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Nature Communications Jun 2024Failure to appropriately predict and titrate reactivity to threat is a core feature of fear and anxiety-related disorders and is common following early life adversity...
Failure to appropriately predict and titrate reactivity to threat is a core feature of fear and anxiety-related disorders and is common following early life adversity (ELA). A population of neurons in the lateral central amygdala (CeAL) expressing corticotropin releasing factor (CRF) have been proposed to be key in processing threat of different intensities to mediate active fear expression. Here, we use in vivo fiber photometry to show that ELA results in sex-specific changes in the activity of CeAL CRF+ neurons, yielding divergent mechanisms underlying the augmented startle in ELA mice, a translationally relevant behavior indicative of heightened threat reactivity and hypervigilance. Further, chemogenic inhibition of CeAL CRF+ neurons selectively diminishes startle and produces a long-lasting suppression of threat reactivity. These findings identify a mechanism for sex-differences in susceptibility for anxiety following ELA and have broad implications for understanding the neural circuitry that encodes and gates the behavioral expression of fear.
Topics: Animals; Corticotropin-Releasing Hormone; Fear; Neurons; Mice; Female; Male; Anxiety; Central Amygdaloid Nucleus; Reflex, Startle; Mice, Inbred C57BL; Behavior, Animal; Stress, Psychological
PubMed: 38951506
DOI: 10.1038/s41467-024-49828-3 -
CJEM Jul 2024People experiencing homelessness and marginalization face considerable barriers to accessing healthcare services. Increased reliance on technology within healthcare has...
OBJECTIVES
People experiencing homelessness and marginalization face considerable barriers to accessing healthcare services. Increased reliance on technology within healthcare has exacerbated these inequities. We evaluated a hospital-based prescription phone program aimed to reduce digital health inequities and improve access to services among marginalized patients in Emergency Departments. We examined the perceived outcomes of the program and the contextual barriers and facilitators affecting outcomes.
METHODS
We conducted a constructivist qualitative program evaluation at two urban, academic hospitals in Toronto, Ontario. We interviewed 12 healthcare workers about their perspectives on program implementation and outcomes and analyzed the interview data using reflexive thematic analysis.
RESULTS
Our analyses generated five interrelated program outcomes: building trust with patients, facilitating independence in healthcare, bridging sectors of care, enabling equitable care for marginalized populations, and mitigating moral distress among healthcare workers. Participants expressed that phone provision is critical for adequately serving patients who face barriers to accessing health and social services, and for supporting healthcare workers who often lack resources to adequately serve these patients. We identified key contextual enablers and challenges that may influence program outcomes and future implementation efforts.
CONCLUSIONS
Our findings suggest that providing phones to marginalized patient populations may address digital and social health inequities; however, building trusting relationships with patients, understanding the unique needs of these populations, and operating within a biopsychosocial model of health are key to program success.
PubMed: 38951473
DOI: 10.1007/s43678-024-00735-y -
Klinische Padiatrie Jul 2024We sought to investigate adherence to the current pediatric syncope guideline in the emergency department and its impact on the frequency of missed or unnecessary...
BACKGROUND
We sought to investigate adherence to the current pediatric syncope guideline in the emergency department and its impact on the frequency of missed or unnecessary diagnostic measures. For the first time, in 2014 updated guideline defines indispensable basic diagnostic measures and a consecutive algorithm for safe clinical decision making.
PATIENTS AND METHOD
We analyzed retrospectively 314 pediatric patients, 166 were presented before and 148 after publication of this guideline update.
RESULTS
After guideline publication, 54 patients (36.5%) were not treated in accordance with the guideline and 2 (0.63%) cases caused by epileptic seizures were initially misdiagnosed as reflex syncope. Among these 54 patients, 32 (59.3%) inpatient admissions were inappropriate, as well as 11 (20.4%) electroencephalographies, 4 (7.4%) sleep-deprivation EEGs, 2 (3.7%) magnetic resonance imaging, 5 (9.3%) urine diagnostics and 32 (59.3%) blood tests. In 21 cases (38.9%), the medical history was insufficient. ECG was missed in 42 patients (77.8%). There was no significant difference between the pre- and post-guideline groups concerning diagnostic work-up (p=0,12).
DISCUSSION
This non-compliance with the guideline did not cause a large number of misdiagnosed epileptic seizures (1.4%) or adverse outcomes but led to waste of resources in healthcare system and undue burdens on patients and their families.
CONCLUSION
In addition to establishment of clinical guidelines, the need for additional measures and strategies to promote their implementation seems obvious.
PubMed: 38950601
DOI: 10.1055/a-2345-3343 -
Death Studies Jul 2024The COVID-19 pandemic changed the way people lived, but also the way they died. It accentuated the physical, psychological, social, and spiritual vulnerabilities of...
The COVID-19 pandemic changed the way people lived, but also the way they died. It accentuated the physical, psychological, social, and spiritual vulnerabilities of patients approaching death. This study explored the lived experience of palliative inpatients during the pandemic. We conducted interviews with 22 palliative inpatients registered in a Canadian urban palliative care program, aimed to uncover how the pandemic impacted participants' experiences of approaching end-of-life. The reflexive thematic analysis revealed 6 themes: putting off going into hospital, the influence of the pandemic on hospital experience, maintaining dignity in care, emotional impact of nearing death, making sense of end-of-life circumstances and coping with end-of-life. Findings highlight the vulnerability of patients approaching death, and how that was accentuated during the pandemic. Findings reveal how the pandemic strained, threatened, and undermined human connectedness. These lived experiences of palliative inpatients offer guidance for future pandemic planning and strategies for providing optimal palliative care.
PubMed: 38950572
DOI: 10.1080/07481187.2024.2353974 -
Neurosurgical Focus Jul 2024This study aimed to determine the validity of quantitative pupillometry to predict the length of time for return to full activity/duty after a mild traumatic brain...
OBJECTIVE
This study aimed to determine the validity of quantitative pupillometry to predict the length of time for return to full activity/duty after a mild traumatic brain injury (mTBI) in a cohort of injured cadets at West Point.
METHODS
Each subject received baseline (T0) quantitative pupillometry, in addition to evaluation with the Balance Error Scoring System (BESS), Standardized Assessment of Concussion (SAC), and Sport Concussion Assessment Tool 5th Edition Symptom Survey (SCAT5). Repeat assessments using the same parameters were conducted within 48 hours of injury (T1), at the beginning of progressive return to activity (T2), and at the completion of progressive return to activity protocols (T3). Pupillary metrics were compared on the basis of length of time to return to full play/duty and the clinical scores.
RESULTS
The authors' statistical analyses found correlations between pupillometry measures at T1, including end-initial diameter and maximum constriction velocity, with larger change and faster constriction predicting earlier return to play. There was also an association with maximum constriction velocity at baseline (T0), predicting faster return to play.
CONCLUSIONS
The authors conclude that that pupillometry may be a valuable tool for assessing time to return to duty from mTBI by providing a measure of baseline resiliency to mTBI and/or autonomic dysfunction in the acute phase after mTBI.
Topics: Humans; Brain Concussion; Military Personnel; Male; Young Adult; Female; Pupil; Reflex, Pupillary; Adult; Predictive Value of Tests; Biomarkers; Brain Injuries, Traumatic; Adolescent; Recovery of Function; Cohort Studies
PubMed: 38950435
DOI: 10.3171/2024.4.FOCUS24140 -
PLoS Computational Biology Jul 2024After spinal cord injuries (SCIs), patients may develop either detrusor-sphincter dyssynergia (DSD) or urinary incontinence, depending on the level of the spinal injury....
AIM
After spinal cord injuries (SCIs), patients may develop either detrusor-sphincter dyssynergia (DSD) or urinary incontinence, depending on the level of the spinal injury. DSD and incontinence reflect the loss of coordinated neural control among the detrusor muscle, which increases bladder pressure to facilitate urination, and urethral sphincters and pelvic floor muscles, which control the bladder outlet to restrict or permit bladder emptying. Transcutaneous magnetic stimulation (TMS) applied to the spinal cord after SCI reduced DSD and incontinence. We defined, within a mathematical model, the minimum neuronal elements necessary to replicate neurogenic dysfunction of the bladder after a SCI and incorporated into this model the minimum additional neurophysiological features sufficient to replicate the improvements in bladder function associated with lumbar TMS of the spine in patients with SCI.
METHODS
We created a computational model of the neural circuit of micturition based on Hodgkin-Huxley equations that replicated normal bladder function. We added interneurons and increased network complexity to reproduce dysfunctional micturition after SCI, and we increased the density and complexity of interactions of both inhibitory and excitatory lumbar spinal interneurons responsive to TMS to provide a more diverse set of spinal responses to intrinsic and extrinsic activation of spinal interneurons that remains after SCI.
RESULTS
The model reproduced the re-emergence of a spinal voiding reflex after SCI. When we investigated the effect of monophasic and biphasic TMS at two frequencies applied at or below T10, the model replicated the improved coordination between detrusor and external urethral sphincter activity that has been observed clinically: low-frequency TMS (1 Hz) within the model normalized control of voiding after SCI, whereas high-frequency TMS (30 Hz) enhanced urine storage.
CONCLUSION
Neuroplasticity and increased complexity of interactions among lumbar interneurons, beyond what is necessary to simulate normal bladder function, must be present in order to replicate the effects of SCI on control of micturition, and both neuronal and network modifications of lumbar interneurons are essential to understand the mechanisms whereby TMS reduced bladder dysfunction after SCI.
PubMed: 38950067
DOI: 10.1371/journal.pcbi.1012237 -
Contemporary Nurse Jul 2024Transformation of healthcare is necessary to ensure patients receive high-quality care. Working with the evidence-based practice (EBP) principles enables nurses to make...
BACKGROUND
Transformation of healthcare is necessary to ensure patients receive high-quality care. Working with the evidence-based practice (EBP) principles enables nurses to make this shift. Although working according to these principles is becoming more common, nurses base their actions too much on traditions and intuition. Therefore, to promote EBP in nursing practice and improve related education, more insight into nurses' needs is necessary to overcome existing EBP barriers.
OBJECTIVE
To identify the current needs to work with EBP principles among hospital and community care nurses and student nurses.
DESIGN
A qualitative, exploratory approach with focus group discussions.
METHODS
Data was collected between February and December 2020 through 5 focus group discussions with 25 nurses and student nurses from a hospital, a community care organisation, and nursing education schools (bachelor and vocational). Data were analysed using reflexive thematic analysis, and the main themes were synchronised to the seven domains from the Tailored Implementation for Chronic Diseases (TICD) checklist.
RESULTS
Nurses and student nurses experience EBP as complex and require more EBP knowledge and reliable, ready-to-use evidence. They wanted to be facilitated in access to evidence, the opportunity to share insights with colleagues and more time to work on EBP. The fulfilment of these needs serves to enhance motivation to engage with evidence-based practice (EBP), facilitate personal development, and empower nurses and student nurses to take more leadership in working according to EBP principles and improve healthcare delivery.
CONCLUSION
Nurses experience difficulties applying EBP principles and need support with their implementation. Nurses' and student nurses' needs include obtaining more EBP knowledge and access to tailored and ready-to-use information. They also indicated the need for role models, autonomy, incentives, dedicated time, and incorporation of EBP in daily work practice.
PubMed: 38949881
DOI: 10.1080/10376178.2024.2369660 -
Revista Da Escola de Enfermagem Da U S P 2024The aim is to conduct theoretical reflection on the inseparability among public health, planetary health and the nursing process in light of complexity thinking, with...
The aim is to conduct theoretical reflection on the inseparability among public health, planetary health and the nursing process in light of complexity thinking, with the aim of contributing to healthy and sustainable development. Study with a theoretical-reflexive approach that accessed bibliographical sources from contemporary authors who defend the inseparability between public health and planetary health and, at the same time, provide theoretical-systemic support to the nursing process, under an inductive critical bias. The nursing process is conceived as a complex phenomenon, which comprises interdependent dynamics, dialogical approaches, critical-reflective perception and prospective leadership. Theoretical reflection on the nursing process and sustainable development raises an expanded, contextualized and interdependent look at the role of nursing professionals in different health contexts, in order not to compromise well-being and environmental health.
Topics: Sustainable Development; Public Health; Humans; Global Health; Nursing Process; Environmental Health; Nurse's Role
PubMed: 38949513
DOI: 10.1590/1980-220X-REEUSP-2024-0026en -
Disability and Rehabilitation.... Jul 2024Disability influences activities of daily living, leading to unsafe conditions, poor quality of life, and dependence on others and assistive technologies. Despite...
BACKGROUND
Disability influences activities of daily living, leading to unsafe conditions, poor quality of life, and dependence on others and assistive technologies. Despite limited access and unmet needs, assistive technology enables users to participate in education and be independent members of their community. Students with disabilities in higher education face many challenges in their day-to-day activities and evidence is limited in the study area. Therefore, this study aimed to explore assistive technology experience and daily living challenges among students with disabilities in higher education.
METHOD
A descriptive qualitative study design was employed at the University of Gondar, Gondar, Ethiopia, between December 20, 2022, and January 20, 2023. A purposive sampling method was employed to recruit 14 students with disabilities. An in-depth interview was employed using semi-structured questionnaires. Open Code version 4 software for coding and reflexive thematic analysis approach was employed for the analysis.
RESULT
A total of 14 students with disabilities were included in an in-depth interview. Four main themes emerged, which included activities of daily living, attitudes toward people with disabilities, barriers to accessibility, and access to assistive technology.
CONCLUSION
Barriers to activities of daily living among students with disabilities were poor accessibility of infrastructural facilities, lack of teaching/learning materials in an accessible format, and negative attitudes. The present study's finding is needed to support students in higher education for their academic achievement and to design appropriate rehabilitation strategies and policies on the accessibility of physical infrastructures, inclusive education, and the provision of assistive technology.
PubMed: 38949131
DOI: 10.1080/17483107.2024.2362248 -
Indian Journal of Orthopaedics Jul 2024This study was to evaluate the efficacy of multiple platelet-rich plasma injections in reflex sympathetic dystrophy following distal radius fracture after previous...
INTRODUCTION
This study was to evaluate the efficacy of multiple platelet-rich plasma injections in reflex sympathetic dystrophy following distal radius fracture after previous various treatments have failed.
MATERIALS AND METHODS
This comparative prospective study was designed for 64 patients of reflex sympathetic dystrophy developed following distal radius fracture, from January 2009 to December 2020 were enrolled in this study. This cohort of patient was given either four multiple subcutaneous platelet-rich plasma injections at weekly interval ( = 32) or two injections in a month with 15 days interval ( = 32). The primary outcome measure assessed with patient rated wrist evaluation questionnaire score. The secondary outcome was a visual analogue scale pain score. The final follow up was at 2 years. ≤ 0.05 is considered statistically.
RESULTS
The patient rated wrist evaluation score for usual and specific activities and EQ-VAS for pain level showed statistically significant greater improvement in group A (42 21%) compared to group B (19 24%), ( = 0.37). Patients also had improvement in wrist movements with no statistically significant differences in both groups. The standard difference in means of all three functional scores was almost similar between both groups A and B (standard difference in means = 0.032; 95% CI 0.236-0.830; = 0.495), considered clinically meaningful.
CONCLUSION
This study results suggest autologous platelet-rich plasma injections seem to be safe, cost effective, efficacious algorithm treatment for reflex sympathetic dystrophy following distal radius fracture patients where previous treatments have failed.
PubMed: 38948381
DOI: 10.1007/s43465-024-01171-x