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Summary Introduction Burnout syndrome (BOS) affects all professional categories, particularly in the medical sector. Perceived deterioration of working conditions in university hospital centres impacts not only hospital doctors, but also and more generally, university hospital (UH) staff. The goal of this survey was to analyse workplace quality of life among French UH digestive surgeons. Methods An online questionnaire was addressed to all members of sub-section 52-02 (digestive and visceral surgery) of the national university council (CNU). It contained isolated questions, as well as the specific Copenhagen Burnout Inventory (CBI) questionnaire, which assesses three fields: personal burnout (PBO), work-related burnout (WBO) and client-related burnout (CBO). Results While 132 (85%) out of the 156 surgeons responded, only 110 (70%) filled out the CBI questionnaire. Their perceptions of quality of life were poor or very poor (57%), and progressively poorer; this was mainly due to a lack of human, logistical and financial means, and also to conflictual relations with administration. The CBI questionnaire showed high scores for PBO (37%) and WBO (30%), with lower scores for CBO (8%). Depressive syndrome appeared among 26% of respondents. There were no significant differences according to region, gender or age. Conclusion This study objectifies a perceived deterioration of the working conditions of UH digestive surgeons, with elevated rates of BOS and a depressive risk superior to that of the overall population.

Background More than 10 years have passed since the first nationwide study on the reasons for tooth extraction in Japan. In the present study, we conducted the second nationwide survey to update the previous data. Methods This was a descriptive study. A sample population consisting of 5,250 dentists was selected by systematic random sampling using the 2018 membership directory of the Japan Dental Association. The reason for each permanent tooth extraction was documented by each dentist during a period of 1 week from June 4 to June 10, 2018. A questionnaire was provided for documentation. Reasons for tooth extraction were categorised into 6 groups as follows: caries, periodontal disease, fracture, orthodontics, impacted teeth, and others. Results A total of 2345 identified dentists responded to the questionnaire (recovery rate: 44.8%). Information on 7809 extracted teeth from 6398 patients was obtained. Periodontal disease was the main reason for tooth extraction for both sexes (men: 40.4%, women: 34.9%). Caries accounted for 30.2% of tooth extractions among men and 29.0% among women. Periodontal disease was predominant in the groups older than 55 years of age. Dental fracture accounted for 16.8% of tooth extractions among men and 19.2% among women. Conclusions Caries and periodontal disease are still the main reasons for tooth extraction in Japan. Moreover, dentists should note that fractures accounted for approximately one-fifth of permanent tooth extractions after the age of 45 years.

Context and Aims: The Medical Science Liaison's (MSL's) value to the company has evolved into a more strategic role with a wide variety of responsibilities. We conducted an online survey of current MSLs nationwide to assess their profile, activity development, performance evaluation, and career development. Subjects and Methods: A 37-item survey was hosted on SurveyMonkey© and accessible from December 2018 to February 2019. The survey was open to current MSLs from different pharmaceutical companies in Spain and included questions about the participant profile, activity development, performance evaluation, and career development. Statistical Analysis Used: The results were expressed as valid percentages; to establish relationships between the answers to different questions, exclusion and comparison filters were used on the web platform. Results: A total of 179 MSLs responded to the anonymous survey. Off-label information management (79%), relationships with key opinion leaders (76%), continuous medical training for HCPs (70%), involvement in clinical trials/investigator-initiated trials (68%), and elaboration of the National Strategy (67%) were mentioned as the top new competencies. Fifty-eight percent spend an average of 61%–80% of their time out in the field and 68% use remote interactions. Fifty-six percent did not agree that their current performance metrics are a reflection of their true value. Forty-five percent of the participants disagreed when asked if their activity is easily balanced with their personal lives. Conclusions: Based on our findings, we believe that there is a need to consider the MSL's strategic priorities, to define metrics that accurately assess MSL performance, and to find ways to fully maximize their limited time.

Aim Digestive reconstruction after pharyngolaryngectomy with total esophagectomy (PLTE) remains challenging, with the optimal method remaining unclear. The current study aimed to clarify the short‐term outcomes after PLTE and determine the optimal digestive reconstruction method. Methods Based on a nationwide survey of 151 patients who underwent PLTE, outcomes of digestive reconstruction methods are described. Results Among digestive reconstruction methods, a simple gastric tube was most frequently used (37.1%), followed by gastric tube combined with free graft transfer (FGT) (35.1%), gastric tube with microvascular anastomosis (22.5%), and other procedures (5.3%). Intraoperative evaluation of microcirculation (IOEM) was utilized in 29 patients (19.2%). Among the included patients, 66.9% developed any‐grade complications, 41.0% developed severe complications, and 23.8% developed digestive reconstruction‐related complications (DRRCs; leakage or necrosis). Reoperation within 30 days for any complications and DRRCs was required in 13.9% and 8.6% of the patients, respectively. Mortality within 90 days was observed in 4.6%. Among the three major methods, gastric tube combined with FGT promoted the least DRRCs in the gastric tube (P = .005), although the overall incidence of DRRCs was comparable. The use of IOEM was significantly associated with a reduction of severe DRRCs (P = .005). Conclusions Pharyngolaryngectomy with total esophagectomy is a high‐risk surgery significantly associated with the occurrence of postoperative morbidity and mortality. Nonetheless, the addition of FGT can help prevent gastric tip complications, while IOEM can be an effective method for improving outcomes., In this nationwide survey on digestive reconstruction following pharyngolaryngectomy with total esophagectomy, reconstruction using a gastric tube with free graft transfer was significantly associated with fewer digestive reconstruction‐related complications (DRRCs) in the gastric tube. However, it did not decrease overall and severe DRRCs. Intraoperative evaluation of microcirculation significantly reduced severe DRRCs.

Objectives Ketamine is used to treat chronic refractory pain. However, there are no scientific guidelines for ketamine use in the Netherlands. The aim of this survey was to provide an overview of the use of ketamine for chronic pain in the Netherlands. Methods All pain clinics in the Netherlands were contacted. A digital survey, available from June 2019 to January 2020, was sent to 68 pain clinics. The survey was completed by one pain physician as a representative of the entire pain department. The survey included questions about ketamine treatment indications, administration, dose, duration, treatment repetition and the inpatient or outpatient setting. Results The survey was completed by 51 pain clinics (75.0%). Thirty-one clinics used ketamine for chronic pain treatment. The most common indication was Complex Regional Pain Syndrome (83.9%). Pain clinics administered ketamine via intravenous infusions (96.8%), iontophoresis (61.3%), subcutaneous (3.2%) or oral administration (3.2%). Intravenous ketamine treatment was offered in an inpatient setting in 14 pain clinics, in both an inpatient and outpatient setting in 11 pain clinics and in six pain clinics in an outpatient setting. In the outpatient setting, the median starting dose was 5 mg/h (IQR=17.5–5). The median maximum dose was 27.5 mg/h (IQR=100–11.9). The median infusion duration was 6 h (IQR=8–4). In the inpatient setting, the median starting dose was 5 mg/h (IQR=5–1.5) and the median maximum dose was 25 mg/h (IQR=25–14). Patients were admitted to hospital for a median of 4 days (IQR=5–1). Conclusions The results of this Dutch nationwide survey study show that there are heterogeneous treatment protocols with different indications, treatment setting and dosing regimen for the treatment of chronic pain with ketamine. This study encourages the formulation of a broader consensus and the development of evidence based guidelines for ketamine treatment.

PURPOSE To determine if physicians' self-reported knowledge, attitudes, and practices regarding genetic counseling and testing (GCT) vary by patients' race. METHODS We conducted a nationwide 49-item survey among breast oncology physicians in the United States. We queried respondents about their own demographics, clinical characteristics, knowledge, attitudes, practices, and perceived barriers in providing GCT to patients with breast cancer. RESULTS Our survey included responses from 277 physicians (females, 58.8%; medical oncologists, 75.1%; academic physicians, 61.7%; and Whites, 67.1%). Only 1.8% indicated that they were more likely to refer a White patient than refer an African American patient for GCT, and 66.9% believed that African American women with breast cancer have lower rates of GCT than White women. Regarding perceived barriers to GCT, 63.4% of respondents indicated that African American women face more barriers than White women do and 21% felt that African American women require more information and guidance during the GCT decision-making process than White women. Although 32% of respondents indicated that lack of trust was a barrier to GCT in all patients, 58.1% felt that this was a greater barrier for African American women ( P < .0001). Only 13.9% believed that noncompliance with GCT is a barrier for all patients, whereas 30.6% believed that African American women are more likely than White women to be noncompliant ( P < .0001). CONCLUSION We demonstrated that racial differences exist in oncology physicians' perceived barriers to GCT for patients with breast cancer. This nationwide survey will serve as a basis for understanding physicians' determinants of GCT for African American women and highlights the necessity of education and interventions to address bias among physicians. Awareness of such physician biases can enable further work to address inequities, ultimately leading to improved GCT equity for African American women with breast cancer.

Background This study aimed to evaluate the reliability and validity of the self-administered questionnaire for Korean radiation workers. Methods From May 24, 2016, to June 30, 2017, 20,608 participants completed the questionnaire, providing information on sociodemographics, lifestyle, work history and practices, medical radiation exposure, and medical history, which was linked to the National Dose Registry and the National Cancer Registry. The validity of the questionnaire was evaluated using the responses of 20,608 workers, and reliability was evaluated using the responses of 3043 workers who responded to the survey twice. Results Responses concerning demographic characteristics and lifestyle showed reliability with a moderate-to-high agreement (kappa: 0.43–0.99), whereas responses concerning occupation and medical radiation exposure had a wide range of agreement (kappa: 0.05–0.95), possibly owing to temporal variability during employment. Regarding validity, responses to the question about the first year of employment had an excellent agreement with the national registry (intraclass correlation coefficient = 0.9); however, responses on cancer history had a wide range of agreement (kappa: 0.22–0.85). Conclusion Although the reliability and validity of the questionnaire were not distinguished by demographic characteristics, they tended to be low among participants whose occupational radiation exposure was minimal. Overall, the information collected can be reliable for epidemiological studies; however, caution must be exercised when using information such as medical exposure and work practices, which are prone to temporal variability.

Summary This study assessed the hand hygiene performance in French nursing homes using the consumption of alcohol-based hand rubs (AHRs) as a surrogate. Nursing homes from the 17 French regions were contacted to collect their AHR consumption and occupancy in 2018 and 2019. A total of 1290 nursing homes from 15 French regions participated in the survey. The estimated median number of hand hygiene actions per resident-day was 1.48 (interquartile range: 1.04–2.03) in 2018 and 1.60 (1.10–2.26) in 2019. A significantly higher AHR consumption was observed in public nursing homes with an infection control team or link nurse.

Musculoskeletal disorders (MSDs) constitute a significant occupational hazard among dental practitioners. An online-based e-survey was conducted among 252 registered dentists of Nepal using the Nordic musculoskeletal questionnaire (NMQ) to assess musculoskeletal complaints and work-related characteristics. Musculoskeletal complaints in lower regions were found to be highly prevalent among dental practitioners with prevalence of 76, 27 and 28.2% in the last 12 months, 1 month and 7 days, respectively, followed by musculoskeletal complaints in the neck, wrist/hand and shoulder. Musculoskeletal complaint during the last 12 months was significantly associated with age, years in dental practice after graduation and leave from duty in the past 12 months. Similarly, educational qualification, medical comorbidities and leave from duty were associated with complaints in the last 1 month. Musculoskeletal complaint during the last 7 days was associated with gender, working hours in a day, practice of four-handed dentistry and patients examined in a day.

Background/Aims: This study aimed to determine the current status of facilities, equipment, and personnel for endoscopic sedation from endoscopy units of representative hospitals in South Korea.Methods: A questionnaire survey was conducted on 50 qualified endoscopy units accredited by the Korean Society of Gastrointestinal Endoscopy.Results: All included endoscopy units had regulations and educational programs regarding sedation training for endoscopists and nursing personnel. There present one assisting nurse during endoscopy in 35 units (70%) and at least two nurses in 12 units (24.0%). All endoscopy units had examination rooms equipped with oxygen supply and suction systems. Endoscopist-directed sedation was performed in 48 units (96.0%). Propofol-based sedation was the most used sedation method. All units had a separate recovery bay. The daily number of patients per bed was greater than 10 in 17 units (34.0%). In 26 (52.0%) units, a single nurse cared for ≥10 patients per day. All the units fulfilled the discharge criteria.Conclusions: This study presents data regarding endoscopic sedation clinical practice in 50 endoscopy units in South Korea. This study presents the current status of endoscopic sedation clinical practice in 50 qualified endoscopy units accredited by the KSGE, which provide excellent quality management.

Background Despite a significant shortage of psychiatrists in China, an ever-increasing number of psychiatrists in China are experiencing burnout and job dissatisfaction and considering leaving their jobs. Yet, to our knowledge, there have been no nationwide studies to date that examined both burnout and job dissatisfaction of psychiatrists in China. Therefore, this study evaluated burnout and job dissatisfaction of psychiatrists in China, and identified relevant characteristics. Methods We conducted a nationwide, cross-sectional survey in March 2019. Psychiatrists from all tertiary psychiatric hospitals in China were invited to participate. The Maslach Burnout Inventory-Human Service Survey and the short version of the Minnesota Satisfaction Questionnaire were used to measure burnout and job satisfaction. Data on socio-demographic and occupational characteristics were collected. Multivariate logistic regression was conducted to identify socio-demographic and occupational characteristics associated with burnout and job satisfaction. Results In total, 4520 psychiatrists from tertiary psychiatric hospitals in China completed the questionnaire. Overall, 38.4% of respondents met the criteria for burnout and 35.6% were dissatisfied with their jobs. Being male, more years of practice, having no leadership role, and longer working hours per week were significantly associated with burnout and job dissatisfaction. Lower monthly pay was significantly associated with job dissatisfaction but not burnout. Moreover, burnout was significantly associated with job dissatisfaction. Conclusions Our data suggest a high rate of burnout and job dissatisfaction among psychiatrists in China. In order to preserve and strengthen the mental health workforce, proactive measures are urgently needed to mitigate burnout and job dissatisfaction among psychiatrists in China.

A nationwide survey of chigger mites causing scrub typhus and an investigation of epidemiologic factors for chigger mites was conducted at 16 localities in 8 provinces in Korea during autumn 2009, 2012, and 2013. A total of 233 Apodemus agrarius were captured, and all were infested with chigger mites. The chigger index was highest in Chungcheongbuk-do in 2009 (358.3) and 2012 (290.1) and Chungcheongnam-do in 2013 (294.4). The predominant chigger mite species was Leptotrombidium pallidum in the northern and central parts and L. scutellare in the southern and western parts, Korea. L. pallidum was not found in Jellanam-do and Gyeongsangnam-do and the distribution of L. scutellare had been expanded in the northern parts of Korea. The chigger index of L. pallidum was positively correlated with temperature and negatively correlated with humidity. The incidence of scrub typhus is dependent on L. scutellare index. These findings could be helpful to monitor the distribution of chigger mites and to develop a preventive measures for scrub typhus in Korea.

To identify factors associated with COVID-19 vaccine hesitancy and acceptance among the Mexican population.In a web-based nationwide survey in early December 2020, respondents were inquired about their sociodemographic characteristics and their willingness to accept a hypothetical COVID-19 vaccine given a 50% or 90% effectiveness. A logistic regression model was used to identify the factors associated with hesitancy and acceptance.A total 3 768 responses were analyzed. A 90% effective vaccine was accepted by 85% of respondents, while only 46% would accept being vaccinated with a 50% effective vaccine. In univariate analysis, each age group (40-49, 50-59, and ≥60) was strongly associated with vaccine hesitancy for a 90% effective vaccine (OR 0.48, 95% CI 0.38, 0.63; OR 0.33, 95 CI 0.26, 0.41; and OR 0.28, 95 CI 0.21, 0.38, respectively) compared to the 18-39 age group. After multivariable adjustment, similar magnitudes of association were observed. Being female and higher socioeconomic status were also associated with higher vaccine hesitancy.Vaccine hesitancy represents a major public health problem in Mexico and is driven by multiple factors. Our study provides relevant insights for the development of effective policies and strategies to ensure widespread vaccination in Mexico.Determinar los factores asociados a la aceptación y la reticencia frente a la vacunación contra la COVID-19 en la población mexicana.En una encuesta basada en la web a escala nacional, realizada a principios de diciembre del 2020, se preguntó a las personas entrevistadas sobre sus características sociodemográficas y su disposición a aceptar una hipotética vacuna contra la COVID-19 si garantizase 50% o 90% de efectividad. Se empleó un modelo de regresión logística para determinar los factores asociados con la aceptación y la reticencia.Se analizó un total de 3 768 respuestas. Una vacuna con 90% de efectividad fue aceptada por 85% de las personas entrevistadas, si bien solo 46% aceptaría una vacuna con 50% de efectividad. En el análisis con una variable, cada grupo etario (de 40 a 49, de 50 a 59 y más de 60) estuvo estrechamente relacionado con una reticencia a la vacunación de una vacuna con 90% de efectividad (OR 0,48, IC de 95% 0,38, 0,63; OR 0,33, IC de 95% 0,26, 0,41; y OR 0,28, IC de 95% 0,21, 0,38, respectivamente) en comparación con el grupo etario de 18 a 39 años. Tras el ajuste multivariante, se observaron magnitudes de asociación similares. También se asoció ser mujer y tener una mejor situación socioeconómica con una mayor reticencia a la vacunación.La reticencia frente a la vacunación representa un importante problema de salud pública en México y está impulsada por diversos factores. Nuestro estudio ofrece observaciones pertinentes para la elaboración de políticas y estrategias eficaces que garanticen una vacunación generalizada en México.Identificar os fatores associados a hesitação e aceitação em relação à vacina contra a COVID-19 na população mexicana.Em uma pesquisa nacional via internet, no início de dezembro de 2020, os participantes foram questionados acerca de suas características sociodemográficas e sua disposição de aceitar uma vacina hipotética contra a COVID-19, com eficácia de 50% ou 90%. Foi utilizado um modelo de regressão logística para identificar os fatores associados à hesitação e à aceitação.Foi analisado um total de 3.768 respostas. Uma vacina com eficácia de 90% seria aceita por 85% dos participantes, enquanto uma vacina com eficácia de 50% seria aceita por somente 46%. Na análise univariada, cada faixa etária (40-49, 50-59, e ≥60) apresentou forte associação com hesitação em relação a uma vacina com eficácia de 90% (OR 0,48, IC de 95% 0,38, 0,63; OR 0,33, IC 95% 0,26, 0,41; e OR 0,28, IC 95% 0,21, 0,38, respectivamente), em comparação com a faixa etária de 18-39 anos. Após ajuste na análise multivariada, magnitudes semelhantes de associação foram observadas. Ser do sexo feminino e de faixa socioeconômica de renda mais alta também mostrou associação com maior hesitação em relação à vacina.A hesitação em relação à vacina representa um grande problema de saúde pública no México, e é impulsionada por múltiplos fatores. Nosso estudo traz informações relevantes para o desenvolvimento de políticas e estratégias efetivas para assegurar ampla vacinação no México.

Background People often prefer to stay at home until the end of life, but hospital admissions are quite common. In previous research bereaved relatives were found to be less positive about palliative care in hospital. However, it was not known how the content and quality of palliative care differ between home care and hospitals from the perspectives of hospital nurses and home care nurses and how palliative care in these settings could be improved. Methods A survey was held among hospital and home care nurses, recruited from a nationwide Nursing Staff Panel and through open calls on social media and in an online newsletter. The pre-structured online survey included questions on the palliative care provided, the quality of this care and the respondent’s perceived competence in providing palliative care. The questionnaire was completed by 229 home care nurses and 106 hospital nurses. Results Most nurses provided palliative care in the physical and psychological domains, fewer provided care in the social and spiritual domains. A higher percentage of home care nurses stated that they provided care in these domains than hospital nurses. Overall, 70% of the nurses rated the quality of palliative care as very good to excellent. This percentage was higher among home care nurses (76.4%) than hospital nurses (59.4%). Moreover, a higher percentage of home care nurses (94.4%) stated they felt competent to a great extent to provide palliative care compared to hospital nurses (84.7%). Competencies regarding the physical domain were perceived as better compared to the competencies concerning the other domains. The nurses recommended paying more attention to inter-professional collaboration and communication, timely identification of the palliative phase and advance care planning, and more time available for palliative care patients. Conclusion Although the quality of palliative care was rated as very good to excellent by nurses, improvements can still be made, particularly regarding palliative care in hospitals. Although patients often prefer to die at home rather than in hospital, still a considerable number of people do die in hospital; therefore hospital nurses must also be trained and be able to provide high-quality palliative care.

Context Terminal dyspnea in dying cancer patients is frequent and distressing, and the impact extends to their families. Families are often involved in providing care for terminal dyspnea. Objectives This study aimed to describe various care strategies for terminal dyspnea in cancer patients hospitalized in palliative care units (PCUs), evaluate families’ satisfaction with care for terminal dyspnea, and explore determinants contributing to families’ satisfaction. Methods A nationwide, cross-sectional survey was conducted using a self-reported questionnaire among bereaved families of cancer patients who died in PCUs. The questionnaire consisted of questions on the perceptions of care offered to patients with terminal dyspnea and their families, satisfaction with care for terminal dyspnea, family-perceived intensity of terminal dyspnea, use of oxygen, and background data of patients and families. Results In total, 533 participants (response rate = 54%) returned the completed questionnaires, and 231 reported that their loved one had experienced terminal dyspnea. Dedicated and compassionate care was perceived by 60%–89% of the participants as the strategy provided for patients. Care for family members was perceived by 58%–69% of the participants. Perception of dedicated and compassionate care for patients and that of care for family members were significantly associated with high satisfaction (odds ratio, 95% confidence interval: 8.64, 3.85–19.36 and 15.37, 5.00–47.25, respectively). Conclusion Dedicated and compassionate care may be the essential part of the care for terminal dyspnea. Dedicated and compassionate care for patients and care for family members have a potential of improving the care satisfaction among family caregivers.

When the COVID-19 pandemic struck in 2020, many schools made the decision to cancel face-to-face classes and move instruction online. To better understand how the pandemic affected science educators’ plans to conduct classroom animal dissection exercises, we conducted a nationwide survey of biology teachers (n = 2131) and asked about their experience as classes transitioned to online. Our survey revealed that 72% of biology educators had planned on having their students participate in classroom animal dissection exercises in the spring of 2020. Of those educators, 29% shifted to the use of dissection alternatives, such as web-based programs, as a result of remote learning. Our survey investigated which alternatives were most used, whether teachers were already familiar with the alternatives, how teachers identified those alternatives, and whether the educators planned to use dissection alternatives again for in-person or online learning. These survey results provide insight into biology educators’ use of dissection alternatives during the COVID-19 pandemic as well as their post-pandemic plans and may increase awareness and usage of dissection alternatives within the educational community.

Objectives Up-to-date information on the current practices and attitudes of veterinarians in Australia to acute pain management in cats was sought in 2017–2018 in the first nationwide survey in over 20 years. Methods An online survey was created, consisting of 54 questions in four sections, with 18 feline-specific questions. Veterinarians throughout Australia were invited to participate in the survey through advertisements in the veterinary press, electronic and regular mail, and through in-clinic visits and promotional materials. Results A total of 614 veterinarians completed the survey, with 513 (83.6%) completing the feline-specific section. The demographics of the respondents of this survey were an accurate representation of the registered veterinarians in Australia at the time. Multiple different opioids and non-steroidal anti-inflammatory drugs (NSAIDs) were widely available in practices to manage pain, with analgesic efficacy reported as the primary factor influencing drug selection. Opioids were most commonly used in the preoperative period and NSAIDs were most commonly used postoperatively. Despite the wide availability in clinic (>99%), only 55% of respondents reported regularly using local anaesthetic techniques in cats. Pain assessment of hospitalised patients was primarily performed by veterinarians (91.1%); however, 84.7% of respondents did not routinely use a validated pain scale. Conclusions and relevance Veterinary practitioners in Australia are adequately equipped with analgesic medication to treat pain in their patients. In the management of acute pain in cats, they frequently use a multimodal approach and practice a variety of analgesic protocols. Based on the results of this survey, potential areas for improvement in feline pain management include an increase in duration of postoperative analgesia and more routine use of validated pain scales, performed by nurses and veterinarians alike, to assess individual analgesic needs.

Background The uncertainty of how neurosyphilis is diagnosed and treated in clinical settings led us to investigate whether this serious manifestation of syphilis infection is properly managed in China. Methods: This national cross-sectional study of the diagnosis and treatment of neurosyphilis included 1392 clinicians at 398 hospitals located in 116 cities in China. Results: Of 398 hospitals, 244 (61.3%) failed to perform diagnostic laboratory tests and 181 (45.5%) failed to provide recommended treatment for neurosyphilis. Of 1392 clinicians, 536 (38.5%) had previously diagnosed patients with neurosyphilis, but 419 (78.2%) of the latter provided diagnoses that did not meet the criteria set by national guidelines. Of the 485 clinicians who had previously treated patients with neurosyphilis, 280 (57.7%) failed to follow national guidelines for treatment. Analysis indicated that clinicians working in North China (adjusted odds ratio (aOR), 4.24; 95% confidence interval (CI), 1.65–10.88), tertiary hospitals (aOR, 3.23; 95% CI, 1.63–6.41), and hospitals specialising in sexually transmitted infections (aOR, 2.49; 95% CI, 1.24–4.99) were more likely to follow national guidelines for neurosyphilis treatment. Conclusion: Lack of knowledge in disease management poses a great obstacle to prevent the serious consequences of neurosyphilis in Chinese patients. More effective measures are urgently needed to improve this suboptimal situation.

Objective Particularly for pediatric patients presenting with acute conditions or challenging diagnoses, identifying variation in emergency radiology staffing models is essential in establishing a standard of care. We conducted a cross-sectional survey among radiology departments at academic pediatric hospitals to evaluate staffing models for providing imaging interpretation for emergency department imaging requests. Methods We conducted an anonymous telephone survey of academic pediatric hospitals affiliated with an accredited radiology residency program across the United States. We queried the timing, location, and experience of reporting radiologists for initial and final interpretations of emergency department imaging studies, during weekday, overnight, and weekend hours. We compared weekday with overnight, and weekday with weekend, using Fisher’s exact test and an α of 0.05. Results Surveying 42 of 47 freestanding academic pediatric hospitals (89%), we found statistically significant differences for initial reporting radiologist, final reporting radiologist, and final report timing between weekday and overnight. We found statistically significant differences for initial reporting radiologist and final report timing between weekday and weekend. Attending radiologist involvement in initial reports was 100% during daytime, but only 33.3% and 69.0% during overnight and weekends. For initial interpretation during overnight and weekend, 38.1% and 28.6% use resident radiologists without attending radiologists, and 28.6% and 2.4% use teleradiology. All finalized reports as soon as possible during weekdays, but only 52.4% and 78.6% during overnight and weekend. Discussion A minority of hospitals use 24-hour in-house radiology attending radiologist coverage. During overnight periods, the majority of academic pediatric emergency departments rely on resident radiologists without attending radiologist supervision or outside teleradiology services to provide initial reports. During weekend periods, over a quarter rely on resident radiologists without attending radiologist supervision for initial reporting. This demonstrates significant variation in staffing practices at academic pediatric hospitals. Future studies should look to determine whether this variation has any impact on standard of care.

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a tremendous impact on healthcare systems worldwide. Although the most common presentation of COVID-19 is respiratory illness, neurologic manifestations are increasing and the pandemic may have consequential effects on urgent conditions such as acute ischemic stroke. In this document, we describe the current status of neurointervention in Korea affected by COVID-19 based on a nationwide survey and review relevant literature from other countries and professional societies.

Aims To describe nurse anesthetists' attitudes towards the importance of parental presence during their child's anaesthesia induction and to explore associating factors. Design A cross-sectional design. Methods Nurse anesthetists from 55 Swedish hospitals were asked to participate (n = 1,285). A total of 809 completed the questionnaire, Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) during 2018. Data were analysed by descriptive statistics and multiple linear regression analysis. Results Nurse anesthetists generally had a positive attitude towards the importance of parental presence. They reported a more positive attitude in family as a resource in nursing care (median = 40) followed by family as a conversational partner (median = 25), family not as a burden (median = 17) and family as its own resource (median = 13). Multiple linear regression analyses showed that working in a district hospital, working only with children, having routines/memorandum about parental presence, being a woman, allowing both parents to be present in their child's anaesthesia and greater experience of children's anesthesia, were associated with a more positive attitude. Conclusion This nationwide survey contributes important knowledge for understanding nurse anesthetists' attitudes and the result shows that nurse anesthetists generally have a positive attitude towards the importance of parents. Areas of improvement were, however, identified; the nurses tend to not value family as its own resource and family as a conversational partner highly. Impact Nurse anesthetists have a crucial role in children's anesthesia care since the quality of parental presence experience depends on a positive attitude from the nurses. Parental involvement is important to establish a child-centered anaesthesia care, which should be highlighted in the education of nurse anesthetists. Parental involvement should also be addressed in healthcare policies and routines should be established.

The COVID‐19 pandemic has disturbed medical training. Haematology registrars were surveyed using SurveyMonkey. Eighty‐nine out of 269 (24.9%) responded. Reported stressors included concerns about transmitting the infection, disruption of leave, inferior patient outcomes, survivors’ guilt and interruption of career progression. Only 31.2% felt ready to progress to the next training stage. Reported causes of lack of training were disruption of clinics and training days and utilisation of telephone consultations. Several stressors negatively impacted haematology registrars’ well‐being, training and progression. More emphasis on psychological support, outpatient clinic work and e‐learning is needed.

A 12-year nationwide survey (2008-2019) was performed to investigate the prevalence of Enterobius vermicularis infection among preschool children in Seoul, 4 large cites (Busan, Incheon, Daegu, and Ulsan), and 9 provinces (grouped into 5 localities) in the Republic of Korea (=Korea). The survey was carried out once a year by 16 regional offices of the Korea Association of Health Promotion. The cello-tape perianal swab method (1 smear per child) was applied to detect eggs of E. vermicularis and other helminths. According to the results, the egg positive rate of E. vermicularis infection in 2008-2009 was 1.8-2.0%, but it decreased gradually to 0.6% in 2019 (P

Background: The relationship between advance care planning and religious beliefs, which are important for palliative care, is controversial in Western countries and has not been verified in Asian countries. Aim: To investigate the association between advance care planning discussions and religious beliefs in Japan. Design: A nationwide survey conducted in 2016 using a quota sampling method to obtain a representative sample of Japan’s general population. Setting/participants: We analyzed responses from 3167 adults aged 20–84 years (mean age ± standard deviation, 50.9 ± 16.8 years). The outcome was measured by asking whether the respondents had ever discussed advance care planning, and the main exposure by whether they had any religious beliefs or affiliations, and if so, their degree of devoutness. We analyzed religious beliefs, affiliations, and devoutness in relation to the occurrence of discussions using multivariable logistic regression models adjusted for possible sociodemographic covariates. Results: Compared with respondents without, those with religious beliefs had significantly higher odds of having had discussions (adjusted odds ratio: 1.45, 95% confidence interval: 1.22–1.73). The devoutness of religious belief was proportional to the propensity of the occurrence of discussions ( p for trend < 0.001). In addition, Buddhists and Christians had higher odds of having had discussions than did nonbelievers. Conclusion: The results suggest that holding religious beliefs, especially in Japanese Buddhism and Christianity, facilitates advance care planning discussions among Japanese adults, and thus, may help health-care providers identify those prioritized for facilitating engagement in advance care planning, especially in palliative and spiritual care settings.

Background Sarcopenia is an independent risk factor not only for advanced‐stage non‐alcoholic fatty liver disease (NAFLD) but also for mortality. We investigated the association of sarcopenia and/or NAFLD with mortality among the Korean general population. Methods Individuals aged 35–75 years without any history of cancer, ischaemic heart disease, ischaemic stroke, or secondary causes of chronic liver disease were selected from the Korean National Health and Nutrition Examination Surveys from 2008 to 2015. Their mortality data until December 2018 were retrieved from the National Death Registry. NAFLD and sarcopenia were defined by hepatic steatosis index and appendicular skeletal muscle mass divided by body mass index (BMI), respectively. Results A total of 28 060 subjects were analysed [mean age, 50.6 (standard error, 0.1) years, 48.2 (0.3) % men]; the median follow‐up duration was of 6.8 (interquartile range, 4.8, 8.4) years. NAFLD predicted mortality after adjustment for age, sex, BMI, hypertension, dyslipidaemia, and smoking (HR 1.32, 95% CI 1.03–1.70), but this prediction lost its statistical significance after additional adjustment for diabetes mellitus. In contrast, NAFLD with advanced fibrosis independently increased the risk of mortality after adjustment for all covariates (HR 1.68, 95% CI 1.02–2.79). Stratified analysis revealed that NAFLD and sarcopenia additively increased the risk of mortality as an ordinal scale (HR 1.46, 95% CI 1.18–1.81, P for trend = 0.001). The coexistence of NAFLD and sarcopenia increased the risk of mortality by almost twice as much, even after adjustment for advanced fibrosis (HR 2.18, 95% CI 1.38–3.44). Conclusions Concurrent NAFLD and sarcopenia conferred a two‐fold higher risk of mortality. The observation that NAFLD and sarcopenia additively increase mortality suggests that risk stratification would be helpful in predicting mortality among those with metabolic derangement.

Objective This study was aimed to determine the characteristics of middle ear cholesteatoma and to investigate short-term outcomes regarding the rates of residual and recurrent cholesteatoma and the postoperative hearing results in Japan, via a nationwide survey using staging and classification criteria for middle ear cholesteatoma, as proposed by the Japan Otological Society (JOS). Methods The first-round survey was conducted in 2016. The target was patients with middle ear cholesteatoma who were surgically treated in Japan between January and December 2015. Medical information on the patients was anonymized. The questionnaire entries were age, sex, cholesteatoma classification and stage, preoperative hearing level, mastoid development, status of the stapes, and surgical method. There were a total of 1,787 registered patients from 74 facilities from all over Japan. The second survey was conducted in January 2018 and received 1,456 responses from 49 facilities in Japan. Of the 1,456 cases, 1,060 were conducted in the postoperative hearing survey and 1,084 in the residual recurrence survey. Results The most common cholesteatoma type was pars flaccida cholesteatoma (63.3%), followed by pars tensa cholesteatoma (13.0%), congenital cholesteatoma (12.9%), and cholesteatoma secondary to chronic tensa perforation (5.6%). Cholesteatoma of uncertain origin accounted for 5.0% (90 cases). Stage II was predominant in pars flaccida and pars tensa cholesteatoma, which frequently involves the mastoid, whereas about half of cases of cholesteatoma secondary to chronic tensa perforation and congenital cholesteatoma were classified as stage I. One hundred fifty-two of 1,084 cases (14.0%) had recurrent cholesteatoma, residual cholesteatoma, or both following first surgeries. The postoperative rates of hearing success rate was 63.3%. Conclusion We were able to clarify not only the current epidemiological status of middle ear cholesteatoma but also the current trends of cholesteatoma surgery in Japan. The development of a staging system by the JOS Committee serving an epidemiological database for international or time-dependent comparison. It is possible to use this staging system with reasonable reliability.

Background/Aims Esophageal high-resolution manometry (HRM) enables the comprehensive evaluation of the esophageal motor function. However, protocols are not uniform and clinical practices vary widely among institutions. This study aims to understand the current HRM practice in Korea. Methods The survey was sent via email through the Korean Society of Neurogastroenterology and Motility. The questions covered descriptive information, preparation, techniques, analysis, and reporting of esophageal HRM. Results The survey was completed in 32 (74.4%) out of 43 centers, including 24 tertiary and 8 secondary referral centers. Of the 32 centers, 25 (78.1%) performed HRM in a sitting position, while 7 centers (21.9%) reported performing HRM in a supine position. All the centers utilized single wet swallows as a standard, but the volume, frequency, and interval between swallows varied widely. Sixteen centers (50.0%) applied adjunctive tests, including multiple rapid swallows (n = 16) and rapid drink challenges (n = 9). Parameters assessed and documented in the report were similar. In addition to the assessment of the esophagogastric junction and esophageal body, 27 centers (84.8%) and 18 centers (56.3%) included measurements for the upper esophageal sphincter and the pharynx, respectively, in the HRM protocol. Conclusions We found a variation in the available HRM practice among centers, even though they broadly agreed in the data analysis. Efforts are needed to develop a standardized protocol for HRM measurement. (J Neurogastroenterol Motil 2021;27:347-353)

Oral and maxillofacial surgery (OMFS) has undergone pioneering progress through the development of three-dimensional (3D) printing technologies. The aim of this study was to evaluate the use of 3D printing at OMFS university and non-university hospitals and private practices in Germany. For explorative assessment, a dynamic online questionnaire containing 10–22 questions about the current use of 3D printing and the reasons behind it was sent to OMFS university and non-university hospitals and private practices in Germany by the study group from the German Association of Oral and Maxillofacial Surgery (DGMKG). In total, 156 participants responded from university (23 [14.7%]) and non-university hospitals (19 [12.2%]) and private practices without (85 [50.5%]) and with 29 (18.6%) inpatient treatment facility. Highest applications of 3D printing were in implantology (57%), microvascular bone reconstructions (25.6%), and orthognathics (21.1%). Among the participants, 37.8% reportedly were not using 3D printing. Among the hospitals and private practices, 21.1% had their own 3D printer, and 2.5% shared it with other departments. The major reason for not having a 3D printer was poor cost efficiency (37.6%). Possessing a 3D printer was motivated by independence from external providers (91.3%) and rapid template production (82.6%). The preferred printing methods were stereolithography (69.4 %) and filament printing (44.4%). OMFS 3D printing is established in Germany with a wide range of applications. The prevalence of 3D printing in hospitals and private practices is moderate. This may be enhanced by future innovations including improved cost efficiency.

OBJECTIVE: The impact of the coronavirus disease 2019 (COVID-19) pandemic has led to a significant transformation in medical practice and training. This nationwide survey study aims to evaluate the 1-year impact of the pandemic on training of neurosurgical residents. METHODS: A 38-question Web-based survey was sent to 356 neurosurgery residents. Two hundred and thirty-five participated in the study (66% response rate), representing more than half of all neurosurgical residents in the country. RESULTS: Assignment to direct COVID-19 medical care was common (85.5%). Many of the neurosurgery residents (37.9%) were tested positive for COVID-19. Almost half of the respondents reported a decrease in work hours. Most participants (84.3%) reported a decline in total operative case volume (mean change, -29.1% ± 1.6%), largely as a result of a decrease in elective (-33.2% ± 1.6%) as opposed to emergency cases (-5.1% ± 1.8%). For theoretic education, most respondents (54.9%) indicated a negative impact, whereas 25.1% reported a positive impact. For practical training, most respondents (78.7%) reported an adverse effect. A decrease in elective surgical case volume predicted a positive impact on theoretic training but a negative impact on practical training. Research productivity was reported by 33.2% to have decreased and by 23% to have increased. Forty-two percent indicated an increase in concerns about their training and career, with a negative impact on practical training being the most important predictor. Most (57.4%) had considered extending residency training to overcome negative effects of the pandemic. CONCLUSIONS: COVID-19 has had a significant impact on neurosurgical practice and training. Effective measures should be used to mitigate these effects and better prepare for the future challenges.

Malignant hepatic tumors (MHTs) in children are rare and account for approximately 5% of candidates for pediatric liver transplantation (LT) in Japan. We conducted a national survey of pediatric patients undergoing living donor LT for MHTs between October 1990 and April 2018. In total, 116 children underwent LT for MHTs during this study period: 100 hepatoblastomas (HBLs), 10 hepatocellular carcinomas (HCCs), and six other MHTs. The overall patient survival rate at 5 years was 81.3% for HBL, 60.0% for HCC, and 80.0% for other MHTs (P = 0.047). In patients with HBL, there was no significant difference in the 1- and 5-year patient survival rates between patients undergoing primary LT and those who received salvage LT for tumor recurrence (89.7%, 81.6% vs. 88.0%, 76%; P = 0.526). The 5-year overall survival rate after LT for HBL significantly improved from 63.2% in 1996-2008 to 89.8% in 2009-2018 (P = 0.018). The presence of lung metastasis before LT had no significant influence on the long-term survival (P = 0.742). Five patients with HCC died, including two who fell outside the Milan criteria. In conclusion, LT for pediatric MHTs, especially HBL, is a valuable treatment option for select patients.

Background: There is considerable demographic overlap of inguinal hernia patients and prostate cancer patients. Previous laparo-endoscopic inguinal hernia mesh repairs can complicate subsequent radical prostatectomies due to adhesions and distortion of anatomic planes. This study aims to assess the experience of urological surgeons on the safety and feasibility of performing radical prostatectomies after laparo-endoscopic inguinal hernia mesh repair. Methods: For this cross-sectional study, an online 24 question survey was developed regarding the experience in performing a radical prostatectomy and pelvic lymph node dissection (PLND) with a prior preperitoneal inguinal hernia mesh repair. Between June 2016 and December 2017, the questionnaire was sent to all 68 urological surgeons performing radical prostatectomy in the Netherlands. Results: The response rate of urological surgeons was 69% (n = 47). The majority (77%) of urological surgeons perform robot-assisted laparoscopic prostatectomies. A previous preperitoneal inguinal hernia repair was reported by 40% of urological surgeons in 10–30% of patients undergoing radical prostatectomy. Radical prostatectomy with prior preperitoneal inguinal hernia mesh repair is considered more difficult by 49%, predominantly because of (occasionally to always) experienced longer operating times (88.4%), increased blood loss (46.5%), difficult dissection of Retzius space (88.4%), nerve-sparing difficulties (32.6%), less adequate PLND (69.8%), and bladder- (16.3%) or peritoneal perforations (27.9%). Additionally, 11.6% had performed mesh explantation, 16.3% had aborted radical prostatectomies, and 35.7% experienced increased inguinal hernia recurrences after radical prostatectomies with prior preperitoneal inguinal hernia mesh repair. More experienced urological surgeons reported an increased difficulty for all outcomes. Conclusions: Laparo-endoscopic inguinal hernia mesh repair has a significant impact on performing a radical prostatectomy and PLND. Surgeons should postpone the inguinal hernia repair of patients in the workup for a radical prostatectomy, with the preferable option of performing the radical prostatectomy and inguinal hernia repair in the same procedure. Alternatively, a Lichtenstein repair can be performed.

Background There are no reports of a large-scale survey on the infection prevention measures against coronavirus disease 2019 (COVID-19) in nephrology facilities. This study investigated the facility-level nephrology practices adopted during the COVID-19 pandemic and their associated challenges. Additionally, the treatment patterns and outcomes of chronic kidney disease (CKD) patients with COVID-19 were reviewed. Methods We conducted a nationwide questionnaire survey of 704 educational facilities that were certified by the Japanese Society of Nephrology (JSN) from October 20, 2020 to November 16, 2020. The questionnaire reviewed the facility characteristics, infection prevention measures taken during routine nephrology practice, impact of COVID-19 on nephrology practice, experiences in managing CKD patients with COVID-19, and nosocomial transmission in the nephrology unit. Results Of the 347 facilities that responded, 95.1% checked outpatients’ body temperatures and COVID-19 symptoms at their visits. To reduce face-to-face contact, 80% and 70% of the facilities lengthened the intervals between outpatient visits and introduced online/telephonic consultations, respectively. As a result, more than half of the hospitals experienced a decrease in the numbers of outpatients and inpatients (64% and 50%, respectively). During the study period, 347 facilities managed 479 CKD patients with COVID-19. Oxygen administration and mechanical ventilation were performed for 47.8% and 16.5% of the patients, respectively, with a 9.2% total mortality rate. Conclusion This survey demonstrated that JSN-certified educational nephrology facilities adopted multiple measures to manage the COVID-19 pandemic; however, they faced several challenges. Sharing these experiences could standardize these approaches and prepare us better for the future. Supplementary Information The online version contains supplementary material available at 10.1007/s10157-021-02082-z.

Giving an overview of the current implementation and limitations of point-of-care ultrasound (POCUS) in Belgian Emergency Departments (EDs).A survey, consisting of questions regarding demographics, practice patterns, policies, difficulties of implementing ultrasound (US) and training of emergency physicians was sent out to all Belgian EDs (n = 109).Seventy-two percent of all the EDs responded. Eighty percent of these had an US device, 10% intended to have one in the near future whilst the remaining 10% had no intention of obtaining one. The main reasons for not having US were insufficient training (50%), no budget to purchase a device (31%), resistance from other specialties (31%), no return from investment (25%) and uncertainty about liability (19%).Eighty-four percent of the responding hospitals had a prehospital MUG (Mobiele Urgentiegroep) - team or SMUR (Service Mobile d'Urgence et de Réanimation). In 29% of these, prehospital US (PHUS) was used, 18% were in the process of purchasing a device whilst 53% had no intention of implementing PHUS. The main reasons for not implementing PHUS were short transfer times (38%), insufficient training (33%), the cost of a device (25%), no return from investment (19%), the assumption that PHUS delays administering urgent care (19%) and the uncertainty about liability (8%). Nationwide, 40% of all emergency physicians have had some form of US training.POCUS is regularly used in Belgian EDs for diagnostic and management purposes. Further implementation of POCUS will depend on how barriers are being addressed in the near future.

Background/Aims: The coronavirus disease 2019 (COVID-19) pandemic has necessitated modifications to allow the safe practice of clinical gastroenterology and gastrointestinal endoscopy. This study aimed to investigate the characteristics of clinical gastroenterology and gastrointestinal endoscopy practices during the COVID-19 pandemic in Indonesia. Methods: This cross-sectional study enrolled physician members of the Indonesian Society for Digestive Endoscopy. We used an online self-administered questionnaire disseminated via social media. The 32-item survey determined the baseline characteristics of the participants, characteristics of clinical gastroenterology and gastrointestinal endoscopy practices, involvement of the physicians in the management of COVID-19, and overall impact of the pandemic on practice. All collected data were analyzed using descriptive statistics. Results: The 200 participants in this study had a median age of 50 (34-76) years. Modifications in clinical gastroenterology practice were frequently reported in the outpatient (95.5%) and inpatient (100%) settings. All participants reported changes in the gastrointestinal endoscopy practice patterns. Of the participants, 86.0% were working in high-risk zones, and several of them reported inadequate protective personal equipment (34.0%). The median overall impact score of the pandemic on practice was 9 (2-10). Conclusions: Physicians practicing clinical gastroenterology and gastrointestinal endoscopy in Indonesia work in high-risk settings. Modifications in clinical gastroenterology and gastrointestinal endoscopy practices are prevalent during the COVID-19 pandemic.

Background: The “retired husband syndrome” refers to the negative impact of the husband’s retirement on the wife’s health. This study provided new insights by examining whether and to what extent the wife’s social participation, interactions with her husband, and job status prior to her husband’s retirement affected the evolution of her mental health after her husband’s retirement. Methods: We collected data from a 12-wave nationwide panel survey conducted from 2005 to 2016, starting with individuals aged 50–59 years. Focusing on 3,794 female respondents whose husbands retired during the survey period, we applied random-effects linear regression models to investigate the evolution of their mental health as measured by the Kessler 6 (K6) score (range, 0–24; Mean, 3.41; standard deviation, 4.11) during the 5 years after their husbands’ retirement. Results: On average, the wife’s K6 score rose by 0.18 (95% confidence interval [CI], 0.08–0.28), 0.18 (95% CI, 0.03–0.34), and 0.19 (95% CI, −0.02 to 0.43) in the first 3 years, respectively, after the husband’s retirement, before declining toward the baseline level. However, the wife’s active social participation, intense interactions with her husband, and absence of paid employment before her husband’s retirement prevented her mental health from deteriorating. Conclusion: The results suggest the limited relevance of the “retired husband syndrome” among middle-aged Japanese couples. The effects of a husband’s retirement on the wife’s mental health depended heavily on her prior behavior.

The aim of this study was to analyze the current situation of trainees in OMFS in a nationwide survey at German universities and teaching hospitals. A questionnaire about their training in OMFS and discrimination, gender (in-)equality, and reconcilability of work and family life was sent to many OMFS residents in Germany. Seventy-five questionnaires were included. The average age of the participants was 32.15 years (± 0.75 years); 47 participants were male, 22 female, and 3 "diverse". The participants' overall satisfaction rate was good. Training concepts existed in most of the teaching hospitals (54.67%). 8.11% of the participants stated discrimination existed against men while, 24.32% agreed that discrimination existed against women. Stating that discrimination against women exists, it was associated with female gender (p 0.001), being married (p = 0.042), and not aiming for further academic degrees (p = 0.009). Overall, the training situation in Germany seems structured in most teaching hospitals. Apart from the residents' general satisfaction with the training concepts, there seems to be a matter of concern regarding discrimination especially against women and the reconcilability of work and family life in OMFS training. Furthering the establishment of structured training concepts might be useful to overcome these issues in the course of training in OMFS.

Aims Non-coding microRNA (miRNA) in extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs) may promote neuronal repair after spinal cord injury (SCI). In this paper we report on the effects of MSC-EV-microRNA-381 (miR-381) in a rodent model of SCI. Methods In the current study, the luciferase assay confirmed a binding site of bromodomain-containing protein 4 (BRD4) and Wnt family member 5A (WNT5A). Then we detected expression of miR-381, BRD4, and WNT5A in dorsal root ganglia (DRG) cells treated with MSC-isolated EVs and measured neuron apoptosis in culture by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. A rat model of SCI was established to detect the in vivo effect of miR-381 and MSC-EVs on SCI. Results We confirmed an interaction between miR-381 and BRD4, and showed that miR-381 overexpression inhibited the expression of BRD4 in DRG cells as well as the apoptosis of DRG cells through WNT5A via activation of Ras homologous A (RhoA)/Rho-kinase activity. Moreover, treatment of MSC-EVs rescued neuron apoptosis and promoted the recovery of SCI through inhibition of the BRD4/WNT5A axis. Conclusion Taken altogether, miR-381 derived from MSC-EVs can promote the recovery of SCI through BRD4/WNT5A axis, providing a new perspective on SCI treatment. Cite this article: Bone Joint Res 2021;10(5):328–339.

Background Antimicrobial stewardship (AMS) programs are usually limited in resources and scope. Therefore, wider engagement of hospital pharmacists in reviewing antimicrobial orders is necessary to ensure appropriate prescribing. We assessed hospital pharmacists’ self-reported practice and confidence in reviewing antimicrobial prescribing, and their knowledge in making AMS interventions. Methods We conducted an Australia-wide, cross-sectional survey in October 2017. A link to the online survey was emailed to hospital pharmacists via the Society of Hospital Pharmacists of Australia. Factors associated with higher knowledge scores were explored using linear regression models. Results There were 439 respondents, of whom 272 (61.7%) were from metropolitan public hospitals. Pharmacists were more likely to assess the appropriateness of intravenous, broad-spectrum or restricted antibiotics than narrow-spectrum, oral antibiotics within 24–72 h of prescription; p p ≤ 0.01. Conclusion Gaps in practice, confidence and knowledge among hospital pharmacists were identified that could inform the design of educational strategies to help improve antimicrobial prescribing in Australian hospitals.

Background Involving the end-users of scientific research (patients, carers and clinicians) in setting research priorities is important to formulate research questions that truly make a difference and are in tune with the needs of patients. We therefore aimed to generate a national research agenda for Juvenile Idiopathic Arthritis (JIA) together with patients, their caregivers and healthcare professionals through conducting a nationwide survey among these stakeholders. Methods The James Lind Alliance method was used, tailored with additional focus groups held to involve younger patients. First, research questions were gathered through an online and hardcopy survey. The received questions that were in scope were summarised and a literature search was performed to verify that questions were unanswered. Questions were ranked in the interim survey, and the final top 10 was chosen during a prioritisation workshop. Results Two hundred and seventy-eight respondents submitted 604 questions, of which 519 were in scope. Of these 604 questions, 81 were generated in the focus groups with younger children. The questions were summarised into 53 summary questions. An evidence checking process verified that all questions were unanswered. A total of 303 respondents prioritised the questions in the interim survey. Focus groups with children generated a top 5 of their most important questions. Combining this top 5 with the top 10s of patients, carers, and clinicians led to a top 21. Out of these, the top 10 research priorities were chosen during a final workshop. Research into pain and fatigue, personalised treatment strategies and aetiology were ranked high in the Top 10. Conclusions Through this study, the top 10 research priorities for JIA of patients, their caregivers and clinicians were identified to inform researchers and research funders of the research topics that matter most to them. The top priority involves the treatment and mechanisms behind persisting pain and fatigue when the disease is in remission.

Despite the increasing incidence rate of vestibular schwannomas (VS), controversies in their management are still present.A 35-item multiple-choice survey investigating the current practice patterns of VS care was sent to the members of the Italian Society of Otolaryngology, Head and Neck Surgery (SIO) and of the Italian Society of Neurosurgery (SINCH).Among 66 respondents, 37 (56.0%) claimed to be actively involved in VS management. Most interviewees (35.1%) declared20 years of experience and 59.5% claimed to work in an academic practice. The number of cases evaluated in each centre per year varied widely, with 54.0% evaluating25 cases/year and only 13.6%100 cases/year. Multidisciplinary care for VS evaluation was confirmed by 50.0% of respondents, and multidisciplinary surgical care by 62.2%. Observation and surgery were the most common management options proposed. Further details regarding VS care are presented.The present study provides the first overview on the current practice patterns of VS care in Italy. Although integrated in most centres, a multidisciplinary model of care needs to be encouraged. Wide heterogeneity in experience and practices is mostly influenced by the surgeon's different specialties and by the lack of shared guidelines.L’attuale gestione dello schwannoma vestibolare in Italia: risultati di una survey nazionale.Nonostante il costante incremento di incidenza dello schwannoma vestibolare (VS), non vi è ancora uniformità nella gestione di tale patologia.Un questionario di 35 domande sulle strategie di trattamento del VS è stato sottoposto ai membri della SIO e della SINCH.Tra i 66 intervistati che hanno risposto al questionario, il 56,0% ha confermato di prendere parte attivamente nel trattamento dello VS. La maggioranza dei partecipanti (35,1%) dichiarava20 anni di esperienza nel settore, e il 59,5% di lavorare in un contesto accademico. Il 54,0% degli intervistati ha affermato di valutare25 casi/anno, mentre solo il 13,6%100 casi/anno. Il 50,0% ha dichiarato di valutare lo VS nell’ambito di un gruppo multidisciplinare, mentre il 62,2% di operare in un contesto multidisciplinare. L’approccio conservativo e la chirurgia si confermavano le strategie terapeutiche più frequentemente proposte.Lo studio presenta una prima panoramica sulle strategie di trattamento dello VS in Italia. Nonostante un modello multidisciplinare di gestione dello VS sia già diffuso in molti centri, è necessario incrementarne ulteriormente lo sviluppo. Le diverse specializzazioni del chirurgo e la mancanza di linee guida condivise contribuiscono a determinare la vasta eterogeneità osservata nella gestione del VS nel nostro Paese.