Article Reviews Research Articles

A narrative review and update on drain-related outbreaks

Outbreaks linked to hospital drainage systems are well reported and continue to present challenges to incident management teams. Such outbreaks can be protracted and complex, with multi-modal strategies being required for remediation. The aim was to summarise recent drain related outbreaks, investigate whether multimodal control measures are being implemented and determine any antecedent factors. Databases were searched for drain related outbreaks over a five-year period. Search terms employed included healthcare drainage outbreaks; drain outbreaks;drainage system outbreaks; sink outbreaks; shower outbreaks . Information was collected on country of origin, pathogens involved, unit affected, drain types, patient numbers, drainage system interventions, type of drain disinfectant, infection control interventions, typing method, outcomes and any antecedent factors. Nineteen drain related outbreak papers were reviewed. The majority of incidents were due to Carbapenemase producing Enterobacterales (CPE) and were from critical care settings. Most (16/19) recognised the need for a multi-modal approach. Information on the success of interventions was not documented for all but 13/19 reported no further cases after control measures. Variation in the choice of agent and frequency of application exists with regards to drain disinfection. Seven studies discussed antecedent factors. Despite drain related outbreaks being reported for the last 24 years and review articles on the subject, outbreaks continue to pose significant challenges. There is currently no UK guidance on the management of drain related outbreaks or the design of new buildings to mitigate the risk. Addressing the challenges from hospital drainage systems should be considered a priority by agencies and guidance developers.

Pembrolizumab-induced myocarditis: A systematic review of case reports.

e14605 Background: Immune checkpoint inhibitors, such as pembrolizumab, have revolutionized cancer therapy but are associated with immune-related adverse events (irAEs), including myocarditis, which can have serious clinical consequences. This systematic review aims to comprehensively analyze case reports to better understand pembrolizumab-induced myocarditis. Methods: Using keywords of "pembrolizumab" or "Keytruda" and "myocarditis" in the PubMed/Medline, ScienceDirect and clinicaltrials.gov databases and manual searches on Google Scholar, we reviewed all cases reported up to the year 2023. In total, 296 studies received primary screening. Duplicated articles and those meeting the exclusion criteria (not myocarditis, not human, not English, trials done in vitro, combination immunotherapies) were excluded. Review articles, retrospective studies, systematic reviews, and meta-analyses were also excluded. Finally, 45 studies matching the inclusion criteria were included (total of 46 patients). Data on patient demographics, clinical presentation, diagnostic criteria, management strategies, and outcomes were extracted and analyzed. Results: In the included 46 patients, the mean age was 65.5 years, with a slight male predominance (56.5%). Predominant cancer types included lung cancer (30.4%), thymoma (15.2%), melanoma (13.0%), and genitourinary cancers (13.0%). 45.7% of patients developed myocarditis after their first cycle of Pembrolizumab while 41.3% developed myocarditis after two cycles. 47.8% of patients presented with dyspnea, 23.9% with fatigue, 10.9% with chest pain, while 13% of the patients were asymptomatic and were subsequently diagnosed with myocarditis while presenting with other immune-related adverse events. Troponin levels were assessed in 45 individuals, with only 2.2% (one patient) having normal levels. ECG changes included ST segment elevation in 21.7%, conduction abnormalities (RBBB 15.2%, LBBB 6.5%, AV block 26.1%, and one unspecified conduction abnormality) in 50%, and arrhythmias in 37% of cases. Treatment included steroids for all, with varying outcomes. Four patients each received one of the following treatments: batacept, ruxolitinib, alemtuzumab, and methotrexate. All four of these patients showed improvement. Two patients received infliximab (4.3%) and both of them died. Outcomes revealed 34.8% mortality, 63.0% improvement, and 2.2% deterioration, including one sudden cardiac death 35 days post-discharge. Conclusions: Pembrolizumab-induced myocarditis is a rare but potentially life-threatening irAE. This systematic review provides a comprehensive overview of the clinical characteristics, diagnostic challenges, treatment approaches, and outcomes of this condition. Further research is needed to elucidate the underlying mechanisms and identify risk factors for pembrolizumab-induced myocarditis, enabling early detection and prevention strategies.

Hidden From Sight—From the Closet to the Paywall: A Rapid Evaluation of Restricted and Monetized Access to LGBTQ+ Inclusive Palliative, End-of-Life, and Bereavement Care Research

IntroductionLGBTQ+ people experience higher burdens of life-limiting illnesses, poorer health outcomes, and multilevel barriers to accessing palliative, end-of-life, and bereavement care. High quality evidence is needed to inform interventions to address these inequities, and inform inclusive practices and policies. Despite global initiatives to improve availability of peer-reviewed journal articles, the minority of research is open access (OA). We aimed to evaluate accessibility of literature related to LGBTQ+ inclusive palliative, end-of-life, and bereavement care. MethodsA rapid review of the evidence regarding LGBTQ+ inclusive palliative, end-of-life, and bereavement care was conducted; OA status of identified articles was assessed. Articles from three published systematic reviews were included (2012, 2016, and 2020). Review articles were updated using the original search and inclusion/exclusion strategies. Results66 articles related to LGBTQ+ inclusive palliative, end-of-life and bereavement care were identified between 1990-2022. Of these, only 21% (n=14) were OA. Of the OA articles, 79% were published between 2017 and 2022, and 50% were published between 2020-2022, reflecting more recent shifts towards OA publishing. DiscussionHealth and social care professionals and policy makers rely on access to high quality evidence to inform their work. Failing to make articles related to the needs of LGBTQ+ people and populations OA risks further marginalisation and worsened inequities. Innovative journal policies and funding are needed to enable access, particularly for research that foregrounds the needs of marginalised communities. Where articles are currently behind paywalls, there is a need for accessible summaries or policy briefs to inform inclusive policy and practice.

A Review on Intention towards Consumption Behavior of Gastronomy in Sarawak, Malaysia

As gastronomy tourism research continues to experience exponential growth, several review articles have explored the connection between gastronomy and tourism through various thematic and disciplinary lenses. However, what is currently lacking is a comprehensive summary that encompasses the interdisciplinary aspects of this research field. Therefore, as a conceptual paper, this article uses the previous empirical data of the theory between Theory Planned Behavior (TPB) and Social Cognitive Theory (SCT) to obtain insight into the local gastronomy in Sarawak experiences through quantitative methods by using a questionnaire. The conceptual framework comprises eight factors (i.e., knowledge, experiences, cultural awareness, food safety, gastronomy image, epistemic value, and environmental factors, and willingness to pay). This study established an in-depth understanding of the consumption of local gastronomy in Sarawak.

Transition Metal-free α-C-H Functionalization of Tertiary Amines Catalysed/ Promoted by Acids: A Brief Review

Abstract: C-H Functionalization of α-carbon of tertiary amines has been of great importance for the past two decades as N-heterocycles can be synthesized by this approach and these heterocycles are highly useful as drugs or drug precursors in the pharmaceutical industry. In this review article, we have summarized only the α-C-H functionalization reactions of tertiary amines that are catalysed or promoted by acids. These C-H functionalization reactions are usually catalysed by transition metal salts, although metal-free catalysts are also used. However, several such reactions have been reported that are efficiently catalysed by acids. They are cost-effective, have a simple purification process, less sensitive to air/moisture, and are relatively environmentally benign. However, this area has not received enough focus due to the lack of review articles, which encouraged us to write this review.

The Participation of Ca2+ Channels in Epilepsy: A Bibliometric Analysis of the Scientific Literature in Latin America.

Bibliometric analysis allows us to quantify and evaluate scientific activity, and it has become increasingly important in all areas of scientific literature. Thanks to these analyses, we can infer where science should put greater efforts into elucidating the underlying mechanisms of diseases that have yet to be fully described or investigated. This paper delves into published articles related to the involvement of calcium (Ca2+) channels in epilepsy, which is a condition with a high prevalence in Latin America. We followed the scientific publication on SCOPUS and analyzed the impact of publications from Latin America in the field of epilepsy and the study of Ca2+ channels. We identified the countries with the largest number of publications and found that 68% of them were experimental (animal models), while 32% were clinical. We also identified the main journals, growth over time, and citation numbers. We found a total of 226 works produced by Latin American countries from 1976 to 2022. The countries that have contributed the most to the topic are Brazil, Mexico, and Argentina, with occasional collaborations between them to make contributions to the study of epilepsy and Ca2+ channels. Additionally, we found that the journal with the most citations is Nature Genetics. The number of authors per article ranges from 1 to 242, and neuroscience journals are the preferred target for researchers, with a predilection for publishing original articles, although 26% of the publications are review articles.

Suboptimally Controlled Diabetes in Pregnancy: A Review to Guide Antepartum and Delivery Management.

Diabetes mellitus is one of the most common complications in pregnancy with adverse maternal and neonatal risks proportional to the degree of suboptimal glycemic control, which is not well defined. Literature guiding providers in identifying and managing patients at highest risk of complications from diabetes is lacking. This article reviews the definition, epidemiology, and pathophysiology of suboptimal control of diabetes in pregnancy, including "diabetic fetopathy"; explores proposed methods of risk stratification for patients with diabetes; outlines existing antepartum management and delivery timing guidelines; and guides direction for future research. Original research articles, review articles, and professional society guidelines on diabetes management in pregnancy were reviewed. The reviewed available studies demonstrate worsening maternal and neonatal outcomes associated with suboptimal control; however, the definition of suboptimal based on parameters followed in pregnancy such as blood glucose, hemoglobin A1c, and fetal growth varied from study to study. Studies demonstrating specific associations of adverse outcomes with defined suboptimal control were reviewed and synthesized. Professional society recommendations were also reviewed to summarize current guidelines on antepartum management and delivery planning with respect to diabetes in pregnancy. The literature heterogeneously characterizes suboptimal glucose control and complications related to this during pregnancy in individuals with diabetes. Further research into antepartum management and delivery timing for patients with varying levels of glycemic control and at highest risk for diabetic complications is still needed.

Methods for non-proportional hazards in clinical trials: A systematic review.

For the analysis of time-to-event data, frequently used methods such as the log-rank test or the Cox proportional hazards model are based on the proportional hazards assumption, which is often debatable. Although a wide range of parametric and non-parametric methods for non-proportional hazards has been proposed, there is no consensus on the best approaches. To close this gap, we conducted a systematic literature search to identify statistical methods and software appropriate under non-proportional hazard. Our literature search identified 907 abstracts, out of which we included 211 articles, mostly methodological ones. Review articles and applications were less frequently identified. The articles discuss effect measures, effect estimation and regression approaches, hypothesis tests, and sample size calculation approaches, which are often tailored to specific non-proportional hazard situations. Using a unified notation, we provide an overview of methods available. Furthermore, we derive some guidance from the identified articles.

The Role of the Combination Paracetamol/Caffeine in Treatment of Acute Migraine Pain: A Narrative Review.

Thirty years ago, the first migraine-specific drugs (triptans) appeared. Todaytwo new categories (gepants and ditans) are marketed for acute migraine treatment. That said, is there still a role for conventional therapy? The aim of the present narrative review is to provide an expert overview examining the possible role of the combination paracetamol/caffeine in treatment of acute migraine pain. To understand possible settings for more appropriate use of paracetamol/caffeine (1000mg/130mg) in treatment of acute migraine, a structured literature search was performed using the PubMed database by a panel of experts from major Italian headache centers; articles not referring to migraine pain were excluded from this review; review articles were prioritized. Overall response, even to newer specific and selective trigeminal targeted drugs (TTTs), is not over 60%; thus, there is still room for conventional therapies in acute migraine treatment. The panel identified settings in which the use of paracetamol/caffeine combination to treat acute migraine attacks might offer benefit considering the consolidated use through years, despite the lack of studies directly addressing the efficacy of paracetamol/caffeine in the identified populations: subjects > 65years of age; presence of cardiovascular (CV) comorbidities; TTTs non-responders; pregnancy and breastfeeding; subjects < 18years of age; paracetamol/caffeine as add-on therapy. Paracetamol is included in the World Health Organization (WHO) essential drug list and has a high level of popularity among patients. Caffeine enhances the analgesic effect of other drugs including paracetamol. In early treatment of acute migraine pain, prescribing physicians might consider using the paracetamol/caffeine combination among other options.

Screening oncology articles in a qualitative literature review using large language models: A comparison of GPT4 versus fine-tuned open source models using expert-annotated data.

e23196 Background: Clinical Outcome Assessment (COA) conceptual gap analyses for oncology are complex and time consuming. Artificial Intelligence may efficiently reduce time to completion of such analyses. We aimed to assess two AI models’ performance for literature screening to identify relevant qualitative oncology research. We also compared accuracy and run-time for both AI models. Methods: We manually curated a dataset of title/abstract screening (n = 1,700 study references) across 17 landscape reviews. Among these, 11 landscape reviews (n = 951 study references) spanning over were in oncology, including 8 solid cancers (breast, lung, urothelial, colorectal, esophageal, head and neck, pancreatic, and stomach) and 3 non-solid cancers (lymphoma, acute myeloid leukemia, and multiple myeloma). Each citation was annotated for eligibility (Y/N) by population, study design (qualitative), and reporting of concepts (how patients feel or function). We then compared the accuracy of two AI models at predicting the screening decisions of expert researchers. The two AI models were Generative Pre-trained Transformers 4 (GPT4, OpenAI) prompts and a fine-tuned SciFive biomedical large language model (LLM). We used 70% of the data for training and 30% for test. Accuracy estimates were obtained only for the models’ ability to label eligibility within the 11 oncology datasets. Results: Both LLMs performed well for assessing relevance by oncology population, with F1-scores for the GPT4 and SciFive models being 0.92 and 0.83 respectively (precision was 0.92 and 0.93 respectively). For concept reporting the fine-tuned SciFive model outperformed GPT4 with an F1-score and precision 0.88 and 0.92 versus 0.81 and 0.79. The same was true but less pronounced for eligibility by study design, with an F1-score and precision 0.81 and 0.90 versus 0.86 and 0.76. For overall eligibility, the customized SciFive model outperformed the GPT4 model with an F1-score and precision of 0.84 and 0.92 versus 0.85 and 0.82. Lastly, it took the GPT4 prompts between 10-30 minutes to screen 100 abstracts. By contrast, the customized SciFive model took 1-2 minutes on a computer with a Quadro RTX 8000 GPU. Conclusions: In conclusion, both AI models are promising. The fine-tuned SciFive model appears slightly more accurate and performs substantially faster than the GPT4 model.

The relation of complex problem solving with reflective abstraction: a systematic literature review

&lt;span lang="EN-US"&gt;Complex problem solving (CPS) is a new paradigm in solving problems and is one of the soft skills needed to face the industrial revolution 4.0. Reflective abstraction is associating and modifying pre-existing conceptions into new situations. This article reviews research on CPS and reflective abstraction. This research is needed to know the relationship between reflective abstraction and CPS. The systematic writing of this review was assisted by the Publish or Perish 7 application, Mendeley, and VOSviewer. A literature search was performed through the ScienceDirect and ERIC databases. Based on the search results with the term “complex problem solving” and several exclusion criteria, 58 articles were found, whereas with the word “reflective abstraction” there were 23 articles, totaling 81 papers. Based on the literature review, it was found that there is a relationship between CPS and reflective abstraction by obtaining common ground in the form of prior knowledge. CPS requires prior knowledge from reflective abstraction to integrate the most relevant information. To improve CPS, efforts and special attention can be made to build initial knowledge through reflective abstraction. This article contributes to further research and becomes a study for the themes of CPS and reflective abstraction in learning and education.&lt;/span&gt;

Emerging role of the lateral habenula in conditioned inhibition and depression.

Associating a neutral conditioned stimulus (CS) with the absence of a biologically significant unconditioned stimulus (US) confers conditioned inhibitory properties upon the CS, referred to as conditioned inhibition. Conditioned inhibition and conditioned excitation, an association of a CS with the presence of the US, are fundamental components of associative learning. While the neural substrates of conditioned excitation are well established, those of conditioned inhibition remain poorly understood. Recent research has shed light on the lateral habenula (LHb) engagement in conditioned inhibition, along with the midbrain dopaminergic neurons. This article reviews behavioral tasks conducted to assess conditioned inhibition and how experimental LHb manipulations affect performance in these tasks. These results underscore the critical role of the LHb in conditioned inhibition. Intriguingly, stress increases LHb reactivity and impairs performances in tasks consisting of a component of conditioned inhibition in animals. Dysfunction of the LHb is observed in patients with depression. The ability of an organism to perform conditioned inhibition is closely linked to altered neuronal activity in the LHb, which has implications for mental disorders. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Artificial intelligence in veterinary diagnostics

Artificial intelligence is becoming increasingly important in veterinary medicine and is likely to play a significant role in how the profession develops in the future. It is already impacting the way veterinarians practice, with several technologies readily available. Its application to the interpretation of diagnostic images, clinicopathological data and histopathology has been demonstrated. It is hoped that these technologies will increase the speed and accuracy of a diagnosis. This article reviews some studies investigating the application of artificial intelligence to the diagnosis of disease in animals and considers future uses and limitations of the technology.

The nonsalvageable tibia: amputation and prosthetics.

Mangled extremities are a challenging problem for the orthopaedic surgeon. The decision for salvage versus amputation is multifactorial. Several work groups have attempted to create scoring systems to guide treatment, but each case must be regarded individually. As surgical technique and prosthetics continue to improve, amputations should be seen as a viable reconstructive option, rather than failure. This article reviews scoring systems for the mangled extremity, outcomes on salvage versus amputation, amputation surgical technique, and prosthetic options.

Can fracture liaison services prevent second fractures in patients with osteoporosis?

Patients who have had fractures are at increased risk for a second or fragility fracture. A fracture liaison service (FLS), often staffed or led by physician associates/assistants or NPs, may help reduce second fractures and patient mortality. This article reviews FLSs and their effectiveness.

Neonatal Seizures.

Neonatal seizures are common among patients with acute brain injury or critical illness and can be difficult to diagnose and treat. The most common etiology of neonatal seizures is hypoxic-ischemic encephalopathy, with other common causes including ischemic stroke and intracranial hemorrhage. Neonatal clinicians can use a standardized approach to patients with suspected or confirmed neonatal seizures that entails laboratory testing, neuromonitoring, and brain imaging. The primary goals of management of neonatal seizures are to identify the underlying cause, correct it if possible, and prevent further brain injury. This article reviews recent evidence-based guidelines for the treatment of neonatal seizures and discusses the long-term outcomes of patients with neonatal seizures.

Measuring due process and fairness in the child welfare court system

AbstractUpholding the fundamental rights of families during child welfare court cases is critical to ensuring equal access to justice. This article review research related to the due process measures in the Judicial, Court, and Attorney Measures of Performance (JCAMP). Studies of due process practices early in the case to avoid unnecessary involvement of families are presented. These represent divergent opinions on the role of the judge and arguments for the early appointment of parent attorneys. Future research is critical to understand practices which promote fairness and address the over‐representation of families of color in the child welfare system.

State of the Art in Low-Grade Glioma Management: Insights From Isocitrate Dehydrogenase and Beyond.

Low-grade gliomas present a formidable challenge in neuro-oncology because of the challenges imposed by the blood-brain barrier, predilection for the young adult population, and propensity for recurrence. In the past two decades, the systematic examination of genomic alterations in adults and children with primary brain tumors has uncovered profound new insights into the pathogenesis of these tumors, resulting in more accurate tumor classification and prognostication. It also identified several common recurrent genomic alterations that now define specific brain tumor subtypes and have provided a new opportunity for molecularly targeted therapeutic intervention. Adult-type diffuse low-grade gliomas are frequently associated with mutations in isocitrate dehydrogenase 1 and 2 (IDH1/2), resulting in production of 2-hydroxyglutarate, an oncometabolite important for tumorigenesis. Recent studies of IDH inhibitors have yielded promising results in patients at early stages of disease with prolonged progression-free survival (PFS) and delayed time to radiation and chemotherapy. Pediatric-type gliomas have high rates of alterations in BRAF, including BRAF V600E point mutations or BRAF-KIAA1549 rearrangements. BRAF inhibitors, often combined with MEK inhibitors, have resulted in radiographic response and improved PFS in these patients. This article reviews emerging approaches to the treatment of low-grade gliomas, including a discussion of targeted therapies and how they integrate with the current treatment modalities of surgical resection, chemotherapy, and radiation.

Application of fourier transform infrared (FTIR) spectroscopy in sample preparation: Material characterization and mechanism investigation

The principle of Fourier Transform Infrared (FTIR) spectroscopy is based on atoms vibration and rotation, and it has become a universal and widely used spectral methodology to detect the internal molecular structures in all kinds of fields. Numerous review articles related to the applications of FTIR spectroscopy have been published in recent years. In addition, more and more scientists are aware the significance role of sample preparation to improve our life quality in life science. However, the application of FTIR spectroscopy in sample preparation hasn't been summarized. Thus, in the current paper, the application of FTIR spectroscopy in sample preparation was reviewed with the focuses on characterization of separation materials including both solid sorbents and liquid extractants, and the extraction mechanisms involved in the separation towards different targets including inorganic molecules such as rare earth elements, organic molecules such as phenolics, pharmaceuticals and illicit-drugs, and biomacromolecules of DNA and proteins. We believe that the current paper will be interested for the researchers in food science, forensic medicine, clinical medicine, environmental analysis and analytical chemistry.

Immunotherapy related patient-reported outcomes from five randomized controlled trials in patients with triple negative breast cancer: A systematic review.

e23167 Background: Immunotherapy (IO) has improved clinical outcomes in patients with early-stage Triple Negative Breast Cancer (TNBC) receiving neoadjuvant therapy and certain patient subsets in the metastatic setting. This study aims to evaluate IO-related Patient-Reported Outcomes (PRO) in patients older than 65 years. Methods: We searched Medline ALL (Ovid), Embase (Elsevier), Cochrane Central (Wiley), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform. The searches combined terms reflecting (1) the immune checkpoint inhibitors atezolizumab, durvalumab, and pembrolizumab; (2) breast cancer; and (3) randomized controlled trials. Results were limited to items published in English from 2013 through September 2023. We excluded review articles and clinical trial records without results. Two independent reviewers (C.S. and M.L.) screened the studies using the systematic review management tool Covidence, and conflicts were resolved by a third reviewer (W.I.Z.). We included studies that reported on PRO in adults with TNBC receiving any of the three immunotherapies of interest. Results: Five publications composed of two peer-reviewed papers and three abstracts were identified, including 3878 total patients and 3184 with PRO. Three pembrolizumab studies had 2643 total patients (2056 with PRO) and two atezolizumab studies (IMPASSION 130, IMPASSION 031) had 1235 total patients (1128 with PRO). The PRO analysis in KEYNOTE 522 included 1145 patients in the neoadjuvant phase and 847 in the adjuvant phase. The PRO analysis in KEYNOTE 355 included total 847 patients and 317 with Combined Positive Score (CPS) ≥10. No study specified PRO data for patients older than 65 years. Baseline completion rates for all studies were &gt; 80%. All studies used standardized PRO instruments, including the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC- QLQ C30) and its Breast Cancer Module (QLQ-BR23), the Functional Assessment of Cancer-Therapy-General (FACT-G GP5), and the EuroQol-5 Dimension (EQ-D5). All studies showed no statistical difference, or clinical meaningful decline in PRO endpoints between patients who received chemo with IO versus chemo with placebo, during and post treatment follow up. The PRO analysis from KEYNOTE 119, which included total 594 patients of which 187 had CPS ≥10, demonstrated that patients receiving single agent chemotherapy had worse PROs related to systemic therapy side effects and hair loss while the pembrolizumab group had decreased worry about future health. None included subgroup analysis by age, including patients older than 65 years. Conclusions: Our systematic review demonstrates that in both early and advanced TNBC, IO did not worsen PRO. Prospective and retrospective data in IO-related PRO in older patient population are needed.