regrettably, there is limited research on the eating patterns and behaviours of AYA with SBH, as well as their body image perceptions.

OBJECTIVES

The purpose of this study was to explore the nature of disordered eating behaviours among AYA with SBH and their perceptions surrounding their body image. This study represents the first investigation of its kind conducted within a Canadian population. It fills a literature gap regarding the understanding of disordered eating behaviours and body image perceptions among young individuals with SBH in Canada.

METHODS

The study comprised a self-report, cross-sectional online survey of AYA with SBH across Canada. The survey comprised validated brief measures to evaluate eating behaviours, disordered eating and body esteem. AYA aged 12-26 years with any type of SBH were eligible to participate.

RESULTS

Twenty-four participants were recruited. Results indicated that AYA with SBH may face an elevated risk for eating disorders/disordered eating compared to their typically developing peers, due to a myriad of reasons not typically experienced in the general population such as bowel and bladder management, mobility issues and eating aversions. Findings also indicated that some AYA with SBH may have poor body image and that it is possible that this is not discussed in SBH clinics.

CONCLUSION

Our work underscores the urgency for further research that focuses on assessing eating disorders/disordered eating behaviours in AYA with SBH.

Living with chronic myelogenous leukemia in rural communities: Exploring factors related to tyrosine kinase inhibitors adherence with a mixed methods approach

PURPOSE

Tyrosine kinase inhibitors (TKIs) improve chronic myeloid leukemia (CML) outcomes dramatically. However, limited research exists on patient-specific, medical, and psychosocial factors influencing TKI adherence. The purpose of the study was to better understand TKI adherence among rural CML patients, using a convergent parallel mixed-method design guided by the Information Motivation and Behavioral Skills Model.

METHODS

Survivors with CML participated in semistructured interviews and completed self-reported questionnaires, including demographics, perceived stress, side effects, emotional support, and self-efficacy for managing chronic conditions. Qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated.

RESULTS

Sixteen participants aged 26 to 76 years completed the study. The duration of TKI therapy ranged from 0 to 12 years (mean ± standard deviation, 5.56 ± 4.08). While all reported adherence to TKI therapy, 31% held misconceptions about treatment duration, and 38% misunderstood reasons for blood tests prior to treatment or TKI refilled. Qualitative data yielded five major themes with descriptions of the shock of diagnosis, educational experiences regarding CML and its treatment, challenges in managing side effects and refills, the importance of social support, and strategies for maintaining remission and motivating adherence to TKI.

CONCLUSIONS

This study describes the knowledge, motivations, challenges, and skills related to TKI adherence among rural patients with CML. A patient-centered approach is recommended for health care providers to improve adherence and enhance outcomes for CML patients on TKI therapy.

Frequency and Outcome of Emergency Penetrating Keratoplasty in Infectious Keratitis in Sweden During the 21st Century

PURPOSE

To study the frequency over time and outcome of penetrating keratoplasty (PK), "keratoplasty à chaud," in patients with infectious keratitis with 2-year follow-up data.

METHODS

This register-based study included keratitis cases that had undergone PK in Sweden between 2001 and 2020 and reported to the Swedish Corneal Transplant Register.

RESULTS

During the study period, 69 eyes were subjected to acute PK due to progressive infectious keratitis. The number increased from 2 annual procedures in the first half of the study period to 5 in the second half ( P = 0.01). Preoperative corneal perforation was present in 43.5% (n = 30) of the eyes. Two years after surgery, follow-up data were completed in the register for 53 eyes; of these, 62.3% (n = 33) were considered to have functioning grafts, and 20.8% (n = 11) had experienced a rejection episode. The visual acuity improved from hand motion to counting fingers ( P = 0.002), and the proportion of eyes with a visual acuity of ≤1.0 logMAR increased from 5.7% (n = 3) before the surgery to 45.3% (n = 24) at the 2-year follow-up ( P < 0.001).

CONCLUSIONS

The number of active infectious keratitis cases undergoing keratoplasty à chaud increased in Sweden during the 21st century. Most of the cases were successful regarding the structural integrity of the bulb, that is, "had a saved eye" and even a functioning graft 2 years after corneal transplantation. The visual gain was distinct, albeit modest. In cases with severe infectious keratitis, and even a concomitant perforation in the cornea due to the infection, corneal transplantation should continue to be an option.

Posttraumatic stress disorder in the aftermath of the Turkey earthquake: exploring the role of demographics, level of exposure, and personality traits

BACKGROUND AND OBJECTIVES

Post-Traumatic Stress Disorder (PTSD) is an important mental disorder that can develop after mass traumas such as earthquakes. In our study, we aimed to investigate the development of PTSD after the Turkey earthquake (6 February 2023) and its association with some demographic variables, personality traits, and psychological vulnerability.

METHOD

547 participants completed assessments of personality, disaster exposure, and PTSD symptoms. Multiple regression analyses were used to identify predictors of PTSD symptoms.

RESULTS

PTSD scores were higher in women, single people, those with low educational level, those who witnessed someone else's injury or death, those who were injured, and those whose homes were destroyed. Physical injury, conscientiousness, marital status, income, and agreeableness predicted PTSD. Among these variables, physical injury was the strongest predictor of PTSD.

CONCLUSIONS

Psychological vulnerability, conscientiousness, physical injury, employment, witnessing someone else's injury, gender, and emotional stability predicted PTSD score in a significant way. Physical injury, conscientiousness, marital status, income, agreeableness predicted PTSD in a significant way.

Evidence-Based Medicine in Otolaryngology Part 16: Qualitative and Quantitative Methods-Contrasting and Complementary Approaches

Qualitative methods have been increasingly applied in our literature, providing richness to data and incorporating the nuances of patient and family perspectives. These qualitative research techniques provide breadth and depth beyond what can be gleaned through quantitative methods alone. When both quantitative and qualitative approaches are coupled, their findings provide complementary information which can further substantiate study conclusions. We thus aim to provide insight into qualitative and quantitative methods in comparison and contrast to each other, as well as guidance on when each approach is most apt. In relation, we also describe mixed methods and the theory supporting their framework. In doing so, we provide the foundation for an ensuing, more detailed exposition of qualitative methods.