Careful Review Research Articles

JPSM Controversies in Palliative Care: “What is the Most Important, Measurable Goal of Serious Illness Conversations in the Ambulatory Setting?”

There is widespread agreement that clinicians should talk to seriously ill patients and their families about their illnesses. However, advance directives as a quality metric have been called into question because of the lack of data that these conversations lead to goal-concordant care. The controversy has led many to reexamine the purpose of conversations with seriously ill patients and what should be discussed in ambulatory visits. In this Controversies in Palliative care, experts in palliative care review the literature and suggest both how it influences their clinical practice and what research needs to be done to clarify the controversy. While there is not a single outcome that the experts agree on, they posit a variety of different ways to assess these conversations.

Flexibility and access to dental postgraduate speciality training.

Increasingly, there is a clear emphasis on the need for improved access to flexible training. This reflects changing societal attitudes and expectations towards work-life balance and increasing demand for flexible working. The recently published Advancing dental care review: final report (2021) reflects these same demands within dental postgraduate training. Increasing flexible training options has the potential for far-reaching beneficial effects for dental speciality training. There are barriers to accessing speciality training for specific applicant groups and this risks potentially excluding excellent-quality candidates from pursuing speciality training. There is opportunity in utilising and developing flexible training options to support widening access to dental speciality training. Recruitment and working pattern arrangements should reflect these aspirations, ensuring that the best trainees are successful irrespective of their personal circumstances.

Commentary Kirchhoff's Laws and Hepatic Clearance, Well-Stirred Model - Is There Common Ground?

Clearance concepts are extensively applied in drug development and drug therapy. The well-stirred model (WSM) of hepatic elimination is the most widely adopted physiologic model in pharmacokinetics owing to its simplicity. A common feature of this organ model is its use to relate hepatic clearance of a compound to the physiological variables: organ blood flow rate, binding within blood, and hepatocellular metabolic and excretory activities. Recently, Kirchhoff's laws of electrical network have been applied to organ clearance with the claim that they yield the same equation for hepatic clearance as the WSM, and that the equation is independent of a mechanistic model. This commentary analyzes this claim and shows that, implicit in the application of Kirchhoff's approach are the same assumptions as those of the WSM. Concern is also expressed in the interpretation of permeability or transport parameters and related rate equations, as well as the inappropriateness of the corresponding equation defining hepatic clearance. There is no value, and some dangers, in applying Kirchhoff's voltage law to organ clearance. Significance Statement This commentary refutes this claim by Pachter et al. [Pharmacology and Therapeutics 239 (2022) 108278], who suggest that the well-stirred model (WSM) of hepatic elimination, the most widely applied physiologic model of hepatic clearance, provides the same equation as Kirchhoff's laws of electrical network that is independent of a physiologic model. A careful review shows that the claim is groundless and fraught with errors. We conclude that there is no place for the application of Kirchhoff's laws to clearance models.

Pathways to scale up early childhood programs: A scoping review of Reach Up and Care for Child Development.

Evidence-based early childhood development (ECD) programs that strengthen nurturing parenting skills and promote early stimulation, such as Reach Up (RU) and Care for Child Development (CCD), are critical investments for interrupting cycles of intergenerational poverty; however, the implementation impact of these programs varies greatly globally. Analyzing systematically the evidence on the implementation pathways based on contexts (i.e., external and internal influences on intervention implementation), implementation strategies (i.e., mechanisms used to promote program initiation, design, and delivery with existing systems), and implementation outcomes (i.e., related to the implementation goals) can increase the likelihood of implementation success. Our scoping review aimed to identify implementation pathways of RU and CCD programs in low- and middle-income countries. A search in English, Spanish, and Portuguese of grey literature and five databases of peer reviewed literature; from inception through July 16, 2022, yielded 2,267 publications. Using predetermined eligibility criteria, 75 records yielded implementation details for 33 programs across 23 low- and middle-income countries. Two reviewers independently extracted program data on context, implementation strategies, and implementation outcomes following a program theory. A thematic analysis identified 37 implementation strategies across six "building blocks of implementation": program emergence, intersectoriality, intervention characteristics, workforce, training, and monitoring systems. Implementation pathways across building blocks are highly influenced by contextual factors, such as infrastructure, social norms, and the target population's demand and interest, which may shape different implementation outcomes. Six 'building blocks' shaping implementation pathways of CCD and RU in LMICs were identified. The careful consideration of context and use of intentional evidence-based planning can enable the successful implementation of ECD nurturing care interventions. We recommend the use of the ECD Implementation Checklist for Enabling Program Scale Up to guide decision-making regarding context and implementation strategies to support implementation outcomes and subsequent ECD program success.

Spinal Arachnoid Cyst Analysis of Surgical Experience in a Single Tertiary Care Centre and Review of Literature

To study patients with spinal arachnoid cysts, who underwent cyst excision with dural defect repair or marsupialization, and their outcomes. The retrospective analysis involved reviewing the records of 38 patients who underwent surgical treatment for spinal arachnoid cysts in the Department of Neurosurgery at Christian Medical College, Vellore, between August 2004 and December 2022. The study examined the demographics, clinical presentation, imaging, surgical intervention, and outcomes of these patients. The majority of patients in the study were male (29/38, with 76.3%) and the thoracic region was the most common location for the cyst (17, with 44.7%). Weakness was the primary complaint and 94.7% of patients had myelopathy. The bladder was affected in 13 patients (34.2%). Of the 38 patients, 26 (71%) had cysts in extradural locations, while the rest were intradural. In total, 45.5% of intradural cysts were located in the ventral region. Seventeen (65.4%) had dural defects along the root sleeve and 29 (76.3%) underwent complete excision. All extradural cysts underwent complete excision and repair of the dural defect. Thirty patients (78.9%) experienced improved outcomes with reduced spasticity and improved weakness. One patient developed new-onset weakness postoperatively due to epidural hematoma. The mean follow-up period was 41months and one patient experienced a recurrence. Spinal arachnoid cyst is a rare benign spinal condition that is typically treated with surgery in symptomatic patients. Surgical intervention may involve either the excision of the cyst or marsupialization.

Ossification of the Ligamentum Flavum of the Cervical Spine in an Iranian Woman: Report of a Case With Myelopathy and Review of the Literature

Background and Importance: Ossification of the ligamentum flavum (OLF) is a pathological condition that affects the yellow ligaments, mostly in adult males between the ages of 45 to 70. Ossification is more common in the thoracolumbar region with an accompanying progressive neurological deficit, and its occurrence within the cervical spine is quite rare. Ossification of the yellow ligament is so common in East Asian countries that it is regarded as a frequently occurring aging pathology in the people of this region. Its existence in other ethnic groups is significantly lower. Case Presentation: A 68-year-old Iranian woman with progressive quadriparesis is presented. Cervical computerized tomography and MRI scans revealed two-level, bilateral, posteriorly located, ossified masses occurring at the C4-C5 and C5-C6 levels, which coincided with the ossification of the yellow ligament. Cervical laminectomy and excision of both masses were undertaken and the patient gradually recovered from his resultant neurological symptoms. Conclusion: Symptomatic cervical OLF is a markedly rare pathological finding and is typically illustrated as a medical case report. In a careful review of the literature including the presented patient, we could uncover only 77 cases involving a documented symptomatic cervical OLF.

A mixed-method systematic review of unmet care and support needs among Japanese cancer survivors.

To synthesize published studies regarding Japanese cancer survivors' needs/unmet needs of care/support, change of unmet needs over time, and preferred care/support providers. A mixed-method systematic review was conducted. MEDLINE, PsycINFO, CINAHL, and Ichu-shi were searched from inception to May 2022. Quantitative and qualitative studies were separately analyzed using narrative synthesis and meta-ethnography. Each finding was synthesized using a line of argument. Twenty-four studies (13 quantitative and 11 qualitative studies) were included. Six quantitative studies reported unmet needs in survivors of adolescent and young adult (n=1) and adulthood (n=5) cancer. No longitudinal studies regarding changes in unmet needs were identified. One study reported that adults preferred care/support providers. The quantitative studies identified more help in physical (48.2-51.0%, n=2) and psychological issues (17.4-78.8%, n=5), information (27.9-58.0%, n=3), and healthcare services (25.3-67.1%, n=2) among adults. The qualitative studies emphasized more tailor-made information about life events for young cancer survivors. More empathic and trustworthy interactions with surrounding people, including healthcare professionals, were demanded, regardless of age. A line of argument illustrated that cancer survivors had insufficient resources for activities and empowerment to face life with cancer at all phases. Japanese cancer survivors' unmet needs are diverse. More information and resources for psychological care/support and local healthcare services post-treatment are needed, which may hinder the optimal transition to survivorship. The synthesized evidence should be utilized to implement a comprehensive care/support system in practice and educate people surrounding cancer survivors, regardless of age.

Advanced Practice Nursing Experience of a Female Adolescent With Leigh Syndrome and Her Family: A Family Strengths-Oriented Therapeutic Conversations Approach

This article applied a family strengths-oriented therapeutic conversations approach to explore the advanced practice nursing experience of a female adolescent with Leigh Syndrome and her family. During the nursing care period from September 20 to November 19, 2022, the author collected data through direct care, observation, interview, telecare, home visits, and medical record reviews and confirmed the nursing problems to be the inadequate coping capability of the family. The author leveraged her advanced nurse practitioner role and used family strength-oriented therapeutic conversations to enable the parents of the patient to reflect on their experiences with this disease and to improve their quality of life and satisfaction with healthcare services. Three modes of care, including accessibility, coordination, and comprehensiveness, were offered to the female adolescent patient and her family to achieve the goal of family-centered, community-based, and medical-system-centered care. It is suggested that before making healthcare decisions, patients and their families should be given the opportunity to participate in the healthcare process and reach consensus on healthcare decisions based on existing evidence and their values and preferences. The medical decisions made by patients and their families after carefully considering their current situation and needs should be supported and assisted.

Profitability from training and development programmes

The purpose of this document is to provide a conceptual overview of the employee training and improvement software and its benefits. This post examines the nature and drivers of employee training and software improvement, and then discusses the impact on quality for employees and the organization. Organizations are finding it difficult to live aggressively in today's global economy. The importance of developing worker improvement software is for companies looking to gain a competitive edge. Staffs are valued for help from the agency and achievement or failure of the relief agency in the overall staff performance. Therefore, companies fund large amounts of education and training programs for employees. In addition, in education software is a great support for companies to highlight the knowledge, understanding and potential of employees. There is a great dialogue between specialists and researchers about the impact of enhancement software on every employee and agency. The overview defined here is a careful review of the literature on essential worker enhancement software and its benefits for companies and employees.

Alcohol Dependence and Rib Fracture Outcomes: A Systematic Review and Meta-Analysis.

Chronic alcohol use has been associated with impaired pulmonary function, increased risk of pneumonia and poor outcomes after trauma. With a high incidence of rib fractures in this population, the clinical and physiological factors associated with alcohol dependence may influence how these patients recover from thoracic injuries. Therefore, the aim of the systematic review was to examine the effect of alcohol dependence on rib fracture outcomes. The Embase, PubMed and Web of Science databases were searched for studies examining adult patients with rib fractures, with and without a history of alcohol dependency. The outcomes of interest were mortality, pulmonary complications, intensive care length of stay, ventilator days and hospital length of stay. A meta-analysis was performed to combine the data and compare results. Three studies met the criteria for inclusion in the review and all studies were observational in design. Alcohol dependency was associated with increased mortality (OR 1.44 (95% CI: 1.33-1.56)), pneumonia (OR 2.14 (2.02-2.27)) and ARDS (OR 1.71(1.48-1.98)) as well as longer stays in hospital and intensive care (p<0.05). No difference was found in ventilator days between the two groups.Early intensive care review should be considered to reduce complications in this population alongside prompt management of withdrawal symptoms. However, limited primary research exists on this topic and the quality of current evidence is low. Additional primary research is needed to further understand this correlation and draw meaningful conclusions.

Articulo traducido] Serie de 69 dermatosis relacionadas con la COVID-19 con biopsia, estudio inmunohistoquímico con anti-spike 3, hibridación in situ y PCR: Una revisión crítica de la afectación cutánea relacionada con la COVID-19

BackgroundDespite the large number of articles published on skin lesions related to COVID-19, clinicopathological correlation has not been performed consistently and immunohistochemistry to demonstrate spike 3 protein expression has not been validated through RT-PCR. Material and methodsWe compiled 69 cases of patients with confirmed COVID-19, where skin lesions were clinically and histopathologically studied. Immunohistochemistry (IHC) and RT-PCR was performed in skin biopsies. ResultsAfter a careful review of the cases, 15 were found to be dermatosis not related to COVID-19, while the rest of the lesions could be classified according to their clinical characteristics as vesicular (4), maculopapular eruptions (41), urticariform (9), livedo and necrosis (10) and pernio-like (5). Although histopathological features were similar to previously reported results, we found two previously unreported findings, maculopapular eruptions with squamous eccrine syringometaplasia and neutrophilic epitheliotropism.IHC showed in some cases endothelial and epidermal staining but RT-PCR was negative in all the tested cases. Thus, direct viral involvement could not be demonstrated. ConclusionsDespite presenting the largest series of confirmed COVID-19 patients with histopathologically studied skin manifestations, direct viral involvement was difficult to establish. Vasculopathic and urticariform lesions seem to be those more clearly related to the viral infection, despite IHC or RT-PCR negative results failed to demonstrate viral presence. These findings, as in other dermatological areas, highlight the need of a clinico-pathological correlation to increase knowledge about viral involvement in COVID-19 skin-related lesions.

Stopping Firestone and starting a citizen ‘revolution from below’: reflections on the enduring exploitation of Liberian land and labour

Attempting to reduce America’s dependence on foreign-sourced rubber, Firestone established in 1926 the world’s largest industrial plantation in Liberia under a controversial 99-year-lease agreement. Nearly a century later, backlash against the exploitative nature of corporate hegemony and economic globalisation crystallised in a transnational campaign, Stop Firestone, and class action suit to hold the multinational accountable. I argue in this article that Liberia’s unequal incorporation into global capitalism has configured and reconfigured the set of relations between government and citizens through parallel, albeit interrelated, processes—the globalisation of capital (via trade and investments) and the globalisation of rights (via universalised notions of citizenship as a human right). While the pursuit of foreign direct investment (FDI) in particular placed the interests of investors like Firestone ‘above’ the state thus undermining government–citizen relations, it simultaneously created a politicised workforce and network of Liberian activists thus strengthening citizen–citizen relations. Based on careful review of concession agreements and court proceedings as well as interviews conducted with government officials, activists and legal advocates based in Liberia and the United States, this article is the first to meld historical and contemporary developments, underscoring the twenty-first century implications of Firestone’s enduring exploitation of Liberian land and labour.

Betting on Dark Literary Tourism: Exploratory Research on Sulina Town (Romania)

ABSTRACT Exploring the tourist potential of the easternmost town in the European Union and also the only one that can only be reached by water, this article highlights the role of dark and literary destinations as ‘additional attractions’ related to other types of tourism. The article is based on careful analysis and review of abundant literature and on the consultation with several actors involved in tourism: institutions, tour operators, NGOs, bloggers and media. The analysis highlights that, as long as the institutions and economic actors involved in the field of tourism do not consider other participants in the tourism phenomenon, the opportunity of a pragmatic approach to managing and attracting as many and diverse tourists as possible is lost. The study also demonstrates that officials approach tourism differently, as compared to NGOs and tourism bloggers, the latter being more pragmatic in highlighting the real dimension of the tourist attractions of the destination.

White-Box Fuzzing RPC-Based APIs with EvoMaster: An Industrial Case Study

Remote Procedure Call (RPC) is a communication protocol to support client-server interactions among services over a network. RPC is widely applied in industry for building large-scale distributed systems, such as Microservices. Modern RPC frameworks include, for example, Thrift, gRPC, SOFARPC, and Dubbo. Testing such systems using RPC communications is very challenging, due to the complexity of distributed systems and various RPC frameworks the system could employ. To the best of our knowledge, there does not exist any tool or solution that could enable automated testing of modern RPC-based services. To fill this gap, in this article we propose the first approach in the literature, together with an open source tool, for fuzzing modern RPC-based APIs. The approach is in the context of white-box testing with search-based techniques. To tackle schema extraction of various RPC frameworks, we formulate a RPC schema specification along with a parser that allows the extraction from source code of any JVM RPC-based APIs. Then, with the extracted schema we employ a search to produce tests by maximizing white-box heuristics and newly defined heuristics specific to the RPC domain. We built our approach as an extension to an open source fuzzer (i.e., EvoMaster ), and the approach has been integrated into a real industrial pipeline that could be applied to a real industrial development process for fuzzing RPC-based APIs. To assess our novel approach, we conducted an empirical study with two artificial and four industrial web services selected by our industrial partner. In addition, to further demonstrate its effectiveness and application in industrial settings, we report results of employing our tool for fuzzing another 50 industrial APIs autonomously conducted by our industrial partner in their testing processes. Results show that our novel approach is capable of enabling automated test case generation for industrial RPC-based APIs (i.e., 2 artificial and 54 industrial). We also compared with a simple gray-box technique and existing manually written tests. Our white-box solution achieves significant improvements on code coverage. Regarding fault detection, by conducting a careful review with our industrial partner of the tests generated by our novel approach in the selected four industrial APIs, a total of 41 real faults were identified, which have now been fixed. Another 8,377 detected faults are currently under investigation.

Characterization and Prevalence of Pediatric Ramp Lesions Associated with Anterior Cruciate Ligament Tears.

Background: Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus and are common with anterior cruciate ligament (ACL) tears. They cannot be recognized easily on preoperative magnetic resonance imaging (MRI) scans and are difficult to visualize even using standard arthroscopic approaches. We aim to (1) characterize and evaluate the prevalence of ramp lesions in pediatric patients at a major tertiary children's hospital, providing important insights into demographics, diagnosis, treatment, and functional disability and (2) evaluate the efficacy of MRI in its diagnosis.&#x0D; Materials and Methods: We retrospectively reviewed patients under 21 years old undergoing posterior medial meniscal injuries and anterior cruciate ligament ruptures with arthroscopic examination and positive ramp lesions from 2018 to 2021. Patient demographics (including gender and age), initial presentation, physical examination findings, mechanism of injury, pre-operative radiologic findings, and treatment were collected and reviewed via electronic medical record. Exclusion criteria included patients over 18 years old, patients, that did not have an MRI, and patients that were not treated surgically.&#x0D; Results: There were 117 patients that met the inclusion criteria out of 690 patients. The mean age at diagnosis was 15.6±1.6 years and the mean BMI was 26.7±6.4. 83% of injuries occurred secondary to sporting activities. Ramp lesions were only detected on preoperative MRI in 63% of cases, suspected in 3%, and not detected in 33%. The sensitivity of the MRI was 63%.&#x0D; Conclusions: Ramp lesions were found in 117/690 (16.9%) of patients undergoing ACL reconstruction. MRI had a low sensitivity rate of 63%. During ACL reconstruction, a careful review of the posteromedial compartment is important to recognize less obvious trauma. Lack of treatment may lead to continued instability and risk of complications in these patients.

Late Presentation of Chronic Traumatic Encephalopathy in a Former Association Football Player.

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by widespread accumulation of hyperphosphorylated tau that typically occurs in people who have suffered repetitive head impacts. To date, very few cases have been reported in association football players. To describe the clinicopathological features of a case of CTE in an 84-year-old former football player who was clinically diagnosed as having dementia with Lewy bodies (DLB). A retrospective review of the patient's primary care and hospital medical records was performed along with a comprehensive neuropathological examination. This patient presented at age 84 with symmetrical parkinsonism and cognitive impairment that was exacerbated by prochlorperazine. His condition was rapidly progressive with recurrent falls within 1 year. Other features included headaches, depression, anxiety, suicidal ideation, disturbed sleep and aggression. He received a clinical diagnosis of DLB and died approximately 2 years after the onset of symptoms. A post-mortem examination revealed stage 4 CTE. While the contemporaneous onset of parkinsonism and cognitive symptoms in the context of possible neuroleptic sensitivity is suggestive of DLB, the additional symptoms of aggressive behavior, depression and suicidality in a former football player are consistent with the neuropathological diagnosis of CTE. This case, which is notable for the late presentation, demonstrates that CTE may masquerade as other dementias and highlights the importance of seeking a history of repetitive head impacts.

Review of Care for Older Adults in India: Living Arrangements and Quality of Life

Review of Care for Older Adults in India: Living Arrangements and Quality of Life

Islamic social finance for achieving sustainable development goals: a systematic literature review and future research agenda

Purpose The sustainable development goals (SDGs) devised by the United Nations (UN) call on countries – whether rich or poor – to solve global issues, improve lives and save the planet for future generations. However, the UN predicts that between $5 and $7tn will need to be spent annually between now and 2030 to accomplish these goals, posing a major financial hurdle. Islamic social finance, if used ethically, seeks to realise SDGs through fairness, justice and equity. Thus, this study aims to determine how Islamic social finance instruments such as Zakat, Waqf, Sadaqat and Qard-hasan contribute to realising SDGs. Design/methodology/approach This study used a preferred reporting items for systematic reviews and meta-analyses-based systematic literature review. Scopus and Google Scholar were chosen for the qualitative and meta-analysis of studies. The topic was reviewed in 178 academic papers from 2000 to 2022. The required articles were analysed after careful review. Findings Islamic social financing mechanisms have the capacity to solve many social issues and create better welfare conditions by ensuring economic, social and environmental sustainability in line with the SDGs. Indonesia and Malaysia lead Islamic social finance research, the survey found. The review revealed that Islamic social funding can achieve 11 out of 17 SDGs. Islamic commercial finance can be used for the remaining goals. The paper highlights Islamic social funding research limitations and opportunities. Research limitations/implications The review study shows that Islamic social finance can fill the SDG funding gap, especially considering the post-pandemic financial crisis that has increased global income inequality and social disparities. Originality/value To the best of the authors’ knowledge, this article is the first of its kind to review the potential of Islamic social financing instruments to help achieve the SDGs.

Parents living with and beyond cancer: A scoping review of unmet supportive care needs and impact on daily life

Introduction: Parenting is a valued and complex role that is shaped by culture and context, which can be significantly impacted by a cancer diagnosis. This scoping review explored the unmet supportive care needs and impact on daily life for parents living with and beyond cancer. Methods: We used the PRISMA extension for scoping reviews (PRISMA-ScR) reporting guidelines to conduct a scoping review of the literature. Peer-reviewed literature published between January 2006 and December 2021 was searched using five databases: CINAHL, PsycINFO, PubMed, EMBASE, and Web of Science. Results: A total of 47 articles were included in the review representing 14 countries. Unmet supportive care needs persist across physical, spiritual, psychological, social, informational, practical, emotional domains, regardless of cancer diagnosis, stage of cancer or phase of the cancer care continuum. These unmet needs significantly impacted the daily lives of mothers and fathers living with and beyond cancer throughout studies. Conclusion: The results from this review highlight the range of reported supportive care needs of parents and its impact potentially contributing to occupational disruption. This provides a unique opportunity for occupational therapy practitioners to contribute to the occupational needs of parents living with and beyond cancer as an integral member of the interprofessional cancer care team.

What can be done to manage hyperpigmentation and melasma during pregnancy?

Pregnancy-induced hyperpigmentation and melasma are extremely common. While not associated with mortality or morbidity, these phenomena can still have a significant impact on a patient's psychological wellbeing. If treatment does commence, to ensure the safety of mother and child, careful review of the available modalities is essential. Francesca Ramadan presents an overview of the options that are considered both efficacious and safe for use during pregnancy and lactation