Improving the Uptake of the Australian Home Medicines Review through Patient Segmentation

The Australian Home Medicines Review (HMR) Program, aimed at reducing the number of medication-related problems and hospital admissions, has not been used to the extent projected and is little known among eligible consumers. PURPOSE: This paper investigates the problems patients and caregivers have with using medicines appropriately, their desire for assistance with managing medications and their self-perceived need for a Home Medicines Review. DESIGN: A qualitative research study was conducted with 8 semi-structured focus groups including a total of 50 HMR-eligible patients and caregivers. Participants who were purposively sampled represented older males, older females, younger chronically ill patients, patients from Chinese and Arabic backgrounds and the general HMR target group. FINDINGS: According to the types of medicine problems encountered by participants, their level of medicine understanding and their desire for assistance with using medicines, four distinct patient types are identified and explicated: the heedless patient, the aware patient, the scrupulous patient and the self-sufficient patient. PRACTICAL IMPLICATIONS: The uptake of the HMR service can be effectively increased by direct-to-consumer HMR promotion that is tailored to the behaviors, needs and desires of eligible patients and caregivers. The proposed segmentation model of HMR-eligible consumers addresses these differences and can be used to inform health policy makers regarding a more effective promotion of the HMR service. ORIGINALITY: This is the first study to investigate how the HMR-uptake could be increased from the perspective of eligible patients and their caregivers

Sustainability, Innovation and Biological Technology in Wine Production: An Empirical Analysis

The agri-food industry is strongly connected to environmental issues of sustainability; the very concept of quality agri-food goes hand in hand with the development of crops and production methods that protect the territory, and which increasingly reduce the use of substances harmful to humans and the environment (Casini et al, 2010; Cantino et al., 2018). This type of reasoning can be applied to the wine sector which has traditionally shown great attention to the environmental aspect, recognizing in this element a factor of wine quality (Gilinsky et al., 2015). As pointed out in the First Report on the Sustainability of Wine (http://www.vinosostenibile.org), awareness of the technical and commercial importance of the link between characteristics of the place of production and characteristics and identity of the wine led already in the 19th century to the development of the concept of territory and subsequently, with increasing sensitivity to social and environmental issues, many companies, also with a view to corporate social responsibility, have adopted innovations in corporate processes aimed at greater respect for the environment (Szolnoki, 2013; Siepmann, 2018). The wine world has reacted to the challenge of sustainable development through the development of collective initiatives (Castellini et al., 2014) for the implementation of sustainability programs (Roualt et al., 2016) for the analysis and evaluation of the production processes in the companies involved, with a view to continuous improvement, sharing of best practices for internal and external communication of performance achieved in terms of sustainability (Olaru et al., 2014). In Italy, the world of winegrowing has positevely reacted to the challenge of sustainable development. In the past twenty years, attention to the issue of environmental sustainability has increased more and more, year after year. The reasons are manifold, both environmental, economic and ethical. According to data published by SINAB (National Information System on Organic Agriculture), since 2010 the area for organic agriculture in Italy has increased by almost 800,000 hectares and 27 thousand farms (SINAB, 2019). The data as at 31 December 2018 therefore confirm the growth of the organic farming sector while maintaining the positive trend, as organic areas increased by 2.6% compared to 2017, reaching almost 2 million hectares. Most of the agricultural sectors have recorded an increase in the biological area. Growth for vines and olives is more contained (with only a plus of 1%) (SINAB, 2019). As for the regional distribution of biological surfaces, the largest extension was recorded in Sicily with 385,356 hectares, followed by Puglia with 263,653 hectares, Calabria with 200,904 hectares and Emilia-Romagna with 155,331 hectares. Compared to 2017, biological areas in Sicily and Calabria decreased by 10% and 1% respectively, while in Puglia and Emilia-Romagna they increased by 4% and 15% respectively. The biological surface of these four regions holds 51% of the entire national biological surface (SINAB, 2019). At the end of 2018 in Italy it was recorded that 79,046 businesses were included in the certification system for organic agriculture, recording a 4% increase compared to 2017. It is noted that 58,954 exclusive producers (farms) show a 3% increase over the previous year (SINAB, 2019). Of the total area cultivated in Italy, organic grows to affect 15.5% only of the national UAA (Utilized Agricultural Area), given that in 2017 it grows by one percentage point compared to 2016. From the processing of the surface data, it is clear that on every 100 hectares of UAA are organic: 5.6 hectares in the North-West, 9.3 hectares in the North-East, 20.1 hectares in the Center and in the South and 19.2 hectares in the Islands. Organic farms in Italy, on the other hand, represent 6.1% of total farms. This figure is uniform in all areas of the country. As regards the average size of the farms that make up the Italian organic sector, the average surface area was 28.2 hectares. Larger company areas have been registered in the Center, South and Islands, while North-East and North-West are smaller (SINAB, 2019)

People-related TQM practices: the role of metaperceptions

Purpose– The authors investigate the role of people-related Total Quality Management (TQM) practices, specifically metaperceptions, in hearing care students’ vocational decision-making. In Italy, audiologists are health professionals and must hold a degree in hearing care. They operate according to clinical principles but must also develop marketing and commercial skills. While employers take these aspects for granted, the expectations of hearing care students often differ from reality. Thus, the authors aim to investigate the vocational expectations of hearing care students. Design/methodology/approach– A survey was distributed to 600 hearing care students. Multiple regression analysis with bootstrapped confidence intervals was employed to test the hypotheses. Findings–Studentswhoperceivedaudiologyastheircallingweremoreinterestedintheclinicalaspectsthan the marketing and commercial aspects of audiology. Moreover, those desiring a meaningful career path in audiology were more interested in becoming a store owner or franchisee. Social implications– Universities and recruiters should consider the influence of relevant others’ metaperceptions on students’ self-perceptions of their aptitudes for different careers. Universities should assist studentstoidentifyaptitudesthatare relevanttocareer-related decision-making.Inthis context,people-related TQMcanhelp students avoid incorrect aspirations and expectations. Originality/value– This study is the first to investigate the role of metaperceptions from a people-related TQMperspective. Metaperceptions play a crucial role in determining the correct course of study as well as job satisfaction and expectations

BIOMECHANICAL ANALYSIS OF THREE DIFFERENT BLOCKING FOOTWORK TECHNIQUES IN VOLLEYBALL: A PILOT STUDY

The purpose of this study was to analyse three different blocking footwork techniques in volleyball. In particular the attention was focused on the correlation between anthropometric and kinematic parameters. Three female athletes playing in the first national league were recruited for a pilot study. Bosco tests were executed to have a morphological classification. A stereophotogrammetric system was used to acquire three blocking footwork techniques: slide step, running and jab cross over patterns. Parameters of interest included the blocking time, the jump height, the horizontal and vertical speed of the centre of mass, the frontal position of the body with respect to the net and the invasion angle of the hands over the net. A correlation between jump height and blocking time was observed only in the running step technique. The time of centre of mass maximum speed was significantly less for the jab cross-over step technique. The most effective blocking technique for every athlete was finally obtained

High-pitch dual-source CT angiography without ECG-gating for imaging the whole aorta: intraindividual comparison with standard pitch single-source technique without ECG-gating

PURPOSE:We aimed to perform intraindividual comparison of computed tomography (CT) parameters, image quality, and radiation exposure between standard CT angiography (CTA) and high-pitch dual source (DS)-CTA, in subjects undergoing serial CTA of thoracoabdominal aorta.METHODS:Eighteen subjects with thoracoabdominal CTA by standard technique and high-pitch DS-CTA technique within 6 months of each other were retrieved for intraindividual comparison of image quality in thoracic and abdominal aorta. Quantitative analysis was performed by comparison of mean aortic attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Qualitative analysis was performed by visual assessment of motion artifacts and diagnostic confidence. Radiation exposure was quantified by effective dose. Image quality was apportioned to radiation exposure by means of figure of merit.RESULTS:Mean aortic attenuation and noise were higher in high-pitch DS-CTA of thoracoabdominal aorta, whereas SNR and CNR were similar in thoracic aorta and significantly lower in high-pitch DS-CTA of abdominal aorta (P = 0.024 and P = 0.016). High-pitch DS-CTA was significantly better in the first segment of thoracic aorta. Effective dose was reduced by 72% in high-pitch DS-CTA.CONCLUSION:High-pitch DS-CTA without electrocardiography-gating is an effective technique for imaging aorta with very low radiation exposure and with significant reduction of motion artifacts in ascending aorta; however, the overall quality of high-pitch DS-CTA in abdominal aorta is lower than standard CTA

Regional differences in clear cell metastatic renal cell carcinoma patients across the USA

Purpose To test for regional differences in clear cell metastatic renal cell carcinoma (ccmRCC) patients across the USA. Methods The Surveillance, Epidemiology, and End Results (SEER) database (2000–2018) was used to tabulate patient (age at diagnosis, sex, race/ethnicity), tumor (N stage, sites of metastasis) and treatment characteristics (proportions of nephrectomy and systemic therapy), according to 12 SEER registries. Multinomial regression models, as well as multivariable Cox regression models, tested the overall mortality (OM) adjusting for those patient, tumor and treatment characteristics. Results In 9882 ccmRCC patients, registry-specific patient counts ranged from 4025 (41%) to 189 (2%). Differences across registries existed for sex (24–36% female), race/ethnicity (1–75% non-Caucasian), N stage (N1 25–35%, NX 3–13%), proportions of nephrectomy (44–63%) and systemic therapy (41–56%). Significant inter-registry differences remained after adjustment for proportions of nephrectomy (46–63%) and systemic therapy (35–56%). Unadjusted 5-year OM ranged from 73 to 85%. In multivariable analyses, three registries exhibited significantly higher OM (SEER registry 5: hazard ratio (HR) 1.20, p = 0.0001; SEER registry 7:HR 1.15, p = 0.008M SEER registry 10: HR 1.15, p = 0.04), relative to the largest reference registry (n = 4025). Conclusion Important regional differences including patient, tumor and treatment characteristics exist, when ccmRCC patients included in the SEER database are studied. Even after adjustment for these characteristics, important OM differences persisted, which may require more detailed analyses to further investigate these unexpected differences

Three vs. Four Cycles of Neoadjuvant Chemotherapy for Localized Muscle Invasive Bladder Cancer Undergoing Radical Cystectomy: A Retrospective Multi-Institutional Analysis

Three or four cycles of cisplatin-based chemotherapy is the standard neoadjuvant treatment prior to cystectomy in patients with muscle-invasive bladder cancer. Although NCCN guidelines recommend 4 cycles of cisplatin-gemcitabine, three cycles are also commonly administered in clinical practice. In this multicenter retrospective study, we assessed a large and homogenous cohort of patients with urothelial bladder cancer (UBC) treated with three or four cycles of neoadjuvant cisplatin-gemcitabine followed by radical cystectomy, in order to explore whether three vs. four cycles were associated with different outcomes

Neutrophil percentage-to-albumin ratio predicts mortality in bladder cancer patients treated with neoadjuvant chemotherapy followed by radical cystectomy

To investigate the prognostic role of neutrophil percentage-to-albumin ratio (NPAR) in muscle-invasive bladder cancer (MIBC) patients treated with neoadjuvant chemotherapy (NAC) and radical cystectomy (RC)

Changes in renal function after nephroureterectomy for upper urinary tract carcinoma: analysis of a large multicenter cohort (Radical Nephroureterectomy Outcomes (RaNeO) Research Consortium)

Purpose To investigate prevalence and predictors of renal function variation in a multicenter cohort treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods Patients from 17 tertiary centers were included. Renal function variation was evaluated at postoperative day (POD)-1, 6 and 12 months. Timepoints differences were Delta 1 = POD-1 eGFR - baseline eGFR; Delta 2 = 6 months eGFR - POD-1 eGFR; Delta 3 = 12 months eGFR - 6 months eGFR. We defined POD-1 acute kidney injury (AKI) as an increase in serum creatinine by >= 0.3 mg/dl or a 1.5 1.9-fold from baseline. Additionally, a cutoff of 60 ml/min in eGFR was considered to define renal function decline at 6 and 12 months. Logistic regression (LR) and linear mixed (LM) models were used to evaluate the association between clinical factors and eGFR decline and their interaction with follow-up. Results A total of 576 were included, of these 409(71.0%) and 403(70.0%) had an eGFR < 60 ml/min at 6 and 12 months, respectively, and 239(41.5%) developed POD-1 AKI. In multivariable LR analysis, age (Odds Ratio, OR 1.05, p < 0.001), male gender (OR 0.44, p = 0.003), POD-1 AKI (OR 2.88, p < 0.001) and preoperative eGFR < 60 ml/min (OR 7.58, p < 0.001) were predictors of renal function decline at 6 months. Age (OR 1.06, p < 0.001), coronary artery disease (OR 2.68, p = 0.007), POD-1 AKI (OR 1.83, p = 0.02), and preoperative eGFR < 60 ml/min (OR 7.80, p < 0.001) were predictors of renal function decline at 12 months. In LM models, age (p = 0.019), hydronephrosis (p < 0.001), POD-1 AKI (p < 0.001) and pT-stage (p = 0.001) influenced renal function variation (ss 9.2 +/- 0.7, p < 0.001) during follow-up. Conclusion Age, preoperative eGFR and POD-1 AKI are independent predictors of 6 and 12 months renal function decline after RNU for UTUC

High Risk of Secondary Infections Following Thrombotic Complications in Patients With COVID-19

Background. This study’s primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications. Methods. This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray’s method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections. Results. Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8–11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7–21.0) and 9.3 (95% CI, 7.9–11.0) per 1000-PDFU, respectively (P = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018–3.140; P = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications. Conclusions. In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections