bluuebunny/crossref_metadata_2025 huggingface dataset:
Engagement of Occupational Therapy Organizations with Public Policy: A Qualitative Analysis
Authors: Osman Alia , Webber Cecelia , Oliel Stefanie , Couture-Lavoie Karine , Lencucha Raphael , Shikako-Thomas Keiko
Published: October 2020

Background.

Public policy is an important feature of occupational therapy practice. Occupational therapy organizations have a mandate to engage in policy processes to improve the conditions for clients, including the nature of care received.

Purpose.

Describe the approaches that Canadian occupational therapy organizations use to engage with and impact public policy.

Methods.

This study used interpretive description methodology. Participants were recruited from Canadian occupational therapy professional organizations. Participants shared their experiences and perspectives on policy engagement through semi-structured interviews. Data was analyzed inductively.

Findings.

Engagement with policy involved reaching out (building relationships, educating practitioners about policy and occupational therapy contributions, and developing statements), and reaching in (consulting with occupational therapists and generating data informing policy).

Implications.

Occupational therapy organizations can share and coordinate approaches to impact public policy and advocate for both clients and the profession. Future research can expand this analysis in other contexts to generate a deeper understanding of engagement.
Will For-Profits Keep Up the Pace in the United States? The Future of the Program of All-Inclusive Care for the Elderly and Implications for Other Programs Serving Medically Vulnerable Populations
Authors: Gonzalez Lori
Published: October 2020

The Program of All-Inclusive Care for the Elderly (PACE) has provided, for more than 4 decades, high-quality, cost-effective medical and social care to older people in the United States under nonprofit ownership. Recent rulings by the Centers for Medicare & Medicaid Services (CMS), however, will fundamentally change the initial intent and operation of the program. CMS’s final rule (4168-F) removes the provision that PACE operators be nonprofit. This article provides the legislative background for the final ruling and critiques the study that was used to justify the removal of the nonprofit provision. Although the Balanced Budget Act of 1997 listed a number of requirements for evaluating for-profit PACE programs, the secretary of the Department of Health and Human Services did not follow them before establishing for-profit PACE sites as permanent providers. It also argues that the ruling was made without much evidence that for-profit compared to nonprofit operators can provide a similar level of quality of care, access, and cost-effectiveness and urges policymakers to increase regulatory accountability, given what we know about other shifts in profit status and health care.
Exploring the influence of transnationalism on the immigrant integration process: The case of Ghanaians’ transnational housing activities in Toronto, Canada
Authors: Firang David
Published: October 2020

Many studies of immigrant housing and integration do so within the borders of a nation-state without reference to transnationalism. Using a mixed-method approach, this study demonstrates that immigrant groups, like Ghanaians in Toronto, with strong ties or attachments to their homeland will invest in housing in the country of origin because investment in housing in the country of origin confers high social status among these immigrants. Investments in housing in the homeland affect immigrants’ settlement and integration process. The study prompts for international social work practices to have a deeper understanding of the nuances of transnational practices when delivering services.
Social work practice education and training during the pandemic: Disruptions and discoveries
Authors: Kourgiantakis Toula , Lee Eunjung
Published: October 2020

The COVID-19 pandemic evoked a disruption to social work (SW) practice education and this brief note describes discoveries made in teaching SW practice virtually. One example is Virtual Practice Fridays, adapted to build SW practice competencies online, and another example is a re-designed course on cross-cultural SW practice using simulation-based learning.
Reflecting on a second-migration experience: Issues and implications for social work practice
Authors: Kang Wook-Mo , Lim Jeongmi , Park Hong-Jae
Published: October 2020

The purpose of this article is to present the research findings from a qualitative study on a type of second migration experienced by Korean-New Zealand immigrants in Australia. Data were collected from 16 in-depth interviews with those people who initially moved from South Korea to New Zealand, and then migrated to Australia. The study findings show that the participants were likely to experience ‘soft-landing’ relocation, ethnically internal belonging and identity flexibility. A critical reflection on this second-migration phenomenon is presented in order to help social work professionals broaden their perspectives on today’s fluid migration and its implications for practice.
Roads to Rule, Roads to Rebel: Relational State Capacity and Conflict in Africa
Authors: Müller-Crepon Carl , Hunziker Philipp , Cederman Lars-Erik
Published: October 2020

Weak state capacity is one of the most important explanations of civil conflict. Yet, current conceptualizations of state capacity typically focus only on the state while ignoring the relational nature of armed conflict. We argue that opportunities for conflict arise where relational state capacity is low, that is, where the state has less control over its subjects than its potential challengers. This occurs in ethnic groups that are poorly accessible from the state capital, but are internally highly interconnected. To test this argument, we digitize detailed African road maps and convert them into a road atlas akin to Google Maps. We measure the accessibility and internal connectedness of groups via travel times obtained from this atlas and simulate road networks for an instrumental variable design. Our findings suggest that low relational state capacity increases the risk of armed conflict in Africa.
Telepsychiatry and Telepsychotherapy: Critical Issues Faced by Indian Patients and Psychiatrists
Authors: Sousa Avinash De , Shrivastava Amresh , Shah Bhumika
Published: October 2020

Telepsychiatry and telepsychotherapy are new treatment modalities that have been used more than ever during the COVID-19 pandemic. There are many challenges that are faced with the use of this modality for both patients and psychiatrists alike. There are critical issues faced with regard to the development of rapport, managing the entire teleconsultation set up, privacy and issues related to fees, issues related to prescribing and monitoring, and issues while handling emergencies. The challenges faced are discussed and some solutions if possible are laid out.
COVID19 Acute respiratory distress syndrome and extra-corporeal membrane oxygenation; A mere option or ultimate necessity
Authors: Ahmed Taha , Ahmed Talha , Karimi Hussain , Tolle Leslie , Iqbal Muhammad Nouman
Published: October 2020

Extracorporeal membrane oxygenation (ECMO) is considered a salvage therapy in patients with acute respiratory distress syndrome (ARDS) and refractory hypoxemia (hypoxemia persisting despite lung-protective ventilation). One aspect of ECMO is whether there would be an application of the technology related to the Coronavirus pandemic. The number of people diagnosed with Coronavirus disease (COVID19) has crossed the five million mark on 9 August 2020, with a case fatality rate of 5.2%. Due to this exponential increase in the number of coronavirus disease (COVID19) cases particularly the ones associated with ARDS, experts are evaluating the need for ECMO in intensive care units. Herein, we chronicle a review encompassing the available evidence on ECMO and its potential role in COVID19 ARDS, as we aim for optimal patient care with appropriate resource utilization and conservation.
A manifesto for researching entrepreneurial ecosystems
Authors: Spigel Ben , Kitagawa Fumi , Mason Colin
Published: October 2020

Entrepreneurial ecosystems are the focus of government economic policies around the world for their potential to generate entrepreneur-led economic development. The paper identifies key research questions and challenges to building effective public policy: (i) the limitations of existing data sources, (ii) the need to balance findings from quantitative and qualitative studies, (iii) the danger that entrepreneurial ecosystems will be just a policy fad, (iv) the narrow focus of policy and research on high tech firms and scale-ups, and (v) the need to balance research approaches between simplified models and a complex systems approach. There is a need for a better understanding of the diversity of policy contexts (level of government, country context) and model of ecosystem governance. A more granulated understanding of ecosystem thinking is required, with greater consideration of the diversity of actors and the institutional context, with more attention given to the heterogeneous nature of places and complex interactions between actors and networks. Looking to the future, the potential of new data sources and methodologies is identified. Future research should give greater consideration to the institutional context to understand how policy can better support entrepreneurial activity and the extent to which specific policies can be replicated elsewhere.
Identification of Parkinson’s disease-related pathways and potential risk factors
Authors: Shen Jun , Chen Xiao-Chang , Li Wang-Jun , Han Qiu , Chen Chun , Lu Jing-Min , Zheng Jin-Yu , Xue Shou-Ru
Published: October 2020

Objective

To identify Parkinson’s disease (PD)-associated deregulated pathways and genes, to further elucidate the pathogenesis of PD.

Methods

Dataset GSE100054 was downloaded from the Gene Expression Omnibus, and differentially expressed genes (DEGs) in PD samples were identified. Functional enrichment analyses were conducted for the DEGs. The top 10 hub genes in the protein–protein interaction (PPI) network were screened out and used to construct a support vector machine (SVM) model. The expression of the top 10 genes was then validated in another dataset, GSE46129, and a clinical patient cohort.

Results

A total of 333 DEGs were identified. The DEGs were clustered into two gene sets that were significantly enriched in 12 pathways, of which 8 were significantly deregulated in PD, including cytokine–cytokine receptor interaction, gap junction, and actin cytoskeleton regulation. The signature of the top 10 hub genes in the PPI network was used to construct the SVM model, which had high performance for predicting PD. Of the 10 genes, GP1BA, GP6, ITGB5, and P2RY12 were independent risk factors of PD.

Conclusion

Genes such as GP1BA, GP6, P2RY12, and ITGB5 play critical roles in PD pathology through pathways including cytokine−cytokine receptor interaction, gap junctions, and actin cytoskeleton regulation.
Impact of waiting times on tumour growth and pathologic upstaging in patients with non-small cell lung cancer having lung resection
Authors: Bhat Insha , Okiror Lawrence , Nair Arjun , Billè Andrea
Published: October 2020

Objective:

There are limited data on tumour growth or pathologic upstaging in patients with early-stage lung cancer awaiting lung resection. We aimed to evaluate whether waiting times on the current lung cancer treatment pathway were associated with significant tumour growth or pathologic upstaging.

Methods:

This is a retrospective observational study of a consecutive series of patients with early-stage, non-small cell lung cancer who underwent resection for lung cancer. The difference between tumour size at diagnostic and preoperative computed tomography (CT) scans was calculated. Significant tumour growth was defined as a diameter increase of ⩾5 mm or ⩾20%. The time intervals between baseline and repeat CT (CT-int) and between baseline CT and date of surgery (Surg-int), as well as other potential clinical and pathologic prognostic factors, were compared between upstaged and nonupstaged patients.

Results:

There were 121 patients identified. Fifty-four patients (44.6%) had tumour growth ⩾5 mm and 27 patients (22%) had tumour growth ⩾20%. Median CT-int and Surg-int were 2.4 and 2.6 months, respectively. Forty-four patients (36%) were upstaged at surgery due to new lymph node involvement (n = 19), pleural invasion (n = 12), satellite nodules (n = 4), or increase in tumour diameter (n = 9). There was a marginal, but statistically insignificant, difference in median CT intervals in patients who had tumour growth <20% vs ⩾20% at 2.4 vs 2.6 months ( p = 0.06).

Conclusion:

Current cancer pathway waiting times are not associated with significant tumour growth or pathologic upstaging in this cohort.
Validation of the Colon Life nomogram in patients with refractory metastatic colorectal cancer enrolled in the RECOURSE trial
Authors: Pietrantonio Filippo , Fucà Giovanni , Manca Paolo , Pagani Filippo , Raimondi Alessandra , Prisciandaro Michele , Randon Giovanni , Corti Francesca , de Braud Filippo , Cremolini Chiara , Miceli Rosalba
Published: October 2020

Background:

The RECOURSE trial (Study of TAS-102 in Patients With Metastatic Colorectal Cancer Refractory to Standard Chemotherapies) demonstrated an overall survival (OS) benefit of trifluridine/tipiracil (FTD/TPI) vs placebo in refractory metastatic colorectal cancer (mCRC). Given the limited benefit of later line treatments, we developed the Colon Life nomogram to assess the 12-week death probability in the refractory setting.

Methods:

This post hoc analysis of RECOURSE included patients with available data to calculate the nomogram score: Eastern Cooperative Oncology Group Performance Status, primary tumor resection, lactate dehydrogenase, and peritoneal metastases. The nomogram calibration was assessed by calibration plots and C-index. The nomogram prognostic and predictive ability was assessed by Cox model analyses and the nomogram score predictive value was explored according to the cutoff identified at maximum value of the Youden index in time-dependent receiver operating characteristic curve analysis.

Results:

Overall, 251 trial patients were evaluable: 90 in the placebo arm and 161 in the FTD/TPI arm. The calibration was optimal in the placebo arm (C-index 0.807) and suboptimal in the FTD/TPI arm (0.657). The cutoff of the nomogram score of 23 showed the best discriminative ability for 12-week OS (hazard ratio 3.46, 95% confidence interval 2.17–5.51 for scores 40 vs 15) and had maximum value of the Youden index (0.381). Median OS and 3-month PFS were 9.0 vs 7.5 months and 39.3% vs 5.2%, respectively, for FTD/TPI vs placebo in the low-risk group (score <23) and 4.8 vs 3.4 months and 22.3% vs 9.8% in the high-risk group (score ⩾23) (interaction NS).

Conclusion:

The Colon Life nomogram is an accurate tool for estimating life expectancy in refractory mCRC. The benefit of FTD/TPI was independent of the predicted risk of early death.
FoxP3, CTLA-4, and IDO in Canine Melanocytic Tumors
Authors: Porcellato Ilaria , Brachelente Chiara , Cappelli Katia , Menchetti Laura , Silvestri Serenella , Sforna Monica , Mecocci Samanta , Iussich Selina , Leonardi Leonardo , Mechelli Luca
Published: October 2020

Despite promising immunotherapy strategies in human melanoma, there are few studies on the immune environment of canine melanocytic tumors. In humans, the activation of immunosuppressive cell subpopulations, such as regulatory T cells (Tregs) that express forkhead box protein P3 (FoxP3), the engagement of immunosuppressive surface receptors like cytotoxic T lymphocyte antigen (CTLA-4), and the secretion of molecules inhibiting lymphocyte activation, such as indoleamine-pyrrole 2,3-dioxygenase (IDO), are recognized as immunoescape mechanisms that allow tumor growth and progression. The aim of our study was to investigate the expression of these immunosuppression markers in canine melanocytic tumors and to postulate their possible role in melanoma biology and progression. Fifty-five formalin-fixed, paraffin-embedded canine melanocytic tumors (25 oral melanomas; 20 cutaneous melanomas; 10 cutaneous melanocytomas) were selected to investigate the expression of FoxP3, CTLA-4, and IDO by immunohistochemistry and RT-qPCR (real-time quantitative polymerase chain reaction). All of the tested markers showed high gene and protein expression in oral melanomas and were differently expressed in cutaneous melanomas when compared to their benign counterpart. IDO expression was associated with an increased hazard of death both in univariable and multivariable analyses ( P < .05). FoxP3 protein expression >6.9 cells/HPF (high-power field) was an independent predictor of death ( P < .05). CTLA-4 gene and protein expressions were associated with a worse prognosis, but only in the univariable analysis ( P < .05). FoxP3, CTLA-4, and IDO likely play a role in canine melanoma immunoescape. Their expression, if supported by future studies, could represent a prognostic tool in canine melanoma and pave the way to future immunotherapeutic approaches in dogs.
The use of everyday technology; a comparison of older persons with cognitive impairments’ self-reports and their proxies’ reports
Authors: Jakobsson Elin , Nygård Louise , Kottorp Anders , Olsson Cecilia Bråkenhielm , Malinowsky Camilla
Published: October 2020

Introduction

Older persons with cognitive impairment have often been disregarded in providing information on their own perceptions. This study explored the number of relevant everyday technologies and the ability to use everyday technologies as perceived by persons with cognitive impairment in comparison with their proxies’ estimates using the Short Everyday Technology Use Questionnaire.

Method

In this cross-sectional study, persons with cognitive impairment ( n = 21) and their proxies ( n = 21) were interviewed on separate occasions with the Short Everyday Technology Use Questionnaire, which measures the number of relevant everyday technologies and the ability to use everyday technologies. The data were analysed with t-tests, z-comparisons, and Fisher’s exact test. The level of significance was set at p < 0.05.

Results

At the group level, no significant differences were found between persons with cognitive impairments’ perceptions and their proxies’ estimates regarding the number of relevant everyday technologies or the ability to use everyday technologies. On the individual level, significant differences were found in the ability measures within four out of the 21 dyads.

Conclusion

The persons with cognitive impairment and their proxies verified each other’s responses, providing evidence that persons with cognitive impairment should be the primary source for information about their own everyday technology use.
The Driftless Oaks: A new network of tree-ring chronologies to improve regional perspectives of drought in the Upper Midwest, USA
Authors: Larson Evan R , Allen Sara A , Underwood Chris A
Published: October 2020

New and updated multi-century tree-ring chronologies from living oak trees, remnants, and archeological beams from across the Driftless Area of southwest Wisconsin and northeast Iowa, USA, were developed to fill a spatial gap in the network of available tree-ring chronologies. We produced a robust 303-year summer drought reconstruction (June–August Palmer’s Modified Drought Index (PMDI): r 2 = 0.45) that identified clusters of extreme droughts and pluvials (PMDI ≤ –4.0 or ≥ 4.0) in the early 1700s and more even distributions of drought conditions, with the exception of the post 1930s period when drought became relatively infrequent. Compared to the Living Blended Drought Atlas (LBDA) and the North American Drought Atlas (NADA), our reconstruction more accurately represented moderate moisture conditions across the Driftless Area, the NADA and LBDA more closely represented extreme pluvials, and our reconstruction and the LBDA better represented extreme drought years. The three reconstructions largely captured the same high-frequency variability in drought conditions and differed most at low frequencies. Significant correlations were identified between our reconstruction and corn ( r = 0.30, n = 91, p = 0.002) and soybean ( r = 0.25, n = 81, p = 0.012) yields, with the strength of the correlations increasing over recent decades suggesting a tighter coupling of interannual climate variability and crop productivity in the region. Superposed epoch analyses indicated significantly wetter conditions in the Driftless Area two years after major volcanic eruptions. In the context of long-term climatic variability, the Driftless Oaks drought reconstruction demonstrated that drought and pluvial conditions more extreme than those experienced during the instrumental record have occurred in the past.
The Markus way with dichotomies: Corrective and distributive justice
Authors: Glass Arthur
Published: October 2020

How should we understand the categorical distinction Aristotle draws between praxis and poesis? If this distinction gains its meaning only in a specific social and cultural context, what does this tell us about another famous Aristotelian distinction, namely, the distinction he draws between two types of justice: corrective and distributive? In particular, what is the orienting role of this distinction (and what should we make of this) in accounts of justice based on Kantian right and accounts based on Rawls’ principles of justice?
Thromboembolic Events and Role of Point of Care Ultrasound in Hospitalized Covid-19 Patients Needing Intensive Care Unit Admission
Authors: Kapoor Sumit , Chand Sudham , Dieiev Vladyslav , Fazzari Melissa , Tanner Tristan , Lewandowski David C. , Nalla Anil , Abdulfattah Omar , Aboodi Michael S. , Shiloh Ariel L. , Gong Michelle N.
Published: October 2020

Background:

Covid-19 associated coagulopathy (CAC) is associated with prothrombotic state and thromboembolism. However, true incidence of thromboembolic events is difficult to determine in the ICU setting. The aim of our study was to investigate the cumulative incidence of thromboembolic events in Covid-19 patients needing intensive care unit (ICU) admission and assessing the utility of point of care ultrasound (POCUS) to screen for and diagnose lower extremity deep venous thrombosis (DVT).

Methods:

We conducted a prospective observational study between April 22nd and May 26th, 2020 where all adult patients with the diagnosis of Covid-19 pneumonia admitted to 8 ICUs of Montefiore Medical Center were included. POCUS exam was performed on all patients at day 1 of ICU admission and at day 7 and 14 after the first exam.

Results:

The primary outcome was to study the cumulative incidence of thromboembolic events in Covid-19 patients needing ICU admission. A total of 107 patients were included. All patients got POCUS exam on day 1 in the ICU, 62% got day 7 and 41% got day 14 exam. POCUS diagnosed 17 lower extremity DVTs on day 1, 3 new on day 7 and 1 new on day 14. Forty patients developed 52 thromboembolic events, with the rate of 37.3%. We found a high 45-day cumulative incidence of thromboembolic events of 37% and a high 45-day cumulative incidence of lower and upper extremity DVT of 21% and 10% respectively. Twelve (30%) patients had failure of therapeutic anticoagulation. Occurrence of a thromboembolic event was not associated with a higher risk of mortality (HR 1.08, p value = .81).

Conclusions:

Covid-19 patients in ICU have a high cumulative incidence of thromboembolic events, but not associated with higher mortality. POCUS is an excellent tool to help screen and diagnose DVT during a pandemic.
Altruism, Volunteering and Cognitive Performance Among Older Adults: A 2-Year Longitudinal Study
Authors: Corrêa Jimilly Caputo , Ávila Maria Priscila Wermelinger , Lucchetti Alessandra Lamas Granero , Lucchetti Giancarlo
Published: October 2020

This study aims to investigate whether altruism and volunteering are associated differently with cognitive functioning in community-dwelling older adults. A 2-year longitudinal study of 291 Brazilian older adults was conducted. In the baseline analysis, altruism, but not volunteering, was associated with higher scores for the composite cognitive score, the Mini-Mental State Examination, the verbal fluency and the CERAD Recall. Concerning the longitudinal analyses, volunteering at baseline, but not altruism, was associated with verbal fluency and CERAD Word List Recall after 2 years of follow up. Same results were obtained while investigating changes in score. Altruism and volunteering were associated with cognitive tests, albeit in different ways. Volunteering, but not altruism, was associated with lower cognitive decline. However, altruism, but not volunteering, was associated with higher absolute score on these tests. These findings can further understanding of this new field of health research.
Impact of the COVID-19 pandemic on patients with systemic lupus erythematosus: Observations from an Indian inception cohort
Authors: Rathi Manish , Singh Parmeshar , Bi Hayath Peta , Shivanna Archana , Kavadichanda Chengappa , Tripathy Saumya Ranjan , Parthasarathy Janani , Tota Sneha , Maurya Supriya , Vijayalekshmi Vishnupriya , Bhavani D , Jain Avinash , Gupta Ranjan , Danda Debashish , Rajasekhar Liza , Negi Vir Singh , Shobha Vineeta , Das Bidyut , Aggarwal Amita
Published: October 2020

Introduction

The ongoing pandemic of COVID-19 has led to severe disruption of healthcare services worldwide. We conducted this study to assess the impact of COVID-19 pandemic on the management of Systemic Lupus Erythematosus (SLE) patients who were enrolled in the nation-wide inception cohort.

Methods

A questionnaire was administered to the SLE patients enrolled in the inception cohort. Questions related to the effect on disease activity, preventive measures adopted against COVID-19, the incidence of COVID-19, hardships faced in getting access to health care professionals and availability of medicines, adherence, fear of COVID-19 and the potential benefits of being part of the registry.

Results

A total of 1040 (90% females) patients completed the questionnaire. The mean age was 27.5 ± 19.1 years and the mean disease duration was 1.25 years. Twenty-Four (2.3%) patients had developed fever (>1 day) during this period, including one patient with additional symptoms of diarrhoea and anosmia, however, none of the patients developed COVID-19 infection. 262 patients (25.2%) reported financial difficulty during this period and patients reported an average excess expenditure of at least 2255.45 INR ($30) per month. 378 patients (36%) reported problems in getting their prescribed medicines due to lockdown. Of these, 167 (40%) patients needed to change their medication schedule due to this non-availability. Almost 54% of patients missed their scheduled follow up visits during the lockdown period and 37% of patients were unable to get their investigations done due to closure of laboratories and hospitals. 266 patients (25.5%) reported worsening of various symptoms of SLE during this period. Almost 61% patients felt confident that being associated with the inception cohort had helped them in managing their disease better during this period of lockdown as they received help in the form of timely and frequent telephonic consults, assistance in making the medicines available, and regular counselling resulting in abetment of their fears and anxieties.

Conclusion

The current COVID-19 pandemic has made a huge impact on our SLE patients. Patients faced difficulty in the availability of medicines, missed the doses of medicines, had financial constraints, and spent more money on health during the pandemic.
Toward a Science of Effective Cognitive Training
Authors: Smid Claire R. , Karbach Julia , Steinbeis Nikolaus
Published: October 2020

A long-standing question in the behavioral sciences is whether cognitive functions can be improved through dedicated training. It is uncontested that training programs can lead to near transfer, meaning increased performance on untrained tasks involving similar cognitive functions. However, whether training also leads to far transfer, meaning increased performance on loosely related untrained tasks or even activities of daily living, is still hotly debated. Here, we review the extant literature and, in particular, the most recent meta-analytic evidence and argue that the ongoing crisis in the field of cognitive-training research may benefit from taking a more mechanistic approach to studying the effectiveness of training. We propose that (a) adopting a more rigorous theoretical framework that builds on a process-based account of training and transfer, (b) considering the role of individual differences in the responsiveness to training, and (c) drawing on Bayesian models of development may help to solve controversial issues in the field and lead the way to designing and implementing more effective training protocols.
Implications of Subject Matter Expertise as a Requirement for Debriefing: A Randomized Control Trial
Authors: Díaz Desiree A. , Gonzalez Laura , Anderson Mindi , MacKenna Valorie , Hoyt Erica , Hill Peggy P.
Published: October 2020

Introduction. Healthcare certification standards do not mention subject matter expertise. This research answers the question: Is there a difference in participant perception of simulation effectiveness between simulation facilitators and SME simulation facilitators during the debrief?

Methods. Senior-level nursing students (N=120) were randomized into groups to complete one pediatric critical care simulation. Simulation-based education (SBE) was delivered across five weeks. Two experienced facilitators, one with pediatric expertise and one without, used the PEARLS method to debrief each simulation. Following each debrief, participants completed a demographic survey and a SET-M. Results were analyzed using SPSS Version 24.

Results. Eighty-four students completed the survey and SET-M instrument. Independent samples t-tests showed no significant difference between facilitators based on the SET-M total scores (p=.516), or mean scores (p=.492). Debriefing-specific items also showed no difference (p=.983).

Conclusion. Subject matter expertise did not change the perception of simulation effectiveness for undergraduate nursing students during a critical care scenario. While SMEs are valuable for scenario creation and coaching non-SME facilitators on key elements for guided reflection, they may not be required to facilitate the debrief. Further research in this area is needed.
Value of Advance Care Directives for Patients With Serious Illness in the Era of COVID Pandemic: A Review of Challenges and Solutions
Authors: Gupta Amol , Bahl Bhavyaa , Rabadi Saher , Mebane Alexander , Levey Robert , Vasudevan Viswanath
Published: October 2020

Advance care directives (ACDs) are instructions regarding what types of medical treatments a patient desires and/or who they would like to designate as a healthcare surrogate to make important healthcare decisions when the patient is mentally incapacitated. At end-of-life, when faced with poor prognosis for a meaningful health-related quality of life, most patients indicate their preference to abstain from aggressive, life-sustaining treatments. Patients whose wishes are left unsaid often receive burdensome life sustain therapy by default, prolonging patient suffering. The CoVID pandemic has strained our healthcare resources and raised the need for prioritization of life-sustaining therapy. This highlights the urgency of ACDs more than ever. Despite ACDs’ potential to provide patients with care that aligns with their values and preferences and reduce resource competition, there has been relatively little conversation regarding the overlap of ACDs and CoVID-19. There is low uptake among patients, lack of training for healthcare professionals, and inequitable adoption in vulnerable populations. However, solutions are forthcoming and may include electronic medical record completion, patient outreach efforts, healthcare worker programs to increase awareness of at-risk minority patients, and restructuring of incentives and reimbursement policies. This review carefully describes the above challenges and unique opportunities to address them in the CoVID-19 era. If solutions are leveraged appropriately, ACDs have the potential to address the described challenges and ethically resolve resource conflicts during the current crisis and beyond.
An Empirical Investigation of Mental Illness, Impostor Syndrome, and Social Support in Management Doctoral Programs
Authors: Pervez Adam , Brady Lisa L. , Mullane Ken , Lo Kevin D. , Bennett Andrew A. , Nelson Terry A.
Published: October 2020

Scholars in multiple cross-disciplinary studies have found rates of mental illness among graduate students exceed the reported averages. Yet mental illness among management doctoral students remains largely unexplored. In this study, we surveyed 113 management doctoral students to ascertain the prevalence of symptoms for two common mental illnesses, depression and anxiety, as well as experiences of impostor syndrome and perceived sources of social support. Empirical findings from the first phase of our research suggest that management doctoral students are at greater risk than the general population of experiencing symptoms of depression, anxiety, and feelings of being an impostor. However, social support from a supervisor and from friends was negatively related to symptoms of depression and anxiety, indicating that these sources can be helpful. In phase two of our research, a thematic analysis of data from structured interviews with nine management doctoral students revealed themes linking impostor syndrome with social support, highlighting that the type of social support may be as beneficial as the source of social support. Recommendations for future research, as well as for students, supervisors, and administrators, are provided.
The Submental Nasal Appearance Scale for the Assessment of Repaired Unilateral Complete Cleft Lip: A Validation Study
Authors: Tan R. A. , Schipper I. E. , de Vet H. C. W. , Griot J. P. W. Don
Published: October 2020

Objective:

To reassess reliability and validity of the Submental Nasal Appearance Scale (SNAS) compared to the preliminary pilot study, for assessment of patient photographs with repaired unilateral cleft lip and palate (UCLP). When utilizing the SNAS, 3 nasal features (1. nasal outline; 2. alar base position; 3. nostril axis) must be graded according to symmetry between the cleft and noncleft side using a 5-point scale with reference photographs for each feature. The mean score calculated from the graded features reflects the overall degree of nasal symmetry, which is considered an important goal when repairing UCLP.

Design:

Fifty patient photographs were selected and cropped, displaying the submental view. Six raters assessed these photographs using the SNAS and a separate 5-point scale to assess the overall submental appearance. Interrater reliability was determined for both methods and correlation was calculated between these as an indication of construct validity.

Setting:

Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.

Patients:

Six- to 9-year-old patients with repaired UCLP.

Results:

Interrater reliability of 0.73 and 0.48 was found for the SNAS and overall appearance assessment, respectively, while in the pilot study values of 0.79 and 0.69 were found. Correlation of 0.59 and 0.74 was found in the current and pilot study, respectively, between the SNAS and overall appearance assessment.

Conclusions:

The SNAS is a reliable tool to assess nasal symmetry from the submental perspective. Reliability of the SNAS is higher compared to grading overall appearance, but validity of the SNAS was less well supported.
Struggle for the Soul of Medicaid
Authors: Huberfeld Nicole , Watson Sidney , Barkoff Alison
Published: October 2020

Medicaid is uniquely equipped to serve low-income populations. We identify four features that form the “soul” of Medicaid, explain how the administration is testing them, and explore challenges in accountability contributing to this struggle. We highlight the work of watchdogs acting to protect Medicaid and conclude with considerations for future health reform.
Following the Money
Authors: Sage William M. , Westmoreland Timothy M.
Published: October 2020

It is no exaggeration to say that American health policy is frequently subordinated to budgetary policies and procedures. The Affordable Care Act (ACA) was undeniably ambitious, reaching health care services and underlying health as well as health insurance. Yet fiscal politics determined the ACA’s design and guided its implementation, as well as sometimes assisting and sometimes constraining efforts to repeal or replace it. In particular, the ACA’s vulnerability to litigation has been the price its drafters paid in exchange for fiscal-political acceptability. Future health care reformers should consider whether the nation is well served by perpetuating such an artificial relationship between financial commitments and health returns.
An International Review of Health Technology Assessment Approaches to Prescription Drugs and Their Ethical Principles
Authors: Rand Leah Z. , Kesselheim Aaron S.
Published: October 2020

In many countries, health technology assessment (HTA) organizations determine the economic value of new drugs and make recommendations regarding appropriate pricing and coverage in national health systems. In the US, recent policy proposals aimed at reducing drug costs would link drug prices to six countries: Australia, Canada, France, Germany, Japan, and the UK. We reviewed these countries’ methods of HTA and guidance on price and coverage recommendations, analyzing methods and guidance documents for differences in (1) the methodologies HTA organizations use to conduct their evaluations and (2) considerations they use when making recommendations. We found important differences in the methods, interpretations of HTA findings, and condition-specific carve-outs that HTA organizations use to conduct evaluations and make recommendations. These variations have ethical implications because they influence the recommendations of HTA organizations, which affect access to the drug through national insurance and price negotiations with manufacturers. The differences in HTA approaches result from the distinct political, social, and cultural contexts of each organization and its value judgments. New cost-containment policies in the US should consider the ethical implications of the HTA reviews that they are considering relying on to negotiate drug prices and what values should be included in US pricing policy.
Drug-related problems in head and neck cancer patients identified by repeated medication reviews on consecutive therapy cycles
Authors: Vucur Corinna , Wirtz Daniel A , Weinhold Leonie , Zipfel Matthias , Schmid Matthias , Schmidt-Wolf Ingo GH , Jaehde Ulrich
Published: October 2020

Background

Head and neck cancer (HNC) patients are particularly vulnerable to drug-related problems (DRPs) given the toxicity of concomitant chemoradiotherapy (CCRT).

Objective

To investigate the number and type of potential DRPs (pDRPs) in HNC outpatients undergoing five consecutive cycles of CCRT.

Methods

A single-centre, non-randomized, non-interventional, observational study was conducted at the Oncological Outpatient Clinic of the Center for Integrated Oncology at the University Hospital Bonn, Germany. Clinical pharmacists took a comprehensive medication history, documented laboratory data, assessed patients’ symptom burden, and retrospectively performed medication reviews at study entry and on the first day of each therapy cycle without any clinical intervention.

Results

In 26 patients, the mean number of pDRPs continuously increased during therapy course, from 4.8 (SD 2.7, range 2–12) at cycle 1 to 6.9 (SD 2.6, range 2–12) at cycle 5, with drug-drug interactions, adverse drug reactions, inappropriate durations of use, and inappropriate dosage intervals being the most common. Considering only new and recurrent pDRPs, the mean number was 4.3 (SD 2.3, range 2–9) at cycle 1 and lower in the further therapy course with an average of 1.3 (SD 1.7, range 0–7) at cycle 2 and 1.9 (SD 1.5, range 0–5) at cycle 5. The number of pDRPs was found to be associated with medication regimen complexity and health-related quality of life assessed in the first therapy cycle.

Conclusion

pDRPs frequently occurred in HNC outpatients demonstrating the need for pharmaceutical care. A methodological framework for repeated medication reviews was established, facilitating implementation into routine healthcare practice.
Evaluating the traditional bread properties with new formula: Affected by triticale and cress seed gum
Authors: Sheikholeslami Zahra , Mahfouzi Maryam , Karimi Mahdi , Hejrani Toktam , Ghiafehdavoodi Mahdi , Ghodsi Masoud
Published: October 2020

During recent years, composite bread is more popular among consumers due to its functional and nutritional properties. Among cereals, triticale has been studied, along with careful observation of its characteristics. In addition, hydrocolloids can be replaced as an appropriate resource due to a decrease in the gluten content. The present study aimed to evaluate the effect of triticale flour replacement at the levels of 0, 100, 150, and 250 g/kg, and cress seed gum at the concentrations of 0, 3, 6, and 10 g/kg on the rheological parameters of dough and physicochemical, textural, microstructural, and sensory properties of bread. Based on the results, formula including composite flour (150 g/kg triticale flour+850 g/kg wheat flour) and cress seed gum at 6 g/kg was the best formulation for improving the texture, color parameters, and general acceptance of both types of bread (Barbari and Lavash). Regarding the Iranian Barbari bread, cress seed gum increased the specific volume, porosity, and brightness, while reduced the hardness compared to the control. Besides, sensory evaluation manifested that 150 g/kg of wheat flour could be replaced with triticale flour for providing a good quality of bread. In conclusion, the addition of 150 g/kg of triticale and 6 g/kg of cress seed gum into composite flour and bread formulations had positive effects on all properties measured in both types of bread.
Examining the Relationship of Personality Functioning and Treatment Completion in Substance Misuse Treatment
Authors: Papamalis Fivos E.
Published: October 2020

Background:

Treatment retention is a major factor contributing to favourable outcome in the treatment of substance misuse, but the literature remains very limited. Despite evidence of the association of personality with drug use experimentation and relapse, surprisingly little is known about its role in the treatment process. Clients’ personality functioning as measured by malleable and context sensitive characteristic adaptations in treatment are of concern.

Aims:

This study examines whether, and to what extent, personality functioning contributes to or hinders treatment completion. This paper examined the extent to which service users’ characteristic adaptations may be potential determinants of treatment completion.

Methodology:

A longitudinal multi-site design was utilised, examining the therapy process in a naturalistic setting in five inpatient treatment units. The study examined whether service users’ characteristic adaptations (SIPP-118) predict completion, while controlling psychosocial, motivational and treatment engagement indicators involving n = 340 participants from 5 inpatient centres. Multivariate regression analyses were applied to examine the predictive role of characteristic adaptations on treatment completion.

Results:

Findings indicated that certain dysfunctional characteristic adaptations emerged as strong predictors of treatment completion. Dysfunctional levels on Self-control and Social concordance were significant predictors of drop out from treatment. Individuals with low capacity to tolerate, use and control one’s own emotions and impulses were almost three times more likely to drop-out compared to those without [OR] = 2.73, Wald = 6.09, P = .014, 95% CI [1.2, 6.0]. Individuals with dysfunctional levels on the ability to value someone’s identity, withhold aggressive impulses towards others and work together with others were 2.21 more times more likely to complete treatment [OR] = 2.21, Wald = 4.12, P = .042, 95% CI [1.0, 4.7]. The analysis at the facet level provided additional insight. Individuals with higher adaptive levels on Effortful Control were 46% more times likely to complete treatment than the group [OR] = 4.67, Wald = 10.231, P = .001, 95% CI [1.81, 12.04], 47% more likely on Aggression regulation [OR] = 4.76, Wald = 16.68, P < .001, 95% CI [2.1, 10.3], and 26% more likely on Stable self-image [OR] = 2.62, Wald = 6.75, P < .009, 95% CI [0.9, 3.0].

Conclusions:

These findings extend our knowledge of the predictive role of characteristic adaptations in treatment completion and highlight the clinical utility of capturing these individual differences early on. Delineating the role of characteristic adaptations in treatment may provide the basis for enhancing treatment effectiveness through individualized interventions that are scientifically driven and may open new avenues for the scientific enquiry of personality and treatment.
Optimization of transmural care by implementation of an online expert panel to assess treatment strategy in patients suffering from colorectal cancer liver metastases: A prospective analysis
Authors: Hellingman Tessa , Swart Merijn E de , Meijerink Martijn R , Schreurs Wilhelmina H , Zonderhuis Barbara M , Kazemier Geert
Published: October 2020

Introduction

Centralization of oncological care results in a growing demand for specialized consultations and referrals. Improved telemedicine solutions are needed to facilitate access to specialist care and select patients eligible for referral. The purpose of this quality improvement initiative was to optimize transmural care for patients suffering from colorectal cancer liver metastases through implementation of an online expert panel.

Methods

A digital communication platform was developed to share medical data, including high-quality diagnostic imaging of patients suffering from colorectal cancer liver metastases. Feasibility of local treatment strategies was assessed by a panel of liver specialists to select patients for referral. After implementation, an observational cohort study was conducted to evaluate quality improvement in transmural care using revised Standards for Quality Improvement Reporting Excellence guidelines.

Results

From September 2016–September 2018, eight hospitals were connected to the platform, covering a population of 3 m. In total, 123 cases were assessed, of which 54 (43.9%) were prevented from needless physical referral. Assessment of treatment strategy by an online expert panel significantly reduced the average lead time during multidisciplinary team meetings from 3.73 min to 2.12 min per patient ( p < 0.01).

Conclusions

Implementation of an online expert panel is an innovative, accessible and user-friendly way to provide cancer-specific expertise to regional hospitals. E-consultation of such panels may result in more efficient multidisciplinary team meetings and prevent fragile patients from needless referral. Sustainability of these panels however is subject to structural financial compensation, so a cost-effectiveness analysis is warranted.