bluuebunny/crossref_metadata_2025 huggingface dataset:
GDI flex fuel engine: Influence of different fuels on the performance
Authors: Machado Guilherme Bastos , de Melo Tadeu C. Cordeiro , da Silva Katia Moniz
Published: November 2020

The internal combustion engine has been the main source of automotive propulsion for more than 100 years, but nowadays is facing challenges to significantly increase efficiency and reduce pollutants in the path to a low carbon mobility world. In this scenario, several developments have been implemented in the last years and new researches are being developed aiming high efficient and low emission vehicles. More stringent specifications for the fossil fuels and their blends with biofuels can play an important role to reduce carbon footprint of these new engines. In Brazil, since the 1970’s ethanol is widely used for spark ignited engines, either pure or blended in the gasoline (Brazilian gasoline). Brazilian flex fuel vehicles, which can run on hydrous ethanol, Brazilian gasoline or any mixture of these fuels, were released in 2000’s and represent nowadays over 90% of national light duty vehicles production. More recently, gasoline direct injection (GDI) technology was released at Brazilian flex fuel engines. Regarding fuel market, imported gasoline increased its share in recent years and although the compliance with the Brazilian specification, some properties may have significant differences compared to the ones of the average gasoline produced in Brazil. Results of performance, fuel consumption and combustion parameters of a GDI flex fuel engine running on hydrous ethanol and two different gasolines, one imported and other produced in Brazil, are shown in this paper. It is commented that flexibility to use gasoline and ethanol should be accompanied with more sophisticated engine hardware and control software to better explore the potential of the different fuels, and that different types of gasolines can affect many engine performance parameters, although this can be minimized adopting more tight fuels specifications. It is concluded that flex fuel engine designs and calibrations could be improved to obtain optimized performance with different fuels.
How do Bookmakers Interpret Running Performance of Teams in Previous Games? Evidence From the Football Bundesliga
Authors: Soebbing Brian P. , Wicker Pamela , Weimar Daniel , Orlowski Johannes
Published: November 2020

This study examines how running performance (intensive runs, total distance covered) of football teams in previous games impacts betting markets as it relates to expected win probability. Theoretically, bookmakers could interpret team’s running performance as effort or fatigue, with sports science studies suggesting that distance covered reflects effort and intensive runs signal fatigue. Using data from the 2011/12-2018/19 seasons of the German Bundesliga, beta regression models reveal that bookmakers interpret team’s running performance in previous games contrary to physiological explanations in sports sciences. Tests of market efficiency incorporating these findings do not find a profitable betting strategy for bettors.
Home-Based Physical Activity in Patients With Breast Cancer: During and/or After Chemotherapy? Impact on Cardiorespiratory Fitness. A 3-Arm Randomized Controlled Trial (APAC)
Authors: Vincent François , Deluche Elise , Bonis Joëlle , Leobon Sophie , Antonini Marie-Thérèse , Laval Caroline , Favard Florent , Dobbels Eloïse , Lavau-Denes Sandrine , Labrunie Anaïs , Thuillier Frédéric , Venat Laurence , Tubiana-Mathieu Nicole
Published: November 2020

Objectives:

Physical activity (PA) programs are recommended for breast cancer care. However, their modalities remain to be discussed. This study determined the best time to begin a personalized or adapted program based on cardiopulmonary exercise test function. This randomized controlled trial evaluated the effect of home-based adapted PA (APA) performed during or after treatment on cardiorespiratory fitness (CRF) at 12 months.

Method:

The primary endpoint was the peak oxygen consumption (VO2peak) at 12 months (group A vs C and B vs C). Secondary endpoints included the 6-minute walking test, assessment of muscle strength, fatigue, quality of life, anxiety, and depression, and a questionnaire on PA levels. All tests were evaluated at baseline and at 6 and 12 months. A total of 94 patients with breast cancer were randomized to 3 different groups: group A, performing 6 months of APA during adjuvant care; group B, 6 months of APA after adjuvant care; and group C, 12 months of APA during and after specific care. The program combined 1 resistance session and 2 aerobic sessions per week. Analysis of variance was used for repeated measures, Student’s t-test or the Mann–Whitney U-test for continuous variables, and χ2 test for binary or categorical variables.

Results:

The study assessed 81 participants at 6 months and 73 at 12 months. The majority of patients completed more than 85% of the exercise sessions. The baseline for VO2peak and secondary outcomes did not differ among the groups. VO2peak increased during the exercise period and decreased during the chemotherapy period without APA, but at 12 months no significant difference was observed. The same variation was observed in the 6-minute walking test, with significance at 6 months between A+C versus B ( P = .04), but no difference among the groups at 12 months. In the 3 groups, no decreases in other studied parameters were noted, except at 6 months in group B without APA.

Conclusion:

Home-based APA in breast cancer patients has a positive effect on CRF and physical functions, with no differences based on the timing of this program based on specific cancer treatment.

Trial Registration:

ClinicalTrials.gouv.fr (NCT01795612). Registered 20 February 2013.
Comparison Between Transposed Brachiobasilic Fistula and Arteriovenous Graft for Upper Limb Arteriovenous Access in Patients on Hemodialysis
Authors: Cheng Chen-Ting , Chang Yuan-Chen , Tam Ka-Wai , Yen Yu-Chun , Ko Yu-Chen
Published: November 2020

Background:

Creating and maintaining a functioning arteriovenous access is essential for long-term hemodialysis patients. Transposed brachiobasilic fistula (BBF) or arteriovenous graft (AVG) becomes an option when radiocephalic or brachiocephalic fistula cannot be created or fails. This study compared the patency and complications between BBFs and AVGs among patients on hemodialysis.

Methods:

A retrospective study was performed in Shuang Ho Hospital, Taiwan, from November 2015 to May 2020. All the operations were done by a single surgeon. Primary outcomes were primary patency, primary-assisted patency, and secondary patency of the BBF and AVG groups. Secondary outcomes were incidence of complications and reinterventions.

Results:

Of the 144 consecutive patients, 20 and 124 patients underwent BBF and AVG creation, respectively. Median follow-up time was 19.2 months. Primary patency at 1 and 2 years were 67% and 19% in the BBF group and 44% and 16% in the AVG group (P = 0.126). Primary-assisted patency at 1 and 2 years were 82% and 54% in the BBF group and 54% and 30% in the AVG group (P = 0.012). Secondary patency at 1 and 2 years were 100% and 82% in the BBF group and 81% and 67% in the AVG group (P = 0.078). The incidence of complication was significantly higher in the AVG than in the BBF group (1.7 per patient-year vs 0.93, P < 0.001).

Conclusion:

Compared with the AVG group, BBF group showed better primary-assisted patency, less complication and intervention rates. Therefore, BBF is a reliable option for patients with exhausted cephalic veins if basilic vein is available for reconstruction.
Testing of a (Spiritual) Self-Assessment Tool ((S)SAT) in a Community Hospital Setting
Authors: Bond Robert , Brown N. Shira
Published: November 2020

The (Spiritual) Self-Assessment Tool Study was designed to test the novel engagement tool’s effectiveness. Providing the (Spiritual) Self-Assessment Tool Study to newly admitted medical patients led to few instances where the tool was completed. Nevertheless, the (Spiritual) Self-Assessment Tool Study patient questionnaire generated significant secondary findings: a third of responding patients consider their hospital care incomplete without their care team having access to (Spiritual) Self-Assessment Tool data. Nursing staff also desire this data, but are unable to access it without the (Spiritual) Self-Assessment Tool or an equivalent source.
Out Of The Ashes: The Alberta Consortium For Supervised Pastoral Education Program
Authors: Pranke Darlene , Clark Margaret
Published: November 2020

In Alberta, Canada, supervised pastoral education has grown and thrived for over 50 years. In 2008, due to healthcare funding changes, it was nearly eliminated. This article describes regenerative processes by which former structures have transformed into a new configuration for supervised pastoral education program delivery, including innovative roles for spiritual care preceptors and theological colleges. Out of the ashes, a phoenix is rising. It is called the Alberta Consortium for Supervised Pastoral Education program.
COVID-19: No Distinction for Children’s Spiritual Growth
Authors: Mamahit Henny Christine
Published: November 2020

COVID-19 cannot rob us of our ability to perform our ministry for children. As adults and ministers, we can show our support for the spiritual growth of children. COVID-19 has not deprived us of our creativity in praise, telling of God’s love, prayers, and support for all the children and parents. COVID-19 has not defeated our spiritual life.
Caring for Patients’ Reproductive Healthcare During the COVID-19 Pandemic
Authors: Bass Maya
Published: November 2020

Abortion care requires supporting a patient through the decision to end a pregnancy, the process of having an abortion, and how to care for themselves after the decision is made. This process is nuanced in the best of times and has been exacerbated by the COVID-19 pandemic. This article provides a foundation for clergy and mental health providers on some of the issues that patients will experience accessing abortion care, specifically during the pandemic.
Chart Audit of Spiritual Care Documentation: Continuous Quality Improvement
Authors: Stang Vivian B. , Beavis Mary Jane , Côté Geneviève
Published: November 2020

Eight spiritual care practitioners at an acute care teaching hospital undertook a systematic chart audit of their documentation practices in the patient electronic health record. The purpose was to evaluate their practices using the standards of their professional association and regulatory college. A preliminary “mock audit” was essential for the overall success of the audit. Plans for ongoing chart audits will lead to continuous quality improvement. A limitation was that their manager acted as both improvement coach and performance evaluator.
Assisting Faith-Based Organizations Increase Sense of Belonging during the Covid-19 Pandemic
Authors: Hathaway Elizabeth
Published: November 2020

The Covid-19 pandemic has negatively affected the three basic needs of individuals. Faith-based organization leaders are carrying the additional weight of stewardship of members during these challenging times. Many Faith-based organization leaders feel a sense of responsibility to create environments where members feel a sense of belonging. Five considerations for Faith-based organization leaders hoping to increase belonging are discussed below. Specifically, low-cost options are presented that could be implemented in small-to-large Faith-based organizations.
Preoperative Endoscopic Biliary Stenting Before Pancreaticoduodenectomy: Does Timing Matter?
Authors: Bhatti Abu Bakar Hafeez , Jafri Roshni Z. , Khan Muhammed Kashif , Dar Faisal Saud
Published: November 2020

Background. The role of preoperative biliary stenting (PBS) before pancreaticoduodenectomy (PD) in patients with obstructive jaundice is debatable. The objective of the current study was to assess PD outcomes after upfront surgery or PBS and determine the impact of stent to surgery duration on PD outcomes. Methods. We reviewed patients who underwent PD between 2011 and 2019. Patients were grouped based on whether they underwent upfront surgery (n = 67) or PBS (n = 66). We further assessed outcomes based on stent to surgery duration. Results. There was no significant difference in 30-day mortality (3% vs. 2.9%, P = 1), 90-day mortality (7.5% vs. 4.4%, P = .4), and Grade B-C pancreatic fistula rates (7.5% vs. 4.4%, P = .4) in the PBS and upfront surgery groups, respectively. A significant increase in wound infections (22.7% vs. 7.4%, P = .01) and readmissions (10.6% vs. 0, P = .006) was seen in the PBS group. The highest rate of wound infection was seen when stent to surgery duration was 4-6 weeks (41.6%). The wound infection rates in the upfront surgery group, high-risk PBS group (4-6 weeks), and low-risk PBS group were 5/67(7.4%), 5/12(41.6%), and 7/36(19.4%), respectively ( P = .008). Conclusions. PBS increases postoperative wound infections when compared with upfront surgery. Patients operated between 4 and 6 weeks after stenting have the highest rate of wound infection.
Insights From Setting up the First Wave of a Qualitative Longitudinal Study
Authors: Wöhrer Mag. Dr. Veronika , Jesser MMag. Dr. Andrea , Mataloni Barbara , Schmidt Andre
Published: November 2020

In this paper we describe and reflect upon the process of setting up the first wave of a complex qualitative longitudinal study with young people in Vienna. We explain the project’s agenda, design, and organizational structure connecting experienced and early career researchers with master’s students. In particular, we describe the tools used to coordinate the research, the challenges and benefits of blending research and teaching, and the materials and strategies we employed to ensure data quality and self-reflexivity. We conclude with reflections upon ethical challenges associated with incorporating marginalized young people into the research within the context of school, especially concerning pseudonymization, informed consent, and hierarchical settings shaping the research.
A Bayesian response-adaptive dose-finding and comparative effectiveness trial
Authors: Heath Anna , Yaskina Maryna , Pechlivanoglou Petros , Rios David , Offringa Martin , Klassen Terry P , Poonai Naveen , Pullenayegum Eleanor
Published: November 2020

Background/Aims:

Combinations of treatments that have already received regulatory approval can offer additional benefit over Each of the treatments individually. However, trials of these combinations are lower priority than those that develop novel therapies, which can restrict funding, timelines and patient availability. This article develops a novel trial design to facilitate the evaluation of New combination therapies. This trial design combines elements of phase II and phase III trials to reduce the burden of evaluating combination therapies, while also maintaining a feasible sample size. This design was developed for a randomised trial that compares the properties of three combination doses of ketamine and dexmedetomidine, given intranasally, to ketamine delivered intravenously for children undergoing a closed reduction for a fracture or dislocation.

Methods:

This trial design uses response-adaptive randomisation to evaluate different dose combinations and increase the information collected for successful novel drug combinations. The design then uses Bayesian dose-response modelling to undertake a comparative effectiveness analysis for the most successful dose combination against a relevant comparator. We used simulation methods determine the thresholds for adapting the trial and making conclusions. We also used simulations to evaluate the probability of selecting the dose combination with the highest true effectiveness the operating characteristics of the design and its Bayesian predictive power.

Results:

With 410 participants, five interim updates of the randomisation ratio and a probability of effectiveness of 0.93, 0.88 and 0.83 for the three dose combinations, we have an 83% chance of randomising the largest number of patients to the drug with the highest probability of effectiveness. Based on this adaptive randomisation procedure, the comparative effectiveness analysis has a type I error of less than 5% and a 93% chance of correcting concluding non-inferiority, when the probability of effectiveness for the optimal combination therapy is 0.9. In this case, the trial has a greater than 77% chance of meeting its dual aims of dose-finding and comparative effectiveness. Finally, the Bayesian predictive power of the trial is over 90%.

Conclusions:

By simultaneously determining the optimal dose and collecting data on the relative effectiveness of an intervention, we can minimise administrative burden and recruitment time for a trial. This will minimise the time required to get effective, safe combination therapies to patients quickly. The proposed trial has high potential to meet the dual study objectives within a feasible overall sample size.
Recruitment and retention in randomized controlled trials with urban American Indian/Alaska Native adolescents: Challenges and lessons learned
Authors: Dickerson Daniel L , Parker Jennifer , Johnson Carrie L , Brown Ryan A , D’Amico Elizabeth J
Published: November 2020

Background:

Although the majority of American Indians/Alaska Natives reside in urban areas, there are very few randomized controlled trials analyzing culturally centered substance use prevention interventions for this population.

Methods:

We describe methods employed to recruit and retain urban American Indian/Alaska Native adolescents into a randomized controlled trial, which was focused on testing the potential benefits of a substance use prevention intervention for this population. We also report challenges encountered in recruitment and retention of participants and strategies employed addressing these challenges. Data collection occurred from August 2014 to October 2017.

Results:

We partnered with two community-based organizations in different cities in California. We utilized American Indian/Alaska Native recruiters from communities, placed flyers in community-based organizations, and asked organizations to post flyers on their web and social media sites. We also offered gift cards for participants. Our initial recruitment and retention model was moderately successful; however, we encountered five main challenges: (1) transportation, (2) increasing trust and interest, (3) adding research sites, (4) getting the word out about the project, and (5) getting youth to complete follow-up surveys. Strategies employed to overcome transportation challenges included shortening the number of sessions, offering sessions on both weekends and weekdays, and increasing bus tokens and transportation options. We hired more staff from American Indian/Alaska Native communities, added more research sites from our previously established relationships, and were more proactive in getting the word out on the project in American Indian/Alaska Native communities. We also utilized more field tracking and emailed and mailed survey invitations to reach more participants for their follow-up surveys. Because of our efforts, we were nearly able to reach our initial recruitment and retention goals.

Conclusion:

Although our research team had previously established relationships with various urban American Indian/Alaska Native communities, we encountered various recruitment and retention challenges in our study. However, by identifying challenges and employing culturally appropriate strategies, we were able to collect valuable data on the potential effectiveness of a substance use prevention intervention for urban American Indian/Alaska Native adolescents. Findings from this study assist toward the development of potentially successful strategies to successfully recruit and retain urban American Indian/Alaska Native adolescents in randomized controlled trials.
Motor neurone disease
Authors: Knight Lisa
Published: November 2020

Motor neurone disease describes a group of rare, fatal, neurodegenerative disorders. They are devastating conditions that cause the loss of upper and/or lower motor neurones, leading to a variety of progressive neurological symptoms that can develop over months to years. Due to the rarity of these conditions and the differing and often insidious symptoms there is typically a prolonged delay between presentation and diagnosis of between 15 and 18 months on average. There is often a short prognosis of 3 years, though this can vary significantly depending on the type of syndrome diagnosed. Primary care clinicians play a key role in both facilitating early diagnosis and subsequent management and co-ordination of care in the community.
Breastfeeding attitudes of refugee women from Syria and influencing factors: a study based on the transition theory
Authors: Ozkaya Meltem , Korukcu Oznur , Aune Ingvild
Published: November 2020

Aims:

This review was designed to systematically examine studies that determine the breastfeeding attitudes of Syrian mothers, and factors influencing their breastfeeding behavior.

Methods:

Studies published between 2010 and 2020 were examined using ‘Syria OR Syrian mother OR Syrian refugee AND breastfeeding OR breastfeeding practices OR intention OR attitudes OR exclusive breastfeeding’ as keywords on PubMed, GoogleScholar, MEDLINE, Scopus, ProQuest, National Thesis Center, Web of Science, ScienceDirect and CINAHL; and five publications meeting the inclusion criteria were included in the study. The researchers independently used JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies and JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses, developed by Joanna Briggs Institute, to assess the methodological quality.

Results:

A total of 6546 studies were accessed as a result of the literature review. Five studies meeting the inclusion criteria were included in the study. Women who are in this process experience a developmental and situational transition according to the framework of Meleis’ theory. Factors affecting their breastfeeding attitudes were grouped under three main and four sub-themes. It was determined that personal factors (socioeconomic factors, cultural beliefs, the significance of breastfeeding practice, preparation), factors related to the immediate environment and social factors affect these women’s attitudes toward breastfeeding.

Conclusion:

It was found that most of the Syrian women had positive attitudes toward breastfeeding; however, the breastfeeding duration was less than 6 months for most of the refugees. Furthermore, according to the results of the studies, refugee women from Syria who did not receive social support from their spouses and relatives stopped breastfeeding.
The run-in phase of the prospective WSG-ADAPT HR+/HER2– trial demonstrates the feasibility of a study design combining static and dynamic biomarker assessments for individualized therapy in early breast cancer
Authors: Nitz Ulrike , Gluz Oleg , Kreipe Hans H. , Christgen Matthias , Kuemmel Sherko , Baehner Frederick L. , Shak Steven , Aktas Bahriye , Braun Michael , Lüdtke-Heckenkamp Kerstin , Forstbauer Helmut , Grischke Eva-Maria , Nuding Benno , Darsow Maren , Schumacher Claudia , Krauss Katja , Malter Wolfram , Thill Marc , Warm Mathias , Wuerstlein Rachel , Kates Ronald E. , Harbeck Nadia
Published: November 2020

Background:

Endocrine sensitivity, as determined by response of the proliferation marker Ki-67 to short-term preoperative endocrine therapy (ET), is currently not included in adjuvant treatment decisions in hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)− breast cancer (BC).

Methods:

The prospective WSG-ADAPT HR+/HER2− trial included patients with N0/N1 early BC who were candidates for adjuvant chemotherapy based on clinical–pathological criteria alone. The trial utilized a genomic assessment [the Recurrence Score (RS)] plus endocrine sensitivity testing to guide treatment. All patients received 3 (±1) weeks of preoperative induction ET. According to protocol, patients with RS 0–11 or RS 12–25 plus endocrine proliferation response (EPR, post-induction Ki-67 ⩽ 10%) were to be spared adjuvant chemotherapy.

Results:

The ADAPT HR+/HER2− trial run-in phase included 407 patients with baseline RS, of whom 386 (median age: 54 years) had complete data for Ki-67 at both baseline and post-induction. RS distribution: 23.1% RS 0–11, 58.3% RS 12–25, and 18.7% RS 26–100. EPR occurred in 84.3%, 76.0%, and 36.1% of these RS groups, respectively. Differences in EPR proportions (RS 26–100 versus others, RS 0–11 versus others) were significant (both p < 0.001); Ki-67 quotients were higher for RS 26–100 ( p = 0.02, Mann–Whitney). In premenopausal women ( n = 146, mostly tamoxifen-treated), median quotient of Ki-67 level (post/pre) was significantly higher than in postmenopausal women ( n = 222, mostly aromatase-inhibitor treated; 0.67 versus 0.25, p < 0.001). EPR was significantly associated with baseline estrogen-receptor status as determined by immunohistochemistry ( p = 0.002) or real-time polymerase chain reaction ( p < 0.001). Also, a strong correlation was observed between RS measured pre- and post-ET (RS = 0.7, n = 181).

Conclusions:

This phase of the WSG-ADAPT HR+/HER2− trial confirms trial design estimates of RS and EPR. It indicates that the ADAPT concept of combining static and dynamic biomarker assessment for individualized therapy decisions in early BC is feasible using the EPR criterion post-induction Ki-67 ⩽ 10%.

Clinicaltrials.gov identifier:

NCT01779206.
Is there a relationship between personality traits and fruit and vegetable intake among pregnant women?
Authors: Leszko Magdalena , Keenan-Devlin Lauren , Grobman William A , Smart Britney , Borders Ann , Mroczek Daniel K
Published: November 2020

Previous studies have shown that certain personality traits such as neuroticism and conscientiousness influence dietary choices. Pregnancy is a unique period in a woman’s life during which most women are highly intrinsically and extrinsically motivated to start a diet rich in fruit and vegetables. Yet, an adequate consumption of fruits and vegetables remains a challenge for many women. The present study investigates the relationships between personality traits and fish, dairy, fruit, and vegetable intake. Data was collected from 602 pregnant women and analyzed using descriptive statistics and hierarchical regression analyses in order to examine predictive relationships between the variables of interest. The results demonstrated that high scores in openness to experience, older maternal age, higher income, and educational attainment were positively associated with increased fish, vegetable, and fruit intake. These findings have important implications for interventions that seek to improve eating behaviors of pregnant women, thereby increasing the health of their pregnancies.
Support for families of isolated or deceased COVID-19 patients in sub-Saharan Africa
Authors: Endomba Francky Teddy , Wafeu Guy Sadeu , Efon-Ekangouo Arnauld , Djune-Yemeli Linda , Donfo-Azafack Cyrille , Nana-Djeunga Hugues C , Kamgno Joseph
Published: November 2020

Aside the direct effect of the COVID-19 on infected patients, this infectious disease outbreak has various psychological consequences. These mental health repercussions pertain to the general population of uninfected individuals, and particularly families of isolated or deceased COVID-19 patients. This aspect is of substantial interest amid sub-Saharan African communities, considering the key place and cultural significance of mourning and funerals in these settings. In this commentary, we discuss on the issue of psychological and social support of COVID-19 patients’ families, by taking into account some sub-Saharan African cultural considerations.
Sequential changes in lower extremity function after total knee arthroplasty
Authors: Tsubosaka Masanori , Muratsu Hirotsugu , Nakano Naoki , Kamenaga Tomoyuki , Kuroda Yuichi , Miya Hidetoshi , Kuroda Ryosuke , Matsumoto Tomoyuki
Published: November 2020

Purpose:

The effectiveness of total knee arthroplasty (TKA) for recovering ambulation and balance functions has not been investigated in detail. The present study aimed to measure functional changes in the lower limb before and after TKA by measuring ambulation function with the 3 m Timed Up and Go (TUG) test and balance function using one-leg standing time (ST).

Methods:

The study included 137 patients (116 women and 21 men) with osteoarthritis of the knee who underwent primary TKA. The mean age of the patients was 74.4 years. The mean postoperative hospital stay for rehabilitation was 23.9 days. The TUG test and ST were performed preoperatively, 2 weeks postoperatively, at discharge, and 3, 6, and 12 months postoperatively. These results from these six measurements were also compared using one-way repeated measures analysis of variance.

Results:

The TUG test and ST were significantly improved at 3 months after surgery. However, both the TUG test and ST did not improve further from 3 months to 6 months postoperatively or from 6 months to 1 year postoperatively.

Conclusion:

TKA is useful for restoring lower limb function, as both ambulation and balance functions were significantly improved 3 months after surgery. However, no further improvement in ambulation or balance function was recognized beyond 3 months.
Efficacy of Long-Term Adjuvant Therapy With Imatinib Mesylate After Extensive Surgical Treatment for Ruptured Gastrointestinal Stromal Tumors of the Small Intestine With Peritoneal Metastases: A Case Report
Authors: Kimura Toshihisa , Togawa Tamotsu , Onishi Kenji , Iida Atsushi , Sato Yasunori , Goi Takanori
Published: November 2020

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Although most patients with advanced GISTs benefit from imatinib mesylate (IM) as standard targeted therapy, the optimal duration of adjuvant IM for GIST patients with high risk of recurrence who underwent surgical resection remains unknown. In this article, we present a case of a ruptured GIST of the small intestine accompanied by peritoneal metastases, which was effectively treated by surgical procedure followed by long-term adjuvant therapy with IM. Surgical resection was performed for the ruptured small intestinal GIST, and multitude of peritoneal metastases were cauterized. The patient received adjuvant therapy with IM (400 mg/day) for 12 years without an interruption or a dose change. Peritoneal metastatic recurrence was observed by the follow-up computed tomography scan obtained 12 years after surgery, and surgical resection of the recurrent GIST was performed. The molecular examination indicated a KIT exon 11 deletion mutation in both the primary GIST and recurrent GIST. An additional point mutation was observed in the recurrent GIST in exon 17 that caused resistance to IM. The present case might indicate that extensive removal of the tumor cells through surgery and long-term administration of IM without an interruption or a dose change were important for achieving improved recurrence-free survival in patients with ruptured GISTs of the small intestine with peritoneal metastases.
Impacts on Surgery Resident Education at a First Wave COVID-19 Epicenter
Authors: Ostapenko Alexander , McPeck Samantha , Liechty Shawn , Kleiner Daniel
Published: November 2020

Purpose:

This study aims to identify the effects of the COVID-19 pandemic on surgical resident training and education at Danbury Hospital.

Methods:

We conducted an observational study at a Western Connecticut hospital heavily affected by the first wave of the COVID-19 pandemic to assess its effects on surgical residents, focusing on surgical education, clinical experience, and operative skills development. Objective data was available through recorded work hours, case logs, and formal didactics. In addition, we created an anonymous survey to assess resident perception of their residency experience during the pandemic.

Results:

There are 22 surgical residents at our institution; all were included in the study. Resident weekly duty hours decreased by 23.9 hours with the majority of clinical time redirected to caring for COVID-19 patients. Independent studying increased by 1.6 hours (26.2%) while weekly didactics decreased by 2.1 hours (35.6%). The operative volume per resident decreased by 65.7% from 35.0 to 12.0 cases for the period of interest, with a disproportionately high effect on junior residents, who experienced a 76.2% decrease. Unsurprisingly, 70% of residents reported a negative effect of the pandemic on their surgical skills.

Conclusions:

During the first wave of the COVID-19 pandemic, surgical residents’ usual workflows changed dramatically, as much of their time was dedicated to the critical care of patients with COVID-19. However, the consequent opportunity cost was to surgery-specific training; there was a significant decrease in operative cases and time spent in surgical didactics, along with elevated concern about overall preparedness for their intended career.
The First Orally Deliverable Small Molecule for the Treatment of Spinal Muscular Atrophy
Authors: Singh Ravindra N , Ottesen Eric W , Singh Natalia N
Published: November 2020

Spinal muscular atrophy (SMA) is one of the leading causes of infant mortality. SMA is mostly caused by low levels of Survival Motor Neuron (SMN) protein due to deletion of or mutation in the SMN1 gene. Its nearly identical copy, SMN2, fails to compensate for the loss of SMN1 due to predominant skipping of exon 7. Correction of SMN2 exon 7 splicing by an antisense oligonucleotide (ASO), nusinersen (Spinraza™), that targets the intronic splicing silencer N1 (ISS-N1) became the first approved therapy for SMA. Restoration of SMN levels using gene therapy was the next. Very recently, an orally deliverable small molecule, risdiplam (Evrysdi™), became the third approved therapy for SMA. Here we discuss how these therapies are positioned to meet the needs of the broad phenotypic spectrum of SMA patients.
Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study
Authors: Scolari Fernando Luís , Schneider Daniel , Fogazzi Débora Vacaro , Gus Miguel , Rover Marciane Maria , Bonatto Marcely Gimenes , de Araújo Gustavo Neves , Zimerman André , Sganzerla Daniel , Goldraich Lívia Adams , Teixeira Cassiano , Friedman Gilberto , Polanczyk Carisi Anne , Rohde Luis Eduardo , Rosa Regis Goulart , Wainstein Rodrigo Vugman
Published: November 2020

Background

To evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®.

Methods

Serum lactate and clearance were measured before MCS and at 1 h, 6 h, 12 h, and 24 h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality.

Results

VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6 h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6 h, 12 h, and 24 h after MCS. Serum lactate > 1.55 mmol/L at 24 h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67–0.94); positive predictive value = 86%). Failure to improve serum lactate after 24 h was associated with 100% mortality.

Conclusions

Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24 h were the strongest independent predictors of short-term survival.
Digital consultations in Swedish primary health care: a qualitative study of physicians’ job control, demand and support
Authors: Fernemark Hanna , Skagerström Janna , Seing Ida , Ericsson Carin , Nilsen Per
Published: November 2020

Background

Digital consultation with primary care physicians via mobile telephone apps has been spreading rapidly in Sweden since 2014. Digital consultation allows remote working because physicians can work from home, outside their traditional primary care environment. Despite the spread of digital consultation in primary care, there is a lack of knowledge concerning how the new service affects physicians’ psychosocial work environment. Previous research has focused primarily on the patients’ point of view and the cost-effectiveness of digital consultation. Hence, there is a paucity of studies from the perspective of physicians, focusing on their psychosocial work environment. The aim of this study was to investigate primary care physicians’ perceived work demands, control over working processes, and social support when providing digital consultation to primary care patients.

Methods

The study has a qualitative design, using semi-structured interviews conducted in Sweden in 2019. We used a purposeful sampling strategy to achieve a heterogeneous sample of physicians who represented a broad spectrum of experiences and perceptions. The interviews were conducted by video meeting, telephone, or a personal meeting, depending on what suited the participant best. The interview questions were informed by the Job Demand-Control-Support (JDCS) model, which was also used as the framework to analyze the data by categorizing the physicians’ perceptions and experiences into the three categories of the model (Demand, Control, Support), in the deductive analysis of the data.

Results

Analysis of the data yielded 9 subcategories, which were mapped onto the 3 categories of the JDCS model. Overall, the participants saw numerous benefits with digital consultations, not only with regard to their own job situation but also for patients and the health care system in general even though they identified some shortcomings and risks with digital care.

Conclusions

This study has demonstrated that physicians perceive working with digital consultation as flexible with a high grade of autonomy and reasonable to low demands. According to the participants, digital consultation is not something you can work with full time if medical skills and abilities are to be maintained and developed.
Can usual gait speed be used as a prognostic factor for early palliative care identification in hospitalized older patients? A prospective study on two different wards
Authors: Van de Vyver Celine , Velghe Anja , Baeyens Hilde , Baeyens Jean-Pierre , Dekoninck Julien , Van Den Noortgate Nele , Piers Ruth
Published: November 2020

Background

Timely palliative care in frail older persons remains challenging. Scales to identify older patients at risk of functional decline already exist. However, factors to predict short term mortality in older hospitalized patients are scarce.

Methods

In this prospective study, we recruited patients of 75 years and older at the department of cardiology and geriatrics. The usual gait speed measurement closest to discharge was chosen. We used the risk of dying within 1 year as parameter for starting palliative care. ROC curves were used to determine the best cut-off value of usual gait speed to predict one-year mortality. Time to event analyses were assessed by COX regression.

Results

On the acute geriatric ward (n = 60), patients were older and more frail (assessed by Katz and iADL) in comparison to patients on the cardiology ward (n = 82); one-year mortality was respectively 27 and 15% (p = 0.069). AUC on the acute geriatric ward was 0.748 (p = 0.006). The best cut-off value was 0.42 m/s with a sensitivity and specificity of 0.857 and 0.643. Slow walkers died earlier than faster walkers (HR 7.456,p = 0.011), after correction for age and sex. On the cardiology ward, AUC was 0.560 (p = 0.563); no significant association was found between usual gait speed and survival time.

Conclusions

Usual gait speed may be a valuable prognostic factor to identify patients at risk for one-year mortality on the acute geriatric ward but not on the cardiology ward.
Adult case of giant sacrococcygeal teratoma: case report
Authors: Mindaye Esubalew T. , Kassahun Mulugeta , Prager Sarah , Tufa Tesfaye H.
Published: November 2020

Background

Sacrococcygeal teratomas are tumors originating from pluripotent embryonic germ cell layers located in the fetal coccyx. These tumors are highly vascular if they undergo malignant transformation. Typically, they are found in infants and children and occasionally can be diagnosed prenatally. Adult cases are very rare, and represent tumors present since birth with delayed detection.

Case presentation

We describe a case of a giant sacrococcygeal teratoma in a 25 years old female college student presenting with right gluteal swelling of 4 months’ duration. In addition to the huge disfiguring mass on the perineal area, she also had lower abdominal pain, urinary complaints, and difficulty with ambulation.

Discussion

Pre-operative impression was of a sacrococcygeal mass and histopathology following complete surgical excision revealed a sacrococcygeal teratoma. She recovered well after surgery with no radiologic evidence of recurrence at six months.

Conclusion

Although rare, sacrococcygeal teratoma should be considered as a differential diagnosis for female adults presenting with perineal and/or pelvic masses. Complete surgical excision remains the mainstay of treatment.
Parastomal hernia repair with onlay mesh remains a safe and effective approach
Authors: De Robles Marie Shella , Young Christopher J.
Published: November 2020

Background

Parastomal hernia (PSH) management poses difficulties due to significant rates of recurrence and morbidity after repair. This study aims to describe a practical approach for PSH, particularly with onlay mesh repair using a lateral peristomal incision.

Methods

This is a retrospective review of consecutive patients who underwent PSH repair between 2001 and 2018.

Results

Seventy-six consecutive PSH with a mean follow-up of 93.1 months were reviewed. Repair was carried out for end colostomy (40%), end ileostomy (25%), ileal conduit (21%), loop colostomy (6.5%) end-loop colostomy (5%) and loop ileostomy (2.5%). The repair was performed either with a lateral peristomal incision (59%) or a midline incision (41%). Polypropylene mesh (86%), biologic mesh (8%) and composite mesh (6%) were used. Stoma relocation was done in 9 patients (12%). Eight patients (11%) developed postoperative wound complications. Recurrence occurred in 16 patients (21%) with a mean time to recurrence at 29.4 months. No significant difference in wound complication and recurrence was observed based on the type of stoma, incision used, type of mesh used, and whether or not the stoma was repaired on the same site or relocated.

Conclusion

Onlay mesh repair of PSH remains a practical and safe approach and could be an advantageous technique for high-risk patients. It can be performed using a lateral peristomal incision with low morbidity and an acceptable recurrence rate. However, for patients with significant adhesions and very large PSH, a midline approach with stoma relocation may also be considered.
Nurses’ knowledge, attitude, and fall prevention practices at south Korean hospitals: a cross-sectional survey
Authors: Cho Mi-young , Jang Sun Joo
Published: November 2020

Background

Fall-prevention activities are nursing interventions which are designed to improve patient safety. The introduction of evaluations of medical institutions and an increase in medical litigation has led institutions to emphasize the importance of fall-prevention activities. The current situation regarding falls among patients in small and medium-sized hospitals is poorly understood. This study assessed knowledge and attitudes regarding falls, and fall-prevention activities of nurses working in small- and medium-sized hospitals.

Methods

Nurses (N = 162) from seven small- and medium-sized hospitals participated in the study. Data on participants’ characteristics, education regarding patient falls, knowledge of stretcher cart use, attitudes regarding patient falls, and fall-prevention activities were collected from August 1 to September 1, 2016.

Results

Nurses’ knowledge of patient falls was positively correlated with their experience with inpatient falls. Furthermore, nurses’ attitudes regarding falls were influenced by their nursing experience and fall prevention education. Attitudes positively correlated with fall-prevention activities, but knowledge did not. Nurses’ attitudes regarding patient falls were correlated with fall-prevention activities.

Conclusion

Hospitals should develop incentive programs to improve nurses’ attitudes which are based on their subjective norms and tailored to each hospital’s specific circumstances to ensure engagement in fall prevention activities. In short, we recommend that consistent, repeated, and custom fall-prevention education should be implemented in small- and medium-sized hospitals to promote engagement in fall-prevention activities. Patient safety activities in small- and medium-sized hospitals can be enhanced by creating an environment that encourages active and self-directed participation in developing fall-prevention strategies using motivation and rewards.
Could KL-6 levels in COVID-19 help to predict lung disease?
Authors: Frix AN , Schoneveld L. , Ladang A. , Henket M. , Duysinx B. , Vaillant F. , Misset B. , Moutschen M. , Louis R. , Cavalier E. , Guiot J.
Published: November 2020

Background

Coronavirus disease COVID-19 has become a public health emergency of international concern. Together with the quest for an effective treatment, the question of the post-infectious evolution of affected patients in healing process remains uncertain. Krebs von den Lungen 6 (KL-6) is a high molecular weight mucin-like glycoprotein produced by type II pneumocytes and bronchial epithelial cells. Its production is raised during epithelial lesions and cellular regeneration. In COVID-19 infection, KL-6 serum levels could therefore be of interest for diagnosis, prognosis and therapeutic response evaluation.

Materials and methods

Our study retrospectively compared KL-6 levels between a cohort of 83 COVID-19 infected patients and two other groups: healthy subjects (n = 70) on one hand, and a heterogenous group of patients suffering from interstitial lung diseases (n = 31; composed of 16 IPF, 4 sarcoidosis, 11 others) on the other hand. Demographical, clinical and laboratory indexes were collected. Our study aims to compare KL-6 levels between a COVID-19 population and healthy subjects or patients suffering from interstitial lung diseases (ILDs). Ultimately, we ought to determine whether KL-6 could be a marker of disease severity and bad prognosis.

Results

Our results showed that serum KL-6 levels in COVID-19 patients were increased compared to healthy subjects, but to a lesser extent than in patients suffering from ILD. Increased levels of KL-6 in COVID-19 patients were associated with a more severe lung disease.

Discussion and conclusion

Our results suggest that KL-6 could be a good biomarker to assess ILD severity in COVID-19 infection. Concerning the therapeutic response prediction, more studies are necessary.