3,955 research outputs found

    Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

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    Development and validity evidence for the intraprofessional conflict exercise: An assessment tool to support collaboration.

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    BackgroundEffective collaboration is the foundation for delivering safe, high quality patient care. Health sciences curricula often include interprofessional collaboration training but may neglect conflicts that occur within a profession (intraprofessional). We describe the development of and validity evidence for an assessment of intraprofessional conflict management.Methods and findingsWe designed a 22-item assessment, the Intraprofessional Conflict Exercise, to evaluate skills in managing intraprofessional conflicts based on a literature review of conflict management. Using Messick's validity framework, we collected evidence for content, response process, and internal structure during a simulated intraprofessional conflict from 2018 to 2019. We performed descriptive statistics, inter-rater reliability, Cronbach's alpha, generalizability theory, and factor analysis to gather validity evidence. Two trained faculty examiners rated 82 trainees resulting in 164 observations. Inter-rater reliability was fair, weighted kappa of 0.33 (SE = 0.03). Cronbach's alpha was 0.87. The generalizability study showed differentiation among trainees (19.7% person variance) and was highly reliable, G-coefficient 0.88, Phi-coefficient 0.88. The decision study predicted that using one rater would have high reliability, G-coefficient 0.80. Exploratory factor analysis demonstrated three factors: communication skills, recognition of limits, and demonstration of respect for others. Based on qualitative observations, we found all items to be applicable, highly relevant, and helpful in identifying how trainees managed intraprofessional conflict.ConclusionsThe Intraprofessional Conflict Exercise provides a useful and reliable way to evaluate intraprofessional conflict management skills. It provides meaningful and actionable feedback to trainees and may help health educators in preparing trainees to manage intraprofessional conflict

    Dual-task versus single-task gait rehabilitation after stroke: the protocol of the cognitive-motor synergy multicenter, randomized, controlled superiority trial (SYNCOMOT)

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    Background Gait disorders and cognitive impairments are prime causes of disability and institutionalization after stroke. We hypothesized that relative to single-task gait rehabilitation (ST GR), cognitive-motor dual-task (DT) GR initiated at the subacute stage would be associated with greater improvements in ST and DT gait, balance, and cognitive performance, personal autonomy, disability, and quality of life in the short, medium and long terms after stroke. Methods This multicenter ( n =12), two-arm, parallel-group, randomized (1:1), controlled clinical study is a superiority trial. With p <0.05, a power of 80%, and an expected loss to follow-up rate of 10%, the inclusion of 300 patients will be required to evidence a 0.1-m.s −1 gain in gait speed. Trial will include adult patients (18–90 years) in the subacute phase (0 to 6 months after a hemispheric stroke) and who are able to walk for 10 m (with or without a technical aid). Registered physiotherapists will deliver a standardized GR program (30 min three times a week, for 4 weeks). The GR program will comprise various DTs (phasic, executive function, praxis, memory, and spatial cognition tasks during gait) in the DT (experimental) group and gait exercises only in the ST (control) group. The primary outcome measure is gait speed 6 months after inclusion. The secondary outcomes are post-stroke impairments (National Institutes of Health Stroke Scale and the motor part of the Fugl-Meyer Assessment of the lower extremity), gait speed (10-m walking test), mobility and dynamic balance (timed up-and-go test), ST and DT cognitive function (the French adaptation of the harmonization standards neuropsychological battery, and eight cognitive-motor DTs), personal autonomy (functional independence measure), restrictions in participation (structured interview and the modified Rankin score), and health-related quality of life (on a visual analog scale). These variables will be assessed immediately after the end of the protocol (probing the short-term effect), 1 month thereafter (the medium-term effect), and 5 months thereafter (the long-term effect). Discussion The main study limitation is the open design. The trial will focus on a new GR program applicable at various stages after stroke and during neurological disease. Trial registration NCT03009773 . Registered on January 4, 2017

    Smart Nonlinear Photonics: From On-chip Pulse Processing to Tailored Nonlinear Fiber Propagation

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    We review recent work using integrated and fibered platforms for advanced optical processing techniques. We show that machine learning in photonics systems can be leveraged to generate custom optical wave-packets relevant for targeted applications

    Towards optimal use of antithrombotic therapy of people with cancer at the end of life: A research protocol for the development and implementation of the SERENITY shared decision support tool

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    Anticoagulants; Hemorrhage; ThrombosisAnticoagulantes; Hemorragia; TrombosisAnticoagulants; HemorrĂ gia; TrombosiBackground Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. Methods The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe. Results SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. Conclusions We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers

    Traumatic dental injuries over an 8-year period at a German dental center: a retrospective overview and cross-sectional analysis

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    Abstract Background/aim The aim of this study was to analyze a population of patients who had suffered from traumatic dental injuries (TDIs) by using different patient-, trauma- and treatment-related parameters. Material and methods All dental records of patients ≄ 3 years old who had presented at the dental emergency service between Jan 1, 2009 and Dec 31, 2016 for the treatment of dental trauma were analyzed. A total of 2758 patients were invited for a recall examination at the Department for Dental Surgery and Implantology, ZZMK Carolinum, Goethe University Frankfurt, Germany; of these, 269 patients attended their recall appointments. Results The enrolled patient population consisted of 1718 males and 1040 females, with a mean age of 19.63 years (median 12.00 ± 17.354 years). A total of 4909 injured teeth were assessed, with a mean of 1.78 injured teeth per patient (median 2.00 ± 1.279). Males were found to be more frequently affected by TDIs compared to females (1.65:1). The majority of these injuries occurred in the first two decades of life (66.1%; n = 1824). The majority of the patients presented for initial treatment within 24 h of their accident (95.7%). The most frequent TDIs were isolated luxation injuries 49.4% (n = 2426) and isolated crown fractures 30% (n = 1472). Combination injuries were diagnosed in 20.6% of the cases (n = 1011). Conclusions Based on the findings of the present analysis, it can be concluded that males were more frequently affected by TDIs than females. Most patients had suffered from TDI before they had turned 10 years of age. Overall, the enamel–dentin fracture was found to be the most frequent injury, followed by concussions and lateral luxations. Graphical Abstrac

    Effect of intramodal and intermodal nonlinearities on the flexural resonant frequencies of cantilevered beams

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    Sensing applications that utilize nanomechanical resonators require careful control of nonlinear effects in their eigenmodes to ensure robust measurement. While the effect of intra- and intermodal nonlinearities on the resonant frequencies of doubly clamped elastic beams have been widely studied using theory and experiment, commensurate studies on cantilevered beams are limited in comparison. Here, we present such a detailed study that includes an explicit and simple formula for the flexural resonant frequencies of slender cantilevered beams that accounts for intra- and intermodal nonlinearities. Using this general theory, numerical results for the modal nonlinear coefficients are tabulated for the first 20 flexural eigenmodes of cantilevered beams possessing uniform cross sections. The accuracy of this theory, and the effect of cantilever aspect ratio (length/width) on these nonlinear coefficients, is explored using high-accuracy laser Doppler vibrometry experiments. We anticipate that these results will find utility in single- and multimode applications, where the effect of finite oscillation amplitude on the cantilever resonant frequencies can significantly impact measurement design and interpretation

    Impact of Implant Diameter on Success and Survival of Dental Implants: An Observational Cohort Study

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    Narrow-diameter implants (NDIs) can be inserted instead of standard dental implants (SDIs) in sites with limited space and bone availability. The aim of this study was to evaluate the effect of implant diameter on peri-implant bone, attached mucosa, and on the associated probability of implant success and survival. The implants with progressive thread design and platform switching (AnkylosÂź, Dentsply Sirona; Mannheim, Germany) investigated were identified retrospectively and assigned to two groups based on their diameter: 3.5 mm (NDIs) and 4.5 mm (SDIs). Peri-implant bone loss was analyzed based on available radiographs. Descriptive and implant-associated factors were gathered from patient files. Data were statistically analyzed using the Kolmogorov–Smirnov–Lilliefors test and regression analyses. The level of significance was p ≀ 0.05. Results: In total, data for 415 implants in 194 patients were included in the study. Ten-year survival was 95.8% (NDIs) and 91.1% (SDIs). Implant diameter had no significant effect on peri-implant crestal bone loss (p = 0.098) or on the width of the attached gingiva (p = 0.052). Survival and success rates of NDIs were like or slightly better than those of SDIs. Because implant diameter had no effect on peri-implant tissue, NDIs can be recommended in selected cases

    Osteolytic lesions: Multiple myeloma or prostate cancer?

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    Multiple myeloma is a cancer which is characterized by proliferation of malignant B-cells and plasma cell infiltration of bone marrow. Lytic lesions are one of its hallmarks, on radiological assessment. We report 2 cases who presented within 1 year to our hospital with bony lytic lesions on CT scan. They were investigated for multiple myeloma; however, there were no further features to suggest this. Both patients were confirmed to have prostate cancer. This is unusual as prostate cancer produces sclerotic lesions (unusual hardening or thickening of the bone)