Developing a core outcome set for hand fractures and joint injuries in adults: a systematic review

This study identifies the treatment outcome domains used in recently published studies on the treatment of hand fractures and joint injuries with the aim to inform development of a core outcome set. Seven databases were searched from January 2014 to March 2019 for randomized and quasi-randomized studies and large prospective observational studies. We identified 1777 verbatim outcomes in 160 eligible studies. From the verbatim outcomes we distinguished 639 unique outcomes, which we categorized into 74 outcome domains based on the World Health Organization International Classification of Functioning, Disability, and Health framework. The primary outcome was appropriately identified in only 65% (72/110) of randomized and quasi-randomized controlled trials. Of the 72 studies with a primary outcome identified, 74% (53/72) had an appropriate power calculation. The vast heterogeneity in outcome selection across studies highlights the need for a core outcome set of what outcomes to measure in future clinical research on hand fractures and joint injuries

Händels Musik und Programmgestaltung in Londons Kristallpalast, 1859–1874 [Programming Handel’s music at the Crystal Palace, 1859–1874]

Dieser Aufsatz beleuchtet die Funktion gemischter Konzertprogramme im Hin-blick auf den historischen Aufführungskontext Händelscher Musik sowie den Kanonisierungsprozess verschiedener anfänglich wenig bekannter Werke. Das Hauptaugenmerk liegt dabei auf den Konzerten im Kristallpalast im Londoner Vorort Sydenham in den Jahren 1859 bis 1874, wobei sowohl die regulären Samstagskonzerte als auch die ‚Selection Days‘ des Triennial Handel Festival berücksichtigt werden. Die Untersuchung zeigt, wie einzelne Nummern aus Händels großen Werken Einzug in die Samstagskonzerte fanden und wie ­Händels Musik für die Aufführungen an den Selection Days, den Herzstücken des Festivals, neu zusammengestellt, aufgeführt und anschließend veröffentlicht wurden. Aufführungsgeschichte – weniger die in der historischen Aufführungspra-xis bedachten spezifischen spieltechnischen Nuancen, sondern die eigentliche Biographie eines Werkes auf der Bühne – wird häufig im Prozess des „Kontex­ tualisierens, Inszenierens und Vermittelns“ übersehen, der laut Lydia Goehr einen entscheidenden Anteil daran hat, den Rang eines Werks dem Publikum näherzubringen. Meist rückt die besser erforschte kritische und wissenschaft-liche Literatur in den Vordergrund. Die im 19. Jahrhundert gängige Praxis, klangliche Vielfalt durch thematisch gemischte Konzertprogramme und die Einbeziehung diverser Genres herzustellen, wird besonders oft als Verstoß gegen die ‚Absichten des Komponisten oder der Komponistin‘ abgetan oder als Ver-such verstanden, den scheinbar richtigen Aufführungskontext eines Werks zu finden. Dennoch wird eingeräumt, dass diese Vorstellungen oft nicht mit der Erfahrung des Komponisten oder der Komponistin im Einklang stehen. Je-doch ermöglichen derartige Untersuchungen interessante Einblicke in Kanoni-sierungsprozesse sowie in Kräfteverhältnisse zwischen KomponistInnen (heute und in der Geschichte), MusikerInnen und dem Publikum. Wie dieser Aufsatz zeigen wird, herrschte in der Musikkritik des 19. Jahrhundert keine Einigkeit über die flexible Programmgestaltung, aber sie hatte dennoch einen Anteil an der „weitverbreiteten und umfassenden Vertrautheit“, die ein kanonisiertes Werk ausmacht.5 Obwohl eine derartige Flexibilität in der Programmgestal-tung – zum Beispiel das Ersetzen oder Neuzusammensetzen von Gesangsnum-mern oder die Aufführung ausgewählter Ausschnitte eines Werks – heutzutage in der Aufführung Händelscher Werke kaum noch anzutreffen ist, war sie zu Händels Lebzeiten die Norm und hatte auch einen Einfluss auf den komposi-torischen Schaffensprozess.*******This essay explores the role of nineteenth-century miscellaneous concert programming in the history of Handel performance and the canonisation stages of various initially little-known works. It focuses on the concerts at the Crystal Palace in the London suburb of Sydenham in 1859–1874, both the regular Saturday concerts, and the Selection Days of the Triennial Handel Festivals. It reveals how individual numbers from Handel’s large-scale works were presented in the Saturday concerts; and how Handel’s music was reassembled, performed, and subsequently published in the Selection Day concerts, the central concert of the vast Handel Festivals. Performance history – not so much the individual nuances which usually preoccupy historical performance practitioners, but the actual concert programming – is a much overlooked part of the ‘framing, staging and placement’ which Lydia Goehr has argued is a crucial way of communicating a work’s status to audiences; it is usually overlooked in favour of the far better scrutinised critical and scholarly literature. Miscellany programming – the widespread nineteenth-century practice of ensuring timbral variety by mixing genres in a concert in an unthematised way – is especially often dismissed as a contravention of the ‘composer’s intentions’, or a stage on the way to a ‘correct’ understanding of how to perform a work, even while acknowledging that those intentions often have little to do with the composer’s experience. However, it can reveal an enormous amount about necessary processes of canonisation, as well as the complex power balances between composers (living and dead), performers and audiences. As is shown below, nineteenth-century critics were inconsistent in their responses to such flexibility, but it was nevertheless part of the ‘widespread and multivalent familiarity’ which ensures a work’s canonical life. Furthermore, while flexibility – for instance, replacing or recomposing vocal numbers, interpolating instrumental numbers, or performing just sections of a work – is now rarely encountered in Handel performance, it was the norm in his day and clearly underpinned compositional thought. Loose ties between movements become a positive advantage for nineteenth-century programming. Ultimately, the act of appropriation that performers undertook when they selected fragments which suited their needs from a longer score is worth reconsidering today, as concert practices become increasingly stagnant and rule-bound

Is a HIV vaccine a viable option and at what price? An economic evaluation of adding HIV vaccination into existing prevention programs in Thailand

<p>Abstract</p> <p>Background</p> <p>This study aims to determine the maximum price at which HIV vaccination is cost-effective in the Thai healthcare setting. It also aims to identify the relative importance of vaccine characteristics and risk behavior changes among vaccine recipients to determine how they affect this cost-effectiveness.</p> <p>Methods</p> <p>A semi-Markov model was developed to estimate the costs and health outcomes of HIV prevention programs combined with HIV vaccination in comparison to the existing HIV prevention programs without vaccination. The estimation was based on a lifetime horizon period (99 years) and used the government perspective. The analysis focused on both the general population and specific high-risk population groups. The maximum price of cost-effective vaccination was defined by using threshold analysis; one-way and probabilistic sensitivity analyses were performed. The study employed an expected value of perfect information (EVPI) analysis to determine the relative importance of parameters and to prioritize future studies.</p> <p>Results</p> <p>The most expensive HIV vaccination which is cost-effective when given to the general population was 12,000 Thai baht (US$1 = 34 Thai baht in 2009). This vaccination came with 70% vaccine efficacy and lifetime protection as long as risk behavior was unchanged post-vaccination. The vaccine would be considered cost-ineffective at any price if it demonstrated low efficacy (30%) and if post-vaccination risk behavior increased by 10% or more, especially among the high-risk population groups. The incremental cost-effectiveness ratios were the most sensitive to change in post-vaccination risk behavior, followed by vaccine efficacy and duration of protection. The EVPI indicated the need to quantify vaccine efficacy, changed post-vaccination risk behavior, and the costs of vaccination programs.</p> <p>Conclusions</p> <p>The approach used in this study differentiated it from other economic evaluations and can be applied for the economic evaluation of other health interventions not available in healthcare systems. This study is important not only for researchers conducting future HIV vaccine research but also for policy decision makers who, in the future, will consider vaccine adoption.</p

Nivel de conocimientos de estudiantes de medicina sobre diagnóstico y manejo del infarto agudo del miocardio

Introduction: acute myocardial infarction is a disease with high morbidity and mortality.Objective: to determine the knowledge level of medical students about the diagnosis and management of acute myocardial infarction.Method: an observational, descriptive and cross-sectional study was carried out between January and February 2022 in medical students from the University of Medical Sciences of Pinar del Río who participated in the provincial update workshop on acute myocardial infarction. Through intentional sampling, a sample of 92 students was selected. To collect the information, a survey was used using Google Forms.Results: the female sex (65,21%), the age group from 21 to 22 years (65,21%) and the fourth-year students (50%) prevailed. Hypertension was the most identified risk factor (97,98%). 97,82% of the students identified precordial pain as the main clinical manifestation. 100% identified the presentation with complications, where sudden death was the most identified (81,52%). 100% point to the electrocardiogram as the main complementary, where ST alterations were the most identified (84,78%). 95,65% of the students indicated constant monitoring of vital parameters and cardiovascular function as the management measure.Conclusions: Medicine students belonging to the clinical area at the University of Medical Sciences of Pinar del Río have an adequate level of knowledge about the diagnosis and management of acute myocardial infarction.Introducción: el infarto agudo del miocardio constituye una enfermedad con elevada morbilidad y mortalidad.Objetivo: determinar el nivel de conocimientos de estudiantes de medicina sobre el diagnóstico y manejo del infarto agudo del miocardioMétodo: se realizó un estudio observacional, descriptivo y transversal entre enero y febrero de 2022 en estudiantes de Medicina de la Universidad de Ciencias Médicas de Pinar del Río del ciclo clínico que participaron en el Taller provincial de actualización sobre infarto agudo de miocardio. Mediante un muestreo intencional se seleccionó una muestra de 92 estudiantes. Para la recolección de la información se empleó una encuesta mediante Google Forms.Resultados: predominó el sexo femenino (65,21 %), el grupo etario de 21 a 22 años (65,21 %) y los estudiantes de cuarto año (50 %). La hipertensión fue el factor de riesgo más identificado (97,98 %). El 97,82 % de los estudiantes identificó el dolor precordial como principal manifestación clínica. El 100 % identificó la presentación con complicaciones, donde la muerte súbita fue la más identificada (81,52 %). El 100 % señala al electrocardiograma como principal complementario, donde las alteraciones del ST fueron las más identificada (84,78 %). El 95,65 % de los estudiantes indicaron la monitorización constante de los parámetros vitales y función cardiovascular como la medida de manejo.Conclusiones: los estudiantes de Medicina pertenecientes al área clínica en la Universidad de Ciencias Médicas de Pinar del Río poseen un adecuado nivel de conocimientos sobre el diagnóstico y manejo del infarto agudo del miocardio.