The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review

Psychosocial factors related to different degrees of clinical impairment and quality of life in the preoperative period may influence outcomes from elective spine surgery. Patients have expressed a need for individualized information given in sufficient quantities and at the appropriate time. Therefore, this review article aims to determine whether a preoperative education session improves clinical, psychological and economic outcomes in elective spinal surgery. PubMed, Cochrane Library, CINAHL Complete, Medline Complete and PsychINFO were searched in July 2018 for randomized clinical trials to evaluate the effects of a preoperative education intervention on psychological, clinical and economic outcomes in spinal surgery. The search yielded 78 results, of which eleven papers (seven studies) were relevant for inclusion. From these results, there is limited, fair-quality evidence that supports the inclusion of a preoperative education session for improving clinical (pain, function and disability), economic (quality-adjusted life years, healthcare expenditure, direct and indirect costs) and psychological outcomes (anxiety, depression and fear-avoidance beliefs) from spinal surgery. Other benefits are reported to be improved patient knowledge, feelings of better preparation, reduced negative thinking and increased levels of physical activity after the intervention. No differences in quality of life, return to work, physical indicators or postoperative complications were reported. From the limited evidence, it is not possible to conclusively recommend that preoperative education should be delivered as a standalone intervention before elective spine surgery; however, given the low risk profile and promising benefits, future research in this area is warrante

‘It's the kids that suffer’: Exploring how the UK's benefit cap and two-child limit harm children

The benefit cap and the two-child limit reduce entitlement for households claiming means-tested benefits and disproportionately affect households with dependent children. This article explores the harms the policies are doing to children through drawing upon data collected from interviews with parents affected by the benefit cap and the two-child limit. To investigate the impacts of these policies we draw on the Investment Model and the Family Stress Model, models principally developed by quantitative scholars seeking to understand how economic disadvantage adversely affects children over the longer-term. While there has been frequent quantitative analysis of these models, there has been very little qualitative engagement with them: this article directly addresses this gap in the literature. We show that the benefit cap and the two-child limit cause multiple and severe overlapping harms to children, principally by exacerbating and deepening financial economic disadvantage. Our research evidence illuminates causal processes underpinning both the Investment Model and the Family Stress Model, but also reveals additional harms that are not foregrounded by either model. We conclude by calling for the removal of both policies as a vital first step in reducing child poverty, and further reflect on the need for greater recognition of the harm child poverty does to experiences of childhood; as well as to their future selves

Local validation of the use of Evolution for Bone for bone SPECT imaging

Purpose In order to locally validate the technique, a retrospective review of a cohort of randomly selected single-photon emission computed tomography (SPECT) bone scans reconstructed with ordered subsets expectation maximization (OSEM) and Evolution for Bone was undertaken. Materials and methods Thirty consecutive bone SPECT patient data sets (17 spine, nine pelvis, and four spine and pelvis) were chosen. Poisson resampling was used to simulate reduced count data at 50, 75, and 100% of the original number of counts. Evolution for Bone applied resolution recovery to the reduced count images. All images were compared with the original OSEM images, currently used as the standard for clinical use. A qualitative blinded assessment was made by two independent observers, who assessed for noise, contrast, and resolution. Results Both radiologists saw an improvement in resolution (P=0.776), noise (P=0.007), and image quality with all data sets, compared with images processed purely with OSEM and viewed in Volumetrix. However, they completely disagreed on contrast, as the two radiologists scored contrast differently; however, the results are understandable. Conclusion Images with 50, 75, and 100% of the original counts viewed using Evolution for Bone have improved image quality compared with images processed purely with OSEM and viewed in Volumetrix. Evolution for Bone therefore has great potential in departments for reducing either patient doses, waiting lists, or both.</p

Response to The Department of the Prime Minister and Cabinet's discussion paper "Connecting with Confidence"

The ACS has prepared this response to the discussion paper to assist with the design of the cyber whitepaper expected in 2012. The ACS also welcomes the opportunity to promote discussion and support of our digital economy to position Australia for the future. Drawing from its membership of ICT professionals, and academics - particularly in areas of cyber resilience and security - the ACS established a Cyber Taskforce for this purpose. The ACS recommends: greater focus on education - noting that ICT education in primary and secondary schooling is essential - to developing ICT skills of the future and that school level educational activity forms the base on which appropriate tertiary level education programs can function for the education and training of ICT professionals; greater assistance to small and medium sized business as this is the engine room of the Australian economy; policy coordination on trusted identities; better coordination of cyber related education and research; providing consumers and businesses with resources directed to the everyday real-life challenges they face; global Internet governance changes designed to underpin and deliver trustworthy people, processes and systems including, where appropriate, a legislated mandatory baseline of trustworthiness attributes analogous to the non-excludable warranties implied in consumer contacts

Co-culture of mechanically injured cartilage with joint capsule tissue alters chondrocyte expression patterns and increases ADAMTS5 production

We studied changes in chondrocyte gene expression, aggrecan degradation, and aggrecanase production and activity in normal and mechanically injured cartilage co-cultured with joint capsule tissue. Chondrocyte expression of 21 genes was measured at 1, 2, 4, 6, 12, and 24 h after treatment; clustering analysis enabled identification of co-expression profiles. Aggrecan fragments retained in cartilage and released to medium and loss of cartilage sGAG were quantified. Increased expression of MMP-13 and ADAMTS4 clustered with effects of co-culture, while increased expression of ADAMTS5, MMP-3, TGF-β, c-fos, c-jun clustered with cartilage injury. ADAMTS5 protein within cartilage (immunohistochemistry) increased following injury and with co-culture. Cartilage sGAG decreased over 16-days, most severely following injury plus co-culture. Cartilage aggrecan was cleaved at aggrecanase sites in the interglobular and C-terminal domains, resulting in loss of the G3 domain, especially after injury plus co-culture. Together, these results support the hypothesis that interactions between injured cartilage and other joint tissues are important in matrix catabolism after joint injury

An oligonucleotide microarray for transcriptome analysis of Schistosoma mansoni and its application/use to investigate gender-associated gene expression

Global profiling transcriptomes of parasitic helminths offers the potential to simultaneously identify co-ordinately expressed genes, novel genetic programs and uniquely utilized metabolic pathways, which together provide an extensive and new resource for vaccine and drug discovery. We have exploited this post-genomic approach to fabricate the first oligonucleotide DNA microarray for gene expression analysis of the parasitic trematode Schistosoma mansoni. A total of 17,329 S. mansoni DNA sequences were used to design a microarray consisting of 7335 parasite elements or approximately 50% of this parasite's transcriptome. Here, we describe the design of this new microarray resource and its evaluation by extending studies into gender-associated gene expression in adult schistosomes. We demonstrate a high degree of reproducibility in detecting transcriptional differences among biologically replicated experiments and the ability of the microarray to distinguish between the expression of closely related gene family members. Importantly, for issues related to sexual dimorphism, labour division, gamete production and drug target discovery, 197 transcripts demonstrated a gender-biased pattern of gene expression in the adult schistosome, greatly extending the number of sex-associated genes. These data demonstrate the power of this new resource to facilitate a greater understanding into the biological complexities of schistosome development and maturation useful for identifying novel intervention strategies

Determinants of successful clinical networks : The conceptual framework and study protocol

Background Clinical networks are increasingly being viewed as an important strategy for increasing evidence-based practice and improving models of care, but success is variable and characteristics of networks with high impact are uncertain. This study takes advantage of the variability in the functioning and outcomes of networks supported by the Australian New South Wales (NSW) Agency for Clinical Innovation's non-mandatory model of clinical networks to investigate the factors that contribute to the success of clinical networks. Methods/Design The objective of this retrospective study is to examine the association between external support, organisational and program factors, and indicators of success among 19 clinical networks over a three-year period (2006-2008). The outcomes (health impact, system impact, programs implemented, engagement, user perception, and financial leverage) and explanatory factors will be collected using a web-based survey, interviews, and record review. An independent expert panel will provide judgements about the impact or extent of each network's initiatives on health and system impacts. The ratings of the expert panel will be the outcome used in multivariable analyses. Following the rating of network success, a qualitative study will be conducted to provide a more in-depth examination of the most successful networks. Discussion This is the first study to combine quantitative and qualitative methods to examine the factors that contribute to the success of clinical networks and, more generally, is the largest study of clinical networks undertaken. The adaptation of expert panel methods to rate the impacts of networks is the methodological innovation of this study. The proposed project will identify the conditions that should be established or encouraged by agencies developing clinical networks and will be of immediate use in forming strategies and programs to maximise the effectiveness of such networks

Contextualising social capital in online brand communities

Online brand communities (OBC) are growing in number and becoming an increasingly important interface where marketers can effectively facilitate the relationship between their brand and consumers. A qualitative study using a four-month netnography over three OBCs followed by focus groups with OBC members explored the dynamics of social capital in these communities. Findings indicate that social capital is an important driver in the success of OBCs, and all the elements of social capital including a shared language, shared vision, social trust and reciprocity are evident. Moreover, results from this study indicate that these elements are crucial in developing the network ties that are integral to building loyalty and brand equity

The HELLP syndrome: Clinical issues and management. A Review

<p>Abstract</p> <p>Background</p> <p>The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence.</p> <p>Methods</p> <p>Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases.</p> <p>Results and conclusion</p> <p>About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (≥ 70 U/L), and platelets < 100·10⁹/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (≥ 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery.</p