Final Analysis Research Articles

Biomechanical imaging biomarker during chemoradiotherapy predicts treatment response in head and neck squamous cell carcinoma

Objective. For response-adapted adaptive radiotherapy (R-ART), promising biomarkers are needed to predict post-radiotherapy (post-RT) responses using routine clinical information obtained during RT. In this study, a patient-specific biomechanical model (BM) of the head and neck squamous cell carcinoma (HNSCC) was proposed using the pre-RT maximum standardized uptake value (SUVmax) of 18F-fluorodeoxyglucose (FDG) and tumor structural changes during RT as evaluated using computed tomography (CT). In addition, we evaluated the predictive performance of BM-driven imaging biomarkers for the treatment response of patients with HNSCC who underwent concurrent chemoradiotherapy (CCRT). Approach. Patients with histologically confirmed HNSCC treated with definitive CCRT were enrolled in this study. All patients underwent CT two times as follows: before the start of RT (pre-RT) and 3 weeks after the start of RT (mid-RT). Among these patients, 67 patients who underwent positron emission tomography/CT during the pre-RT period were included in the final analysis. The locoregional control (LC), progression-free survival (PFS), and overall survival (OS) prediction performances of whole tumor stress change (TS) between pre- and mid-RT computed using BM were assessed using univariate, multivariate, and Kaplan–Meier survival curve analyses, respectively. Furthermore, performance was compared with the pre and post-RT SUVmax, tumor volume reduction rate (TVRR) during RT, and other clinical prognostic factors. Main results. For both univariate, multivariate, and survival curve analyses, the significant prognostic factors were as follows (p < 0.05): TS and TVRR for LC; TS and pre-RT FDG-SUVmax for PFS; and TS only for OS. In addition, for 2 year LC, PFS, and OS prediction, TS showed a comparable predictive performance to post-RT FDG-SUVmax. Significance. BM-driven TS is an effective prognostic factor for tumor treatment response after CCRT. The proposed method can be a feasible functional imaging biomarker that can be acquired during RT using only routine clinical data and may provide useful information for decision-making during R-ART.

Fetal Anterior Abdominal Wall Thickness as an Indicator of Gestational Diabetes: A Sonographic Study

Objective: During pregnancy, sonographic measurements of subcutaneous adipose tissue may be a reliable diagnostic predictor of gestational diabetes mellitus (GDM) and fetal metabolism. A sonographic view of the fetal abdominal circumference can be used to measure the fetal anterior abdominal wall thickness (AAWT), which is straightforward and simple. Consequently, in this study, the aim was to evaluate whether the fetal AAWT value could be used as a diagnostic indicator of GDM, thus preventing the adverse neonatal and maternal outcomes thereof, including shoulder dystocia, neonatal hypoxia, and injury to the birth canal, secondary to fetal macrosomia. Materials and Methods: This prospective cross-sectional study was conducted at a hospital in Lahore, Pakistan, over a 9-month period. A total of 176 female participants in their third trimester of pregnancy were included in this study. The participants were assigned to two cohorts: a cohort of 88 participants diagnosed with GDM and a control cohort of 88 participants without GDM. An independent sample t test, analysis of variance, and chi-square test were used to compare the characteristics between the two cohorts of participants. A final analysis was performed to determine the strength of the correlations between the estimated fetal weight (EFW) and AAWT values. Results: The GDM and control cohorts had mean fetal AAWT values of 12.65 ± 1.276 and 6.389 ± 1.503, respectively. Thus, a statistically significant difference in the fetal AAWT values was observed between the GDM and control cohorts. Furthermore, a statistically significant positive correlation between the EFW and AAWT values was observed ( P = .01). Conclusion: This study highlighted that women with GDM have a considerably higher fetal AAWT values than those without GDM. In addition, the findings revealed that the AAWT value was correlated with the EFW value. Consequently, an increased fetal AAWT value can potentially be utilized as a predictive indicator for those pregnant women at risk of developing GDM, thus preventing adverse maternal and fetal outcomes.

Long-term outcomes and quality of life following implementation of dedicated mitral valve Heart Team decisions for patients with severe mitral valve regurgitation in tertiary cardiovascular care center.

This study was purposed to investigate which treatment strategy was associated with the most favourable prognosis for patients with severe mitral regurgitation (MR) following Heart Team (HT)-decisions implementation. In this retrospective study, long-term outcomes of patients with severe MR qualified after HT discussion to: optimal medical treatment (OMT) alone, OMT and MitraClip (MC) procedure or OMT and mitral valve replacement (MVR) were evaluated. The primary endpoint was defined as cardiovascular (CV) death and the secondary endpoints included all-cause mortality, myocardial infarctions (MI), strokes, hospitalizations for heart failure exacerbation and CV events during a mean (standard deviation [SD]) follow-up of 29 (15) months. From 2016 to 2019, 176 HT meetings were held and a total of 157 participants (mean age [SD] = 71.0 [9.2], 63.7% male) with severe MR and completely implemented HT decisions (OMT, MC or MVR for 53, 58 and 46 patients, respectively) were included into final analysis. Comparing OMT, MC and MVR groups statistically significant differences between the implemented procedures and occurrence of primary and secondary endpoints with the most frequent in OMT-group were observed (p < 0.05). However, for interventional strategy MC was non-inferior to MVR for all endpoints (p > 0.05). General health status assessed at the end of follow-up were significantly the lowest for MVR, then for MC and the highest for OMT-group (p < 0.01). In the present study it was demonstrated that after careful HT evaluation of patients with severe MR at high risk of surgery, percutaneous strategy (MC) can be considered as equivalent to surgical treatment (MVR) with non-inferior outcomes.

Cetuximab versus methotrexate in first-line treatment of older, frail patients with inoperable recurrent or metastatic head and neck cancer (ELAN UNFIT): a randomised, open-label, phase 3 trial

At present, there is no established standard treatment for frail older patients with recurrent or metastatic head and neck squamous cell carcinoma. We aimed to compare the efficacy and safety of cetuximab to those of methotrexate (the reference regimen) in this population. This randomised, open-label, phase 3 trial was done at 20 hospitals in France. Patients aged 70 years or older, assessed as frail by the ELAN Geriatric Evaluation, with recurrent or metastatic head and neck squamous cell carcinoma in the first-line setting and with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 were eligible for inclusion. Patients were randomly assigned (1:1) to receive cetuximab 500 mg/m2 intravenously every 2 weeks or methotrexate 40 mg/m2 intravenously every week, with minimisation by ECOG performance status, type of disease evolution, Charlson Comorbidity Index score, serum albumin concentration, and geriatrician consultation. To avoid deterministic minimisation and assure allocation concealment, patients were allocated with a probability of 0·80 to the treatment that most reduced the imbalance. Treatment was continued until disease progression or unacceptable toxicity, whichever occurred first. The primary endpoint was failure-free survival (defined as the time from randomisation to disease progression, death, discontinuation of treatment, or loss of 2 or more points on the Activities in Daily Living scale, whichever occurred first) and was analysed in the intention-to-treat population. 151 failures expected out of 164 patients were required to detect a hazard ratio (HR) of 0·625 with 0·05 alpha error, with 80% power. A futility interim analysis was planned when approximately 80 failures were observed, based on failure-free survival. Safety analyses included all patients who received at least one dose of the study drug. This study is registered on ClinicalTrials.gov (NCT01884623) and was stopped for futility after the interim analysis. Between Nov 7, 2013, and April 23, 2018, 82 patients were enrolled (41 to the cetuximab group and 41 to the methotrexate group); 60 (73%) were male, 37 (45%) were aged 80 years or older, 35 (43%) had an ECOG performance status of 2, and 36 (44%) had metastatic disease. Enrolment was stopped for futility at the interim analysis. At the final analysis, median follow-up was 43·3 months (IQR 30·8-52·1). At data cutoff, all 82 patients had failure; failure-free survival did not differ significantly between the groups (median 1·4 months [95% CI 1·0-2·1] in the cetuximab group vs 1·9 months [1·1-2·6] in the methotrexate group; adjusted HR 1·03 [95% CI 0·66-1·61], p=0·89). The frequency of patients who had grade 3 or worse adverse events was 63% (26 of 41) in the cetuximab group and 73% (30 of 41) in the methotrexate group. The most common grade 3-4 adverse events in the cetuximab group were fatigue (four [10%] of 41 patients), lung infection (four [10%]), and rash acneiform (four [10%]), and those in the methotrexate group were fatigue (nine [22%] of 41), increased gamma-glutamyltransferase (seven [17%]), natraemia disorder (four [10%]), anaemia (four [10%]), leukopenia (four [10%]), and neutropenia (four [10%]). The frequency of patients who had serious adverse events was 44% (18 of 41) in the cetuximab group and 39% (16 of 41) in the methotrexate group. Four patients presented with a fatal adverse event in the cetuximab group (sepsis, decreased level of consciousness, pulmonary oedema, and death of unknown cause) as did two patients in the methotrexate group (dyspnoea and death of unknown cause). The study showed no improvement in failure-free survival with cetuximab versus methotrexate. Patients with an ECOG performance status of 2 did not benefit from these systemic therapies. New treatment options including immunotherapy should be explored in frail older patients with recurrent or metastatic head and neck squamous cell carcinoma, after an initial geriatric evaluation, such as the ELAN Geriatric Evaluation. French programme PAIR-VADS 2011 (sponsored by the National Cancer Institute, the Fondation ARC and the Ligue Contre le Cancer), GEMLUC, GEFLUC, and Merck Santé. For the French translation of the abstract see Supplementary Materials section.

Factors Impacting Academic Productivity and Satisfaction of Surgeon-scientists: A Nationwide Survey.

To identify factors related to research success for academic surgeons. Many recognize mounting barriers to scientific success for academic surgeons, but little is known about factors that predict success for individual surgeons. A phase 1 survey was emailed to department chairpersons at highly funded US departments of surgery. Participating chairpersons distributed a phase 2 survey to their faculty surgeons. Training- and faculty-stage exposures and demographic data were collected and compared with participant-reported measures of research productivity. Five primary measures of productivity were assessed including number of grants applied for, grants funded, papers published, first/senior author papers published, and satisfaction in research. Twenty chairpersons and 464 faculty surgeons completed the survey, and 444 faculty responses were included in the final analysis. Having a research-focused degree was significantly associated with more grants applied for (PhD, incidence rate ratio (IRR)=6.93; masters, IRR=4.34) and funded (PhD, IRR=4.74; masters, IRR=4.01) compared to surgeons with only clinical degrees (all P<0.01). Having a formal research mentor was significantly associated with more grants applied for (IRR=1.57, P=0.03) and higher satisfaction in research (IRR=2.22, P<0.01). Contractually protected research time was significantly associated with more grants applied for (IRR=3.73), grants funded (IRR=2.14), papers published (IRR=2.12), first/senior authors published (IRR=1.72), and research satisfaction (Odds ratio=2.15) (all P<0.01). The primary surgeon-identified barrier to research productivity was lack of protection from clinical burden. Surgeons pursuing research-focused careers should consider the benefits of attaining a research-focused degree, negotiating for contractually protected research time, and obtaining formal research mentorship.

More fear reduction, better posttraumatic stress symptoms resilience: 1 year longitudinal study based on the psychological trauma recover project-5-6.

The outbreak of COVID-19 not only raised public health concerns but also caused tremendous psychological distress. Deficits in fear played a role in the development and maintenance of posttraumatic stress symptoms (PTSS). We aimed to investigate the relationship between fear and PTSS during COVID-19 at two points. The questionnaire at the first time of investigation (T1) was conducted through WeChat or phone from January 30, 2020 to February 25, 2020 as part of the psychological trauma recover project-5-6 in China. And the questionnaire at the second time of investigation (T2) was collected from March 17, 2021 to June 17, 2021. After 12 months, data from 150 participants were included in the final analysis. Fear was measured by a self-reported question. Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was designed to assess PTSS. Pearson correlation, multivariate regression analysis, and multiple mediator model were used as statistical analyses. Fear reduced significantly over time. Participants with higher fear presented worse PTSS in both T1 and T2. Positive correlations between fear and PTSS of participants were found over time. Occupation and change of fear are significant predictors in the severity of PTSS over time. Change of fear partially mediated the relationship between the PCL-5 total score in T1 and the development of PTSS. Fear reduction was beneficial to trauma resilience. Future interventions could be developed to reduce excessive fear in facing natural disasters or following epidemics. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trauma-Informed Care Training in Forensic Mental Health Services: A Scoping Review

Within forensic populations, exposure to traumatic experiences is high. These experiences are associated with multiple mental and physical health problems later in life. Forensic services would therefore ideally adopt a trauma-informed approach. The aim of this scoping review is to identify trauma-informed training or education for staff within forensic mental health care. A database search of English or Dutch language articles from PubMed, PsycINFO, Embase, Scopus and Web of Science was performed. Researchers reviewed 6,386 articles and nine were included for final analysis, all in justice-involved youth populations. Results show that training in trauma-informed care may facilitate the relationship between staff members and residents and create safer treatment units. Besides this, a reduction in post-traumatic stress symptoms and greater clinical improvement in depression, anxiety, hope and optimism among justice-involved youth was noted. Trauma-informed staff training may also lead to a decrease in incidents taking place as well as a decrease in use of restraints and seclusion.

확장된 목표지향적 행동모형을 적용한 e스포츠 팬 시청의도 영향 요인 분석

This study was conducted to explore the factors influencing the intention to watch esports leagues among fans. The aim was to identify marketing factors for esports leagues and enhance the sustainability of the esports league. The study targeted adult fans who had experience watching Korean esports leagues. 349 datasets for the final analysis. Data collection and analysis were performed using SPSS 24 and AMOS 22 for Windows, and the methods included frequency analysis, confirmatory factor analysis, correlation analysis, and structural equation path model analysis. The results of the study are as follows. First, attitude, subjective norms, perceived behavioral control, and frequency of past esports experiences had a significant impact on desire. Second, positive and negative anticipated emotions did not have a significant impact on desire. Third, perceived behavioral control, frequency of past esports experiences, and desire significantly influenced viewing intention. This study is significant in that it identified factors that can enhance esports league viewership, improving the sustainability of esports.

Efficacy of propofol-supplemented cardioplegia on biomarkers of organ injury in patients having cardiac surgery using cardiopulmonary bypass: a statistical analysis plan for the ProMPT-2 randomised controlled trial

BackgroundThe ProMPT-2 trial (Propofol for Myocardial Protection Trial #2) aims to compare the safety and efficacy of low- and high-dose propofol supplementation of the cardioplegia solution during adult cardiac surgery versus sham supplementation. This update presents the statistical analysis plan, detailing how the trial data will be analysed and presented. Outlined analyses are in line with the Consolidated Standards of Reporting Trials and the statistical analysis plan has been written prior to database lock and the final analysis of trial data to avoid reporting bias (following recommendations from the International Conference on Harmonisation of Good Clinical Practice).Methods/designProMPT-2 is a multi-centre, blinded, parallel three-group randomised controlled trial aiming to recruit 240 participants from UK cardiac surgery centres to either sham cardioplegia supplementation, low dose (6 µg/ml) or high dose (12 µg/ml) propofol cardioplegia supplementation. The primary outcome is cardiac-specific troponin T levels (a biomarker of cardiac injury) measured during the first 48 h following surgery.The statistical analysis plan describes the planned analyses of the trial primary and secondary outcomes in detail, including approaches to deal with missing data, multiple testing, violation of model assumptions, withdrawals from the trial, non-adherence with the treatment and other protocol deviations. It also outlines the planned sensitivity analyses and exploratory analyses to be performed.DiscussionThis manuscript prospectively describes, prior to the completion of data collection and database lock, the analyses to be undertaken for the ProMPT-2 trial to reduce risk of reporting and data-driven analyses.Trial registrationISRCTN ISRCTN15255199. Registered on 26 March 2019.

Factor Xa inhibitors versus warfarin in severely obese patients with venous thromboembolism or atrial fibrillation

Objectives: Clinical data for the safety and efficacy of Factor Xa (FXa) inhibitors in severely obese patients is limited. Additional information is needed to assess the risks and benefits of using FXa inhibitors in this patient population. Materials and Methods: A single-center and retrospective chart review was conducted in severely obese patients (body mass index [BMI] &gt;40 kg/m2 or weight &gt;120 kg), who received rivaroxaban, apixaban or warfarin for venous thromboembolism (VTE) treatment or prevention of stroke and systemic embolism in non-valvular atrial fibrillation (AF). The primary endpoint was treatment failure, defined as recurrent VTE in VTE treatment or stroke, transient ischemic attack or systemic embolism in AF within one year of anticoagulation initiation. Secondary endpoints included a composite of major bleeding rates and clinically relevant non-major bleeding (CRNMB) rates. Results: Seventy-three patients were included in the final analysis consisting of 43 patients in the FXa inhibitor arm (apixaban [n = 33] and rivaroxaban [n = 10]) and 30 patients in the warfarin arm. The rate of treatment failure was similar between the FXa inhibitor and warfarin groups (4.7% vs. 6.7%; P = 0.814). Although not statistically significant, major bleeding and CRNMB occurred less frequently in patients receiving FXa inhibitors compared to warfarin (9.3% vs. 23.3%; P = 0.182). Subgroup analysis in patients with BMI &gt;50 kg/m2 or weight &gt;150 kg demonstrated similar efficacy and safety outcomes. The use of non-recommended dosing was more common in the apixaban group compared to the rivaroxaban group. Conclusion: FXa inhibitors (apixaban and rivaroxaban) appear to have similar efficacy and safety compared to warfarin in severely obese patients. Larger prospective studies are needed to confirm these results.

Development of Anti-Radical Comics Electronic Media Based on Local Wisdom (Mekar-Bekal)

This research is motivated by as education develops, the challenges of the government and educators are also getting bigger to protect their students from the infiltration of wrong teachings or ideas about religious understanding, which in the end will lead to radicalism that triggers the emergence of radical movements among students. Facing the signs of intellectual degradation and the latest curriculum changes, there are several things that need to be followed up. The purpose of this research is to develop comics as an alternative learning media to counter radicalism. The research method used is research and development with qualitative and quantitative approaches. The resulting product is in the form of e-comic as a learning medium to strengthen the profile of Pancasila students The results show that the development of e-comic as a Civics learning medium on basic norms that apply in social life to realize justice has passed through four stages of development, namely needs analysis, product design, media production, validation and analysis, while for the product revision stage, testing product trial and final analysis and revision is done. The validation and analysis phase includes validation by material experts, media experts and MTs as resource persons. Eligibility of Civics e-comic In KD the norms that apply in social life to realize justice, in terms of material aspects, language, presentation, media effects on learning strategies and overall appearance. The results of the assessments from material experts, media experts and Civics teachers on all measured aspects stated the results of the assessment in the categories of Very Good and Decent.

Hourly Heat Exposure and Acute Ischemic Stroke

Previous studies have demonstrated the associations of daily high temperature with hospitalizations and mortality from ischemic stroke, but the hourly association of ambient heat and acute ischemic stroke (AIS) onset has been rarely examined. To evaluate the association between hourly high ambient temperature and the onset of AIS. This time-stratified case-crossover study was conducted using a nationwide registry that collects data from more than 200 stroke centers in China. Participants were adult patients with AIS who were hospitalized in the warm seasons between January 1, 2019, and December 31, 2021. Hourly temperature and single-hour temperature exposure lag up to 24 hours before the AIS onset (lag 0 hours to lag 24 hours). The main outcome was onset of AIS. Associations between hourly mean temperatures and AIS onset were analyzed using conditional logistic regression integrated with the distributed lag nonlinear model. Stratification analyses were applied to examine potential association modifiers. Several sensitivity analyses were conducted to examine the robustness of the results. A total of 82 455 patients with AIS (mean [SD] age, 65.8 [11.9] years; 52 267 males [63.4%]) were included in the final analysis. A monotonically increasing risk of AIS onset was associated with higher temperatures. The excess AIS risk occurred immediately at lag 0 hours and persisted for 10 hours. Compared with the reference temperature (12.1 °C), the cumulative odds ratio (OR) over lag 0 to 10 hours of AIS onset associated with extremely high temperature (33.3 °C) was 1.88 (95% CI, 1.65-2.13) nationwide. The exposure-response curve was steeper in the north than in the south (OR, 1.80 [95% CI, 1.53-2.11] vs 1.57 [95% CI, 1.31-1.87]). The ORs were greater for males and patients with a history of dyslipidemia or atrial fibrillation, but the differences were not significant. Results of this study suggest that hourly heat exposure is associated with increased risk of AIS onset. This finding may benefit the formulation of public health strategies to reduce cerebrovascular risk associated with high ambient temperature under global warming.

Реєстр PULSE-COR: взаємозв’язок між еластичністю лівого шлуночка та жорсткістю артерій у пацієнтів з есенціальною артеріальною гіпертензією

For a long time, the problem of the formation of diastolic dysfunction (DD) of the left ventricle (LV) in patients with arterial hypertension (AH) remained insufficiently studied. It was demonstrated that the formation of LV DD is largely related to the increase in stiffness of this heart chamber. We decided to evaluate the extent to which increased LV stiffness, determined noninvasively by echocardiography, is associated with LV diastolic dysfunction and determine the relationship of this method with arterial stiffness indicators for which validated methods have been developed.Materials and methods. A one-center registry called PULSE-COR was established in 2011 and is still in operation. There were 779 AH participants in our sample. A distinct cohort of patients (n=283) with essential AH and no substantial comorbidities were found from the final analysis, which comprised 320 patients who had undergone all requisite diagnostic procedures. Our tool of choice for measuring carotid-femoral pulse wave velocity (cfPWV) was the SphygmoCor device (AtCor, Australia). We also used the VaSera 1500 device (Fukuda Denshi, Japan) to measure cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI). Vascular ultrasound and intima-media thickness measurement (IMT) were included in the ultrasound diagnosis. The ASE 2016 recommendations were followed for the evaluation of diastolic LV function, and the standardized ASE protocol was followed for echocardiography. A standardized formula was used to assess the ventriculo-arterial coupling (VAC) which also included LV end-systolic elastance (Ees) and arterial elastance (Ea) evaluation. We conducted Spearman correlation analysis to identify relationships.Results and discussion. Our cohort were patients with AH, 51 % males; the mean age was 53.6±2.0 years. Mean office blood pressure (BP) was 159.8±4.5 mm Hg for systolic (SBP), 97.9±2.6 mm Hg for diastolic (DBP), 62.0±3.5 mm Hg for pulse blood (PBP) BP, and 76.6±2.2 bits per minute was the mean heart rate (HR). Both the left and right CAVI (R=0.698; p=0.012 and R=0.683; p=0.014) showed a strong correlation with VAC. Both E/A and E/e showed a substantial correlation with ABI (R=0.716; p=0.006 and R=0.764; p=0.002, respectively). cfPWV was linked with nearly the same parameters (R=0.248; p=0.001 for correlation with IMT, R=0.382; p=0.01 for correlation with low-density lipoproteins). Ea was substantially associated with IMT (R=0.491; p=0.24), total cholesterol (R=0.499; p=0.07), and low-density lipoproteins (R=0.687; p=0.001). Ees was substantially correlated with end diastolic volume (R=0.644; p=0.001), blood lymphocytes (R=–0.678; p=0.001), E/A (R=0.159; p=0.007), and E/e’ (R=–0.130; p=0.029).Conclusions. We have found a substantial correlation between validated arterial stiffness measurements and non-invasive LV stiffness evaluation parameters (VAC). VAC also was associated with LV diastolic function parameters

A Qualitative Systematic Review of Healthcare Practitioners' Experience of Workplace Violence.

Healthcare practitioners face significant risks of workplace violence due to various reasons such as hospital congestion, miscommunication, and aggressive behaviours of patients and relatives. Exposure to workplace violence may disrupt the workflow process and compromise patient care in healthcare facilities, ultimately affecting job performance, reducing job satisfaction, and negatively affecting the physical and mental health of healthcare practitioners. This study aimed to review all the published studies conducted on the experiences of workplace violence among healthcare practitioners. This study is a systematic review of qualitative studies. Data were collected through online databases including ScienceDirect, PubMed, MEDLINE and JSTOR were searched from the year 2015-2021. The inclusion criteria were: qualitative methods and mixed methods of data collection and analysis; studies that were carried out among healthcare practitioners who have been experience on workplace violence; scope of the primary studies included experience of workplace violence; and published in English/Malay in academic journal between 2015 and 2021. A total of 15 papers were included in the final analysis. The overall quality of the included papers was high. Of the 15 papers, 12 studies fully met the CASP criteria. The results of the 15 included studies were organised into the thematic groups of: i) verbal violence as the common workplace violence; ii) perceived causes of workplace violence and iii) seeking help. Across different countries, verbal violence was the most common type of workplace violence reported by healthcare practitioners. This review also identified that a lack of information, failure to meet patient expectations, and delayed treatment were the main contributing factors to workplace violence.

Avoidable emergency department visits among palliative care cancer patients: novel insights from Saudi Arabia and the Middle East

BackgroundSeveral studies emerging from developed countries have highlighted a significant number of potentially avoidable emergency department (ED) visits by cancer patients during the end-of-life period. However, there is a paucity of information from developing nations regarding palliative care practices and the utilization of the ED by palliative care patients. Herein, we aim to characterize ED admissions among patients receiving palliative care at our tertiary center in Saudi Arabia.MethodsThis is a retrospective, cross-sectional study evaluating ED visits amongst adult patients with advanced cancer who were receiving treatment under the palliative care department. This study took place over a period of 12 months from July 2021 through to July 2022. Three palliative care specialist physicians independently and blindly reviewed each patient’s ED visits and determined whether the visit was avoidable or unavoidable.ResultsA total of 243 patients were included in the final analysis, of which 189 (78.1%) patients had unavoidable visits and 53 (21.9%) patient visits were classified as avoidable. A significantly higher proportion of breast cancer patients presented with unavoidable admissions (14.3% vs. 3.8%, P = 0.037) compared to other cancer types. The incidence of dyspnea (23.8% vs. 5.7%, P < 0.001) and fevers/chills (23.3% vs. 5.7%, P = 0.005) was significantly higher in patients with unavoidable visits. Patients with avoidable visits had a significantly greater proportion of visits for dehydration (13.2% vs. 2.1%, P = 0.002). Notably, although hospital stay was significantly longer in the unavoidable group (P = 0.045), mortality for palliative care patients—regardless of whether their ED visit was avoidable or unavoidable—was not statistically different (P=-0.069).ConclusionTo our knowledge, this is the largest and most comprehensive study from Saudi Arabia and the Middle East providing insights into the utilization of palliative care services in the region and the propensity of advanced cancer patients towards visiting the ED. Future studies ought to explore interventions to reduce the frequency of avoidable ED visits.

Insomnia disorder and cancer mortality in South Korea: a secondary analysis of musculoskeletal disease cohort.

The association between insomnia disorder and cancer-related mortality risk remains controversial. Therefore, this study aimed to investigate the correlation between insomnia disorder and cancer-related mortality. Patients who were diagnosed with musculoskeletal disease (MSD) between 2010 and 2015 were included in this study as a secondary analysis of a patient cohort with MSD in South Korea. Cancer mortality was evaluated between January 1, 2016, and December 31, 2020, using multivariable Cox regression modeling. Patients with and without insomnia disorder constituted the ID and non-ID groups, respectively. The final analysis incorporated a total of 1,298,314 patients diagnosed with MSDs, of whom 11,714 (0.9%) died due to cancer. In the multivariable Cox regression model, the risk of total cancer-related mortality was 14% (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.10-1.19; P < 0.001) higher in the ID group than in the non-ID group. Moreover, the ID group had a higher risk of mortality due to esophageal (HR, 1.46; 95% CI, 1.08-1.96; P = 0.015), colorectal (HR, 1.20; 95% CI, 1.05-1.36; P = 0.007), head and neck (HR, 1.39; 95% CI, 1.01-1.94; P = 0.049), lung (HR, 1.17; 95% CI, 1.08-1.27; P < 0.001), and female genital organ (HR: 1.39, 95% CI: 1.09, 1.77; P = 0.008) cancers; leukemia; and lymphoma (HR, 1.30; 95% CI, 1.12-1.49; P < 0.001). Insomnia disorder was associated with elevated overall cancer mortality in patients with MSDs, which was more evident for cancer mortality due to esophageal, colorectal, head and neck, lung, and female genital organ cancers; leukemia; and lymphoma.

Learning Immersion According to the Learning Orientation of Adult Learners and Research on Impact on Learning Outcomes

This study confirmed how adult learners' learning orientation affects learning outcomes and empirically analyzed the mediating effect of learning flow. Based on previous research at home and abroad, theories of learning orientation, learning flow, and learning outcomes were reviewed, and a research model and hypothesis were derived based on the theories. Of the 200 returned survey responses, 186 were selected, excluding 14 inappropriate ones, and were subjected to final analysis. The results of this study are as follows. The activity-oriented, learning-oriented, and goal-oriented types of adult learners' learning orientation were found to have a significant effect on learning flow, and learning flow had a significant effect on learning performance. The learning-oriented and goal-oriented types of learning orientation influenced learning outcomes, and learning flow was found to mediate the relationship between the activityoriented, learning-oriented, and goal-oriented types of learning orientation and learning outcomes. What can be seen from these results is that in order for adult learners to participate in learning activities and increase awareness of learning outcomes according to learner orientation, it is necessary to provide various opportunities and incentive systems at lifelong education institutions to increase learning immersion. I'm doing it. Therefore, differentiated lifelong education programs are needed by distinguishing the learning orientation of adult learners.

A pilot study on the "ScoliBrace" in the treatment of adolescent idiopathic scoliosis.

Bracing for adolescents with idiopathic scoliosis (AIS) is a treatment option to prevent curve progression to surgical level. This study aimed to assess the efficacy of a 3D fully customized over corrective brace, "ScoliBrace," an orthosis treatment for AIS. This was a prospective pilot study of AIS female patients with inclusion criteria followed recommended Scoliosis Research Society (SRS) Guidelines. Cobb angles measured at: baseline (T0), 21months (T5-2), skeletal maturity (T6), 6months post-brace (T7), along with hours of brace wear using a thermal sensor and health-related quality of life (HRQoL) using the SRS-22r questionnaire. A total of 30 female AIS patients with mean age 11.85 ± 0.68years, predominantly Risser 0 (70%), and median Cobb angle 29° were recruited; 21 patients were included for the final analysis. Results showed significant difference in Cobb angle between T0 and T5-2 (median = 22.5° vs. 28.5°, p = 0.0082). 57.14% had reduction in Cobb angle by ≥ 5° at skeletal maturity. Cobb angle reduced 0.794° for each additional hour of dosage (p = 0.036, 95% CI = - 1.532°, - 0.056°). Although pain level was increased at T6 (4.37 ± 0.51vs.4.70 ± 0.41, p = 0.014), patients reported significantly greater satisfaction with management of their condition (3.90 ± 0.90vs.3.29 ± 0.88, p = 0.020). Results show similar findings to the BRAIST study, whereby curves remained under surgical threshold and showed improvement. More than half had curve reduction of ≥ 5° at skeletal maturity. Increased dose was also associated with improved outcomes. Using "ScoliBrace" as a non-surgical treatment, maintained curves below surgical threshold and showed curve reduction, improving patient satisfaction with management.

Therapeutic Hypothermia in Low-Risk Nonpumped Brain-Dead Kidney Donors

Delayed graft function in kidney-transplant recipients is associated with increased financial cost and patient burden. In donors with high Kidney Donor Profile Index whose kidneys are not pumped, therapeutic hypothermia has been shown to confer a protective benefit against delayed graft function. To determine whether hypothermia is superior to normothermia in preventing delayed graft function in low-risk nonpumped kidney donors after brain death. In a multicenter randomized clinical trial, brain-dead kidney donors deemed to be low risk and not requiring machine perfusion per Organ Procurement Organization protocol were prospectively randomized to hypothermia (34.0-35 °C) or normothermia (36.5-37.5 °C) between August 10, 2017, and May 21, 2020, across 4 Organ Procurement Organizations in the US (Arizona, Upper Midwest, Pacific Northwest, and Texas). The final analysis report is dated June 15, 2022, based on the data set received from the United Network for Organ Sharing on June 2, 2021. A total of 509 donors (normothermia: n = 245 and hypothermia: n = 236; 1017 kidneys) met inclusion criteria over the study period. Donor hypothermia (34.0-35.0 °C) or normothermia (36.5-37.5 °C). The primary outcome was delayed graft function in the kidney recipients, defined as the need for dialysis within the first week following kidney transplant. The primary analysis follows the intent-to-treat principle. A total of 934 kidneys were transplanted from 481 donors, of which 474 were randomized to the normothermia group and 460 to the hypothermia group. Donor characteristics were similar between the groups, with overall mean (SD) donor age 34.2 (11.1) years, and the mean donor creatinine level at enrollment of 1.03 (0.53) mg/dL. There was a predominance of Standard Criteria Donors (98% in each treatment arm) with similar low mean (SD) Kidney Donor Profile Index (normothermia: 28.99 [20.46] vs hypothermia: 28.32 [21.9]). Cold ischemia time was similar in the normothermia and hypothermia groups (15.99 [7.9] vs 15.45 [7.63] hours). Delayed graft function developed in 87 of the recipients (18%) in the normothermia group vs 79 (17%) in the hypothermia group (adjusted odds ratio, 0.92; 95% CI, 0.64-1.33; P = .66). The findings of this study suggest that, in low-risk non-pumped kidneys from brain-dead kidney donors, therapeutic hypothermia compared with normothermia does not appear to prevent delayed graft function in kidney transplant recipients. ClinicalTrials.gov Identifier: NCT02525510.

로스터리 커피전문점의 물리적 환경과 메뉴품질이 고객 만족 및 재방문의도에 미치는 영향

The purpose of this study is to investigate the impact of the physical environment and menu quality of roastery coffee shops on customer satisfaction and their intention to revisit. To achieve these objectives, a questionnaire was developed based on previous research. A total of 300 questionnaires were distributed, and after discarding 12, 288 were used for the final analysis. The results are as follow: First, the physical environment of roastery coffee shops has a significantly positive effect on customer satisfaction. Second, the menu quality of these coffee shops also positively affects customer satisfaction. Third, customer satisfaction significantly influences the intention to revisit. This study is significant as it provides theoretical material on roastery coffee shops operated by individual proprietors, at a time when the domestic coffee shop market has reached saturation due to quantitative growth, contrasting with studies on franchise coffee shops.