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Effective nutrition policies require timely, accurate individual dietary consumption data; collection of such information has been hampered by cost and complexity of dietary surveys and lag in producing results. The objective of this work was to assess accuracy and cost-effectiveness of a streamlined, tablet-based dietary data collection platform for 24-hour individual dietary recalls (24HR) administered using INDDEX24 platform v. a pen-and-paper interview(PAPI) questionnaire, with weighed food record (WFR) as a benchmark. This cross-sectional comparative study included women 18–49 years old from rural Burkina Faso (n 116 INDDEX24; n 115 PAPI). A WFR was conducted; the following day, a 24HR was administered by different interviewers. Food consumption data were converted into nutrient intakes. Validity of 24HR estimates of nutrient and food group consumption was based on comparison with WFR using equivalence tests (group level) and percentages of participants within ranges of percentage error (individual level). Both modalities performed comparably estimating consumption of macro- and micronutrients, food groups and quantities (modalities’ divergence from WFR not significantly different). Accuracy of both modalities was acceptable (equivalence to WFR significant at P < 0·05) at group level for macronutrients, less so for micronutrients and individual-level consumption (percentage within ±20 % for WFR, 17–45 % for macronutrients, 5–17 % for micronutrients). INDDEX24 was more cost-effective than PAPI based on superior accuracy of a composite nutrient intake measure (but not gram amount or item count) due to lower time and personnel costs. INDDEX24 for 24HR dietary surveys linked to dietary reference data shows comparable accuracy to PAPI at lower cost.

Objective The medical record is critical for documentation and communication between healthcare professionals. This study compared the completeness of orthopaedic documentation between the electronic medical record (EMR) and paper medical record (PMR). Methods A review was undertaken of 400 medical records (200 EMR, 200 PMR) of patients with operatively managed traumatic lower limb injury. The operative report, discharge summary and first and second out-patient reviews were evaluated using criteria designed by a senior orthopaedic surgeon and senior physiotherapist. The criteria included information deemed critical to the post-operative care of the patient in the first 6 weeks post-surgery. Results In all cases, an operative report was completed by a senior surgeon. Notable findings included inferior documentation of patient weight-bearing status on the operative report in the EMR than PMR group (P = 0.018). There was a significant improvement in the completion of discharge summaries in the EMR compared with PMR cohort (100% vs 82.5% respectively; P

The essence of this paper is eminent to advance the study of Human Resource Management (HRM) in the profound new directions that has been introduced due to the covid-19 pandemic. This particular review elaborates on the following such as: Challenges Caused by Covid-19 to HRM Principles and Practice, HRM Outlook within Continents in this Coronavirus Pandemic, How Information Technology can still grow HRM in new Practices, The Case of HRM Practice in Developing World with Covid-19, How Both National and International HRM Practice is portrayed with Covid-19, Moving Forward with HRM Practice and Covid-19, and Organisational and Institutional Challenges and Demands in HRM Policies and Law. The general conclusion with this new Human Resource Management is associated with massive application of technology that Human Resource Management practices in various organisational operations and ways of doing things in the traditional HRM way has changed. Many of the roles are been performed remotely using internet and relevant HRM laws, applications and policies to deliver in managing work and the people. This is eminent for HRM practitioners and professionals to further educate and train themselves in this covid-19 era to avert themselves with the new principles instituted by organisations and governments in the area of HRM of activities and people. In this review the HRM is been twisted and thereby its efficacies are challenged which is why this new study is important to the practitioners and professionals to adapt and/or adopt.

Objectives Unlike the technological advances in cross-sectional imaging, the adoption of CR and DR has been relatively overlooked in terms of the additional radiographer skills and competences required for optimal practice. Furthermore, projection radiography is often referred to as basic, plain or other words suggesting simplicity or entry-level skill requirements. Radiographers’ professional identity is connected with the discourse expressed via the language used in daily practice and consequently, if the perception of projection radiography is regarded as simple practice not requiring much reflection or complex decision-making, apathy and carelessness may arise. The purpose of this narrative review was to raise projection radiography from its longstanding lowly place and re-position it as a specialist imaging field. Key findings Danish pre-registration radiography curricula contain little mention of projection radiography and a low proportion (n = 17/144; 11.8%) of Danish radiography students chose to focus on projection radiography within publicly available BSc. theses between 2016 and 2020 as compared to topics related to CT and MRI (n = 60/144; 41.7%). Conclusion By changing how we as the profession perceive the role and position of projection radiography, we can start to rebuild its lost prestige and demand a greater, more detailed and clinically relevant educational offering from academic partners. For this to commence, the language and terminology we use to describe ourselves and tasks undertaken must reflect the complexity of the profession. Implications for practice Regardless of imaging modality, every patient should be assured that a radiographer with expertise in acquiring images of diagnostic quality undertakes their examination. Reclaiming the prestige of projection radiography may lead students and radiographers to recognize projection radiography as a demanding specialist field for the benefit of the patients.

PurposeThe study aimed to measure scientific and social impacts of Iranian researchers' “Top Papers” in clinical medicine using citation and altmetric indicators.Design/methodology/approachIn this applied descriptive-analytical study, it used scientometric analysis. A total of 166 “Top Papers” of Iranian researchers in clinical medicine category of Web of Science (WoS) database including “Highly Cited Papers” and “Hot Papers” published between 2009 and 2019 were used. Overall, 29 indicators and their data were extracted from WoS, Scopus, ResearchGate (RG) and PlumX in March 2020.FindingsThe results showed that there exists a positive correlation between the number of citations in WoS, Scopus, RG, PubMed and Crossref. In addition, it was found that there existed a positive correlation between the received citations by articles and altmetric indicators. According to the results, there is a strong correlation between RG Research Interest and citation impact. The correlation analysis on the Plum Analytics categories including “Usage”, “Capture”, “Mention”, “Social Media” and “Citation” showed the correlations between five dimensions of impact were positive and significant. The results have led the authors to think more about new metrics that can response to new developments in the new information areas.Research limitations/implicationsThere are limitations to access altmetric.com in Iran and cannot be used easily. On the other hand, because of considering 24 indicators, authors had to investigate only a sample of 166 top papers from Iranian researchers to present the detailed results. About nature of altmetric indicators, although they reflect the nonacademic impact of articles alongside bibliographic indicators, they still cannot be a complete representative of the influence of their owners.Practical implicationsThis study can indicate a practical application appropriate for the future study. It would be valuable to further examine how social academic platforms construct images of impact of research and how this impacts the social impact of the university as a mission. This study suggests that social media attention to academic research can be much greater than what is shown in traditional indicators such as citation.Originality/valueThis study examines 29 indicators from four platforms including RG, WoS, Scopus and PlumX, simultaneously and measures the relationship among them.

Objective: The objective of the study is to compare three techniques, routinely used rapid diagnostic tests (lateral flow immune chromatography) versus nucleic acid amplification test (NAT) versus Paper-based microfluidics for DNA diagnostics of Malaria, in terms of their sensitivity and specificity as diagnostic tests in detecting malarial infection among febrile illnesses, suspected of malaria, as well as to compare their cost-effectiveness. Methodology: Three seventy febrile cases suspected of malaria with negative results with RDT will be screened by real-time PCR and DNA microfluidics techniques, sensitivity and specificity of these as screening tests will be compared. The number of extra positive cases detected by NAT gives us the yield. Cost-effectiveness analysis will be done by calculating the incremental cost-effectiveness ratio (ICER) and average cost-effectiveness ratio (ACER) for the tests. Statistical Analysis: Statistical analysis will be done using SPSS version 21. Sensitivity, specificity, Positive predictive values will be computed. Comparison of sensitivity and specificity of NAT, a paper microfluidic technique for DNA diagnostics and RDT will be carried out using McNemar’s test. Receiver operating curves will be generated separately to assess the utility of the NAT. Conclusion: The Implications of this study from the patient's perspective would mean early diagnosis which forms the tenet of control of the disease by increasing the yield. Early diagnosis at the community level would translate into the application of efficient prevention mechanisms to spread the infection. The cost-effectiveness analysis would provide a scientific basis for the adoption of the best test for the diagnosis, given the economic feasibility of the study.

Spinocerebellar ataxias (SCAs) represent a large group of hereditary degenerative diseases of the nervous system, in particular the cerebellum, and other systems that manifest with a variety of progressive motor, cognitive, and behavioral deficits with the leading symptom of cerebellar ataxia. SCAs often lead to severe impairments of the patient's functioning, quality of life, and life expectancy. For SCAs, there are no proven effective pharmacotherapies that improve the symptoms or substantially delay disease progress, i.e., disease-modifying therapies. To study SCA pathogenesis and potential therapies, animal models have been widely used and are an essential part of pre-clinical research. They mainly include mice, but also other vertebrates and invertebrates. Each animal model has its strengths and weaknesses arising from model animal species, type of genetic manipulation, and similarity to human diseases. The types of murine and non-murine models of SCAs, their contribution to the investigation of SCA pathogenesis, pathological phenotype, and therapeutic approaches including their advantages and disadvantages are reviewed in this paper. There is a consensus among the panel of experts that (1) animal models represent valuable tools to improve our understanding of SCAs and discover and assess novel therapies for this group of neurological disorders characterized by diverse mechanisms and differential degenerative progressions, (2) thorough phenotypic assessment of individual animal models is required for studies addressing therapeutic approaches, (3) comparative studies are needed to bring pre-clinical research closer to clinical trials, and (4) mouse models complement cellular and invertebrate models which remain limited in terms of clinical translation for complex neurological disorders such as SCAs.

This ANMCO (Associazione Nazionale Medici Cardiologi Ospedalieri) position paper aims to analyse the complex action of sodium-glucose co-transporter 2 inhibitors at the level of the kidney and cardiovascular system, focusing on the effect that these molecules have shown in the prevention and treatment of heart failure in diabetic and non-diabetic subjects. The goal was pursued by comparing the data generated with pathophysiology studies and with multicentre controlled studies in large populations. In accordance with the analysis carried out in the document, the following recommendations are issued: (i) canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin are molecules recommended for the prevention of heart failure hospitalizations in type 2 diabetic subjects; (ii) canagliflozin and dapagliflozin are recommended for the prevention of heart failure hospitalizations in type 2 diabetic subjects with severe chronic kidney disease, dapagliflozin proved to be safe and effective also in diabetic subjects; and (iii) dapagliflozin and empagliflozin are recommended to reduce the combined risk of heart failure and cardiovascular death in diabetic and non-diabetic subjects with heart failure and reduced ejection fraction.

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility; however, whether women with PCOS and spontaneous or drug-induced ovulatory cycles have the same reproductive potential as non-PCOS controls is a matter of debate. In the present opinion paper, the author takes the opportunity to summarize the collective evidence supporting the hypothesis of reduced fertility potential in women with PCOS, regardless of ovulatory status, and speculate that reduced reproductive potential may be caused by altered oocytes, embryo and endometrial competence, and infertility-related co-morbidities as well as an increased risk of pregnancy complications.

Background Electronic prescriptions are often created and delivered electronically to the pharmacy while paper-based/handwritten prescriptions may be delivered to the pharmacy by the patients. These differences in the mode of creation and transmission of the two types of prescription could influence the rate at which outpatients fill new prescriptions of previously untried medications. Objectives This study aimed to evaluate literatures to determine the impact of electronic prescribing compared with paper-based/handwritten prescribing on primary medication adherence in an outpatient setting. Methods The keywords and phrases “outpatients,” “e-prescriptions,” “paper-based prescriptions,” and “primary medication adherence” were combined with their relevant synonyms and medical subject headings. A comprehensive literature search was conducted on EMBASE, CINAHL, and MEDLINE databases, and Google Scholar. The results of the search were screened and selected using predefined inclusion and exclusion criteria. The Critical Appraisal Skills Program (CASP) was used for quality appraisal of included studies. Data relevant to the objective of the review were extracted and analyzed through narrative synthesis. Results A total of 10 original studies were included in the final review, including 1 prospective randomized study and 9 observational studies. Nine of the 10 studies were performed in the United States. Four of the studies indicated that electronic prescribing significantly increases initial medication adherence, while four of the studies suggested the opposite. The remaining two studies found no significant difference in primary medication adherence between the two methods of prescribing. The variations in the studies did not allow the homogeneity required for meta-analysis to be achieved. Conclusion The conflicting findings relating to the efficacy of primary medication adherence across both systems demonstrate the need for a standardized measure of medication adherence. This would help further determine the respective benefits of both approaches. Future research should also be conducted in different countries to give a more accurate representation of adherence.

BACKGROUND: The authors aim to publish the results of their studies in peer-reviewed targeted international journals with a high impact-factor as possible, but they are also exposing to “predatory” publishers. AIM: The aim of the study was to offer some advices for authors to help to identify relevant medical journals, avoid “predatory” journals and publishers, use intermediary services, know a journal policy, and expectations of good journal editor(s). RECOMMENDATIONS: During the publication process authors should find suitable journals, assume a risk to encounter “predatory” or “hijacked” journals, know the advantages and disadvantages of using intermediary publishing services, understand expectations of editor(s), and make payment for article processing. CONCLUSIONS: The advices can help many researchers to publish their papers in relevant journals with cited indexes, and avoid many problems within the publication process.

Background In 2019, a randomized controlled trial (RCT) authored by Dr. Ismail was retracted due to concerns about data integrity. Since there are no policies in place to investigate other publications of authors of retracted studies, we investigated Dr. Ismail’s other trials. Methods We searched for RCTs authored by Dr. Ismail. We made pairwise comparisons of values in baseline and outcome tables between trials. We assessed whether the distributions of baseline characteristics were compatible with properly conducted randomization, using Monte Carlo simulations and the Kolmogorov-Smirnov test. We read the publications carefully for unusual features. Results Dr. Ismail was author in eight published and one unpublished trial. In three of his first author studies we found multiple identical values in the baseline and/or outcome tables from different trials. At least some of the trials were unlikely to have followed a proper randomization process. There were a number of other unusual features in the papers we reviewed. Conclusions It is probable that other trials published by Dr. Ismail contain questionable data. We call for a thorough investigation of the original trial data and related official documents. Our exercise suggests that the practice to assess research integrity should include all publications of authors with retracted fabricated articles.

This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.

Obesity is a condition that increases the possibility of developing a wide range of non-communicable diseases and as a serious consequence, also promotes the chances of being suffered by deadly infectious diseases. This is most clearly noticeable in the pandemic situation of global spread of the COVID-19. Obesity is considered as an access to various non-communicable diseases as well as mental-health illness and in present scenario it has been found to be a key factor in COVID-19 complications and mortality. Further, obesity has been identified as a major comorbity in patients with asthmatic disorders which also proves it as a risk factor for more serious corona virus disease. Obesity has been recognized as a disease in its own right as well as a risk factor for other health issues including significantly worsening the outcomes of COVID-19 infection. Keywords: Obesity, COVID-19, Pandemic, Comorbity.

It is estimated that 621 million children throughout the world have untreated caries on primary teeth. 1 Early childhood caries (ECC), which affects preschool children, progresses rapidly and is associated with pain, difficulty chewing, weight loss, difficulty sleeping, altered behaviour, and a poorer quality of life for affected children and theirfamilies. Children with dental caries have greater treatmentneed, which is expensive and not readily accessible in most developing countries. In South Africa, ECC is a major public health problem with caries rates among children as high as 70% in some provinces.

Lymphedema is a common condition of tissue swelling and fluid retention. Due to improper tissue drainage and is a sign of lymphatic system dysfunction. It may occur on the trunk, limbs and in the head and neck region - head and neck cancer. Head and neck lymphedema is a common complication of ENT procedures. The research reveals that up to 50% of patients with head and neck cancer develop head and neck lymphedema. The lack of appropriate diagnostics and treatment of lymphedema lead to serious complications, longer hospitalization and much higher costs of treatment. Head and neck lympedema significantly increases the level of frustration in patients, especially those with cancer who experience greater stress and anxiety as a result of uncertain prognosis. Therefore, it is advisable to broaden the research on HNL diagnosis and treatment. This review presents symptoms, current diagnosis strategies, treatment and recommendations in head and neck lymphedema.

Approaches for rapid reviews that focus on streamlining systematic review methods are not always suitable for exploring complex policy questions, as developing and testing theories to explain these complexities requires configuring diverse qualitative, quantitative, and mixed methods studies. Our objective was therefore to provide a guide to selecting approaches for rapidly (i.e., within days to months) addressing complex questions related to health policy and system issues. We provide a two-stage, transdisciplinary collaborative process to select a rapid review approach to address complex policy questions, which consists of scoping the breadth and depth of the literature and then selecting an optimal approach to synthesis. The first stage (scoping the literature) begins with a discussion with the stakeholders requesting evidence to identify and refine the question for the review, which is then used to conduct preliminary searches and conceptually map the documents identified. In the second stage (selection of an optimal approach), further stakeholder consultation is required to refine and tailor the question and approach to identifying relevant documents to include. The approach to synthesizing the included documents is then guided by the final question, the breadth and depth of the literature, and the time available and can include a static or evolving conceptual framework to code and analyze a range of evidence. For areas already covered extensively by existing systematic reviews, the focus can be on summarizing and integrating the review findings, resynthesizing the primary studies, or updating the search and reanalyzing one or more of the systematic reviews. The choice of approaches for conducting rapid reviews is intertwined with decisions about how to manage projects, the amount of work to be done, and the knowledge already available, and our guide offers support to help make these strategic decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s13643-021-01834-y.

ZusammenfassungHintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung, oftmals auf der Grundlage einer Typ-2-Inflammation. Für die Behandlung von Patienten mit einer schweren Ausprägung ohne ausreichendes Ansprechen auf die Standardtherapie mit topischen nasalen Steroiden und/oder Zustand nach endonasaler Operation sind als Biologika aktuell Dupilumab und Omalizumab für die Therapie zugelassen. Nachdem wir in einer früheren Publikation für Dupilumab bereits entsprechende Hinweise gegeben haben, ist das Ziel der vorliegenden Arbeit die Standardisierung von Patienteninformation und -aufklärung vor einer Therapie mit Omalizumab.Methoden Auf Grundlage des aktuellen Wissensstandes zur Immunologie der CRSwNP und zu den erwünschten und möglichen unerwünschten Wirkungen von Omalizumab werden Empfehlungen für die Patienteninformation entwickelt.Ergebnisse Basierend auf der internationalen Literatur, der aktuellen Fachinformation und Erfahrungen aus der praktischen Anwendung und den derzeitigen Pharmakovigilanz-Daten hat ein Expertengremium Empfehlungen für die Patienteninformation und -aufklärung zur Anwendung von Omalizumab bei CRSwNP entwickelt und auf dieser Grundlage einen Patienteninformations- und Aufklärungsbogen erstellt.Schlussfolgerung Die Information und Einwilligung des Patienten wird vor der Verordnung bzw. Verabreichung von allen Biologika, damit auch Omalizumab, empfohlen. Das vorliegende Positionspapier enthält wichtige Informationen zur praktischen Umsetzung und einen Vorschlag für eine Patienteninformation.

Es hat sich viel getan in der Welt der Schlafmedizin in der Kardiologie, weshalb eine vollwertige Uberarbeitung des Positionspapiers „Schlafmedizin in der Kardiologie“ erforderlich wurde. In der aktuellen neuartigen Version finden sich nicht nur alle verfugbaren Studien, Literaturstellen und Updates zu Pathophysiologie, Diagnostik- und Therapieempfehlungen, sondern auch Ausblicke auf neue Entwicklungen und zukunftige Forschungserkenntnisse. Dieses uberarbeitete Positionspapier gibt Empfehlungen fur Diagnostik und Therapie von Patienten mit kardiovaskularen Erkrankungen mit schlafassoziierten Atmungsstorungen und erteilt daruber hinaus einen fundierten Uberblick uber verfugbare Therapien und Evidenzen, gibt aber ebenso Ratschlage wie mit Komorbiditaten umzugehen ist. Insbesondere enthalt dieses uberarbeitete Positionspapier aktualisierte Stellungnahmen zu schlafassoziierten Atmungsstorungen bei Patienten mit koronarer Herzerkrankung, Herzinsuffizienz, arterieller Hypertonie, aber auch fur Patienten mit Vorhofflimmern. Daruber hinaus finden sich erstmals Empfehlungen zur Telemedizin als eigenes, neues Kapitel. Dieses Positionspapier bietet Kardiologen sowie Arzten in der Behandlung von kardiovaskularen Patienten die Moglichkeit einer evidenzbasierten Behandlung der wachsend bedeutsamen und mit zunehmender Aufmerksamkeit behafteten Komorbiditat schlafassoziierter Atmungsstorungen. Und nicht zuletzt besteht mit diesem neuen Positionspapier eine enge Verknupfung mit dem neuen Curriculum Schlafmedizin der Deutschen Gesellschaft fur Kardiologie, weshalb dieses Positionspapier eine Orientierung fur die erworbenen Fahigkeiten des Curriculums im Umgang von kardiovaskularen Patienten mit schlafassoziierten Atmungsstorungen darstellt.

Morphea (localized scleroderma) is an inflammatory connective tissue disease. Borrelia burgdorferi, as a causative factor, has been discussed controversially. The aim of this original study was to ...

A current osteopathic tenet inherited from Native American principles involves viewing each person as a dynamic interaction of body-mind-spirit (BMS). Because of its traditional medicine heritage and current evidence-based approach, the osteopathic profession is, arguably, uniquely positioned to promote evidence-informed person-centered approaches that transcend improvements in pain and musculoskeletal function. It may be particularly relevant in the context of integrating the BMS tenet into osteopathic care according to the diversity of patients’ values and sociocultural assumptions towards health, symptoms, and subsequent care, which range from the typical Western to complementary and alternative medicine perspectives. There is currently a lack of robust clinical practice frameworks in this area, confusing patients and practitioners and blurring professional identities. The current commentary provides an opportunity to initiate discussions in the profession with a rationale for creating a roadmap to develop an evidence-informed framework for osteopathic care that integrates the BMS tenet.

Background High-frequency patient-reported outcome (PRO) assessments are used to measure patients' symptoms after surgery for surgical research; however, the quality of those longitudinal PRO data has seldom been discussed. Objective The aim of this study was to determine data quality-influencing factors and to profile error trajectories of data longitudinally collected via paper-and-pencil (P&P) or web-based assessment (electronic PRO [ePRO]) after thoracic surgery. Methods We extracted longitudinal PRO data with 678 patients scheduled for lung surgery from an observational study (n=512) and a randomized clinical trial (n=166) on the evaluation of different perioperative care strategies. PROs were assessed by the MD Anderson Symptom Inventory Lung Cancer Module and single-item Quality of Life Scale before surgery and then daily after surgery until discharge or up to 14 days of hospitalization. Patient compliance and data error were identified and compared between P&P and ePRO. Generalized estimating equations model and 2-piecewise model were used to describe trajectories of error incidence over time and to identify the risk factors. Results Among 678 patients, 629 with at least 2 PRO assessments, 440 completed 3347 P&P assessments and 189 completed 1291 ePRO assessments. In total, 49.4% of patients had at least one error, including (1) missing items (64.69%, 1070/1654), (2) modifications without signatures (27.99%, 463/1654), (3) selection of multiple options (3.02%, 50/1654), (4) missing patient signatures (2.54%, 42/1654), (5) missing researcher signatures (1.45%, 24/1654), and (6) missing completion dates (0.30%, 5/1654). Patients who completed ePRO had fewer errors than those who completed P&P assessments (ePRO: 30.2% [57/189] vs. P&P: 57.7% [254/440]; P Conclusions It is possible to improve data quality of longitudinally collected PRO through ePRO, compared with P&P. However, ePRO-related sampling bias needs to be considered when designing clinical research using longitudinal PROs as major outcomes.

The short-term mortality and rehospitalization rates after admission for acute heart failure (AHF) remain high, despite the high level of adherence to contemporary practice guidelines. Observational data from non-randomized studies in AHF strongly support the in-hospital administration of oral evidence-based modifying chronic heart failure (HF) medications (i.e., b-blockers, ACE inhibitors, mineralocorticoid receptor antagonists) to reduce morbidity and mortality. Interestingly, a well-designed prospective randomized multicenter study (PIONEER-HF) showed an improved clinical outcome and stress/injury biomarker profile after in-hospital administration of sacubitril/valsartan (sac/val) as compared to enalapril, in hemodynamically stable patients with AHF. However, sac/val implementation during hospitalization remains suboptimal due to the lack of an integrated individualized plan or well-defined appropriateness criteria for transition to oral therapies, an absence of specific guidelines regarding dose selection and the up-titration process, and uncertainty regarding patient eligibility. In the present expert consensus position paper, clinical practical recommendations are proposed, together with an action plan algorithm, to encourage and facilitate sac/val administration during hospitalization after an AHF episode with the aim of improving efficiencies of care and resource utilization.

Multiple myeloma is the second most common hematological malignancy in the USA and Europe. Despite improvements in the 5-year and overall survival rates over the past decade, older adults (aged ≥65 years) with multiple myeloma continue to experience disproportionately worse outcomes than their younger counterparts. These differences in outcomes arise from the increased prevalence of vulnerabilities such as medical comorbidities and frailty seen with advancing age that can influence treatment-delivery and tolerance and impact survival. In general, geriatric assessments can help identify those patients more likely to benefit from enhanced toxicity risk-prediction and aid treatment decision-making. Despite the observed benefits of geriatric assessments and other screening frailty tools, provider and systems-level barriers continue to influence the overall perception of the feasibility of geriatric assessments in clinical practice settings. Clinical trials are underway evaluating the efficacy and safety of various multiple myeloma therapies in less fit/frail older adults, with a minority examining fitness-based/risk-adapted approaches. Thus, significant gaps exist in knowing which myeloma therapies are most appropriate for older and more vulnerable adults with multiple myeloma. The purpose of this Review is to discuss how geriatric assessments can be used to guide the management of transplant-ineligible patients; and to highlight frontline therapies for standard-risk and high-risk cytogenetic abnormalities [i.e., t(4;14), t(14;16), and del(17p)] associated with multiple myeloma. We also discuss the current shortcomings of the existing clinical approaches to care and highlight ongoing clinical trials evaluating newer fitness-based approaches to managing transplant-ineligible patients.

Background: Probiotics can improve immune function leading to the prevention and management of viral infections like SARS-CoV-2 infection (COVID-19 disease). Methods: We searched PubMed, EMBASE, Google Scholar, Science Direct, Scopus, and Web of Science up to May 2020 to identify interventional & observational studies documenting the effects of probiotics on incidence, severity, duration, and other clinical manifestations of viral infections, especially SARS-CoV-2-induced. Results: From a total of 91 records, 24 studies were obtained and classified into three domains based on the efficacy of probiotics on 1) shortening the period and severity of infections (n=9), 2) incidence (n=6), and 3) other clinical complications that may be followed by viral disorders (n=9). Identified probiotics have positive effects on the mentioned domains. Conclusion: Based on the evidence, some probiotic strains may be useful in SARS-CoV-2 infection; randomized trials are needed to show the facts.

Brachiocephalic arteriovenous fistulas (AVF) makeup approximately one third of prevalent dialysis vascular accesses. The most common cause of malfunction with this access is cephalic arch stenosis (CAS). The accepted requirement for treatment of a venous stenosis lesion is ⩾50% stenosis associated with hemodynamically abnormalities. However, the correlation between percentage stenosis and a clinically significant decrease in access blood flow (Qa) is low. The critical parameter is the absolute minimal luminal diameter (MLD) of the lesion. This is the parameter that exerts the key restrictive effect on Qa and results in hemodynamic and functional implications for the access. CAS is the result of low wall shear stress (WSS) resulting from the effects of increased blood flow and the unique anatomical configuration of the CAS. Decrease in WSS has a linear relationship to increased blood flow velocity and neointimal hyperplasia exhibits an inverse relationship with WSS. The result is a stenotic lesion. The presence of downstream venous stenosis causes an inflow-outflow mismatch resulting in increased pressure within the access. Qa in this situation may be decreased, increased, or within a normal range. Over time, the increased intraluminal pressure can result in marked aneurysmal changes within the AVF, difficulties with cannulation and the dialysis treatment, and ultimately, increasing risk of access thrombosis. Complete characterization of the lesion both hemodynamically and anatomically should be the first step in developing a strategy for management. This requires both access flow measurement and angiographic imaging. Patients with CAS present a relatively broad spectrum as relates to both of these parameters. These data should be used to determine whether primary treatment of CAS should be directed toward the anatomical lesion (small MLD and low Qa) or the pathophysiology (large MLD and high Qa).

This article explores how young prenatal women negotiate, articulate, and manage their experiences of chronic pelvic pain (CPP). I argue that chronic pelvic pain lies at the intersection of chronic illness, pain, feminization, sex, and legibility, and that pain of this character is deeply stigmatized. Investigating it offers a visceral view into the affective layers of chronic pain. This project draws on ethnographic interviews with CPP sufferers aged eighteen to thirty, pelvic health care providers, and sex and treatment tool production companies. The analysis is rooted in histories of frigidity, hysteria, and chronic illness that together affect how CPP is socially understood today. This article explicates the critical differences between prompted recurrent pain and constant bodily pain in terms of the subjectivity of associated experiences, the problematic insistence on vaginal penetration as evidence of cure, and the dilemmas of treating pain with doubly painful therapies.

Alcohol and cannabis use as a contraindication to organ transplantation is a controversial issue. Until recently, patients in Canada with alcohol-associated liver disease were required to demonstrate abstinence for 6 mo to receive a liver transplant. There is no equivalent rule that is applied consistently for cannabis use. There is some evidence that alcohol and cannabis use disorder pretransplant could be associated with worse outcomes posttransplantation. However, early liver transplantation for patients with alcohol-associated liver disease in France and in the United States has led to challenges of the 6-mo abstinence rule in Canada in the media. It has also resulted in several legal challenges arguing that the rule violates human rights laws regarding discrimination in the provision of medical services and that the rule is also unconstitutional (this challenge is still before the court). Recent legalization of cannabis use for adults in Canada has led to questions about the appropriateness of limiting transplant access based on cannabis use. The ethics committee of the Canadian Society of Transplantation was asked to provide an ethical analysis of cannabis and alcohol abstinence policies. Our conclusions were as follows: neither cannabis use nor the 6-mo abstinence rule for alcohol use should be an absolute contraindication to transplantation, and transplant could be offered to selected patients, further research should be conducted to ensure evidence-based policies; and the transplant community has a duty not to perpetuate stigma associated with alcohol and cannabis use disorders.

Introduction The disruption score is a new bibliometric tool that has recently been utilized to identify studies that are innovative and shift paradigms. We sought to identify and characterize the top 100 most disruptive publications in pediatric surgery. Methods The 100 most disruptive and cited publications in 17 pediatric surgery journals were identified from a validated dataset and linked with the iCite NIH tool. The top 100 most disruptive publications were reviewed to determine study design, clinical focus, and perceived contribution. Results The publications included in the top 100 list were more disruptive than 99.5% of the entire PubMed universe. Journal of Pediatric Surgery (n = 45) had the most articles included. There was a weak correlation between citation count and disruption score (r = 0.27). Retrospective cohort studies (38%), contributions in clinical outcomes (39%), technical/technological innovations (31%), clinical focus in trauma (18%), and disorders of the gastrointestinal tract (18%) were the most represented. The disruption score identified a unique subset of literature that has created new paradigms with long lasting influence and may be further applied as another tool to measure scientific impact. This wide array of literature highlights both technical and technological innovations as well as key moments in the history of pediatric surgery. Level of evidence V

This study's objective was to assess which caring recruitment behaviors correlate with the successful recruitment of older African-American adults-a two-step cross-sectional design employing a vignette-based survey methodology. Kristen Swanson's middle-range theory of caring was used to guide the examination of African-American adults' (65 years of age and older) perceptions of research-study-recruiter recruitment behaviors. This study's main findings are twofold: Step 1: Seven of ten invited experts identified major revisions of the two core vignettes, written at an eighth-grade reading level and high school comprehension. Step 2: A 51% response rate yielded findings that this methodology successfully captured older African-American adults' perception of research study recruiters' behavioral characteristics during the recruitment process. Older African-Americans who received the hypothetical caring vignette were twice as likely to indicate their willingness to enroll in a research study with a high commitment (i.e., brain donation) compared to their counterparts who received the hypothetical uncaring recruitment scenario. Vignette-based survey methodology holds promise as a tool for informing the recruitment of older African-American adults and other minorities into federally funded health-related research studies.

Introduction: Current guidelines recommend prophylactic treatment of hemophilia B with the missing coagulation factor IX, either with standard half-life or extended half-life products. Extended half-life products have half-lives three to six times longer than the former, allowing a reduction in the number of weekly injections and therefore, potentially impacting on treatment adherence and quality of life. Albutrepenonacog alfa is an extended half-life fusion protein of coagulation factor IX with recombinant human albumin, indicated for both on-demand and prophylactic treatment for bleeding in patients with hemophilia B of all ages.Areas covered: The authors review the clinical and pharmacokinetic characteristics of albutrepenonacog alfa, as well as the available information regarding trough levels and real-world evidence. Given the availability of other factor IX products in the market, indirect comparisons of clinical and pharmacokinetic characteristics are presented.Expert opinion: The authors exhibit their expert opinion on which patient profiles are candidates for prophylactic treatment with albutrepenonacog alfa, and on the management of patients in terms of dosing, regimens of administration and protocols for switching the treatment.

Bladder duplication is a rare anomaly classified as sagittal or coronal, depending on the axis of the septum. VACTER association involves congenital anomalies affecting the vertebrae, anus, heart, trachea, esophagus, kidney and genitourinary system. This is the first description of a case of coronal bladder duplication in a patient that also presented with anomalies on the foregut and other organs that correspond to VACTER association. Pertinent literature is systematically reviewed and compared with our case.

Heart disease has been one of the ruling causes for death for quite some time now. About 31% of all deaths every year in the world take place as a result of cardiovascular diseases [1]. A majority of the patients remain uninformed of their symptoms until quite late while others find it difficult to minimise the effects of risk factors that cause heart diseases. Machine Learning Algorithms have been quite efficacious in producing results with a high level of correctness thereby preventing the onset of heart diseases in many patients and reducing the impact in the ones that are already affected by such diseases. It has helped medical researchers and doctors all over the world in recognising patterns in the patients resulting in early detections of heart diseases.

Coronavirus disease 2019 (COVID-19) vaccine BNT162b2 received approval and within the first few days of public vaccination several severe anaphylaxis cases occurred. An investigation is taking place to understand the cases and their triggers. The vaccine will be administered to a large number of individuals worldwide and concerns raised for severe adverse events might occur. With the current information, the European Academy of Allergy and Clinical Immunology (EAACI) states its position for the following preliminary recommendations that are to be revised as soon as more data emerges. To minimize the risk of severe allergic reactions in vaccinated individuals, it is urgently required to understand the specific nature of the reported severe allergic reactions, including the background medical history of the individuals affected and the mechanisms involved. To achieve this goal all clinical and laboratory information should be collected and reported. Mild and moderate allergic patients should not be excluded from the vaccine as the exclusion of all these patients from vaccination may have a significant impact on reaching the goal of population immunity. Health care practitioners vaccinating against COVID-19 are required to be sufficiently prepared to recognise and treat anaphylaxis properly with the ability to administer adrenaline. A mandatory observation period after vaccine administration of at least 15 minutes for all individuals should be followed. The current data has not shown any higher risk for patients suffering from allergic rhinitis or asthma and this message should be clearly stated by physicians to give our patients trust. The benefit of the vaccination clearly outweighs the risk of severe COVID-19 development including the more than 30% of the population suffering from allergic diseases.

Heterozygous familial hypercholesterolaemia (FH) is among the most common genetic metabolic lipid disorders characterised by elevated low-density lipoprotein cholesterol (LDL-C) levels from birth and a significantly higher risk of developing premature atherosclerotic cardiovascular disease. The majority of the current pediatric guidelines for clinical management of children and adolescents with FH does not consider the impact of genetic variations as well as characteristics of vascular phenotype as assessed by recently developed non-invasive imaging techniques. We propose a combined integrated approach of cardiovascular (CV) risk assessment and clinical management of children with FH incorporating current risk assessment profile (LDL-C levels, traditional CV risk factors and familial history) with genetic and non-invasive vascular phenotyping. Based on the existing data on vascular phenotype status, this panel recommends that all children with FH and cIMT ≥0.5 mm should receive lipid lowering therapy irrespective of the presence of CV risk factors, family history and/or LDL-C levels Those children with FH and cIMT ≥0.4 mm should be carefully monitored to initiate lipid lowering management in the most suitable time. Likewise, all genetically confirmed children with FH and LDL-C levels ≥4.1 mmol/L (160 mg/dL), should be treated with lifestyle changes and LLT irrespective of the cIMT, presence of additional RF or family history of CHD.

The development of microfluidic devices for point-of-care (POC) testing has been widely applied for food quality control, environmental monitoring, and clinical diagnoses. Regarding the latter, microfluidic paper-based analytical devices (µPADs) have a great potential in developing portable and disposable platforms for fast disease-relevant biomarker detection in remote areas. In this work, k-nearest neighbors (k-NN) classifiers were applied to demonstrate the reliability of using chemical data obtained from µPADs for diagnosis of diseases like diabetes mellitus and hyperuricemia. Predictors based on glucose, lactate, and uric acid biomarkers were evaluated to reach this goal. Healthy adults were differentiated from the diagnosed patients with a perfect success rate. Metabolic disorders were suitably predicted with 95.0% overall accuracy. This model also showed sensitivities and specificities in the ranges 75–100% and 93–100%, respectively, indicating that the classification protocol is robust. The k-NN modeling proved the potential of the µPADs to be applied in telemedicine for reliable off-site diagnoses.

Objective The aim of the study was to determine the response rate to a mixed-mode survey using email compared with that to a paper survey in survivors of critical illness. Design This is a prospective randomised controlled trial. Setting The study was conducted at a single-centre quaternary intensive care unit (ICU) in Adelaide, Australia. Participants Study participants were patients admitted to the ICU for ≥48 h and discharged from the hospital. Interventions The participants were randomised to receive a survey by paper (via mail) or via online (via email, or if a non-email user, via a letter with a website address). Patients who did not respond to the initial survey received a reminder paper survey after 14 days. The survey included quality of life (EuroQol-5D-5L), anxiety and depression (Hospital Anxiety and Depression Scale), and post-traumatic symptom (Impact of Event Scale-Revised) assessment. Main outcome measures Survey response rate, extent of survey completion, clinical outcomes at different time points after discharge, and survey cost analysis were the main outcome measures. Outcomes were stratified based on follow-up time after ICU discharge (3, 6, and 12 months). Results A total of 239 patients were randomised. The response rate was similar between the groups (mixed-mode: 78% [92/118 patients] vs. paper: 80% [97/121 patients], p = 0.751) and did not differ between time points of follow-up. Incomplete surveys were more prevalent in the paper group (10% vs 18%). The median EuroQol-5D-5L index value was 0.83 [0.71–0.92]. Depressive symptoms were reported by 25% of patients (46/187), anxiety symptoms were reported by 27% (50/187), and probable post-traumatic stress disorder was reported by 14% (25/184). Patient outcomes did not differ between the groups or time points of follow-up. The cost per reply was AU$ 16.60 (mixed-mode) vs AU$ 19.78 (paper). Conclusion The response rate of a mixed-mode survey is similar to that of a paper survey and may provide modest cost savings.