The effectiveness and cost-effectiveness of upper limb prostheses

The cost of upper limb prostheses related health care are rising. One reason may be the more frequent prescription of the expensive multi-grip myoelectric hand prostheses. However, signs of non-usage of the additional grip options of these hands are described. In these cases, a more simple prosthesis might also suit the users’ needs. Therefore, we investigated: 1. Factors that affect prosthesis choice and use A qualitative meta-synthesis, focus group and a nationwide survey in which 358 participants selected their top-10 most important items regarding prosthesis use were performed. Based on these results, a measurement tool, the PUF-ULP, was developed, which provides a single score that represents the match between the user and their prosthesis. 2. Cost-effectiveness of upper limb prosthesis A total of 242 upper limb prostheses users completed a quality of life questionnaire, the PUF-ULP, and a cost questionnaire. Results indicated that myoelectric prostheses, especially the multi-grip ones, are the most expensive compared to other prostheses types, while no differences in quality of life or user experiences were apparent. 3. Multi-grip versus standard myoelectric hands Fourteen multi-grip myoelectric hand prosthesis users performed multiple tests with both the multi-grip and standard myoelectric hand. Additionally, the users’ experiences of the multi-grip myoelectric hand prostheses were compared with these of 19 standard myoelectric hand prosthesis users using questionnaires. Results showed no relevant advantages of the multi-grip hand over the standard hand. 4. Development decision aidIn a systematic co-creation process a decision aid about hand prosthesis was developed and implemented nationwide

No Room for Racism: A Critical Analysis on Corporate Social Responsibility and Racial Justice Advocacy in the English Premier League

The English Premier League\u27s No Room For Racism campaign is dedicated toward stopping racism in the league, sport, and society as a whole. The campaign is two years old at the time of this publication, and has had several phases. This study examines the campaign from the framework of corporate social responsibility and corporate social advocacy. The stakeholders affected by No Room For Racism are affected and react in differing ways, while using different communication methods in their promotion of the campaign. One key stakeholder, the Premier League\u27s fans, took to social media to express their opinions on the campaign. Their reactions have been sampled and analyzed through this study for content and sentiment. As an evolving campaign, No Room For Racism has used current events and stakeholder feedback in its different phases as guidance for the actions taken through the campaign. The actions and impact have been examined through direct communication from stakeholders and articles by the popular press

Computer assisted surgical anatomy mapping : applications in surgical anatomy research, tailor-made surgery and presonalized teaching

This thesis presents a novel anatomy mapping tool named Computer Assisted Surgical Anatomy Mapping (CASAM). It allows researchers to map complex anatomy of multiple specimens and compare their location and course. Renditions such as safe zones or danger zones can be visualized, summarizing complex anatomy into comprehensive images, making anatomy research more Accessible. The web-based version of CASAM is used for Personalized Teaching, giving individual feedback on incision lines drawn during surgical courses. It also provides a platform for future International Collaboration between anatomical wetlabs, standardizing anatomy research. The current algorithms used in CASAM are verified and also ready to map complex 3D Anatomy. Future iterations of CASAM will extend its use to everyday surgical practice and tailor-made surgery

User-relevant factors determining prosthesis choice in persons with major unilateral upper limb defects:A meta-synthesis of qualitative literature and focus group results

Objective Considering the high rejection rates of upper limb prostheses, it is important to determine which prosthesis fits best the needs of each user. The introduction of the multi-grip prostheses hands (MHP), which have functional advantages but are also more expensive, has made prosthesis selection even harder. Therefore, we aimed to identify user opinions on factors determining prosthesis choice of persons with major unilateral upper limb defects in order to facilitate a more optimal fit between user and prosthesis. Methods A qualitative meta-synthesis using a 'best-fit framework' approach was performed by searching five databases (PROSPERO registration number: CRD42019126973). Studies were considered eligible if they contained qualitative content about adults with major unilateral upper limb defects experienced in using commercially available upper limb prostheses and focused on upper limb prosthesis users' opinions. Results of the meta-synthesis were validated with end-users (n = 11) in a focus group. Results Out of 6247 articles, 19 studies were included. An overview of six main themes ('physical', 'activities and participation', 'mental', 'social', 'rehabilitation, cost and prosthetist services' and 'prosthesis related factors') containing 86 subthemes that could affect prosthesis choice was created. Of these subthemes, 19 were added by the focus group. Important subthemes were 'work/school', 'functionality' and 'reactions from public'. Opinions of MHP-users were scarce. MHPs were experienced as more dexterous and life-like but also as less robust and difficult to control. Conclusion The huge number of factors that could determine upper limb prosthesis choice explains that preferences vary greatly. The created overview can be of great value to identify preferences and facilitate user-involvement in the selection process. Ultimately, this may contribute to a more successful match between user and prosthesis, resulting in a decrease of abandonment and increase of cost-effectiveness

The systematic and participatory development of a patient decision aid about terminal devices for people with upper limb absence:The PDA-TULA

Selecting an upper limb prosthesis seems to be a challenge considering the high rejection rates. A patient decision aid (PDA) could support the decision-making process by providing information about available options and clarifying the patients' values related to those options. This study aims to describe the developmental process of a PDA about terminal devices (TDs) for people with upper limb absence: PDA-TULA. The developmental process was based on The International Patient Decision Aid Standards. We aimed at adults with major unilateral upper limb absence. A steering group including patients, clinicians, researchers, software and implementation experts was composed. The content and design of the PDA were based on a qualitative literature meta-synthesis, focus groups with patients and clinicians, surveys among patients and prosthetists, a nationwide digital meeting with clinicians and prosthetists, and information from manufacturers. Information on features of TDs was systematically collected, ordered, and refined. Subsequently, drafts of the PDA-TULA were made, improved, integrated into the software, and alpha tested. The digital PDA-TULA consists of three parts: (1) information about TDs; (2) consideration of personal values regarding the TDs; (3) comparison of TD profiles with a personal profile based on indicated preferences. A summarizing overview is offered to patients and clinicians. To conclude, a digital PDA, which was integrated into the national working process of clinicians, was developed in a systematic co-creation process. The PDA enables patients and their significant others to consider and formulate their preferences about TDs during the prosthesis selection process.</p

Diabetes Self-Management Education and Support: Referral and Attendance at a Patient-Centered Medical Home

Background: Although evidence shows that diabetes self-management education and support (DSMES) is an effective tool to help individuals with type 2 diabetes (T2DM) improve their health outcomes, there remains a large number of individuals not attending DSMES. Understanding how frequently patients receive referrals to DSMES and the number of DSMES hours they receive is important to determine, as well as patients' health outcomes of utilizing DSMES. This will help us understand patterns of utilization and the outcomes that occur when such a valuable resource is utilized. Methods: Secondary data analysis was conducted of patient electronic medical records at a primary healthcare federally qualified clinic and 2 area hospitals. We identified 105 adult patients with a new T2DM diagnosis with at least 2 A1c lab results 3 to 12 months apart during the study period. Results: Only 53.5% were referred to DSMES. Out of those who were referred, 66% received no DSMES, 17% received 1-hour assessment, 4% received partial DSMES, and 13% received 8 or more hours. Linear regression of percent change in A1c and number of DSMES hours received, revealed that receiving 1 (P =.001) or 8 or more hours of DSMES (P =.022) had a significant negative relationship with the percent difference in A1c compared to the group who received no DSMES. Patients who had an hour of assessment had a similar percent reduction in A1c to those who had partial DSMES. Conclusion: Referral rates and enrollment in DSMES remain low. Those who enrolled often dropped out after the one-hour assessment session. Results suggest making the one-hour assessment session more educationally comprehensive or longer to retain patients. Improving the DSMES referral process and further investing physicians' decisions on whether to refer or not refer patients to DSMES are key for future studies.Scopu

Bullying no ensino médio: a percepção de alunos e professores / Bullying in high school: the perception of students and teachers

Este artigo analisa a compreensão e as percepções das demandas em relação a abordagem do bullying como um problema na escola, a partir da perspectiva de professores e alunos de uma instituição da rede estadual de ensino. Propõe-se uma reflexão no sentido de contribuir para que a temática do bullying, bem como preconceito e discriminação, seja de fato, trabalhados por professores, visando a proposta de práticas horizontais que possam assumir uma característica de inovação social. A fundamentação teórica tem como base, autores que discorrem sobre os determinantes do bullying e diferentes formas de ocorrência deste fenômeno. A metodologia utilizada foi a qualitativa, com finalidade exploratória. Como procedimentos de coleta de dados adotou-se a entrevista semiestruturada, que foi transcrita e submetida a análise de conteúdo temático.  Os resultados apontam, sobre a necessidade de se trazer à pauta das salas de aula, as origens, causas, determinantes e desdobramentos do bullying, visto que este problema, está presente no dia a dia dos alunos e professores, justificando a necessidade da proposição de discussão do tema aqui tratado

The anatomy of collective failure in the Netherlands

A review of evaluation findings on Dutch policy successes and failures points to the influence of political culture on policy effectiveness

The course of the radial nerve in the distal humerus: A novel, anatomy based, radiographic assessment

Iatrogenic nerve injury during fracture surgery of the upper arm is a well-known complication. Prevention of this type of injuries would be of great value. The literature describes several methods to reduce this type of injury, but no perfect solution is at hand. In this study we introduce a new radiographic evaluation of the course and variation of the radial nerve in the distal part of the humerus in relation to bony landmarks as observed on a plain (trauma) radiographs. Aim of this new approach is to reduce the chance of iatrogenic nerve injury by defining of a danger zone in the distal upper arm regarding the radial nerve and hence give an advise for future implant fabrication. Methods and findings: Measurements were done on both arms of ten specially embalmed specimens. Arms were dissected and radiopaque wires attached to the radial nerve in the distal part of the upper arm. Digital radiographs were obtained to determine the course of the radial nerve in the distal 20 cm of the humerus in relation to bony landmarks; medial epicondyle and capitellum-trochlea projection (CCT). Analysis was done with ImageJ and Microsoft Excel software. We also compared humeral nail specifications from different companies with the course of the radial nerve to predict possible radial nerve damage. Results: The distance from the medial epicondyle to point where the radial nerve bends from posterior to lateral was 142 mm on AP radiographs and 152 mm measured on the lateral radiographs. The average distance from the medial epicondyle to point where the radial nerve bends from lateral to anterior on AP radiographs was 66 mm. On the lateral radiographs where the nerve moves away from the anterior cortex 83 mm to the center of capitellum and trochlea (CCT). The distance from the bifurcation of the radial nerve into the posterior interosseous nerve (PIN) and superficial radial nerve was 21 mm on AP radiographs and 42 mm on the lateral radiographs (CCT). Conclusions: The course of the radial nerve in the distal part of the upper arm has great variety. Lateral fixation is relatively safe in a zone between the center of capitellum-trochlea and 48 mm proximal to this point. The danger zone in lateral fixation is in-between 48–122 mm proximal from CCT. In anteroposterior direction; distal fixation is dangerous between 21–101 mm measured from the medial epicondyle. The more distal, the more medial the nerve courses making it more valuable to iatrogenic damage. The IMN we compared with our data all show potential risk in case of (blind) distal locking, especially from lateral to medial direction

Infant Feeding Practices and Subsequent Dietary Patterns of School-Aged Children in a US Birth Cohort

BACKGROUND: Infant feeding practices are thought to shape food acceptance and preferences. However, few studies have evaluated whether these affect child diet later in life. OBJECTIVE: The study objective was to examine the association between infant feeding practices and dietary patterns (DPs) in school-aged children. DESIGN: A secondary analysis of data from a diverse prospective birth cohort with 10 years of follow-up (WHEALS [Wayne County Health Environment Allergy and Asthma Longitudinal Study]) was conducted. PARTICIPANTS/SETTING: Children from the WHEALS (Detroit, MI, born 2003 through 2007) who completed a food screener at age 10 years were included (471 of 1,258 original participants). MAIN OUTCOME MEASURES: The main outcome was DPs at age 10 years, identified using the Block Kids Food Screener. STATISTICAL ANALYSIS PERFORMED: Latent class analysis was applied for DP identification. Breastfeeding and age at solid food introduction were associated with DPs using a 3-step approach for latent class modeling based on multinomial logistic regression models. RESULTS: The following childhood DPs were identified: processed/energy-dense food (35%), variety plus high intake (41%), and healthy (24%). After weighting for loss to follow-up and covariate adjustment, compared with formula-fed children at 1 month, breastfed children had 0.41 times lower odds of the processed/energy-dense food DP vs the healthy DP (95% CI 0.14 to 1.25) and 0.53 times lower odds of the variety plus high intake DP (95% CI 0.17 to 1.61), neither of which were statistically significant. Results were similar, but more imprecise, for breastfeeding at 6 months. In addition, the association between age at solid food introduction and DP was nonsignificant, with each 1-month increase in age at solid food introduction associated with 0.81 times lower odds of the processed/energy-dense food DP relative to the healthy DP (95% CI 0.64 to 1.02). CONCLUSIONS: A significant association between early life feeding practices and dietary patterns at school age was not detected. Large studies with follow-up beyond early childhood that can also adjust for the multitude of potential confounders associated with breastfeeding are needed