bluuebunny/crossref_metadata_2025 huggingface dataset:
Piloter le changement par un projet sur les valeurs managériales : contribution des espaces de concertation comme instrument de gestion et d’innovation de l’action publique
Authors: Anton Philippe , Grimand Amaury , Boespflug Magali , Becuwe Audrey
Published: October 2021

La modernisation des collectivités locales constitue un enjeu de management public. Les différentes conduites de changement qui s’y opèrent peuvent impacter les identités sociales, culturelles et institutionnelles. Le management par les valeurs conduit dans des contextes participatifs peut constituer alors des opportunités, mais les valeurs peuvent également être perçues comme des objets complexes à gérer pour piloter le changement. Il s’agit ainsi de comprendre comment faire des valeurs managériales tout comme de la concertation un objet légitime de gestion (Godelier, 2009). Nous proposons au travers d’une recherche conduite au sein d’une ville de plus de 150 000 habitants, qui n’avait pas connu l’alternance politique depuis 102 ans, d’articuler concertation, changement et va leurs managériales. La démarche méthodologique mise en œuvre prend appui sur le cadre théorique de la sociologie de la traduction (Akrich, Callon et Latour, 2006) mobilisée le plus souvent dans les travaux gestionnaires a posteriori pour développer une approche compréhensive et rétrospective des processus de changement organisationnel. Nous montrons comment ce cadre d’analyse peut être mobilisé ex ante dans le cadre d’une recherche-intervention pour penser les conditions d’un projet de changement ancré sur les valeurs managériales et prenant appui sur la mise en place d’espaces de concertation.
Du pilotage de la performance médico-économique au pilotage de la performance servicielle des GHT
Authors: Roche Régine
Published: October 2021

Cette communication pose la question de «  la mesure de périmètre d’application du service public hospitalier au sein des réseaux territorialisés d’organisations hospitalières  », auquel le tableau de bord prospectif modélisé répond par l’évaluation de la performance globale d’un Groupement Hospitalier de Territoire. La recherche s’appuie sur un cas de recherche-intervention mené de 2016 à 2018. Cette étude de cas a pour objet un GHT regroupant 9 établissements de santé publics de tailles hétérogènes, dont un CHU assure par délégation de compétences la gestion des missions et des fonctions supports depuis le 30 juin 2016. Les résultats obtenus mettent en évidence que la mise en intelligence collective de la recomposition territoriale de l’offre de soins contribue à la territorialisation du service public hospitalier. Concrètement, ces derniers montrent que ce changement de paradigme résulte de l’inscription de la prise en charge de l’ usager-client dans une réponse globale décloisonnée des modes de gestion et de financement de ses besoins de soins, et donc en pratique au passage d’une logique de leadership à celle de partnership . La modélisation d’indicateurs d’évaluation de la performance globale basés sur des valeurs collectives, et non plus seulement sur des données médico-économiques, permet à cette recherche de renouveler la conception du contrôle de gestion à l’aune d’un pilotage serviciel de la performance des GHT.
La Turquie en Libye à l’ère Biden
Authors: Seni Nora
Published: October 2021

Cet article montre la place devenue centrale de la Libye dans la stratégie de puissance régionale du président turc. Les investissements économiques, militaires et politiques effectués par Ankara dans ce pays témoignent d’une volonté farouche de présence pérenne qui donne à la Turquie accès à des eaux territoriales dont elle est exclue et au trafic de pipelines énergétiques entre Israël, l’Égypte, Chypre, la Grèce et l’Italie. L’arrivée de Biden à la Maison-Blanche se présente comme une nouvelle donne qui remet en cause les ambitions turques.
Janvier 1991, une tempête dans le désert consacre la puissance aérienne
Authors: Steininger Philippe
Published: October 2021

En janvier 1991, la puissance aérienne de la coalition a obtenu la décision face à une armée irakienne formatée pour l’action terrestre. La guerre du Golfe a ainsi révélé l’apport stratégique de la troisième dimension, ouvrant une ère nouvelle largement dominée par les États-Unis ayant tiré les leçons de la guerre du Vietnam.
La guerre du Golfe vue de Washington : les enjeux de la guerre en coalition
Authors: Gros Philippe
Published: October 2021

La guerre du Golfe a été l’occasion pour Washington d’entrer dans l’ère des coalitions ad hoc et d’imposer de fait les normes américaines tant dans l’organisation du commandement, la conception des opérations puis leur conduite, avec cependant des difficultés liées à l’interopérabilité et au manque de concertation.
La transformation de la conduite politico-militaire de la guerre à l’issue de la guerre du Golfe
Authors: Lanxade Jacques
Published: October 2021

Le mode de conduite politico-militaire des opérations a été transformé à l’issue de la guerre du Golfe. Le rôle du Cema a été renforcé, de même que l’organisation du commandement opérationnel. Le choix de la professionnalisation s’est imposé en 1996. La prochaine étape serait un Conseil de sécurité rattaché au Président.
Réformer le renseignement militaire français après la guerre du Golfe : un enjeu politique
Authors: Bat Jean-Pierre
Published: October 2021

Les réformes de 1992 ont profondément transformé le ministère de la Défense et les forces armées. L’organisation du renseignement militaire a été complètement réformée avec la création de la DRM et du COS. Cette mutation a été entamée à partir de 1988 et s’est accélérée suite aux leçons de la guerre du Golfe.
L’impact de la seconde guerre du Golfe sur la présence française au Moyen-Orient
Authors: Razoux Pierre
Published: October 2021

Le rôle et la place de la France ont beaucoup évolué depuis le tournant des années 1990, avec une marginalisation réelle, malgré quelques succès d’estime dans la vente d’armes. Toutefois, les mutations actuelles avec le relatif retrait de Washington pourraient accélérer les transformations, obligeant Paris à de nouveaux choix.
La guerre du Golfe, creuset de la projection de forces contemporaine ?
Authors: Motte Martin
Published: October 2021

La projection de forces est une réalité ancienne pour les armées françaises, alternant avec les phases de défense du territoire. À partir du milieu des années 1970, les forces ont construit une aptitude à être projetées, sans pour autant être confronté à des engagements de haute intensité qui pourraient redevenir une réalité opérationnelle.
Les conséquences de la guerre du Golfe sur le modèle de l’Armée de l’air
Authors: de Lespinois Jérôme
Published: October 2021

La guerre du Golfe a accéléré les mutations propres à l’Armée de l’air qui avaient été amorcées avec le plan Armées 2000. En modifiant en profondeur l’organisation et le fonctionnement, celle-ci a vu une rupture confirmée ensuite par le Retex du conflit puis par la professionnalisation décidée en 1996.
Napoléon et l’esclavage
Authors: Klen Michel
Published: October 2021

Les récentes polémiques sur Napoléon et l’esclavage ont passé sous silence la volonté de l’Empereur de libérer les individus. Il supprima ainsi le servage dans plusieurs parties de l’Europe et interdit la traite et la vente des esclaves, prélude à la disparition de cette barbarie alors pratiquée de façon courante.
Metastasectomy Versus Non-Metastasectomy for Giant Cell Tumor of Bone Lung Metastases
Authors: Tsukamoto Shinji , Mavrogenis Andreas F. , Tanaka Yuu , Kido Akira , Honoki Kanya , Tanaka Yasuhito , Errani Costantino
Published: October 2021

Approximately 2% to 9% of giant cell tumor of bone (GCTB) metastasizes systemically, mainly to the lungs. The biological behaviors and clinical courses of lung metastases are difficult to predict, and their treatment recommendations vary, including metastasectomy and non-metastasectomy with chemotherapy (denosumab, interferon-alfa, bisphosphonates), with radiation therapy, or with observation alone. However, it is unclear whether metastasectomy for GCTB lung metastases decreases the mortality rate of these patients. Therefore, the authors performed this systematic review to compare metastasectomy and non-metastasectomy for GCTB patients with operable lung metastasis. Of the 919 relevant studies, 16 studies (138 patients) were included for analysis; 61.6% of patients had metastasectomy and 38.4% had non-metastasectomy. Analysis showed that mortality rates were similar for the patients who had metastasectomy compared with those who did not; the proportion of patients who died of disease was 7.1% in the metastasectomy group and 17.0% in the non-metastasectomy group, with an overall pooled odds ratio of 0.64 (
P
=.36). Therefore, physicians should reconsider the potential risks and benefits of metastasectomy for patients with GCTB and lung metastasis, because metastasectomy does not reduce the mortality rate in these patients. [
Orthopedics
. 2021;44(6):e707–e712.]
Management of Posttraumatic Avascular Necrosis of the Proximal Humerus
Authors: Ayyash Ali M. , Bui Tuan M. , O'Brien Michael J. , Mulcahey Mary K.
Published: October 2021

The etiology of avascular necrosis (AVN) of the proximal humerus can be classified as idiopathic or posttraumatic, the latter being mainly due to proximal humerus fractures. Evidence suggests that posttraumatic AVN may require surgical intervention more often than idiopathic AVN of the proximal humerus. This article provides a comprehensive review of the management of posttraumatic AVN of the proximal humerus. Early stage AVN (stages 1 to 3) is commonly treated with nonoperative intervention or core decompression of the humeral head, whereas later stage disease (stages 4 and 5) may require hemiarthroplasty or total shoulder arthroplasty to restore function. [
Orthopedics
. 2021;44(6):367–375.]
Circumferential and Segmental Labral Reconstruction: A Systematic Review
Authors: Maldonado David R. , Kyin Cynthia , Shapira Jacob , Rosinsky Philip J. , Walker-Santiago Rafael , Domb Benjamin G.
Published: October 2021

The purposes of this study were to synthesize, report, and compare patient-reported outcomes (PROs) between arthroscopic segmental and circumferential labral reconstruction. A systematic review was performed in February 2019 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method. Inclusion criteria were levels I to IV evidence, articles in English, arthroscopic labral reconstruction, and PROs data. Exclusion criteria were labral treatment without reconstruction, open surgery, and less than 6-month follow-up. Eleven studies were identified. Nine studies (212 hips) reported outcomes of segmental reconstruction. Two studies (194 hips) reported outcomes of circumferential reconstruction. Significant improvement in PROs at short-term with either segmental or circumferential reconstruction was found. [
Orthopedics
. 2021;44(6):361–366.]
Evaluation and Management of a Painful Knee After Total Knee Arthroplasty
Authors: Cooper Alexus M. , Connolly Keith , Penna Sreeram , Parvizi Javad
Published: October 2021

Pain after total knee arthroplasty (TKA) is not infrequent and may be indicative of a broad spectrum of prosthesis-related, intra-articular, or extra-articular pathologies. To diagnose and treat the underlying cause of a painful TKA, systematic evaluation of the patient is critical to ensure that they are managed appropriately and expeditiously. This evidence-based review presents current concepts regarding the pathophysiology, etiology, and diagnosis of painful TKA and our recommended approach for management. [
Orthopedics
. 2021;44(6):341–352.]
Minimizing the Risk of Opioid Misuse and Abuse in the Surgical Setting
Authors: Shah Aakash A. , Shah Abha A.
Published: October 2021

The misuse of opioids continues to be a public health problem. Acute post-surgical pain management requires a careful balance between the benefits and risks of opioids. Opioids should be part of a multimodal treatment plan, including the use of nonopioid and nonpharmacologic treatment options. Multimodal pain management allows for individualized treatment and improved patient satisfaction while limiting the risks inherent to opioids, including diversion. Surgeons should avoid overprescribing opioids and have a plan for decreasing the use of opioids in the postsurgical time frame. With careful consideration of the risks, opioids can be prescribed to treat acute postsurgical pain effectively. [
Orthopedics
. 2021;44(6):353–359.]
Detection of Surgical Wrap Defects in the Operating Room Setting
Authors: Kelly Shayne R. , Huish Eric G. , Holmboe Michael C. , Lara Daniel L. , Trzeciak Marc A. , Cash Robert
Published: October 2021

Surgical site infection is a challenging complication that places a significant burden on the patient and the health care system. Emphasis is being placed on the prevention and treatment of surgical site infections. We evaluated the accuracy of identifying surgical wrap defects based on defect size, location, and operating room staff experience. Forty sterilization wraps were divided into 4 separate groups based on the size of the puncture defects created. Defects measuring 1.2 mm, 3.7 mm, and 6.8 mm were compared with a control group of surgical wraps with no defects. Defects were randomly placed on an inner or outer line with circumference of 7 cm or 14 cm, respectively. Twenty operating room staff of varying levels of experience evaluated each wrap for defects. The detection rates for the 1.2-mm, 3.7-mm, and 6.8-mm wraps and the wraps with no defects were 3%, 73%, 80%, and 99%, respectively. A significant difference was seen between the detection rates for the small defects vs all other size defects. No significant difference was seen in detection rate based on the location of defects. The detection rate was higher among staff members with greater than 1 year of experience vs those with less than 1 year of experience. Sterilization wrap defects of all sizes went undetected at very high rates. Small defects of 1.2 mm, which have been shown to allow bacterial contamination, were missed 97% of the time. Operating room staff with more experience detected more defects than those with less than 1 year of experience. Wrap defects may be a source of bacterial contamination that may frequently go unnoticed. [
Orthopedics
. 2021;44(6):735–e738.]
Iatrogenic Contamination With a Surgical Helmet System in Orthopedic Surgery
Authors: Eggers John P. , Krumme John W. , Kotwal Suhel
Published: October 2021

Surgical helmet systems (SHSs) have been used to decrease iatrogenic contamination to prevent periprosthetic joint infections. However, the use of SHSs has been controversial. Therefore, the purpose of this study was to investigate iatrogenic contamination of traditional surgical attire (TSA), SHSs, and SHSs with delayed ventilation (SHS-DV) (helmet fan not turned on until surgeon gowned and gloved). A total of 180 orthopedic surgical procedures were prospectively enrolled and randomized into one of three cohorts. The TSA cohort included any orthopedic procedures, while the SHS and SHS-DV cohorts included arthroplasty procedures. Cultures were obtained from bilateral forearms, axillae, the sternum, and face shields for SHS groups. There were 60 surgeries in each group. The rate of positive cultures was calculated for each cohort and stratified by location and type of microorganism. The positive culture rates were 15% in the TSA, 25% in the SHS, 18% in the SHS-DV cohorts. The positive swab culture rates were 6% in the TSA, 7% in the SHS, and 4% in the SHS-DV cohorts. The positive culture rate was highest from the forearms in the TSA cohort (10%), the face shield in the SHS cohort (20%), and the chest in the SHS-DV cohort (7%). Coagulase-negative
Staphylococcus
was the most common bacteria cultured. The overall bacterial contamination rates were similar between the TSA and the SHS cohorts, with a lower rate in the SHS-DV cohort. Waiting to initiate airflow in SHSs and treating the shields as contaminated may reduce iatrogenic contamination. [
Orthopedics
. 2021;44(6):e753–e756.]
The Changing Face of Bullying and What We Can Do to Stop It
Authors: Khan Leah
Published: October 2021

Bullying is a pervasive problem that affects all races, religions, genders, and socioeconomic groups. It occurs primarily at school but can also follow children and adolescents to their home, work, and activities. In more recent years, bullying has also taken on a new form via digital and electronic means. The avenues for bullying are constantly evolving as society and technology evolve as well. Bullying can have a significant impact on both short-term health and functioning as well as long-term success and well-being. For this reason, it is important to be able to identify bullies and their victims and implement strategies to stop bullying before it occurs and manage the consequences when it does happen.

[
Pediatr Ann
. 2021;50(10):e398–e401.]
Bedside Ultrasound for Procedural Assistance in Pediatrics
Authors: Braverman Jaime
Published: October 2021

Point-of-care ultrasound (POCUS) is a noninvasive imaging tool with both diagnostic and therapeutic applications. In this article, the author will review the role of POCUS for vascular access, endotracheal intubation, lumbar puncture, chest tube, and diagnosing coronavirus disease 2019 lung pathology. This will include a review of the evidence, technique, and strategies for optimizing performance of these procedures.

[
Pediatr Ann
. 2021;50(10):e404–e410.]
Factors predicting perioperative outcomes in patients with myasthenia gravis or thymic neoplasms undergoing thymectomy by video-assisted thoracoscopic approach
Authors: Vigneshwaran B. , Bhoi Sanjeev Kumar , Sable Mukund Namdev , Muduly Dillip , Sultania Mahesh , Jha Menkha , Mohakud Sudipta , Kar Madhabananda
Published: October 2021

Background:

The purpose of this study was to identify the factors which predict the perioperative outcomes after video-assisted thoracoscopic surgery (VATS) thymectomy in patients with myasthenia gravis (MG) or thymic neoplasms

Patients and Methods:

Data of consecutive patients who had undergone VATS thymectomy in our institution from August 2016 to April 2018 were collected retrospectively from a prospectively maintained database followed by prospective recruitment of patients who underwent VATS thymectomy from April 2018 to February 2020.

Results:

A total of 31 patients were included. Females were more common (51.6%), and 29 patients (93.5%) had MG. The most common indication for thymectomy was the presence of both MG and thymoma (51.6%). Most MG patients had moderate disease (55.2%) or severe (24.1%) disease preoperatively. Mean operative time and blood loss were 196.9 ± 63.5 min and 122.5 ± 115.3 ml, respectively. Mean hospital stay was 7.9 ± 6.7 days. The rate of major and minor complications was 16.18% and 35.4%, respectively. Multivariate linear regression analysis established that MG symptoms >12 months, prolonged invasive ventilation (intubation ≥24 h), and complications were associated significantly with a prolonged hospital stay. Adjusting for outliers, pre-operative disease severity (MG Foundation of America class), and intubation ≥24 h were the only factors that had a significant impact on perioperative outcomes.

Conclusion:

Pre-operative disease severity and post-operative invasive ventilation are strong determinants of perioperative outcomes. Pre-operative optimisation and early extubation protocols can further reduce morbidity in patients undergoing thymectomy by the VATS approach.
A rare case of first-trimester placenta increta in an unscarred uterus
Authors: Locsin Stephanie F. , Tongco Carmencita B.
Published: October 2021

Placenta accreta syndrome (PAS) is rare in first-trimester abortions with an unscarred uterus. It is this rarity that makes diagnosis and management difficult and challenging. This is a case report of a multigravid with an early incomplete abortion complicated by PAS (placenta increta) manifesting as an ill-defined hypervascular uterine cavity mass on transvaginal ultrasound, with decreasing trends of serum beta-human chorionic gonadotropin. PAS was successfully diagnosed preoperatively, and an uneventful hysterectomy was performed. A curettage that could potentially lead to catastrophic hemorrhage was prevented. This case highlights the diagnostic dilemma in early trimester PAS, the importance of early accurate diagnosis, and a good correlation with ancillary diagnostics to provide prompt and appropriate management.
“Antipodal asymmetry” – The undiagnosed twin in the opposite uteri
Authors: Lim Ivy Grace C. , Gamboa Michelle E. , Reyes Lylah D.
Published: October 2021

Muüllerian duct anomalies (MDAs) are congenital defects arising from probable teratogenic assault at 6–22 weeks of gestation. Uterine didelphys arises from complete lack of fusion of Muüllerian ducts, resulting in two entirely separate hemiuteri, cervices and vaginas. The incidence of MDA is <5% and the frequency of uterine didelphys is 1 in 1000–30,000 women and twin pregnancy in uterus didelphys is only 1 in a million. This is a case of a gravida 1 para 0, with uterine didelphys and unilateral renal agenesis diagnosed of single live intrauterine pregnancy in the left half of uterine didelphys who had a spontaneous passage of meaty material from the right hemiuterus which were histopathologically consistent with degenerating products of conception, hence confirming a dicavitary twin pregnancy. Management should be wholistic encompassing preconception, prenatal, intrapartum, and postpartum period as any complications may arise at any point.
Cost-effectiveness analysis of first trimester screening for preeclampsia and early initiation of aspirin therapy for prevention of the disease in a private tertiary hospital
Authors: Violago Carol Joanna G. , Quinio Irene B.
Published: October 2021

Background:

Preeclampsia (PE) has significant health and economic burden. Early screening for PE through first trimester screening (FTS) can direct decision-making on early initiation of aspirin (ASA) therapy, which has been known to reduce the incidence of PE.

Objectives:

The objective of the study is to evaluate the cost-effectiveness of FTS and early initiation of ASA for disease prevention.

Methodology:

A population of 1916 women who delivered in a private tertiary hospital from January 2019 to March 2020 was categorized based on the risk of developing PE, results of FTS, initiation of ASA therapy, development of PE, and mode of delivery. Descriptive statistics using counts and percentages were used to summarize the data. Association between ASA therapy and PE was assessed using the Chi-square test. Costs of screening, ASA therapy, inpatient management, and delivery were computed.

Results and Conclusion:

Results showed that PE was prevented in 71.4% of those high-risk patients who underwent FTS and started on ASA therapy. Total cost of urgent care of PE and delivery was P119,687.02 to P149,687.02 for early PE, and P103,587.02 to P133,587.02 for late PE. Prevention of early PE and late PE results in net cost savings of P69,694.02 and P53,594.02, respectively, with the investment of P9,993.00 on FTS and ASA therapy. Implementation of FTS and initiation ASA therapy is an effective and cost-saving approach that can prevent PE.
Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps
Authors: Yuan Xin , Gao Hui , Liu Cenqin , Cui Hongyao , Zhang Zhixin , Xie Jiarong , Lu Hongpeng , Xu Lei
Published: October 2021

Background:

We performed a systematic review and pooled analysis to assess the effectiveness and safety of different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps.

Methods:

Articles in PubMed, EMBASE, and the Cochrane Library related to the common endoscopic treatment of 10- to 20-mm nonpedunculated polyps published as of April 2020 were searched. Primary outcomes were the R0 resection rate and en bloc resection rate. Secondary outcomes were safety and the recurrence rate. Meta-regression and subgroup analysis were also performed.

Results:

A total of 36 studies involving 3212 polyps were included in the final analysis. Overall, the effectiveness of resection methods with a submucosal uplifting effect, including endoscopic mucosal resection (EMR), cold EMR and underwater EMR (UEMR), was better than that of methods without a nonsubmucosal uplifting effect [R0 resection rate, 90% (95% confidence interval (CI) 0.81–0.94, I2= 84%) vs 82% (95% CI 0.78–0.85, I2= 0%); en bloc resection rate 85% (95% CI 0.79–0.91, I2= 83%) vs 74% (95% CI 0.47–0.94, I2= 94%)]. Regarding safety, the pooled data showed that hot resection [hot snare polypectomy, UEMR and EMR] had a higher risk of intraprocedural bleeding than cold resection [3% (95% CI 0.01–0.05, I2= 68%) vs 0% (95% CI 0–0.01, I2= 0%)], while the incidences of delayed bleeding, perforation and post-polypectomy syndrome were all low.

Conclusions:

Methods with submucosal uplifting effects are more effective than those without for resecting 10- to 20-mm nonpedunculated colorectal polyps, and cold EMR is associated with a lower risk of intraprocedural bleeding than other methods. Additional research is needed to verify the advantages of these methods, especially cold EMR.
2019 New Drug Update
Authors: Hussar Daniel A. , Finn Laura A.
Published: October 2021

Five new drugs marketed in 2018 that are used for medical problems often experienced by the elderly have been selected for consideration in this review. The uses and most important properties of these agents are discussed, and a rating for each new drug is determined using the New Drug
Comparison Rating system developed by the author (DAH). Advantages, disadvantages, and other important information regarding each new drug are identified and used as the basis for determining the rating. The drugs include two agents for type 2 diabetes mellitus, a drug for hyperkalemia, an
antiviral agent for influenza, and a drug for the treatment of open-angle glaucoma and ocular hypertension.
Provider Education About Pneumococcal Vaccination Practices for Older Adults
Authors: McKeirnan Kimberly C. , Colorafi Karen , Panther Shannon G. , Potyk Darryl , McCarthy John
Published: October 2021

OBJECTIVE: To describe an interdisciplinary academic detailing project implemented to address low pneumococcal immunization rates. SETTING: Two medical clinics and four community pharmacies in rural Washington state. PRACTICE DESCRIPTION: The two medical clinics
and four community pharmacies were all located in two rural counties and serve geographically large rural areas. PRACTICE INNOVATION: Academic detailing is an evidence-based approach designed to change clinical practice and improve decision-making. Our team utilized the academic detailing
model to provide educational outreach to local rural health care providers. The detailing team visited each clinic and pharmacy on a defined schedule and provided information to physicians, clinic administrators, nurses, pharmacists, pharmacy technicians, medical assistants, and clinic front-end
staff. MAIN OUTCOME MEASUREMENTS: The project team maintained detailed field notes from each academic detailing the visit and met to debrief about each encounter. From the field notes, through the process of thematic analysis and analytic memoing, the project team produced a list of
"lessons learned" that could be used to guide other interprofessional teams wishing to embark on an academic detailing project. RESULTS: We have identified four key "lessons learned": Interprofessional team members bring different strengths to the project; using same-discipline team
members paved the way for success; involving students aids in educating future practitioners in interprofessional practice; and scheduling meetings in advance is important. CONCLUSION: We described an approach to enhanced academic detailing using interprofessional team delivery, bringing
interprofessional practice into the real-world practice setting.
Aspirin Use for Primary Prevention of Cardiovascular Disease in Older Patients: A Review of Clinical Guidelines and Updated Evidence
Authors: Lewis Jelena , Bethishou Laressa , Tsu Laura V.
Published: October 2021

OBJECTIVE: To provide an up-to-date review of current guidelines, previous trials, and new trials regarding aspirin use in primary prevention of cardiovascular (CV) disease in the elderly population. DATA SOURCES: A PubMed search of articles published through April 2019
was performed using a combination of the following words: aspirin, bleeding, cardiovascular, elderly, hemorrhage, myocardial infarction, primary prevention, stroke. STUDY SELECTION/DATA EXTRACTION: Relevant randomized controlled trials, meta-analyses, and guidelines were assessed for
the use of aspirin in primary prevention of CV disease in older patients. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results. DATA SYNTHESIS: The role of aspirin for primary
prevention of CV disease in older adults is not well defined. As a result, the guideline recommendations for the use of aspirin in this setting are inconsistent. In 2018, the ARRIVE, ASCEND, and ASPREE studies were published. These studies tried to address some of the inconsistencies regarding
the use of aspirin in primary prevention of CV disease. This article reviews the current recommendations along with previous and recent studies for aspirin use for primary prevention in older adults. CONCLUSION: The role of aspirin for primary prevention of CV disease in older adults
should be individualized based on patient's risk factors, including risk of CV disease and likelihood of bleeding. Updated evidence provides more guidance regarding which patient populations will benefit from therapy.
Zinc and Probiotic Therapy for Management of Hepatic Encephalopathy
Authors: Gonzales Alessa D. , Reinert Justin P.
Published: October 2021

Hepatic encephalopathy is a complication of decompensated liver disease that consumes considerable health care resources and has a negative impact on quality of life. For several decades, maintenance therapy with lactulose has been considered the standard of care, but emerging data
from clinical trials demonstrate that other therapeutic options may be available and could have a better tolerability profile than lactulose. This brief review will discuss the pathophysiology of hepatic encephalopathy and proposed mechanisms of action of zinc and probiotics in this context,
discussing the findings of key trials.
Patient-Driven Payment Model Checkup
Authors: Baldwin Paul
Published: October 2021

Despite initial worries, the new patient-driven payment model appears to have resulted in increased revenue for nursing facilities.
New Developments in the Safe and Quality Use of Medicines in Australia: Cycles-of-Care and Telehealth Services
Authors: Jackson Shane
Published: October 2021

In early 2019, a report from Australia documented significant data about the harms associated with medication use. This editorial reports on the Australian government's changes to cycles-of-care and telehealth reviews, changes made to improve patient health outcomes, and payment to
pharmacists—information that may be useful to other countries.
Skin Tears in Older People
Authors: Hardie Chevannah , Wick Jeannette Y.
Published: October 2021

Skin tears are a common occurrence in older people, though many are unfamiliar with them until late in life. These painful wounds are more likely to occur with age as the skin experiences age-related changes. Numerous factors including declining dermal thickness and loss of elasticity
contribute to their development. Risk increases in patients who need assistance with activities of daily living or who need help transferring from bed or chair. Polypharmacy is a risk factor. Prevention is the best approach, but once skin tears develop, treatment needs to be tailored to the
tear's grade.
Adjuvanted inactivated influenza Vaccine Quadrivalent for Older People
Authors: Barranco Daylin , Chahine Elias B.
Published: October 2021

Advanced age is associated with an increase in morbidity and mortality from influenza. Immunization is the best option to protect individuals against influenza and its complications. Older people are less likely than their younger counterparts to mount an appropriate immune response
to influenza vaccines. The adjuvanted inactivated influenza vaccine quadrivalent (aIIV4) is designed to elicit a more robust immune response in older people compared with traditional inactivated influenza vaccines. The aIIV4 is indicated for active immunization against influenza caused by
influenza virus subtypes A and types B contained in the vaccine and is licensed by the Food and Drug Administration for use in persons 65 years of age and older. The aIIV4 should be administered by intramuscular injection. Like other influenza vaccines, aIIV4 carries a warning regarding the
occurrence of Guillain-Barré syndrome. The most common adverse reactions associated with aIIV4 are injection site pain, fatigue, headache, arthralgia, and myalgia.
COVID-19 and Academic Pharmacy: Navigating Uncharted Territory
Authors: Karaoui Lamis R. , Chahine Elias B.
Published: October 2021

The current COVID-19 pandemic with the associated social distancing measures has imposed unprecedented challenges on educational institutions around the globe. Schools and colleges of pharmacy across the United States have responded by offering distance learning options and are designing
contingency plans to maintain operations. The pandemic has impacted all aspects of pharmacy education including didactic instruction, experiential education, interprofessional education, cocurricular activities, community service, scholarship, professional service, well-being, resilience,
recruitment, admissions, and celebrating student success. Pharmacy faculty, staff, and students are subsequently trying to navigate a rapidly changing environment by taking advantage of opportunities as they arise while mitigating many threats that are affecting their professional and personal
lives. Pharmacy faculty will need to remain flexible, embrace change, and create innovative solutions to help students progress through the curriculum while maintaining their contributions to society. Students will need to find creative ways to remain engaged with their courses and cocurricular
activities.
Rates and Predictors of Physician-Recommended and Self-Reported Aspirin Use in 2015
Authors: Naberhaus Taylor , Early Nicole K. , Fairman Kathleen A. , Buckley Kelsey
Published: October 2021

OBJECTIVE: This study assesses the rate of providerrecommended aspirin use through the National Ambulatory Medical Care Survey (NAMCS) database versus self-reported aspirin use through the Behavioral Risk Factor Surveillance System (BRFSS) database and identifies factors that
predict initiation of aspirin. This study provides insight into the rate of providerrecommended aspirin use versus self-reported aspirin use prior to the 2016 United States Preventive Service Task Force primary prevention recommendation update.
 DESIGN: Retrospective, cross-sectional
analysis of US population data obtained from medical records (NAMCS) and community-dwelling residents in four states (BRFSS) in 2015.
 SETTING: Physician offices (NAMCS) and households or telephone (BRFSS).
 PATIENTS, PARTICIPANTS: NAMCS: visits made by patients
40 years of age or older to physicians who permitted federal employees to abstract officevisit data. BRFSS: household or telephone interview respondents 40 years of age or older.
 INTERVENTIONS: Comparisons of persons with (secondary prevention) versus without (primary prevention)
cardiovascular disease.
 MAIN OUTCOME MEASURED: Recommended (NAMCS) or self-reported (BRFSS) use of aspirin.
 RESULTS: The sample included 19 170 patients (NAMCS), with 2 205 having a history of cardiovascular disease and 14 872 respondents (BRFSS) with 2
024 having a history of cardiovascular disease. For both primary and secondary prevention, respondents from BRFSS reported higher rates of aspirin use (27.7% primary, 65.6% secondary prevention) compared with prescribed rates from NAMCS (11.7% primary, 45.6% secondary prevention).

CONCLUSIONS: Study results highlight the value of obtaining a complete medication history, including aspirin use, from all patients.
$G$-homotopy invariance of the analytic signature of proper co-compact $G$-manifolds and equivariant Novikov conjecture
Authors: Fukumoto Yoshiyasu
Published: October 2021

The main result of this paper is the

G

-homotopy invariance of the

G

-index of the signature operator of proper co-compact

G

-manifolds. If proper co-compact

G

-manifolds

X

and

Y

are

G

-homotopy equivalent, then we prove that the images of their signature operators by the

G

-index map are the same in the

K

-theory of the

C^*

-algebra of the group

G

. Neither discreteness of the locally compact group

G

nor freeness of the action of

G

on

X

are required, so this is a generalization of the classical case of closed manifolds. Using this result, we can deduce the equivariant version of Novikov conjecture for proper co-compact

G

-manifolds from the strong Novikov conjecture for

G

.
Adherence to oral HIV pre-exposure prophylaxis among female sex workers in Kampala, Uganda
Authors: Kakoola Nalukwago Grace , Bosco Isunju John , Muwonge Timothy , Katairo Thomas , Bunani Nelson , Semitala Fred , Kyambadde Peter , Matovu Flavia
Published: October 2021

Introduction: In Kampala Uganda, female sex workers (FSWs) have high HIV prevalence (33%). Oral PrEP is a novel HIV prevention intervention that offers hope to decrease HIV incidence in key populations especially among FSWs. Studies have shown that with poor adherence, oral PrEP has no efficacy, and therefore adherence to PrEP is critical among FSWs to maximize HIV prevention. However, implementation data on adherence to PrEP among FSWs is limited so this study sought to assess adherence to PrEP. Specifically, we sought to 1) determine the level of adherence to PrEP among FSWs, and 2) determine factors associated with PrEP adherence.

Methods: This cross-sectional study was conducted from November to December 2018; 126 FSWs using PrEP were inter- viewed using a questionnaire. Adherence was categorically defined as high adherence and low adherence. Logistic regression was done.

Results: Using long-term contraception methods (OR 0.06, 95% CI: 0.04-0.77) and not using condoms with clients (OR 0.07, 95% CI: 0.01-0.42) were negatively associated with high PrEP adherence.

Conclusion: Barriers to PrEP adherence need to be addressed for successful PrEP implementation to improve adherence going forward. Service care providers should reinforce positive behaviors such as use of condoms devotedly during PrEP breaks.

Keywords: Oral PrEP; adherence; female sex workers.
Knowledge, attitudes and practices of HIV-positive mothers regarding the benefits of exclusive breastfeeding at a regional hospital in the north east of Namibia
Authors: Opotamutale Ashipala Daniel , Shikukumwa Getruida , Hangula Joel Medusalem
Published: October 2021

Background: In sub-Saharan Africa, over 1,000 newborns are infected with HIV every day, despite available medical in- terventions. Mother-to-child transmission (MTCT) remains one of the primary sources of HIV infection in children and without interventions 40% of babies born from HIV-positive mothers would be infected with the virus. It is estimated that 300 000 children become infected with HIV worldwide, whilst 1.5 million children die when their mothers opt for other choices instead of breastfeeding.

Objective: The purpose of the study was to assess and describe the knowledge, attitudes and practices of HIV-positive mothers regarding the benefits of exclusive breastfeeding at Rundu Intermediate Hospital, Kavango East Region in Namibia.

Method: The study was a descriptive cross-sectional survey that used convenience sampling, as the researcher sought to use subjects available during the time of study to select 79 HIV positive mothers.

Results: Participants in this study (94%; n=51) had good knowledge of the benefit of exclusive breastfeeding and that the benefits of breastfeeding outweigh the risk of HIV transmission from mother to child. The results confirmed that (77.2%; n=42) of the mothers opted to take ART with the babies until they stop breastfeeding.

Conclusion: HIV positive mothers had good knowledge, attitudes and practices regarding the benefits of exclusive breast- feeding. A significant number of mothers were, however, not sure about breastfeeding exclusively for 6 months as they would stop if offered free formula milk for the baby. Support by the fathers and others in the community is vital.

Keywords: Knowledge; HIV; breastfeeding; attitudes; practices; HIV-positive mothers; Namibia.
Anatomical variations of the renal artery: a computerized tomographic angiogram study in living kidney donors at a Nigerian Kidney Transplant Center
Authors: Aremu Abayomi , Igbokwe Martin , Olatise Olalekan , Lawal Ahmad , Maduadi Kester
Published: October 2021

Background: Understanding of the renal vascular anatomy is key to a safe and successful donor nephrectomy, which ulti- mately impacts on the renal graft function and survival in kidney transplant recipients.

Objective: To report the various anatomical configurations of the renal artery identified in living kidney donors in a Nige- rian kidney transplant institution .

Materials and Methods: The computerized tomography angiograms of 100 consecutive living kidney donors were pro- spectively reviewed over an 18-month period. Anatomical variations of the renal arteries including accessory arteries and early divisions were noted. Duration of surgery and ischemic time were recorded intra-operatively. Data analysis was carried out using IBM SPSS version 20.

Results: There were variations in renal artery configuration in 50 (50%) cases, 32% were accessory renal arteries while 18% were early branches of the renal artery. The classical bilateral solitary renal arteries were found in 50 (50%) of potential do- nors. There was statistically significant longer operating and ischemic time in donors with multiple renal arteries as compared with solitary arteries (p<0.05).

Conclusion: There are a wide variety of renal artery configurations seen in potential kidney donors. The classical solitary renal artery remains the commonest and most favourable configuration for donor nephrectomy and transplantation.

Keywords: Renal artery; variations; living kidney donors.
Inflammatory cytokines and sleep parameters response to life style intervention in subjects with obese chronic insomnia syndrome
Authors: M Al-Sharif Fadwah , M Abd El-Kader Shehab
Published: October 2021

Background: Chronic primary insomnia is a prevalent sleep disorder that is associated with adverse effects on health out- comes. Sleep disturbance is usually associated with abnormal level of systemic inflammation biomarkers.

Objective: The aim of this study was to detect changes in sleep quality and inflammatory markers following weight loss among subjects with chronic primary insomnia.

Material and Methods: Eighty previously sedentary subjects with chronic primary insomnia subjects enrolled in this study, their age ranged from 32-51 year were randomly assigned to life style intervention group (group A, n=40) or control group (group B, n=40). Polysomnographic recordings for sleep quality assessment, IL-6, IL-10 and TNF-α were measured before and at the end of the study after six months.

Results: There was a significant increase in the total sleep duration, sleep efficiency, sleep onset latency and IL-10 in addi- tion to significant reduction in awake time after sleep onset, REM latency, IL-6 and TNF-α after 6 months of in group(A) as a result of weight loss program; while the results of the control group (group B) were not significant. Also, there were significant differences between both groups at the end of the study.

Conclusion: Life style intervention modulates systemic inflammatory parameters and sleep quality among subjects with chronic primary insomnia.

Keywords: Chronic primary insomnia; inflammatory cytokines; life style intervention; sleep quality.
Prevalence of sickle cell trait and its association to renal dysfunction among blood donors at university of medical sciences teaching hospital, Ondo, Nigeria
Authors: Ayodeji Akinbodewa Akinwumi , Ogunleye Adeyemi , Ademola Adejumo Oluseyi
Published: October 2021

Introduction: Prospective blood donors are routinely screened for blood borne infections but medical illnesses and haemo- globin genotype are overlooked despite a high prevalence of haemoglobin AS among Nigerian donors.

Objective: To determine the prevalence of haemoglobin AS and its association to renal function, if any.

Method: Apparently healthy donors were studied between February and December 2018. Their haemoglobin genotype and, estimated glomerular filtration rates were determined.

Results: There were 96 males (94.1%) and 6 (5.9%) females with mean age of 26.7±4.5 years (range 19-44 years) and mean eGFR of 103.97±19.00ml/min/1.73m2. Eighty one (79.4%) and 21 (20.6%) subjects had haemoglobin AA and AS geno- types respectively. The mean eGFR for subjects with haemoglobin AA and AS were 105.2±18.6ml/min/1.73m2 and 99.9 ± 21.2ml/min/1.73m2 respectively (p value = 0.270). Eighty one (79.4%), 20 (19.6%) and 1 (1.0%) subjects had renal function at >90ml/min/1.73m2, 60-89ml/min/1.73m2 and 30-59ml/min/m2 respectively. There was no significant difference in the mean eGFR between subjects with haemoglobin AA and AS (mean difference 5.3, p = 0.265, 95%CI = -4.07 to 14.60).

Conclusion: The prevalence of sickle cell trait among Nigerian blood donors is high. There is no significant difference in the renal function status of blood donors with SCT and normal haemoglobin genotype.

Keywords: Haemoglobin genotype; sickle cell trait; renal function; blood donor; Nigeria.
Presentation, etiology and treatment outcome of neovascular glaucoma in Ekiti state, South Western Nigeria
Authors: Ajayi Iyiade , Omotoye Olusola , Ajite Kayode , Abah Emmanuel
Published: October 2021

Background: Neovascular glaucoma (NVG), a form of secondary glaucoma has varying causes across geographical loca- tions.

Objective: The objective of this study was to determine the presentation, aetiology, and outcome of treatment of patients with NVG in a Nigerian tertiary hospital.

Method: A retrospective review of records of all cases of NVG seen over a 5year period was carried out. Demographic characteristics, presenting visual acuity and coexisting ocular and systemic conditions were noted. Data were analysed with Statistical Package for Social Sciences (SPSS) version 25.

Results: 29 eyes of patients with NVG were analysed. Most of the patients (89.70%) presented with visual acuity less than 3/60 in the affected eye. All patients except one were treated with anti-glaucoma medications while only 9(31%) consented to and received anti-vascular endothelial growth factor. No patient had improvement in visual acuity despite resolution of other symptoms at 12week follow up.

Conclusion: NVG though not as common as other forms of glaucoma accounted for a large proportion of monocular blindness in the affected eyes at presentation. There is need for health promotion and education among our people on the need for early preventive eye check practices.

Keywords: Neovascular glaucoma; retinal ischemia; rubeosis iridis; secondary glaucoma.