Search

Our previous work identified that nine leading guidance documents for seven different types of systematic review advocated the same process of literature searching. We defined and illustrated this process and we named it 'the Conventional Approach'. The Conventional Approach appears to meet the needs of researchers undertaking literature searches for systematic reviews of clinical interventions. In this article, we report a new and alternate process model of literature searching called 'A Tailored Approach'. A Tailored Approach is indicated as a search process for complex reviews which do not focus on the evaluation of clinical interventions. The aims of this article are to (1) explain the rationale for, and the theories behind, the design of A Tailored Approach; (2) report the current conceptual illustration of A Tailored Approach and to describe a user's interaction with the process model; and (3) situate the elements novel to A Tailored Approach (when compared with the Conventional Approach) in the relevant literature. A Tailored Approach suggests investing time at the start of a review, to develop the information needs from the research objectives, and to tailor the search approach to studies or data. Tailored Approaches should be led by the information specialist (librarian) but developed by the research team. The aim is not necessarily to focus on comprehensive retrieval. Further research is indicated to evaluate the use of supplementary search methods, methods of team-working to define search approaches, and to evaluate the use of conceptual models of information retrieval for testing and evaluation. [ABSTRACT FROM AUTHOR]

Due to rising costs and declining response rates, surveys are increasingly moving from face-to-face interviewing to a self-administered mixed-mode design. Mixed-mode surveys can be conducted using a concurrent or a sequential design. A sequential design in which the web mode is offered first is a common strategy for mixed-mode surveys as it reduces survey costs. However, when deciding which mode choice sequence to use, sample balance should also be considered. One approach to achieving a balanced sample might be to tailor the sequence of the choice of modes, or the mode choice sequence. For this purpose, we use an indicator that assigns the sampled persons to the different mode choice sequences to minimize the variability of response probabilities. In this study, we compare the sample composition achieved with a concurrent and a sequential design. Additionally, we investigate whether indicator-based tailoring of the two mode choice sequences can improve sample composition. We implemented a randomized experiment in the 2021 German General Social Survey (ALLBUS), which surveyed the general population aged 18 and older in private households (N  =   5,342) using a mixed-mode design (web and mail). In a first step, respondents were randomly assigned to a concurrent or a sequential design. We find that the two mode choice sequences lead to a similar sample composition. Next, we identify age as the best available single indicator of the variables known before the survey to tailor the mode choice sequence. Our analyses show that a tailored approach based on age improves the sample composition slightly. [ABSTRACT FROM AUTHOR]

The management of reverse osmosis concentrate (ROC) poses a challenge to utilities as it requires expensive disposal methods and advanced treatment in order to comply with regulations. This paper presents studies of natural treatment approaches, such as constructed wetlands (CWs), that have been tailored to treat ROC. Conceptually, with testing and planning, these wetlands could meet regulatory criteria before discharging to the surface water and achieving multiple benefits. Lessons learned from pilot studies of wetland treatment of ROC point to the potential benefits of designing full-scale wetlands for concentrate management. Studies have illustrated the ability of CWs to reduce the concentrations of metals and simultaneously remove nutrients to meet state standards for aquatic and wildlife designated uses. Nutrient removal processes include denitrification for nitrogen removal (possibly supplemented with Annamox reduction of NO3-N), labile carbon assimilation supporting oxidized nitrogen reduction, and phosphate-P uptake and precipitation. Because of the evaporative water loss, mass removal efficiencies were greater than concentration reductions. Studies illustrate how engineered wetlands help with the management of ROC produced from reclaimed water through reductions in concentration and volume for disposal through evapotranspiration. The associated creation of wildlife habitats and coastal wetland restoration could result in the renewal of multiple ecosystem services. [ABSTRACT FROM AUTHOR]

AimsSupraventricular tachycardias may trigger atrial fibrillation (AF). The aim of the study was to evaluate the prevalence of supraventricular tachycardia (SVT) inducibility in patients referred for AF ablation and to evaluate the effects of SVT ablation on AF recurrences.Methods and results249 patients (mean age: 54 ± 14 years) referred for paroxysmal AF ablation were studied. In all patients, only AF relapses had been documented in the clinical history. 47 patients (19%; mean age: 42 ± 11 years) had inducible SVT during the electrophysiological study and underwent an ablation targeted only at SVT suppression. Ablation was successful in all 47 patients. The ablative procedures were: 11 slow-pathway ablations for atrioventricular nodal re-entrant tachycardia; 6 concealed accessory pathway ablations for atrioventricular re-entrant tachycardia; 17 focal ectopic atrial tachycardia ablations; 13 with only one arrhythmogenic pulmonary vein. No recurrences of SVT were observed during the follow-up (32 ± 18 months). 4 patients (8.5%) showed recurrence of at least one episode of AF. Patients with inducible SVT had less structural heart disease and were younger than those without inducible SVT.ConclusionA significant proportion of candidates for AF ablation are inducible for an SVT. SVT ablation showed a preventive effect on AF recurrences. Those patients should be selected for simpler ablation procedures tailored only to the triggering arrhythmia suppression.

In the setting of patients with indication to receive dual antiplatelet therapy undergoing surgery or invasive procedures, the risk of perioperative cardiac ischemic events, particularly stent thrombosis, is high, because surgery has a prothrombotic effect and antiplatelet therapy is withdrawn in order to avoid bleeding complications. Cangrelor, an intravenous P2Y12 receptor antagonist, has been tested in a randomized trial as a “bridge” to cardiac surgery from discontinuation of oral P2Y12 receptor antagonists. Thus, a consensus document extended its off-label use in this setting and before non-cardiac surgery. Currently, despite the implementation of a standardized bridging protocol with cangrelor, a residual risk of adverse outcome mainly due to bleeding events, still persist during the perioperative phase. Accordingly, a personalized management driven by platelet reactivity serial measurements and careful assessment of ischemic and bleeding risks has potential to optimize outcomes and costs as compared to a standardized bridging protocol, based on average pharmacodynamic data of oral P2Y12 inhibitors. While specific indications for bridging have been extensively addressed in the aforementioned consensus statement, the aim of the present document is the proposal of a “tailored” clinical decision-making algorithm inspired to the principle of personalized medicine dealing with complex clinical scenarios.

Improving nutritional status during pregnancy is a global interest. Frequently, women either fail to meet or exceed nutrient recommendations. Current strategies to improve maternal nutrition focus on a "one-size-fits-all" approach and fail to consider individual factors that affect the mother's overall nutritional status. The objectives of this review were to determine the importance of key nutrients for optimal maternal and fetal health, to explore to what extent current recommendations consider individual factors, and to explore novel strategies to close the gap between current guidelines and real-world challenges through more personalized approaches. This review intercalated different nutritional guidelines and recent scientific publications and research initiatives related to maternal nutrition. Based on that, an overview of current recommendations, challenges related to present approaches, and perspectives for future directions are described. Current guidelines are not optimally supporting adequate nutrient intake and health of expectant mothers and their offspring. Existing recommendations are not consistent and do not sufficiently take into account how interindividual variation leads to differences in nutrient status. Personalized nutrition offers women the opportunity to improve their health by using strategies that are tailored to their unique nutritional needs. Such strategies can include personalized supplementation, holistic lifestyle interventions, digital and application-based technologies, and dietary assessment through blood biomarker and genetic analysis. However, these approaches warrant further investigation and optimization. More personalized approaches have the potential to optimize mothers' and their offspring's health outcomes more appropriately to their nutritional needs before, during, and after pregnancy. Moving away from a generalized "one-size-fits-all" approach can be achieved through a variety of means. Future aims should be to provide supporting evidence to create customized subpopulation-based or individualized recommendations, improve nutrition education, and develop novel approaches to improve adherence to dietary and lifestyle interventions. [ABSTRACT FROM AUTHOR]

In the setting of patients with indication to receive dual antiplatelet therapy undergoing surgery or invasive procedures, the risk of perioperative cardiac ischemic events, particularly stent thrombosis, is high, because surgery has a prothrombotic effect and antiplatelet therapy is withdrawn in order to avoid bleeding complications. Cangrelor, an intravenous P2Y12 receptor antagonist, has been tested in a randomized trial as a "bridge" to cardiac surgery from discontinuation of oral P2Y12 receptor antagonists. Thus, a consensus document extended its off-label use in this setting and before non-cardiac surgery. Currently, despite the implementation of a standardized bridging protocol with cangrelor, a residual risk of adverse outcome mainly due to bleeding events, still persist during the perioperative phase. Accordingly, a personalized management driven by platelet reactivity serial measurements and careful assessment of ischemic and bleeding risks has potential to optimize outcomes and costs as compared to a standardized bridging protocol, based on average pharmacodynamic data of oral P2Y12 inhibitors. While specific indications for bridging have been extensively addressed in the aforementioned consensus statement, the aim of the present document is the proposal of a "tailored" clinical decision-making algorithm inspired to the principle of personalized medicine dealing with complex clinical scenarios. [ABSTRACT FROM AUTHOR]

The management of reverse osmosis concentrate (ROC) poses a challenge to utilities as it requires expensive disposal methods and advanced treatment in order to comply with regulations. This paper presents studies of natural treatment approaches, such as constructed wetlands (CWs), that have been tailored to treat ROC. Conceptually, with testing and planning, these wetlands could meet regulatory criteria before discharging to the surface water and achieving multiple benefits. Lessons learned from pilot studies of wetland treatment of ROC point to the potential benefits of designing full-scale wetlands for concentrate management. Studies have illustrated the ability of CWs to reduce the concentrations of metals and simultaneously remove nutrients to meet state standards for aquatic and wildlife designated uses. Nutrient removal processes include denitrification for nitrogen removal (possibly supplemented with Annamox reduction of NO3-N), labile carbon assimilation supporting oxidized nitrogen reduction, and phosphate-P uptake and precipitation. Because of the evaporative water loss, mass removal efficiencies were greater than concentration reductions. Studies illustrate how engineered wetlands help with the management of ROC produced from reclaimed water through reductions in concentration and volume for disposal through evapotranspiration. The associated creation of wildlife habitats and coastal wetland restoration could result in the renewal of multiple ecosystem services.

Increasing operators' experience and improvement of the technique have resulted in a drastic reduction in complications following transcatheter aortic valve replacement (TAVR) in patients with lower surgical risk. In parallel, the procedure was considerably simplified, with a routine default approach including local anesthesia in the catheterization laboratory, percutaneous femoral approach, radial artery as the secondary access, prosthesis implantation without predilatation, left ventricle wire pacing and early discharge. Thus, the "simplified" TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety. The minimalist strategy must not become dogmatic and careful pre-, per- and post-procedural evaluation of patients with well-defined protocols guarantee optimal care following TAVR. This review aims to evaluate the benefits and limits of the simplified TAVR procedure in a current and future vision. [ABSTRACT FROM AUTHOR]

Several important sex and gender differences in the clinical manifestation of diseases have been known for a long time but are still underestimated. The infectious Coronavirus 2019 disease pandemic has provided evidence of the importance of a sex and gender-based approach; it mainly affected men with worse symptomatology due to a different immune system, which is stronger in women, and to the Angiotensin-converting enzyme 2 and Transmembrane protease serine 2 roles which are differently expressed among the sexes. Additionally, women are more inclined to maintain social distance and smoke less. Analysis of data on the infectious Coronavirus 2019 disease testing from people admitted to the Amedeo di Savoia Hospital, a regional referral center for infectious diseases, has been applied to the whole of 2020 data (254,640 records). A high percentage of data in the dataset was not suitable due to a lack of information or entering errors. Among the suitable samples, records have been analyzed for positive/negative outcomes, matching records for unique subjects (N = 123,542), to evaluate individual recurrence of testing. Data are presented in age and sex-disaggregated ways. Analyses of the suitable sample also concerned the relation between testing and hospital admission motivation and symptoms. Our analysis indicated that a sex and gender-based approach is mandatory for patients and the National Health System's sustainability. [ABSTRACT FROM AUTHOR]

Primary (umbilical, epigastric hernias) and secondary (incisional hernias) ventral hernias are among the most common surgical indications in general and visceral surgery. The defect width and defect localization have a considerable impact on treatment decision-making and outcomes. Therefore, preoperative computed tomography (CT) examination is increasingly recommended particularly for larger incisional hernias. Despite the good results reported in meta-analyses and registry analyses, in recent years there has been a marked trend away from the intraperitoneal onlay mesh (IPOM) technique as severe complications have repeatedly been reported. To continue to benefit from the advantages conferred by a minimally invasive access route with fewer wound complications, a myriad of new techniques with small incisions or endoscopic access have been developed. These involve mesh placement in the sublay/retromuscular/preperitoneal position. This provides a relatively differentiated tailored approach. [ABSTRACT FROM AUTHOR]

The systematic review examined research on tailored digital gamification for learning based on 43 peer-reviewed articles published between 2013 and 2022. The study aimed to investigate tailored approaches and game elements, contributing to the use of tailored digital gamification in educational settings. The tailored approaches were categorized as personalization, adaptation, and recommendation, with user modeling as their basis. Five clusters of game elements were employed when using these tailored approaches in digital gamified classes. The findings imply that most of the articles in this review were still in the stage of class preparation and focused on what information can be used to tailor. More empirical studies need to be conducted to examine the motivating effects of tailored digital gamifying classes, using the approaches of personalization, adaptation, and recommendation. Additionally, twenty-three game elements were found in this review study, among which reward was the most often used. Then these game elements were grouped into five clusters based on their functions, that is, performance, personal, social, ecological, and fictional cluster. A variety of game element clusters reflect multiple aspects of gamification. The use of them in each tailored approach might contribute to a better understanding and selection of game elements when tailoring digital gamification. These findings provide a holistic picture of common approaches and related game elements in tailored digital gamifying classes. Teachers and curriculum designers can benefit from this study by considering appropriate approaches and game elements. • 5 game element types were used in personalized, adaptive and recommended approaches. • Most reviewed articles were still at the user modeling stage, without implementation. • Capturing student dynamic data using adaptation was the most encouraged in class. • Giving instant responses to student actions was most needed in whatever approaches. • Only a few studies integrated all five game element types when tailoring. [ABSTRACT FROM AUTHOR]

The new Nuclear Posture Review (NPR), published in January 2018, stipulates a “tailored” strategy towards each country which Washington sees as presenting a nuclear challenge to the United States. Yet each “tailored” strategy is based on the same reiterated assumption that the U.S. measures and programs are developed in response to external hostile actions. The NPR cites other countries’ aggressive behavior and military buildup as the reason to reinstitute the role of nuclear weapons as the key component of the U.S. deterrent, modernize the U.S. strategic triad and dual-capable aircraft, develop new small-yield warheads, create sealaunched cruise missiles, and reinforce the C3 systems to support them. These initiatives go along with the new expanded understanding of “extreme circumstances” which allow for a U.S. nuclear response to a non-nuclear attack, as well as with other new features of the U.S. nuclear doctrine: the creation of “more usable” types of nuclear weapons, the integration of nuclear and conventional elements of planning and operations, the enhanced focus on cyber threats, and the prioritization of “flexibility,” “uncertainty,” and “hedging” – which all increase the danger of an actual use of nuclear weapons. The NPR presents Russia as a higher threat compared to China, while China – as a major challenge to the United States in the Asian region. Yet the NPR does not call these two states “adversaries” and stresses the need to avoid confrontation and an arms race. Besides Russia’s “aggressive policies,” military programs and bellicose declarations, the NPR focuses on its alleged adherence to the concept of “escalation for de-escalation” – early first use of nuclear weapons to end a conventional conflict on favorable terms – a notion that the NPR sets to counteract. The requirements formulated by the NPR towards Iran and North Korea include ensuring their non-nuclear status, countering their growing influence in the respective Middle East and Asia-Pacific regions, preventing the transfer of nuclear and missile technologies and sensitive materials to third parties and states, and convincingly demonstrating that their aggression, including a conventional one, would be met with resolute action by the United States and its allies. Yet, in a shuffle of a kind, opposite to how the Obama Administration renounced military solution to the Iran problem and chose negotiations with this country with no preliminary condition, – and at the same time preferred the tactics of isolating North Korea and disregarding its claims, – now it is with Seoul that Washington may engage with, while simultaneously demonstrating a tough line towards Teheran. Yet the shifts towards a settlement on the Korean Peninsula, along with certain signs of restraint in the NPR, offer some grounds to hope that – given political will and active international efforts – the worst-case scenarios and further deterioration of international situation may successfully be avoided.

Several important sex and gender differences in the clinical manifestation of diseases have been known for a long time but are still underestimated. The infectious Coronavirus 2019 disease pandemic has provided evidence of the importance of a sex and gender-based approach; it mainly affected men with worse symptomatology due to a different immune system, which is stronger in women, and to the Angiotensin-converting enzyme 2 and Transmembrane protease serine 2 roles which are differently expressed among the sexes. Additionally, women are more inclined to maintain social distance and smoke less. Analysis of data on the infectious Coronavirus 2019 disease testing from people admitted to the Amedeo di Savoia Hospital, a regional referral center for infectious diseases, has been applied to the whole of 2020 data (254,640 records). A high percentage of data in the dataset was not suitable due to a lack of information or entering errors. Among the suitable samples, records have been analyzed for positive/negative outcomes, matching records for unique subjects (N = 123,542), to evaluate individual recurrence of testing. Data are presented in age and sex-disaggregated ways. Analyses of the suitable sample also concerned the relation between testing and hospital admission motivation and symptoms. Our analysis indicated that a sex and gender-based approach is mandatory for patients and the National Health System’s sustainability.

Introduction: The Accreditation and Certification of Hernia Centers and Surgeons (ACCESS) Group of the European Hernia Society (EHS) recognizes that there is a growing need to train specialist abdominal wall surgeons. The most important and relevant argument for this proposal and statement is the growing acceptance of the increasing complexity of abdominal wall surgery due to newer techniques, more challenging cases and the required 'tailored' approach to such surgery. There is now also an increasing public awareness with social media, whereby optimal treatment results are demanded by patients. However, to date the complexity of abdominal wall surgery has not been properly or adequately defined in the current literature.Methods: A systematic search of the available literature was performed in May 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, with 75 publications identified as relevant. In addition, an analysis of data from the Herniamed Hernia Registry was performed. The percentage of patients with hernia- or patient-related characteristics which unfavorably impacted the outcome of inguinal and incisional hernia repair was also calculated.Results: All present guidelines for abdominal wall surgery recommend the utilization of a 'tailored' approach. This relies on the prerequisite that any surgical technique used has already been mastered, as well as the recognized learning curves for each of the several techniques that can be used for both inguinal hernia (Lichtenstein, TEP, TAPP, Shouldice) and incisional hernia repairs (laparoscopic IPOM, open sublay, open IPOM, open onlay, open or endoscopic component separation technique). Other hernia- and patient-related characteristics that have recognized complexity include emergency surgery, obesity, recurrent hernias, bilateral inguinal hernias, groin hernia in women, scrotal hernias, large defects, high ASA scores, > 80 years of age, increased medical risk factors and previous lower abdominal surgery. The proportion of patients with at least one of these characteristics in the Herniamed Hernia Registry in the case of both inguinal and incisional hernia is noted to be relatively high at around 70%. In general surgery training approximately 50-100 hernia repairs on average are performed by each trainee, with around only 25 laparo-endoscopic procedures.Conclusion: A tailored approach is now employed and seen more so in hernia surgery and this fact is referred to and highlighted in the contemporaneous hernia guidelines published to date. In addition, with the increasing complexity of abdominal wall surgery, the number of procedures actually performed by trainees is no longer considered adequate to overcome any recognized learning curve. Therefore, to supplement general surgery training young surgeons should be offered a clinical fellowship to obtain an additional qualification as an abdominal wall surgeon and thus improve their clinical and operative experience under supervision in this field. Practicing general surgeons with a special interest in hernia surgery can undertake intensive further training in this area by participating in clinical work shadowing in hernia centers, workshops and congresses. [ABSTRACT FROM AUTHOR]

Acute heart failure (AHF) after ST-segment elevation myocardial infarction (STEMI) is usually treated with inotropic support or vasoactive medications. In this study, we aimed at investigating the role of levosimendan on cardiovascular determinants of contractility and afterload in patients with AHF following STEMI treated with percutaneous coronary intervention (PCI). Forty-eight consecutive STEMI patients were retrospectively enrolled. Non-invasive assessment of left ventricular elastance (Ees) and arterial elastance (Ea) and their relationship, ventriculo-arterial coupling (VAC) was performed before and after levosimendan infusion. After infusion of levosimendan a significant increase in SV was detected in all patients (from 48 ± 17 to 60 ± 21 ml, p < 0.001). VAC slightly decreased from 1.74 ± 0.8 to 1.66 ± 0.7 (p = NS) as a result of a profound reduction in arterial elastance (Ea 2.34 ± 1.09 to 1.74 ± 0.5 mm Hg/ml, p < 0.001) and in ventricular elastance (Ees 1.57 ± 0.12 to 1.24 ± 0.09 mm Hg/ml, p = 0.021). Ejection fraction (EF) (from 0.29 ± 0.1 to 0.32 ± 0.1, p < 0.01) and WMSI, (from 2.16 ± 0.47 to 2.05 ± 0.54, p < 0.05) also, significantly improved. Finally, baseline VAC was able to predict the use of norepinephrine (NE) and early and one-year mortality of patients treated. In STEMI patients with AHF the use of levosimendan significantly increases stroke volume after 24-hour treatment through Ea reduction. Baseline VAC seemed to predict early and late mortality and early and prolonged use of NE, however, this needs to be tested in larger series of patients and multivariate adjustments for other prognostic predictors. • Non-invasive analysis of VAC is feasible in patients with AHF after STEMI. • Levosimendan is able to improve VAC mainly due to afterload decrease. • VAC is able to predict the use of norepinephrine and mortality. • Echo-dynamic approach might lead to a more tailored treatment. [ABSTRACT FROM AUTHOR]

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Introduction: Carotid artery stenting (CAS) has recently changed the status in the treatment of the extracranial carotid atheromasic disease. In recent years, evolution in both stents and protection devices as well as in carotid stenting techniques, has resulted in an important reduction in the rate of stroke in patients undergoing CAS procedures. Areas covered: The purpose of this article is reviewing the literature and summarizing the current evidence of the new available materials to underline the importance of the correct choice of the devices during the procedure. Expert commentary: Certainly a key issue in order to limit the periprocedural events to the lowest possible, is to select the appropriate device for the appropriate patient anatomy and clinical syndrome, the so called ‘tailored approach’. [ABSTRACT FROM PUBLISHER]

Energy savings from building retrofits often fall short due to occupant behaviour. Current retrofit guidance may be significantly undermined due to standardised behavioural assumptions used in modelling calculations. This paper investigated the impact of household behaviour on the effectiveness and optimum ranking of domestic retrofit measures. It compared the energy saving potential from eight single retrofit measures across five household behavioural patterns, using a case study dwelling and dynamic building simulation modelling. The results confirmed that behavioural impact is significant in optimising retrofit strategies, suggesting tailoring domestic retrofit by incorporating occupant behaviour is vital for realising the energy saving potential. [ABSTRACT FROM AUTHOR]