bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic pelvic pain syndrome/chronic prostatitis: Is it related to human papillomavirus infection? A case-control study from Eastern India
Authors: Jain Pritesh , Ghosh Amlan , Jana Debarshi , Pal Dilip Kumar
Published: January 2020

Introduction:

Relationship between human papillomavirus infection and chronic prostatitis/chronic pelvic pain syndrome is not clear in the Indian population. The present study evaluated human papillomavirus infection as a risk factor in the development of chronic prostatitis/chronic pelvic pain syndrome.

Methods:

Patients between the age group of 18 and 50 years, diagnosed with chronic prostatitis/chronic pelvic pain syndrome (Cases) or sexually active asymptomatic men with primary infertility (Controls), were recruited. Recording of the personal and/or family history and National Institute of Health-chronic prostatitis symptom index scoring (pain score, urinary score, and quality-of-life score) was done in all prostatitis patients. Seminal fluids of all study patients were evaluated for genomic sequences of human papillomavirus including oncogenic subtypes human papillomavirus-16 and -18.

Results:

Study participants were divided in cases (n = 50) and controls (n = 50). The mean age of cases and controls were 30.72 and 32.48 years, respectively. Among the cases, the mean duration of symptoms was 9.98 months and mean total National Institute of Health-chronic prostatitis symptom index scoring score and mean International Prostate Symptom Score were 20.52 and 5.8, respectively. Among cases, 26 (52%) were found positive for human papillomavirus infection compared to only 6 (12%) in control group (risk ratio = 0.43; 95% confidence interval = 0.3–0.62; p < 0.001). Infection with human papillomavirus-16 subtype was significantly associated with patients from cases group (χ2 = 4.17; risk ratio (confidence interval) (0.39–0.59); p = 0.041). Oncogenic human papillomavirus-18 subtype was not found in any of the group.

Conclusion:

These observations indicate that infection with human papillomavirus (HPV-16 subtype) can be considered as a risk factor for the development of chronic prostatitis/chronic pelvic pain syndrome in Indian males under the age of 50 years.
Fostering Well-Being Among Public Employees With Disabilities: The Roles of Disability-Inclusive Human Resource Practices, Job Resources, and Public Service Motivation
Authors: Tuan Luu Trong , Rowley Chris , Khai Dinh Cong , Qian David , Masli Eryadi , Le Hanh Quyen
Published: January 2020

Regardless of their disabilities, employees with disabilities can contribute to the performance of public organizations. Our research purpose is to investigate how and when disability-inclusive human resource (HR) practices nurture the well-being of employees with disabilities in the public sector. Participants for this study consisted of employees with disabilities from departments and wards (grassroot-level governments) under the district-level governments in Ho Chi Minh City, Vietnam. Our results revealed the relationships between disability-inclusive HR practices and the well-being of public employees with disabilities via job resources as a mediator. The results further demonstrated that the effect of job resources on employee well-being was stronger for employees low in public service motivation than for those high in public service motivation.
‘Evoking the Other’: Towards Feminist Gesture for Any Assembly
Authors: Cones Bryan
Published: January 2020

While some church bodies and denominations have taken steps towards language for the divine and human informed by feminist theological reflection and practice, the embodiment of common prayer across traditions is little changed. Feminist liturgical reflection and practice, however, offer patterns of movement and gesture, voice, and leadership that are no less critical to renewed and liberating liturgical practice in assemblies not consciously identified as ‘feminist’. The following suggests strategies for embodying in liturgical assemblies ritual patterns that would extend and develop the insights of liturgical feminism beyond liturgical texts.
The Lean Startup Framework: Closing the Academic–Practitioner Divide
Authors: Shepherd Dean A. , Gruber Marc
Published: January 2020

The lean startup framework is one of the most popular contributions in the practitioner-oriented entrepreneurship literature. This study seeks to generate new insights into how new ventures are started by describing the five main building blocks of the lean startup framework (business model, validated learning/customer development, minimum viable product, perseverance vs. pivoting, market-opportunity navigation), enriching the framework with existing research findings, and proposing promising research opportunities in a way that reduces the academic−practitioner divide. In so doing, we hope to enhance researchers’ understanding of the startup process; provide knowledge for educators; and, ultimately, improve the startup process for practitioners.
American Roma: A Cultural Care Case Study
Authors: Ares Terri L.
Published: January 2020

This case study depicts the cultural conflict that occurred when an American Roma (Gypsy) woman delivered her baby at a small hospital that had no knowledge or experience with the Roma culture. The case is analyzed based on the three modes of nursing actions and decisions for culturally congruent nursing care, an important tenet of Leininger’s culture care theory. Culture care preservation and maintenance efforts included enabling family presence, respecting the culture’s moral code, and acknowledging child-rearing norms. Cultural care accommodation and negotiation focused on the patient’s hospital room accommodation, negotiating adherence to identification and security measures, and formulating the discharge plan. Cultural care repatterning and restructuring was not attempted. Recommendations for nursing practice are made based on this case, migration trends, and recent cultural changes.
Quality Improvement Project to Promote Identification and Treatment of Children With Obesity Admitted to Hospital
Authors: Myers Joseph , Werk Lloyd N. , Hossain M. Jobayer , Lawless Stephen
Published: January 2020

Among children hospitalized for acute problems, comorbid obesity is commonly unaddressed. The objective was to improve identification and initial management of obesity among hospitalized children. In collaboration with nurses and dietitians, pediatric hospitalists of 2 children’s hospitals conducted a quality improvement project to improve body mass index (BMI) documentation, obesity diagnosis, diet, and nutrition consultation through clinician education, development of computerized clinical decision-support system tools, and workflow modifications. Participants received monthly performance feedback. Among those with elevated BMI, diagnosis rose to 70.2%; a documented obesity diagnosis was associated with being 35 times more likely ( P < .001) to receive at least 1 intervention while hospitalized. Participants reported an increase in skill in (27%), comfort with (27%), and knowledge of (33%) obesity management. Improvement in health care provider recognition and management of obesity in the inpatient setting is achievable. Additional work is needed to identify how best to sustain desired practice patterns.
Extensor Tendon Transfers for Treatment of Foot Drop in Charcot-Marie-Tooth Disease: A Biomechanical Evaluation
Authors: Pfeffer Glenn B. , Michalski Max , Nelson Trevor , An Tonya W. , Metzger Melodie
Published: January 2020

Background:

In Charcot-Marie-Tooth (CMT) disease, selective weakness of the tibialis anterior muscle often leads to recruitment of the long toe extensors as secondary dorsiflexors, with subsequent clawing of the toes. Extensor hallucis longus (EHL) and extensor digitorum longus (EDL) tendon transfers offer the ability to augment ankle dorsiflexion and minimize claw toe deformity. The preferred site for tendon transfer remains unknown. Our goal was to quantify ankle dorsiflexion in the “intact” native tendon state, compared with tendon transfers to the metatarsal necks or the cuneiforms. We hypothesized that EHL and EDL transfers would improve ankle dorsiflexion as compared with the intact state and would produce similar motion when anchored at the metatarsal necks or cuneiforms.

Methods:

Eight fresh-frozen cadaveric specimens transected at the midtibia were mounted into a specialized jig with the ankle held in 20 degrees of plantarflexion. The EHL and EDL tendons were isolated and connected to linear actuators with suture. Diodes secured on the first metatarsal, fifth metatarsal, and tibia provided optical data for tibiopedal position in 3 dimensions. After preloading, the tendons were tested at 25%, 50%, 75%, and 100% of maximal physiologic force for the EHL and EDL muscles, individually and combined.

Results:

Transfers to metatarsal and cuneiform locations significantly improved ankle dorsiflexion compared with the intact state. No difference was observed between these transfer sites. Following transfer, only 25% of maximal force by combined EHL and EDL was required to achieve a neutral foot position.

Conclusion:

Transfer of the long toe extensors, into either the metatarsals or cuneiforms, significantly increased dorsiflexion of the ankle.

Clinical Relevance:

The transferred extensors can serve a primary role in treating foot drop in CMT disease, irrespective of the presence of clawed toes. This biomechanical study supports tendon transfers into the cuneiforms, which involves less time, fewer steps, and easier tendon balancing without compromising dorsiflexion power.
Current state assessment survey of challenges of pharmacogenomics within oncology pharmacy practice
Authors: Przybylski Daniel J , Dow-Hillgartner Elizabeth N , Reed Michael P , Fallon Michael J
Published: January 2020

Purpose

The goal of this survey was to identify opportunities for health systems to increase implementation and adoption of oncology-focused pharmacogenomics services.

Methods

An online survey assessing respondent demographics, baseline knowledge and training in pharmacogenomics, comfort level with pharmacogenomic data, and challenges of implementing clinical pharmacogenomic platforms was distributed to professional colleagues and over national oncology pharmacy listservs. Pharmacists were grouped based on their comfort level with pharmacogenomic data. Results were analyzed utilizing Pearson chi-square test. A p value of <0.05 was considered significant.

Results

A total of 84 participants from 58 cancer centers participated in the survey. Most participants were post-graduate year 2 trained and a majority reported being comfortable assessing oncology pharmacogenomic data. Respondents indicated that pharmacogenomics reported within the electronic medical record was the most common institutional process to support pharmacogenomics for oncology patients. Despite this, poor visibility of pharmacogenomics within the electronic medical record was the most challenging aspect of implementing a pharmacogenomic program. Additional challenges included lack of resources for pharmacogenomic programs, insurance denials for pharmacogenomic-driven testing and medication, and prolonged turnaround time of pharmacogenetic results. Length of practice, post-graduate year 2 residency training, institutions with pharmacist involvement on hematology/oncology molecular tumor board, and institutions where a pharmacist helped create local pharmacogenomic policies were significantly associated with respondents’ comfortability in assessing pharmacogenomics.

Conclusion

Oncology pharmacists reported substantial challenges in implementing a pharmacogenomic program. Future efforts to assist in developing pharmacogenomic efforts should focus on increasing pharmacist involvement, expanding education and training, and improving clinical decision support tools.
Effects of Home-Based Working Memory Training on Visuo-Spatial Working Memory in Parkinson’s Disease: A Randomized Controlled Trial
Authors: Giehl Kathrin , Ophey Anja , Reker Paul , Rehberg Sarah , Hammes Jochen , Barbe Michael T , Zokaei Nahid , Eggers Carsten , Husain Masud , Kalbe Elke , van Eimeren Thilo
Published: January 2020

Background:

Cognitive impairment is a very frequent and severe nonmotor symptom of Parkinson’s disease (PD). Early intervention in this at-risk group for cognitive decline may be crucial for long-term preservation of cognitive functions. Computerized working memory training (WMT) has been proven beneficial in non-PD patient populations, but such evidence is still needed for patients with PD.

Objective:

This study aimed to evaluate the effect of WMT on visuo-spatial working memory (WM) in cognitively unimpaired patients with PD.

Methods:

A single-blind randomized controlled trial encompassing 76 patients with PD but no cognitive impairment according to level II diagnostic criteria was conducted. Thirty-seven patients engaged in home-based adaptive WMT 5 times per week for a period of 5 weeks, whereas the remaining patients were in the waiting list arm of the study (control group [CG]). Working memory performance was evaluated using a computerized task before and after intervention and at 14-week follow-up, allowing to quantify the precision of WM on a continuous scale, ie, to test not only if an item was remembered but also how well the location of this item was retained.

Results:

Coincidently, the WMT group showed slightly worse WM performance compared with the CG at baseline, which was ameliorated after WMT. This training-induced effect remained stable until follow-up.

Conclusion:

Patients showing relatively low WM performance, despite not formally diagnosable as Parkinson’s disease with mild cognitive impairment (PD-MCI), seem to benefit from home-based WMT. Thus, WMT could potentially be implemented in future trials as a time- and cost-efficient route to counteract subtle cognitive changes in early disease stages.

Trial registration:

German Clinical Trial Register (drks.de, DRKS00009379)
Gitanas without a tambourine: Notes on the historical representation and personal self-representation of the Spanish Romani woman
Authors: Alba Pagán Ester , Vasileva Ivanova Aneta
Published: January 2020

The performative representation of the Spanish Roma woman reveals a historical journey that brings her closer to many symbolic elaborations of the feminine, giving her a special affinity with the imaginary concerning the colonized woman, particularly with the Orientalist vision. Developed initially by the travelling intellectuals in Spain who sought a fusion of the topics of sexualized exoticism, the myth was reworked by local artists and thinkers without undermining their power to silence and make invisible the reality of the most vulnerable and most represented members of the ethnic group, their women. Today, a growing awareness of the importance of collective action directs Roma women to initiatives such as the revision of their historical memory, at the intersection between the external gaze and self-perception. These searches lead to the pioneering creation of community museum institutions, which have arisen around feminine Roma associations and are a symptom of an emerging desire to be heard. Based on the terminological tools shared by women and memory studies, this article seeks the personal dimension of this invitation to listen. The authors analyse a series of interviews with Roma women that investigate the social agents of representation, self-representation and their conceptual and experiential foundations.
World Health Organization Essential Medicines List: Multiple sclerosis disease-modifying therapies application
Authors: McDonell Jennifer , Costello Kathleen , Laurson-Doube Joanna , Rijke Nick , Giovannoni Gavin , Banwell Brenda , Baneke Peer
Published: January 2020

Introduction:

The World Health Organization (WHO) publishes a biennial Essential Medicines List (EML) to assist governments in low-resource settings to prioritize their spending on medicines. Currently, no medicines on the EML have a multiple sclerosis (MS) indication. Multiple Sclerosis International Federation (MSIF) prepared an application for inclusion of MS disease-modifying therapies (DMTs) for the 2019 EML together with the regional Committees for Treatment and Research in Multiple Sclerosis (TRIMS) and the World Federation of Neurology.

Rationale:

The MSIF taskforce categorized 15 DMTs according to their efficacy and risk profiles to ensure the ability to treat as many different clinical scenarios as possible. Three DMTs were selected: glatiramer acetate, fingolimod, and ocrelizumab.

Outcome:

The WHO Expert Committee did not recommend the addition of any of the DMTs to the EML. They acknowledged the public health burden of MS, the need for effective and affordable MS medications, and the high volume of letters received in support of the application but requested a revised application.

Discussion:

Despite the negative outcome, the repeated recognition of MS as a global public health burden is sending a powerful message to governments globally that a range of affordable and good quality medications need to be available to health systems and people affected by MS.
Forecasting tourism demand with KPCA-based web search indexes
Authors: Xie Gang , Li Xin , Qian Yatong , Wang Shouyang
Published: January 2020

Search query data (SQD) can be helpful in predicting tourism demand by generating web search indexes. However, valuable nonlinear information in SQD may be neglected by researchers. To effectively capture the nonlinear information, we used kernel principal component analysis (KPCA) to extract web search indexes from SQD. Then, several models with KPCA-based web search indexes were developed for tourism demand forecasting. An empirical study was conducted with collected SQD and real data of tourist arrivals at Hong Kong. The results suggest that models with KPCA-based web search indexes are more accurate than other models because of the nonlinear data processing ability of the KPCA and demonstrate that KPCA-based web search indexes can be excellent predictors for tourism demand forecasting.
The effects of shocks on Turkish tourism demand: Evidence using panel unit root test
Authors: Saglam Yagmur , Ampountolas Apostolos
Published: January 2020

This empirical study examines the stationarity of tourism demand in Turkey in response to the effects of structural breaks, which indicate external or internal shocks based on tourist arrivals from 12 Slavic-speaking countries between 2000 and 2016. We employed a panel unit root test based on the Flexible Fourier approach, which Karul enhanced to allow gradual shifts and a smooth transition process; structural break dates come from the Carrion-i-Silvestre unit root test framework. The empirical findings indicate that there are differences in the effects of these structural breaks across the 12 countries in question.
An improved compliant contact force model using a piecewise function for impact analysis in multibody dynamics
Authors: Yu Jie , Chu Jinkui , Li Yang , Guan Le
Published: January 2020

Contact-impact problems have attracted more and more attention in mechanical multibody systems. In the past period of time, a few compliant contact force models have been put forward. However, some compliant contact force models are only applicable to a specific range of coefficient of restitution impact problems. And, some compliant contact force models have large errors with the actual situation. In order to reduce the errors, an improved compliant contact force model is proposed in this paper, which is applicable to the whole range of coefficient of restitution impact problems. In this work, the permanent deformation is taken into account during the contact process. Meanwhile, the method of piecewise fitting is used to reduce the errors in numerical solutions. Therefore, the improved compliant contact force model uses a piecewise function for the whole range of coefficient of restitution. In order to illustrate the situation, six independent contact force models are numerically analyzed by using Matlab codes. The result shows that the improved compliant contact force model in this paper is applicable to both soft and hard impact and nearer to the actual situation.
Prediction of pilling of polyester–cotton blended woven fabric using artificial neural network models
Authors: Xiao Qi , Wang Rui , Zhang Shujie , Li Danyang , Sun Hongyu , Wang Limin
Published: January 2020

In this article, an intelligent pilling prediction model using back-propagation neural network model and an optimized model with genetic algorithm is introduced. Genetic algorithm is proposed in consideration of the initial weight and threshold of back-propagation artificial neural network, and further improves training speed and the accuracy for prediction pilling of polyester–cotton blended woven fabrics. The results show that the maximum numbers of training steps of the optimized model by genetic algorithm are reduced from 164 steps to 137 steps compared with that of back-propagation model. The training fitness of optimized model by genetic algorithm is improved from 0.914 to 0.945. The simulation fitness is increased from 0.912 to 0.987. And the root mean square error decreased from 1.0431 to 0.6842. The optimized model by genetic algorithm shows a better agreement between the experimental and predicted values.
Blackness in Arab transnational television comedy: Fresh pushback against entrenched stereotypes
Authors: Downing John DH , Gamil Abdulla Idris
Published: January 2020

We address a hitherto understudied site of ‘racial’ representation, namely comedy discourses in contemporary Arab transnational TV, especially in the enormously popular Saudi show Tash Ma Tash (a 1992–2011 Ramadan special). Arab TV comedy’s ‘racial’ representation melds the globally familiar generic depreciation of phenotypical Blackness with traits and tropes distinctive to Nubian Egyptians, Sudanese, and Gulf Afro-Arabs. Symptomatic readings derived via core elements of critical discourse analysis, and self-reflexive experience, are deployed to interpret the media texts selected. We also explore the pushback voiced by those racialized, especially since the advent of Web–TV and social media. We conclude that the region’s TV comedy professionals do not pursue a consciously anti-Black agenda, but that they should urgently review conventional professional practices that ‘dehumanize’ (Bastian and Haslam) Afro-Arabs.
Metabolomic Determination of Specialized Metabolites Using Liquid Chromatography-Tandem Mass Spectrometry in the Traditional Chinese Medicines Astragali Radix and Hedysari Radix
Authors: Bai Hai-Ying , Zheng Wen-Hui , Han Shu , Bao Fang , Sun Li-Li , Zhang Kai-Xue , Wang Li-Yao , Du Hong , Li Yi-Meng , Feng Shi-Lan , Nakabayashi Ryo , Yang Zhi-Gang
Published: January 2020

The Traditional Chinese Medicines (TCMs) Astragali Radix (AR) derived from Astragalus membranaceus (Fisch.) Bge. var. mongholicus (Bge.) Hsiao and A. membranaceus (Fisch.) Bge., and Hedysari Radix (HR) derived from Hedysarum polybotrys Hand.-Mazz. (family Leguminosae) are well-known for increasing the tonic effects on “Qi.” A better insight into the specialized (secondary) metabolites is essential to understand the effects of TCM; however, such metabolites remain largely unknown. Here, we performed a metabolomics-based analysis using liquid chromatography-tandem mass spectrometry in 3 plant tissues—periderm, phloem, and xylem—to identify potential bioactive metabolites. Multivariate statistical analysis revealed 29 metabolites showing a significant difference between groups and 10 biomarker candidates of AR and HR. An anti-inflammatory assay showed that the xylem of both AR and HR and the phloem of HR showed higher anti-inflammatory activity than the positive control quercetin in terms of nitric oxide inhibition.
Could Personal Resources Influence Work Engagement and Burnout? A Study in a Group of Nursing Staff
Authors: Contreras Francoise , Espinosa Juan C. , Esguerra Gustavo A.
Published: January 2020

The aim of this research is twofold. First, to identify the role of personal resources on burnout and work engagement in nursing staff and second to evaluate whether these last two concepts are or not, opposite faces of the same construct. Personal resources are understood as individuals’ aspects that make people more confident to control their environment successfully. This study used a cross-sectional approach with a sample composed of 219 Colombian nursing personnel all of them were women. In line with our predictions, personal resources were positively related to employees’ work engagement ( rxy = .40) and negatively to burnout ( rxy = -.51), as well as engagement and burnout showed to be different constructs that are inversely related ( rxy = -.95). The greater inverse correlation between personal resources and burnout seems to indicate that personal resources could be an important protective factor for nursing staff. Since personal resources can be developed, these findings have important implications for the human resource management in the health care settings. Due to the complexity of health work environment, further research needs to find more evidence to understand the role of personal resources in these environments.
Cloak of Invisibility: A Literature Review of Physical Disability in Ghana
Authors: Mfoafo-M’Carthy Magnus , Grischow Jeff D. , Stocco Nicole
Published: January 2020

This literature review surveys the state of current scholarship on physical disability in Ghana. The intention is to identify major themes and opinions relating to the challenges faced by Ghanaians with physical disabilities. After an extensive literature review, the authors selected 21 articles for inclusion based on the criteria that they had to focus on physical disability in a Ghanaian setting. Reviewing the articles revealed that most scholars have focused on the pervasive oppression of Ghanaians with physical disabilities. Six major topic areas emerged, including the experience of the disability rights movement from the 1990s to the present, the public perception of people with physical disabilities, the issue of families and abuse, the rights to education, challenges around employment and finances, and health care for disabled Ghanaians. This literature review presents these topics, discusses their implications, and makes suggestions for further research and action to improve human rights for Ghanaians with physical disabilities.
Psychologically Resilient, but Physically Vulnerable? Exploring the Psychosocial Determinants of African American Women’s Mental and Physical Health
Authors: Erving Christy L. , Satcher Lacee A. , Chen Yvonne
Published: January 2020

Integrating the intersectionality framework and stress theory, this study identifies the stressors and psychosocial resources contributing to the physical and psychological health status of African American women. Using the National Survey of American Life ( N = 2,077), the authors examine the relationship between stress exposures, psychological resources, and health among African American women. The results show that not all psychological resources buffered the deleterious health effects of multiple stress exposures and that the effects of stress and psychological resources differ by health domain. One important finding is that chronic stress negatively affects both mental and physical health, even after adjusting for other stress exposures and psychological resources. Traditional forms of psychological resources, such as social support, mastery, and self-esteem, do not completely ameliorate the negative effects of stress and, in some cases, amplify the negative effects of stress on health. The findings demonstrate the need to disentangle the differential impact of psychosocial factors on African American women’s health.
Thinking Lean in Sonography
Authors: Jaworsky Michael S.
Published: January 2020

AbstractThinking LEAN is an informal way to continuously be aware of and look to improve the value of your surroundings. A sonography department has many moving parts or “steps.” Identification and reduction of unnecessary steps may create greater efficiency and value for a process. This may ultimately provide a better experience for the sonographer and the customer.
A systematic survey of randomised trials that stopped early for reasons of futility
Authors: Walter S. D. , Han H. , Guyatt G. H. , Bassler D. , Bhatnagar N. , Gloy V. , Schandelmaier S. , Briel M.
Published: January 2020

Background

Randomised trial protocols may incorporate interim analyses, with the potential to stop the study for futility if early data show insufficient promise of a treatment benefit. Previously, we have shown that this approach will theoretically lead to mis-estimation of the treatment effect. We now wished to ascertain the importance of this phenomenon in practice.

Methods

We reviewed the methods and results in a set of trials that had stopped for futility, identified through an extensive literature search. We recorded clinical areas, interventions, study design, outcomes, trial setting, sponsorship, planned and actual treatment effects, sample sizes; power; and if there was a data safety monitoring board, or a published protocol. We identified: if interim analyses were pre-specified, and how many analyses actually occurred; what pre-specified criteria might define futility; if a futility analysis formed the basis for stopping; who made the decision to stop; and the conditional power of each study, i.e. the probability of statistically significant results if the study were to continue to its complete sample size.

Results

We identified 52 eligible trials, covering many clinical areas. Most trials had multiple centres, tested drugs, and 40% were industry sponsored. There were 75% where at least one interim analysis was planned a priori; a majority had only one interim analysis, typically with about half the target total sample size. A majority of trials did not pre-define a stopping rule, and a variety of reasons were given for stopping. Few studies calculated and reported low conditional power to justify the early stop. When conditional power could be calculated, it was typically low, especially under the current trend hypothesis. However, under the original design hypothesis, a few studies had relatively high conditional power. Data collection often continued after the interim analysis.

Conclusions

Although other factors will typically be involved, we conclude that, from the perspective of conditional power, stopping early for futility was probably reasonable in most cases, but documentation of the basis for stopping was often missing or vague. Interpretation of truncated trials would be enhanced by improved reporting of stopping protocols, and of their actual execution.
Orthopaedic surgeons’ perceptions of frailty and frailty screening
Authors: Archibald Mandy M. , Lawless Michael , Gill Tiffany K. , Chehade Mellick J.
Published: January 2020

Background

Over the past decade, there has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures. Emerging as a major clinical and research focus in aged care is the concept of frailty and its associations with fragility, sarcopenia, falls and rehabilitation. Currently, research is lacking on how orthopaedic surgeons perceive frailty and the role of frailty screening. A baseline understanding of these perceptions is needed to inform integration of frailty identification and management for patient optimization in orthopaedic practices, as well as research and education efforts of patients and healthcare professionals in orthopaedic contexts.

Methods

We used an exploratory design guided by qualitative description to conduct 15 semi-structured telephone and in-person interviews across three orthopaedic surgeon subgroups (Registrars, Junior Consultants, and Senior Consultants). Data collection and analysis occurred iteratively and was guided by thematic saturation.

Results

Orthopaedic surgeons have a disparate understanding of frailty. Between colleagues, frailty is often referred to non-specifically to suggest a general state of risk to the patient. Frailty screening is regarded positively but its specific utility in orthopaedic environments is questioned. Easy-to-administer frailty screening tools that are not exclusive assessments of functional status are viewed most satisfactorily. However these tools are rarely used.

Conclusions

There is little understanding among orthopaedic surgeons of frailty as a phenotype. Beliefs around modifiability of frailty were dissimilar as were the impact of related risk factors, such a cognitive status, chronic disease, social isolation, and environmental influences. This in turn may significantly impact on the occurrence and treatment outcomes of fragility fracture, a common orthopaedic problem in older populations. This study highlights need for knowledge translation efforts (e.g. education) to achieve cohesive understanding of frailty among health professionals.
Development and evaluation of a strength-based method to promote employment of work-disability benefit recipients with multiple problems: a feasibility study
Authors: Brongers Kor A. , Cornelius Bert , van der Klink Jac J. L. , Brouwer Sandra
Published: January 2020

Background

For people with disabilities, chances to find or keep work are negatively affected by multiple problems like lower education, poverty and poor health. Furthermore, although active labour market policies proved to be effective for unemployed in general, success rates are poor for persons who are unemployed due to multiple problems. The present study aims to describe the development of a method as well as professional training to teach its application, and to assess the feasibility of method and training. The Strength-based method (CARm) aims to promote employment of work-disability benefit recipients with multiple problems.

Methods

The main principles of the Strength model were redesigned for better applicability in a population of work-disability beneficiaries, resulting in the CARm method. As part of the CARm method, a training module for Labour Experts (LEs) was developed. To assess the new designed method and training, a one-group, pre-post design was used. Data were collected from eight participating LEs, five female and 3 male, aged between 41and 55 years and having 2–17 years working experience. We used self-report questionnaires and a semi-structured discussion meeting after the training sessions with the LEs.

Results

Eight labour experts (LEs) from the Dutch Social Security Institute participated in the study. Most LEs felt an improvement in their ability to ascertain developmental needs, opportunities and threats in the client’s situation. Three months after the training, LEs almost unanimously agreed on the statements ‘I expect to use the CARm method more frequently in the future’ and ‘I use the CARm method in daily practice whenever possible’. The overall rating for the training on a scale from 1 to 10 was 7.6 (range 7–9). The overall satisfaction with the trainers was good.

Conclusions

The CARm method and training was found to be a feasible approach to facilitate LEs working at the UWV reintegration service to support clients with multiple problems. Sufficient managerial support for participating LEs is a key factor for successful implementation of CARm. Results show that CARm is worth testing for efficacy in a future trial.
Prevalence and incidence of bronchiectasis in Italy
Authors: Aliberti Stefano , Sotgiu Giovanni , Lapi Francesco , Gramegna Andrea , Cricelli Claudio , Blasi Francesco
Published: January 2020

Background

The understanding of the epidemiology of bronchiectasis is still affected by major limitations with very few data published worldwide. The aim of this study was to estimate the epidemiological burden of bronchiectasis in Italy in the adult population followed-up by primary care physicians.

Methods

This study analyzed data coming from a large primary care database with 1,054,376 subjects in the period of time 2002–2015. Patients with bronchiectasis were selected by the use of International Statistical Classification of Diseases, 9th revision, Clinical Modification codes (ICD-9-CM).

Results

Patients with bronchiectasis were more likely to have a history of tuberculosis (0.47% vs. 0.06%, p < 0.0001), had higher rates of asthma (16.6% vs. 6.2%, p < 0.0001), COPD (23.3% vs. 6.4%, p < 0.0001) and rheumatoid arthritis (1.9% vs. 0.8%, p < 0.0001). The prevalence and incidence of bronchiectasis in primary care in Italy in 2015 were 163 per 100,000 population and 16.3 per 100,000 person-years, respectively. Prevalence and incidence increased with age and overall rates were highest in men over 75 years old. Prevalence and incidence computed after the exclusion of patients with a diagnosis of either asthma or COPD is 130 per 100,000 and 11.1 cases per 100,000 person-years, respectively.

Conclusions

Bronchiectasis is not a rare condition in Italian adult population. Further studies are needed to confirm our results and provide a better insight on etiology of bronchiectasis in Italy.

Trial registration

not applicable.
Diagnostic sensitivity and specificity of dynamic three-dimensional CT analysis in detection of cam and pincer type femoroacetabular impingement
Authors: Röling Maarten A. , Mathijssen Nina M. C. , Bloem Rolf M.
Published: January 2020

Background

Cam and pincer-type morphologies can cause femoroacetabular impingement syndrome (FAI) and can be measured on plain radiographs using the alpha angle and the center edge angle. As an addition to plain radiographs and to assess femoroacetabular impingement, it is possible to visualize the interplay of the acetabular and femoral morphology by means of dynamic three-dimensional simulation of hip joint. Therefore, the objective of this study is to compare alpha angles and center edge angles on plain radiographs with the dynamic computerized tomography (CT) analysis in patients with complaints of femoroacetabular impingement.

Methods

All patients from our prospective cohort from 2012 to 2015 who underwent radiographs and a dynamic CT analysis for FAI were selected. Cam type morphologies were measured with the alpha angle and pincer type morphologies with lateral center-edge angle on radiographs and with CT analysis. The dynamic CT analysis also calculated position and size of impingement of femur and acetabulum. Intra-operative assessment was used to confirm impingement. Sensitivity, specificity and predictive values were calculated compared with respect to the intra-operative assessment.

Results

A total of 127 patients were included. 90 cam morphologies and 45 pincer morphologies were identified intra-operatively.

The sensitivity and specificity for cam morphology measured with radiographs was 84 and 72% compared to 90 and 43% with three dimensional dynamic analyses. The sensitivity and specificity for pincer morphology measured with radiographs was 82 and 39% compared to 84 and 51% with three dimensional dynamic analyses.

Conclusions

Diagnostic accuracy is comparable in three-dimensional dynamic analysis of CT scans and radiographs representing FAI caused by cam or pincer type morphology.

Level of evidence

IV
Complete-arch fixed reconstruction by means of guided surgery and immediate loading: a retrospective clinical study on 12 patients with 1 year of follow-up
Authors: Lerner Henriette , Hauschild Uli , Sader Robert , Ghanaati Shahram
Published: January 2020

Background

Guided implant surgery is considered as a safe and minimally invasive flapless procedure. However, flapless guided surgery, implant placement in post-extraction sockets and immediate loading of complete-arch fixed reconstructions without artificial gum are still not throughly evaluated. The aim of the present retrospective clinical study was to document the survival and success of complete-arch fixed reconstructions without artificial gum, obtained by means of guided surgery and immediate loading of implants placed also in fresh extraction sockets.

Methods

A total of 12 patients (5 males and 7 females, with a mean age of 50.0 ± 13.8) were enrolled in this study. Implant planning was performed with a guided surgery system (RealGuide®, 3Diemme, Como, Italy), from which 3D-printed surgical templates were fabricated. All implants (Esthetic Line-EL®, C-Tech, Bologna, Italy) were placed through the guides and immediately loaded by means of a temporary fixed full-arch restoration without any artificial gum; the outcome measures were implant stability at placement, implant survival, complications, prosthetic success, soft-tissue stability, and patient satisfaction.

Results

One hundred ten implants (65 of them post-extractive) were placed flapless through a guided surgery procedure and then immediately loaded by means of provisional fixed full arches. Successful implant stability at placement was achieved in all cases. After a provisionalization period of 6 months, 72 fixed prosthetic restorations were delivered. Only 2 implants failed to osseointegrate and had to be removed, in one patient, giving a 1-year implant survival rate of 98.2% (108/110 surviving implants); 8/12 prostheses did not undergo any failure or complication during the entire follow-up period. At the 1-year follow-up control, soft-tissue was stable in all patients and showed satesfactory aesthetic results.

Conclusions

Within the limits of this study, complete-arch fixed reconstruction by means of guided surgery and immediate loading of implants placed in fresh extraction sockets appears to be a reliable and successful procedure. Further long-term prospective studies on a larger sample of patients are needed to confirm these positive outcomes.
Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study
Authors: Harris Kristin , Søfteland Eirik , Moi Asgjerd Litleré , Harthug Stig , Storesund Anette , Jesuthasan Sebastius , Sevdalis Nick , Haugen Arvid Steinar
Published: January 2020

Background

Patients’ involvement in patient safety has increased in healthcare. Use of checklists may improve patient outcome in surgery, though few have attempted to engage patients’ use of surgical checklist. To identify risk elements of complications based on patients’ and healthcare workers’ experiences is warranted. This study aims to identify what the patients and healthcare workers find to be the risk elements that should be included in a patient-driven surgical patient safety checklist.

Method

A qualitative study design where post-operative patients, surgeons, ward physicians, ward nurses, and secretaries from five surgical specialties took part in focus group interviews. Eleven focus groups were conducted including 25 post-operative patients and 27 healthcare workers at one tertiary teaching hospital and one community hospital in Norway. Based on their experiences, participants were asked to identify perceived risks before and after surgery. The interviews were analysed using content analysis.

Results

Safety risk factors were categorised as pre-operative information: pre-operative preparations, post-operative information, post-operative plans and follow-up. The subcategories under pre-operative information and preparations were: contact information, medication safety, health status, optimising health, dental status, read information, preparation two weeks before surgery, inform your surgical ward, planning your own discharge, preparation on admission and just before surgery. The subcategories under post-operative information, further plans and follow-up were: prevention and complications, restriction and activity, medication safety, pain relief, stomach functions, further care and appointments. Both healthcare workers and patients express the need for a surgical patient safety checklist.

Conclusion

A broad spectre of risk elements for a patient safety checklist were identified. Developing a surgical safety checklist based on these risk elements might reduce complications and unwanted errors.

Trail registration

The study is registered as part of a clinical trial inClinicalTrials.gov: NCT03105713.
Cost-effectiveness analysis of pembrolizumab compared to standard of care as first line treatment for patients with advanced melanoma in Hong Kong
Authors: Loong Herbert H. , Wong Carlos K. H. , Leung Linda K. S. , Tan S. C. , Jen Jason , Lee Mary Y. K. , Aguiar-Ibáñez Raquel , Wang Jingshu
Published: January 2020

Background

Pembrolizumab has been shown to improve overall survival (OS) and progression free survival (PFS) compared to ipilimumab in patients with ipilimumab-naïve advanced melanoma; however, there are no published data on the cost-effectiveness for pembrolizumab compared to standard-of-care treatments currently used in Hong Kong for advanced melanoma.

Methods

A partitioned-survival model based on data from a recent randomized phase 3 study (KEYNOTE-006) and meta-analysis was used to derive time in PFS, OS, and post-progression survival for pembrolizumab and chemotherapy, such as dacarbazine (DTIC), temozolomide (TMZ), and the paclitaxel-carboplatin combination (PC). A combination of clinical trial data, published data, results of meta-analysis, and melanoma registry data was used to extrapolate PFS and OS curves. The base-case time horizon for the model was 30 years with costs and health outcomes discounted at a rate of 5% per year. Individual patient level data on utilities and frequencies of adverse events were obtained from the final analysis of KEYNOTE-006 (cut-off date: 3-Dec-15) for pembrolizumab. Cost data included drug acquisition, treatment administration, adverse event management, and clinical management of advanced melanoma. The distribution of patient weight from the Hong Kong population was applied to calculate the drug costs. Analyses were performed from a payer’s perspective. The incremental cost effectiveness ratio (ICER) expressed as cost in US Dollars (USD) per quality-adjusted life years (QALYs) was the main outcome.

Results

In base-case scenario, the ICER for pembrolizumab as a first-line treatment for advanced melanoma was USD49,232 compared to DTIC, with the ICER values lower than cost-effectiveness threshold in Hong Kong. Results comparing pembrolizumab to TMZ and to PC were similar to that when compared to DTIC. Probability sensitivity analyses showed that 99% of the simulated ICERs were below three times the Gross Domestic Product (GDP) per capita for Hong Kong (currently at $119,274//QALY threshold). In a scenario analysis comparing pembrolizumab with ipilimumab, the estimated ICER was USD8,904.

Conclusions

Pembrolizumab is cost-effective relative to chemotherapy (DTIC, TMZ and PC), and highly-cost-effective compared to ipilimumab, for the first-line treatment of advanced melanoma in Hong Kong.