bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond monitoring functionality to results evaluation of eHealth interventions: Development and validation of an eHealth evaluation framework
Authors: Ashaba Justus , Nabukenya Josephine
Published: November 2022

Evidencing eHealth interventions, benefits generates data as a basis for assessing whether observed changes in behavior, processes or healthcare outcomes can be attributed to the eHealth interventions. Generating such evidence requires the use of frameworks or some other type of organizing schemes to help in guiding the process and making sense of eHealth systems and the findings. The frameworks available in literature do not clearly guide on how to monitor eHealth implementation and evaluate eHealth implementation results. This study aimed to develop and validate an eHealth evaluation framework to guide the process of monitoring eHealth implementations and evaluation of eHealth results in terms of outcomes and impact on healthcare in developing countries. The Design Science Research Methodology was followed to conduct this study. Recommendations from an eHealth evaluation exploratory study in Uganda and other eHealth evaluation literature formed key inputs into the design and development of the framework. The framework consists of a generic reference model with eHealth monitoring and evaluation dimensions, performance indicators, and guidelines on how to conduct eHealth monitoring and evaluation. The eHealth evaluation framework received high acceptance (>80%) as regards its fitness for purpose during its validation.
Ethnic prejudices and public support for anti-discrimination policies on the housing market
Authors: Verhaeghe Pieter-Paul , Martiniello Billie , Bourabain Dounia
Published: November 2022

Notwithstanding persistent levels of ethnic discrimination on the rental housing market, we have witnessed in many West-European countries a shift from targeted multicultural to colour-blind policies. At the same time, anti-immigration attitudes remained relatively stable. Whether and how these attitudes are translated in support or aversion toward anti-discrimination policies is, however, still unclear. As the first study in Europe we analyse public support for eight policy measures to tackle rental discrimination against ethnic minorities. Based on multilevel analyses among a sample of 899 adults in Belgium, we show that there is large support among the general public for testing, training and campaigning against ethnic discrimination on the housing market. General support for affirmative action measures is, however, much lower. In addition, support for anti-discrimination policies is strongly related to ethnic prejudices. People with more – especially subtle – prejudices are less likely to support policies against rental discrimination. Moreover, prejudices also mediate the effects of interethnic contacts and outgroup size on policy support. Finally, local housing market indicators do not play a significant role in the public support for anti-discrimination policies on the housing market.
Prestige Orientation and Reconciliation in the Workplace
Authors: Ohtsubo Yohsuke , Yamaura Kazuho
Published: November 2022

Human social hierarchies comprise two distinct bases of status: dominance and prestige. One can acquire high social status not only by physically intimidating others (dominance) but also by providing information goods to others (prestige). Given that prestige-oriented individuals need to be liked and accepted by others, we hypothesized that they would be more eager to reconcile with their coworkers when they were involved in interpersonal conflicts in their workplaces. Study 1 asked 487 respondents about their conciliatory behaviors in response to workplace conflicts. Prestige-oriented individuals were more apologetic (when they hurt someone in their workplace) and forgiving (when they were hurt by someone). However, analyses of a subsample of respondents who had conflicts with their followers showed that organizational leaders’ prestige orientation was associated only with forgiveness but not with apologetic behavior. Study 2 collected comparable data from 678 organizational leaders. Study 2 confirmed the results of the subsample analysis of Study 1. Compared with leaders low in prestige orientation, leaders high in prestige orientation were more likely to forgive their subordinates; however, they were no more likely to apologize to their subordinates.
China: The Under-Researched Nexus of Activity
Authors: Probert Simon
Published: November 2022

In recent years there has been a significant shift in the international school market in China, from educating predominantly the children of expatriates to educating Chinese nationals. This article will examine the problems such schools face in terms of putting together an international curriculum, not least in terms of the complex web of stakeholders often involved in such schools, and also the need to comply with local curriculum standards. Examining the notion of the ‘glocal’, and intercultural communicative competence as a means of bridging the divide between local and global curriculum themes, this article will consider ways of reducing the impact of these issues on curriculum planning, proposing a model moving forward, and arguing that these schools represent a new paradigm in the evolution of international education in China.
Sustainable Leadership in Private International Schools: Lessons from Kuwait
Authors: Ellen Kelly Mary
Published: November 2022

The rapid, global growth of the private international school sector has raised demand for qualified school administrators to lead schools in that sector. Many administrators hired into that sector face particular challenges when coming from public systems in other countries. The question is in what ways do gaps between the training and experience of recruits and the demands of the sector compromise the sustainability of effective leadership in private international schools. There are implications for policy development around training and support for leaders in this sector as, unlike many national public systems, it lacks a supply of specifically trained leaders. This article presents a qualitative study of semi-structured interviews with 17 international school leaders who moved from national public systems abroad to private international schools in Kuwait. The major themes that emerged in those interviews were the challenges faced by leaders in adjusting to differing governance structures, the business and marketing aspects of private international schools, and managing the transience of staff. A number of similar themes have been cited in research on international schools in other world regions, although some expressions of those themes are particular to Kuwait. This article concludes with a discussion of the need to provide sustainable norms for leadership across the international school sector, with training and support to help school leaders transition and work more effectively in the sector.
Incentivizing Pregnant Women to Quit Smoking in the Real World—A Community-Based Pilot Intervention
Authors: Yon Bethany , Williams Rhonda , Wedin Jennifer , Underhill Lisa , Kurti Allison
Published: November 2022

Smoking during pregnancy is a leading preventable cause of poor pregnancy outcomes. Financial incentives interventions yield quit rates of approximately 30% during pregnancy, versus approximately 4% in traditional smoking cessation programs. This pilot study assessed the feasibility of translating an efficacious University of Vermont research-based intervention into a rural community setting delivered by the Vermont Department of Health. Pregnant women using tobacco products were recruited from the Women, Infants and Children program and Rutland Women’s Healthcare. Women were provided in-person tobacco cessation counseling during regularly scheduled meetings and received gift cards throughout pregnancy and 3 months postpartum contingent upon biochemically verified smoking abstinence. Cessation counseling and abstinence monitoring began with high frequency (three visits per week), tapering through postpartum to biweekly visits. Gift card values began at $15, increasing by $5 for consecutive negative samples, to $40 maximum. Participants completed three surveys (enrollment, 4–6 weeks postpartum, 6–12 months postpartum) assessing smoking habits, and barriers and facilitators of treatment engagement and success. From 2018 to 2020, we enrolled 20 pregnant women, of whom six self-reported quitting tobacco at some point during the intervention. At study completion, three reported sustained abstinence. Results suggest that it is feasible to translate a research-based smoking cessation program into a community setting. This article discusses the challenges faced and the lessons learned when implementing research in a rural community setting, recruiting and retaining participants, and adapting protocols during the Covid-19 pandemic.
The Effect of Black Cohosh on Ki67 expression and Tumor Volume: A Pilot Study of Ductal Carcinoma in Situ Patients
Authors: Trant Amelia A. , Chagpar Anees , Wei Wei , Neumeister Veronique , Rimm David , Stavris Karen , Lurie Bonnie , Frederick Courtney , Andrejeva Liva , Raghu Madhavi , Killelea Brigid , Horowitz Nina , Lannin Donald , Knill-Selby Elspeth , Sturrock Tracy , Hofstatter Erin
Published: November 2022

Background:

Black cohosh (BC) ( Cimicifuga racemosa) may prevent and treat breast cancer through anti-proliferative, pro-apoptotic, anti-estrogenic, and anti-inflammatory effects. This study sought to evaluate the effect of BC on tumor cellular proliferation, measured by Ki67 expression, in a pre-operative window trial of ductal carcinoma in situ (DCIS) patients.

Methods:

Patients were treated pre-operatively for 2 to 6 weeks with BC extract. Eligible subjects were those who had DCIS on core biopsy. Ki67 was measured using automated quantitative immunofluorescence (AQUA) pre/post-operatively. Ki67, tumor volume, and hormone changes were assessed with 2-sided Wilcoxon signed-rank tests, α = .05.

Results:

Thirty-one patients were treated for an average of 24.5 days (median 25; range 15-36). Ki67 decreased non-significantly (n = 26; P = .20; median pre-treatment 1280, post-treatment 859; range pre-treatment 175-7438, post-treatment 162-3370). Tumor volume, estradiol, and FSH did not change significantly. No grade 3 or 4 adverse events were reported.

Conclusions:

BC use showed no significant impact on cellular proliferation, tumor volume, or invasive disease upgrade rates in DCIS patients. It was well-tolerated, with no observed significant toxicities. Further study is needed to elucidate BC’s role in breast cancer treatment and prevention. ClinicalTrials.gov Identifier: NCT01628536 https://clinicaltrials.gov/ct2/show/NCT01628536
Fatigue During Cancer-Related Radiotherapy and Associations with Activities, Work Ability and Quality of Life: Paying Attention to Subgroups more Likely to Experience Fatigue
Authors: Tödt Kristina , Engström Maria , Ekström Magnus , Efverman Anna
Published: November 2022

Background:

Having knowledge of which patients are more likely to experience fatigue during radiotherapy and the relationship between fatigue and health-related quality of life (HRQL) is important to improve identification and care of patients experiencing burdensome fatigue.

Objective:

To identify subgroups of patients, varying in situational, physiological, and psychological factors, who are more likely to experience fatigue an ordinary week of radiotherapy, and to compare patients experiencing and not experiencing fatigue regarding perceived HRQL and functional performance, that is, daily and physical activity and work ability.

Methods:

Cross-sectional study of 457 patients (52% women) undergoing radiotherapy (38% breast, 32% prostate cancer), using self-reported questionnaire data on fatigue, HRQL and functional performance analyzed using multivariable regression models.

Results:

Of the 448 patients who answered the fatigue question, 321 (72%) experienced fatigue. Patients reporting any comorbidity or depressed mood were more likely to experience fatigue, relative risk (RR) 1.56 ([95% confidence interval (CI)] 1.13-2.16) and RR 2.57 (CI 1.73-3.83), respectively. Patients with fatigue reported worse HRQL and performed less physical activity, including daily ( P = .003), vigorous ( P = .003) and moderate ( P = .002) activity. Patients with and without fatigue reported 60% versus 40% sickness absence.

Conclusion:

Patients with depressed mood or comorbidity were more likely to experience fatigue an ordinary week of radiotherapy than other patients were. Patients experiencing fatigue perceived worse HRQL and performed less daily and physical activity compared to patients not experiencing fatigue. Cancer care practitioners may consider paying extra attention to these subgroups of patients.
Patterns of Pathology
Authors: Kilianski Scott , Beenhakker Mark P.
Published: November 2022

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Genetic Mechanisms Behind Severe Psychotic Reactions to Levetiracetam
Authors: Andrade Danielle M.
Published: November 2022

[Box: see text]
Aligning Orifice of the Renal Artery with Fish-Mouth FIXation Technique During Endovascular Aortic Aneurysm Repair for Hostile Neck Anatomy
Authors: Domoto Satoru , Azuma Takashi , Hayakawa Minako , Yamagata Akiko , Isomura Shogo , Niinami Hiroshi
Published: November 2022

Background: As the success of endovascular aortic aneurysm repair (EVAR) depends on sufficient proximal fixation of the endograft to the aortic wall, the proximal hostile neck anatomy (HNA) is the major potential treatment-limiting factor in EVAR. The Aorfix endovascular stent graft was designed to operate on highly angulated aortic necks. The Aligning Orifice of the Renal artery with fish-mouth FIXation (AORFIX) technique uniquely and accurately aligns the trough part of the proximal stent end with the orifice of the lower renal artery and is used to optimize the proximal fish-mouth design for maximum proximal seal use. Herein, we aimed to evaluate the usefulness of the AORFIX technique for EVAR in patients with HNA. Methods: Eighty-one consecutive patients who underwent EVAR with the AORFIX technique (+AORFIX technique group, n = 16) and without (standard group, n = 65) were evaluated. The HNA was defined as any of the following: neck angulation ≥60°, neck length ≤15 mm, or neck thrombus or calcification ≥50% of the circumference and conical neck. Results: Each HNA criterion was similar between the two groups. However, the average number of HNA criteria was significantly higher in the +AORFIX technique group (1.9 ± .2 vs. 1.3 ± .1; P < .01). The two groups showed 100% procedural success. The concurrent renal angioplasty and stenting rates (88% vs. 4.6%; P < .01) were significantly higher in the +AORFIX technique group. There were no 30-day deaths in either group and no in-hospital device-related events in the +AORFIX technique group. The median follow-up period was 39 months, and there was no significant between-group difference in freedom from reintervention rate (+AORFIX group vs. standard group, 100% vs. 91.0%; P = .327). Conclusion: EVAR using the AORFIX technique might be useful even in patients with more complex HNA.
Research ethics in a changing social sciences landscape
Authors: Brown Nicole
Published: November 2022

The role of research ethics committees, and research ethics issues more broadly are often not viewed in the context of the development of scientific methods and the academic community. This topic piece seeks to redress this gap. I begin with a brief outline of the changes we experience within the social sciences before exploring in more detail their impact on research ethics and the practices of research ethics committees. I conclude with recommendations for how the existing research ethics processes may be made more future-proof.
Musculoskeletal symptoms and training characteristics differ between sex and playing positions: A cross-sectional study among high-performance Brazilian beach handball players
Authors: de Carvalho-Nicolau Raquel , Bittar Simoni Teixeira , Tilp Markus , de Azevedo Lago Silvo , dos Santos Oliveira Leonardo
Published: November 2022

This study analysed self-reported musculoskeletal symptoms and training characteristics of high-performance Brazilian beach handball athletes. In a cross-sectional study, 28 men (mean (standard deviation), age: 23 (5) years, body mass: 81.9 (14.4) kg, height: 181.3 (8.6) cm, experience: 13.3 (5.4) years) and 27 women (mean (standard deviation), age: 28 (8) years, body mass: 65.5 (12.7) kg, height: 170.4 (4.9) cm, experience: 9.3 (3.0) years) answered an online questionnaire about anthropometric and sociodemographic aspects, musculoskeletal symptoms, and training characteristics. The results showed that the musculoskeletal symptoms are more prevalent in the knees during the previous seven days and in the shoulder during the previous 12 months. Left-wing players were more affected by musculoskeletal symptoms in the shoulder than right-wing players and central defenders during the previous seven days regardless of the sex. Problems in the elbow area presented a higher prevalence in the male players compared to the female players in the past 12-month period. The training volume was higher for men compared to women, regardless of the playing position. Moreover, beach handball athletes who reported training five days/week or 360 min/week or more were more likely to develop musculoskeletal symptoms in the elbow compared to those who had a lower frequency and duration of training. Musculoskeletal symptoms occurred most in the shoulders and knees, differing between sex and playing positions. Higher frequency and duration of training were independent risk factors for chronic musculoskeletal symptoms in the elbow compared to a lower volume of training.
The subjective task load responses and movement characteristics associated with purposefully designed games in junior Touch players
Authors: Dobbin Nick , Atherton Anthony , Hill Colin
Published: November 2022

This study sought to design five touch-specific modified games and evaluate the subjective task load responses and movement characteristics. Forty-two high-performance junior Touch players completed five modified games during a single training session. Each game was designed to increase the physical, technical, mental, frustration or temporal load. Subjective task loads were measured after each game using the NASA task load index (NASA-TLX) questionnaire. Movement characteristics were recorded using global positioning systems. Data were analysed using a one-way repeated measures analysis of variance, and the association between movement characteristics and subjective task loads were assessed using linear mixed modelling. Clear between-game differences were observed in physical, technical, mental, frustration, temporal and technical load, indicating that the load for which the game was designed to increase (e.g. physical load  =  physical game) was higher than all other games (ηp2  =  0.118–0.211, all P < 0.001). No differences were observed across games for effort, performance, mean or total load (ηp2  =  0.004–0.030, P  =  0.178–0.947). Small to large differences in the movement characteristics were observed across the five games (ηp2  =  0.057–0.577, P < 0.001–0.017). The most prominent movement characteristic associated with the NASA-TLX responses was relative distance; it was positively associated with physical and temporal load ( r  =  0.16–0.24, both P < 0.05) and negatively associated with technical, mental and effort load ( r  =  −0.29 to −0.06, P < 0.001–0.353). Overall, coaches and sport scientists can design games for Touch players that increase loads through the rules, intention of the game, and by altering relative distance.
Journalistic role orientations in Rwanda, Uganda and Kenya
Authors: McIntyre Karen , Sobel Cohen Meghan
Published: November 2022

This study examines how journalists in Rwanda, Uganda and Kenya perceive their journalistic role orientations in light of the countries’ differing political systems, Rwanda representing the nation with the most restrictive political system, Uganda sitting in the middle and Kenya illustrating the nation that is home to the least restrictive political system. Data were analyzed from a comparative, quantitative online survey completed by 424 journalists from the three East African nations. Overall, the journalistic role orientations that emerged in each country align with the freedoms afforded by the political system in each country, revealing a trend that journalists in non-Western countries lean toward more interventionist roles (at times to the point of actively supporting their government), and journalists in countries with less restrictive political systems lean toward more adversarial roles (keeping their government in check).
A review of the therapeutic management of ulcerative colitis
Authors: Aslam Nasar , Lo Sheng Wei , Sikafi Rafid , Barnes Tom , Segal Jonathan , Smith Philip J , Limdi Jimmy K
Published: November 2022

Ulcerative colitis (UC) is a chronic relapsing and remitting gastrointestinal disorder of uncertain aetiology. The last two decades have seen an expansion in the therapeutic arsenal used to treat UC. This has resulted in improved clinical remission and response rates. Nonetheless, staples in our current medical management originate from trials conducted in the early 20th century. In this review article, we aim to outline the key milestones in the history of the medical management of UC in addition to highlighting promising therapeutic developments for the future.
Clearance of ctDNA in triple-negative and HER2-positive breast cancer patients during neoadjuvant treatment is correlated with pathologic complete response
Authors: Ciriaco Nikaoly , Zamora Esther , Escrivá-de-Romaní Santiago , Miranda Gómez Ignacio , Jiménez Flores José , Saura Cristina , Sloane Hillary , Starus Anna , Fredebohm Johannes , Georgieva Lucy , Speight Graham , Jones Frederick , Ramón y Cajal Santiago , Espinosa-Bravo Martín , Peg Vicente
Published: November 2022

Background:

Although the standard of care is to perform surgery of primary breast cancer (BC) after neoadjuvant chemotherapy (NAC), for certain patients achieving clinical complete response (cCR) and pathologic complete response (pCR), omission of surgical treatment may be an option. Levels of circulating tumor DNA (ctDNA) during and after therapy could identify patients achieving minimal residual disease. In this study, we evaluated whether ctDNA clearance during NAC could be a correlate to effective response in human epidermal growth factor receptor 2 positive (HER2+) and triple-negative (TN) BC patients.

Methods:

A prospective study was conducted to identify patient-specific PIK3CA and TP53 mutations in tissue using next-generation sequencing, which could then be used to track the presence/absence of mutations prior to, during, and following NAC using Sysmex SafeSEQ technology. All patients underwent a surgical excision after NAC, and pCR was assessed.

Results:

A total of 29 TN and HER2+ BC patients were examined and 20 that carried mutations in the PIK3CA and/or TP53 genes were recruited. Overall, 19 of these 20 patients harbored at least one tumor-specific mutation in their plasma at baseline. After NAC, 15 patients (75.0%) achieved pCR according to the histopathologic evaluation of the surgical specimen, and 15 patients (75.0%) had a cCR; 18 of 20 patients (90.0%) had concordant pCR and cCR. The status of ‘no mutation detected’ (NMD) following NAC in cCR patients correctly identified the pCR in 14 of 15 patients (93.33%), as well as correctly ruled out pCR in three patients, with an accuracy of 89.47%. During the 12-month follow-up after surgery, 40 plasma samples collected from 15 patients all showed no detectable ctDNA (NMD), and no patient recurred.

Conclusion:

These findings prompt further research of the value of ctDNA for non-invasive prediction of clinical/pathological response, raising the possibility of sparing surgery following NAC in selected BC patients.
From an Obedient Union of Wills to Embodied Theosis: A Pathway to Divinization in St John of the Cross
Authors: Benitan M. C.
Published: November 2022

The union of human and divine wills is a concept that features abundantly in Christian spiritual literature. Yet, it gets very little hearing in most systematic works on theosis despite the fact that it offers a way of talking about the process of divinisation. I propose that the union of human and divine wills is the pinnacle of the virtue of obedience, and that the union in turn constitutes a pathway to divinization. I map this trajectory in St John of the Cross and plot his works as a vademecum on the way to deification. Finally, I consider John’s understanding of the impact of this supernatural union on the human body as well as the role of the latter in deification. Despite uncovering unexpected resources for embodied theosis in John’s writings, I also list major omissions with regards to his (reconstructed) spiritual theology concerning the body transformed by union.
Expression of m6A Methylation Regulator in Osteoarthritis and Its Prognostic Markers
Authors: Zhang Di , Zhang DanDan , Yang XiaoLi , Li Qiang , Zhang RongQiang , Xiong YongMin
Published: November 2022

Objective

Osteoarthritis (OA) is a multifactorial disorder, in which genetic factors are strongly associated with its development. However, the pathogenesis of OA is still unclear, and recently it has been observed that epigenetic modifications are also involved in the pathogenesis of OA. This study aims to study the potential role of m6A-related genes in the occurrence and development of OA.

Design

We downloaded the OA expression profile data (GSE55235) from the Gene Expression Omnibus database. First, function enrichment analysis of 17 representative m6A methylation regulatory factors was performed using the DAVID database and Metascape online tool. Then, we analyzed the expression of 17 m6A methylation regulatory factors in OA and the correlation between regulatory factors using Perl software. Finally, receiver operating characteristic (ROC) curve analysis and the area under the ROC curve were used to evaluate the diagnostic effectiveness of m6A-related genes for discriminating patients with OA and healthy.

Results

We first identified that 12 of the 17 genes were differentially expressed in OA. ALKBH1, EIF3, IGF2BP3, WTAP, and YTHDC1 were associated with early diagnosis and prognosis of OA.

Conclusions

m6A RNA methylation regulator factors are key players in the progression of OA and have potential role in the stratification of prognosis and the formulation of treatment strategies.
EUROVISCO Good Practice Recommendations for a First Viscosupplementation in Patients with Knee Osteoarthritis
Authors: Conrozier Thierry , Diraçoglù Demirhan , Monfort Jordi , Chevalier Xavier , Bard Hervé , Baron Dominique , Jerosch Jörg , Migliore Alberto , Richette Pascal , Henrotin Yves
Published: November 2022

Rationale

Viscosupplementation (VS) with hyaluronic acid is widely used in the management of knee osteoarthritis. There is no clear recommendation on the decision-making to achieve VS.

Design

Based on extensive research of the literature and expert opinion, the members of the EUROVISCO (European Viscosupplementation Consensus Group) task force were asked to give their degree of agreement with 60 issues, using a Delphi method.

Results

The expert panel achieved unanimous agreement in favor of the following statements: It is recommended to assess pain on a visual or 10-point numeric scale before considering VS. VS can be considered for patients with pain scores between 3 and 8. A standard x-ray must be obtained before the decision of VS. If the x-ray is normal, osteoarthritis must be confirmed by MRI or computed tomography (CT) arthrogram before considering VS. The aims of VS are relieving pain, improving function, and reducing non-steroidal anti-inflammatory drug (NSAID) consumption. The use of VS must not be considered for treating an osteoarthritis flare. VS can be envisaged as a first-line pharmacological treatment in patients having a contra-indication to NSAIDs or analgesics. VS can be considered in patients with contra-indications to arthroplasty. In the case of severe comorbidities (diabetes, hypertension, gastrointestinal disorders, renal failure), VS can avoid the use of potentially dangerous treatments. VS can be considered in patients receiving antiplatelet agents, vitamin K antagonists, and direct factor Xa or thrombin inhibitors. Five other statements obtained a high level of consensus.

Conclusion

These recommendations, illustrated in a decision algorithm, have been established to help practitioners in the decision-making of knee VS.
Treatment of acquired pyloric stenosis via Y-U pyloroplasty in a Burmese cat
Authors: Preibisz Aleksandra , Slunsky Pavel , Schwedes Claudia Sabine
Published: November 2022

Case summary

An 11-year-old female spayed Burmese cat was presented for chronic intermittent vomiting. Previous medical and dietary treatments were unsuccessful. Endoscopically, a narrow pyloric outlet was found and Y-U pyloroplasty was performed. The clinical signs disappeared postoperatively after treatment with a proton pump inhibitor and dietary management.

Relevance and novel information

This is the first case report of feline-acquired pyloric stenosis with documented histopathological findings from a full-thickness biopsy of the pyloric sphincter. In addition, this is the first case of Y-U pyloroplasty being conducted in a cat. The histopathological findings might help explain the pathogenesis of this disorder in cats.
Interaction at the primary–secondary care interface: Patients’ and physicians’ perceptions of teleconsultations
Authors: Maria Ana Rita J , Serra Helena , Castro Maria G , Heleno Bruno
Published: November 2022

Introduction

Previous qualitative research on teleconsultations has focused on synchronous communication between a patient and a clinician. This study aims to explore physicians' and patients' perceptions of the interaction on the interface between primary care and the Cardiology service of a referral hospital through teleconsultations.

Methods

This qualitative study was embedded in an organizational case study concerning the introduction and rollout of a new service model that took place at the point of care. The patients and physicians were recruited for semi-structured interviews until thematic saturation was achieved, between September 2019 - January 2020. The interviews were audiorecorded and anonymized. The transcribed interviews were stored, coded, and analyzed in MAXQDA, following the steps for conventional content analysis.

Results

A total of 29 participants were interviewed. Patients and physicians presented clear views about the role of the GP and the cardiologist and their function in overall structure of healthcare. GPs felt their role was to bring expertise in the patient which could supplement the cardiologists' expertise on the condition. However, GPs had to renegotiate roles in the teleconsultations when they saw themselves in a new situation, together with another physician and the patient.

Conclusions

Our findings suggest that joint teleconsultations can promote continuity of care for patients in the primary/secondary care interface. Active coordination between physicians with delineation of roles throughout primary-secondary care interface is needed to manage selected patients who may benefit the most from shared care.
Access, charge and quality of tele-dermatology e-consults in China: A standardized patients study
Authors: Guo Rui , Hou Mengchi , Han Yangyang , Feng Xing Lin
Published: November 2022

Objective

Direct-to-consumer telemedicine is rapidly changing the way that patients seek medical care. This study provided the first report on access, cost and quality of text- and image-based tele-dermatology e-consults, in China.

Methods

We adopted the Standardized Patients approach to evaluate the services of tele-dermatology e-consults in two metropolitan cities, that is, Beijing and Hangzhou, in China. We measured quality from four dimensions: service process, diagnosis accuracy, prescription and treatment comprehensiveness, based on China's national clinical guidelines. We performed logistic regressions to investigate factors that were associated with high-quality care.

Results

For 114 physicians eligible for inclusion, we succeeded in 87 (76%) validated visits. The median waiting time was 100 minutes (IQR 19–243 minutes) and the median length of consultation was 636 minutes (about 10 hours, IQR 188–1528 minutes). Per visit costs varied from $0 to $38, with a median of $8 (IQR 4–9). Among all, 15% of visits showed high quality in service process, 84% arrived in the correct diagnosis, 24% provided high-quality prescriptions and 71% provided comprehensive treatment. Providing images was associated with high quality in service process (OR 7.22, 95% CI 1.49–34.88). Visits in metropolitan Beijing and on non-work days had better prescription quality than that in metropolitan Hangzhou (OR 6.05, 95% CI 1.75–20.95) and that on workdays (OR 3.75, 95%CI 1.27–11.04), respectively.

Conclusions

Tele-dermatology e-consults seem to be easy to access and less expensive in China. However, great efforts are warranted to ensure that service processes and prescriptions adhere to clinical guidelines.
Effectiveness of an Accelerated Rehabilitation Protocol After Tibial Tubercle Osteotomy
Authors: Morgan Courtney , Bell Ryan M. , Burland Julie P. , Kriscenski Danielle , Ilinski Adrian , Cote Mark P. , Edgar Cory M.
Published: November 2022

Background:

Patients with recurrent patellar dislocations with trochlear dysplasia are commonly treated surgically with a tibial tubercle osteotomy (TTO). Recovery and rehabilitation processes are often nonoperative out of concern for fixation failure or fracture. A more accelerated rehabilitation protocol allowing for early weightbearing and quadriceps strengthening may help to improve patient outcomes as long as complications are not increased.

Purpose:

To evaluate the safety and effectiveness of an accelerated weightbearing and early strengthening postoperative rehabilitation program for patients who undergo TTO.

Study Design:

Case series; Level of evidence, 4.

Methods:

Included were patients who underwent unilateral/staged bilateral TTO performed by a single surgeon between August 2013 and February 2018 with ≥6 months of follow-up. The surgical indication was primarily for patients with recurrent patellar instability. In all cases, a diagnostic arthroscopy was performed to evaluate the cartilage surfaces and document patellar tracking. The TTO was performed using a freehand technique and two 3.5-mm fully threaded screws for fixation. Patients underwent an accelerated postoperative rehabilitation program that allowed for weightbearing and lower extremity strengthening starting at 4 weeks. Objective and subjective outcome measures included any postoperative complications, knee range of motion, and patient-reported outcome scores (Kujala Anterior Knee Pain Scale [AKPS] and Knee injury and Osteoarthritis Outcome Score composite [(KOOS5]).

Results:

A total of 51 knees in 50 patients (38 female, 12 male) with a mean age of 31.24 ± 12.57 years were included in the final analysis. Compared with preoperative values, postoperative maximum knee flexion was significantly improved (117.67° ± 32.65° vs 131.12° ± 9.02°, respectively; P = .022). Postoperative complications included 6 patients with arthrofibrosis requiring manipulation under anesthesia, 4 with removal of symptomatic hardware, 1 tibial fracture (due to a fall), and 1 conversion to patellofemoral arthroplasty. The mean postoperative AKPS and KOOS5 scores were 72.98 ± 21.51 and 75.05 ± 16.02, respectively.

Conclusion:

Accelerated postoperative rehabilitation in TTO patients was an effective means of treatment with good subjective and objective outcomes and complication rates lower than traditional rehabilitation protocols.
Return to Sport After Revision ACL Reconstruction: A Comparative Cohort Study of Outcomes After Single- Versus Multiple-Revision Surgeries
Authors: El Khoury Georges , Hardy Alexandre , Saint-Etienne Adrien , Saghbiny Elie , Meyer Alain , Grimaud Olivier , Gerometta Antoine , Lefevre Nicolas , Bohu Yoann
Published: November 2022

Background:

The return-to-sport rate at 2 years after multiple-revision anterior cruciate ligament (ACL) reconstructions has not been evaluated.

Hypothesis:

It was hypothesized that patients who undergo multiple-revision ACL reconstructions would have a lower return-to-sport rate at 2 years after surgery than those who undergo a single-revision reconstruction. Furthermore, it was hypothesized that the multiple-revision group would have lower functional scores.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A single-center cohort study in patients who underwent revision ACL reconstruction was begun in 2012. This study included 2 groups: Patients who underwent a single revision, and those who underwent multiple revisions. The main evaluation criterion was the return to sport at the 2-year follow-up. The secondary criteria were the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and ACL–Return to Sport after Injury (ACL-RSI) functional knee scores at the 1- and 2-year follow-ups.

Results:

A total of 322 patients (single-revision group: n = 302; multiple-revision group: n = 20) were included. A significant difference in the percentage of patients who stopped all sports activity was found between the 2 groups at 2 years (single-revision group: 19.4%; multiple-revision group: 50%). The return-to-sport rate at the same or lower level of performance was higher in the single-revision group as well (17% vs 14.3% for return at the same level; 45.6% vs 14.3% for return at a lower level; P = .03). At the 2-year follow-up, the functional scores of the single-revision group were significantly higher those than in the multiple-revision group: IKDC (77.7 ± 13.82 vs 64.79 ± 15.22; P < .001), KOOS (72.66 ± 17.63 vs 52.5 ± 15.64; P < .001), Lysholm (84.05 ± 11.88 vs 72.5 ± 13.49; P < .001), and ACL-RSI (52.34 ± 21.83 vs 46.43 ± 14.8; P = .0036).

Conclusion:

Only a small percentage of patients returned to the same level of sport after single- revision and multiple-revision ACL reconstruction, yet significantly more in the former. More patients who underwent multiple revisions gave up their sport. Functional scores were higher for single-revision than multiple-revision surgeries.
Range of Motion, Strength, and Function After ACL Reconstruction Using a Contralateral Patellar Tendon Graft
Authors: Shelbourne K. Donald , Benner Rodney , Gray Tinker , Bauman Scot
Published: November 2022

Background:

Regaining preinjury levels of activity and progressing rehabilitation factors after anterior cruciate ligament (ACL) reconstruction have shown mixed results.

Purpose:

To evaluate the timing and rate of return for knee range of motion (ROM), stability, strength, and subjective scores after ACL reconstruction with contralateral patellar tendon graft (PTG).

Study Design:

Case series; Level of evidence, 4.

Methods:

Included were 2148 patients (1238 male patients, 910 female patients) who underwent primary ACL reconstruction with a contralateral PTG between 1995 and 2017 and had complete objective data through 3 months of follow-up. All patients participated in a rehabilitation program specific to goals for each knee. Patients were evaluated objectively with goniometric measurement of ROM, isokinetic quadriceps strength testing, and laxity with a KT-2000 arthrometer. Subjective data were collected at 2 and 5 years.

Results:

Normal extension on the reconstructed knee was attained for 95% of patients at 1 week postoperatively; normal flexion on the reconstructed knee was reached by 77% of patients by 3 months. At 3 months postoperatively, mean limb symmetry index strength was 104%, and the strength on the ACL-reconstructed and graft-donor knees was 87% and 86% of their respective preoperative strength. Mean manual maximum side-to-side difference in laxity was 2.0 mm at 1 month. Most patients (90%) returned to level 8 sports or higher and did so at an average of 5.7 months. Mean International Knee Documentation Committee scores for the ACL-reconstructed and graft-donor knees were 89 and 91 at 2 years (n = 1015 patients) and 84 and 90 at 5 years (n = 1275 patients), respectively. Mean Cincinnati Knee Rating Scale scores for the ACL-reconstructed and graft-donor knees were 92 and 96 at 2 years (n = 1184) and 88 and 94 at 5 years (n = 1236), respectively.

Conclusion:

For patients who underwent ACL reconstruction with a contralateral PTG, postoperative ROM and strength were restored quickly by splitting the rehabilitation into different goals between the two knees. Using a contralateral PTG, this structured rehabilitation plan can lead to a relatively quick return to sport and good subjective long-term outcomes.
A New Normality Illuminated by Past and Present! A Qualitative Study: Experiences and Challenges of Everyday Life in Patients With Advanced Heart or Lung Failure
Authors: Graarup Jytte , Højskov Ida Elisabeth
Published: November 2022

The aim of this study was to gain insight into the phenomena of everyday life as experienced and coped with by patients living with advanced heart or lung failure. We employed a qualitative design using a phenomenological hermeneutic approach. Data derived from 10 nursing consultations in a holistic setting. Ricoeur’s theory of interpretation inspired the text analysis. The study emphasizes time (past, present, and future) as an overall everyday life theme, playing an essential role associated with improvements or poor outcomes related to physical, mental, and intersubjective challenges. Patients accepted and lived with the challenges, experiencing changes, as transition, but also coped with their new normal, which involved improvements or poor outcomes, some invisible to the community. Assumptions about everyday life changed significantly, the changes possibly essential for intersubjective relations. A reflective approach, can help patients to evolve, using knowledge from the past and present to cope with the future.
Predicting housing construction period based on a cox proportional hazard model––an empirical study of housing completions in the greater Toronto and Hamilton area
Authors: Zhang Yu , Miller Eric J
Published: November 2022

The completion progress of residential development projects and the length of construction are frequently discussed in the construction industry, but rarely studied by urban modellers. Nonetheless, a realistic reflection of housing supply processes is important for urban microsimulation and land use modelling. To predict the dwelling units generated over space and time, this paper decomposes the housing supply process into two major components: housing starts and completions, the nature and modelling logic of which are quite different. This paper deals with the latter segment, aiming to answer the question of: how long will it take to complete construction of new dwellings? A Cox Proportional Hazard (CPH) Model is employed to examine the “survival” rate of residential building projects and the probabilistic distribution of construction periods. Narrowing down the scope of research, this study investigates housing completions at the individual project level, and discusses the impact of structure type, surrounding land use, and accessibility on the housing completion rate. The Cities of Toronto, Hamilton, and Brampton in the Greater Toronto and Hamilton Area (GTHA) were selected to conduct the empirical study, with each representing different types of urban form to test model compatibility. The hazard models show good performance in replicating completion rates, and the impact of each factor on hazard ratio indicates that, single detached dwelling units with relatively homogeneous land use have the shortest completion time. This study could provide one component of a comprehensive framework for modelling housing supply, especially in urban microsimulation systems.
The Interaction of Trauma Exposure and DNA Methylation on Blood Pressure Among Black Women in the InterGEN Study
Authors: Caceres Billy A , Huang Yunfeng , Barcelona Veronica , Wang Zeyuan , Newhall Kevin P , Cerdeña Jessica P , Crusto Cindy A , Sun Yan V , Taylor Jacquelyn Y
Published: November 2022

Objective:

Despite evidence that trauma exposure is linked to higher risk of hypertension, epigenetic mechanisms (such as DNA methylation) by which trauma potentially influences hypertension risk among Black adults remain understudied.

Methods:

Data from a longitudinal study of Black mothers were used to test the hypothesis that direct childhood trauma (ie, personal exposure) and vicarious trauma (ie, childhood trauma experienced by their children) would interact with DNA methylation to increase blood pressure (BP). Separate linear mixed effects models were fitted at each CpG site with the DNA methylation beta-value and direct and vicarious trauma as predictors and systolic and diastolic BP modeled as dependent variables adjusted for age, cigarette smoking, and body mass index. Interaction terms between DNA methylation beta-values with direct and vicarious trauma were added.

Results:

The sample included 244 Black mothers with a mean age of 31.2 years (SD = ±5.8). Approximately 45% of participants reported at least one form of direct childhood trauma and 49% reported at least one form of vicarious trauma. Epigenome-wide interaction analyses found that no CpG sites passed the epigenome-wide significance level indicating the interaction between direct or vicarious trauma with DNAm did not influence systolic or diastolic BP.

Conclusions:

This is one of the first studies to simultaneously examine whether direct or vicarious exposure to trauma interact with DNAm to influence BP. Although findings were null, this study highlights directions for future research that investigates epigenetic mechanisms that may link trauma exposure with hypertension risk in Black women.
Arthroscopic Stabilization of Posterior Shoulder Instability Without Glenoid Bone Loss
Authors: Feinstein Shawn D. , Gregory James M.
Published: November 2022

Background:

Contact athletes who experience posterior shoulder instability have a high likelihood of recurrence necessitating surgery.

Indications:

Patients with posterior shoulder instability without glenoid or humeral head bone loss who have failed activity modification, bracing, and physical therapy may benefit from arthroscopic stabilization surgery.

Technique Description:

We describe a technique for arthroscopic labral repair with capsular plication through 4 portals in the lateral decubitus position.

Results:

Arthroscopic capsulolabral reconstruction is an effective and reliable treatment for posterior shoulder instability with good patient-reported outcomes, low recurrence rates, and high rate of return-to-play.

Discussion/Conclusion:

Arthroscopic capsulolabral reconstruction in the lateral decubitus position with appropriately placed portals allows for safe and effective repair of the labrum and capsular plication to address posterior shoulder instability. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.