bluuebunny/crossref_metadata_2025 huggingface dataset:
Factor structure and short version of the modified Fresno test to assess the use of the evidence-based practice in physiotherapists
Authors: da Silva Anderson Martins , Padula Rosimeire Simprini
Published: February 2021

Background

The Modified Fresno Test has been used to evaluate the use of the Evidence-Based Physiotherapy (EBP). So far, none of the versions of the Fresno Test were subjected to analysis of the factorial structure. The objective of the study was to describe the exploratory and confirmatory factor structure of theModified Fresno Testadapted to the Portuguese-Brazilian and analyze the statistical feasibility for the elaboration of a short version.

Methods

The questionnaire was applied with a convenience sample of 57 physiotherapists, being 36 professionals (13 of these also professors) and 21 students from the last semester of the physiotherapy course. Exploratory Factor Analysis (EFA) was performed by the method of principal components. Confirmatory Factor Analysis (CFA) was performed by the method of maximum likelihood. The total score of the answers in the test and retest was evaluated, totalling 228 observations. Reliability was assessed by means of internal consistency, using Cronbach’s alpha coefficient.

Results

Reliability was satisfactory (α 0.81) for all questions of the instrument. The coefficient α calculated for the corrected item-total showed values higher than 0.20 except for item 9. Preliminary tests for Exploratory Factor Analysis showed acceptable values with Kaiser-Meyer-Olkin (KMO = 0.80) and Bartlett’s test of sphericity [chi-square (78) = 1149.615,p < 0.001], indicating that the correlations were sufficient for analysis. The analysis revealed the presence of 3 factors (eigenvalues> 1), which explains 60.9% of the instrument’s total variance. In Confirmatory Factor Analysis, none of the indices came close to an acceptable level (≥ 0.90), however, the second model which tested a three-factor structure provided a better fit to the data. From the results of this study the Modified Fresno Test short version was drawn.

Conclusion

The analysis showed good factor validity and adequate internal consistency for the use of the instrument consisting of 13 questions and 3 factors. This model proved to be better than the original model. The short version consisting of 9 questions may be an appropriate alternative for use in the population of interest.
Establishing a postgraduate programme in nutritional epidemiology to strengthen resource capacity, academic leadership and research in the democratic republic of Congo
Authors: Ali Mapatano Mala , Haskins Lyn , John Vaughn , Hatløy Anne , Luthuli Silondile , Mapumulo Sphindile , Engebretsen Ingunn M. S. , Tylleskär Thorkild , Mutombo Paulin , Horwood Christiane
Published: February 2021

Background

Low- and Middle-income countries (LMIC) face considerable health and nutrition challenges, many of which can be addressed through strong academic leadership and robust research translated into evidence-based practice. A North-South-South partnership between three universities was established to implement a master’s programme in nutritional epidemiology at the Kinshasa School of Public Health (KSPH), Democratic Republic of Congo (DRC). The partnership aimed to develop academic leadership and research capacity in the field of nutrition in the DRC. In this article we describe the educational approach and processes used, and discuss successes, challenges, and lessons learned.

Methods

Self-administered questionnaires, which included both open and closed questions, were sent to all graduates and students on the master’s programme to explore students’ experiences and perceptions of all aspects of the educational programme. Quantitative data was analysed using frequencies, and a thematic approach was used to analyse responses to open-ended questions.

Results

A two-year master’s programme in Nutritional Epidemiology was established in 2014, and 40 students had graduated by 2020. Key elements included using principles of authentic learning, deployment of students for an internship at a rural residential research site, and support of selected students with bursaries. Academic staff from all partner universities participated in teaching and research supervision.

The curriculum and teaching approach were well received by most students, although a number of challenges were identified. Most students reported benefits from the rural internship experience but were challenged by the isolation of the rural site, and felt unsupported by their supervisors, undermining students’ experiences and potentially the quality of the research. Financial barriers were also reported as challenges by students, even among those who received bursaries.

Conclusion

The partnership was successful in establishing a Master Programme in Nutritional Epidemiology increasing the number of nutrition researchers in the DRC. This approach could be used in other LMIC settings to address health and nutrition challenges.
Knowledge, attitudes, ethical and social perspectives towards fecal microbiota transplantation (FMT) among Jordanian healthcare providers
Authors: Al-Bakri Amal G. , Akour Amal A. , Al-Delaimy Wael K.
Published: February 2021

Background

Fecal microbiota transplant (FMT) is a treatment modality that involves the introduction of stool from a healthy pre-screened donor into the gastrointestinal tract of a patient. It exerts its therapeutic effects by remodeling the gut microbiota and treating microbial dysbiosis-imbalance. FMT is not regulated in Jordan, and regulatory effort for FMT therapy in Jordan, an Islamic conservative country, might be faced with unique cultural, social, religious, and ethical challenges. We aimed to assess knowledge, attitudes, and perceptions of ethical and social issues of FMT use among Jordanian healthcare professionals.

Methods

An observational, cross-sectional study design was used to assess knowledge, attitudes, and perceptions of ethical and social issues of FMT among 300 Jordanian healthcare professionals.

Results

A large proportion (39 %) thought that the safety and efficacy of this technique are limited and 29.3 % thought there is no evidence to support its use. Almost all (95 %) responded that they would only perform it in certain cases, if ethically justified, and 48.3 % would use it due to treatment failure of other approaches. When reporting about reasons for not using it, 40 % reported that they would not perform it due to concerns about medical litigation, fear of infections (38 %), and lack of knowledge of long safety and efficacy (31.3 %). Interestingly, all practitioners said they would perform this procedure through the lower rather than upper gastrointestinal tract modality and the majority will protect the patient’s confidentiality via double-blinding (43.3 %). For a subset of participants (n = 100), the cultural constraints that might affect the choice of performing FMT were mainly due to donor’s religion, followed by dietary intake, and alcohol consumption.

Conclusions

Our healthcare practitioners are generally reluctant to use the FMT modality due to religious and ethical reasons but would consider it if there was a failure of other treatment and after taking into consideration many legislative, social, ethical and practice-based challenges including safety, efficacy and absence of guidelines.
How is organisational fit addressed in Australian entry level midwifery job advertisements
Authors: Bloxsome Dianne , Glass Courtney , Bayes Sara
Published: February 2021

Background

Midwifery job retention is an ongoing global issue. Prior research has recognised that considering an individual’s attributes in relation to their work environment may assist in improving job satisfaction among midwives, leading to improved long-term job retention in the midwifery profession. The aim of this study was to evaluate whether, and how organisational fit is addressed in current entry level midwifery job advertisements within Australia.

Methods

Midwifery jobs were searched for within 12 search engines, using the search term ‘midwife’, including Seek.com, Indeed.com, government employment websites for all Australian states and territories, and private health organisation websites. Data were extracted from eligible job advertisements by three independent researchers. Extracted data encompassed elements addressing person-job fit and person-organisation fit. Content analysis involving chi-square and Fischer exact tests were completed on extracted data.

Results

Key findings demonstrate private health care organisations (29.2%) are more likely than public health care organisations (8.8%) to ask potential candidates to have additional qualifications, however, public health care organisations (34.1% vs. 16.7%) are more likely to ask for dual registration as a midwife and nurse. This is further supported by private health care organisations being more likely to refer to the candidate as a midwife (72.9% vs. 48.4%) than as a nurse. Private health care organisations more often noted access to support for employees and were more likely to mention access to employee assistance programs (41.7% vs. 13.2%), orientations (16.7% vs. 0%) and included benefits (72.9% vs. 42.9%). Clinical skills and personality traits were more frequently addressed in public health organisation advertisements; these included a requirement of employees to be accountable (49.5% vs. 6.3%), innovative (28.6% vs. 0%), have teamwork (69.2% vs. 52.1%) and conflict resolution skills (36.3% vs. 8.3%), and have knowledge of legislation (44.0% vs. 25.0%) and contemporary midwifery issues (28.6% vs. 4.2%).

Conclusion

This study highlights that organisations employing midwives may be unwittingly contributing to the problem of midwife attrition through inattention to factors that endear midwives to workplaces in job advertisements. Further work developing employee selection and recruitment processes that are informed by the concept of person-job-organisation fit, is necessary.
Translation and cultural adaptation of a romanian version of the communication assessment tool (CAT_Ro)
Authors: Balanescu Andra Rodica , Bojinca Violeta Claudia , Schweitzer Ana-Maria , Joca Bogdan , Mardale Denise Ani , Badea Denisa , Bojinca Mihai
Published: February 2021

Background

The communication between health providers and patients influences the quality of medical care. The Communication Skills Assessment (CAT) is a reliable, validated tool, which was developed to assess interpersonal communication skills between physicians and patients. The purpose of this study was to obtain a Romanian version of the CAT (CAT_Ro), using a controlled and systematic process to translate and cross-culturally adapt the original questionnaire, since there are no validated instruments to assess healthcare professionals’ communication capability in Romania.

Methods

The study was conducted in two Departments of Internal Medicine and Rheumatology from Bucharest, Romania, using a rigorous scientific methodology for the translation process, according to literature recommendations, implicating conceptual evaluation, semantics, and cultural adaptation, which involved several steps. The updated version was pre-tested in a pilot study, which included 89 outpatients.

Results

The results showed a narrow range of variability in item interpretation, without differences in patients’ responses according to variables such as age, gender, education, disease type, number of previous visits with the same doctor.

Conclusion

CAT-Ro is the result of a comprehensive process study. It represents the first translation and cultural adaptation in Romanian of an instrument able to assess the health providers’ communication skills, which was validated in a pilot study and is to be used in more extensive studies with patients from several specialties.
Production of small ruminant morbillivirus, rift valley fever virus and lumpy skin disease virus in CelCradle™ -500A bioreactors
Authors: Rhazi Halima , Safini Najete , Mikou Karima , Alhyane Meryeme , Tadlaoui Khalid Omari , Lin Xiangliang , Venkatesan Nandini P. , Elharrak Mehdi
Published: February 2021

Background

Animal vaccination is an important way to stop the spread of diseases causing immense damage to livestock and economic losses and the potential transmission to humans. Therefore effective method for vaccine production using simple and inexpensive bioprocessing solutions is very essential. Conventional culture systems currently in use, tend to be uneconomic in terms of labor and time involved. Besides, they offer a limited surface area for growth of cells. In this study, the CelCradle™-500A was evaluated as an alternative to replace conventional culture systems in use such as Cell factories for the production of viral vaccines against small ruminant morbillivirus (PPR), rift valley fever virus (RVF) and lumpy skin disease virus (LSD).

Results

Two types of cells Vero and primary Lamb Testis cells were used to produce these viruses. The study was done in 2 phases as a) optimization of cell growth and b) virus cultivation. Vero cells could be grown to significantly higher cell densities of 3.04 × 109 using the CelCradle™-500A with a shorter doubling time as compared to 9.45 × 108 cells in Cell factories. This represents a 19 fold increase in cell numbers as compared to seeding vs only 3.7 fold in Cell factories. LT cells achieved modestly higher cell densities of 6.7 × 108 as compared to 6.3 × 108 in Cell factories. The fold change in densities for these cells was 3 fold in the CelCradle™-500A vs 2.5 fold in Cell factories. The titers in the conventional system and the bioreactor were not significantly different. However, the Cell-specific virus yield for rift valley fever virus and lumpy skin disease virus are higher (25 virions/cell for rift valley fever virus, and 21.9 virions/cell for lumpy skin disease virus versus 19.9 virions/cell for rift valley fever virus and 10 virions/cell for lumpy skin disease virus).

Conclusions

This work represents a novel study for primary lamb testis cell culture in CellCradle™-500A bioreactors. In addition, on account of the high cell densities obtained and the linear scalability the titers could be further optimized using other culture process such us perfusion.
Clinical and metabolomic predictors of regression to normoglycemia in a population at intermediate cardiometabolic risk
Authors: Sevilla-González Magdalena del Rocío , Merino Jordi , Moreno-Macias Hortensia , Rojas-Martínez Rosalba , Gómez-Velasco Donají Verónica , Manning Alisa K.
Published: February 2021

Background

Impaired fasting glucose (IFG) is a prevalent and potentially reversible intermediate stage leading to type 2 diabetes that increases risk for cardiometabolic complications. The identification of clinical and molecular factors associated with the reversal, or regression, from IFG to a normoglycemia state would enable more efficient cardiovascular risk reduction strategies. The aim of this study was to identify clinical and biological predictors of regression to normoglycemia in a non-European population characterized by high rates of type 2 diabetes.

Methods

We conducted a prospective, population-based study among 9637 Mexican individuals using clinical features and plasma metabolites. Among them, 491 subjects were classified as IFG, defined as fasting glucose between 100 and 125 mg/dL at baseline. Regression to normoglycemia was defined by fasting glucose less than 100 mg/dL in the follow-up visit. Plasma metabolites were profiled by Nuclear Magnetic Resonance. Multivariable cox regression models were used to examine the associations of clinical and metabolomic factors with regression to normoglycemia. We assessed the predictive capability of models that included clinical factors alone and models that included clinical factors and prioritized metabolites.

Results

During a median follow-up period of 2.5 years, 22.6% of participants (n = 111) regressed to normoglycemia, and 29.5% progressed to type 2 diabetes (n = 145). The multivariate adjusted relative risk of regression to normoglycemia was 1.10 (95% confidence interval [CI] 1.25 to 1.32) per 10 years of age increase, 0.94 (95% CI 0.91–0.98) per 1 SD increase in BMI, and 0.91 (95% CI 0.88–0.95) per 1 SD increase in fasting glucose. A model including information from age, fasting glucose, and BMI showed a good prediction of regression to normoglycemia (AUC = 0.73 (95% CI 0.66–0.78). The improvement after adding information from prioritized metabolites (TG in large HDL, albumin, and citrate) was non-significant (AUC = 0.74 (95% CI 0.68–0.80), p value = 0.485).

Conclusion

In individuals with IFG, information from three clinical variables easily obtained in the clinical setting showed a good prediction of regression to normoglycemia beyond metabolomic features. Our findings can serve to inform and design future cardiovascular prevention strategies.
Traditional and non-traditional risk factors for peripheral artery disease development/progression in patients with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study
Authors: Cardoso Claudia R. L. , Melo Juliana V. , Santos Thainá R. M. , Leite Nathalie C. , Salles Gil F.
Published: February 2021

Background

The prognostic importance of non-traditional risk factors for peripheral artery disease (PAD) development/progression is scarcely studied in diabetes. We investigated if carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) added prognostic information beyond traditional cardiovascular risk markers for PAD outcomes.

Methods

Ankle-brachial index (ABI) was measured at baseline and after a median of 91 months of follow-up in 681 individuals with type 2 diabetes. Multivariate Cox regressions examined the associations between the candidate variables and the outcome. PAD development/progression was defined by a reduction in ABI ≥ 0.15 (to a level < 0.9) or limb revascularization procedures, lower-extremity amputations or death due to PAD. The improvement in risk discrimination was assessed by increases in C-statistics of the models.

Results

Seventy-seven patients developed/progressed PAD: 50 reduced ABI to < 0.9, seven had lower-limb revascularizations, and 20 had amputations or death. Age, male sex, diabetes duration, presence of microvascular complications (peripheral neuropathy and diabetic kidney disease), baseline HbA1c, 24-h systolic BP (SBP) and mean cumulative office SBP and LDL-cholesterol were associated with PAD development/progression in several models. CIMT and cf-PWV were additionally associated with PAD outcomes, and their inclusion further improved risk discrimination (with C-statistic increases between 0.025 and 0.030). The inclusion of ambulatory 24-h SBP, instead of office SBP, also improved PAD risk discrimination.

Conclusions

Increased CIMT and aortic stiffness are associated with greater risks of developing/progressing PAD, beyond traditional risk factors, in type 2 diabetes.
The role of the gut microbiota on the metabolic status of obese children
Authors: Yuan Xin , Chen Ruimin , McCormick Kenneth L. , Zhang Ying , Lin Xiangquan , Yang Xiaohong
Published: February 2021

Background

The term “metabolically healthy obese (MHO)” denotes a hale and salutary status, yet this connotation has not been validated in children, and may, in fact, be a misnomer. As pertains to obesity, the gut microbiota has garnered attention as conceivably a nosogenic or, on the other hand, protective participator.

Objective

This study explored the characteristics of the fecal microbiota of obese Chinese children and adolescents of disparate metabolic statuses, and the associations between their gut microbiota and circulating proinflammatory factors, such as IL-6, TNF-α, lipopolysaccharide-binding protein (LBP), and a cytokine up-regulator and mediator, leptin.

Results

Based on weight and metabolic status, the 86 Chinese children (ages 5–15 years) were divided into three groups: metabolically healthy obese (MHO, n = 42), metabolic unhealthy obese (MUO, n = 23), and healthy normal weight controls (Con, n = 21). In the MUO subjects, the phylum Tenericutes, as well as the alpha and beta diversity, were significantly reduced compared with the controls. Furthermore, Phylum Synergistetes and genus Bacteroides were more prevalent in the MHO population compared with controls. For the MHO group, Spearman’s correlation analysis revealed that serum IL-6 positively correlated with genus Paraprevotella, LBP was positively correlated with genus Roseburia and Faecalibacterium, and negatively correlated with genus Lactobacillus, and leptin correlated positively with genus Phascolarctobacterium and negatively with genus Dialister (all p < 0.05).

Conclusion

Although there are distinct differences in the characteristic gut microbiota of the MUO population versus MHO, dysbiosis of gut microsystem is already extant in the MHO cohort. The abundance of some metabolism-related bacteria associates with the degree of circulating inflammatory compounds, suggesting that dysbiosis of gut microbiota, present in the MHO children, conceivably serves as a compensatory or remedial response to a surfeit of nutrients.
A foci cohort analysis to monitor successful and persistent foci under Thailand’s Malaria Elimination Strategy
Authors: Sudathip Prayuth , Kitchakarn Suravadee , Shah Jui A. , Bisanzio Donal , Young Felicity , Gopinath Deyer , Pinyajeerapat Niparueradee , Sintasath David , Lertpiriyasuwat Cheewanan
Published: February 2021

Background

Thailand’s success in reducing malaria burden is built on the efficient “1-3-7” strategy applied to the surveillance system. The strategy is based on rapid case notification within 1 day, case investigation within 3 days, and targeted foci response to reduce the spread of Plasmodium spp. within 7 days. Autochthonous transmission is still occurring in the country, threatening the goal of reaching malaria-free status by 2024. This study aimed to assess the effectiveness of the 1-3-7 strategy and identify factors associated with presence of active foci.

Methods

Data from the national malaria information system were extracted from fiscal years 2013 to 2019; after data cleaning, the final dataset included 81,012 foci. A Cox’s proportional hazards model was built to investigate factors linked with the probability of becoming an active focus from 2015 to 2019 among foci that changed status from non-active to active focus during the study period. We performed a model selection technique based on the Akaike Information Criteria (AIC).

Results

The number of yearly active foci decreased from 2227 to 2013 to 700 in 2019 (68.5 %), and the number of autochthonous cases declined from 17,553 to 3,787 (78.4 %). The best Cox’s hazard model showed that foci in which vector control interventions were required were 18 % more likely to become an active focus. Increasing compliance with the 1-3-7 strategy had a protective effect, with a 22 % risk reduction among foci with over 80 % adherence to 1-3-7 timeliness protocols. Other factors associated with likelihood to become or remain an active focus include previous classification as an active focus, presence of Plasmodium falciparum infections, level of forest disturbance, and location in border provinces.

Conclusions

These results identified factors that favored regression of non-active foci to active foci during the study period. The model and relative risk map align with the national malaria program’s district stratification and shows strong spatial heterogeneity, with high probability to record active foci in border provinces. The results of the study may be useful for honing Thailand’s program to eliminate malaria and for other countries aiming to accelerate malaria elimination.
Maternal factors associated with moderate and severe stunting in Ethiopian children: analysis of some environmental factors based on 2016 demographic health survey
Authors: Amaha Nebyu Daniel , Woldeamanuel Berhanu Teshome
Published: February 2021

Background

Stunting or chronic undernutrition is a significant public health problem in Ethiopia. In 2019, 37% of Ethiopian children under-5 were stunted. Stunting results from a complex interaction of individual, household and social (environmental) factors. Improving the mother’s overall care is the most important determinant in reducing the stunting levels in developing countries. We aimed to determine the most important maternal factors associated with stunting and quantify their effects.

Methods

This study used data from the nationally representative 2016 Ethiopian Demographic Health Survey (EDHS). Common maternal factors were first selected and analyzed using Pearson’s chi-square of association followed by multiple logistic regression. To quantify the effect of a unit change of a predictor variable a model for the continuous maternal factors was developed. All analyses were carried out using IBM SPSS© Version 23.

Results

Higher maternal educational level, better maternal autonomy, average or above maternal height and weight, having at least 4 antenatal care (ANC) clinic visits, and delivering in a health facility were significantly associated with lower severe stunting levels. Unemployed mothers were 23% less likely (p = 0.003) to have a stunted child compared with employed mothers. Mothers delivering at home had 32% higher odds of stunting (p = 0.002). We found that short mothers (< 150 cm) were 2.5 more likely to have stunted children when compared with mothers above 160 cm. Every visit to the ANC clinic reduces stunting odds by 6.8% (p <  0.0001). The odds of stunting were reduced by 7% (p = 0.028) for every grade a girl spent in school. A unit increase in Body Mass Index (BMI) reduced the odds of stunting by 4% (p = 0.014) and every centimeter increase in maternal height reduced the odds of stunting by 0.5% (p = 0.01).

Conclusion

Maternal education, number of antenatal care visits, and place of delivery appear to be the most important predictors of child stunting in Ethiopia.. Therefore, educating and empowering women, improving access to family planning and ANC services, and addressing maternal malnutrition are important factors that should be included in policies aiming to reduce childhood stunting in Ethiopia.
Ensuring the right to food for indigenous children: a case study of stakeholder perspectives on policy options to ensure the rights of tamariki Māori to healthy food
Authors: McKerchar Christina , Lacey Cameron , Abel Gillian , Signal Louise
Published: February 2021

Background

The United Nations Convention on the Rights of the Child confirms a child’s right to adequate food, and to the highest attainable standard of health. For indigenous children, these rights are also recognised in the UN Declaration on the Rights of Indigenous Peoples. However, Indigenous children endure higher rates of obesity and related health conditions than non-indigenous children, including in Aotearoa New Zealand (NZ). For indigenous tamariki (Māori children) in NZ, high levels of obesity are interconnected with high rates of food insecurity. Therefore there is a need for action. This study aimed to investigate policy options that would safeguard the rights of indigenous children to healthy food. We explored with key stakeholder’s policy options to ensure the rights of indigenous children to healthy food, through a case study of the rights of tamariki.

Methods

Interviews were conducted with 15 key stakeholders, with experience in research, development or delivery of policies to safeguard the rights of tamariki to healthy food. Iterative thematic analysis of the transcripts identified both deductive themes informed by Kaupapa Māori theory and literature on rights-based approaches and inductive themes from the interviews.

Results

The analysis suggests that to ensure the right to adequate food and to healthy food availability for tamariki, there needs to be: a comprehensive policy response that supports children’s rights; an end to child poverty; food provision and food policy in schools; local government policy to promote healthy food availability; and stronger Māori voices and values in decision-making.

Conclusions

The right to food for indigenous children, is linked to political and economic systems that are an outcome of colonisation. A decolonising approach where Māori voices and values are central within NZ policies and policy-making processes is needed. Given the importance of food to health, a broad policy approach from the NZ government to ensure the right to adequate food is urgent. This includes economic policies to end child poverty and specific strategies such as food provision and food policy in schools. The role of Iwi (tribes) and local governments needs to be further explored if we are to improve the right to adequate food within regions of NZ.
Propensity score matching for multilevel spatial data: accounting for geographic confounding in health disparity studies
Authors: Davis Melanie L. , Neelon Brian , Nietert Paul J. , Burgette Lane F. , Hunt Kelly J. , Lawson Andrew B. , Egede Leonard E.
Published: February 2021

Background

Diabetes is a public health burden that disproportionately affects military veterans and racial minorities. Studies of racial disparities are inherently observational, and thus may require the use of methods such as Propensity Score Analysis (PSA). While traditional PSA accounts for patient-level factors, this may not be sufficient when patients are clustered at the geographic level and thus important confounders, whether observed or unobserved, vary by geographic location.

Methods

We employ a spatial propensity score matching method to account for “geographic confounding”, which occurs when the confounding factors, whether observed or unobserved, vary by geographic region. We augment the propensity score and outcome models with spatial random effects, which are assigned scaled Besag-York-Mollié priors to address spatial clustering and improve inferences by borrowing information across neighboring geographic regions. We apply this approach to a study exploring racial disparities in diabetes specialty care between non-Hispanic black and non-Hispanic white veterans. We construct multiple global estimates of the risk difference in diabetes care: a crude unadjusted estimate, an estimate based solely on patient-level matching, and an estimate that incorporates both patient and spatial information.

Results

In simulation we show that in the presence of an unmeasured geographic confounder, ignoring spatial heterogeneity results in increased relative bias and mean squared error, whereas incorporating spatial random effects improves inferences. In our study of racial disparities in diabetes specialty care, the crude unadjusted estimate suggests that specialty care is more prevalent among non-Hispanic blacks, while patient-level matching indicates that it is less prevalent. Hierarchical spatial matching supports the latter conclusion, with a further increase in the magnitude of the disparity.

Conclusions

These results highlight the importance of accounting for spatial heterogeneity in propensity score analysis, and suggest the need for clinical care and management strategies that are culturally sensitive and racially inclusive.
Assessment of the health utility of patients with leukemia in China
Authors: Zeng Xueyun , Sui Mingjie , Liu Rui , Qian Xinyu , Li Wenfeng , Zheng Erwei , Yang Jinjin , Li Jinmei , Huang Weidong , Yang Hongbin , Yu Hongjuan , Luo Nan
Published: February 2021

Objectives

This study aimed to assess the health utility of leukemia patients in China using the EQ-5D-5L, compare it with the population norms, and identify the potential factors associated with health utility.

Methods

A hospital based cross-sectional survey was conducted in three tertiary hospitals from July 2015 to February 2016. A total of 186 patients with leukemia completed the EQ-5D-5L and their health utility scores were calculated using the Chinese value set. EQ-5D-5L utility and dimensions scores of leukemia patients were compared with China’s population norms using Kruskal–Wallis test and chi square test. Potential factors associated with health utility were identified using Tobit regression.

Results

The mean EQ-5D-5L utility scores of patients with leukemia, grouped by either gender or age, were significantly lower than those of the general population (p < 0.001). The same results were found for individual dimensions of EQ-5D-5L, where leukemia patients reported more health problems than the general population (p < 0.001). The utility score of leukemia patients was found to be significantly related to medical insurance, religious belief, comorbidities, social support and ECOG performance status.

Conclusion

This study indicated that leukemia patients have worse health status compared to the general population of China and that multiple factors affect the health utility of the patients. The utility scores reported in this study could be useful in future cost-utility analysis.
Metastases can occur in cirrhotic livers with patent portal veins
Authors: Mahdi Zaid , Ettel Mark G. , Gonzalez Raul S. , Hart John , Alpert Lindsay , Fang Jiayun , Liu Natalia , Hammer Suntrea T. , Panarelli Nicole , Cheng Jerome , Greenson Joel K. , Swanson Paul E. , Westerhoff Maria
Published: February 2021

Objectives

Metastases are common in non-cirrhotic livers but are considered unlikely in the setting of cirrhosis. However, the degree of fibrosis in cirrhosis may vary; thus metastases may still access the liver vasculature and present as a mass in cirrhotic livers. This possibility may affect pathologists’ diagnostic algorithms when faced with a liver mass biopsy.

Methods

We hypothesized that metastases can occur in cirrhotic livers if fibrous remodeling is not severe or abnormal veno-arterial shunting exists to override an obstructed portal system. We searched departmental archives for cirrhotic livers with masses, categorizing fibrosis by Laennec staging: 4A = mild cirrhosis, 4B = moderate, 4 C = severe.

Results

Of 1453 cirrhotic livers with masses, 1429 were primary tumors and 24 were metastases (1.7 %). Of livers with metastases, most had 4A or 4B cirrhosis by Laennec staging (n = 17; 71 %). Eleven patients were evaluated by ultrasound Doppler; 2 of 5 with Laennec 4 C had reversal of portal vein flow, but all 4A & 4B patients had patent portal veins without reversed flow. Echocardiograms (13 patients) showed no ventricular or atrial septal defects or arteriovenous shunts.

Conclusions

Metastases are uncommon in cirrhotic livers, accounting for 1.7 % of masses. Most involved livers had mild or moderate cirrhosis (Laennec 4A/4B) and patent portal veins; however, as some Laennec 4 C cases also contained metastases, obstructed portal access may not be enough to deter metastatic access.
Dosimetric study between a single isocenter dynamic conformal arc therapy technique and Gamma Knife radiosurgery for multiple brain metastases treatment: impact of target volume geometrical characteristics
Authors: Chea Michel , Fezzani Karen , Jacob Julian , Cuttat Marguerite , Croisé Mathilde , Simon Jean-Marc , Feuvret Loïc , Valery Charles-Ambroise , Maingon Philippe , Benadjaoud Mohamed-Amine , Jenny Catherine
Published: February 2021

Purpose

To compare linac-based mono-isocentric radiosurgery with Brainlab Elements Multiple Brain Mets (MBM) SRS and the Gamma Knife using a specific statistical method and to analyze the dosimetric impact of the target volume geometric characteristics. A dose fall-off analysis allowed to evaluate the Gradient Index relevancy for the dose spillage characterization.

Material and methods

Treatments were planned on twenty patients with three to nine brain metastases with MBM 2.0 and GammaPlan 11.0. Ninety-five metastases ranging from 0.02 to 9.61 cc were included. Paddick Index (PI), Gradient Index (GI), dose fall-off, volume of healthy brain receiving more than 12 Gy (V12Gy) and DVH were used for the plan comparison according to target volume, major axis diameter and Sphericity Index (SI). The multivariate regression approach allowed to analyze the impact of each geometric characteristic keeping all the others unchanged. A parallel study was led to evaluate the impact of the isodose line (IDL) prescription on the MBM plan quality.

Results

For mono-isocentric linac-based radiosurgery, the IDL around 70–75% was the best compromise found. For both techniques, the GI and the dose fall-off decreased with the target volume. In comparison, PI was slightly improved with MBM for targets < 1 cc or SI > 0.78. GI was improved with GP for targets < 2.5 cc. The V12Gy was higher with MBM for lesions > 0.4 cc or SI < 0.84 and exceeded 10 cc for targets > 5 cc against 6.5 cc with GP. The presence of OAR close to the PTV had no impact on the dose fall off values. The dose fall-off was higher for volumes < 3.8 cc with GP which had the sharpest dose fall-off in the infero-superior direction up to 30%/mm. The mean beam-on time was 94 min with GP against 13 min with MBM.

Conclusions

The dose fall-off and the V12Gy were more relevant indicators than the GI for the low dose spillage assessment. Both evaluated techniques have comparable plan qualities with a slightly improved selectivity with MBM for smaller lesions but with a healthy tissues sparing slightly favorable to GP at the expense of a considerably longer irradiation time. However, a higher healthy tissue exposure must be considered for large volumes in MBM plans.
Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen
Authors: Chen Joe-Bin , Luo Shao-Ciao , Chen Chou-Chen , Wu Cheng-Chung , Yen Yun , Chang Chuan-Hsun , Chen Yun-An , P’eng Fang-Ku
Published: February 2021

Background

En bloc right hemicolectomy plus pancreaticoduodenectomy (PD) is administered for locally advanced colon carcinoma that invades the duodenum and/or pancreatic head. This procedure may also be called colo-pancreaticoduodenectomy (cPD). Patients with such carcinomas may present with acute abdomen. Emergency PD often leads to high postoperative morbidity and mortality. Here, we aimed to evaluate the feasibility and outcomes of emergency cPD for patients with advanced colon carcinoma manifesting as acute abdomen.

Methods

We retrospectively reviewed 4898 patients with colorectal cancer who underwent curative colectomy during the period from 1994 to 2018. Among them, 30 had locally advanced right colon cancer and had received cPD. Among them, surgery was performed in 11 patients in emergency conditions (bowel obstruction: 6, perforation: 3, tumor bleeding: 2). Selection criteria for emergency cPD were the following: (1) age ≤ 60 years, (2) body mass index < 35 kg/m2, (3) no poorly controlled comorbidities, and (4) perforation time ≤ 6 h. Three patients did not meet the above criteria and received non-emergency cPD after a life-saving diverting ileostomy, followed by cPD performed 3 months later. We analyzed these patients in terms of their clinicopathological characteristics, the early and long-term postoperative outcomes, and compared findings between emergency cPD group (e-group, n = 11) and non-emergency cPD group (non-e-group, n = 19). After cPD, staged pancreaticojejunostomy was performed in all e-group patients, and on 15 of 19 patients in the non-e-group.

Results

The non-e-group was older and had a higher incidence of associated comorbidities, while other clinicopathological characteristics were similar between the two groups. None of the patients in the two groups succumbed from cPD. The postoperative complication rate was 63.6% in the e-group and 42.1% in the non-e-group (p = 0.449). The 5-year overall survival rate were 15.9% in the e-group and 52.6% in the non-e-group (p = 0.192).

Conclusions

Emergency cPD is feasible in highly selected patients if performed by experienced surgeons. The early and long-term positive outcomes of emergency cPD are similar to those after non-emergency cPD in patients with acute abdominal conditions.
The management and outcome of paediatric splenic injuries in the Netherlands
Authors: Grootenhaar Maike , Lamers Dominique , Ulzen Karin Kamphuis-van , de Blaauw Ivo , Tan Edward C.
Published: February 2021

Background

Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre.

Methods

The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature.

Results

There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage.

Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493.

Conclusion

Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management.

Level of evidence

Therapeutic study, level III
The efficacy and safety of fast track surgery (FTS) in patients after hip fracture surgery: a meta-analysis
Authors: Jiang Mingyang , Liu Siyi , Deng Huachu , Liang Xuzhi , Bo Zhandong
Published: February 2021

Background

Fast track surgery (FTS) has been gradually applied in perioperative management of orthopedic surgery, but there still some research suspected that the prognosis of patients is not as expected and the cost is high, the effect of the FTS still urgently needed for support by evidence-based medicine.

Methods

We retrieved RCTs from medical research literature databases. Risk ratios (RR), standard mean difference (SMD), and 95% confidence intervals (CI) were calculated to compare the primary and safety endpoints.

Results

Overall, a total of 8886 patients were retrieved from 57 articles, of which 4448 patients (50.06%) were randomized to experimental group whereas 4438 patients (49.94%) were randomized to control group. The result showed that FTS could significantly shorten the length of stay (LOS), decrease the visual analog scale (VAS), reduce the leaving bed time and the hospitalization costs, and improve Harris hip joint function score. The incidence of complications such as respiratory system infection, urinary system infection, venous thrombus embolism (VTE), pressure sore, incision infection, constipation, and prosthesis dislocation also has been decreased significantly. Meanwhile, FTS improved patients’ satisfaction apparently.

Conclusions

This meta-analysis reveals that FTS could significantly shorten the length of stay, alleviate the pain, reduce the leaving bed time and the hospitalization costs, and improve hip function. The incidence of complications also has been decreased significantly. Meanwhile, FTS has been spoken highly in patients in terms of nursing satisfaction. Its efficacy and safety were proved to be reliable.
Etoricoxib is safe and effective in preventing heterotopic ossification after primary total hip arthroplasty
Authors: Oberberg Stella , Nottenkämper Jan , Heukamp Matthias , Krapp Jan , Willburger Roland E.
Published: February 2021

Background

Heterotopic ossifications are a common complication after total hip arthroplasty. Low-dose radiation therapy and non-steroidal anti-inflammatory drugs have proven to effectively reduce the rate of heterotopic ossification after total hip arthroplasty. However, a low number of studies describe an equal efficiency of etoricoxib. This work shows first results on the examination of a larger group with 194 subjects to analyze efficiency and rate of side effects under treatment with etoricoxib.

Methods

Clinical examinations were performed the day before surgery and after at least 12 months. The survey of clinical and functional outcome was done with Harris Hip Score (HHS). Conventional antero-posterior radiographs and second plane in frog leg position were assessed.

Results

In total, 14 undesirable side effects (7.4%) and only four early terminations of therapy (2.1%) were documented. A complete 1-year follow-up examination including radiographs could be done in 143 subjects (79.4%). Only 28 subjects (19.6%) developed heterotopic ossifications from which 92.9% were classified in type 1 and 7.1% in type 2 using the method described by Brooker. The results do not show correlations with body mass index, extended treatment (more than ten days), or clinical and functional outcome (measured by “Harris Hip Score”). However, male subjects show a significantly higher rate of heterotopic ossifications.

Conclusions

The investigations presented in this study confirm a good efficiency of etoricoxib for the prevention of heterotopic ossifications in comparison with classical methods such as radiation or drug therapy and show a low rate of undesirable side effects.