bluuebunny/crossref_metadata_2025 huggingface dataset:
A Phase 3 Randomized Controlled Trial to Evaluate Efficacy and Safety of New-Formulation Zenon (Rosuvastatin/Ezetimibe Fixed-Dose Combination) in Primary Hypercholesterolemia Inadequately Controlled by Statins
Authors: Catapano Alberico L. , Vrablik Michal , Karpov Yuri , Berthou Baptiste , Loy Megan , Baccara-Dinet Marie
Published: November 2022

Objective:

In primary hypercholesterolemia many people treated with statins do not reach their plasma LDL-C goals and are at increased risk of cardiovascular disease (CVD). This study aimed to evaluate efficacy and safety of a new fixed-dose combination (FDC) formulation of rosuvastatin/ezetimibe (R/E) in this population.

Methods:

This was a multicenter, multinational, randomized, double-blind, double-dummy, active-controlled, parallel-arm study of FDC R/E in people with primary hypercholesterolemia at very high risk (VHR) or high risk (HR) of CVD, inadequately controlled with 20 mg or 10 mg stable daily dose of rosuvastatin or equipotent dose of another statin. The primary objective was to demonstrate superiority of FDC R/E versus rosuvastatin monotherapy uptitrated to 40 mg (R40) or 20 mg (R20) in reduction of LDL-C after 6 weeks.

Results:

Randomized VHR participants (n = 244) were treated with R40, R40/E10, or R20/E10; randomized HR participants (n = 208) received R10/E10 or R20. In VHR participants, superiority of R40/E10 and R20/E10 versus R40 was demonstrated on LDL-C percent change from baseline to Week 6 with least squares mean differences (LSMD) of −19.66% (95% CI: −29.48% to −9.84%; P < .001) and −12.28% (95% CI: −22.12% to −2.44%; P = .015), respectively. In HR participants, superiority of R10/E10 over R20 was not demonstrated (LSMD −5.20%; 95% CI: −15.18% to 4.78%; P = .306), despite clinically relevant LDL-C reduction with R10/E10. No unexpected safety findings were reported.

Conclusions:

The results from this study suggest that R/E FDCs improve LDL-C reduction and goal achievement in people with primary hypercholesterolemia inadequately controlled with statins and at VHR/HR of CVD.
Application of CPMV* for improving the indoor thermal environment under global solar radiation
Authors: Zhang Huan , Duan Deyi , Yang Xueqing , Zheng Wandong
Published: November 2022

The impacts of solar radiation on indoor thermal comfort are growing with the popularity of curtain walls in modern constructions. In order to accurately assess indoor thermal comfort under global solar radiation, a previous study proposed a corrected predicted mean vote with global solar radiation (CPMV*) and validated the model in summer. To further investigate the year-round applicability of the model, field experiments were conducted in transparent envelope buildings in winter, and 1098 valid thermal responses were obtained. The results indicate that CPMV* fits well with the thermal sensation vote, and it has important applications in guiding the design of indoor thermal environments and the operation of ventilation and air conditioning systems throughout the year. Besides, the predicted percentage dissatisfied with global solar radiation and the percentage unacceptable are proven to be feasible in evaluating the thermal acceptability of buildings with solar radiation. Based on CPMV*, we can calculate the indoor thermal comfort zone matching various solar radiation intensities and reasonably regulate the actual operation of the heating, ventilation and air conditioning systems. The indoor thermal environment exposed to solar radiation would be significantly improved by these findings.
Gambling operators’ social media image creation in Finland and Sweden 2017–2020
Authors: Lindeman Mikaela , Männistö-Inkinen Vilja , Hellman Matilda , Kankainen Veera , Kauppila Emmi , Svensson Johan , Nilsson Robin
Published: November 2022

Aim: This is a first audit of how gambling operators in Finland and Sweden address citizens on social media. The study is able to pinpoint some differences between how gambling operators utilise social media in a state monopoly system (Finland) and in a license-based regulatory framework (Sweden). Methods: Curated social media posts from Finland- and Sweden-based accounts in national languages were collected from March 2017, 2018, 2019 and 2020. The data ( N = 13,241) consist of posts published on YouTube, Twitter, Facebook, and Instagram. The posts were audited in terms of frequency of posting, content and user engagement. Results/Conclusions: Operators in both countries were, in general, active on their social media accounts, but there was a decline in number of posts between 2017 and 2020. A substantial number of the analysed posts did not visually portray gambling or games. In the Swedish license system, operators seem to present themselves more straightforwardly as gambling companies, whereas in the Finnish monopoly system the image was more tied to a social role of public good doing. Beneficiaries of gambling revenues became less visible in the Finnish data over time.
جمال_خاشقجي# #JamalKhashoggi: Unraveling multilingual Twitter sentiment dynamics in a longitudinal comparative analysis of tweets in Arabic and English
Authors: Zeid Nour , Frissen Thomas , Scherr Sebastian
Published: November 2022

In 2018, Jamal Khashoggi, a Saudi journalist who wrote for the Washington Post, was last seen alive entering the Saudi Consulate in Istanbul. Confirmed news of his murder ignited a heated and polarized public debate on Twitter. We use agenda melding as a theoretical lemma and argue that Twitter sentiment flourishes within multilingual, ad hoc public spheres contributing to an emotional agenda. We examined the Twitter sentiment from 2018 to 2021 by looking at the most popular hashtags used in both the Arabic-and-English language spheres. The daily sentiment analysis of 3,278,464 tweets revealed that both languages had a predominantly negative sentiment; however, the English sphere was more extreme in their emotional expression. An additional analysis of external media URLs found in a subsample of tweets highlighted distinct references to media discourse, emphasizing an East–West divide. Implications for global communication are discussed.
The orchestrated digital inequalities of the IoT: How vendor lock-in hinders and playfulness creates IoT benefits in every life
Authors: van der Zeeuw Alex , van Deursen Alexander JAM , Jansen Giedo
Published: November 2022

As the Internet of Things (IoT) is becoming the next frontier for the digital divide, we argue that access to most of the IoT and its benefits are hindered by vendor lock-in. Yet, people with an advanced set of operational skills can find creative ways to overcome vendor lock-in. In this article, we study socio-contextual dispositions to why some people are better able to capitalize on IoT benefits creatively than others. We use interview data and a novel approach to a diary study using a mobile application among 30 households. By focusing on vendor lock-in against the interplay between operational skills and creative IoT uses, we find those with the least access to IoT benefits are users who mainly task-oriented and consider IoT tools to solve specific problems. Those with a more play orientation are better positioned to access IoT benefits and further develop their operational skills.
Finding comfort and conviviality with urban trees
Authors: Straughan Elizabeth , Phillips Catherine , Atchison Jennifer
Published: November 2022

This paper develops cultural geographic understandings of more-than-human comfort and conviviality by analysing emails sent to trees living in the City of Melbourne, Australia. The emails arrive from near and far, sharing personal dilemmas, jokes, poetry, confessions, political concerns, and more. These messages provide a unique opportunity to consider how trees become foregrounded in people’s everyday lives. Working through the geographies of comfort expressed in these emails, the paper develops understanding about the politics of dis/comfort by examining how it is generative of conviviality. In doing so, the paper builds on a small body of work exploring more-than-human conviviality by bringing comfort into these discussions. The paper argues this sensibility provides insights into: how and why attachments between humans and other-than-humans are fostered and maintained; how trees shape and are shaped by urban places; and, how comfort, as an overlooked element of more-than-human conviviality, can be politically generative, assisting in the re-imagining of human and tree togetherness.
Epidemiology, management and outcome of candidaemia in patients with diabetes
Authors: Preece Gabriel , Bhola Shalini , Davidson Andrew , Collier Andrew , Bal Abhijit M
Published: November 2022

Background:

Candidaemia is the commonest fungal bloodstream infection in hospitalised patients. Diabetes is one of the risk factors for mortality from candidaemia.

Methods:

We compared the epidemiology, clinical characteristics and management of candidaemia in patients with and without diabetes.

Results:

Over a 10-year period, 200 episodes of Candida bloodstream infection were documented. Patients with diabetes were younger (58.7 vs 65.5 years), less likely to be suffering from cancer (21.8% vs 36%), and had significantly lower 30-day and 90-day crude mortality (17.2% vs 35.6% and 28.4% vs 48.6%, respectively). Candida glabrata was more common in patients with diabetes (39.3% vs 29.7%). Based on European Confederation of Medical Mycology (ECMM) quality indicators, the management of patients with and without diabetes was similar.

Discussion:

Our study highlights the importance of epidemiological data in relation to candidaemia in patients with diabetes and the growing threat of invasive C. glabrata infection in this subset of patients.
Smoke-Free Policy Adoption in Horizon City and El Paso Community College: A Strategic Campaign Approach That Turns a “No” Into a “Yes”
Authors: O’Neil Dara , King Laura , Enderle Joan , Leal Monica , Olivas Eva
Published: November 2022

Coalitions in Horizon City in El Paso County, Texas and the El Paso Community College (EPCC) had previously attempted to pass smoke-free policies in 2008 and 2016, respectively; however, both policies failed to pass at those times. The coalitions refocused their activities and were successful in passing policies in EPCC in 2020 and in Horizon City in 2021. We employed a participatory case study method to understand what factors changed between the first and second attempts at smoke-free policy adoption in Horizon City and EPCC. Using the Advocacy Coalition Framework as a basis for analysis, we identified the role of coalitions, their beliefs, use of power resources, role of policy brokers, and external events. We identify best practices and make recommendations for coalitions seeking to adopt smoke-free policies in other locations.
Does Long-Term Shift Work Increase the Risk of Dementia? A Systematic Review and Meta-Analysis
Authors: Hai Yang , Xue Ying , Wang Yu-hong
Published: November 2022

Background: Shift work is associated with impaired sleep quality and disrupted circadian rhythms, but the way in which it increases the risk of dementia remains controversial. We conducted a systematic review and meta-analysis to assess the integrated risk of dementia with shift work. Methods: Searching in PubMed, Cochrane Library, and the Web of Science databases, the relative risks of dementia with shift work were extracted from 12 included studies with 3975 dementia cases from 84 492 participants. The subgroup analysis was stratified by age, gender, sample size, dementia cases, shift schedule, occupation, and follow-up time. Heterogeneity analysis and publication bias analysis were conducted for quality control. Results: The pooled risk ratios (RRs) of dementia with shift work were 1.15 (95%CI = 1.02-1.30). The subgroup analysis found that continuous evening shifts reversibly reduced the risk, but continuous night shifts remarkedly increased the risk of dementia. In addition, a larger cohort and longer follow-up significantly increased the risk of dementia with shift work. Conclusion: Shift work shows mild increases in the risk of dementia using meta-analysis.
Otitis externa in general practice
Authors: Dolan Sean , Ellis Sarah
Published: November 2022

Otitis externa is a common condition encountered in primary care, with 10% of the population being affected during their lifetime. It can cause many patient issues including pain, sleep disturbance, hearing loss and temporary loss of income. It can have a significant burden on patients’ mental health and psychosocial wellbeing.
Challenges facing Thai higher education institutions financial stability and perceived institutional education quality
Authors: Scott Timothy , Guan Wenyu
Published: November 2022

Thailand 4.0 is an ambitious reform strategy that seeks to offset the impact of the Thai aging population by transitioning the economy towards a knowledge-based society skilled in advanced technology. Education reforms are paramount for Thailand 4.0 to succeed; however, significant challenges exist that draw into question the capabilities and quality of the nation’s higher education institutions. The low perceived quality can be attributed to government inefficiencies, pronounced education inequality between rural and urban students, declining K12 students’ core curriculum performance, and a growing dependence on international students to support higher education institutions’ financial stability. This paper discusses the numerous challenges limiting higher education institutions from achieving an improved perception of academic quality both domestically and abroad. The recommendations proposed highlight the need for additional government oversight and educational funding. National and regional education policies must be promoted in a clear, consistent, and measurable method, emphasizing short, medium, and long-term goals. Improved national examinations and institutional collaboration will further support the necessary step to address festering conditions limiting any meaningful transition towards a knowledge-intensive workforce.
ASEAN and Great Power Rivalry in Regionalism: From East Asia to the Indo-Pacific
Authors: Yoshimatsu Hidetaka
Published: November 2022

The Association of Southeast Asian Nations (ASEAN), which serves as the linchpin of regionalism in East Asia, is facing a new challenge of great power politics. This article explores ASEAN's position in and strategy for taking cooperative regional initiatives by referring to the management of confrontational politics between rival states. It explains ASEAN's handling of great power politics theoretically by impartial enmeshment for managing great powers’ material interests and moral legitimacy in developing specific ideational frameworks. This article argues that ASEAN managed great powers’ rivalry by enmeshing them into its regional initiatives impartially and maintaining organisational legitimacy by developing systems of socio-cultural norms. It also contends that ASEAN needs, in envisioning the future of Indo-Pacific regionalism, to extend its strategic reach through alignments with other parties and enhance moral legitimacy by deepening and broadening normative frameworks for advancing collective interests for the Indo-Pacific region.
A service evaluation to examine the effectiveness of chronic pain management programmes delivered using video conferencing technology compared to in-person
Authors: Joy Deborah , Caddle Annie
Published: November 2022

Introduction

The Covid-19 pandemic required rapid substitution of in-person Pain Management Programmes (PMP) delivery with delivery via videoconferencing technologies (VCT). No prior published VCT-PMP effectiveness findings were found, so an evaluation was conducted to explore effectiveness of this method and to compare psychometric outcomes with pre-pandemic, in-person- PMPs, delivered in routine clinical settings.

Methods

Participants were routinely attending PMPs. A consecutive series of six in-person-PMPs ( n = 61) immediately prior to the pandemic were compared with the first series of six VCT-PMPs ( n = 64) delivered in the same services. A within-subjects comparison of clinical outcomes (pre-post for VCT-PMP and in-person PMP) and a between-subjects comparison of delivery type was conducted (two-way mixed ANOVA). Reliable change indices examined reliable improvements and deteriorations by delivery type.

Results

Both PMP delivery format groups made significant improvements in anxiety, depression, pain self-efficacy, chronic pain acceptance and pain catastrophising. No significant difference was found between VCT-PMP and in-person-PMP on each of the measures. Reliable change indices indicated similar levels of improvement and deterioration with each delivery format with improvements far outweighing deteriorations. Attrition was greater in the VCT format (33%) versus in-person-PMP (18%).

Conclusion

This study indicates that meaningful change as measured by standard psychometric questionnaires can occur in PMPs delivered via VCT and appear broadly equivalent to that achieved through in-person delivery. Physical performance outcomes such as quality and amount of movement were not measured or explored.
Examining Factor Structure and Validity of Psychological Capital and Its Relationship with Learning Orientation
Authors: Goswami Meghna , Agrawal Rakesh Kumar , Goswami Anil Kumar
Published: November 2022

This study aims to empirically examine the factor structure and validity of psychological capital in the Indian context. Further, it also examines the linkage of psychological capital with learning orientation. A quantitative methodology was adopted, and data were collected using a questionnaire from 700 employees of public sector research organisations, information and communication technology companies, and academic universities and colleges in India. The findings reveal that psychological capital construct has a four-factor second-order structure and a synergetic effect on outcomes, and its four factors are related but distinct constructs. The findings also confirm that psychological capital has significant positive influence on the learning orientation of members of the organisation. Further, the level of psychological capital was found to vary across gender, age, work experience and executive level but not with qualification. This research will add into theory a detailed understanding about psychological capital and its relationship with learning orientation. The findings suggest that management should emphasise on preparing psychological capital interventions and trainings based on specific target groups in order to gain sustainable competitive advantage.
Pancytopenia due to Restrictive Food Intake in an Autistic Adult
Authors: Lowe Danielle , Barrett Christian , Shepherd Chelsea , Charles Jane , Kalivas Benjamin
Published: November 2022

Autism spectrum disorder (ASD) is a neuro-behavioral syndrome that develops in childhood and can be comorbid with restrictive and avoidant food intake disorder. This case details a young man who was hospitalized with pancytopenia due to restrictive nutritional intake related to his severe ASD. He was found to have undetectable vitamin B12 levels. His blood counts improved with transfusion, nutritional supplementation, and dental care. This report illustrates the importance of understanding ASD and potential medical complications of related behaviors.
Professionals’ Understanding of Accessibility Regarding Business Communication Materials
Authors: Drye Sherrie L. , Kelly Stephanie , Woodard Thelma
Published: November 2022

The purpose of this study was to gauge the understanding of accessibility related to business communication material among individuals working in corporate America. Participants were asked to define accessibility, then given a definition of accessibility, and then asked to identify how to make a report and a visual accessible. A substantial number of participants were not able to define accessibility, nor identify how to make accessible changes to a report or visual. Those who could define accessibility considered accessibility goals in terms of general access to resources, usability, audience analysis, or disability-related accessibility. Business majors were less likely than other majors to be able to identify disability-related methods of making a report or visual accessible. Implications for business communication education are discussed.
Taliban 2.0 and Afghanistan–Pakistan Relations
Authors: Hussain Ejaz
Published: November 2022

Afghanistan remained at the centre stage of regional and global politics owing to its unique geopolitical location in the Cold War period. Afghan jihad of the 1980s impacted not only Afghanistan but also its neighbours particularly Pakistan. In the post-Cold War period, civil war engulfed the war-ravaged and poverty-stricken country which was controlled by the Taliban in 1996. Pakistan recognised the Taliban rule which was ended by the American military might in the wake of 9/11. In the post-Taliban period, the USA-led NATO alliance experimented a Western-style political and economic order in tradition-bound Afghanistan. Paradoxically, after 20 years, different political personalities and presidential terms failed to stabilise the country. Since the Obama years the USA seemed more interested in Indo-Pacific than West Asia. Hence, it opted to withdraw from Afghanistan while doing a deal with the Taliban in Doha in February 2020. The withdrawal policy was operationalised by the Biden Administration. Since 15 August 2021 Afghanistan has been under the Taliban control for the second time, hence, it is termed Taliban 2.0 by this study. Compared to their first regime, the Taliban 2.0 has not been formally recognised by any country so far. Will the Taliban gain regional, if not, international recognition in the foreseeable future? Will Pakistan aid the Taliban in this respect? To what extent intra-Taliban friction impacts bilateral relations? How does Pakistan view Tehreek-i-Taliban Pakistan (TTP) and vice versa? And, above all, how will Afghanistan and Pakistan treat each other in the coming months? These are some crucial questions that this study attempts to address underpinned by primary and secondary sources.
The Educational Trajectories of Latinx Undocumented Students: Illegality and Threats to Emotional Well-Being
Authors: Bazo Vienrich Alessandra , Torres Stone Rosalie A.
Published: November 2022

For undocumented students, the high school–to–college pipeline is filled with social, economic, and psychological stressors. Yet very little is known about the impact of legal status on the experiences of undocumented Latinx college students living in states without tuition equity policies. Using qualitative data from 37 interviews exploring undocumented college students’ educational trajectories in Massachusetts and North Carolina, the authors examine the impact of legal status on the emotional well-being of undocumented Latinx students, including those who benefited from Deferred Action for Childhood Arrivals. The findings show that even when undocumented students gain access to higher education, barriers to legal status generate chronic feelings of despair and hopelessness that persist throughout their educational trajectories. Additionally, the authors find that academic motivation and persistence do not always equate with emotional resilience. The authors propose strategies to help facilitate emotional well-being for undocumented students.
International Delphi-based consensus on the appropriate use and effect of Benzydamine hydrochloride in the treatment of sore throat
Authors: Passali Desiderio , Barat Veronica , Cadevall Olga , Freire Hugo Miguel , Grattagliano Ignazio , Gutu Ioan , Mösges Ralph , Pavlysh Andrey
Published: November 2022

Background

Benzydamine hydrochloride is a locally-acting Non-Steroidal Anti-Inflammatory Drug (NSAID) with combined local anesthetic and analgesic properties, indicated for the symptomatic relief of pain in acute sore throat. The aim of this study was to obtain an European Consensus among pharmacists, general practitioners and pediatricians on the appropriate use of benzydamine hydrochloride in the treatment of sore throat.

Methods

The authors developed a Delphi questionnaire organized into 15 statements focused on 4 topics: the mechanism of action of benzydamine, the benzydamine treatment in an adult patient and in a pediatric patient, and the advantages of benzydamine over other topical treatments. The survey was administered to a panel of to 320 participants including general practitioners, pediatricians, and pharmacists from 6 European countries (Italy, Germany, Portugal, Romania, Russia, and Spain), who rated their level of agreement or disagreement with each statement on a 6-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with each statement.

Results

Panelists’ agreement on statements was very high. Consensus was reached for all 15 statements in the Delphi survey, with more than 98% positive agreement on topic 4, suggesting a shared view among European healthcare professionals (HCPs) about the advantages of benzydamine over other topical treatments. A strong consensus (> 99%) was reached for all the statements of topic 1 regarding the mechanism of action of benzydamine, except for its anesthetic properties (79%). Strong agreement was reached for all statements in topics 2 and 3 regarding the treatment of acute sore throat symptoms in the adult and pediatric patient, except for one on the efficacy of benzydamine in preventing post-operative sore throat, for which it was 67%.

Conclusion

Because all relevant publications on benzydamine are dated and there are no recommendations on its use for the symptomatic treatment of sore throat in European guidelines, this Delphi-based international consensus may be important in reinforcing the appropriate use and effect of benzydamine in the treatment of sore throat among health care professionals.
Change lifestyle modification plan/transtheoretical model in non-alcoholic simple fatty liver disease: a pilot randomized study
Authors: Li Lijuan , Hou Kun , Yuan Mengya , Zhang Yan , Zhang Yang
Published: November 2022

Background

Non-alcoholic simple fatty liver disease patients have very low compliance with almost all types of physical activities. A transtheoretical model-oriented lifestyle modification plan awakens the patient’s consciousness in the pre-intention stage. Aim to evaluate whether a management by stages of change plan based on the Transtheoretical Model and Stages of Change promoted behavior change for patients with non-alcoholic simple fatty liver disease.

Methods

Patients with simple fatty liver diagnosed from July to December 2019 were randomly divided into the transtheoretical model and non-transtheoretical model groups. Primary outcome was change in health belief and health behavior based on questionnaires. Secondary outcomes included changes in blood lipids, body mass indexes, and waist circumference 12-months after intervention.

Results

Of 200 enrolled patients 194 were analyzed (non-transtheoretical model group n = 98, transtheoretical model group n = 96). After intervention, total health belief scores (120.91 ± 4.94 vs. 118.82 ± 5.48) and total health behavior scores (131.71 ± 5.87 vs. 119.96 ± 7.12) were higher in the transtheoretical model group (all P < 0.05). Blood lipids, body mass index, and waist circumference more obviously improved in the transtheoretical model group (all P < 0.05).

Conclusion

A transtheoretical model-based lifestyle modification intervention can be effectively applied to patients with non-alcoholic simple fatty liver.

Clinical Research Registration Number

ChiCTR2100049354. The registration date is August 1, 2021.
Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as potential markers for ulcerative colitis: a retrospective study
Authors: Feng Wan , Liu Yajun , Zhu Lei , Xu Luzhou , Shen Hong
Published: November 2022

Purpose

Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder affecting the large intestine. Inflammatory biomarkers in UC are nonspecific, simple and cheap biomarker is needed. Our study aimed to explore the possible relationship of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) with the disease activity in UC. Furthermore, the correlation of PLR or NLR with other clinical indicators was evaluated.

Methods

We retrospectively reviewed the clinical data of UC patients presented to the Affiliated Hospital of Nanjing TCM University. A total of 306 UC patients were included in the study. Clinical characteristics, NLR, PLR, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin (FC) and other data were collected.

Results

PLR and NLR were elevated in active UC patients than those in remission. The receiver-operating characteristic (ROC) analysis revealed the optimal cutoff of NLR for active UC was 2.19, with sensitivity and specificity of 78.8 and 65%, respectively. For PLR, the best cut-off value was 147.96, with sensitivity and specificity of 58.3 and 75%, respectively. Both NLR and PLR were positively correlated with CRP, ESR and FC.

Conclusions

PLR and NLR were elevated in patients with active UC as compared with patients in remission. NLR and PLR could be used in patients with UC as noninvasive markers of disease activity.
Introduction of a pilot program to measure and improve the clinical care of melanoma patients in the Lower Silesian Voivodeship in Poland: a report of 20 months experience
Authors: Ziętek Marcin , Wierzbicki Jędrzej , Pawlak Edyta , Maciejczyk Adam , Matkowski Rafał
Published: November 2022

Background

In recent years, benchmarking and assessment methods to improve the quality of care have become increasingly important. Such approaches allow for a uniform assessment, comparisons between centers or over time, and the identification of weaknesses. In this study, the results of a 20-month pilot program to assess, monitor and improve the quality of care in melanoma patients primarily treated surgically are presented.

Methods

The pilot program started in May 2020 at the Lower Silesian Oncology, Pulmonology and Hematology Center (LSOPHC) in Wroclaw, Poland (Lower Silesian Voivodeship, southwestern province of Poland with a population of 2,9 million). The program involved the introduction of a synoptic histopathological protocol, medical coordinators, and a set of measures to assess oncological care. In total, 11 Skin Cancer Unit (SCU) measures were introduced to analyze clinical outcomes, diagnostic quality, and duration. Data from 352 patients covered by the program were analyzed. In addition, the completeness of diagnostics from external sites was compared to our own results. Furthermore, the timeliness of the initial diagnostic tests and in-depth diagnostics were assessed and compared to the timeliness before implementation of the pilot program.

Results

The introduced measures assessed the mortality related to oncological treatment, the rate of complications, advanced stages of melanoma, the completeness and duration of diagnostics, the involved nodes after lymphadenectomy, and melanoma screening. During the study period, the timeliness of the initial diagnostics was maintained at 87.8%, and the timeliness of the in-depth diagnostics at 89.5%. Compared to a similar period before the program, these values were 36.1% and 67.5%, respectively.

Conclusion

The introduced measures seem to be effective and practical tools for benchmarking clinical and diagnostic aspects. They also allowed for a sensitive assessment of individual issues and indicated sensitive points. Furthermore, the actions undertaken in this pilot program allowed for a shortening of the duration of diagnostics.
A nationwide cross-sectional review of in-hospital hepatitis B virus testing and disease burden estimation in Ghana, 2016 - 2021
Authors: Nartey Yvonne Ayerki , Okine Rafiq , Seake-Kwawu Atsu , Ghartey Georgia , Asamoah Yaw Karikari , Senya Kafui , Duah Amoako , Owusu-Ofori Alex , Amugsi James , Suglo Damasus , Bampoh Sally Afua , Hiebert Lindsey , Njuguna Henry , Ward John W. , Plymoth Amelie , Roberts Lewis Rowland , Bockarie Ansumana Sandy , Awuku Yaw Asante , Obiri-Yeboah Dorcas
Published: November 2022

Background and aims

Data are needed to inform hepatitis B virus (HBV) testing and treatment policies in Ghana to make progress towards achieving the 2030 WHO elimination targets. This study investigated testing patterns for HBV and described the age, sex, and region-specific prevalence of HBV infection in Ghana using hospital data.

Methods

A nationwide multi-centre cross-sectional study was performed where hospital-based registers were reviewed. These included review of 139,966 laboratory, 169,048 blood bank, and 83,920 delivery register entries from 22 healthcare institutions in Ghana. Frequencies and proportions, and crude and pooled estimates reported. Chi squared test was used for tests of independence. Logistic regression was used to identify factors associated with a positive test result.

Results

The crude HBsAg seroprevalence was 8.48% (95%CI 8.25–8.57%) with pooled estimate of 11.40% (95%CI 10.44–12.35). HBsAg seroprevalence among children under 5 years was 1.87% (95%CI 1.07-3.27) and highest age-specific seroprevalence was in those 40-49 years. The highest region-specific seroprevalences was in the Savannah (22.7%). Predictors of a positive HBsAg RDT test included female sex (OR 0.81 95% CI 0.74–0.88), and age (OR 1.005 95%CI 1.002–1.007). The proportion of parturient women receiving HBsAg testing increased between 2017 (87.2%) and 2020 (94.3%) (p < 0.001). The crude HBsAg seroprevalence in parturient women was 6.14% (95% CI 5.97-6.31). Among blood donors the crude HBsAg seroprevalence was 5.69% (95%CI 5.58–5.80). Data from 2 teaching hospitals indicated that in 2020, although 1500 HBsAg positive tests were recorded only 746 serological profile and 804 HBV DNA tests were performed. HBV e antigen seroprevalence was 6.28% (95%CI 4.73–7.84).

Conclusion and recommendations

Ghana remains a country with high HBV burden. There is an unequal distribution, with higher HBsAg seroprevalence in the north of the country. Furthermore, PCR testing is not widely available outside of large teaching hospitals, which limits diagnostic work-up. Hepatitis reporting systems and registers should be improved to facilitate data capture of indicators and standardised across the country to allow for comparability. Furthermore, where gains have been made in testing among pregnant women, there is a need for linkage to appropriate care.
Retrospective review comparing intrapleural fibrinolytic therapy (alteplase) and surgical intervention in complex pleural effusion
Authors: Abdul Hamid Mohamed Faisal , Hasbullah Ahmad Hadyan Husainy , Mohamad Jailaini Mas Fazlin , Nik Abeed Nik Nuratiqah , Ng Boon Hau , Haron Hairulfaizi , Md Ali Nur Ayub , Ismail Muhammad Ishamuddin , Nik Ismail Nik Azuan , Abdul Rahman Mohd Ramzisham , Ban Andrea Yu-Lin
Published: November 2022

Background

Intrapleural fibrinolytic therapy (IPFT) is one of the treatment options for complex pleural effusion. In this study, the IPFT agent used was alteplase, a tissue plasminogen activator (t-PA). This study aims to determine the difference in the outcome of patients with complex pleural effusion between IPFT and surgery in terms of radiological improvement, inflammatory parameters, length of stay, and post-intervention complications.

Methods

A retrospective review of patients with complex pleural effusion treated at Universiti Kebangsaan Malaysia Medical Center from January 2012 to August 2020 was performed. Patient demographics, chest imaging, drainage chart, inflammatory parameters, length of hospital stay, and post-intervention and outcome were analyzed.

Results

Fifty-eight patients were identified (surgical intervention, n = 18; 31% and IPFT, n = 40, 69%). The mean age was 51.7 ± 18.2 years. Indication for surgical intervention was pleural infection (n = 18; 100%), and MPE (n = 0). Indications for IPFT was pleural infection (n = 30; 75%) and MPE (n = 10; 25%). The dosages of t-PA were one to five doses of 2–50 mg. The baseline chest radiograph in the IPFT group was worse than in the surgical intervention group. (119.96 ± 56.05 vs. 78.19 ± 55.6; p = 0.029) At week 1, the radiological success rate for IPFT and surgical intervention were 27% and 20%, respectively, and at weeks 4–8, the success rate was 56% and 80% respectively. IPFT was associated with lesser complications; fever (17.5%), chest pain (10%), and non-life-threatening bleeding (5%).

Conclusion

IPFT was comparable to surgery in radiological outcome, inflammatory parameters, and length of stay with lesser reported complications.
A predictive model for the critical shoulder angle based on a three-dimensional analysis of scapular angular and linear morphometrics
Authors: Smith Geoffrey C. S. , Geelan-Small Peter , Sawang Michael
Published: November 2022

Background

The purpose of this study was to define the features of scapular morphology that are associated with changes in the critical shoulder angle (CSA) by developing the best predictive model for the CSA based on multiple potential explanatory variables, using a completely 3D assessment.

Methods

3D meshes were created from CT DICOMs using InVesalius (Vers 3.1.1, RTI [Renato Archer Information Technology Centre], Brazil) and Meshmixer (3.4.35, Autodesk Inc., San Rafael, CA). The analysis included 17 potential angular, weighted linear and area measurements. The correlation of the explanatory variables with the CSA was investigated with the Pearson’s correlation coefficient. Using multivariable linear regression, the approach for predictive model-building was leave-one-out cross-validation and best subset selection.

Results

Fifty-three meshes were analysed. Glenoid inclination (GI) and coronal plane angulation of the acromion (CPAA) [Pearson’s r: 0.535; -0.502] correlated best with CSA. The best model (adjusted R-squared value 0.67) for CSA prediction contained 10 explanatory variables including glenoid, scapular spine and acromial factors. CPAA and GI were the most important based on their distribution, estimate of coefficients and loss in predictive power if removed.

Conclusions

The relationship between scapular morphology and CSA is more complex than the concept of it being dictated solely by GI and acromial horizontal offset and includes glenoid, scapular spine and acromial factors of which CPAA and GI are most important. A further investigation in a closely defined cohort with rotator cuff tears is required before drawing any clinical conclusions about the role of surgical modification of scapular morphology.

Level of evidence

Level 4 retrospective observational cohort study with no comparison group.
Risk factors for revision surgery in operative treatment of traumatic injuries of the olecranon and prepatellar bursa
Authors: Schöbel T. , Hantusch G. , Hennings R. , Schleifenbaum S. , Kleber C. , Spiegl U.
Published: November 2022

Introduction

Traumatic lacerations of the prepatellar (PB) and olecranon bursa (OB) are common injuries. The aim of this study was to gain descriptive data and to identify risk factors associated with complications that made revision surgery after primary bursectomy necessary.

Material and methods

In this retrospective monocentric study at a level I trauma center, all patients with traumatic lacerations of the PB or OB who were treated with primary surgical bursectomy from 2015 to 2020 were analyzed.

Results

150 consecutive patients were included. In 44% of cases, the PB was affected (n = 66), in 56% the OB (n = 84). The reoperation rate after surgical bursectomy was 10.7% (n = 16). The main cause of reoperation was wound infection (50%; n = 8). The most common pathogen of postoperative infections was Staphylococcus aureus (87.5%). Several comorbidities have been identified as risk factors for reoperation after primary surgical bursectomy, such as heart diseases, arterial hypertension, the use of antihypertensives and anticoagulation. In contrast, surgical expertise, use of drains, postoperative immobilization, and postoperative antibiotics had no statistically significant effect. A significantly higher postoperative infection rate (17.6%) was observed in patients who were operated more than 48 h after initial trauma.

Conclusions

Given the limited recommendations for therapy of these common injuries, further investigations should focus on standardized therapeutic options for lacerations of the PB or OB. Delayed surgical interventions after trauma were associated with higher complication rates. Therefore, urgent surgery within 48 h after trauma may help to prevent revisions.

Level of evidence

Level of evidence IV.
The effect of orthodontic vertical control on the changes in the upper airway size and tongue and hyoid position in adult patients with hyperdivergent skeletal class II
Authors: Liu Yining , Chen Wenyuanfeng , Wei Yu , Zhang Guorui , Zhang Xinzhu , Sharhan Hasan M. , Cao Baocheng
Published: November 2022

Background

At present, there are still controversies about the influence of orthodontic treatment on the size of upper airway and the position of hyoid bone. We investigated the effect of orthodontic vertical control therapy on the size of the upper airway and position of the tongue and hyoid bone in adult patients with hyperdivergent skeletal Class II.

Methods

Overall, 15 adults with hyperdivergent skeletal Class II and normal occlusion, respectively, were selected as the experimental and control groups. The angle and line of the craniofacial structure, upper airway, hyoid bone position and three-dimensional (3D) upper airway indexes were measured using the Uceph 4.2.1 standard version and Mimics 21.0 software, respectively. The paired t-test, Wilcoxon symbol rank test, t-test of two independent samples, two independent sample nonparametric tests, Mann–Whitney U test, Pearson correlation analysis, the Univariate linear regression analysis and Multiple linear regression analysis were performed.

Results

After treatment, the S-Go/N-Me (%) and the MP-SN and XiPm-SN angles were significantly different (P < 0.01). The U-MPW and PAS significantly increased (P < 0.05), sagittal diameter L2increased significantly, and transverse diameter L2decreased significantly (P < 0.01). Although no significant correlation was observed between the vertical change in the jaw and that in U-MPW and PAS, the sagittal diameter L2showed a significant correlation (P < 0.05). The Multiple linear regression analysis showed that there was a significant negative correlation between the variables MP-SN and sagittal diameter L2and positive correlation between S-Go/N-Me(%) and H-MP(P < 0.05). Furthermore, significant differences between the Hv (P < 0.01) and sagittal diameter L1(P < 0.05) were observed before and after treatment.

Conclusions

After the orthodontic vertical control therapy in patients with hyperdivergent skeletal Class II, the upper airway only underwent adaptive changes during treatment without substantial size changes, the position of tongue body and hyoid bone did not change significantly. Furthermore, compared with normal occlusion, the velopharyngeal segment airway of patients with hyperdivergent skeletal Class II remains narrow and long after treatment.
Digital versus radiographic accuracy evaluation of guided implant surgery: an in vitro study
Authors: Yi Chun , Li Sha , Wen Aonan , Wang Yong , Zhao Yijiao , Zhang Yu
Published: November 2022

Background

Cone-beam computed tomography (CBCT) is the most widely used method for postsurgical evaluation of the accuracy of guided implant surgery. However, the disadvantages of CBCT include radiation exposure, artifacts caused by metal implants, and high cost. Few studies have introduced a digital registration method to replace CBCT for evaluating the accuracy of guided surgery. The purpose of this study was to compare digital registration to conventional CBCT in terms of the capacity to evaluate the implant positioning accuracy of guided surgery.

Materials and methods

This in vitro study included 40 acrylic resin models with posterior single mandibular tooth loss. Guided surgery software was used to determine the optimal implant position; 40 tooth-supported fully guided drilling templates were designed and milled accordingly. After the guided surgery, the accuracies of the surgical templates were evaluated by conventional CBCT and digital registration. For evaluation by conventional CBCT, postsurgical CBCT scans of the resin models were performed. The CBCT data were reconstructed and superimposed on the implant planning data. For digital registration, we constructed a virtual registration unit that consisted of an implant replica and a scan body. Next, we obtained postsurgical optical scans of resin models with the scan body. The postsurgical implant position was identified by superimposition of the registration unit and optical scan data. The implant planning data and postsurgical implant position data were superimposed; deviations were reported in terms of distance for implant entry/apex point and in terms of angle for the implant axis. Interclass correlation coefficients (ICCs) and Bland–Altman plots were used to analyze the agreement between the two evaluation methods.

Results

The ICCs between the two methods were 0.986, 0.993, and 0.968 for the entry point, apex point, and angle, respectively; all were significantly greater than 0.75 (p < 0.001). Bland–Altman plots showed that the 95% limits of agreement of the differences were − 0.144 to + 0.081 mm, − 0.135 to + 0.147 mm, and − 0.451° to + 0.729° for the entry point, apex point, and angle, respectively; all values were within the maximum tolerated difference.

Conclusion

Conventional CBCT and digital registration showed good agreement in terms of evaluating the accuracy of implant positioning using tooth-supported surgical templates.