bluuebunny/crossref_metadata_2025 huggingface dataset:
Antimicrobial stewardship in the neonatal unit reduces antibiotic exposure
Authors: McCarthy KN , Hawke A , Dempsey EM
Published: March 2018

Aim

Antimicrobial stewardship plays an important role in ensuring that the appropriate drug, dose, route and duration are employed to provide adequate treatment while minimising the risks of unnecessary antibiotic use. Surveillance of antibiotic use with prescriber feedback is recommended as a high‐impact stewardship intervention. The aim of this study was to reduce unnecessary antimicrobial use in a neonatal unit.

Methods

A prospective audit was performed to assess compliance with antimicrobial guidelines. Following this, educational interventions were applied, electronic prescribing was introduced to the neonatal unit, and re‐audit was performed. The primary outcome was a reduction in days of therapy (DOT).

Results

There were 312 neonatal admissions. There was a significant overall reduction in the primary outcome of DOT/1000 patient days from 572 to 417 DOT. This represents a 27% reduction in total antibiotic use. Prolonged antibiotic treatment courses >36 hours in negative sepsis evaluations were reduced from 82 DOT to 7.5 DOT. Similarly, treatment courses greater than five days for culture‐negative sepsis were reduced from 46.5 DOT to 7 DOT.

Conclusion

Monitoring antibiotic prescribing data can provide useful insights into the trends of antibiotic use and also inform clinicians of potential areas where antibiotic use may be safely reduced.
Combined multichannel intraluminal impedance‐pH monitoring should be used to diagnose reflux‐related otitis media with effusion in children
Authors: Pavić Ivan , Babić Irena , Matijašić Nuša , Hojsak Iva
Published: March 2018

Aim

This study investigated the diagnostic usefulness of combined multichannel intraluminal impedance‐pH monitoring (MII‐pH) in children with suspected reflux‐related otitis media with effusion (OME) as existing data were scarce.

Methods

This was a prospective study that included children up to seven years of age who underwent MII‐pH due to OME lasting more than three months. The study was conducted in the Children's Hospital Zagreb, Croatia, from January 2014 to August 2016.

Results

The study comprised 63 children (63% male) with a mean age of 4.7 years. Gastroesophageal reflux (GER) disease was detected by impedance in 22 (35%) of the children and by pH‐metry in nine (14%). In children with OME, MII‐pH found a median number of 24 proximal GER episodes, of which a median of nine was acidic and a median of 11 was weakly acidic. There was a significant positive correlation between the number of GER episodes and the presence of eosinophils in nasal swabs.

Conclusion

Both acidic and weakly acidic refluxes seemed to play a significant role in the pathogenesis of OME. Localised nasal eosinophilia may serve as a marker of extraoesophageal reflux in children with suspected reflux‐related OME.
Head‐up tilt test provokes dynamic alterations in total peripheral resistance and cardiac output in children with vasovagal syncope
Authors: Li Hongxia , Liao Ying , Han Zhenhui , Wang Yuli , Liu Ping , Zhang Chunyu , Tang Chaoshu , Du Junbao , Jin Hongfang
Published: March 2018

Aim

This study examined the total peripheral vascular resistance (TPVR) and cardiac output changes due to the head‐up tilt test (HUTT) in children with vasovagal syncope (VVS).

Methods

From December 2013 to January 2016, we recruited 77 children diagnosed with VVS group at Peking University First Hospital, China, and 28 children without VVS provided the control group. Heart rate, blood pressure, TPVR, cardiac output and baroreflex sensitivity were monitored during the HUTT.

Results

In the supine position, TPVR and baroreflex sensitivity were higher in the patients with VVS than the controls, but cardiac output did not differ between the two groups. There were obvious increases in the VVS patients from TPVR in the supine position to the prepositive response period (p < 0.05), then the positive response period (p < 0.01). However, we noted the opposite trend in cardiac output, from the supine position to the prepositive response period (p < 0.01) then the positive response period (p < 0.01).

Conclusion

During HUTT, children with VVS demonstrated increases in TPVR but decreases in cardiac output, during the transition from the supine position to the positive response. This response might be involved in the pathogenesis of VVS.
Paediatric antiepileptic polytherapy: systematic review of efficacy and neurobehavioural effects and a tertiary centre experience
Authors: Plevin D , Jureidini J , Howell S , Smith N
Published: March 2018

Aim

This paper presents the prevalence of antiepileptic polytherapy at a single tertiary institution and systematically reviews the evidence base for its efficacy and neurobehavioural safety in children.

Method

Prevalence of antiepileptic polypharmacy was determined from pharmacy dispensing records at a paediatric tertiary hospital and neurobehavioural comorbidities quantified through casenote review; comparison is made with studies evaluating the neurobehavioural safety of antiepileptic polytherapy, identified via systematic literature review.

Results

Amongst 262 patients at the hospital, 117 (44.7%) were prescribed polytherapy; with patients having an intellectual disability statistically more likely to be prescribed polytherapy than those without (70.5% vs 40.6%; p < 0.0001). Systematic review identified no trials addressing the efficacy or neurobehavioural outcomes of polytherapy as a primary outcome. Several observational studies identified associations between polytherapy and neurobehavioural adverse outcomes such as anxiety and behavioural disturbance. Observational studies also suggest that a reduction in polytherapy load is generally not associated with worsening seizure control.

Conclusion

Whilst antiepileptic polytherapy is common practice within paediatric epilepsy cohorts attending tertiary care institutions, evidence is lacking to support its efficacy. There are significant practical difficulties to undertaking randomised controlled trials within this population. Nonetheless, clinicians must consider that adverse neurobehavioural consequences of polytherapy might outweigh benefits to seizure control.
Observation study showed that the continuity of skin‐to‐skin contact with low‐birthweight infants in Uganda was suboptimal
Authors: Watkins Heather C. , Morgan Melissa C. , Nambuya Harriet , Waiswa Peter , Lawn Joy E.
Published: March 2018

Aim

Kangaroo mother care (KMC) is a safe and effective method of reducing neonatal mortality in resource‐limited settings, but there has been a lack of data on the duration of skin‐to‐skin contact (SSC) in busy, low‐resource newborn units. Previous studies of intermittent KMC suggest the duration of SSC ranged from 10 minutes to 17 hours per day.

Methods

This was an observational study of newborn infants born weighing less than 2000 g, which collected quantitative data on SSC over the first week after birth. The study took place in July 2016 in the newborn unit of a low‐resource facility in Uganda.

Results

The mean daily duration of SSC over the first week after birth was three hours. This differed significantly from the World Health Organization recommendation of at least 20 hours of SSC per day. SSC was provided by mothers most of the time (73.5%), but other family members also took part, especially on the day of birth.

Conclusion

Our study found a disappointingly low daily duration of SSC in this Ugandan newborn unit. However, advocacy and community education of SSC may help to decrease the stigma of KMC, improve overall acceptance and reduce the age at SSC initiation.
Reductions in otitis and other respiratory tract infections following childhood pneumococcal vaccination
Authors: Johansson Kostenniemi Urban , Palm Jessica , Silfverdal Sven‐Arne
Published: March 2018

Aim

Streptococcus pneumoniae commonly causes respiratory tract infections including acute otitis media and pneumonia. In this study, we evaluated the impact of general infant pneumococcal vaccination, introduced in Sweden in 2009, on respiratory tract infections.

Methods

We studied the incidence of respiratory tract infections and antibiotic consumption in Västerbotten County, Sweden, during 2005–2014 using the County Council's diagnosis register.

Results

Comparing the prevaccination period of 2005–2008 to 2014, the incidences of all‐cause acute otitis media decreased significantly in children aged 0–4 and five years to 17 years, by 41.5% and 20.9%, respectively. In addition, we also noted significant reductions in sinusitis and other upper respiratory tract infections, and some reductions in adults. Antibiotic consumption for upper respiratory tract infections decreased by 37.1%, with the largest decrease occurring in children aged 0–4 years. For pneumonia, the incidence significantly decreased by 28.6% for children aged 0–4 years, with no significant changes in older children or adults.

Conclusion

Pneumococcal vaccination was followed by reduced incidence of upper respiratory tract infections and antibiotic consumption in vaccinated children, with some indications of possible herd immunity. For pneumonia, a major reduction was noted limited to the youngest children.
Multiple functional gastrointestinal disorders are frequent in formula‐fed infants and decrease their quality of life
Authors: Bellaiche Marc , Oozeer Raish , Gerardi‐Temporel Geraldine , Faure Christophe , Vandenplas Yvan
Published: March 2018

Aim

This prospective study evaluated the incidence of functional gastrointestinal disorders (FGIDs) during infancy, on their own or combined with other symptoms.

Methods

We asked 273 French paediatricians with a specific interest in FGIDs to provide feedback on 2757 infants aged zero to six months from March 2013 to January 2014. Gastrointestinal health status was assessed by two questionnaires at inclusion and at a four‐week follow‐up visit. FGIDs were assessed according to the Rome III criteria and quality of life (QoL) was monitored.

Results

Combined FGIDs were diagnosed in 2145 (78%) infants: 63% with two disorders and 15% with three or more disorders. The most frequently combined FGIDs were gas/bloating and colic (28%), colic and regurgitation (17.0%) and gas/bloating and regurgitation (8%). Compared to infants with a single FGID, combined FGID were associated with lower body weight (4.63 vs 4.79 kg, p = 0.009), shorter breastfeeding duration (33 vs 43 days, p < 0.001), a decreased QoL score (5.9 vs 6.5, p < 0.001), more frequent drug prescriptions (25% vs 13%, p < 0.001) and significantly greater improvements in QoL scores after four weeks (p = 0.003).

Conclusion

Combined FGIDs were extremely common in infants up to six months of age and had a negative impact on breastfeeding, weight gain and QoL.
Lower Apgar scores and Caesarean sections are related to attention‐deficit/hyperactivity disorder
Authors: Sucksdorff Minna , Lehtonen Liisa , Chudal Roshan , Suominen Auli , Gissler Mika , Sourander Andre
Published: March 2018

Aim

We examined the associations between prenatal, birth‐related and newborn risk factors and attention‐deficit/hyperactivity disorder (ADHD).

Methods

In this population‐based study, 10 409 subjects diagnosed with ADHD by 31 December 2011 and 39 124 controls, born between 1 January 1991 and 31 December 2005, were identified from Finnish nationwide registers. Perinatal data were obtained from the Birth Register. Conditional logistic regression was used to examine the associations after controlling for confounders.

Results

Lower Apgar scores were associated with a higher risk of ADHD, with odds ratios of 1.12 (95% confidence intervals 1.06–1.19) for one‐minute Apgar scores of 7–8, 1.17 (95% CI 1.02–1.35) for scores of 5–6 and 1.41 (95% CI 1.18–1.68) for scores of 0–4, compared to Apgar scores of 9–10. Elective Caesarean sections were associated with an increased risk of ADHD with an adjusted odds ratio of 1.15 (95% CI 1.05–1.26). Other identified risk factors were breech presentation, induced labour and admission to a neonatal intensive care unit. Low umbilical artery pH did not increase the risk of ADHD.

Conclusion

Elective Caesareans and perinatal adversities leading to lower Apgar scores increased the risk of ADHD. Future research to identify the mechanisms behind these findings is warranted.
WHY WAGES TEND TO BE LOWER IN WORKER‐OWNED FIRMS THAN IN INVESTOR‐OWNED FIRMS
Authors: BONATTI Luigi , LORENZETTI Lorenza A.
Published: March 2018

Consistently with the empirical evidence and in contrast with Shapiro and Stiglitz (1984), we demonstrate that worker‐owned firms exhibit not only more wage flexibility and less employment volatility than investor‐owned firms, but also lower expected wages than the latter. This is due to the informational advantage enjoyed by the firm's owners relatively to the workers concerning some circumstances that affect the performance of the firm. We show this both in the case in which each investor owned firm offers labor contracts to single workers who act atomistically and in the case in which each investor owned firm negotiates labor conditions with its workers who act as a group (a ‘union’). Finally, we show that differences in attitudes towards risk between investor owned firms and their workers are not necessary to explain the typical combination of state‐independent wages and cyclical layoffs that characterizes most industries.
Effects of the butyric acid‐producing strain Clostridium butyricum MIYAIRI 588 on broiler and piglet zootechnical performance and prevention of necrotic enteritis
Authors: Takahashi Motomichi , McCartney Elinor , Knox Anne , Francesch Maria , Oka Kentaro , Wada Kaoruko , Ideno Marie , Uno Koji , Kozłowski Krzysztof , Jankowski Jan , Gracia Marta I. , Morales Joaquin , Kritas Spyridon K. , Esteve‐Garcia Enric , Kamiya Shigeru
Published: March 2018

The objective of this study was to assess the effects of a probiotic strain Clostridium butyricumMIYAIRI 588 (CBM588) on broiler and weaned piglet health and zootechnical performance. Five field studies were carried out in broilers and five in weaned piglets under European feed additive guidelines. Each study followed a randomized blocked design with two treatments: Control (basal diet) and CBM588 supplemented groups. The zootechnical performance parameters selected were body weight, daily gain, feed intake and feed efficiency (feed:gain). Broilers fed diets with CBM588 gained significantly more weight (+2%, p < .001) and exhibited significantly better feed efficiency (−1.6%, p < .001) in comparison with Controls. Similarly, analysis of pooled data of weaned piglet trials showed that CBM588‐fed piglets were significantly heavier than Controls (+2.6%, p = .014), exhibited significantly higher mean daily gain (+4.7%; p = .004), and significantly improved feed efficiency (−4.2%, p = .001). In addition to the zootechnical efficacy studies, the preventive effect of CBM588 on necrotic enteritis (NE) was assessed in a natural challenge model in broilers where CBM588 reduced the incidence and severity of NE lesions. These data indicate the potential of CBM588 to improve broiler and weaned piglet zootechnical performance, and to make a positive contribution to animal health.
CYP3A5*3 and ABCB1 61A>G Significantly Influence Dose‐adjusted Trough Blood Tacrolimus Concentrations in the First Three Months Post‐Kidney Transplantation
Authors: Hu Rong , Barratt Daniel T. , Coller Janet K. , Sallustio Benedetta C. , Somogyi Andrew A.
Published: March 2018

Tacrolimus (TAC) is a first‐line immunosuppressant used to prevent organ rejection after kidney transplantation. There is large inter‐individual variability in its pharmacokinetics. Single nucleotide polymorphisms (SNPs) in genes encoding TAC metabolizing enzymes cytochromes P450 3A4/5 (CYP3A4/5), P‐glycoprotein efflux transporter (ABCB1), their expression regulator pregnane X receptor (NR1I2) and CYP3A co‐factor cytochrome P450 reductase (POR) have been studied for their effects on tacrolimus disposition. However, except for CYP3A5*3, controversies remain about their roles in predicting dose‐adjusted trough blood TAC concentrations (C0/D). This study aimed to investigate the effects of ABCB1 (61A>G, 1199G>A, 1236C>T, 2677G>T and 3435C>T), CYP3A4*22, CYP3A5*3, NR1I2 (8055C>T, 63396C>T and ‐25385C>T) and POR*28 SNPs on TAC C0/D. In total, 165 kidney transplant recipients were included in this study. SNPs were genotyped by probe‐based real‐time polymerase chain reaction. Associations between log‐transformed whole blood TAC C0/D (measured at 1 and 3 months post‐transplant) and genotypes/haplotypes were assessed by linear mixed effects analysis, controlling for age, sex and haematocrit. It was observed that CYP3A5 expressors (*1/*1 + *1/*3) (p = 5.5 × 10−16) and ABCB1 61G allele carriers (p = 0.001) had lower log‐transformed TAC C0/D (56% and 26% lower geometric mean TAC C0/D, respectively) and accounted for approximately 30% and 4%, respectively, of log‐transformed TAC C0/D variability in the first 3 months post‐transplant. In conclusion, CYP3A5*3 is a major, and ABCB1 61A>G is a novel, although minor, genetic factor affecting TAC C0/D in kidney transplant recipients.
Prostaglandin F2α Receptor Modulation Affects Eye Development in Guinea Pigs
Authors: Yang Jinglei , Pan Miaozhen , Reinach Peter S. , Chen Rongfang , Yu Lan , Zhou Feng , Zhang Sen , Qu Jia , Zhou Xiangtian
Published: March 2018

Retinal arachidonic acid (ARA) levels in form‐deprived eyes decline in guinea pigs. As prostaglandin F2α (PGF2α) is an ARA metabolite and endogenous agonist of prostaglandin F receptor (FP), we have been suggested that down‐regulation of PGF2α‐FP receptor signalling pathway contributes to myopia onset. To test this hypothesis, this study determines whether: (i) retinal PGF2α levels decline during the development of form deprivation myopia (FDM) in guinea pigs; (ii) FP receptor agonism and antagonism alter emmetropization and myopia development. Pigmented guinea pigs were randomly assigned to normal vision and form‐deprived groups. Ultraperformance liquid chromatography coupled with a mass spectrometer (UPLC‐MS) measured retinal PGF2α levels 2 weeks after form deprivation (FD). The selective FP agonist, latanoprost acid (LAT) and its corresponding antagonist, AL8810, were peribulbarly injected into each group. An eccentric infrared photorefractor (EIR) monitored refraction. A‐scan ultrasonography measured axial elongation (AL) and vitreous chamber depth (VCD). Tonometry measured the intraocular pressure (IOP). Retinal PGF2α levels declined in form‐deprived eyes compared to those in normal eyes. Neither LAT nor AL8810 affected IOP with or without FD. On the other hand, after 4 weeks of daily 0.5 μg AL8810 treatment, a myopia of −1.99 ± 0.34 dioptre (D) developed, but LAT had no effect on emmetropization in a normal visual environment. Nevertheless, daily 30 μg LAT treatment for 4 weeks inhibited FDM development by 41% (vehicle control: −8.39 ± 0.45 D; LAT: −4.95 ± 0.39 D; two‐way anova with repeated measures, p < 0.05). Down‐regulation of PGF2α‐FP receptor signalling pathway may contribute to myopia onset as retinal PGF2α declined in myopic eyes and antagonism of FP receptor by AL8810 induced a myopic shift in normal vision environment. Meanwhile, up‐regulation of this pathway by LAT inhibited FDM development. However, the mechanism underlying LAT‐induced FDM inhibition needs further clarification. This uncertainty exists because its inhibition of FDM suggests that LAT strengthens the scleral framework which reduces axial elongation. On the other hand, its IOP‐lowering effect is attributed to thinning and weakening the scleral framework in glaucoma treatment.
Integrated Approaches to Testing and Assessment
Authors: Casati Silvia
Published: March 2018

The concept of Integrated Approaches to Testing and Assessment (IATA) has been advanced by the Organisation for Economic Cooperation and Development (OECD) member countries to enable a progressive shift from traditional chemical assessments largely based on the observation of the adverse effect in animal models, using individual methods or predefined batteries of standard toxicity tests, to assessment strategies integrating diverse lines of evidence. The flexible nature of IATA allows the inclusion of mechanistic data generated with non‐animal methods and with new technologies (e.g. high‐throughput and high content methods). The assessment process within IATA is typically conducted through weight‐of‐evidence which inevitably includes the elements of subjective expert judgement. For these reasons, IATA cannot be fully harmonized across sectors and countries. Nevertheless, some of the IATA components, such as defined approaches, which consist of a fixed data interpretation procedure (DIP) applied to data generated with a defined set of information sources, can be harmonized. The focus of this MiniReview is to provide an illustration of the differences between the IATA developed so far in the areas of regulatory toxicology, and ongoing activities related to the international harmonization of defined approaches that rely on multiple non‐animal information sources.
Sensitivity Analysis and Power for Instrumental Variable Studies
Authors: Wang Xuran , Jiang Yang , Zhang Nancy R. , Small Dylan S.
Published: March 2018

In observational studies to estimate treatment effects, unmeasured confounding is often a concern. The instrumental variable (IV) method can control for unmeasured confounding when there is a valid IV. To be a valid IV, a variable needs to be independent of unmeasured confounders and only affect the outcome through affecting the treatment. When applying the IV method, there is often concern that a putative IV is invalid to some degree. We present an approach to sensitivity analysis for the IV method which examines the sensitivity of inferences to violations of IV validity. Specifically, we consider sensitivity when the magnitude of association between the putative IV and the unmeasured confounders and the direct effect of the IV on the outcome are limited in magnitude by a sensitivity parameter. Our approach is based on extending the Anderson–Rubin test and is valid regardless of the strength of the instrument. A power formula for this sensitivity analysis is presented. We illustrate its usage via examples about Mendelian randomization studies and its implications via a comparison of using rare versus common genetic variants as instruments.
Preschoolers' conformity (and its motivation) is linked to own and parents' personalities
Authors: Hellmer Kahl , Stenberg Gunilla , Fawcett Christine
Published: March 2018

Previous studies on conformity have primarily focused on factors that moderate conformity rates overall and paid little attention to explaining the individual differences. In this study, we investigate five‐factor model personality traits of both parents and children and experimentally elicited conformity in 3.5‐year‐olds (N = 59) using an Asch‐like paradigm with which we measure both overt conformity (public responses) and covert opinions (private beliefs after conformist responses): A correct covert opinion after an incorrect conformist response results from a socially normative motivation, whereas an incorrect covert opinion results from an informational motivation. Our data show (1) low parental extroversion is associated with participants' overall rate of conformity, (2) and low participant extroversion and high openness are associated with an informational instead of a normative motivation to conform. This suggests that sensitivity to the social context or social engagement level, as manifested through extroversion, could be an important factor in conformist behaviour.

Statement of contribution

What is already known on this subject?

We all conform, from early in life – and even when we should know better

We can conform for normative and informational motivations

Some are more prone to conform than others

What does this study add?

This is the first study to take an individual differences approach to developmental conformity

Social engagement (extroversion) is an important factor in conformity
Longitudinal associations between younger children's humour styles and psychosocial adjustment
Authors: James Lucy Amelia , Fox Claire Louise
Published: March 2018

Whilst a multitude of studies have examined links between different styles of humour and aspects of adjustment, longitudinal research is noticeably lacking. Following a study which identified bidirectional associations between humour styles and psychosocial adjustment in older children, the current research aimed to investigate these associations in younger children. In total, 413 children aged 8–11 years completed the humour styles questionnaire for younger children (HSQ‐Y) alongside measures of psychosocial adjustment in both the autumn and the summer over the course of a school year. Findings across the school year suggested that children's adjustment may impact significantly on their use of different styles of humour. Further longitudinal research over a longer time period would now be beneficial to further increase our understanding of the associations between humour styles and adjustment throughout development.

Statement of contribution

What is already known on this subject?

Research has identified associations between children's humour styles and psychosocial adjustment.

Research with older children has also identified longitudinal associations.

What does this study add?

This is the first study to identify longitudinal associations between humour styles and adjustment in younger children.

This allows for stronger statements to be made about causal relationships.
Training of parental scaffolding in high‐socio‐economic status families: How do parents of full‐ and preterm‐born toddlers benefit?
Authors: Gärtner Kim Angeles , Vetter Verena Clara , Schäferling Michaela , Reuner Gitta , Hertel Silke
Published: March 2018

Background

Preterm children have an increased risk regarding self‐regulation development. Given the strong link between parenting behaviour (i.e., scaffolding and sensitivity) and children's self‐regulation, parental training presents a promising way to counteract the negative consequences of preterm birth.

Aims

We explored the effectiveness of parental training by comparing a basic scaffolding training and a combined scaffolding/sensitivity training to an active treatment‐control group (stress management). Basic and combined treatments should increase parents’ domain‐specific self‐efficacy (DSSE) and beliefs on parental co‐regulation and the promotion of learning (BCL) more than the control treatment should. No such differences were expected for parents’ domain‐general self‐efficacy (DGSE). We examined whether parents of preterm and full‐term children benefitted equally from training conditions.

Sample(s)

A total of 87 parents of full‐term and 35 parents of preterm toddlers (24–36 months of age, corrected for prematurity) participated.

Methods

Based on a quasi‐experimental pre‐test–post‐test follow‐up design, parents were randomly assigned to treatments. A multimethod approach was applied, including self‐report, parent–child interactions, and standardized behavioural tasks. The presented study is limited to questionnaire data on parents’ DGSE, DSSE, and BCL.

Results

An overall increase resulted from pre‐ to post‐test and/or follow‐up. Parents’ BCL changed significantly stronger in the combined training than in the control group. Parents of preterm and full‐term children benefitted equally from basic and combined training.

Conclusions

The combined training enhanced BCL among parents of full‐term and preterm children the most. If such training also yields improvement on the behavioural level, this finding will advance preterm aftercare.
Evaluating the impact of online discussion boards on student engagement with group work
Authors: Delaney Deborah , Kummer Tyge‐F. , Singh Kishore
Published: March 2018

The purpose of this study is to examine the impact of the use of an online discussion board as an assessment item on students learning performance in relation to group work based on Social Learning Theory. The study uses survey questionnaires at the beginning and end of semester together with student grade information. The data analysis consists of (1) a regression analysis to explore the relationship between student interaction and performance and (2) a repeated measures ANOVA to explore changes in attitude and perceived encouragement. Student's perceptions at the outset were found to be important as was the use of the online discussion board as a learning tool even when it is not assessed. Further, students' attitude to the online discussion board improved through the semester however the online assessment task did not encourage domestic students to be more engaged in group‐based activities. In contrast, international students were more encouraged to participate in group‐based activities at the end of the semester. The study has implications for online group activities in education.
Health‐related quality of life in active surveillance and radical prostatectomy for low‐risk prostate cancer: a prospective observational study (HAROW ‐ Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting)
Authors: Ansmann Lena , Winter Nicola , Ernstmann Nicole , Heidenreich Axel , Weissbach Lothar , Herden Jan
Published: March 2018

Objectives

To compare health‐related quality of life (HRQOL) between patients with localised prostate cancer in an active surveillance (AS) group and a radical prostatectomy (RP) group, as evidence shows that both groups have similar oncological outcomes. Thus, comparative findings on the patients’ HRQOL are becoming even more important to allow for informed treatment decision‐making.

Patients and Methods

The Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting (HAROW) study is a prospective, observational study designed to collect data for different treatment options for newly diagnosed patients with localised prostate cancer under real‐life conditions. At 6‐month intervals, clinical data (D'Amico risk categories, Charlson Comorbidity Index) and HRQOL (European Organisation for Research and Treatment of Cancer quality of life questionnaire 30‐item core questionnaire) were collected. Data were analysed by longitudinal multilevel analysis for patients with localised prostate cancer under AS and RP.

Results

Data from 961 patients (556 RP, 405 AS) were considered. The follow‐up was 3.5 years (median 2 years). The results reveal significant, but not clinically relevant advantages for patients with low‐risk prostate cancer managed with AS in contrast to RP concerning global HRQOL as well as role, emotional and social functioning over time, after controlling for age, comorbidities, and partnership status. In some, but not all HRQOL scales, RP patients start with a slightly lower HRQOL and recover up to the level of AS patients within 1–2 years after diagnosis.

Conclusion

HRQOL is an important aspect in the decision‐making and advising process for patients with prostate cancer. In many aspects of HRQOL, AS is associated with more favourable outcomes than RP within the first 1–2 years after diagnosis in our observational design, although the differences were not clinically significant. The result that HRQOL in AS patients is at least as high as in RP patients should be considered when advising patients about the different treatment options for low‐risk localised prostate cancer.
Low‐intensity extracorporeal shockwave therapy ameliorates diabetic underactive bladder in streptozotocin‐induced diabetic rats
Authors: Wang Hsun Shuan , Oh Byung Seok , Wang Bohan , Ruan Yajun , Zhou Jun , Banie Lia , Lee Yung Chin , Tamaddon Arianna , Zhou Tie , Wang Guifang , Lin Guiting , Lue Tom F.
Published: March 2018

Objectives

To evaluate the therapeutic effect of once‐weekly low‐intensity extracorporeal shock wave therapy (Li‐ESWT) on underactive bladder (UAB) in the streptozotocin (STZ)‐induced diabetic rat model.

Materials and Methods

In all, 36 female Sprague–Dawley rats were divided into three groups: normal control (NC), diabetes mellitus control (DMC), and DM with Li‐ESWT (DM Li‐ESWT). The two DM groups received an intraperitoneal 60 mg/kg STZ injection to induce DM. The Li‐ESWT was applied toward the pelvis of the rats starting 4 weeks after STZ administration and lasting for 4 weeks. The Li‐ESWT was given once weekly, with an energy flux density of 0.02 mJ/mm2 at 3 Hz for 400 pulses. All rats underwent conscious cystometry, leak‐point pressure (LPP) assessment, ex vivo organ‐bath study, histology, immunofluorescence, and Western Blot analysis.

Results

Conscious cystometry revealed voiding dysfunction in the DMC group, whereas the DM Li‐ESWT group showed significantly improved voiding function, reflected in a reduced post‐void residual urine volume and increased LPP compared to the DMC group. Ex vivo organ‐bath studies showed that Li‐ESWT enhanced muscle contractile activity of the bladder and urethra during electrical‐field stimulation and drug stimulation. Histologically, Li‐ESWT significantly restored bladder morphology, reflected by a reduction in the intravesical lumen area and increased muscle proportion of the bladder wall. Western Blot analysis showed higher smooth muscle actin expression in the bladder wall in the DM Li‐ESWT group compared to the DMC group. Immunofluorescence showed decreased nerve‐ending distribution, and destroyed and shortened nerve fibres in the DMC group, and recovery of neuronal integrity and innervation in the DM Li‐ESWT group.

Conclusions

In conclusion, Li‐ESWT ameliorated UAB and urinary incontinence in the diabetic UAB rat model. The improvement appears to be the result of restoration of bladder and urethral structure and function by Li‐ESWT. Li‐ESWT is non‐invasive and may become a better alternative therapy for UAB. Further investigations are warranted.
Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000–2010
Authors: Hsu Ray C. J. , Barclay Matthew , Loughran Molly A. , Lyratzopoulos Georgios , Gnanapragasam Vincent J. , Armitage James N.
Published: March 2018

Objective

To describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC).

Patients and Methods

Adult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed‐up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short‐term surgical outcomes, as well as 1‐ and 5‐year relative survivals.

Results

Annual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron‐sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30‐day mortality rate halved from 2.4% to 1.1% and 90‐day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1‐year relative survival rate increased from 86.9% to 93.4%, whilst the 5‐year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease.

Conclusions

Surgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short‐ and long‐term survival particularly for elderly patients and those with locally advanced disease.
Implementing assessments of robot‐assisted technical skill in urological education: a systematic review and synthesis of the validity evidence
Authors: Goldenberg Mitchell G. , Lee Jason Y. , Kwong Jethro C.C. , Grantcharov Teodor P. , Costello Anthony
Published: March 2018

Objectives

To systematically review and synthesise the validity evidence supporting intraoperative and simulation‐based assessments of technical skill in urological robot‐assisted surgery (RAS), and make evidence‐based recommendations for the implementation of these assessments in urological training.

Materials and Methods

A literature search of the Medline, PsycINFO and Embase databases was performed. Articles using technical skill and simulation‐based assessments in RAS were abstracted. Only studies involving urology trainees or faculty were included in the final analysis.

Results

Multiple tools for the assessment of technical robotic skill have been published, with mixed sources of validity evidence to support their use. These evaluations have been used in both the ex vivo and in vivo settings. Performance evaluations range from global rating scales to psychometrics, and assessments are carried out through automation, expert analysts, and crowdsourcing.

Conclusion

There have been rapid expansions in approaches to RAS technical skills assessment, both in simulated and clinical settings. Alternative approaches to assessment in RAS, such as crowdsourcing and psychometrics, remain under investigation. Evidence to support the use of these metrics in high‐stakes decisions is likely insufficient at present.
Modelling cost‐effectiveness of a biomarker‐based approach to neoadjuvant chemotherapy for muscle‐invasive bladder cancer
Authors: Lotan Yair , Woldu Solomon L. , Sanli Oner , Black Peter , Milowsky Matthew I.
Published: March 2018

Objectives

To model the cost‐effectiveness of a biomarker‐based approach to select patients for neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) in muscle‐invasive bladder cancer (MIBC).

Patients and Methods

We obtained data from the most recent clinical studies on patients with locally advanced MIBC treated by RC, including stage distributions, overall survival (OS) estimates, associated costs, and utilisation/response to NAC. Additionally, we estimated the putative efficacy of three biomarkers to select patients for NAC: DNA‐repair gene panel [ataxia telangiectasia mutated (ATM), retinoblastoma 1 (RB1), and Fanconi anaemia complementation group C (FANCC)], excision repair cross‐complementation group 2 (ERCC2), and ribonucleic acid (RNA) subtypes. A decision analysis model was developed to evaluate the cost‐effectiveness of biomarker‐based approaches to select patients with MIBC for NAC. Comparison of cost‐effectiveness included RC alone, unselected NAC plus RC, and NAC based on the three aforementioned biomarkers.

Results

The DNA‐repair gene panel‐based approach to NAC was the most cost‐effective strategy (mean OS of 3.14 years, $31 482/life year). Under this approach, 38% would undergo NAC, about twice the number of patients who are currently receiving NAC for MIBC. Such an approach would improve mean OS by 5.2, 1.6, and 4.4 months compared to RC alone, a hypothetical scenario where all patients received NAC, and compared to current estimates of NAC utilisation, respectively.

Conclusions

A biomarker‐based strategy to identify patients with MIBC who should undergo NAC was more cost‐effective than unselected use of NAC or RC alone. As further data becomes available, such a model may serve as a basis for incorporating biomarkers into clinical decision making.
Synchronous nephron‐sparing approaches for bilateral renal masses: peri‐operative and renal functional outcomes
Authors: Mason Ross J. , Atwell Thomas , Lohse Christine , Bhindi Bimal , Schmit Grant , Schmitz John , Leibovich Bradley C. , Boorjian Stephen A. , Thompson R. Houston
Published: March 2018

Objectives

To evaluate the peri‐operative and renal functional outcomes of patients undergoing synchronous bilateral partial nephrectomy (PN) or percutaneous cryoablation (PCA).

Patients and Methods

We retrospectively reviewed our institutional nephrectomy and renal mass ablation registries to identify all patients with synchronous bilateral renal masses who underwent simultaneous bilateral PN (n = 76) or PCA (n = 13) between 1974 and 2013. Changes in estimated glomerular filtration rate (eGFR) as well as peri‐operative complications are descriptively reported for each procedure.

Results

The number of treated renal masses in the 76 patients in the PN group and the 13 patients in the PCA group was 249 and 28, respectively. The median (interquartile range [IQR]) age at treatment was 62 (50, 71) years for the PN group and 67 (56, 72) for the PCA group. The median (IQR) maximum tumour sizes were 4.6 (3.4, 6.5) cm and 2.6 (2.4, 3.2) cm for the PN and PCA groups, respectively. The median (IQR) length of hospital stay was 7 (5, 8) days for the PN group and 1 (1, 10) days for the PCA group. The median (IQR) change in eGFR from baseline to discharge was −32 (−46, −15)% for the PN group and −17% (−33, −3) for the PCA group. By 3 months, median (IQR) renal function improved, with changes of −9 (−19, 0)% and −8 (−11, 15)%, respectively, compared with baseline. No patient in either group required renal replacement therapy in the peri‐operative period. Early postoperative complications (within 30 days) occurred in 16 patients (21.6%) in the PN and four patients in the PCA group. In particular, angioembolization for bleeding was required in the postoperative period in two patients (2.7%) in the PN and one patient in the PCA group.

Conclusions

Our experience suggests that synchronous bilateral PN or PCA are feasible treatment options for select patients presenting with bilateral renal masses. In select cases, both approaches appear to have reasonable rates of peri‐operative complications and effects on renal function.
A study into the association between local recurrence rates and surgical resection margins in organ‐sparing surgery for penile squamous cell cancer
Authors: Sri Denosshan , Sujenthiran Arunan , Lam Wayne , Minter Janice , Tinwell Brendan E. , Corbishley Catherine M. , Yap Tet , Sharma Davendra M. , Ayres Benjamin E. , Watkin Nick W.
Published: March 2018

Objective

To evaluate the significance of close surgical margins in organ‐sparing surgery (OSS) in the treatment of penile squamous cell carcinoma (pSCC) and clinicopathological factors that may influence local recurrence.

Patients and Methods

At our tertiary referral centre, between March 2001 and September 2012, 332 patients treated with OSS for pSCC had clear surgical margins. As the focus was the impact of close clear margins on local recurrence, patients with positive margins were excluded for the purpose of this study. Our overall positive margin rate for OSS in penile cancer is 7.6% (42 patients). Analysis was carried out on an on‐going prospective database, including prospective accurate pathological recording of surgical margins. Patients underwent OSS after multidisciplinary team (MDT) discussion. Local recurrence was the primary outcome measured and Fisher's exact test and time‐to‐recurrence curves were used in the analysis. All local recurrences were scrutinised by the MDT and were categorised into: true recurrences or metachronous new occurrences (i.e. tumours arising from a background of penile intraepithelial neoplasia and forming on an epithelial surface not related to the site of initial resection). A multivariate analysis was also conducted to elucidate other factors influencing local recurrence.

Results

In all, 64% of the patients had a <5 mm clear deep surgical margin, with 16% clear by <1 mm. Overall, 4% of patients had a true local recurrence, with a median time to recurrence of 6 months. In all, 53% were due to embolic spread, with residual occult local disease accounting for 47%. There was a statistically significant relationship between cavernosal involvement (P = 0.014) and lymphovascular invasion (LVI; P = 0.001) and local recurrence. Although multivariate analysis revealed that the extent of clear margin was not a predictor of disease (P = 0.405), we found an increased risk of local recurrence in the clear margin cohort of <1 mm compared to those of >1 mm (P < 0.001). Those patients considered to have metachronous tumours were scrutinised by our MDT, and eight patients (2.4%) were found to have new occurrences. Our overall proportion of patients therefore needing further treatment for either new occurrences or recurrent disease after OSS stands at 6.4%.

Conclusions

Overall the presence of local recurrent disease in OSS in our experience is low (4%). We report an embolic mechanism of local recurrence, strongly suggested by the presence of cavernosal involvement and LVI. We conclude that a deep clear margin of >1 mm has a very low risk of local recurrence in penile OSS.
Exploring pathways towards improving patient experience of robot‐assisted radical prostatectomy (RARP): assessing patient satisfaction and attitudes
Authors: Reynolds Bradley R. , Bulsara Caroline , Zeps Nik , Codde Jim , Lawrentschuk Nathan , Bolton Damien , Vivian Justin
Published: March 2018

Objective

To determine patient satisfaction and experience after robot‐assisted radical prostatectomy (RARP) for prostate cancer, using a convergent mixed‐method qualitative analysis approach.

Patients and Methods

412 patients who underwent RARP between January 2014 and June 2016 were mailed questionnaires and invited to participate in focus groups. Qualitative data was thematically analysed using NVivo. Descriptive statistics were obtained from the questionnaire using SPSS.

Results

214 patients responded (52% of sample size) of whom 97.6% were satisfied and 91.1% would likely recommend RARP. Key themes from the qualitative data highlighted the psychosocial impacts of the diagnosis and RARP process. The importance of early recovery, the benefits of pelvic floor exercises and educational resources were emphasised.

Conclusion

Patients were overwhelmingly satisfied with RARP, largely due to relevance and timeliness of the information and support provided both before and after surgery. With an increased understanding of the factors and outcomes that are most important to patients regarding all aspects of hospital care, we can create more targeted care pathways. Key themes will help inform the implementation of an enhanced recovery after surgery (ERAS) protocol to further improve recovery and early return to function.
Media and Punitive Populism inArgentina andChile
Authors: BONNER MICHELLE D.
Published: March 2018

Punitive populism is common throughout Latin America. It involves political and public opinion support for more police officers, greater police autonomy, and tougher laws to punish crime—options that often perpetuate old police practices and resist police reform efforts. This article critically examines the role of the media in fostering punitive populism by examining the sources used by journalists. Comparing the ‘most different’ cases of Argentina and Chile and drawing on interviews conducted from 2009 to 2015, I argue that the choices made by journalists regarding their sources are affected by neoliberal media policies in a particular way that favours tough‐on‐crime discourses.