bluuebunny/crossref_metadata_2025 huggingface dataset:
Military experience in the management of pelvic fractures from OIF/OEF
Authors: Parker William , Despain R W , Bailey J , Elster E , Rodriguez C J , Bradley M
Published: September 2020

Introduction

Pelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures.

Methods

We conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined.

Results

Of 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy.

Conclusions

Pelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.
Practical limitations of emergency donor panels as a risk mitigation in small-scale short-term training team operations
Authors: Grant Simon William James , Heil K M
Published: September 2020

Haemostatic resuscitation with blood products has become the expected standard of care for trauma casualties. As UK Defence increases its deployment of small-scale, short-term training teams (STTTs) in Defence Engagement and influence operations, ever greater reliance is being placed on emergency donor panels (EDP) as a source of whole blood. This paper outlines the practical limitations of using EDPs as a risk mitigation in conventional STTTs which must be considered prior to every deployment.
Activities and programmes that support the emotional wellness and well-being of refugees, immigrants and other newcomers within settlement agencies: a scoping review protocol
Authors: Goopy Suzanne , Suva Cesar , Hayden K. Alix , Silversides Halley , Palova Katerina
Published: September 2020

Introduction

Obstacles to successful settlement—social isolation, language hardship, issues with employment, housing questions, transportation, barriers to health, education and government service access—all potentially play a role in emerging physical and mental health problems. The objective of this scoping review is to map the available evidence in order to provide an overview of the services and resources offered to refugees, immigrants and other newcomers by settlement agencies to support emotional wellness and well-being.

Methods and analysis

The protocol to be followed for this scoping review is based on the Joanna Briggs Institute to provide a map of the current and emergent literature, and examine the extent, range and nature of this literature. The proposed scoping review will also identify the gaps in research pertaining to the emotional wellness of refugees, immigrants and other newcomers as well as summarise and disseminate research findings and provide direction for future reviews. Key databases for this scoping review include APA PsycINFO, Medline, Embase, Cumulative Index of Nursing and Allied Health Literature Plus, Academic Search Complete, and Education Research Complete. The database search start and end dates for this scoping review will be from inception to July 2020. The article searches will take place between August and October 2020.

Ethics and dissemination

Ethics is not required as the research will not involve human or animal subjects. The research is a scoping review, and thus relies on published and grey literature studies and documents. The findings of this proposed scoping review will be disseminated through future publications as well as presentations to relevant stakeholders, including immigrant serving agencies. We anticipate that this scoping review will identify gaps in research pertaining to the emotional wellness of refugees, immigrants and other newcomers. The results of this review will be the first comprehensive recent survey of emotional wellness practices employed by settlement agencies.
Impact of political conflict on tuberculosis notifications in North-east Nigeria, Adamawa State: a 7-year retrospective analysis
Authors: Pembi Emmanuel , John Stephen , Dumre Shyam Prakash , Ahmadu Baba Usman , Vuong Nguyen Lam , Ebied Amr , Mizukami Shusaku , Huy Nguyen Tien , Cuevas Luis E , Hirayama Kenji
Published: September 2020

Objective

We assessed the impact of political conflict (Boko Haram) on tuberculosis (TB) case notiﬁcations in Adamawa State in North-east Nigeria.

Design

A retrospective analysis of TB case notifications from TB registers (2010–2016) to describe changes in TB notification, sex and age ratios by the degree of conflict by local government area.

Setting

Adamawa State.

Participants

21 076 TB cases notified.

Results

21 076 cases (62% male) were notiﬁed between 2010 and 2016, of which 19 604 (93%) were new TB cases. Areas affected by conflict in 2014 and 2015 had decreased case notification while neighbouring areas reported increased case notifications. The male to female ratio of TB cases changed in areas in conflict with more female cases being notified. The young and elderly (1–14 and >65 years old) had low notifications in all areas, with a small increase in case notifications during the years of conflict.

Conclusion

TB case notifications decreased in conflict areas and increased in areas without conflict. More males were notified during peace times and more female cases were reported from areas in conflict. Young and elderly populations had decreased case notifications but experienced a slight increase during the conflict years. These changes are likely to reflect population displacement and a dissimilar effect of conflict on the accessibility of services. TB services in conflict areas deserve further study to identify resilient approaches that could reach affected populations.
Childhood peer status and circulatory disease in adulthood: a prospective cohort study in Stockholm, Sweden
Authors: Miething Alexander , Almquist Ylva Brännström
Published: September 2020

Objectives

Childhood conditions have been recognised as important predictors of short-term and long-term health outcomes, but few studies have considered status position in the peer group as a possible determinant of adult health. Lower peer status, which often reflects experiences of marginalisation and rejection by peers, may impose inequality experiences and leave long-lasting imprints on health. The present study aimed to examine whether peer status is associated with the risk for circulatory disease in adulthood.

Design

Prospective cohort study based on the Stockholm Birth Cohort Multigenerational Study

(SBC Multigen).

Setting

Stockholm metropolitan area.

Participants

All individuals who were born in 1953 and resident in the greater metropolitan area of Stockholm in 1963 (n=14 608). The analytical sample consisted of 5410 males and 5990 females. Peer status was sociometrically assessed in cohort members at age 13. The survey material was linked to inpatient care registers that contained information about circulatory diseases (n=1668) across ages 20–63. Cox proportional hazard models were used for the analysis.

Outcome measure

Circulatory disease.

Results

Peer marginalisation at age 13 resulted in significantly higher risks of circulatory disease in adulthood among males (HR 1.34; 95% CI 1.09 to 1.64) and females (HR 1.33; 95% CI 1.04 to 1.70) alike. A graded relationship between peer status and circulatory diseases was detected in females (p=0.023). Among males there was a threshold effect, showing that only those in the lowest status position had significantly increased risks of circulatory disease. The associations remained significant after adjusting for various conditions in childhood and adulthood.

Conclusions

This study shows that circulatory diseases in adulthood may be traceable to low peer status and marginalisation in childhood. It is suggested that peer status in late childhood may precede social integration in adolescence and adulthood, acting as a long-term stressor that contributes to circulatory disease through biological, behavioural and psychosocial pathways.
Comparison of risk-of-bias assessment approaches for selection of studies reporting prevalence for economic analyses
Authors: Glasgow Matthew J , Edlin Richard , Harding Jane E
Published: September 2020

Objectives

Within cost-effectiveness models, prevalence figures can inform transition probabilities. The methodological quality of studies can inform the choice of prevalence figures but no single obvious candidate tool exists for assessing quality of the observational epidemiological studies for selecting prevalence estimates. We aimed to compare different tools to assess the risk of bias of studies reporting prevalence, and develop and compare possible numerical scoring systems using these tools to set a threshold for inclusion of reports of prevalence in an economic analysis of neonatal hypoglycaemia.

Design

Assessments of bias using two tools (Joanna Briggs Institute (JBI) Checklist for Prevalence Studies and a modified version of Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I)) were compared for 18 studies relevant to a single setting (neonatal hypoglycaemia). Inclusions of studies for use in a decision analysis model were considered based on summary scores derived from these tools.

Results

Both tools were considered easy to use and produced dispersed scores for each of the 40 study–outcome combinations. The modified ROBINS-I scores were more skewed than the JBI scores, particularly at higher thresholds. The studies selected for inclusion are generally the same using either tool; if 50% was used as the cut-off threshold using the Applicable Score both tools would yield the same results. However, the JBI tool is shorter and may be easier to interpret and apply to studies that do not involve a control group, while the modified ROBINS-I tool assesses more methodological detail in studies that include a control group.

Conclusion

Both tools performed well for systematically assessing studies that report on outcome prevalence and provided similar discrimination between studies for risk of bias. This convergent validity supports use of both tools for the purpose of assessing risk of bias and selecting studies that report prevalence for inclusion in economic analyses.
Exercise barriers and facilitators during hematopoietic stem cell transplantation: a qualitative study
Authors: Yu Mi-Seong , An Ki-Yong , Byeon Jiyong , CHOI Meeok , Cheong June-Won , Courneya Kerry , Jeon Justin Y
Published: September 2020

Objective

Although exercise is beneficial in patients undergoing hematopoietic stem cell transplantation (HSCT), motivating patients to exercise is challenging. We aimed to understand exercise barriers and facilitators during HSCT treatment while participating in a daily unsupervised exercise programme.

Participants

Patients scheduled to have HSCT.

Study design

6 participants were included in this descriptive qualitative study during HSCT treatment while participating in an exercise programme to identify perceived barriers and facilitators of the exercise. An average of three semi-structured interviews were conducted per patient.

Setting

Exercise during HSCT treatment in an isolated immune room.

Intervention

Daily unsupervised exercise.

Results

A total of six patients completed a 6-week exercise programme as well as all scheduled interviews, whose compliance to the exercise programme ranged from 12% to 79%. Based on interview results, three themes were identified as barriers to exercise and four themes were identified as facilitators to exercise. Patients experienced physical and psychological barriers such as nausea, vomiting, sore throat, reduced appetite, decreased willpower and anxiety due to feelings of isolation. Environmental factors included negative opinions about exercise programmes and lack of encouragement from the haematologist. Facilitators of exercise included willpower, easy and simple exercise, convincing explanations from haematologists and supervised support from exercise specialists.

Conclusion

Our study has identified potential barriers and facilitators associated with exercise participation during HSCT. Supervised exercise recommended by a haematologist, convincing explanation on the benefit of exercise by medical personnel, positive feedback from other HSCT survivors and supervision by exercise specialists may increase compliance to the exercise programme during HSCT.

Trial registration number

ISRCTN61498391.
Epidemiology and management of atopic dermatitis in England: an observational cohort study protocol
Authors: de Lusignan Simon , Alexander Helen , Broderick Conor , Dennis John , McGovern Andrew , Feeney Claire , Flohr Carsten
Published: September 2020

Introduction

Atopic dermatitis (AD) is one of the most common inflammatory skin conditions in both children and adults. Despite this, contemporary descriptions of the incidence, prevalence and current management of the condition in the UK are lacking.

Methods and analysis

We will perform a series of retrospective studies using a large population-based cohort derived from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database to explore two key research themes: AD epidemiology and AD management.

In the epidemiology theme, we will describe the incidence and prevalence of AD in children and adults in England from 2009 to 2018 inclusive. We will stratify findings by age, national Index of Multiple Deprivation (IMD), ethnicity, urban-rural environment and geographic location; and explore independent associations of these features with AD in multivariable models.

In the management theme, we will explore healthcare utilisation and treatment in people with AD. Regarding healthcare utilisation, we will evaluate rates of AD-associated primary care visits and specialist dermatology referrals in people with AD. Rates will be stratified by age, gender, socioeconomic IMD quintile and ethnicity. We will describe contemporary treatment by estimating prescribing rates across medication classes used in AD (emollients, topical corticosteroids by potency, topical calcineurin inhibitors, topical antimicrobials, antihistamines, oral corticosteroids and systemic immunomodulatory therapies) overall, and by age and sociodemographic groupings. We will also examine trends in prescribing over the study period. In people first diagnosed with AD during the study period, we will describe differences in treatment escalation by sociodemographic factors using time-to-event analysis.

Ethics and dissemination

The Health Research Authority decision tool classed this a study of ‘usual practice’, ethics approval was not required. Study approval was granted by the RCGP RSC Study Approval Committee. Results will be disseminated through peer-reviewed publications.

Trial registration number

NCT03823794.
Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences
Authors: Dooley Jemima , Booker Matthew , Barnes Rebecca , Xanthopoulou Penny
Published: September 2020

Objectives

People with dementia are more vulnerable to complications in urgent health situations due to older age, increased comorbidity, higher dependency on others and cognitive impairment. This review explored the factors associated with urgent care use in dementia and the experiences of people with dementia, informal carers and professionals.

Design

Scoping review. The search strategy and data synthesis were informed by people with dementia and carers.

Data sources

Searches of CINAHL, Embase, Medline, PsycINFO, PubMed were conducted alongside handsearches of relevant journals and the grey literature through 15 January 2019.

Eligibility criteria

Empirical studies including all research designs, and other published literature exploring factors associated with urgent care use in prehospital and emergency room settings for people with dementia were included. Two authors independently screened studies for inclusion.

Data extraction and synthesis

Data were extracted using charting techniques and findings were synthesised according to content and themes.

Results

Of 2967 records identified, 54 studies were included in the review. Specific factors that influenced use of urgent care included: (1) common age-related conditions occurring alongside dementia, (2) dementia as a diagnosis increasing or decreasing urgent care use, (3) informal and professional carers, (4) patient characteristics such as older age or behavioural symptoms and (5) the presence or absence of community support services. Included studies reported three crucial components of urgent care situations: (1) knowledge of the patient and dementia as a condition, (2) inadequate non-emergency health and social care support and (3) informal carer education and stress.

Conclusions

The scoping review highlighted a wider variety of sometimes competing factors that were associated with urgent care situations. Improved and increased community support for non-urgent situations, such as integrated care, caregiver education and dementia specialists, will both mitigate avoidable urgent care use and improve the experience of those in crisis.
Could the arm blood pressure measured with simultaneous bilateral arm method be used for hypertension diagnosis?
Authors: Wan Taixuan , Wu Yuanhao , He Ziqiang , Su Hai
Published: September 2020

Objective

Simultaneous bilateral arm blood pressure (BP) measurement (bilateral arm method) is suggested for the first BP measurement in clinical practice, but whether the arm BP measured with bilateral arm method (RA-2) is similar to that with unilateral arm method (RA-1) is unclear.

Design

Quantitative research, paired sample T-test, Bland-Altman and multivariate linear regression analyses were used.

Setting

This study included 295 subjects (18–90 years, 60.0±14.6 years old, 126 males) in the clinic of cardiovascular medicine of the Second Affiliated Hospital of Nanchang University. They were randomly instructed to one of two BP measurement proposals: (1) right-arm–bilateral arm–right-arm–bilateral arm, or (2) bilateral arm–right-arm–bilateral arm–right-arm to attenuate bias induced by BP measurement order.

Participants

From June to October of 2019, 295 outpatients (18–90 years, 60.0±14.6 years old, 126 males and 169 females) with sinus rhythm (SR) were enrolled. The exclusion criteria were acute myocardial infarction, congenital heart disease, acute heart failure, syncope, hemiplegia, arrhythmia and pulseless (by palpation).

Outcome measures

We compared the BP differences between bilateral arm method and unilateral arm method. The difference between RA-2 and RA-1 was calculated as Dif-RA. Data are expressed as means±SD for continuous variables. The percentage increase (PI) was calculated on the formula: (RA-2−RA-1)/RA-1.

Results

The RA-2 on systolic blood pressure (SBP)/diastolic blood pressure (DBP) was slightly, but statistically higher by 1.2/0.4 mm Hg against the RA-1. Multivariate regression analyses showed that hypertension therapy type was positive impact factor, but RA-1 was negative factor for PI of Dif-RA on SBP, DBP and pulse pressure.

Conclusion

The SBP and DBP of right arm measured with bilateral arm method are slightly, but statistically higher (1.2 and 0.4 mm Hg) than those with the unilateral arm BP method.
Critical appraisal and comparison of recommendations of clinical practice guidelines for treatment of schizophrenia in children and adolescents: a methodological survey protocol
Authors: Alves Maíra Ramos , Bergamaschi Cristiane de Cássia , Sorrilha Flávia Blaseck , Fulone Izabela , Barberato-Filho Silvio , Mayer Rejane Coan Ferretti , Melo Daniela Oliveira de , Lopes Luciane
Published: September 2020

Introduction

The number of clinical practice guidelines (CPGs) have increased substantially mainly in the paediatric area of mental health. However, little is known about the quality or how recommendations for the treatment of disorders such as schizophrenia in children and adolescents have changed over time. The aim of this study will be to assess the quality of the development of CPGs for the treatment and management of schizophrenia in children and adolescents over time using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to compare the recommendations and interventions described in these documents.

Methods and analysis

CPGs will be identified using a prospective protocol through a systematic search of multiple databases (Medline, Embase, Health Systems Evidence, Epistemonikos, Lilacs, etc) and guideline websites from 2004 to December 2020. The quality of the guidelines will be assessed by three reviewers, independently using the AGREE II. CPGs will be considered of high-quality if they scored ≥60% in four or more domains of the AGREE II instrument. Non-parametric tests will be used to test for the change of quality over time. We will summarise the different evidence grading systems and compare the recommendations.

Ethics and dissemination

Ethical approval is not required since it is a literature-based study. Future results of the research can be submitted for publication in scientific journals of high impact, peer reviewed and also published in national and international conferences. The results derived from this study will contribute to the improvement of health institutions and policies, informing about existing recommendation guidelines and about deficiencies and qualities found in those. This study may also identify key areas for future research. This study may guide the search and choice for high quality CPGs by health policy makers and health professionals and subsidise future adaptations.

Protocol registration number

CRD42020164899.
Support for mobilising medical students to join the COVID-19 pandemic emergency healthcare workforce: a cross-sectional questionnaire survey
Authors: Astorp Mike Sæderup , Sørensen Gustav Valentin Blichfeldt , Rasmussen Sten , Emmersen Jeppe , Erbs Alexander Wolfhagen , Andersen Stig
Published: September 2020

Objective

To identify what motivates medical students to join a pandemic emergency healthcare workforce.

Design

Cross-sectional study.

Setting

Aalborg University, Denmark.

Participants

All medical students.

Main outcome measures

Motivational points as perceived by the students to be important. Demographic characteristics and 11 motivational domains scored on a Visual Analog Scale from 0 (low) to 100 (high) responding to the question: ‘To what degree are the following statements important for you to join a national emergency preparedness workforce?’ The questionnaire was developed by an expert panel in a process of four iterations.

Results

A total of 486 students of 688 (70.6%) completed the survey within 7 days in March 2020. 80% had decided to join the pandemic emergency healthcare workforce. Ranked median scores for motivational statements in each domain were: care, 100; learn, 90; pride, 83; team, 77; needed, 75; safety, 75; supervision, 75; job, 73; duty, 66; salary, 62; historic, 50. Supervision (p<0.001), salary (p<0.001) and duty (p=0.001) were given increasing priority with advancing study years. Interestingly, students added that support by the university and clarification of study plans were priorities.

Conclusions

Results guide decision-makers and colleagues on how to motivate or reinforce medical students in joining the pandemic emergency healthcare workforce. Importantly, students emphasised protection for themselves.
Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers
Authors: Asgary Ramin , Lawrence Katharine
Published: September 2020

Introduction

Data regarding underpinning and implications of ethical challenges faced by humanitarian workers and their organisations in humanitarian operations are limited.

Methods

We conducted comprehensive, semistructured interviews with 44 experienced humanitarian aid workers, from the field to headquarters, to evaluate and describe ethical conditions in humanitarian situations.

Results

61% were female; average age was 41.8 years; 500 collective years of humanitarian experience (11.8 average) working with diverse major international non-governmental organisations. Important themes included; allocation schemes and integrity of the humanitarian industry, including resource allocation and fair access to and use of services; staff or organisational competencies and aid quality; humanitarian process and unintended consequences; corruption, diversion, complicity and competing interests, and intentions versus outcomes; professionalism and interpersonal and institutional responses; and exposure to extreme inequities and emotional and moral distress. Related concepts included broader industry context and allocations; decision-making, values, roles and sustainability; resource misuse at programme, government and international agency levels; aid effectiveness and utility versus futility, and negative consequences. Multiple contributing, confounding and contradictory factors were identified, including context complexity and multiple decision-making levels; limited input from beneficiaries of aid; different or competing social constructs, values or sociocultural differences; and shortcomings, impracticality, or competing philosophical theories or ethical frameworks.

Conclusions

Ethical situations are overarching and often present themselves outside the exclusive scope of moral reasoning, philosophical views, professional codes, ethical or legal frameworks, humanitarian principles or social constructivism. This study helped identify a common instinct to uphold fairness and justice as an underlying drive to maintain humanity through proximity, solidarity, transparency and accountability.
Identifying common baseline clinical features of COVID-19: a scoping review
Authors: Ferreira-Santos Daniela , Maranhão Priscila , Monteiro-Soares Matilde
Published: September 2020

Objectives

Our research question was: what are the most frequent baseline clinical characteristics in adult patients with COVID-19? Our major aim was to identify common baseline clinical features that could help recognise adult patients at high risk of having COVID-19.

Design

We conducted a scoping review of all the evidence available at LitCovid, until 23 March 2020.

Setting

Studies conducted in any setting and any country were included.

Participants

Studies had to report the prevalence of sociodemographic characteristics, symptoms and comorbidities specifically in adults with a diagnosis of infection by SARS-CoV-2.

Results

In total, 1572 publications were published on LitCovid. We have included 56 articles in our analysis, with 89% conducted in China and 75% containing inpatients. Three studies were conducted in North America and one in Europe. Participants’ age ranged from 28 to 70 years, with balanced gender distribution. The proportion of asymptomatic cases were from 2% to 79%. The most common reported symptoms were fever (4%–99%), cough (4%–92%), dyspnoea/shortness of breath (1%–90%), fatigue (4%–89%), myalgia (3%–65%) and pharyngalgia (2%–61%), while regarding comorbidities, we found cardiovascular disease (1%–40%), hypertension (0%–40%) and cerebrovascular disease (1%–40%). Such heterogeneity impaired the conduction of meta-analysis.

Conclusions

The infection by COVID-19 seems to affect people in a very diverse manner and with different characteristics. With the available data, it is not possible to clearly identify those at higher risk of being infected with this condition. Furthermore, the evidence from countries other than China is, at the moment, too scarce.
Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system
Authors: Brown Craig S , Vu Joceline V , Howard Ryan A , Gunaseelan Vidhya , Brummett Chad M , Waljee Jennifer , Englesbe Michael
Published: September 2020

Background

Opioids are prescribed in excess after surgery. We leveraged our continuous quality improvement infrastructure to implement opioid prescribing guidelines and subsequently evaluate changes in postoperative opioid prescribing, consumption and patient satisfaction/pain in a statewide regional health system.

Methods

We collected data regarding postoperative prescription size, opioid consumption and patient-reported outcomes from February 2017 to May 2019, from a 70-hospital surgical collaborative. Three iterations of prescribing guidelines were released. An interrupted time series analysis before and after each guideline release was performed. Linear regression was used to identify trends in consumption and patient-reported outcomes over time.

Results

We included 36 022 patients from 69 hospitals who underwent one of nine procedures in the guidelines, of which 15 174 (37.3%) had complete patient-reported outcomes data following surgery. Before the intervention, prescription size was decreasing over time (slope: −0.7 tablets of 5 mg oxycodone/month, 95% CI −1.0 to −0.5 tablets, p<0.001). After the first guideline release, prescription size declined by −1.4 tablets/month (95% CI −1.8 to −1.0 tablets, p<0.001). The difference between these slopes was significant (p=0.006). The second guideline release resulted in a relative increase in slope (−0.3 tablets/month, 95% CI −0.1 to −0.6, p<0.001). The third guideline release resulted in no change (p=0.563 for the intervention). Overall, mean (SD) prescription size decreased from 25 (17) tablets of 5 mg oxycodone to 12 (8) tablets. Opioid consumption also decreased from 11 (16) to 5 (7) tablets (p<0.001), while satisfaction and postoperative pain remained unchanged.

Conclusions

The use of procedure-specific prescribing guidelines reduced statewide postoperative opioid prescribing by 50% while providing satisfactory pain care. These results demonstrate meaningful impact on opioid prescribing using evidence-based best practices and serve as an example of successful utilisation of a regional health collaborative for quality improvement.
Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda
Authors: Espey Julie , Ingabire Rosine , Nyombayire Julien , Hoagland Alexandra , Da Costa Vanessa , Mazzei Amelia , Haddad Lisa B , Parker Rachel , Mukamuyango Jeannine , Umutoni Victoria , Allen Susan , Karita Etienne , Tichacek Amanda , Wall Kristin M
Published: September 2020

Introduction

Postpartum family planning (PPFP) is critical to reduce maternal–child mortality, abortion and unintended pregnancy. As in most countries, the majority of PP women in Rwanda have an unmet need for PPFP. In particular, increasing use of the highly effective PP long-acting reversible contraceptive (LARC) methods (the intrauterine device (IUD) and implant) is a national priority. We developed a multilevel intervention to increase supply and demand for PPFP services in Kigali, Rwanda.

Methods

We implemented our intervention (which included PPFP promotional counselling for clients, training for providers, and Ministry of Health stakeholder involvement) in six government health facilities from August 2017 to October 2018. While increasing knowledge and uptake of the IUD was a primary objective, all contraceptive method options were discussed and made available. Here, we report a secondary analysis of PP implant uptake and present already published data on PPIUD uptake for reference.

Results

Over a 15-month implementation period, 12 068 women received PPFP educational counselling and delivered at a study facility. Of these women, 1252 chose a PP implant (10.4% uptake) and 3372 chose a PPIUD (27.9% uptake). On average providers at our intervention facilities inserted 83.5 PP implants/month and 224.8 PPIUDs/month. Prior to our intervention, 30 PP implants/month and 8 PPIUDs/month were inserted at our selected facilities. Providers reported high ease of LARC insertion, and clients reported minimal insertion anxiety and pain.

Conclusions

PP implant and PPIUD uptake significantly increased after implementation of our multilevel intervention. PPFP methods were well received by clients and providers.
Shared leadership in tertiary care: design of a simulation for patient safety decision-making in healthcare management teams
Authors: Aufegger Lisa , Soane Emma , Darzi Ara , Bicknell Colin
Published: September 2020

Introduction

Simulation-based training (SBT) on shared leadership (SL) and group decision-making (GDM) can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into healthcare management training. The aim of this study was design, develop and validate a robust and evidence-based SBT to explore and train SL and GDM.

Method

Using a two-stage iterative simulation design approach, 103 clinical and non-clinical managerial students and healthcare professionals took part in an SBT that contained real-world problems and opportunities to improve patient safety set within a fictional context. Self-report data were gathered, and a focus group was conducted to address the simulation’s degree of realism, content, relevance, as well as areas for improvement.

Results

Participants experienced the simulation scenario, the material and the role assignment as realistic and representative of real-world tasks and decision contexts, and as a good opportunity to identify and enact relevant tasks, behaviours and knowledge related to SL and GDM. Areas for improvement were highlighted with regard to involving an actor who challenges SL and GDM; more preparatory time to allow for an enhanced familiarisation of the content; and, video debriefs to reflect on relevant behaviours and team processes.

Conclusions

Our simulation was perceived as an effective method to develop SL and GDM within the context of patient safety and healthcare management. Future studies could extend this scenario method to other areas of healthcare service and delivery, and to different sectors that require diverse groups to make complex decisions.
Neoantigen-specific CD4+T-cell response is critical for the therapeutic efficacy of cryo-thermal therapy
Authors: Peng Peng , Hu Hongming , Liu Ping , Xu Lisa X
Published: September 2020

Background

Traditional tumor thermal ablations, such as radiofrequency ablation (RFA) and cryoablation, can result in good local control of tumor, but traditional tumor thermal ablations are limited by poor long-term survival due to the failure of control of distal metastasis. Our previous studies developed a novel cryo-thermal therapy to treat the B16F10 melanoma mouse model. Long-term survival and T-cell-mediated durable antitumor immunity were achieved after cryo-thermal therapy, but whether tumor antigen-specific T-cells were augmented by cryo-thermal therapy was not determined.

Methods

The long-term antitumor therapeutic efficacy of cryo-thermal therapy was performed in B16F10 murine melanoma models. Splenocytes derived from mice treated with RFA or cryo-thermal therapy were coincubated with tumor antigen peptides to detect the frequency of antigen specific CD4+and CD8+T-cells by flow cytometry. Splenocytes were then stimulated and expanded by αCD3 or peptides and adoptive T-cell therapy experiments were performed to identify the antitumor efficacy of T-cells induced by RFA and cryo-thermal therapy. Naïve mice and tumor-bearing mice were used as control groups.

Results

Local cryo-thermal therapy generated a stronger systematic antitumor immune response than RFA and a long-lasting antitumor immunity that protected against tumor rechallenge. In vitro studies showed that the antigen-specific CD8+T-cell response was induced by both cryo-thermal therapy and RFA, but the strong neoantigen-specific CD4+T-cell response was only induced by cryo-thermal therapy. Cryo-thermal therapy-induced strong antitumor immune response was mainly mediated by CD4+T-cells, particularly neoantigen-specific CD4+T-cells.

Conclusion

Cryo-thermal therapy induced a stronger and broader antigen-specific memory T-cells. Specifically, cryo-thermal therapy, but not RFA, led to a strong neoantigen-specific CD4+T-cell response that mediated the resistance to tumor challenge.
The 'armed concrete' approach: stent-screw-assisted internal fixation (SAIF) reconstructs and internally fixates the most severe osteoporotic vertebral fractures
Authors: Distefano Daniela , Scarone Pietro , Isalberti Maurizio , La Barbera Luigi , Villa Tomaso , Bonaldi Giuseppe , Hirsch Joshua A , Cianfoni Alessandro
Published: September 2020

Background

The treatment of severe osteoporotic vertebral compression fractures (VCFs) with middle-column (MC) involvement, high fragmentation, large cleft and/or pedicular fracture is challenging. Minimally invasive 'stent-screw-assisted internal fixation' (SAIF) can reduce the fracture, reconstruct the vertebral body (VB) and fix it to the posterior elements.

Objective

To assess feasibility, safety, technical and clinical outcome of the SAIF technique in patients with severe osteoporotic VCFs.

Methods

80 treated vertebrae were analyzed retrospectively. Severe VCFs were characterized by advanced collapse (Genant grade 3), a high degree of osseous fragmentation (McCormack grade 2 and 3), burst morphology with MC injury, pediculo-somatic junction fracture, and/or large osteonecrotic cleft. VB reconstruction was evaluated on postprocedure radiographs and CT scans by two independent raters. Clinical and radiological follow-ups were performed at 1 and 6 months.

Results

SAIF was performed at 28 thoracic and 52 lumbar levels in 73 patients. One transient neurological complication occurred. VB reconstruction was satisfactory in 98.8% of levels (inter-rater reliability 96%, κ=1). Follow-up at 1 month was available for 78/80 levels and at 6 months or later (range 6–24, mean 7.9 months) for 73/80 levels. Significant improvement in the Visual Analog Scale score was noted at 1 and 6 months after treatment (p<0.05). Patients reported global clinical benefit during follow-up (Patient’s
Global Impression of Change Scale 5.6±0.9 at 1 month and 6.1±0.9 at 6 months). Fourteen new painful VCFs occurred at different levels in 11 patients during follow-up, treated with vertebral augmentation or SAIF. Target-level stability was maintained in all cases.

Conclusions

SAIF is a minimally invasive, safe, and effective treatment for patients with severe osteoporotic VCFs with MC involvement.
Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents
Authors: Mo Yueqiang , Wang Dahui
Published: September 2020

Background

Tibial tubercle avulsion fracture is rare in children. Accumulated knowledge on clinical and epidemiological features of this fracture is of practical significance for clinical colleagues to deal effectively with such fractures.

Methods

Clinical and epidemiological parameters were reviewed retrospectively in 29 patients with tibial tubercle avulsion fracture that was treated in our hospital in the past 7 years.

Results

Totally, 29 children with 30 tibial tubercle fractures were enrolled. They were all boys; the average age was 13.8 (12–15) years, and the average Body Mass Index (BMI) was 26.4 (19.2–34.3). Statistically, 41.4% of injuries occurred during jumping activities, and 1 (3.4%), 12 (41.4%) and 16 (55.2%) patients were injured bilaterally, on the right and left sides, respectively. The patients were classified into type I (4), II (3), III (13) and IV (10) fractures. Two patients (three knees) with fractures of type IV received close reduction and cast immobilization for 6 weeks. One patient with fracture of type IV underwent close reduction and was fixed with two cannulated screws. The remaining 26 patients underwent open reduction and were fixed with two or three cannulated screws. The average follow-up time was 38 (14–98) months; no complication was noted. Twenty-seven patients had an excellent outcome.

Conclusion

In Chinese adolescents, the tibial tubercle avulsion fracture predisposes to boys with higher body weight; jumping is the most common cause of injury; treatments show satisfactory outcome regardless of fracture types.
After the storm: an objective appraisal of the efficacy of c-kit+ cardiac progenitor cells in preclinical models of heart disease
Authors: Bolli Roberto , Tang Xian-Liang , Guo Yiru , Li Qianghong
Published: September 2020

The falsification of data related to c-kit+ cardiac progenitor cells (CPCs) by a Harvard laboratory has been a veritable tragedy. Does this fraud mean that CPCs are not beneficial in models of ischemic cardiomyopathy? At least 50 studies from 26 laboratories independent of the Harvard group have reported beneficial effects of CPCs in mice, rats, pigs, and cats. The mechanism of action remains unclear. Our group has shown that CPCs do not engraft in the diseased heart, do not differentiate into new cardiac myocytes, do not regenerate dead myocardium, and thus work via paracrine mechanisms. A casualty of the misconduct at Harvard has been the SCIPIO trial, a collaboration between the Harvard group and the group in Louisville. The retraction of the SCIPIO paper was caused exclusively by issues with data generated at Harvard, not those generated in Louisville. In the retraction notice, the Lancet editors stated: “Although we do not have any reservations about the clinical work in Louisville that used the preparations from Anversa's laboratory in good faith, the lack of reliability regarding the laboratory work at Harvard means that we are now retracting this paper”. We must be careful not to dismiss all work on CPCs because of one laboratory’s misconduct. An unbiased review of the literature supports the therapeutic potential of CPCs for heart failure at the preclinical level.
MGD-decoupled black holes, anisotropic fluids and holographic entanglement entropy
Authors: Rocha Roldão da , Tomaz Anderson A.
Published: September 2020

The holographic entanglement entropy (HEE) is investigated for a black hole under the minimal geometric deformation (MGD) procedure, created by gravitational decoupling via an anisotropic fluid, in an AdS/CFT on the brane setup. The respective HEE corrections are computed and confronted to the corresponding corrections for both the standard MGD black holes and the Schwarzschild ones.
Reflections on the article “Moving contact lines and dynamic contact angles: a ‘litmus test’ for mathematical models and some new challenges” by Yulii D. Shikhmurzaev
Authors: Bothe Dieter
Published: September 2020

We carefully consider the ‘litmus test’ proposed by Yulii D. Shikhmurzaev [Y.D. Shikhmurzaev, Eur. Phys. J. Special Topics 229, 1945 (2020)] in the context of the sharp-interface/sharp-contact line model.
Numerical simulation of the pier geometry effects on forming the transverse wave in converged spillways
Authors: Biabani Sahar , Hamidi Mehdi , Neya Bahram Navayi
Published: September 2020

Investigating the effect of the geometrical characteristics of the piers, i.e. increase in the length of the pier end, could reduce the transverse wave height and help to achieve the optimal design for the converging chute walls height and reducing the construction costs. In this paper, FLOW-3D is used for three-dimensional simulations of the Khair-Abad dam spillway and investigating the spillway piers geometry effects on forming the transverse waves. The simulation results show that the heights of the second and third waves increase by increasing the length of the pier end which is located adjacent to the chute walls due to the superiority of the effect of the chute convergence on the piers end length changes. It is shown that the suitable way to reduce the transverse wave height is increasing the length of the middle pier end. The simulation results demonstrated that the third wave height does not significantly change by increasing the length of the middle pier end more than a specific value and increasing the end length to more than this value to just increases the construction costs. Consequently, a specific length could be recommended for the spillway piers end optimum length to reduce the possibility of generation of the second and third waves and also to reduce the chute walls height.
Detection of Large-Scale Noisy Multi-Periodic Patterns with Discrete Double Fourier Transform. II. Study of Correlations Between Patterns
Authors: Chechetkin V. R. , Lobzin V. V.
Published: September 2020

The discrete double Fourier transform (DDFT) was developed to search for large-scale multi-periodic patterns in the presence of noise and is based on detection of the equidistant series of harmonics generated by the periodic patterns in the discrete Fourier transform (DFT) spectra. As DDFT retains all generic features of the Fourier transform, the corresponding pattern correlation function (PCF) related to DDFT can be introduced similarly to the data correlation function (DCF) related to DFT on the basis of the Wiener–Khinchin relationship. Peaks in PCF indicate the number of periodic patterns in a dataset under analysis and have direct correspondence with the counterpart peaks in the DFT spectrum. The close correspondence between positions of the peaks in the PCF and DFT spectra strongly enhances statistical significance of detected periodicities. Similar PCFs can also be defined for the cepstrum transform. The combined DFT–DCF and DDFT–PCF technique was applied to the detection of cycles in geomagnetic activity using disturbance storm-time (Dst) index. In addition to the known 27-day, semiannual and 11-year cycles of geomagnetic activity, we have also found the annual cycle of activity. The results were compared with those obtained by the cepstrum transform. A multiple cross-check makes the combined technique much more efficient and robust in comparison with the detection based on a unique particular method.