Experience In Use Research Articles

ELECTRONIC INFORMED CONSENT MODEL DEVELOPMENT FOR IMPLEMENTATION IN CLINICAL TRIALS IN UKRAINE

Objectives: The process of signing the informed consent (IC) is one of the essential procedures during organizing and conducting the clinical trial (CT) of any new drug. During this procedure, the volunteers should read the IC form that is often difficult to understand. Analysis of literature showed lack of experience in use of electronic systems in the IC signing in Ukraine. Abroad such systems are quite new. Thus, the aim of this work is the rationale for the introduction of electronic IC to CT drugs in Ukraine and the development of its general model.Methods: Experience in the use of electronic systems in IC signing analysis was carried out using methods of system analysis, synthesis, abstraction, and generalization.Results: Thus, during the signing process of paper forms risks and errors may arise such as loss of paper copies and signing of an incorrect version of the document by the volunteer. With the use of electronic forms, it is possible to prevent three categories of risks in preparation and signing, such as risks in the development, use, and auditing of IC forms. The opportunities of the electronic IC system to protect trial subjects in its use during organizing and conducting of CT were showed.Conclusions: The study showed that such systems are effective. Therefore, it seems appropriate to introduce electronic IC in CT of new drugs in Ukraine. We have formulated requirements to the system and determined its structure for optimal use.

Exploring Working Relationships in Mental Health Care via an E-Recovery Portal: Qualitative Study on the Experiences of Service Users and Health Providers

BackgroundThe quality of working relationships between service users and health providers is fundamental in the processes of recovery in mental health. How Internet-based interventions will influence these relationships for persons with long-term care needs, and the measures that can be taken to maintain and enhance working relationships through Internet, is still not well understood.ObjectiveThe aim of this study was to gain insights into how service users and health providers experience their working relationships when they are offered the option of supplementing ongoing collaboration with an e-recovery portal.MethodsIn this exploratory and descriptive study, an e-recovery portal was used by service users and their health providers in 2 mental health communities in Norway for at least 6 months and at most 12 months (2015-2016). The portal consists of secure messaging, a peer support forum, and a toolbox of resources for working with life domains including status, goals and activities, network map, crisis plan, and exercises. The portal was owned and managed by the service user while health providers could remotely access parts of the service user–generated content. The participants could use the portal in whatever way they wished, to suit their collaboration. Data from 6 focus groups, 17 individual interviews, and an interview with 1 dyad about their experiences of use of the portal over the study period were inductively coded and thematically analyzed.ResultsThe thematic analysis resulted in 2 main themes: (1) new relational avenues and (2) out of alignment, illustrated by 8 subthemes. The first main theme is about dyads who reported new and enriching ways of working together through the portal, particularly related to written communication and use of the goal module. Illustrative subthemes are ownership, common ground, goals and direction, and sense of presence and availability. The second main theme illuminates the difficulties that arose when service users’ and health providers’ expectations for portal use were not aligned, and the consequences of not addressing these difficulties. Illustrative subthemes are initiative and responsibility, waiting for the other, feeling overwhelmed, and clarifications and agreements.ConclusionsThe degree to which dyads benefited from using the e-recovery portal appeared to be mainly associated with the degree to which the dyads’ relations were open and flexible before the portal was introduced. For those who experienced frustrations, the portal may have both exposed and added to suboptimal working relationships. Use of the goal module appeared to strengthen the person-centered nature of collaboration. A key question is how health providers balance between enabling service users’ greater control over their care, without relinquishing responsibility for the quality of the working relationship, also when using an e-recovery portal. Implications for implementation are discussed.

Expectations and provocations

PurposeThe purpose of this paper is to address participants’ humorous provocations as a part of informal interactions between participants and researcher that can be treated just like the research data. By means of autoethnographic analysis, the author explores the expectations of the researcher and participants that humour research entails and discusses how different expectations are revealed in participants’ provocations.Design/methodology/approachThis paper uses an autoethnographic approach to discuss the informal interactions between participants and the researcher gathered during research into staffroom humour. The informal interactions in general and humour specifically were recorded, analysed, coded, interpreted and theorised just like the data on humour between participants. The theoretical framework used in the study combines Goffman’s (1959) version of symbolic interactionism and Solomon et al. (2006) idea of hybrid spaces.FindingsThe study shows the need for reconsideration of expectations entangled in humour research and proposes to be prepared for unexpected. Expecting unexpected can help stay open minded in the field and in interactions with participants and apply healthy distance towards own research and own expectations. The study shows that whenever certain behaviour was expected and different behaviour was delivered, there was a chance for certain behaviour being interpreted as provocations. Participants’ provocations can result from their own expectations about the research or what they think is expected from them by the researcher and thus they remain subject to different interpretations.Research limitations/implicationsFurther research could investigate and discuss the role of humour in participant-researcher interactions in different research contexts and across different methodologies. Combining and analysing experiences of use of humour from both participants and researchers could allow for creating the guidelines in the use of humour in different research situations. Ethical challenges posed by informal interactions between researcher and participants could be explored further and suggestions as to how to protect the researcher, research and participants in such interactions could be developed.Originality/valueThis paper aims to be a starting point for a discussion about the understudied relationship between expectations humour research is entangled with and participants’ provocations. The study shows innovative approach to informal interactions between participants’ and researcher which are treated as research data and are theorised using original combination of symbolic interactionism and hybrid spaces. The study contributes to the qualitative research methodology by discussing the ethics of both using humour with participants and recording and analysing informal humorous interactions between participants and the researcher.

AUTOMATED INFORMATION SYSTEM OF CONTROL OF AVAILABILITY AND USING OF NATURAL RESOURCES

The purpose of this work is to create an automated system for recording the availability and use of natural resources in the Republic of Belarus. To achieve this goal, the following main tasks were solved: to conduct an analytical review of similar information systems, to highlight their advantages and disadvantages, to develop a new improved version of the system, taking into account previous experience of use, to test the received tool for assessing the environmental friendliness of nature-intensive production and technology. The article provides an analytical review of modern software tools for automation of accounting and rational use of natural resources. It is shown that their application is not possible for a qualitative solution of urgent problems in our country. Three versions of the automated system designed for collecting, storing, processing and presenting subject data on the availability and use of natural resources are consistently described. Comparative analysis with existing analogs is carried out. The distinctive features and advantages of the proposed solution are indicated. With the use of the developed system, the nature of projects in the State Program for Innovative Development of the Republic of Belarus for 20011–2015 was evaluated. The Ministry of Energy is pointed as the state customer of the most resource-intensive use projects and technologies. Thus, it is shown that the proposed automated information system for recording the availability and use of natural resources makes it possible to collect, store, analyze and display the subject information, and is an actual basis for supporting the adoption of management decisions in the field of natural recourses management and environmental protection. The obtained results were used by the State Committee for Science and Technology for the evaluation of projects as part of the State Program of Innovative Development of the Republic of Belarus for 2011–2015 for the sake of natural recourses cost-effectiveness.

Evaluation of an approach to define elicitation guides of non‐functional requirements

Non-functional requirements (NFR) elicitation is a complex activity, since it requires specific knowledge in many different areas, such as performance, security, portability and usability. An approach for the definition of NFR elicitation guides (ADEG-NFR) was proposed with the objective of supporting the requirement engineers in carrying out this activity and providing mechanisms for customer involvement in this process. An elicitation guide consists of a set of questions, templates and examples of requirements to make the elicitation process easier using an appropriate language to customer. Besides, appropriate language to the customer's understanding is the natural language described in a clear way, avoiding the use of technical terms. This study evaluates the results of the experience of use of ADEG-NFR in a software development organisation. Results have shown that ADEG-NFR fulfills its purpose. In addition, the ADEG-NFR evaluation process has identified opportunities for improvement that can help in the evolution and adoption of ADEG-NFR by different organisations in the industry.

CHRONIC PATELLAR INSTABILITY: ANATOMIC PRECONDITION AND APPROACHES TO SURGICAL TREATMENT

The literature review is dedicated to the problem of recurrent patella dislocation treatment. The key anatomic predispositions to patellar instability development are presented. The principles on which the techniques for surgical treatment of recurrent patella dislocation have been developed and used since the early 19th century are described. Thirty years’ experience in use of various surgical techniques for patellar stabilization that show both obvious advantages and certain disadvantages is generalized. Actual problems and issues of recurrent patella dislocation surgical treatment are reflected.

EXPERIENCE IN USE OF BUVANESTIN AND OTHER MODERN LOCAL ANESTHETICS IN TRAUMATOLOGY AND ORTHOPAEDICS

Clinical experience in use of Buvanestin and other local anesthetics (Marcaine,Naropin) in traumatology and orthopaedics is presented. Careful evaluation of the effect of various drugs (Refortan, Ringer’s solution, Mafusol) preinfusion upon the status of hemodynamics in elderly and senile patients at operations for femoral fractures has been performed. It has been shown that by the anesthetic properties Buvanestin practically does not differ from Marcaine. Preinfusion of Mafusol has shown the advantages over the Ringer’s solution and Refortan in ensuring more stable hemodynamics during operation and in the early (within 20-30 min) postoperative period.

Chronic Patellar Instability: Anatomic Precondition and Approaches to Surgical Treatment

The literature review is dedicated to the problem of recurrent patella dislocation treatment. The key anatomic predispositions to patellar instability development are presented. The principles on which the techniques for surgical treatment of recurrent patella dislocation have been developed and used since the early 19th century are described. Thirty years’ experience in use of various surgical techniques for patellar stabilization that show both obvious advantages and certain disadvantages is generalized. Actual problems and issues of recurrent patella dislocation surgical treatment are reflected.

Experience in Use of Buvanestin and Other Modern Local Anesthetics in Traumatology and Orthopaedics

Clinical experience in use of Buvanestin and other local anesthetics (Marcaine,Naropin) in traumatology and orthopaedics is presented. Careful evaluation of the effect of various drugs (Refortan, Ringer’s solution, Mafusol) preinfusion upon the status of hemodynamics in elderly and senile patients at operations for femoral fractures has been performed. It has been shown that by the anesthetic properties Buvanestin practically does not differ from Marcaine. Preinfusion of Mafusol has shown the advantages over the Ringer’s solution and Refortan in ensuring more stable hemodynamics during operation and in the early (within 20-30 min) postoperative period.

Experience in Use of Modified McLaughlin Procedure for Neglected Locked Posterior Subluxation of the Humeral Head

Treatment results for 7 patients who were operated on for neglected locked posterior subluxation of the humeral head with reverse Hill-Sachs lesion during 2013-2016 are presented. Surgical intervention included the open reduction of subluxation and transposition of thelesser tubercle of the humerusto a defect zone. Mean followup period was 14±3 months. Range of motion in shoulder joint and its function were restored almost completely with only small restriction in external rotation. No recurrence of subluxation was observed. All patients returned to professional and day-to-day activity.

El uso de dispositivos móviles por niños: entre el consumo y el cuidado familiar

Este artículo presenta los resultados de una investigación orientada a la comprensión de los intereses, expectativas y conflictos sociales que surgen en torno al uso de tecnologías móviles por parte de niños. Desde un enfoque crítico, se entiende la tecnología como una instrumentalización de intereses sociales en disputa: por una parte, los intereses dominantes que el mercado y el consumo establecen y, por otra, las expectativas familiares en torno a la comunicación y el cuidado familiar. Durante el año 2015 se desarrolló un estudio de casos a partir de la vinculación con estudiantes y apoderados de un curso de Cuarto básico de una escuela municipal de la ciudad de Temuco, Chile, y en el cual se implementaron grupos de discusión, entrevistas en profundidad y otras técnicas de investigación adaptadas al trabajo con niños. El análisis se orientó hacia la comprensión de las experiencias de uso, normas sociales, cambios, conflictos y expectativas familiares asociados con los dispositivos móviles. Se concluye reflexionando sobre la relevancia que la comprensión de fenómenos tecnológicos tiene para el trabajo social, en este caso, especialmente para el trabajo con familias, y se desarrollan propuestas generales de política pública adaptadas al caso chileno.

Percutaneous Transpedicular Fixation in Traumatic Spondylolisthesis of L5 Vertebra

The use of percutaneous transpedicular fixation in traumatic spondylolisthesis of L5 vertebra without neurologic complications in 37 years old patient is presented. Surgical intervention, technical capability and peculiarities of surgery when using low invasive technique for vertebral body reduction are described. In cases of non-complicated injury percutaneous transpedicular fixation could be a prospective alternative to a standard fixation technique. However it should not be recommended to wide clinical application as it requires special skills and experience in use of low invasive systems and appropriate instrumentation.

Percutaneous Transpedicular Fixation in Traumatic Spondylolisthesis of L5 Vertebra

The use of percutaneous transpedicular fixation in traumatic spondylolisthesis of L5 vertebra without neurologic complications in 37 years old patient is presented. Surgical intervention, technical capability and peculiarities of surgery when using low invasive technique for vertebral body reduction are described. In cases of non-complicated injury percutaneous transpedicular fixation could be a prospective alternative to a standard fixation technique. However it should not be recommended to wide clinical application as it requires special skills and experience in use of low invasive systems and appropriate instrumentation.

Inglés

When ergonomic criteria are separately applied to the design of chairs, the feeling of comfort is not guaranteed. In this case, the aesthetic and perceptive features of the chair provide the sensations of comfort, and several studies have determined that comfort and discomfort present some characteristics that make them different from each other. Moreover, early judgements by the user remain invariable when there is no interaction between the person and the object. Therefore, it can be assumed that if a device is considered comfortable after an initial experience of use, it may well not be thought as such after extended use. Based on this, the present research study aimed at establishing the differences in the perceptions of comfort of two chairs before and after extended sitting posture. Six subjects participated in this study, all they were women from 20 to 45 years of age, who usually perform office work in extended sitting posture, with a body mass index (BMI) ranging between 20 and 30 Kg/m2. In the experiment, four office tasks were assigned (reading, transcribing a text, handwriting and searching on the internet) during sixty minutes. The experiment was divided into two sessions, in order to use the two chairs subject of the study. Each participant was assessed at the same hour but in two different days. By means of the semantic differential, evaluations of visual perception were carried out by the participants before and after using the chair. The results reveal differences in the perception evaluation of both chairs before and after their use. In the case of the chair a, the assessment of the adjectives never decreased. This study shows that the pleasure provided by a product is not static and it does evolve on the basis of product time of use and manipulation. Even though there were no statistical differences in the adjective pairs studied when only one chair is examined, it was demonstrated that its perception may improve or worsen on the basis of time. Similarly, this perceptual behavior is not indifferent to the object, finding significant differences before and after use when comparing the chairs. Finally, this analysis tool provides better evidence on product functionality by indicating whether there are failures in the proposed design.

Investigating Idiopathic Inflammatory Myopathy; Initial Cross Speciality Experience with Use of the Extended Myositis Antibody Panel.

The discovery of unique autoantibodies has informed and altered our approach to the diagnosis and management of the inflammatory myopathies. This study reports the initial clinical experience of use of the Extended Myositis Antibody (EMA) panel in the largest university teaching hospital in Ireland. We conducted a retrospective review of all patients who had serum samples tested for myositis specific antibodies and myositis associated antibodies from April 2014 to March 2015. A positive EMA panel was of significant clinical utility in facilitating decisions on appropriate investigations, and need for onward referral to other physicians. Furthermore, this paper highlights the diversity of possible presentations of idiopathic inflammatory myopathy with subsequent need for multi-speciality involvement, and serves to heighten awareness among clinicians of the diagnostic use of extended myositis antibody testing in these cases.

Experience of use of Konegra Deluxe in the therapy of erectile dysfunction

Experience of use of Konegra Deluxe in the therapy of erectile dysfunction

Erasmus students’ involvement in quality enhancement of Erasmus+ mobility through digital ethnography and ErasmusShouts

Erasmus+ is one of the European Union’s flagship programs which supports short-term international student mobility within Europe as one of its primary purposes. Erasmus students are uniquely well placed to compare educational processes of their home and host institutions, the learning environments and student life conditions. They are so far under-utilized resource of information on quality of educational practices and insights on how to improve student experiences. Furthermore, international students often lack a collective voice in university structures where they could contribute to the decisions concerning quality of educational practices. So far, student surveys have been the most frequently used approach in understanding lived experiences of Erasmus and international students. This commentary argues that qualitative approaches to collect data on student lived experiences are superior to survey research, yet more costly. In times when all students are digital natives, it has become possible, however, to canvass data from students through digital ethnographic approaches. The commentary introduces ErasmusShouts, a web application, which engages Erasmus students as auto-ethnographers and prompts them to reflect on, and record their lived experiences of Erasmus mobility. This approach can be adopted to generate large-scale qualitative data on international students’ experiences for use by higher education practitioners and researchers to improve educational practices and learning environments.

Efficacy of eplerenone (Epe) in the management of mineralocorticoid excess (MCE) in men with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone (AA) without prednisone (P).

261 Background: AA is approved for Mcrpc with co-administration with P to prevent MCE toxicity such as hypertension, hypokalemia and edema. However, use of P is often not desirable by the relatively asymptomatic patients because of potential for detrimental effects of long term corticosteroid therapy. Epe is a non-steroidal mineralocorticoid antagonist demonstrated to abrogate MCE. Here we report real world experience of use of Epe with AA in men with mCRPC who wished to avoid concomitant P. Methods: Incidence and grade (CTCAE v4) of MCE, along with baseline demographics, disease characteristics, and progression free survival (PFS) in men with mCRPC treated with AA (1000 mg daily), not willing to be treated with P (and thus received treatment with Epe 50 mg daily) were collected retrospectively, and compared with those treated with AA + P (10 mg daily) during the same time period (Table). Continuous variables were assessed by Wilcoxon rank sum or student t-test, and categorical variables were assessed by Fischer’s Exact test or chi-square as appropriate. PFS was compared by Kaplan-Meier. Results: Baseline and disease characteristics, median PFS, and toxicities of all grades were similar in both cohorts (Table). Conclusions: In real world population of men with mCRPC treated with AA, corticosteroids may be avoided by concomitant treatment with Epe. Data need further validation in a larger cohort. [Table: see text]

Evaluating Factors Affecting Clinicians’ Knowledge on Contrast Media: Kenyan Experience

<strong>Purpose:</strong> Our study aimed to establish exposure to and level of knowledge about contrast media among non-radiological clinicians and evaluate the contributory factors to the status. <strong>Methods and Materials:</strong> A cross-sectional study was conducted between April and December 2015 through interviews using structured questionnaires. We recruited 197 non-radiological clinicians with experience in use of contrast media in their routine practice. They were of different cadres and years of experience, all working in a large referral hospital in Kenya. Levels of basic knowledge on contrast media were evaluated through a scoring system after each clinician responded to the questions provided. We also sought for training on contrast media among these clinicians and where applicable the source of the same recorded. Descriptive and inferential statistical methods were applied across the different clinicians’ subsets. <strong>Results:</strong> Thirty-seven respondents representing 18.8% of the study sample had received formal training on contrast media. Mean knowledge score for all clinicians in this study was 14.6 translating to 14.1% of a set maximal theoretical score of 103 points. The standard deviation was 5.5. Analysis of variance (ANOVA) test for knowledge mean score among different cadres gave a P value 0.079. Unpaired t-test gave a two- tailed P value 0.2410 for mean score when trained and untrained clinicians were compared. The level of knowledge (mean score) when analysed against years of experience for the clinicians produced statistically significant results with P value 0.001084. <strong>Conclusion:</strong> Training and knowledge on contrast media can be profoundly low for clinicians. However, there is a possibility of knowledge improving from experience in practice due to multidisciplinary interaction and the implied advantage of encapsulated knowledge.

Treatment of postmenopausal osteoporosis: a literature-based algorithm for use in the public health care system

Bisphosphonates are considered first-line agents in the treatment of postmenopausal osteoporosis based on extensive experience of use, safety, and proven efficacy in reducing vertebral, non-vertebral and femur fractures. However, post-marketing reports based on the treatment of millions of patients/year over lengthy periods of time have revealed the occurrence of initially unexpected adverse effects, such as osteonecrosis of the jaw and atypical femoral fracture, leading to the restriction of treatment duration with bisphosphonates by global regulatory agencies. However, despite the association between these effects and bisphosphonates, this risk should be analyzed in the context of osteoporosis treatment, alongside the benefit of preventing osteoporotic fractures and their clinical consequences. Therefore, we consider it plausible to discuss the restriction to the use of bisphosphonates, possible indications for prolonged treatment and alternative therapies following the suspension of this drug class for patients with persistent high risk of fracture after initial treatment, especially considering the problems of public health funding in Brazil and the shortage of drugs provided by the government. Thus, to standardize the treatment of osteoporosis in the public health care system, we aim to develop a proposal for a scientifically-based pharmacological treatment for postmenopausal osteoporosis, establishing criteria for indication and allowing the rational use of each pharmacological agent. We discuss the duration of the initial bisphosphonate treatment, the therapeutic options for refractory patients and potential indications of other classes of drugs as first-choice treatment in the sphere of public health, in which assessing risk and cost effectiveness is a priority.