bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes Evaluation after Application of Multidisciplinary Protocol of Shared Hospital Care in Patients Aged 65 Years and Older and Operated for Hip Fracture
Authors: Marín Jorge Salvador , Martinez Francisco Javier Ferrández , Ripoll José Miguel Seguí , Rico José Antonio Quesada , Beltrán Domingo Orozco , Munuera María Concepción Carratalá , López José Fernando Martínez , Campos Juan Carlos Marzo
Published: March 2020

Purpose: In geriatric patients, hip fracture is considered the greatest complication of osteoporosis in terms of morbidity, mortality, and cost. The aim of this study is to assess the effects of a multidisciplinary shared care protocol (trauma services, internal medicine, emergencies, anesthesia, nursing, hematology, pharmacy, rehabilitation, home hospitalization unit, and social services) on hospital stay and in-hospital mortality in inpatients aged 65 years or older and operated for hip fracture.Methods: Retrospective cohort study between January 2011 and December 2017. The unexposed group was made up of patients who did not receive care according to the multidisciplinary protocol, while the exposed group did. We excluded patients with polytrauma, conservative treatment, bilateral hip fracture, pathological fracture, or previous fracture already included in the series. Variables analyzed were demographic data, medical comorbidities, Charlson index, hemoglobin levels, hematocrit and blood transfusion, antiplatelet drugs, length of surgical delay, length of hospital stay, in-hospital mortality, and a composite risk outcome considering in-hospital mortality and/or hospital stay of more than 10 days. We fit a multivariable logistic regression model to calculate the odds ratio (OR) of experiencing outcomes.Results: The cohort included 681 patients: 310 were unexposed and 371, exposed. Compared to the unexposed group, patients receiving protocolized multidisciplinary care showed significantly lower in-hospital mortality (3.5% versus 7.7%; p = 0.015) and were less likely to have a hospital stay of more than 10 (16.4% versus 24.2%; p = 0.012). Mean length of hospital stay was 0.7 fewer days in the exposed group. Multivariable analysis showed the composite risk outcome was 51% lower in the exposed group, after adjusting for age, sex, heart failure, days to surgery, blood transfusion after surgery, and postoperative hemoglobin levels.Conclusion: Implementing the multidisciplinary shared care protocol halved the risk of in-hospital mortality and/or a hospital admission of more than 10 days in patients over 65 years with proximal femur fracture. It also reduced mean length of hospital stay.
Comparative effectiveness of low-level laser therapy and transcutaneous electric nerve stimulation in the treatment of pain caused by temporomandibular joint disorders: a systematic review and network meta-analysis
Authors: Ren Hui , Liu Jingying , Liu Yang , Yu Caiyun , Bao Guangjie , Kang Hong
Published: March 2020

Background: The comparative effectiveness of low-level laser therapy (LLLT) and transcutaneous electric nerve stimulation (TENS) in the treatment of pain caused by temporomandibular joint disorders (TMD) has not been evaluated.Methods: PubMed, Cochrane Library and Embase were searched from their inception until 27 October 2019. Randomized controlled trials (RCTs) that compared the effects of LLLT or TENS or placebo group for TMD patients’ pain reduction were included. The reviewers assessed the risk of bias of individual studies with the Cochrane risk of bias tool, excluding RCTs with a high risk of bias in any domain. Then the reviewers did network meta-analysis and assessed the quality of evidence contributing to network estimate using the GRADE framework.Results: 20 RCTs with 758 patients with TMD were included. In the pair-wise meta-analysis, LLLT and TENs showed a significant pain reduction in the visual analogue scale (VAS) compared with placebo immediately after treatment [mean difference (MD)=1.99, 95% confidence interval (CI):(1.07,2.92); MD=2.16, 95%CI:(0.27,4.04), respectively]. As for pain reduction one month after treatment, LLLT performed better and there was no statistically significant difference for TENS as compared with placebo. Conclusion: The results of this meta-analysis showed the short-term efficacy of LLLT is more positive than TENS in the treatment of pain caused by temporomandibular joint disorders.
Impact of water quality on Chronic Kidney Disease of unknown etiology (CKDu) in Thunukkai Division in Mullaitivu District, Sri Lanka
Authors: Gobalarajah Kalaivani , Prabagar Subramaniam , Jayawardena Uthpala , Gobalarajah Rasiah , Rajendra Subramaniam , Prabagar Jasotha
Published: March 2020

Background

Increase in the number of cases in Chronic Kidney Disease of Unknown etiology (CKDu) in Sri Lanka has become an environmental health issue of national concern. Even though, Northern Province is not identified as a high risk province, there is an increasing trend of CKDu after the end of civil war in the Northern territory.

Methods

The present study was conducted in Thunukkai Division in Mullaitivu District to investigate the socio demographic and clinical pattern of CKDu patients and to evaluate the quality of their water sources. The samples were selected by using stratified purposive random sampling method which represented 29% of total CKDu patients in Thunukkai Division. Pretested structured questionnaire was administrated to collect the data from CKDu patients.

Results

Among the patients, 80% of them were male with an age range of 30-80, majority (88%) involved in farming. 26% and 20% of people were engaged in smoking and taking alcohol, respectively. 17% and 43% were suffered with diabetes and hypertension, respectively. Physicochemical characteristics of more than 50% of the water samples recorded higher electric conductivity, salinity, total dissolved solids, total hardness and Na levels compared to drinking water standards in Sri Lanka.

Conclusions

The association between serum creatine excreted by CKDu patients and water quality parameters were determined by using regression model, revealing a significant negative relationship with phosphate and positive relationship with Total Dissolved Solid and arsenic content of the drinking water. Thus, the study suggests, total dissolved solid and arsenic in drinking water have a positive correlation with CKDu in Thunukkai region in the Mullaitivu District.
Teaching scientific principles in undergraduate medical education – a scoping review on international examples
Authors: Vonneilich Nico , Kurth Sven
Published: March 2020

Background The constant growth of medical scientific knowledge, stronger calls for evidence based medicine and changing roles of physicians are examples for the relevance of teaching scientific principles in undergraduate medical education. The acquisition of scientific skills is comparably weak in undergraduate medical education. This scoping review addresses the following questions: Which examples on teaching scientific principles in undergraduate medical education can be identified in international literature? What is known regarding their educational success and how can they be integrated into undergraduate medical curricula? Methods A systematic scoping review search was conducted in PubMed. Criteria for eligibility were English or German language, publication in a peer-reviewed journal, publication date after 1 st of January 2000 and the publications had to report educational interventions in undergraduate medical education on one of the following basic scientific principles: searching literature, formulating scientific questions, reading and critical appraisal of literature, writing, presentation and understanding of the research process. After full-text screening, 29 studies were included in the analysis. Results Educational interventions focused on literature search (N=14), critical appraisal of scientific publications (N=13) and the formulation of scientific questions (N=13). Evaluation data were included in 16 publications. Outcomes included measures of student satisfaction, student knowledge and scientific competence based on tested instruments. Results were quite heterogeneous regarding the success of educational interventions. Conclusions Publications in this field of medical education vary considerably regarding reporting of results and inclusion of evaluation data, making a comprehensive analysis of the educational interventions a difficult task. Nevertheless, some ideas for the implementation of scientific principles in undergraduate medical education can be named. Student knowledge of and student attitude towards scientific principles in medical education can be fostered by integrating different didactic approaches, by including self-study time and by integrating these principles vertically in undergraduate medical curricula along with clinical aspects.
Influence of Perlite in Peat- and Coir-based Media on Vegetative Growth and Mineral Nutrition of Highbush Blueberry
Authors: Kingston Patrick H. , Scagel Carolyn F. , Bryla David R. , Strik Bernadine C.
Published: March 2020

Peat and coir are commonly used for substrate production of highbush blueberry (Vaccinium sp.). Perlite is also typically added to improve drainage and stability of the media. The purpose of the present study was to determine how various combinations of each affect growth and nutrition in highbush blueberry. Two cultivars, ‘Liberty’ northern highbush blueberry (V. corymbosum L.) and ‘Jewel’ southern highbush blueberry (interspecific hybrid of V. corymbosum L. and V. darrowii Camp.), were grown for 3 months in media containing 0%, 10%, 20%, or 30% perlite, by volume, and a 1:0, 2:1, 1:2, or 0:1 ratio of peat and coir. At 95 days after transplanting, total dry weight of the ‘Liberty’ plants was greatest in pure peat and progressively less as more coir or perlite was added to the media. Total dry weight of ‘Jewel’ also declined with increasing amounts of perlite but, in this case, was unaffected by the ratio of peat and coir. The response of the plants to perlite did not appear to be a function of pH or nutrition and was most likely related to the effects of perlite on media water relations. Response to peat and coir, on the other hand, may have been due to nutrition and salinity of the media. In both cultivars, a higher amount of peat in the media improved uptake of N, P, Mg, and S and decreased uptake of K, B, Zn, and Na. Coir, on the other hand, contained higher concentrations of Na and Cl than peat. These findings suggest that the use of high amounts of perlite in the media could be detrimental when growing highbush blueberry in substrate, and some cultivars may grow better in peat than in coir.
Pistachio Kernel Composition of ‘Kalehghouchi’, ‘Pete 1’, and ‘Lost Hills’ in California
Authors: Polari Juan J. , Ferguson Louise , Wang Selina C.
Published: March 2020

Moisture and fat content, fatty acid profile, and volatile terpenes were measured for the first time for ‘Kalehghouchi’, ‘Pete 1’, and ‘Lost Hills’ pistachios grown at two California microclimates: Lost Hills and Parlier. ‘Kalehghouchi’ had the highest moisture content, followed by ‘Pete 1’ and ‘Lost Hills’, respectively. While the moisture content of ‘Kalehghouchi’ was not significantly affected by location, it was lower for ‘Pete 1’ grown at Parlier (40.8 vs. 40.8 g/100 g) and higher for ‘Lost Hill’ grown there (48.2 vs. 45.2 g/100 g). ‘Pete 1’ grown at the Parlier site had a higher fat content compared with ‘Lost Hills’ (47.7 vs. 43.0 g/100 g). ‘Kalehghouchi’ had a lower fat content at Parlier compared with Lost Hills (42.0 vs. 44.9 g/100 g), and ‘Lost Hills’ was unaffected by location. The main fatty acid measured in the pistachio samples was oleic acid (52% to 58%), followed by linoleic (26% to 33%) and palmitic acids (11% to 13%). While oleic acid content of ‘Lost Hills’ and ‘Kalehghouchi’ was higher for pistachios grown in Parlier, no impact of location was observed for ‘Pete 1’. The fatty acid profiles of all three cultivars appeared to be more dependent on genotype and less affected by microclimate. α-pinene (95–1682 ng/kg), limonene (37–741 ng/kg), and α-terpinolene (1–368 ng/kg) were the most abundant volatiles among all the cultivars and locations. Microclimate was the primary factor in determining volatile terpenes concentration in pistachio kernels.
Comparative Study of Ripening Related Gene Expression and Postharvest Physiological Changes between Astringent and Nonastringent Persimmon Cultivars
Authors: Kou Jingjing , Zhao Zhihui , Wang Wenjiang , Wei Chuangqi , Guan Junfeng , Ference Christopher
Published: March 2020

‘Mopan’ persimmon (Diospyros kaki Thunb.) is a traditional astringent cultivar of persimmon and ‘Yoho’ persimmon (D. kaki) is a newly introduced Japanese nonastringent type of cultivar in northern China. Studies were conducted to investigate the physiological changes and expression of ripening-related genes in the postharvest process at different periods under the effects of endogenous ethylene in both cultivars. Persimmons were harvested and stored under room temperature for 20 days. An analysis of physiological changes showed significant differences between the two cultivars. Total soluble solids declined in ‘Mopan’ fruit, whereas those in ‘Yoho’ fruit increased during storage. Firmness, color, index of absorbance difference, total and soluble tannin contents, ethylene production, and respiration rates showed the same trend, but these values vary by cultivar. ‘Mopan’ fruit softened rapidly after harvest and attained edible quality in 20 days, with an increased rate of softening accompanied by increased expression of ripening-related genes. In contract, ‘Yoho’ fruit softening occurred slowly and did not soften even after 20 days, with minimal accumulation of the ripening-related genes. The information obtained from this study demonstrates that cell wall-hydrolyzing enzymes, the de-astringent process, and endogenous ethylene have critical roles in postharvest ripening, gene expression, and physiological property changes of ‘Mopan’ and ‘Yoho’ persimmon fruit during storage.
Estrategias corporativas y reconfiguración de las cadenas de proveeduría del vestido hacia Estados Unidos: el caso de la firma Levi Strauss & Co.
Authors: García de León P. Guadalupe
Published: March 2020

Este artículo presenta un recuento de las estrategias corporativas de la firma Levi Strauss & Co., empresa que ha tenido un papel protagónico en cada una de las fases del proceso de integración de México a la producción global de prendas de vestir: la integración bajo los programas de producción compartida; la primera etapa del TLCAN; y la etapa actual de caída de las exportaciones mexicanas y reposicionamiento de China. El argumento central es que analizando las estrategias competitivas de las firmas líderes de las redes globales del vestuario –como es el caso de Levi’s–, nos podemos acercar a la lógica de reestructuración de estas redes y entender los términos cambiantes de inserción internacional de los países y firmas involucradas, como es el caso de México.
Participación y deliberación como correctores del sistema democrático
Authors: Santiago Juárez Rodrigo
Published: March 2020

Todo régimen democrático debe asegurar que la participación y la representación se constituyan en dos caras de la misma moneda. En muchas de las democracias actuales no se fomenta la participación de los ciudadanos salvo en casos específicos, como en las elecciones periódicas. Por ello es necesario fomentar la participación y la educación en valores cívicos. Finalmente, deben cobrar fuerza las propuestas que buscan la deliberación política, a fin de otorgar legitimidad a la democracia.
El mercado laboral en la frontera norte de México: estructura y políticas de empleo
Authors: Mendoza Jorge Eduardo
Published: March 2020

El estudio analiza los factores que han impactado el mercado de trabajo y el empleo en los estados de la frontera norte y las principales ciudades de esa región. Se relaciona el patrón del crecimiento económico seguido por la economía mexicana con el mercado laboral de la región. Se destacan las políticas de empleo nacional y en la región de la frontera norte en los últimos años y se analizan sus ventajas y limitaciones. Las tasas de d esempleo abierto en la frontera norte han sido menores a las de otras regiones, aunque existe presión por incorporar la creciente población económicamente activa. Resaltan la capacitación en Baja California y Nuevo León, los cuales han ofrecido cursos requeridos por las empresas en áreas técnicas, industriales y administrativas. Las políticas de empleo han sido un instrumento para canalizar recursos del Estado, pero sólo han logrado combatir el desempleo parcialmente, pues su naturaleza anticíclica les impide impactar efectivamente en el desempleo. El combate al desempleo requiere un esfuerzo para generar educación y capacitación acorde con las necesidades de las empresas.
Apertura comercial, relocalización espacial y salario regional en México
Authors: Castro Lugo David , Félix Verduzco Gustavo
Published: March 2020

El objetivo central de este documento es identificar las transformaciones ocupacionales entre ciudades, así como explorar si existen otros elementos relacionados con las características regionales, tales como economías de aglomeración y accesibilidad a los mercados, que influyan en las diferencias salariales entre ciudades. El aporte metodológico más relevante y que lo distingue de estudios previos en México es que para el análisis utiliza información a nivel de microdatos de trabajadores asalariados provenientes de la Encuesta Nacional de Empleo Urbano para el periodo 1992-2002 considerando 33 áreas urbanas. Los resultados de la investigación indican cambios en la distribución espacial de las actividades manufactureras; asimismo se encuentra evidencia de que las economías de aglomeración y la accesibilidad a los mercados tienen relevancia en la disparidad salarial en los años posteriores al Tratado de Libre Comercio de América del Norte, aunque su influencia es diferente por actividad.
Flexibilidad laboral en Iberoamérica: un análisis comparado
Authors: Ibarra Cisneros Manuel Alejandro
Published: March 2020

La mayoría de los estudios en materia de flexibilidad laboral muestran una imagen parcial sobre la situación de los mercados de trabajo latinoamericanos. Se limitan a confirmar la existencia de elevados grados de rigidez y la necesidad de emprender reformas laborales al margen de las circunstancias nacionales específicas. El diseño de un indicador sintético de rigidez laboral, utilizando la metodología considerada por la ocde, mediante el uso del análisis factorial, pero aplicada a países de Iberoamérica, permite obtener ciertos avances en relación con este debate. Los resultados establecen la elevada importancia de la rigidez en los procedimientos de despido colectivo por encima de aspectos normativos relacionados con contratos por tiempo determinado. Por último, se constata la escasa relación entre niveles de flexibilidad y resultados en términos de desarrollo económico, poniendo en cuestión afirmaciones que intentan extrapolar estrategias flexibilizadoras como medida aislada para facilitar el progreso económico de un país.
Subtipos del síndrome de intestino irritable en niños
Authors: Velasco-Benítez Carlos Alberto , Moreno-Gómez Jairo Enrique , Ramírez-Hernández Carmen Rossy
Published: March 2020

La prevalencia del síndrome de intestino irritable (SII) pediátrico es 1,2%-5,4%, y los subtipos en niños latinoamericanos, no está especificada. El objetivo de este estudio es caracterizar los subtipos del SII y sus posibles asociaciones. Estudio de prevalencia en niños entre los ocho y 18 años de edad con SII según los Criterios de Roma III. Se tomaron variables sociodemográficas, familiares y clínicas. Los subtipos de SII se consideraron por la consistencia de las heces en SII con estreñimiento (SII-e); diarrea (SII-d); mixto (SII-m) y sin subtipo (SII-ss). La estadística incluyó análisis uni y bivariados. Los datos fueron analizados usando t-student a dos colas, chi2, prueba exacta de Fisher y razón de prevalencia (RP) con IC95%, siendo p<0,05 significativa. Fueron incluidos 196 niños (53,6% femeninos; mediana de 11 años); presentándose SII-ss en 64,8%, SII-e en 19,9%, SII-m en 8,7% y SII-d en 6,6%. Hubo diferencias significativas en las características de las heces (p=0,01), en la incontinencia fecal (p=0,02), en los fecalomas (p=0,00); y posibles asociaciones entre el SII-d, ciudad (p=0,00) y malnutrición (p=0,02). En conclusión, luego del SII-ss, ¼ de los niños estudiados presentó SII-e, seguido del SII-m y SII-d; presentándose el SII-d con mayor oportunidad en malnutridos.
Prevalencia de los trastornos de la voz en los docentes universidad del magdalena, Colombia 2017-2018
Authors: Revollo-Zúñiga Francisco , Hernández-Blanco Javier , Salazar-Ceballos Alexander , Davila-Cueto Andrea
Published: March 2020

Se realizo un estudio descriptivo de corte transversal para determinar la prevalencia de los trastornos de la voz y los factores de riesgo asociados en los docentes de la Universidad del Magdalena (Colombia) periodo 2017-2018. Se incluyeron 263 docentes, se recolecto datos de sexo, edad, estrato, programa académico, años de trabajo, horas de clase, alumnos por salón, uso de amplificación, toma de licor, tabaquismo, diagnostico de reflujo gastroesofágico y se les aplico el índice de incapacidad vocal 10 (VHI10). Los docentes con puntaje mayor o igual a 11 fueron valorados en consulta bajo Nasofibrolaringoscopia. Se observó que el 20% de los docentes presentó incapacidad vocal con un puntaje en VHI 10 mayor o igual a 11. En los análisis hubo asociación estadísticamente significativa entre incapacidad vocal y el diagnóstico médico de reflujo. Se evaluaron 28 profesores con Nasofibrolaringoscopia, se determino que cerca del 54% (15/28) presentaron actividad supraglótica y fonación con bandas. Los docentes son un grupo de personas con alteraciones de la voz mayor que la población general y requieren un entrenamiento especial y especifico en su conservación. Independiente de las condiciones particulares de la actividad de enseñanza, la enfermedad por reflujo gastroesofágico mostro estar asociada a incapacidad vocal.
„Amoris laetitia” w perspektywie „lectio divina”
Authors: Gałkowski Tomasz
Published: March 2020

Adhortacja Franciszka Amoris laetitia wzbudziła znaczne zainteresowanie z powodu nowego podejścia duszpasterskiego do osób rozwiedzionych i żyjących w powtórnych związkach. Doprowadziła również do wątpliwości i pytań dotyczących ciągłości nauczania Kościoła o małżeństwie i rodzinie. W oparciu o charakterystykę nowego katolickiego paradygmatu, która została zaprezentowana przez kard. B. Cupich’a, została podjęta w opracowaniu kwestia jednej z możliwych form realizacji podejścia wskazanego przez Franciszka. Autor proponuje czytać Amoris laetitia w kluczu lectio divina oraz wskazuje na nią jako odpowiednią drogę wiodącą do rozpoznania sytuacji osób rozwiedzionych i żyjących w nowych związkach oraz możliwości przystępowania przez nich do komunii świętej.
Headache, Outpatient management and referral to Specialty Clinics, clinical Audit
Authors: Mohammed Sallam Taha , Ragab Abdelgalil Ali , Tayyab Syed Muhammad
Published: March 2020

Background:

Headache is one of the most common presenting symptom for patients attending the outpatient
clinics. The key stone in primary management of cases presented with headache, and then subsequent proper
referral to specialty clinics, depends on careful history taking and clinical examination.

Objective:

The aim of this audit is to get a comprehensive idea about patients presented with headache in the
Outpatient Department (OPD) clinics including patients age, gender, primary management and subsequent referral
to specialty clinics in Hatta hospital. So we can reevaluate and improve our clinical approach in dealing with
patients having headache.

Method:

This study is a retrospective study based on hospital settings and was conducted in 2015 over one year in
Hatta hospital, Dubai. We collected information about patients who attended the OPD with headache as the
primary complaint.

Results:

One hundred eighty patients above the age of 4 years were selected. Females patients were 125(69.4%)
while males were 55(30.6%).The age of most patients suffering from headache range from 15 – 40 years.
Hypertension was found in 20 cases, while diabetes mellitus was diagnosed in 6 cases. Radiological studies (Plain
X‐ray and/or Computerized Tomography) were done in 114 patients (63.3%). Most common causes of headache
encountered in this study were tension headache, migraine and sinusitis.

Conclusion:

The history and clinical examinations usually permit a definitive diagnosis for patients with headache.
Radiological and blood investigations were overused in assessment of patients. Change of life style is important as
part of management plan.
Social Media and Medical Professionalism in the United Arab Emirates
Authors: Han Aaron
Published: March 2020

:

Social media is increasingly used as a platform by medical providers. The
positive contribution is also balanced by risks and governed by codes of professionalism
by the medical community. The values of medical professionalism include universal
tenets and also those unique to the Arab world and the United Arab Emirates. We
propose that institutional guidelines and self governance in the medical community is
important, as well as further dialogue on this important subject.
Project Manager Interventions in Occupational Health and Safety During the Pre-construction Phase in the Gaza Strip
Authors: Tayeh Bassam A. , Yaghi Rola O. , Abu Aisheh Yazan I.
Published: March 2020

Background:

Construction industry is classified as one of the most dangerous industries, where workers are exposed to accidents and risks.

Objective:

This study inspected the role of project manager in promoting Occupational Health and Safety (OHS) during the pre-construction phase in the construction projects in the Gaza Strip. Previous studies were reviewed in order to extract the impact of inadequate health and safety interventions in the construction projects throughout the world, and their applicability in the Gaza Strip was determined.

Methods:

This was achieved through a pilot study and a draft questionnaire. The questionnaire was developed in order to assess and evaluate the perception of project managers on the extent of their roles in promoting health and safety in the pre-construction phase. The sample size was 101, out of which, 77 completed questionnaires were returned by the respondents.

Results:

The study revealed that two project parameters, mainly affected by inadequate health and safety interventions, were quality and labour productivity. The main stage during which a project manager played a significant role in promoting health and safety was the planning stage, with “identifying specific safety issues from prior experience” being the highest sub-factor, which was followed by the designing stage, with “plan works at the design phase through a time schedule, citing the duration of processes, divided into steps and any process priority” being the highest sub-factor.

Conclusion:

Finally, there was the tendering stage, with “make ensure that facilities are provided on site for first aid and emergency medical treatment in the event of an accident” being the highest sub-factor. The results of this study show great awareness of a project manager in promoting health and safety in the pre-construction phase.
Prophylactic Circumferential Laser Retinopexy in Macular Hole and Epiretinal Membrane Surgeries
Authors: Ohana Oded , Rutenberg Ran , Moisseiev Elad , Davidovich Zvi , Lowenstein Anat , Schwartz Shulamit , Barak Adiel
Published: March 2020

Background:

The role of PCLR in vitrectomy surgeries for macular diseases is controversial. Several studies report a reduction in post-operative RD rates, while other studies do not show such reduction. reducing complications stemming from intra- and post- operative retinal tears, especially at sclerotomy sites, are suggested as reasons for PCLR use.

Objective:

To investigate the effect of PCLR on the rate of post-operative RD in patients undergoing pars plana vitrectomy for either Macular Hole (MH) or epiretinal membrane (ERM).

Methods:

This retrospective study included 179 eyes of 170 patients who underwent vitrectomy for either MH or ERM between 2006-2012. Recorded parameters included demographic information, diagnosis, lens status, use and type of tamponade, whether PCLR was performed, follow-up period, the occurrence of RD, the cause and time of RD. Outcome and complication rates were compared between patients who received PCLR (PCLR group) and those who did not (Control group).

Results:

The study included 179 eyes of 170 patients. 126 eyes had PCLR while 53 eyes did not. Pre-operative demographics data, best-corrected visual acuity, lens status and indication for macular surgery were similar between the two groups. Post-operative RD was diagnosed in one eye (1.8%) in the control group and 5 eyes (3.9%) in the PCLR group (Kaplan-Meier survival analysis, log-rank p = 0.28).

Conclusion:

PCLR was not correlated with a decrease in RD in MH and ERM surgeries in our cohort. Intra-operative and post-operative examination for small retinal breaks is essential in all surgeries. PCLR might be unnecessary in small gauge vitrectomies.
Towards an Adoption Framework for Patient Access to Electronic Health Records: Systematic Literature Mapping Study
Authors: van Mens Hugo J T , Duijm Ruben D , Nienhuis Remko , de Keizer Nicolette F , Cornet Ronald
Published: March 2020

Background

Patient access to electronic health records (EHRs) is associated with increased patient engagement and health care quality outcomes. However, the adoption of patient portals and personal health records (PHRs) that facilitate this access is impeded by barriers. The Clinical Adoption Framework (CAF) has been developed to analyze EHR adoption, but this framework does not consider the patient as an end-user.

Objective

We aim to extend the scope of the CAF to patient access to EHRs, develop guidance documentation for the application of the CAF, and assess the interrater reliability.

Methods

We systematically reviewed existing systematic reviews on patients' access to EHRs and PHRs. Results of each review were mapped to one of the 43 CAF categories. Categories were iteratively adapted when needed. We measured the interrater reliability with Cohen’s unweighted kappa and statistics regarding the agreement among reviewers on mapping quotes of the reviews to different CAF categories.

Results

We further defined the framework’s inclusion and exclusion criteria for 33 of the 43 CAF categories and achieved a moderate agreement among the raters, which varied between categories.

Conclusions

In the reviews, categories about people, organization, system quality, system use, and the net benefits of system use were addressed more often than those about international and regional information and communication technology infrastructures, standards, politics, incentive programs, and social trends. Categories that were addressed less might have been underdefined in this study. The guidance documentation we developed can be applied to systematic literature reviews and implementation studies, patient and informal caregiver access to EHRs, and the adoption of PHRs.
Factors Influencing Acceptance of Personal Health Record Apps for Workplace Health Promotion: Cross-Sectional Questionnaire Study
Authors: Park Hyun Sang , Kim Kwang Il , Soh Jae Young , Hyun Young Ho , Jang Sae Kyun , Lee Sol , Hwang Ga Young , Kim Hwa Sun
Published: March 2020

Background

Health care technologies can help improve workers’ health and productivity by supporting workplace health promotion. A personal health record app is used to manage medical data such as results from medical checkups, which facilitates decision making for medical personnel. However, an analysis of users’ technology acceptance is required to provide appropriate services based on personal health record apps.

Objective

The purpose of this study was to analyze the factors influencing the behavioral intention of health experts and workers to use an app in workers’ health centers and to examine differences in their perception of the main variables.

Methods

The study involved health experts and workers who visited 21 workers’ health centers in Korea to verify a research model in which perceived risk was added to the unified theory of acceptance and use of technology, a representative theory of information technology acceptance. After receiving ethical approval from the Korea National Institute for Bioethics Policy, 1050 questionnaires were distributed over 7 weeks with cooperation of the Korea Occupational Safety and Health Agency. A multiple linear regression analysis and multigroup path analysis were performed to verify the hypotheses, and independent samples t tests were performed to analyze differences between workers’ and health experts’ perception of the main variables.

Results

The analysis included data from 866 respondents (687 workers and 179 health experts). Effort expectancy (beta=.08, P=.03), social influence (beta=.43, P<.001), performance expectancy (beta=.07, P=.008), and facilitating conditions (beta=.13, P<.001) exerted significant positive effects on behavioral intention, whereas perceived risk (beta=–.29, P<.001) exerted a significant negative effect on behavioral intention. Performance expectancy had a significant effect on path differences depending on gender (critical ratio=–3.38) and age (critical ratio=1.97). Workers’ mean scores for the main variables were higher relative to those of health experts for all remaining variables except perceived risk, and significant differences were observed for all remaining variables except facilitating condition.

Conclusions

Social influence exerted the strongest effect on behavioral intention to use the personal health record app. Consequently, it is necessary to coordinate health promotion activities in the workplace as well as the operational direction of community institutions such as in workers’ health centers to allow workers to manage their own health via continuous use of the app. In addition, the app should be developed based on a requirement analysis of the balance between both interest groups in consideration of differences in perspective between consumers and service providers.
DenTiUS Plaque, a Web-Based Application for the Quantification of Bacterial Plaque: Development and Usability Study (Preprint)
Authors: Vila-Blanco Nicolás , Freire Vicente , Balsa-Castro Carlos , Tomás Inmaculada , Carreira María J
Published: March 2020

BACKGROUND

In the dentistry field, the analysis of dental plaque is vital because it is the main etiological factor in the 2 most prevalent oral diseases: caries and periodontitis. In most of the papers published in the dental literature, the quantification of dental plaque is carried out using traditional, non-automated, and time-consuming indices. Therefore, the development of an automated plaque quantification tool would be of great value to clinicians and researchers.

OBJECTIVE

This study aimed to develop a web-based tool called DenTiUS and various clinical indices to evaluate dental plaque levels using image analysis techniques.

METHODS

The tool was executed as a web-based application to facilitate its use by researchers. Expert users are free to define experiments, including images from either a single patient (to observe an individual plaque growth pattern) or several patients (to perform a group characterization) at a particular moment or over time. A novel approach for detecting visible plaque has been developed as well as a new concept known as nonvisible plaque. This new term implies the classification of the remaining dental area into 3 subregions according to the risk of accumulating plaque in the near future. New metrics have also been created to describe visible and nonvisible plaque levels.

RESULTS

The system generates results tables of the quantitative analysis with absolute averages obtained in each image (indices about visible plaque) and relative measurements (indices about visible and nonvisible plaque) relating to the reference moment. The clinical indices that can be calculated are the following: plaque index of an area per intensity (API index, a value between 0 and 100), area growth index (growth rate of plaque per unit of time in hours; percentage area/hour), and area time index (the time in days needed to achieve a plaque area of 100% concerning the initial area at the same moment). Images and graphics can be obtained for a moment from a patient in addition to a full report presenting all the processing data. Dentistry experts evaluated the DenTiUS Plaque software through a usability test, with the best-scoring questions those related to the workflow efficiency, value of the online help, attractiveness of the user interface, and overall satisfaction.

CONCLUSIONS

The DenTiUS Plaque software allows automatic, reliable, and repeatable quantification of dental plaque levels, providing information about area, intensity, and growth pattern. Dentistry experts recognized that this software is suitable for quantification of dental plaque levels. Consequently, its application in the analysis of plaque evolution patterns associated with different oral conditions, as well as to evaluate the effectiveness of various oral hygiene measures, can represent an improvement in the clinical setting and the methodological quality of research studies.
A Mobile Gaming Intervention for Persons on Pre-Exposure Prophylaxis: Protocol for Intervention Development and Randomized Controlled Trial (Preprint)
Authors: Whiteley Laura , Olsen Elizabeth , Mena Leandro , Haubrick Kayla , Craker Lacey , Hershkowitz Dylan , Brown Larry K
Published: March 2020

BACKGROUND

In the United States, young minority men who have sex with men (MSM) are the most likely to become infected with HIV. Pre-exposure prophylaxis (PrEP) is an efficacious and promising prevention strategy. However, PrEP’s safety and effectiveness can be greatly compromised by suboptimal adherence to treatment. To maximize the positive impact of PrEP, it is necessary to combine its prescription with cost-effective behavioral interventions that promote adherence and decrease HIV risk behaviors. In this project, we developed a theoretically informed app/gaming intervention to engage young MSM in learning information, practicing behaviors, and improving motivation for HIV preventative behaviors and PrEP adherence.

OBJECTIVE

The goal of this project was to develop and test a cutting-edge, engaging, and entertaining app/gaming intervention for improving adherence to PrEP and building HIV prevention knowledge, skills, and behavior.

METHODS

This study was conducted in two phases. In the developmental phase, we conducted qualitative interviews with young MSM (n=20) to guide the development of the gaming intervention. In the randomized controlled trial, we tested the preliminary efficacy of the gaming intervention compared to a comparison condition among young MSM. Subjects were recruited from the University of Mississippi Medical Center HIV/STI testing clinics (n=60).

RESULTS

Institutional review board approval was received in February 2015. Research activities began in June 2015 and are still ongoing.

CONCLUSIONS

This app/gaming intervention aimed to improve PrEP adherence and HIV preventative behaviors in young MSM. Engaging young MSM in learning information, practicing behaviors, and improving motivation for increased adherence to PrEP has the potential to decrease HIV seroconversion. It is important to develop interventions that are enjoyable, engaging, and easily incorporated into clinical settings.

CLINICALTRIAL

ClinicalTrials.gov RCT02611362; https://tinyurl.com/y65gkuwr

INTERNATIONAL REGISTERED REPORT

DERR1-10.2196/18640
Socially Embodied AI: A Framework for Recognizing the Dynamic Sociality of Artificial Agents Within and Beyond Healthcare (Preprint)
Authors: Seaborn Katie , Miyake Norihisa P. , Pennefather Peter , Otake-Matsuura Mihoko
Published: March 2020

UNSTRUCTURED

Modern forms of technology-augmented healthcare are focusing on personalization of the delivery of medical services. This trend is driven in part by the growing rhetoric around patient diversity, empowerment, and choice as factors that impact the success of care. In parallel, there is a push for applying the latest advances in AI-based systems, especially intelligent agents (IA) or artificial agents (AA), as a way of autonomously carrying out and/or supporting interaction within healthcare service and personal health contexts. Robots, conversational agents, voice assistants, virtual characters—do these disparate forms of AI-based agents applied in care contexts have something in common? When and under what circumstances? Here we describe how they can manifest as “socially embodied AI,” which we define as the state an AI-based agent takes on when embedded within social and technologically nonpartisan “bodies” and contexts: a social form of human-AI interaction (HAII). We argue that this state is constructed by and dependent on human perception, arising when an embodied AI is perceived as having social characteristics and being socially interactive. Moreover, as a “circumstantial” category, we argue that if certain criteria are met, then any embodied AI can become socially embodied; however, this may not be true for all people at all times and in all situations. As a first step towards dealing with this complexity, we present an ontology for demarcating when embodied AI transition into socially embodied AI. We draw from theory and practice in human-machine communication (HMC), human-computer interaction (HCI), human-robot interaction (HRI), human-agent interaction (HAI), and social psychology. We reinforce our theoretical work with expert insights from a card sort workshop. We then propose an ontological heuristic for describing the dynamic threshold through which an AI-based agent becomes socially embodied: the Tepper line. We explore two case studies to illustrate the dynamic and contextual nature of this heuristic in healthcare contexts. We end by discussing possible implications of “crossing the Tepper line” from both AI- and human-centered viewpoints in person-centered care.
Usability of a Detector of Behavioural Disturbances to Monitor Patients with Dementia Living in Long-Term Care Homes: A Focus Group Study (Preprint)
Authors: Choukou Mohamed Amine , Mbabaali Sophia , East Ryan
Published: March 2020

BACKGROUND

The number of Canadians with dementia is expected to rise to nearly 1 million individuals in the next decade. It is more than urgent to find a solution to monitor any unsafe behaviour that could be harmful to patients with dementia and the people around them such as other patients, professionals, or visitors. Current practice does not utilize systems to monitor behaviours of the patients with dementia (PwD) and send alerts when potential dangerous events occur. Events are reported randomly by non-professionals or when a professional notices an absence to a scheduled event.

OBJECTIVE

The purpose of this paper is to evaluate the potential of implementing a detector of behavioural disturbances (DBD) in long-term care homes through a mapping of the perceptions of clinicians and staff members towards this technology.

METHODS

A focus group was conducted with 8 clinicians and staff members and 1 partner of a PwD.

RESULTS

Three themes emerged from a thematic analysis of the perspectives of the stakeholders: (A) capability of the DBD to detect relevant dementia-related behavioural disturbances, (B) characteristics of the DBD and clinical needs and (C) DBD modalities of use.

CONCLUSIONS

The results confirmed the adequacy of the DBD for their daily needs in terms of detecting hazardous behaviours or personal and interpersonal behavioural disturbances. The DBD has been considered useful and easy to use by the focus group participants, meaning that the DBD has a high level of usability.

CLINICALTRIAL

NA
Aftercare of Childhood Cancer Survivors in Switzerland: Protocol for a Prospective Multicenter Observational Study (Preprint)
Authors: Denzler Sibylle , Otth Maria , Scheinemann Katrin
Published: March 2020

BACKGROUND

Most children and adolescents diagnosed with cancer become long-term survivors. For most of them, regular follow-up examinations to detect and treat late effects are necessary, especially in adulthood. The transition from pediatric to adult-focused follow-up care is a critical moment for childhood cancer survivors (CCSs); a substantial proportion of CCSs are lost to follow-up in this transition process and do not attend follow-up care in adulthood. This can have serious effects on survivors’ health if late effects are not discovered in a timely fashion.

OBJECTIVE

In this study, we primarily assess the current follow-up situation, related needs, and knowledge of adolescent and young adult CCSs who have transitioned from pediatric to adult-focused follow-up care. As secondary objectives, we evaluate transition readiness, identify facilitating factors of transition and adherence to long-term follow-up (LTFU) care, and compare three different transition models.

METHODS

The Aftercare of Childhood Cancer Survivors (ACCS) Switzerland study is a prospective, multicenter, observational study that was approved by the ethics committee in February 2019. We are recruiting CCSs from three pediatric oncology centers and using questionnaires to answer the study questions.

RESULTS

To date, we have recruited 58 participants. The study is ongoing, and recruitment of participants will continue until January 2021.

CONCLUSIONS

The ACCS study will provide information on CCSs’ preferences and expectations for follow-up care and their transition into the adult setting. The results will help improve the LTFU care and cancer knowledge of CCSs and subsequently enhance adherence to follow-up care and reduce loss to follow-up in adulthood.

CLINICALTRIAL

ClinicalTrials.gov NCT04284189; https://clinicaltrials.gov/ct2/show/NCT04284189?id=NCT04284189

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/18898