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Rural Patient Experiences of Accessing Care for Chronic Conditions: A Systematic Review and Thematic Synthesis of Qualitative Studies.

Ann Fam Med 2022 May-Jun;20(3):266-272

Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota.

Purpose: Access to health care is a long-standing concern for rural patients; however, administrative measures fail to capture the subjective patient experience of accessing health care. The purpose of this review was to synthesize the qualitative literature on patient and caregiver experiences of accessing health care services for chronic disease management among US residents of rural areas.

Methods: We searched Embase, MEDLINE, PsycInfo, CINAHL, and Scopus to identify qualitative studies published during 2010-2019. Read More

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Considerations Before Selecting a Stepped-Wedge Cluster Randomized Trial Design for a Practice Improvement Study.

Ann Fam Med 2022 May-Jun;20(3):255-261

Northwestern University, Feinberg School of Medicine, Chicago, Illinois.

Purpose: Despite the growing popularity of stepped-wedge cluster randomized trials (SW-CRTs) for practice-based research, the design's advantages and challenges are not well documented. The objective of this study was to identify the advantages and challenges of the SW-CRT design for large-scale intervention implementations in primary care settings.

Methods: The EvidenceNOW: Advancing Heart Health initiative, funded by the Agency for Healthcare Research and Quality, included a large collection of SW-CRTs. Read More

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September 2020

Delirium and the risk of developing dementia: a cohort study of 12 949 patients.

J Neurol Neurosurg Psychiatry 2022 May 23. Epub 2022 May 23.

University of Glasgow, Institute of Infection Immunity and Inflammation, Glasgow, UK.

Background: Delirium is an important risk factor for subsequent dementia. However, the field lacks large studies with long-term follow-up of delirium in subjects initially free of dementia to clearly establish clinical trajectories.

Methods: We undertook a retrospective cohort study of all patients over the age of 65 diagnosed with an episode of delirium who were initially dementia free at onset of delirium within National Health Service Greater Glasgow & Clyde between 1996 and 2020 using the Safe Haven database. Read More

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British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults.

Gut 2022 May 23. Epub 2022 May 23.

Department of Gastroenterology, Sandwell General Hospital, West Bromwich, UK.

Background: Eosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with a significant impact on physical health and quality of life. We have provided a single comprehensive guideline for both paediatric and adult gastroenterologists on current best practice for the evaluation and management of EoE.

Methods: The Oesophageal Section of the British Society of Gastroenterology was commissioned by the Clinical Standards Service Committee to develop these guidelines. Read More

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Venous sinus thrombosis after the first dose of Pfizer BioNTech vaccine.

BMJ Case Rep 2022 May 20;15(5). Epub 2022 May 20.

General Internal Medicine, Northampton General Hospital NHS Trust, Northampton, UK.

mRNA vaccines including Pfizer BioNTech and Moderna have categorically been considered safe when it comes to preventing COVID-19. However, there is still a small associated risk of thromboembolic phenomenon including venous sinus thrombosis with it and our case report highlights one.We describe a patient who developed severe progressive headache, tinnitus and visual disturbance symptoms post-Pfizer-SARS-CoV-2 vaccination. Read More

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Migration of vascular embolisation material from the intravascular space to surrounding interstitial tissues in arteriovenous malformations.

BMJ Case Rep 2022 May 20;15(5). Epub 2022 May 20.

Vascular Surgery, University of California San Diego Health System, La Jolla, CA, USA.

We present the case of a young man active duty in the military who initially presented with pelvic pain and fullness during sexual activity. Extensive workup showed a large pelvic arteriovenous malformation (AVM). He underwent over 10 interventional radiology procedures to embolise his AVM and suffered multiple postoperative complications resulting in exploratory laparotomies, bowel resections and ultimately a colostomy. Read More

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When do people with abdominal symptoms need a fast track referral?

BMJ 2022 May 23;377:o1198. Epub 2022 May 23.

Epidemiology of Cancer Healthcare and Outcomes (ECHO), University College London, UK.

The studyHerbert A, Rafiq M, Pham TM, et al. Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: a cohort study. Read More

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The frequency of visual field testing in a US nationwide cohort of individuals with open angle glaucoma.

Ophthalmol Glaucoma 2022 May 19. Epub 2022 May 19.

Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA; Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.

Purpose: Visual field testing that isn't frequent enough results in delayed identification of open angle glaucoma (OAG) progression. Guidelines recommend at least annual testing. It is not known how frequently patients with OAG across the US receive visual field testing and how patient characteristics and circumstances influence this frequency. Read More

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Contraceptive Service Uptake and Delivery Preferences in Perinatally and Horizontally Infected Female Adolescents Living with HIV: Results from a South Africa-based Mixed-methods Study.

J Pediatr Adolesc Gynecol 2022 May 20. Epub 2022 May 20.

Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.

Study Objective: To investigate whether contraceptive service uptake (including current contraceptive use), unmet need for contraception, unintended pregnancy, preferences for service provision and providers among female adolescents living with HIV (ALHIV) vary with HIV-acquisition route, that is, perinatal HIV acquisition versus horizontal HIV acquisition.

Design: Mixed-methods including exit and in-depth interviews.

Setting: Multi-center, public sector primary healthcare facilities, Cape Town, South Africa. Read More

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Implementing virtual crossmatch based diagnostic management teams in human leukocyte antigen laboratories and transplant programs.

Transpl Immunol 2022 May 20:101629. Epub 2022 May 20.

Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA. Electronic address:

Histocompatibility testing has continuously evolved since its inception. One such advancement is the implementation of the virtual crossmatch (VXM). Recent changes to allograft allocation schemes have resulted in increased organ sharing over greater distances, resulting in expanded utilization of the VXM to assess donor: recipient compatibility. Read More

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A Novel Approach for Semi Automated 3D Quantification of Mitral Regurgitant Volume Reflects a More Physiologic Approach to MR.

J Am Soc Echocardiogr 2022 May 20. Epub 2022 May 20.

Philips Research (Suresnes, France).

Background: Quantification of mitral regurgitation (MR) by echocardiography is an integral to assessing lesion severity, and entails integration of multiple Doppler-based parameters. These methods are primarily founded upon the principle of PISA (proximal isovelocity surface area), a 2D method known to employ several assumptions regarding MR jet characteristics. We analyzed the results of a semi-automated method of 3D-based RV estimation which accounts for jet behavior throughout the cardiac cycle, and compared it to conventional 2D PISA methods for MR. Read More

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Urinary tetracycline antibiotics exposure during pregnancy and maternal thyroid hormone parameters: A repeated measures study.

Sci Total Environ 2022 May 20:156146. Epub 2022 May 20.

School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, No. 81 Meishan Road, Hefei 230032, Anhui, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, China. Electronic address:

Background: Studies on potential maternal thyrotoxicity related to tetracycline antibiotics exposure during pregnancy are lacking. Based on a large prospective cohort study, this study aimed to examine the associations between tetracycline antibiotics exposure in maternal urine and maternal thyroid hormone parameters.

Methods: Based on the Ma'anshan Birth Cohort study, urine and serum samples of 2969 pregnant women were collected in the first, second and third trimesters. Read More

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Comparison of urgent and early endoscopy for acute nonvariceal upper gastrointestinal bleeding in high-risk patients.

Gastroenterol Hepatol 2022 May 20. Epub 2022 May 20.

Department of Gastroenterology, Ankara City Hospital, Bilkent Avenue, 06800 Çankaya, Ankara, Turkey; Department of Gastroenterology, Ankara Yildirim Beyazit University School of Medicine, Bilkent Avenue, 06800 Çankaya, Ankara, Turkey.

Objective: Data regarding early(within 24 hours) and urgent endoscopy(within 12 hours) in non-variceal upper gastrointestinal bleeding(NV-UGIB) revealed conflicting results. This study aimed to investigate the impact of endoscopy timing on the outcomes of high-risk patients with NV-UGIB.

Patients And Methods: From February 2020 to February 2021, consecutive high-risk(Glasgow-Blatchford score≥12) adults admitted to the emergency department with NV-UGIB were analyzed retrospectively. Read More

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Allergists and COVID-19 Vaccine Allergy Safety: A Pilot Study "Hub-and-Spoke" Model for Population-Wide Allergy Service.

Ann Allergy Asthma Immunol 2022 May 20. Epub 2022 May 20.

Division of Rheumatology & Clinical, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong. Electronic address:

Background: Hong Kong started its COVID-19 vaccination program in February 2021. A territory-wide VAS (Vaccine Allergy Safety) Clinic was set up to assess individuals deemed at "higher risk" of COVID-19 vaccine-associated allergies. A novel "Hub-and-Spoke" model was piloted to tackle the overwhelming demand of services by allowing non-allergists to conduct assessment. Read More

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Bacterial diversity of hospital water tanks and the efficacy of hydrogen peroxide based cleaning: experience in a tertiary care center in India.

Am J Infect Control 2022 May 19. Epub 2022 May 19.

Department of Engineering, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Aims And Objectives: - Hospital water is often an overlooked yet preventable source of hospital-acquired infections. CDC recommends annual cleaning of water reservoirs in healthcare settings. In our tertiary care hospital, periodic disinfection and microbiological surveillance of all the water tanks in hospital premises is carried out. Read More

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Translating wastewater reuse for irrigation from OECD guideline: Tramadol sorption and desorption in soil-water matrices.

Chemosphere 2022 May 20:135031. Epub 2022 May 20.

Food Water Waste Research Group. Faculty of Engineering, University of Nottingham, University Park, Nottinghamshire, NG7 2RD, United Kingdom. Electronic address:

Treated and untreated wastewater is often used for agricultural irrigation and, despite the many benefits of this practice, it poses the risk of biologically active chemical pollutants (such as pharmaceuticals, like tramadol) entering the environment. The partitioning of tramadol between soil/water at environmentally relevant concentrations is important to understand its environmental toxicity. Kinetics and isotherm sorption studies based on the Organisation for Economic Cooperation and Development (OECD) 106 Guideline were undertaken, ensuring comparability to previous studies. Read More

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Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease.

Prog Cardiovasc Dis 2022 May 19. Epub 2022 May 19.

Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, Regensburg, Germany.

International guidelines strongly recommend statins alone or in combination with other lipid-lowering agents to lower low-density lipoprotein cholesterol (LDL-C) levels for patients with asymptomatic/symptomatic carotid stenosis (AsxCS/SCS). Lowering LDL-C levels is associated with significant reductions in transient ischemic attack, stroke, cardiovascular (CV) event and death rates. The aim of this multi-disciplinary overview is to summarize the benefits and risks associated with lowering LDL-C with statins or non-statin medications for Asx/SCS patients. Read More

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Selective PPARδ agonist seladelpar suppresses bile acid synthesis by reducing hepatocyte CYP7A1 via the fibroblast growth factor 21 signaling pathway.

J Biol Chem 2022 May 20:102056. Epub 2022 May 20.

Department of Medicine, University of California San Diego, La Jolla, CA, 92093, USA; Department of Medicine, VA San Diego Healthcare System, San Diego, CA, 92093, USA. Electronic address:

Peroxisome proliferator-activated receptor delta (PPARδ) agonists have been shown to exert beneficial effects in liver disease and reduce total bile acid levels. The mechanism(s) whereby PPARδ agonism reduces bile acid levels are, however, unknown, and therefore the aim of the current study was to investigate the molecular pathways responsible for reducing bile acid synthesis in hepatocytes following treatment with the selective PPARδ agonist, seladelpar. We show that administration of seladelpar to wild type mice repressed the liver expression of cholesterol 7 alpha-hydroxylase (Cyp7a1), the rate-limiting enzyme for bile acid synthesis, and decreased plasma 7α-hydroxy-4-cholesten-3-one (C4), a freely diffusible metabolite downstream of Cyp7a1. Read More

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Effect of the COVID-19 pandemic on procedure volumes in gastroenterology in the Netherlands.

Lancet Gastroenterol Hepatol 2022 May 20. Epub 2022 May 20.

Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands.

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Munich Institute of Robotics and Machine Intelligence (MIRMI) Technical University of Munich.

Laryngorhinootologie 2022 May 23;101(S 01):S186-S193. Epub 2022 May 23.

Munich Institute of Robotics and Machine Intelligence (MIRMI), Technische Universität München.

The application of robotic and intelligent technologies in healthcare is dramatically increasing. The next generation of lightweight and tactile robots have provided a great opportunity to be used for a wide range of applications from medical examination, diagnosis, therapeutic procedures to rehabilitation and assistive robotics. They can potentially outperform current medical procedures by exploiting the com- plementary strengths of humans and computer-based technologies. Read More

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