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Shoshan, Tal, and Eric Post. "Prevalence of Protein and Pre-Workout Supplement Use among High School Football Players and Potential Product Contamination." Global Pediatric Health 8 (January 2021): 2333794X2110312. http://dx.doi.org/10.1177/2333794x211031202.
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The purpose was to determine the prevalence of protein and pre-workout supplement usage in high school football players and how many products contained banned substances or dangerous ingredients. A national sample of 102 high school football players was recruited via Qualtrics Research Panels to complete a cross-sectional online questionnaire. Data were summarized as means with standard deviations (SDs) and frequencies with proportions (%). A majority (59.8%) of high school football players reported currently using a protein supplement. Just under one-third (29.4%) reported currently using pre-workout supplements. Five participants reported using a pre-workout product that contained a known NCAA banned substance. Many of the products used contain banned, regulated elsewhere, or unknown substances. Secondary school ATs must educate athletes regarding the use of nutritional supplements and the potential dangers of ingesting banned or unknown substances.
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Afyouni, Imad, Abdullah Murad, and Anas Einea. "Adaptive Rehabilitation Bots in Serious Games." Sensors 20, no. 24 (December 9, 2020): 7037. http://dx.doi.org/10.3390/s20247037.
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In recent years, we have witnessed a growing adoption of serious games in telerehabilitation by taking advantage of advanced multimedia technologies such as motion capture and virtual reality devices. Current serious game solutions for telerehabilitation suffer form lack of personalization and adaptiveness to patients’ needs and performance. This paper introduces “RehaBot”, a framework for adaptive generation of personalized serious games in the context of remote rehabilitation, using 3D motion tracking and virtual reality environments. A personalized and versatile gaming platform with embedded virtual assistants, called “Rehab bots”, is created. Utilizing these rehab bots, all workout session scenes will include a guide with various sets of motions to direct patients towards performing the prescribed exercises correctly. Furthermore, the rehab bots employ a robust technique to adjust the workout difficulty level in real-time to match the patients’ performance. This technique correlates and matches the patterns of the precalculated motions with patients’ motions to produce a highly engaging gamified workout experience. Moreover, multimodal insights are passed to the users pointing out the joints that did not perform as anticipated along with suggestions to improve the current performance. A clinical study was conducted on patients dealing with chronic neck pain to prove the usability and effectiveness of our adjunctive online physiotherapy solution. Ten participants used the serious gaming platform, while four participants performed the traditional procedure with an active program for neck pain relief, for two weeks (10 min, 10 sessions/2 weeks). Feasibility and user experience measures were collected, and the results of experiments show that patients found our game-based adaptive solution engaging and effective, and most of them could achieve high accuracy in performing the personalized prescribed therapies.
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Jagim, Andrew R., Clayton L. Camic, and Patrick S. Harty. "Common Habits, Adverse Events, and Opinions Regarding Pre-Workout Supplement Use Among Regular Consumers." Nutrients 11, no. 4 (April 16, 2019): 855. http://dx.doi.org/10.3390/nu11040855.
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The purpose of the present study was to examine characteristics of multi-ingredient pre-workout supplement (MIPS) users, their common patterns/habits of MIPS ingestion, and their associated feelings about the effectiveness and safety of this class of supplements. An online electronic survey was distributed through social media to assess self-reported supplementation practices and preferences among adult males and females who reported regular MIPS use. A total of 1045 individuals responded, with 872 of these individuals (males: n = 636, 72.9%; females: n = 233, 26.7%; mean ± SD; age = 27.7 ± 7.9 years; training age = 8.2 ± 7.3 years) completing the survey. The majority of respondents reported the length of current or past MIPS consumption as greater than one year (n = 630, 72.2%), with ingestion frequencies primarily of four (n = 210, 24.1%) or five (n = 212, 24.3%) days per week of training. In addition, the three most popular goals for ingesting MIPS were increased energy and focus (n = 776, 89.0%), muscular endurance (n = 325, 37.3%), and blood flow or “pump” (n = 322, 37.0%). Although most users reported ingesting one serving size with each use, 14% reported ingesting two or more, and 18% indicated they ingest MIPS more than once per day. Importantly, over half (54%) of the respondents reported experiencing side-effects following MIPS use, including skin reactions, heart abnormalities, and nausea. Females were more likely than males to experience these side effects, despite being less likely to consume two or more serving sizes per dose. Our findings also indicated that MIPS users should consume no more than the recommended serving size of a given supplement, as the potentially significant variability in the caffeine content of MIPS products is compounded as more doses are consumed. Furthermore, MIPS users should minimize the ingestion of other supplements which contain high levels of niacin and caffeine, as the concurrent consumption of such products may put users above the tolerable upper limits for these substances.
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Latino, Francesca, Francesco Fischetti, Stefania Cataldi, Domenico Monacis, and Dario Colella. "The Impact of an 8-Weeks At-Home Physical Activity Plan on Academic Achievement at the Time of COVID-19 Lock-Down in Italian School." Sustainability 13, no. 11 (May 21, 2021): 5812. http://dx.doi.org/10.3390/su13115812.
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The purpose of this randomized controlled study was to investigate the efficacy of an 8-week exercise programme conducted in e-learning mode on high school students’ academic performance. The aim was to examine the changes in physical fitness and learning outcomes during the enforced period of lockdown caused by outbreak of the second wave of COVID-19 pandemic and the closure of schools in Italy. Thirty high-school students (14–15 years) were randomly assigned to an experimental group (n = 15) that performed an at-home workout programme (~60 min., twice a week), or a control group (n = 15) who received only a regular programme of theoretical lessons where no practice takes place. Both groups were synchronized in real-time with the physical education teacher. In order to assess students’ starting level and significant changes reached, at baseline and after training, a battery of standardized assessment motor tests (Standing long jump test, Harvard step test, sit and reach test, and butt kicks test), and an academic achievement test (Amos 8–15) were administered. In comparison to the control group at baseline and the end of the programme, the experimental group reported considerable improvements in motivation and concentration, significant anxiety reduction, and an increase in capacity to organize studying and to be more flexible. Moreover, it was possible to observe the efficacy of the workout to improve learning ability among practicing students (p < 0.001). No significant changes were found in the control group. The results suggest that a school-based exercise programme conducted online could be a powerful approach in order to achieve the best academic outcomes and for improving students’ physical fitness as well as their cognitive health.
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O’Connor, Patrick J., Phillip D. Tomporowski, and Rodney K. Dishman. "Age Moderates the Association of Aerobic Exercise with Initial Learning of an Online Task Requiring Cognitive Control." Journal of the International Neuropsychological Society 21, no. 10 (November 2015): 802–15. http://dx.doi.org/10.1017/s1355617715000685.
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AbstractThe aim of this study was to examine whether people differed in change in performance across the first five blocks of an online flanker task and whether those trajectories of change were associated with self-reported aerobic or resistance exercise frequency according to age. A total of 8752 men and women aged 13–89 completed a lifestyle survey and five 45-s games (each game was a block of ~46 trials) of an online flanker task. Accuracy of the congruent and incongruent flanker stimuli was analyzed using latent class and growth curve modeling adjusting for time between blocks, whether the blocks occurred on the same or different days, education, smoking, sleep, caffeinated coffee and tea use, and Lumosity training status (“free play” or part of a “daily brain workout”). Aerobic and resistance exercise were unrelated to first block accuracies. For the more cognitively demanding incongruent flanker stimuli, aerobic activity was positively related to the linear increase in accuracy [B=0.577%, 95% confidence interval (CI), 0.112 to 1.25 per day above the weekly mean of 2.8 days] and inversely related to the quadratic deceleration of accuracy gains (B=−0.619% CI, −1.117 to −0.121 per day). An interaction of aerobic activity with age indicated that active participants younger than age 45 had a larger linear increase and a smaller quadratic deceleration compared to other participants. Age moderates the association between self-reported aerobic, but not self-reported resistance, exercise and changes in cognitive control that occur with practice during incongruent presentations across five blocks of a 45-s online, flanker task. (JINS, 2015, 21, 802–815)
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Andersson, Karin, and Jesper Andreasson. "Being a Group Fitness Instructor during the COVID-19 Crisis: Navigating Professional Identity, Social Distancing, and Community." Social Sciences 10, no. 4 (March 25, 2021): 118. http://dx.doi.org/10.3390/socsci10040118.
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Research question and purpose: Les Mills is a New Zealand-based fitness distributor with a community consisting of approximately 140.000 instructors worldwide who teach standardized workout routines. This paper aims to explore how the COVID-19 pandemic and related measurements, such as social distancing affect the everyday lives and professions of Les Mills International (LMI) group fitness instructors. The aim was met with the following research questions: RQ1: How are social distancing and social connectedness understood, and how do they condition LMI instructors’ understanding of their profession? RQ2: What do LMI instructors think about the #LesMillsUnited campaign to maintain a strong trainer community in the midst of the pandemic? RQ3: How do LMI instructors think that group fitness will change long term due to social distancing? Research methods: Using qualitative measures and a case-study-based approach, data were gathered through interviews with LMI-certified group fitness instructors. Seven semi-structured focused group discussions with fifteen group fitness instructors from different countries were conducted and audio recorded. The first round of virtual discussions took place in April 2020, and the follow-up talks in September 2020. A thematic analysis was employed to analyze the material. Results and findings: According to the participants, online classes as a means of upholding group fitness in times of social distancing is an insufficient substitute to face-to-face instructing, lacking social connectedness that is normally maintained through successful rituals or social scripts. Navigating “instructorhood” during the pandemic includes emotional labor where not only relationships to clients are challenged, but instructors also experience societal pressure to reinvent themselves as instructors. Implications: With no way of telling how long social distancing needs to be practiced, the group fitness industry is facing unprecedented challenges. Making sense of the group fitness profession currently preoccupies instructors who may now have to redefine to themselves how they can teach, and who for.
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Fleming, Michael J., and Giang Nguyen. "Price and Size Discovery in Financial Markets: Evidence from the U.S. Treasury Securities Market." Review of Asset Pricing Studies 9, no. 2 (October 4, 2018): 256–95. http://dx.doi.org/10.1093/rapstu/ray008.
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Abstract We study the workup protocol, an important size discovery mechanism in the U.S. Treasury market. We find that workup order flow shocks explain 6%–8% of the variation of returns on benchmark notes and, across maturities, 10% of the variation of the yield curve level factor. Information related to proprietary client order flow is more likely to show up in workup trades, whereas information derived from public announcements tends to come through preworkup trades. Our findings highlight how the nature of information affects the trade-off between speed and execution price when informed traders choose between the lit and workup channels. Received May 3, 2017; Editorial decision August 1, 2018 by Editor Thierry Foucault. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online. Internet Appendix tables are numbered with “IA” prefix.
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Yip, Allison T., Simrat Morris, Nilam D. Patel, Marc Buchner, and Angela Byun Robinson. "Using Online Simulation of Pediatric Musculoskeletal Cases to Evaluate How Knowledge of Costs Affects Diagnostic Workup." Medical Science Educator 30, no. 1 (March 2020): 479–85. http://dx.doi.org/10.1007/s40670-020-00932-1.
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Driska, Andrew P. "A Formative, Utilization-Focused Evaluation of USA Swimming’s Nationwide Online Coach Education Program." International Sport Coaching Journal 5, no. 3 (September 1, 2018): 261–72. http://dx.doi.org/10.1123/iscj.2017-0096.
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Large-scale online coach education programs have become a preferred method of compulsory training for sport governing bodies. In particular, USA Swimming launched a revised online version of its Foundations of Coaching program in 2013. To evaluate its effectiveness, a utilization-focused evaluation was employed to engage program decision-makers in the process of inquiry. After conducting program elicitation exercises with program decision-makers, semi-structured interviews with 21 participant coaches examined course effects on knowledge, attitudes, and behaviours related to coaching swimming. Coaches indicated learning and implementing changes to their coaching of swimming skills, but also indicated the adoption of developmentally-appropriate training practices, which was supported by a corresponding attitude change towards developmentally-appropriate training. Goal setting and incorporating fun into workouts were also endorsed. The evaluation uncovered positive perceptions of the course, and showed that using the course to initiate an ongoing conversation between USA Swimming and its membership could help extend learning opportunities and professional development. The course’s effect on some attitudes (but not others) showed how intentionality of course design and pedagogy were linked to attitude formation. Future evaluations show promise for improving the function of similar large-scale coach education programs.
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Takhar, Rajendra Prasad, Ratan Kumar, Moti Lal Bunkar, Mahendra Pratap Singh, Kuldeep Gupta, and Rakesh Biswas. "I'm Not Sure What Bothers Me in this Chest X-Ray but an HRCT May Help?" Indian Journal of Clinical Medicine 7 (January 2016): IJCM.S32479. http://dx.doi.org/10.4137/ijcm.s32479.
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There are some inevitable risk factors of patient exposure to problems arising from human errors, including missed subtle radiological findings, early identification of which may alter the patient outcomes. Here we are discussing a patient who presented with a prior diagnosis of seasonal allergic rhinitis with symptoms assumed to be bronchial asthma. A second review of chest radiograph after discussion over an online platform (Tabula Rasa group on Facebook) revealed some subtle findings which we missed initially. Further workup of the case revealed some astonishing findings. This case illustrates the importance of discussing unsolved cases on online platforms with peers and also to proceed for higher imaging to detect what has been missed on plain radiography.
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Memari, Amirhossein, Ardalan Shariat, and Albert Thomas Anastasio. "Rising incidence of musculoskeletal discomfort in the wake of the COVID-19 crisis." Work 66, no. 4 (September 17, 2020): 751–53. http://dx.doi.org/10.3233/wor-203221.
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The COVID-19 pandemic has led to the shutdown of much of the world’s economic and social operations. Given shutdown of exercise facilities, there has been a sharp uptick in a sedentary lifestyle. As people have lost their normal daily activity patterns, it is reasonable to assume that musculoskeletal pain-related syndromes will consequently begin to increase. In addition, there has been a rise in social network, television, and online home-based workouts. In the wake of the COVID-19 pandemic, it is unclear whether previous recommendations for physical activities will remain sufficient, given cessation of normal physical activities from day-to-day life. We raise a variety of questions in dealing with the potential fallout of the COVID-19 shutdown from a musculoskeletal standpoint.
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Kass, Lindsy, Terun Desai, Keith Sullivan, Daniel Muniz, and Amy Wells. "Changes to Physical Activity, Sitting Time, Eating Behaviours and Barriers to Exercise during the First COVID-19 ‘Lockdown’ in an English Cohort." International Journal of Environmental Research and Public Health 18, no. 19 (September 24, 2021): 10025. http://dx.doi.org/10.3390/ijerph181910025.
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This study aimed to determine the effect of the first English national COVID-19 lockdown on physical activity (PA), sitting time, eating behaviours and body mass in an adult cohort. This was further examined to determine whether conforming to recommended guidelines on PA and sedentary behaviour was improved. Based on an online survey (n = 818) incorporating the International Physical Activity Questionnaire Short Form (IPAQ-SF), self-reported body mass change showed that in 32.2% of participants body mass increased, with 39.1% reporting an increase in food intake. Never exercising at the gym or undertaking an exercise class (online or live), increased by 50.8% during lockdown, with 53.5% changing from exercising frequently to never exercising, suggesting a lack of engagement with online and home workouts. However, outdoor running and cycling >2 times/week increased by 38% during lockdown. Walking at least 30 min continuously on >2 occasions/week increased by 70% during lockdown with minimum 10-min walks on 7 days per week increasing by 23%. The lockdown had a negative impact on sitting time (>8 h a day), which increased by 43.6% on weekdays and 121% at weekends. Furthermore, sitting <4 h/day decreased during lockdown (46.5% and 25.6% for weekdays and weekends, respectively). Those citing tiredness or lack of time as a barrier to exercise reduced by 16% and 60%, respectively, from pre-lockdown to during lockdown. More of the sedentary group met the Public Health England PA recommendations, however most participants still did not meet the UK Government guidelines for PA. Improvements in health per additional minutes of physical activity will be proportionately greater in those previously doing <30 min/week, the area where most improvements were found although, conversely sitting time was greatly increased. This study may assist in informing whether future lifestyle changes could improve the health of the population.
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Pacer, Elizabeth, Omar Felipe Duenas-Garcia, Lekha Hota, Kristan Hornsby, and Robert Shapiro. "Urethral Diverticulum following Polypropylene Mesh Midurethral Slings: A Literature Review." BioMed Research International 2020 (May 12, 2020): 1–5. http://dx.doi.org/10.1155/2020/6761581.
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Aims. It is currently unknown whether an association exists between polypropylene mesh and urethral diverticulum formation following placement of polypropylene midurethral slings (MUS) for the treatment of stress urinary incontinence (SUI). We aimed to examine the literature associating MUS with the occurrence of urethral diverticula. Methods. Multiple online research databases, including PubMed, Google Scholar, EBSCOhost, and the Cochrane Library, were searched, from January 2019 to February 2019, for evidence related to the occurrence of urethral diverticula following polypropylene MUS procedures. Results. Four case reports were published demonstrating the occurrence of urethral diverticula following the use of polypropylene mesh for surgical treatment of SUI. Subjects of these cases were menopausal and had an elevated body mass index (BMI), recurrent urinary tract infections (UTIs), autoimmune conditions, or prior pelvic floor surgeries. A thorough urologic workup, including imaging prior to sling placement, was not always performed. Conclusion. No clear association exists between polypropylene MUS placement and subsequent urethral diverticulum formation. Factors that diminish polypropylene mesh biocompatibility include elevated BMI, menopause, recurrent UTIs, prior pelvic surgeries, and preexisting medical conditions. Symptoms associated with urethral diverticula should prompt a complete urologic workup prior to MUS placement.
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Knapp, Bobbi A. "Rx’d and Shirtless: An Examination of Gender in a Crossfit Box." Women in Sport and Physical Activity Journal 23, no. 1 (April 2015): 42–53. http://dx.doi.org/10.1123/wspaj.2014-0021.
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Scholars have examined the ways in which gender is reproduced and resisted in various physical activities and their designated spaces such as aerobics (Markula, 2003), weight training (Dworkin, 2001), and fitness training (Ginsberg, 2000). CrossFit, a relatively new entrant on the fitness scene, has seen an increase in popularity and popular media coverage in the past few years. One of the core tenets of CrossFit is the belief that it is accessible to everyone through scaling. Using a critical feminist geographical approach, the purpose of this research was to examine the ways in which gender was reproduced and resisted in one CrossFit box. This ethnographic study incorporated participant observation, semistructured, in-depth interviews, and online archival work. The themes that emerged included sense of community, pushing through physical limits, coed workouts, beat by a girl, and spatial influence. The results indicate that even though there are ways in which gender norms are reinforced in this space there were also multiple ways in which ideal femininity and hegemonic masculinity were resisted.
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Chebrolu, Raja Hirams, Jayashree Janagam, K. C. Muraleedharan, and Resmy R. "Impact of social media and over the top media during COVID-19 lockdown, a cross-sectional study." International Journal Of Community Medicine And Public Health 8, no. 3 (February 24, 2021): 1156. http://dx.doi.org/10.18203/2394-6040.ijcmph20210796.
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Background: Covid-19 outbreak has forced the governments of several countries to enforce lockdown to control the spread of the virus. Staying at their homes, people are subjected to use Social media (SM)/Over the top media (OTTM) for communication, information, and entertainment. The objective is to know the usage of SM/OTTM and the frequently used applications during the lockdown. Also, its association with health, information usage and education.Methods: An online survey was conducted for a month with a specially framed questionnaire which includes the aspects of SM/OTTM usage, health issues due to SM/OTTM usage, education, and information during Covid-19 lockdown.Results: Wilcoxon Signed-Rank test showed a significant difference between time spent on SM/OTTM before and after the lockdown and the median time used was shifted from 2-4 hours to 4-6 hours. Pearson Chi-Square test was done comparing the usage of SM/OTTM to other variables which showed significance in the aspects of interpersonal problems, usage out of boredom, staying connected to friends/family, online workouts/diet plans, false information, awareness on Covid-19, and cyberbullying. Sleeplessness, headache, eye complaints were predominant among the physical ailments whereas Stress, irritability, restlessness, anxiety were predominant among psychological affections due to SM/OTTM usage.Conclusions: SM/OTTM was frequently used and played a key role during the Covid-19 lockdown. SM has helped people to stay connected, acquire information, and stay updated on the pandemic. SM is also responsible for physical and mental health affections due to prolonged usage and exposure to false information during the lockdown.
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Alenezi, A. M. "The relationship of students’ emotional intelligence and the level of their readiness for online education: A contextual study on the example of university training in Saudi Arabia." Education and science journal 22, no. 4 (May 15, 2020): 89–109. http://dx.doi.org/10.17853/1994-5639-2020-4-89-109.
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Introduction. It is well known that the effectiveness of students’ online education depends largely on their skills to interact with the digital educational environment. At the same time, there has been a marked shift in scientific publications from the traditional point of view about the priority of competency formation in students to use educational information and communication technologies on the other aspects of online education, including psychometric.The aim of this research was to investigate the influence of students’ emotional intelligence on their preparedness for online learning programmes.Methodology and research methods. A questionnaire survey was employed as the main tool. In the course of the questionnaire survey, Emotional Intelligence Scale (EIS) and Online Learning Readiness Scale (OLRS) were used to measure the selected characteristics of students. The method of single-factor dispersion analysis ANOVA (analysis of variance) and t-test of equal dispersions were applied to process the obtained empirical data.Results and scientific novelty. 340 Saudi students, admitted into the Faculties of Pharmacy, IT, Sciences and Arts in Northern Border University (Arar), took part in the questionnaire. The sample of respondents was random; only 208 respondents fully completed the survey. The gender of students was considered as a key variable. It was revealed that the level of emotional intelligence in female students is higher than in their male fellow students, which ultimately caused the best readiness of girls for online training. The analysis of the survey data showed the variance between the measured respondents’ characteristics depending on the area of specialisation. If compared with the Sciences and Arts students, the representatives of the Faculties IT and Pharmacy demonstrated higher level skills to undertake online training, more expressed skills of self-control and computer selfefficacy. The level of online communication self-efficacy, recorded among the respondents, was not so significant. However, the respondents of all four faculties demonstrated a high level of motivation for independent online learning activities. It was reliably established that a high level of emotional intelligence correlates with readiness for such forms of work.It was found out that students are not always able to clearly identify their educational needs on their own and to understand them without someone’s assistance, new arsenal of educational tools, their adequate application and quality. In addition, the emotional attitude to online learning is very significant. Therefore, in order to make e-learning effective, it is appropriate to conduct pre-diagnostics, taking into account students’ psychometric parameters, to identify students’ expectations about the online courses and to assess own readiness for such training. According to the author of the current publication, pedagogical support of the process of formation and development of emotional intelligence and formation of students’ skills to regulate their feelings should become an integral part of the curriculum to ensure the success of the learning process. The author identified the critical points of teaching staff activity, which may vary depending on the required scale of the pedagogical intervention and the specific direction of training.Practical significance. The research results can be useful for teachers and administrators of educational institutions engaged in the development and promotion of distance and blended learning.
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JULEAN, IULIA, and REMUS VĂIDĂHĂZAN. "SWIMMING AS A LEISURE PHYSICAL ACTIVITY DURING THE 2020-2021 PANDEMIC COVID-19 IN CLUJ-NAPOCA." Studia Universitatis Babeş-Bolyai Educatio Artis Gymnasticae 66, no. 2 (June 30, 2021): 93–102. http://dx.doi.org/10.24193/subbeag.66(2).18.
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Introduction The Covid-19 pandemic has had a negative impact on the global community, leading to restrictive measures in all areas of activity, including sports. Starting with March 2020, most physical activities have ceased, due to the establishment of the state of emergency in Romania. Swimmers were restricted from accessing their main training facilities and were no longer allowed access to the pools. After a more sedentary period, in which each of us tried to adapt to the existing situation, the need to be involved in sports, the need for movement, and the need for socialization was growing. Thus, the instructors tried to find out alternatives to continue athletes training, so they do not completely lose their physical fitness. Some managed to continue their training in the water, at other pools, others organized workouts outside the pool, maintaining their physical condition at an optimal level. In fewer cases, coaches continued training with athletes online. The purpose of this study was to discover the training strategies applied by swimming coaches during the pandemic, during the State of emergency and the Alert state, in Cluj-Napoca. The results of our study can be used, in the future, by students, teachers and instructors to better reorganize their physical activities, especially swimming, when a special situation arises again.
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Hobusch, Gerhard M., Florian Keusch, Hiroyuki Tsuchiya, Michael Joyce, and Reinhard Windhager. "What Opinions Do Tumor Reconstructive Surgeons Have about Sports Activity after Megaprosthetic Replacement in Hip and Knee? Results of the MoReSports Expert Opinion Online Survey." Journal of Clinical Medicine 9, no. 11 (November 12, 2020): 3638. http://dx.doi.org/10.3390/jcm9113638.
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Sports activity has many benefits in cancer survivors. A key one is having sport activity contribute to the well-being of the individual. However, there are no guidelines about the intensity and kind of postoperative mobility workouts after hip or knee megaprosthetic treatment. Opinion research about sports after modular bone and joint replacement may provide an understanding of surgeons’ attitudes on sports activity after megaprostheses of the hip and knee joint. A web survey with members of three international professional organizations of orthopedic tumor reconstructive surgeons was conducted between September 2016 and January 2018. Members were invited via personalized emails by the European Musculoskeletal Oncology Society (EMSOS), the International Society of Limb Salvage (ISOLS), and the Musculoskeletal Tumor Society (MSTS). The questionnaire included 26 questions. A total of 149 surgeons started the survey, and 76 finished the entire survey (American Association for Public Opinion Research (AAPOR) second response rate (RR2) EMSOS: 12.3%; ISOLS: 21.9%; MSTS: n/a). More than half of the respondents encourage sarcoma survivors after megaprosthetic treatment to reach an activity level that would allow them to regularly participate in active sporting events of University of California, Los Angeles (UCLA) activity level 7 and higher. Orthopedic tumor reconstructive surgeons do fear a number of complications (periprosthetic fracture, allograft failure/fracture, loosening, prosthetic or bearing failure, and early polyethylene wear) due to sports activity after modular bone–joint replacement, but they actually witness fewer complications than they conceptually anticipated. According to the surgeons’ opinions, between four to seven types of sports after surgery could reasonably be recommended depending on the type of hip or knee procedures. This survey provides insights into opinions on what could be recommended, what could be allowed if surgeons and their patients agree on the potential negative outcome, and which sports should definitely not be allowed after hip and knee megaprostheses.
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Waqar, Mueez, Jane Wilcock, Jayne Garner, Benjamin Davies, and Mark Kotter. "Quantitative analysis of medical students’ and physicians’ knowledge of degenerative cervical myelopathy." BMJ Open 10, no. 1 (January 2020): e028455. http://dx.doi.org/10.1136/bmjopen-2018-028455.
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ObjectivesWe have previously identified a delay in general practitioner (GP) referrals for patients with degenerative cervical myelopathy (DCM). The aim of this study was to evaluate whether an education gap existed for DCM along the GP training pathway by quantitatively assessing training in, and knowledge of, this condition.DesignGap analysis: comparison of DCM to other conditions. Comparators selected on the basis of similar presentation/epidemiology (multiple sclerosis), an important spinal emergency (cauda equina syndrome) and a common disease (diabetes mellitus).SubjectsMedical students, foundation doctors and GP trainees.Primary and secondary outcome measures(1) Assessment of training: quantitative comparison of references to DCM in curricula (undergraduate/postgraduate) and commonly used textbooks (Oxford Handbook Series), to other conditions using modal ranks. (2) Assessment of knowledge: using standardised questions placed in an online question-bank (Passmedicine). Results were presented relative to the question-bank mean (+/−).ResultsDCM had the lowest modal rank of references to the condition in curricula analysis and second lowest modal rank in textbook analysis. In knowledge analysis questions were attempted 127 457 times. Performance for DCM questions in themes of presentation (+6.1%), workup (+0.1%) and management (+1.8%) were all greater than the question-bank mean and within one SD. For students and junior trainees, there was a serial decrease in performance from presentation and workup (−0.7% to +10.4% relative to question-bank mean) and management (−0.6% to −3.9% relative to question-bank mean).ConclusionsAlthough infrequently cited in curricula and learning resources, knowledge relating to DCM was above average. However, knowledge relating to its management was relatively poor.
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Ganesh, Aravind, Padmaja Genesh, Malik M. Adil, Malavika Varma, and Eric E. Smith. "Practice Current." Neurology: Clinical Practice 10, no. 4 (July 7, 2020): 362–70. http://dx.doi.org/10.1212/cpj.0000000000000890.
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Mild cognitive impairment (MCI) is characterized by evidence of cognitive impairment with minimal disruption of instrumental activities of daily living and carries a substantial risk of progression of dementia. Whereas current guidelines support a relatively minimalistic workup to identify reversible or structural causes, the field has witnessed the rapid development of various sophisticated imaging, biomarker, and genetic investigations in the past few years. The role of these investigations in routine practice is uncertain. Similarly, although there are no approved treatments for MCI, neurologists may experience uncertainty about using cholinesterase inhibitors or other medications or supplements that have been studied in MCI with limited success, particularly when patients or families are keen to try pharmacologic options. Given these uncertainties, and the paucity of high-quality data in the literature, we sought expert opinion from around the globe on how to investigate and treat patients with MCI. Similar questions were posed to the rest of our readership in an online survey, the preliminary results of which are also presented.
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Pramesh, C. S., Bhawna Sirohi, Shona Milon Nag, Sudeep Gupta, Benjamin O. Anderson, Nancy Renee Feldman, Premal H. Thaker, Sushil Beriwal, and Rajendra A. Badwe. "Prospective study of an AI enabled online intervention to increase delivery of guideline compliant cancer care, on the ground." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 2011. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.2011.
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2011 Background: Despite survival benefits of guideline compliant cancer care, under treatment and over treatment are prevalent. Navya is an AI enabled online intervention that matches a patient’s medical record with NCCN and NCG guidelines (National Cancer Grid, India) and layers live multidisciplinary expert review to recommend actionable treatment plans. It was developed to standardize care and mitigate morbidity and mortality, by delivering on-t ime, guideline based expert treatment plans. Methods: From July 2019 to January 2020, all patients who received a Navya treatment plan based on guidelines and live expert review were included. Intended treatment plans were prospectively collected from the patient. Compliance of intended plans with NCCN (including Resource Stratified Framework) or NCG was measured. Noncompliant intended plans were categorized as overtreatment or undertreatment. After delivery of Navya plan, prospective phone follow up assessed whether noncompliant intended plans were changed to guideline compliant care. Results: Of 1707 consecutive patients who received a Navya plan, 1549 intended plans were available. Patients were diverse with respect to geographic, socioeconomic, and primary tumor distribution: West of India: 28%, North: 26%, East: 21%, South: 15%, Central: 7%, International: 3%; 35% of patients with income < $300/month; GI: 23%, Breast: 14%, Head & Neck: 11%, Thoracic: 10%. Of the 1549 intended plans, 441 (28.47% (95% CI ± 0.26%)) were not compliant with NCCN or NCG. Undertreatment was 35%, overtreatment 26%, incomplete staging workup 28% and 11% could not be categorized. Of 441 patients with noncompliant intended plans, 80.19% (± 0.97%) shared the Navya plan with their treating oncologists and 50.40% (± 0.88%) changed their intended plan to receive the Navya treatment plan. Intervention with Navya increased on-the -ground guideline compliance by ~15% (from 71.53% ±0.42% to 85.87% ± 1.73%). Conclusions: Guideline compliant care ensures best achievable clinical outcomes with existing therapies. A technological earthshot that significantly increases adoption of guideline based care is the first step towards cancer moonshots.
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van Rossum, Huub H. "Moving average quality control: principles, practical application and future perspectives." Clinical Chemistry and Laboratory Medicine (CCLM) 57, no. 6 (May 27, 2019): 773–82. http://dx.doi.org/10.1515/cclm-2018-0795.
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Abstract Moving average quality control (MA QC) was described decades ago as an analytical quality control instrument. Although a potentially valuable tool, it is struggling to meet expectations due to its complexity and need for evidence-based guidance. For this review, relevant literature and the world wide web were examined in order to (i) explain the basic concepts and current understanding of MA QC, (ii) discuss moving average (MA) optimization methods, (iii) gain insight into practical aspects related to applying MA in daily practice and (iv) describe future prospects to enable more widespread acceptance and application of MA QC. Each of the MA QC optimization methods currently available has their own advantages and disadvantages. Recently developed simulation methods provide realistic error detecting properties for MA QC and are available for laboratories. Operational MA management issues have been identified that allow developers of MA software to upgrade their packages to support optimal MA QC application and guide laboratories on MA management issues, such as MA alarm workup. The new insights into MA QC characteristics and operational issues, together with supporting online tools, may promote more widespread acceptance and application of MA QC.
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van Schaik, Jan, Tessa M. Hers, Carla SP van Rijswijk, Maaike S. Schooneveldt, Hein Putter, Daniël Eefting, and Joost R. van der Vorst. "Risk assessment in aortic aneurysm repair by medical specialists versus the American College of Surgeons National Surgical Quality Improvement Program risk calculator outcomes." JRSM Cardiovascular Disease 10 (January 2021): 204800402110065. http://dx.doi.org/10.1177/20480040211006582.
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Objective The aim of this online clinical vignette-based survey study was to compare risk assessments by vascular surgeons, anaesthesiologists and interventional radiologists involved in treating patients with aortic aneurysms in the Netherlands with the NSQIP risk calculator outcomes. Methods Participants, recruited using purposive sampling, provided their estimation of the likelihood of postoperative complications and events following aortic surgery in five fictional cases. These cases were subsequently scored using the NSQIP calculator. The risk assessments were statistically analysed using the ANOVA and student t-test. Results All participating specialists i.e. twelve vascular surgeons, ten interventional radiologists and ten anaesthesiologists completed the survey. In the vast majority of outcomes and vignettes, no significant differences were found between various specialists, whereas significant differences were found between the NSQIP risk calculator outcomes and the combined risk assessments of the specialists. Overall, specialist risk assessments differ from the NSQIP, but neither particularly higher nor lower compared to the risk calculator. Conclusions Risk assessment by vascular surgeons, anaesthesiologists and interventional radiologists differs significantly with NSQIP risk calculator outcomes, within the framework of both endovascular and open aortic aneurysm repair. Based on these results, implementing the NSQIP risk calculator in preoperative workup could be of added value in both patient planning as well as adequately informing patients for obtaining consent.
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Martínez-Hernández, Néstor, Usue Caballero Silva, Alberto Cabañero Sánchez, José Campo-Cañaveral de la Cruz, Andrés Obeso Carillo, José Jarabo Sarceda, Sebastián Sevilla López, et al. "Effect of COVID-19 on Thoracic Oncology Surgery in Spain: A Spanish Thoracic Surgery Society (SECT) Survey." Cancers 13, no. 12 (June 9, 2021): 2897. http://dx.doi.org/10.3390/cancers13122897.
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After the first wave of COVID-19, the Spanish Society of Thoracic Surgeons (SECT) surveyed its members to assess the impact of the pandemic on thoracic oncology surgery in Spain. In May 2020, all SECT members were invited to complete an online, 40-item, multiple choice questionnaire. The questionnaire was developed by the SECT Scientific Committee and sent via email. The overall response rate was 19.2%. The respondents answered at least 91.5% of the items, with only one exception (a question about residents). Most respondents (89.3%) worked in public hospitals. The reported impact of the pandemic on routine clinical activity was considered extreme or severe by 75.5% of respondents (25.5% and 50%, respectively). Multidisciplinary tumour boards were held either with fewer members attending or through electronic platforms (44.6% and 35.9%, respectively). Surgical activity decreased by 95.7%, with 41.5% of centers performing surgery only on oncological patients and 11.7% only in emergencies. Nearly 60% of respondents reported modifying standard protocols for early-stage cancer and in the preoperative workup. Most centers (≈80%) reported using full personal protective equipment when operating on COVID-19 positive patients. The COVID-19 pandemic severely affected thoracic oncology surgery in Spain. The lack of common protocols led to a variable care delivery to lung cancer patients.
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Vilar, E., M. Martinez, V. Alonso, M. Sevilla, J. Sastre, D. Castellano, M. Marazuela, J. Diaz, C. Villabona, and R. Salazar. "Influence of first line treatment in the 5 (5yS) and 10-year (10yS) survival outcomes of patients with gastroenteropancreatic neuroendocrine tumors (GNETs): 2001–2005 Spanish task force GNET group." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 14058. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.14058.
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14058 Background: Data on incidence, morbidity and mortality of GNETs is limited due to the low frequency of these tumors. However this survival data is critical to design studies with new agents. Methods: Data was obtained from medical records of 262 patients with GNETs and centralized in an online registry at www.retegep.net . Among the study parameters were histology, localization, stage, diagnostic workup, 1st line and subsequent treatments, 5yS and 10yS for the whole dataset and for different stages, tumor types and 1st line systemic treatment. Results: Mean age 58, 58% male. Primary tumors: 49% Carcinoids (C), 19% non-functioning pancreatic tumors (PT), 9% insulinomas, 6% gastrinomas and 8% unknown primary. Localizations: midgut (36%), head (17%) and body of pancreas (10%). Functioning symptoms led to diagnosis in 38% of cases. 4% were associated to MEN1. Stage at diagnosis was advanced (Adv) in 46%, localised (L) in 30% and locorregional (LR) in 13% (unknown in 11%). Diagnostic workup were CT Scan (84%), Octreoscan (52%) and US (52%) and serum hormone tests (65%). Treatments for Adv disease included somatostatin analogues (SA) (47%), surgery (S) (43%), chemotherapy (CT) (35%) and interferon (IFN) (34%), embolization (7%) and radiofrequency ablation (3%). 5yS and 10yS for the whole group was 61.6% (SD: 5.2%) and 49.8% (SD: 7.7%) respectively. 5yS and 10yS for the L/LR and Adv stages were 78.1% (SD: 7.3%) and 71% (SD: 10%), and 48.9% (SD: 7.7%) and 29% (SD: 12.4%), respectively. LR PT and C had similar 5 and 10yS but Adv PT did worse than Adv C (5yS of 36.2% and 61.1%, respectively). 1st line systemic treatment for LR and Adv disease (n=90) included SA (39%), CT (34.4%), IFN (5.6%), combinations of SA+IFN (13.3%), A+CT (4.4%) and other combinations (3.3%), with a 10yS rate of 69%, 79%, 50%, 89%, 66% and 50%, respectively. Adv PT perform worse than C regardless of treatment choice. As second line systemic treatment (n=43) 30% received SA, 30% CT, 26% inmunotherapy and 14% combinations. Conclusions: An extensive use of systemic therapy and a scarce use of non-surgical LR treatments is observed in the Adv stages. Choice of 1st line systemic treatment does not seem to influence survival outcomes. No significant financial relationships to disclose.
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Yüce, Imanuel, and Gertrud E. Morlock. "All on one high-performance thin-layer chromatography plate: solvent-free nanomole-scaled on-surface synthesis, workup and online high-resolution mass spectrometry for elucidation of two new degradation products in an ifosfamide formulation." Journal of Chromatography A 1572 (October 2018): 145–51. http://dx.doi.org/10.1016/j.chroma.2018.08.047.
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Alekseyev, Kirill, Alex John, Andrew Malek, Malcolm Lakdawala, Nikhil Verma, Colton Southall, Argyrios Nikolaidis, et al. "Identifying the Most Common CrossFit Injuries in a Variety of Athletes." Rehabilitation Process and Outcome 9 (January 2020): 117957271989706. http://dx.doi.org/10.1177/1179572719897069.
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Background: CrossFit is an increasingly popular, rapidly growing exercise regimen. Few studies have evaluated CrossFit-associated musculoskeletal injuries on a large scale. This study explores such injuries and associated risk factors in detail. Objective: To identify the most common musculoskeletal injuries endured during CrossFit training among athletes at different levels of expertise. Design: Survey-based retrospective cross-sectional study. Setting: Distribution at CrossFit gyms in the United States and internationally. Also published on active online forums. Participants: A total of 885 former and current CrossFit athletes. Methods: Institutional review board-approved 33-question Web-based survey focused on CrossFit injuries and associated risk factors. Survey submissions were accepted for a period of 6 months. Main outcome measurements: Specific injuries with associated workouts, risk factors that affected injury including (1) basic demographics, (2) regional differences in reported injuries, (3) training intensity, and (4) expertise level at time of injury. Results: Of the 885 respondents, 295 (33.3%) were injured. The most common injuries involved the back (95/295, 32.2%) and shoulder (61/295, 20.7%). The most common exercises that caused injury were squats (65/295, 22.0%) and deadlifts (53/295, 18.0%). Advanced-level (64/295, 21.7%) athletes were more significantly injured than beginner-level (40/295, 13.6%) athletes. International participants were 2.2 times more likely than domestic US participants to suffer injury. Individuals with 3+ years of CrossFit experience were 3.3 times more likely to be injured than those with 2 or less years of experience. Participants who trained for 11+ h/week were significantly more likely to be injured than those who trained less than or equal to 10 h/week. Conclusions: As CrossFit becomes more popular, it is important to monitor the safety of its practitioners. Further studies are needed to explore how to lower this injury prevalence of 33.3%. Areas to focus on include factors that have caused the regional (international vs US states) differences, level of expertise/experience differences (advanced level vs intermediate and beginner levels), and stretching routine modifications.
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Isenmann, Eduard, Simon Gavanda, Jule Czudaj, Sascha Schrey, and Stephan Geisler. "Verletzungshäufigkeit und -prävalenz beim CrossFit® in Deutschland." B&G Bewegungstherapie und Gesundheitssport 37, no. 02 (April 2021): 52–59. http://dx.doi.org/10.1055/a-1380-7721.
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ZusammenfassungCrossFit® (CF) bedient sich ständig variierender funktioneller Bewegungen in sogenannten „Workouts of the Day“ (WOD), die oft unter Zeitdruck ausgeführt werden. CF wird daher oft kritisiert, da es möglicherweise ein hohes Verletzungsrisiko birgt. Es existieren Studien zu Verletzungshäufigkeiten beim CF aus den USA, den Niederlanden und Brasilien. Vergleichbare Untersuchungen liegen aus Deutschland bislang nicht vor. Daher war das Ziel der vorliegenden Studie mit Hilfe einer Befragung retrospektiv Verletzungen und Überlastungssyndrome im CF zu analysieren.Anhand eines Online-Fragebogens mit 32 Fragen wurden demografische Merkmale sowie Informationen zum absolvierten Training, der Verletzungshäufigkeit, Körperregion und Verletzungsursache der letzten 12 Monate erfasst. Nur Athletinnen und Athleten, die in einer zertifizierten CF Box trainierten, wurden bei der Auswertung berücksichtigt (n = 577, 32,5 ± 8,2 Jahre; Altersspanne 16-61 Jahre). 53 % der Befragten waren weiblich und 47 % waren männlich. Die meisten Athletinnen und Athleten (90 %) wurden als Fortgeschrittene eingestuft (> 6 Monate CF Trainingserfahrung) und 10 % als Anfänger (≤ 6 Monate CF Trainingserfahrung). Fortgeschrittene trainierten signifikant häufiger als Anfänger (3,7 ± 1,3 vs. 2,8 ± 1,3 Trainingseinheiten / Woche; p < 0,001). Die Hälfte der Befragten erlitt in den letzten 12 Monaten mindestens eine Verletzung, bei 12 % traten zwei und bei 3 % mehr als drei Verletzungen in diesem Zeitraum auf. Es wurden keine signifikanten Unterschiede in der Verletzungshäufigkeit zwischen Männern und Frauen gefunden (p = 0,78), jedoch erlitten Fortgeschrittene signifikant mehr Verletzungen als Anfänger (0,7 ± 0,8 vs. 0,4 ± 0,6, p = 0,002). Die meisten Verletzungen traten während des WOD auf (48 %), gefolgt von Langhanteltraining (21 %). Die am häufigsten betroffenen Stellen waren die Schulter (23 %), der untere Rücken (18 %) und das Knie (10 %).Anhand der vorliegenden Ergebnisse wird vermutet, dass eine höhere Trainingshäufigkeit ein möglicher Faktor darstellt, welcher Verletzungen begünstigt. Daher sollte das Verhältnis der Belastung und der Regeneration in der Praxis individualisiert Berücksichtigung finden. Außerdem sollten auf eine korrekte Übungsausführung auch unter Zeitdruck geachtet und präventive Übungen für die häufig betroffenen Körperregionen (Schulter, Rücken, Knie) in den Trainingsprozess integriert werden, um das Verletzungsrisiko zu reduzieren.
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de Graeff, Nienke, Noortje Groot, Seza Ozen, Despina Eleftheriou, Tadej Avcin, Brigitte Bader-Meunier, Pavla Dolezalova, et al. "European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease – the SHARE initiative." Rheumatology 58, no. 4 (December 7, 2018): 672–82. http://dx.doi.org/10.1093/rheumatology/key344.
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AbstractObjectivesThe European Single Hub and Access point for paediatric Rheumatology in Europe initiative aimed to optimize care for children with rheumatic diseases. Kawasaki disease (KD) is the most common cause of acquired heart disease in children and an important cause of long-term cardiac disease into adulthood. Prompt diagnosis and treatment of KD is difficult due to the heterogeneity of the disease but is crucial for improving outcome. To date, there are no European internationally agreed, evidence-based guidelines concerning the diagnosis and treatment of KD in children. Accordingly, treatment regimens differ widely. The aim of this study is to provide consensus-based, European-wide evidence-informed recommendations for diagnosis and treatment of children with KD.MethodsRecommendations were developed using the EULAR’s standard operating procedures. An extensive systematic literature search was performed, and evidence-based recommendations were extrapolated from the included papers. These were evaluated by a panel of international experts via online surveys and subsequently discussed in three consensus meetings, using nominal group technique. Recommendations were accepted when ⩾80% agreed.ResultsIn total, 17 recommendations for diagnosis and 14 for treatment of KD in children were accepted. Diagnostic recommendations included laboratory and imaging workup for complete as well as incomplete KD. Treatment recommendations included the importance of early treatment in both complete and incomplete KD, use of intravenous immunoglobulin, aspirin, corticosteroids for high-risk cases, and other treatment options for those with resistant disease.ConclusionThe Single Hub and Access point for paediatric Rheumatology in Europe initiative provides international evidence-based recommendations for diagnosing and treating KD in children, facilitating improvement and uniformity of care.
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Feghali, Krystel, Kostas Papamarkakis, Jackson Clark, Neha Malhotra, Lanu Stoddart, and Ibitoro Osakwe. "Vitamin D Toxicity Managed with Peritoneal Dialysis." Case Reports in Endocrinology 2021 (June 28, 2021): 1–6. http://dx.doi.org/10.1155/2021/9912068.
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Vitamin D deficiency is a global health issue that afflicts more than one billion children and adults worldwide. Vitamin D supplementation has increased over the years, whether through medical prescriptions, over-the-counter, or online purchasing. This is driven by a more recognized association between vitamin D sufficiency status and lower risk of cancer. In addition, more recently, it is used as a potential prophylactic and treatment for COVID-19 infection. This can lead to toxicity from overingestion. While rare, it has been reported in the literature. In this case report, we present a 75-year-old man with severe hypercalcemia secondary to vitamin D toxicity managed with peritoneal dialysis. He presented with biochemical evidence of hypercalcemia, acute kidney injury, and pancreatitis. Workup for his hypercalcemia led to the diagnosis of vitamin D toxicity as shown by a level greater than 200 ng/dL (Ref: 20–50 ng/mL) was confirmed by liquid chromatography-mass spectroscopy. Cornerstone medical management of hypercalcemia was provided which included aggressive intravenous fluid hydration, intravenous diuretics, calcitonin, bisphosphonate, and corticosteroid therapy. At every interruption of therapy, calcium levels trended upward. A thorough literature review yielded the finding of a sole case report from 1966 presented at the Third International Congress of Nephrology, in which peritoneal dialysis was used in the management of vitamin D toxicity and hypercalcemia. This modality is established to cause vitamin D deficiency. In collaboration with the nephrology team, 10 sessions of peritoneal dialysis were undertaken with resolution of hypercalcemia and downtrend in 25-hydroxyvitamin D levels as measured by dilution.
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Ticci, Chiara, Daniele Orsucci, Anna Ardissone, Luca Bello, Enrico Bertini, Irene Bonato, Claudio Bruno, et al. "Movement Disorders in Children with a Mitochondrial Disease: A Cross-Sectional Survey from the Nationwide Italian Collaborative Network of Mitochondrial Diseases." Journal of Clinical Medicine 10, no. 10 (May 12, 2021): 2063. http://dx.doi.org/10.3390/jcm10102063.
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Movement disorders are increasingly being recognized as a manifestation of childhood-onset mitochondrial diseases (MDs). However, the spectrum and characteristics of these conditions have not been studied in detail in the context of a well-defined cohort of patients. We retrospectively explored a cohort of individuals with childhood-onset MDs querying the Nationwide Italian Collaborative Network of Mitochondrial Diseases database. Using a customized online questionnaire, we attempted to collect data from the subgroup of patients with movement disorders. Complete information was available for 102 patients. Movement disorder was the presenting feature of MD in 45 individuals, with a mean age at onset of 11 years. Ataxia was the most common movement disorder at onset, followed by dystonia, tremor, hypokinetic disorders, chorea, and myoclonus. During the disease course, most patients (67.7%) encountered a worsening of their movement disorder. Basal ganglia involvement, cerebral white matter changes, and cerebellar atrophy were the most commonly associated neuroradiological patterns. Forty-one patients harbored point mutations in the mitochondrial DNA, 10 carried mitochondrial DNA rearrangements, and 41 cases presented mutations in nuclear-DNA-encoded genes, the latter being associated with an earlier onset and a higher impairment in activities of daily living. Among our patients, 32 individuals received pharmacological treatment; clonazepam and oral baclofen were the most commonly used drugs, whereas levodopa and intrathecal baclofen administration were the most effective. A better delineation of the movement disorders phenotypes starting in childhood may improve our diagnostic workup in MDs, fine tuning management, and treatment of affected patients.
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Dowd, A. Justine, Liam Kronlund, Candice Parmar, Julia T. Daun, Kathryn Wytsma-Fisher, Raylene A. Reimer, Guillaume Y. Millet, and S. Nicole Culos-Reed. "A 12-Week Pilot Exercise Program for Inactive Adults With Celiac Disease: Study Protocol." Global Advances in Health and Medicine 8 (January 2019): 216495611985377. http://dx.doi.org/10.1177/2164956119853777.
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Background Individuals with celiac disease must follow a strict gluten-free diet (GFD) in order to avoid negative short- and long-term health consequences. Unfortunately, many people with celiac disease report poor quality of life (QoL) despite following a strict GFD, and up to 30% still report negative symptoms (eg, gastrointestinal upset). Purpose The purpose of the MOVE-C (understanding the relationship between the Microbi Ome, Vitality, and Exercise in Celiac disease) pilot study is to explore the effects of a 12-week supervised progressive high-intensity interval training (HIIT) and lifestyle intervention on physiological, behavioral, and psychosocial outcomes among inactive adults with celiac disease. Methods/Design: Sixty inactive adults diagnosed with celiac disease will be randomized to HIIT+ or waitlist control (WLC). Participants in the HIIT+ will engage in a 12-week HIIT + lifestyle education program. HIIT sessions will be comprised of 2 workouts per week, working up to 14 × 30-second intervals at 90% maximal heart rate (HRmax) followed by 2 minutes recovery at 50% HRmax. The 6 biweekly lifestyle sessions will involve education on the promotion of a whole foods GFD, sleep hygiene, psychosocial coping skills (eg, self-compassion), and self-regulatory skills to master changes in behaviors. Assessments will occur at pre and post 12-week intervention and 3-month follow-up. WLC participants will be offered a 12-week HIIT program + online lifestyle education sessions after completing the final assessment. The primary outcomes are QoL and gut microbiota composition assessed with 16S rRNA sequencing. The secondary outcomes are markers of metabolic syndrome (waist circumference, fasting glucose, serum lipids, blood pressure, and body composition), gastrointestinal symptoms, sleep quality, adherence to a GFD, exercise behavior, self-regulatory efficacy, and self-compassion. It is hypothesized that participants in the HIIT+ will experience improvements in all outcomes when compared to those in the WLC. These improvements are expected to be maintained at the 3-month follow-up. Discussion The findings from this study will advance the knowledge regarding the effects of HIIT and lifestyle education on key outcomes for an at-risk chronic disease population. Furthermore, the findings can be used to inform future programs to improve fitness and physical and mental health outcomes for people with celiac disease.
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Richards, Jon M., Trever B. Burgon, Diana Tamondong-Lachica, Jacob D. Bitran, Wilfredo L. Liangco, David R. Paculdo, and John W. Peabody. "Reducing Unwarranted Oncology Care Variation Across a Clinically Integrated Network: A Collaborative Physician Engagement Strategy." Journal of Oncology Practice 15, no. 12 (December 2019): e1076-e1084. http://dx.doi.org/10.1200/jop.18.00754.
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PURPOSE: Addressing unwarranted clinical variation in oncology is a high priority for health systems that aspire to ensure consistent levels of high-quality and cost-effective care. Efforts to improve clinical practice and standardize care have proven challenging. Advocate Physician Partners undertook a patient simulation-based practice measurement and feedback project that was focused on breast and lung cancer to engage oncologists in the care standardization process. METHODS: One hundred three medical oncologists cared for online simulated patients using the Clinical Performance and Value platform, receiving feedback on how their care decisions compared with evidence-based guidelines and their peers. We repeated this process every 4 months over six rounds, measuring changes in quality-of-care scores. We then compared simulated patient results with available patient-level claims data. RESULTS: Over the course of the project, overall quality-of-care scores improved 11.9% ( P < .001). Diagnostic accuracy increased 6.7% ( P < .001) and correlated with improved treatment scores, including a nearly 10-percentage point increase in evidence-based chemotherapy regimens ( P = .009) and a 56% increase in addressing palliative needs for patients with late-stage disease ( P < .001). Unnecessary test ordering declined 25% ( P < .001). We compared these results with available patient data and observed concordance with the metastatic imaging workup order rate for early-stage breast cancer. As unnecessary workups declined in the simulations and became more closely aligned with evidence-based guidelines, we saw similar rates of decline in the patient-level data. CONCLUSION: This study demonstrates that an oncology care standardization system that combines simulated patients with serial feedback increases evidence-based and cost-effective clinical decisions in patient simulations and patient-level data.
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Love, Neil, Sagar Lonial, Kathryn Ziel, Douglas Paley, Melanie Elder, and Aviva Asnis-Alibozek. "The Use of An Online Case Database to Obtain Clinical and Psychosocial Information Related to the Selection of and Experience with Initial Systemic Therapy for Multiple Myeloma." Blood 114, no. 22 (November 20, 2009): 1408. http://dx.doi.org/10.1182/blood.v114.22.1408.1408.
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Abstract Abstract 1408 Poster Board I-430 Background: Historically, available information on the clinical course of patients with cancer has been primarily derived from clinical trial reports, and population and hospital registries such as SEER and the American College of Surgeons. While these resources provide useful data on traditional clinical factors, presentation of the results can be delayed, the findings may not be reflective of community-based practice, and psychosocial variables are generally not included. To address these issues, we designed a web-based tool to gather multidimensional information in a rapid and reliable manner, which was pilot-tested in multiple myeloma (MM). Methods: A 60-question case form was developed that requested information on presenting symptoms, diagnostic workup, treatment selection and the treating physician's perceptions and observations of a number of psychosocial variables. US community-based medical oncologists were recruited to enter anonymous case data on patients in their practices diagnosed with MM since January 1, 2008. Invited physicians had previously participated in CME programs developed by our group, and were provided modest, per-patient honoraria. Results: From April 10-27, 2009, 41 physicians entered a total of 203 MM cases in the data bank (minimum 2 cases, maximum 10, median 5). The median patient age was 67, 60% were men, 54% were retired, 97% had health insurance and 64% lived with a spouse or partner, most of whom accompanied the patient to office visits. In 64% of cases, physicians believed that patients had “a great deal” of family support. In 80%, the patient was considered “very or somewhat” proactive toward obtaining medical information, and in 64% the oncologist provided a quantitative estimate of long-term survival. Physicians considered 71% of patients “calm and accepting” of the diagnosis. Only 36% of patients were PS 0, and multiple cancer-related symptoms were common. ISS staging and the use of cytogenetic analyses were inconsistent (Table 1). A variety of systemic regimens were initiated, and treatment resulted in “significant” or “major” toxicities in 21%. The most common side effects were fatigue (47%), neutropenia (28%), thrombocytopenia (25%) and peripheral neuropathy (24%). Bisphosphonates were administered to 77% of patients, mostly zoledronic acid (83%). Clinical trial participation was discussed in 34% of cases, and 22 people (11% of the total) enrolled in a study. In 15% of the cases the oncologist found management to be “somewhat” or “very” challenging and would have liked input on the case. Conclusions: This web-based instrument allowed rapid and efficient collection of relevant information and provided a snapshot of newly diagnosed MM in community-based practice. Clinical findings revealed several potential “knowledge gaps,” represented by heterogeneity in the selection of initial systemic therapy and the lack of adequate staging and prognostic information, including cytogenetics. The psychosocial data obtained may be useful in planning MM support programs, and could be compared to similar information gathered directly from patients. Furthermore, in almost one in six cases, oncologists would have liked to have assistance in making management decisions. These initial findings document the need for related clinical support and education programs that use this information as a benchmark for improvement. Disclosures: Lonial: Amgen, Inc: Consultancy; Bristol-Myers Squibb Co: Consultancy; Celgene Corp: Consultancy; Millennium Pharmaceuticals Inc: Consultancy; Novartis Pharmaceuticals Corp: Consultancy; Ortho Biotech Products LP: Consultancy.
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Krebs, L., N. Hill, C. Villa-Roel, S. Couperthwaite, M. Ospina, B. Holroyd, and B. Rowe. "P077: Piloting imaging-focused knowledge dissemination tools in Alberta emergency departments." CJEM 21, S1 (May 2019): S91. http://dx.doi.org/10.1017/cem.2019.268.
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Introduction: Variation in image ordering exists across Alberta emergency departments (EDs). Evidence-based, pocket-sized knowledge dissemination tools were developed for two conditions (acute asthma [AA] and benign headache [BHA]) for which imaging (chest x-ray [CXR] and computed tomography [CT], respectively) has limited utility. This study explored tool acceptability among ED patients and emergency physicians (EPs). Methods: Tool feedback was provided by EPs, via online survey, and adult patients with AA and BHA via in-person survey. EPs qualitative interviews further explored communication tools. Preliminary descriptive analyses of survey responses and content analysis of interview data were conducted. Results: Overall, 55 EPs (55/192; 29%) and 38 consecutive patients participated in the AA study; 73 EPs (73/192; 38%) and 160 patients participated in the BHA study. In both studies, approximately 50% of EPs felt comfortable using the tool; however, they suggested including radiation risk details and imaging indications and removing references to imaging variation and health system cost. In the BHA study, EPs opposed the four Choosing Wisely® campaign questions fearing they would increase imaging expectations. In both conditions, most patients ( >90%) understood the content and 68% felt the information applied to them. Less than half (AA:45%; BHA: 38%) agreed that they now knew more about when a patient should have imaging workup done. Following tool review, 71% of AA and 50% of BHA patients stated they would discuss their imaging needs with their ED care provider today or during a future presentation. Both patient groups suggested including: additional imaging details (i.e., indications, risk, clinical utility), removing imaging overuse references, and including instructions that encourage patients to ask their EP questions. EP interviews (n = 12) identified preferences for personalized and interactive tools. Tensions were perceived around ED time pressure as well as remuneration schemes that fail to prioritize patient conversation. Tool centralization, easy access, and connection with outpatient support were also key themes. Conclusion: Both patients and EPs provided valuable information on how to improve ED knowledge dissemination tools, using two chronic conditions to demonstrate how these changes would improve tool utility. Implementing these recommendations, and considering preferences of EPs and patients, may improve future tool uptake and impact.
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Willis, Lauren, and Sara R. Fagerlie. "Hematologists Demonstrate Sub-Optimal Knowledge of FLT3 Mutations in Acute Myeloid Leukemia." Blood 132, Supplement 1 (November 29, 2018): 5862. http://dx.doi.org/10.1182/blood-2018-99-115409.
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Abstract Background: The objective of this study was to assess current clinical practices of hematologist/oncologist (hem/onc) specialists related to FLT3 mutations and FLT3 inhibitors used in acute myeloid leukemia (AML), in order to identify knowledge, competency, and practice gaps and barriers to optimal care. Methods: A continuing medical education (CME)-certified clinical practice assessment consisting of 25 multiple choice questions that were designed to measure knowledge, skills, attitudes, and competence of hem/onc specialists regarding FLT3 mutations and FLT3 inhibitors used in AML. The survey instrument was made available online to physicians without monetary compensation or charge. Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses. The activity launched on March 26, 2018, and participant responses are still being collected at the time of abstract submission. Results: At the time of this report there are 122 hem/onc activity participants, collection is on-going. Demographics and treatment practices are listed in Table 1, and levels of confidence and barriers to incorporating mutation testing are listed in Table 2.FLT3 Mutations and Testing RecommendationsThe assessment demonstrated there are low levels of knowledge about prevalence, prognostic significance of, and optimal testing methods for FLT3 mutations in AML.Despite a majority (84%) demonstrating knowledge that FLT3-ITD mutational analysis is strongly recommended (per CAP/ASH guidelines) in all patients at initial workup, only 38% indicated they test 100% of their newly diagnosed AML patients for FLT3 mutations74% could not identify the prevalence of activating FLT3 mutations in adults with AML, and 44% could not identify the prognostic significance of FLT3-ITD and FLT3-TKD mutations in AML94% could not identify the optimal method to determine FLT3 mutation status in newly diagnosed AMLClinical Trial Data and Assessing Treatment ResponseRevealed relatively low levels of knowledge of clinical trial data with FLT3 inhibitors and the appropriate time to assess response to treatment.61% were unable to identify efficacy outcomes from the midostaurin phase 3 RATIFY trial60% were unable to recognize the optimal time to obtain a bone marrow aspiration and biopsy after initiating cycle 1 of induction therapy in a patient that received midostaurinTreatment Related Adverse Events and Administration ConsiderationsLess than optimal awareness of adverse events and drug-drug interactions that can occur with FLT3 inhibitors.47% were unaware that posaconazole can interact with midostaurin leading to increased serum midostaurin levels73% did not recognize the need to hold midostaurin if a patient develops grade 3-4 pulmonary infiltrates, based on the RATIFY trial protocolNovel FLT3 InhibitorsRevealed a very low level of knowledge about second generation FLT3 inhibitors regarding additional targets other than FLT3 and activity against specific FLT3 mutations.96% could not recognize additional targets of novel FLT3 inhibitors79% could not recognize which form of FLT3 mutations (ITD or TKD) novel inhibitors targeted Conclusions: After decades of using the same initial treatment for AML, key advances have led to therapy changes for subsets of patients with AML such as those with FLT3 mutations. Gaps in clinical knowledge and competence for hem/onc practitioners were identified in this assessment.These deficiencies included testing for FLT3 mutations and integrating FLT3 inhibitors into therapy for the treatment of patients with AML. Additionally, the activity demonstrated gaps in the knowledge of testing recommendations and the practice of FLT3 mutation testing in all newly diagnosed AML patients. Additional education is needed to improve the knowledge, competence, and confidence of academic and community hem/onc specialists who care for patients with AML. Disclosures No relevant conflicts of interest to declare.
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Gerds, Aaron T., Betsy Dennison, Joan Latsko, Alice Houk, Stephanie Chisolm, John M. Huber, Richard M. Stone, et al. "Doctor-Patient Communication and Perception of Treatment Discontinuation in Myelodysplastic Syndromes (MDS) Diverge at the Time of Disease Progression." Blood 124, no. 21 (December 6, 2014): 2642. http://dx.doi.org/10.1182/blood.v124.21.2642.2642.
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Abstract Background: MDS are a complex collection of diseases described with terminology that can be confusing for patients (pts) and limited treatment (tx) options. We previously reported on disparities in perceptions of disease characteristics and outcomes between physicians (MDs) and pts (Steensma et al Cancer 2014) at the time of diagnosis. In the current study, we examined gaps in communication between pts and MDs and tx discontinuation patterns throughout the disease course. Methods: We conducted two online surveys between February and April 2014 of MDS pts and MDs registered with the Aplastic Anemia & MDS International Foundation. Pt and MD surveys were 67 and 61 questions, respectively, assessing understanding of MDS, communication between MDs and pts, and factors leading to tx discontinuation. The protocol and consent were approved by a central IRB. Results: Of 4,129 pts invited via e-mail, 314 complete responses were received from 39 US States for an expected response rate of 8%: 53% were men; 67% were age ³60 years; pts were diagnosed with MDS a median of 5 years prior to the survey (range, 0-28 years) with 35% reporting prior tx with an erythropoiesis-stimulating agent (ESA) and 46% with disease-modifying therapy (DMT: azacitidine, decitabine, or lenalidomide). Of 51 MDs providing complete responses (from 19 US states), 29 (57%) practice in an academic setting and 22 (43%) in a community setting. MDs reported seeing a mix of lower (46%) and higher-risk (54%) cases; 37% reported seeing 5-19 unique patients yearly. Although pts and MDs both reported high rates of education about their disease being provided at the time of diagnosis (Table 1), 78% of MDs reported describing MDS as a cancer, but only 22% of patients recall MDS being described as a cancer (P<.001). Likewise, 76% of MDs reported discussing disease risk by IPSS or IPSS-R with their patients, yet only 55% of pts recalled their IPSS/IPSS-R risk category (P=.004), though both an increase in comparison to past surveys. At the start of tx, 83% of pts and 94% of MDs reported discussing tx goals (P=.039), whereas a minority of pts reported receiving disease or tx education at the time of tx change (26%, vs. 47% for MDs, P=.002) or at disease progression (18%, vs. 55% for MDs, P<.001,Table 1). Reasons cited for tx discontinuation differed between pts and MDs. For ESAs, pts were more likely to report that the tx stopped working (68% vs. 29% for MDs, P<.001), where MDs were more likely to cite disease progression (91% vs, 34% for pts, P<.001) and health deterioration (67% vs. 15% for pts, P<.001). Similar patterns held for DMT discontinuation, with physicians more likely to report discontinuation due to disease progression (96% vs. 34% for pts, P<.001) and health deterioration (71% vs. 28% for pts, P<.001). Conclusion: Disease and tx education decline over a pt's disease course. Additionally, at the time of tx discontinuation, MDs are more likely to cite pt or disease factors as justification, whereas pts are more likely to attribute tx cessation to ineffectiveness of therapy. Pts may not understand that their disease is progressing, which in MDS, always indicates a median survival of less than 1.5 years. This, in turn, can affect the likelihood that pts will be referred for or agree to participate in clinical trials, and explore additional lines of tx. Improved communication of disease risk at the time of diagnosis and disease characteristics at the time of tx conclusion, may lead to improved tx persistence and increase enrollment in clinical trials. Table 1. MDS or tx education was providedÉ MDs (N = 51) Pts (N = 314) P-value During workup 49% 24% P<.001 At diagnosis 84% 82% P=.632 At initiating tx 59% 38% P=.005 With change in tx 47% 26% P=.002 At disease progression 55% 18% P<.001 Abstract 2642. Table 2. Reason for Discontinuation ESAs DMTs MDs (N = 42) Pts (N = 83) P-value MDs (N = 101) Pts (N = 47) P-value Finances Lack of money 14% 2% P=.001 23% 2% P=.002 Insurance changed 26% 4% P<.001 29% 2% P<.001 Not eligible for assistance 41% 10% P<.001 33% 4% P<.001 Logistics No transportation 31% 1% P<.001 32% 0% P<.001 Perception Pt didn't think tx was working 29% 68% P<.001 28% 21% NS QoL Tx interfered activities 24% 18% NS 35% 17% P=.028 Tx burden too great on caregiver 31% 4% P<.001 27% 0% P<.001 Pt fatigue too great to continue 36% 18% P=.029 34% 23% NS Tx made pt feel too sick to continue 29% 16% NS 40% 30% NS Disease Status MDS progressed 91% 34% P<.001 96% 34% P<.001 Health Status Developed comorbid condition 67% 15% P<.001 71% 28% P<.001 Disclosures No relevant conflicts of interest to declare.
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Moltke, Julie, and Chandni Hindocha. "Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems." Journal of Cannabis Research 3, no. 1 (February 18, 2021). http://dx.doi.org/10.1186/s42238-021-00061-5.
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Abstract Background Public and medical interest in cannabidiol (CBD) has been rising, and CBD is now available from various sources. Research into the effects of low-dose CBD on outcomes like stress, anxiety, and sleep problems have been scarce, so we conducted an online survey of CBD users to better understand patterns of use, dose, and self-perceived effects of CBD. Methods The sample consisted of 387 current or past-CBD users who answered a 20-question online survey. The survey was sent out to CBD users through email databases and social media. Participants reported basic demographics, CBD use patterns, reasons for use, and effects on anxiety, sleep, and stress. Results The sample (N = 387) consisted of 61.2% females, mostly between 25 and 54 years old (72.2%) and primarily based in the UK (77.4%). The top 4 reasons for using CBD were self-perceived anxiety (42.6%), sleep problems (42.5%), stress (37%), and general health and wellbeing (37%). Fifty-four per cent reported using less than 50 mg CBD daily, and 72.6% used CBD sublingually. Adjusted logistic models show females had lower odds than males of using CBD for general health and wellbeing [OR 0.45, 95% CI 0.30–0.72] and post-workout muscle-soreness [OR 0.46, 95%CI 0.24–0.91] but had higher odds of using CBD for self-perceived anxiety [OR 1.60, 95% CI 0.02–2.49] and insomnia [OR 1.87, 95% CI 1.13–3.11]. Older individuals had lower odds of using CBD for general health and wellbeing, stress, post-workout sore muscles, anxiety, skin conditions, focusing, and sleep but had higher odds of using CBD for pain. Respondents reported that CBD use was effective for stress, sleep problems, and anxiety in those who used the drug for those conditions. Conclusion This survey indicated that CBD users take the drug to manage self-perceived anxiety, stress, sleep, and other symptoms, often in low doses, and these patterns vary by demographic characteristics. Further research is required to understand how low doses, representative of the general user, might impact mental health symptoms like stress, anxiety, and sleep problems.
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Severo Sanchez, A., B. Rivero Santana, E. Arbas Redondo, VM Juarez Olmos, D. Poveda Pinedo, D. Tebar Marquez, R. Dalmau Gonzalez-Galarza, and A. Castro Conde. "Impact of an online cardiac rehabilitation program after an acute coronary syndrome during SARS-CoV-2 pandemic." European Journal of Preventive Cardiology 28, Supplement_1 (May 1, 2021). http://dx.doi.org/10.1093/eurjpc/zwab061.331.
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Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario La Paz Introduction The SARS-CoV-2 pandemic has overloaded health care systems at several fields. Spanish COVID-19 first wave led to the interruption of most cardiac rehabilitation (CRH) programs in our country. Resume activity without compromising patient"s safety has been a challenge. At our centre (a third-level hospital), we modified our routine clinical practice from face-to-face interviews to a complete online CRH program since July 1st 2020. Purpose The aim of this study is to analyse the impact of an online CRH program after hospital discharge for an acute coronary syndrome in health goals and adherence to secondary prevention measures at the end of the program. Methods This is a retrospective study made up of patients who, after suffering an acute myocardial infarction, followed an online CRH program from June to November 2020. A first online assessment is made by a cardiology consultant. Then, it is followed by ten online group interviews of up to three patients and a health care proffesional: either a nurse or a physiotherapist. These interviews last around ninety minutes. Four weeks after, an online follow-up interview is made by a cardiology consultant. These interviews focus either on physical exercise instructions (aerobical exercise and endurance exercise) or educational interviews (ischemic cardiomyopathy, Mediterranean diet, pharmacological treatment, sexual dysfunction, stress management techniques and solution of questions). Results Up to eighty-four patients were included in our CRH program (this means 83% of patients discharged from our hospital after an acute coronary event). Median of time from discharge to first online interview was 8"79 days and from this last one to program beginning, 3"67 days. Four weeks after the beginning of the program, 82% of the patients presented with a LDL-cholesterol level below aim level (< 55 mg/dL). Workout, Mediterranean diet and tobacco abstinence observance rates were over 90%. There were just three patients who gave up or did not complete the program. Conclusion Despite the fact that SARS-CoV-2 pandemic has arisen a huge challenge for ongoing CRH programs in Spain, the benefit that has been showed by them on cardiovascular health, makes it necessary to develop new tools to allow them going on. New technologies are an opportunity for us to keep on following these patients, moreover showing good results as for adherence, availability and patient and operator assesssment.
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Zaworski, Kamil, Zofia Kubińska, Adrianna Dziewulska, and Olga Walasek. "Physical activity of Poles in the care for their health potential before and during the COVID-19 pandemic." Disaster Medicine and Public Health Preparedness, October 22, 2020, 1–13. http://dx.doi.org/10.1017/dmp.2020.398.
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Abstract Objective: The aim of this paper is to present the engagement of adult Poles in physical activity (PA) before and during the coronavirus pandemic, taking into consideration: frequency, duration and types of the activity depending on the gender and age of the participants. Methods: The study was conducted using an online survey questionnaire. 688 residents of Poland aged 18 to 58 (28.61±9.5) years old participated in the study. Results: A statistically significant decrease in the frequency of PA was noted in the group of men (p=0.0001) and in the age group of 39 to 58 years old. The analysis of the duration of a single PA before and during the pandemic has shown a statistically significant reduction in the workout time among both men and women and across all age groups (p=0.05). There was a statistically significant increase in the frequency of women undertaking flexibility exercises, e.g. yoga (p=0.000), as well as a decrease in marching and walks (p=0.003). Men significantly less frequently did strength exercises (p=0.002). Conclusions: During the pandemic, there was a statistically significant decrease in the frequency and duration of PA. The preferences of the participants as to the type of PA undertaken changed as well.
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Kerwin, Michael, BCIT School of Health Sciences, Environmental Health, and Dale Chen. "Comparing the caffeine content of caffeine-containing dietary supplements in British Columbia." BCIT Environmental Public Health Journal, April 1, 2019. http://dx.doi.org/10.47339/ephj.2019.38.
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Background and Purpose: The use of dietary supplements is on the rise in Canada. This raises questions about the safety of the supplements when taken in the recommended dosage. One ingredient of concern in dietary supplements is caffeine, which can cause adverse health effects when consumed in great enough quantities. Given the lack of research into the caffeine content of dietary supplements, along with few regulations that exist regarding labelling or limits on caffeine content within Canada, a major concern is whether or not these supplements pose a risk to the public. The purpose of this study is to compare the caffeine content of various types of dietary supplements, and to determine if the caffeine content warrants a risk to the public. Methods: Supplement stores within the Vancouver Metropolitan Area were visited online and in person, and supplements were categorized as an energy drink, pre-workout supplement, energy bar, fat-loss supplement, or caffeine pill or capsule. The caffeine content per recommended dosage of each supplement was recorded from the label. Results: It was found that the caffeine content did vary between supplement categories (Kruskall-Wallis one way ANOVA test had a p-value < 0.000), and that fat-loss supplements and pre-workout supplements had the highest caffeine content with a mean 221.19mg per serving and 249.68mg per serving respectively. Caffeine pills had a mean of 186.90mg per serving, energy drinks had a mean of 166.84mg per serving, and energy bars had a mean of 85.06mg per serving. Discussion: Health Canada recommends that healthy adults not exceed 400mg of caffeine per day. Exceeding this limit can lead to adverse health reactions, such as anxiety, insomnia, heart palpitations or more serious symptoms such as convulsions or death. It was found in this study that 5% of the samples exceeded 400mg, and can be considered hazardous. Taking multiple doses of supplements, or consuming additional caffeine from alternative sources, such as coffee, also puts consumers at a greater risk of exceeding the recommended limits. Currently there are no regulations in Canada regarding how much caffeine is permitted within these products, or any labeling requirements for caffeine in dietary supplements. Conclusion: Given the increase in popularity of dietary supplements in Canada, along with the limited regulations on labelling requirements, caffeine-containing supplements could potentially pose a risk to consumers. This study shows that the caffeine content differs between types of dietary supplements, and that some supplements exceed the Health Canada guidelines of 400mg. More regulations and guidelines on labeling requirements for these supplements may be necessary to protect the public.
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Nikam, Manasi, Ishan Gawali, Vinit Khollam, Akansksha Lokhande, and Jyoti Mante. "Online UI/UX Platform (Crafter)." International Journal of Scientific Research in Computer Science, Engineering and Information Technology, May 25, 2021, 483–86. http://dx.doi.org/10.32628/cseit217389.
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UI/UX has evolved a lot over time and is one of the trending fields in thistech world. Companies aretrying to improve their UI UX of products to makecustomers more interact with their product A lot of designers do not get proper guidance as to which things theyshould use while practicing UI and get better results. They start taking either something beyond their capabilities or far below their skills. As a result, knowing just gives them the idea of coding but they lack in designing UI which is these days a more focused topic as clients need attractive UI where their users will get attracted towards for betterment of their product and betterment of their small or big business/company. So, for making these things simple, we’re making thing web-application called CRAFTER for making all the problems solved for web-developers. Our goal is to build a strong design community for everyone out there who wants to contribute and learn UI UX designing. In the proposed system we’re going to use Mean stack technology to design and for backend and Mongo DB as database. A blog system will also be designed where the UI UX designers can write their blog articles and shareit with our users. The beginner can get into our UI/UX guidelines and get started with the fundamentals of UI/UX designing. They will also have access to project starter folders which they can download and start building the product without any extra effort. The intermediate designers can refer to our component design guidelines to implement those designsand improvisethem. They can upload their UI UX workon our Behance clone platform where other users can viewappreciate and save their work.
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Harlos, Joachim, Andreas Maierhofer, and Bernard Canaud. "P1067CONDUCTIVITY BASED ONLINE MONITORING OF PREDIALYTIC HYPONATREAMIA AS DIAGNOSTIC TOOL IN HEMODIALYIS." Nephrology Dialysis Transplantation 35, Supplement_3 (June 1, 2020). http://dx.doi.org/10.1093/ndt/gfaa142.p1067.
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Abstract Background and Aims Hyponatremia in dialysis patients is a strong indicator of poor outcome in dialysis patients that requires early detection to facilitate clinical workup and management. However, plasma sodium concentration as determined by lab methods (Na-Lab) is measured at the best monthly in clinical practice. Recently, online monitoring of predialytic plasma Na (pPlNa) as estimated from dialysate conductivity using an electrolyte model has become available at every hemodialysis session, thus providing an unprecedented close and almost continuous monitoring of this crucial indicator. This could be used as diagnostic tool to identify changes in patient status and alert earlier the physician. Method In a monocentric retrospective clinical study in 114 patients on maintenance hemodialysis (>90% online postdilution HDF) for whom online pPlNa was available for a period of at least 12 months at least once a week, kinetics of pPlNa were analyzed. For 10 patients with hyponatremic episodes as manifested in pPlNa, the agreement between time course of pPlNa and Na-Lab and the correlation to the manifestation of clinical findings was explored. Results Time course of pPlNa and Na-Lab showed very good agreement. Hyponatremia onset was clinically related to diagnoses such as fluid overload and congestive heart failure, diarrhea secondary to inflammatory bowel disease, sepsis, liver cirrhosis, cancer and use of loop diuretics. Conclusion The clinical examples show that due to the good agreement of the time course of online monitoring of pPlNa and Na-Lab, pPlNa can be used as adjuvant diagnostic tool for the early detection of onset and progression of morbid events. Due to its routine availability variations in pPlNa could be used to timely trigger clinical workup and investigations.
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D’Arcy, R., M. McDonnell, K. Spence, and C. H. Courtney. "Exogenous T3 toxicosis following consumption of a contaminated weight loss supplement." Endocrinology, Diabetes & Metabolism Case Reports 2017 (August 29, 2017). http://dx.doi.org/10.1530/edm-17-0087.
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Summary A 42-year-old male presented with a one-week history of palpitations and sweating episodes. The only significant history was of longstanding idiopathic dilated cardiomyopathy. Initial ECG demonstrated a sinus tachycardia. Thyroid function testing, undertaken as part of the diagnostic workup, revealed an un-measureable thyroid-stimulating hormone (TSH) and free thyroxine (T4). Upon questioning the patient reported classical thyrotoxic symptoms over the preceding weeks. Given the persistence of symptoms free tri-iodothyronine (T3) was measured and found to be markedly elevated at 48.9 pmol/L (normal range: 3.1–6.8 pmol/L). No goitre or nodular disease was palpable in the neck. Historically there had never been any amiodarone usage. Radionucleotide thyroid uptake imaging (123I) demonstrated significantly reduced tracer uptake in the thyroid. Upon further questioning the patient reported purchasing a weight loss product online from India which supposedly contained sibutramine. He provided one of the tablets and laboratory analysis confirmed the presence of T3 in the tablet. Full symptomatic resolution and normalised thyroid function ensued upon discontinuation of the supplement. Learning points: Free tri-iodothyronine (T3) measurement may be useful in the presence of symptoms suggestive of thyrotoxicosis with discordant thyroid function tests. Thyroid uptake scanning can be a useful aid to differentiating exogenous hormone exposure from endogenous hyperthyroidism. Ingestion of thyroid hormone may be inadvertent in cases of exogenous thyrotoxicosis. Medicines and supplements sourced online for weight loss may contain thyroxine (T4) or T3 and should be considered as a cause of unexplained exogenous hyperthyroidism.
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Walker, Rob, Tom Wiggins, Natalie S. Blencowe, John M. Findlay, Michael Wilson, Andrew C. Currie, Steve Hornby, et al. "A multicenter prospective audit to investigate the current management of patients undergoing anti-reflux surgery in the UK: Audit & Review of Anti-Reflux Operations & Workup." Diseases of the Esophagus 34, no. 7 (January 16, 2021). http://dx.doi.org/10.1093/dote/doaa129.
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Abstract Background There are a variety of surgical and endoscopic interventions available to treat gastroesophageal reflux disease. There is, however, no consensus on which approach is best. The aim of this national audit is to describe the current variation in the UK clinical practice in relation to anti-reflux surgery (ARS) and to report adherence to available clinical guidelines. Methods This national audit will be conducted at centers across the UK using the secure online web platform ALEA. The study will comprise two parts: a registration questionnaire and a prospective multicenter audit of ARS. All participating centers will be required to complete the registration questionnaire comprising details regarding pre-, peri-, and post-operative care pathways and whether or not these are standardized within each center. Following this, a 12-month multicenter prospective audit will be undertaken to capture data including patient demographics, predominant symptoms, preoperative investigations, surgery indication, intraoperative details, and postoperative outcomes within the first 90 days. Local teams will retain access to their own data to facilitate local quality improvement. The full dataset will be reported at national and international scientific congresses and will contribute to peer-reviewed publications and national quality improvement initiatives. Conclusions This study will identify and explore variation in the processes and outcomes following ARS within the UK using a collaborative cohort methodology. The results generated by this audit will facilitate local and national quality improvement initiatives and generate new possibilities for future research in anti-reflux interventions.
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Fernandez, Oscar, Lucienne Costa-Frossard, Maria Luisa Martínez-Ginés, Paloma Montero, Jose María Prieto-González, and Lluís Ramió-Torrentà. "Integrated Management of Multiple Sclerosis Spasticity and Associated Symptoms Using the Spasticity-Plus Syndrome Concept: Results of a Structured Specialists' Discussion Using the Workmat® Methodology." Frontiers in Neurology 12 (September 27, 2021). http://dx.doi.org/10.3389/fneur.2021.722801.
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Background: Multiple sclerosis (MS) treatment has radically improved over the last years; however, MS symptom management is still challenging. The novel Spasticity-Plus syndrome was conceptualized to frame several spasticity-related symptoms that can be addressed together with broad-spectrum medication, such as certain cannabinoid-based drugs. The aim of this project was to gain insight into Spanish neurologists' clinical experience on MS spasticity and associated symptoms, and to assess the acknowledgment and applicability of the Spasticity-Plus syndrome concept in patients with MS.Methods: Ten online meetings were conducted using the Workmat® methodology to allow structured discussions. Fifty-five Spanish neurologists, experts in MS management, completed and discussed a set of predefined exercises comprising MS symptom assessment and its management in clinical practice, MS symptoms clustering in clinical practice, and their perception of the Spasticity-Plus syndrome concept. This document presents the quantitative and qualitative results of these discussions.Results: The specialists considered that polytherapy is a common concern in MS and that simplifying the management of MS spasticity and associated manifestations could be useful. They generally agreed that MS spasticity should be diagnosed before moderate or severe forms appear. According to the neurologists' clinical experience, symptoms commonly associated with MS spasticity included spasms/cramps (100% of the specialists), pain (85%), bladder dysfunction (62%), bowel dysfunction (42%), sleep disorders (42%), and sexual dysfunction (40%). The multiple correspondence analysis revealed two main symptom clusters: spasticity-spasms/cramps-pain, and ataxia-instability-vertigo. Twelve out of 16 symptoms (75%) were scored >7 in a 0–10 QoL impact scale by the specialists, representing a moderate–high impact. The MS specialists considered that pain, spasticity, spasms/cramps, bladder dysfunction, and depression should be a treatment priority given their frequency and chance of therapeutic success. The neurologists agreed on the usefulness of the new Spasticity-Plus syndrome concept to manage spasticity and associated symptoms together, and their experience with treatments targeting the cannabinoid system was satisfactory.Conclusions: The applicability of the new concept of Spasticity-Plus in MS clinical practice seems possible and may lead to an integrated management of several MS symptoms, thus reducing the treatment burden of disease symptoms.
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Long, Adrianna, Robert Cambridge, and Melissa Rosa. "Physician’s changes in management of return visits to the Emergency Department." Emergency Care Journal 1, no. 1 (June 20, 2016). http://dx.doi.org/10.4081/ecj.2016.5594.
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Return visits to the Emergency Department (ED) are estimated between 2-3.1%, which impacts ED care costs and wait times. Adverse events for unscheduled return visits (URVs) have been reported to be as high as 30%. The objective of this study was to characterize the attitudes and management of Emergency Medicine (EM) physicians regarding patients presenting with the same chief complaint to the ED for an URV. An online survey questionnaire was developed and sent to 160 accredited EM Graduate Medical Education programs in the United States. The questionnaire consisted of case vignettes wherein providers were asked to submit what orders they would place for each scenario. The mean numbers of tests and treatments were compared from initial visit to repeat visit with same chief complaint. Physicians also provided feedback regarding their management of URVs. There were estimated 6988 eligible participants with 397 responses (response rate 5.7%). There was a statistical significance (P<0.001) in provider management of URVs with pediatric fever, but there was no statistical significance for management of the other chief complaints. There were 77% of physicians that felt an increased work up is warranted for URVs. The results of this study indicate that majority of EM residents and staff working in training programs feel that they should approach the management of URV patients with a more extensive workup despite no clinical change. These findings suggest that further analysis should be performed regarding provider management of URVs and the associated healthcare costs.
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Goodyear, Victoria A., Ian Boardley, Shin-Yi Chiou, Sally A. M. Fenton, Kyriaki Makopoulou, Afroditi Stathi, Gareth A. Wallis, Jet J. C. S. Veldhuijzen van Zanten, and Janice L. Thompson. "Social media use informing behaviours related to physical activity, diet and quality of life during COVID-19: a mixed methods study." BMC Public Health 21, no. 1 (July 6, 2021). http://dx.doi.org/10.1186/s12889-021-11398-0.
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Abstract Background This mixed methods study explored how social media use informed physical activity and diet-related behaviours, and self-perceived Quality of Life (QoL) during COVID-19, and assessed the contextual factors that drive social media use for health-related behaviour change in diverse groups. During the COVID-19 lockdown periods there were reported changes to social media use and health behaviours, and this gave an opportunity to investigate potential relationships. Methods An explanatory sequential research design of two parts was used: (1) An online survey that assessed social media use in relation to physical activity levels, diet quality and QoL (n = 786; Mage 45.1 ± 19.1 (range 16–88) years; Female =69%); (2) 20 purposive focus groups (n = 69; Mage = 52.88 ± 18.45 years, Female n = 68%) to understand the contextual factors that drive social media use for health-related behaviour change. Descriptive and thematic analysis were conducted. Results Participants in this study reported that social media facilitated the self-management of behaviours related to physical activity, diet and QoL, through access to information to inform workouts and dietary quality, and the opportunities for interaction with peers, family members and within social groups. Contextual factors including work, home and lifestyle arrangements, pre-existing health-related knowledge and behaviours, and the perceived value of social media for health influenced the relationship between social media use and self-reported outcomes. Social media influencers, peers/family members, and official organisations influenced the application of health-related information accessed via social media. Conclusions The evidence shows that participants were critical users of social media and were able to use social media to derive benefit for their health and wellbeing. Detailed guidance for those who use social media, as well as those who recommend and endorse social media content is required to maximise the potential of social media to support health behaviours. Future public health strategies and social media interventions should acknowledge diversity in contextual factors driving social media use for health behaviour change.
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Gondokusumo, Jabez, Mohit Butaney, Adithya Balasubramanian, Joanathan Beilan, Alexander Tatem, Nannan Thirumavalavan, Alexander Pastuszak, and Larry Lipshultz. "The use of scrotal ultrasound in the evaluation of varicoceles: A survey study of reproductive specialists." Canadian Urological Association Journal 14, no. 8 (September 23, 2019). http://dx.doi.org/10.5489/cuaj.6147.
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Introduction: Urologists use ultrasound in the male infertility workup to evaluate scrotal contents and objectively identify varicoceles if their presence is questionable on physical examination. We assessed practice patterns and diagnostic criteria of male reproductive urologists using ultrasound to evaluate varicoceles.
Methods: An anonymous online survey was sent to the Society for Male Reproduction and Urology (SMRU) members. We queried respondents about ultrasonographic criteria and ultrasound techniques employed in varicocele evaluation. Chi-squared was used to determine association between categorical variables.
Results: In total, 110/320 (34.4%) SMRU members responded. Sixty percent of respondents (66/110) reported performing scrotal ultrasound; 92.4 % (61/66) were attending urologists and 87.9% (58/66) completed an andrology fellowship. A total of 37.9% (25/66) performed their own ultrasound, while the remainder had ultrasound performed by an alternate practitioner. Among those performing their own ultrasound, 95.5% (21/22) measured varicocele venous diameter compared to 76% (29/38) when another practitioner performed the ultrasound. Venous diameter used to define a varicocele ranged from 2–4 mm. Although 80% (49/61) of respondents assessed retrograde flow during ultrasound, only 52.5% reported that retrograde flow was required for varicocele diagnosis. Almost all (60/61) indicated that they would fix palpable varicoceles in patients with abnormal semen parameters. Fewer (42.6%, 26/61) respondents stated they would repair varicoceles found exclusively on ultrasound.
Conclusions: Ultrasound is commonly employed by male reproductive urologists to diagnose varicoceles. We identified that practitioners use various ultrasonographic criteria and techniques for varicocele diagnosis. Study limitations include recall bias and high degree of specialization among respondents.
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Jati, Ahmad Waluya. "IbM SCREEN PRINTING AND OFFSET BUSINESS RIZKY, WELDING WORKSHOP JAYA MAKMUR IN THE VILLAGE SEMANDING DAU MALANG DISTRICT." Studi Kasus Inovasi Ekonomi 1, no. 2 (December 13, 2016). http://dx.doi.org/10.22219/skie.v1i2.4461.
Full textAbstract:
Community Service Program Internal entitledIbm Screen Printing And Offset Business Rizky,Welding Work-shop Jaya Makmur In The VillageSemanding Dau Malang District this is done withthe aim of increasing knowledge of entrepreneurs inthe fields of marketing, design and significance of thefinancial statements and the preparation of financialstatements, in order to improve Entrepreneursbusiness develo-pment.Methods of execution in this devotion is in theform of counseling, training and mentoring.Counseling is done to increase awareness and knowledge partner in the field of marketing, especiallyonline marketing. Further training and mentoringdone to train part-ners and assisting in thepreparation of financial statements partners. As forthe design of training we can only suggest to thecourse design program.Based on the discussions, review ofdocuments and interviews with Mr. Sulianto, themarketing system of prin-ting and screen printing aswell as tradi-tional and welding shop is still limitedto Malang, Surabaya, Jember, Banyuwangi andBanjarmasin. Next implementation team working oncreating a broader mar-keting models using theonline system, but it can not be applied because oflimited physical resources and human resources. Sothat the marketing system can not continue to usemarketing system is offered, as well as for programdesign there is also a shortage of human resources.Based on the results of this activity, it can besaid that the SME screen printing and offsetworkshop and Las potential to be developed further,although it is still managed by the management isvery simple, but from the aspect of management canbe said is good. From the marketing aspects ofexisting resources still have a problem in the masteryof technology, as well as from the production aspectwhen designing an employee is not able to design hisown, Mr. Sulianto it is evident that PITT design stilluse the services of design as a subscription to workof the subscription order. This conclusion is drawnwhen the team offered to sell the online system andoffers courses for its employees. While aspects ofpreparedness of the financial statements can be saidof business printing / screen printing and weldingshop is able to understand what we have given in thetraining preparation of financial statements, and toimplement it in the year 2016.Financial reporting system offered andapplied to Business screen printing and offset Rizkyas well as forge welding Jaya Makmur has beenprepared and can be applied in accordance with thedata source, human resources and existing facilities.Operation is very easy and can generate outputaccurate financial state-ments. Mentoring is doneseveral times to do the training and mentoring of thefinancial reporting system applications.Of the three proposals offered to the partnerthat is an online marketing system, design programand preparation of financial statements, but iscurrently only able to provide one single solution,namely the preparation of financial statements