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Journal articles on the topic 'Waist Training Guide'

Author: Grafiati
Published: 28 July 2024
Last updated: 30 July 2024

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1

LAY, YUN-LONG, PEI-WEN CHEN, and HUI-JEN YANG. "THE MACHINE VISION BLIND GUIDE SYSTEM." Biomedical Engineering: Applications, Basis and Communications 14, no. 02 (April 25, 2002): 81–85. http://dx.doi.org/10.4015/s1016237202000127.

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The available guide tools of the orientation and mobility for a blind are the cane, guide dog and electronic guide devices. A cane is easy to detect the hindrance that is in front of the user but not for the hindrance above the user waist. That's why a cane user of a blind sometimes will be hit by the upper hindrance. Guide dog is a very powerful mobility guider but expensive and the training and living care for the dogs are difficult. Hence, guide dog is not popular in many countries. The electronic devices for blind guide tools such as laser cane; sonic glasses, sonic guide etc. can only detect a single point at a time and not for a whole view. In our system, a machine vision blind guide system is proposed. A CCD grabbed the image of front view and divided the image into nine blocks. Each block is calculated to get the distance message, which is multipoint data to guide the blind by the converted voice signal.
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Singh, Rupak, Jayant Rastogi, Chandra Sekara Guru, Varad Apte, Karuna Datta, and Atul Sharma. "EFFECT OF COVID-19 LOCKDOWN ON SPORTS PERFORMANCE PARAMETERS OF COMPETITIVE ATHLETES." Journal of Applied Sports Sciences 1, no. 2022 (July 20, 2022): 16–27. http://dx.doi.org/10.37393/jass.2022.01.2.

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Background: Nationwide lockdown was enforced due to the spread of the new Coronavirus-19. This resulted in cessation of all sports training across the country, including elite athletes. This COVID-19 lockdown was hypothesized to result in detraining effects on elite athletes. Aim: We aimed to study the impact of COVID-19 lockdown on athletes’ physiological and anthropometric sports performance parameters. Methodology: Seventy-five athletes (age: 23.25 ± 3.9 years, training experience 7.49 ± 3.5 years) from different sports participated voluntarily. International Physical Activity Questionnaire was used to grade home-based non-super- vised physical activity undertaken during COVID-19 lockdown (137.81 ± 39.20 days). We compared the measured anthropometric, aerobic, and anaerobic performance parameters post-lockdown with pre-lockdown competitive phase recordings using Kruskal Wallis non-parametric test. Parameters were expressed as mean ± SD with level of significance fixed at p < .05. Results: Statistically significant reduction of 33.28% was observed in aerobic capacity post- COVID-19 lockdown (p = .01). We did not find any statistically significant variation in the other anthropometric and physiological performance parameters, namely weight (↑17.50 %), body mass index (↑20.69 %), body fat mass (↑20.76 %), waist (↑21.07 %), hip (↑19.13 %), waist: hip ratio (↑10.71 %), peak power (↑11.32 %) and mean power (↑5.17 %). Conclusions: We found that the athletes exhibited generalized detraining features despite maintaining home-based physical activity. Compared to other performance parameters, there was a significant decrease in the aerobic capacity post-lockdown. This shows the importance of incorporating an indoor-based supervised program including aerobic exercises to guide and monitor athletes. Practical Implications: Off-season/home confinement requires a remotely supervised tailored exercise program with optimal stimuli to maintain training adaptations. Awareness and incorporation of these findings would aid coaches and trainers in designing training programs to promote athletes’ injury-free gradual return to sports.
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Sutphin, Dean, Susan Meacham, JuliSu Di Mucci-Ward, Anna Kirby, Maria Jose Lopez, Fatima Recinos, Xiomara Erazo, et al. "Waist Circumference Complementing Body Mass Index Measures Assessed as Disease Risk Indicators in Adult Women; A Comparison Study in the Dominican, Honduras and El Salvador." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 914. http://dx.doi.org/10.1093/cdn/nzaa053_119.

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Abstract Objectives To determine differences in nutritional status to guide the culturally specific education interventions. Methods Pilot training occurred in each country using consistent equipment and measurement protocols. The IRB approved protocol for pretesting and educational interventions was conducted daily for a month at each location. Descriptive statistics and Pearson 2-tailed correlations were performed. Results Subjects, all non-pregnant, non-lactating women (n = 126 DR, n = 101 ES, n = 132 HN), ranged in age from 18 to 78 yrs with 30% in their 30’s; mean ages 32.9 DR, ES 37.0, HN 42.8 (all differed, P ≤ 0.05). Most reported their ethnicity as Hispanic/Latino-Americano. At pre-testing, subjects (%) with normal BMI distributions = DR 5.6, ES 18.8, HN 15.9; obese/overweight = DR 88.8, ES 75.3, HN 62.9 (all differed, P ≤ 0.05). Mean (SD) for WC (in) = DR 38.3 ± 5.6, ES 37.4 ± 5.1, HN 36.3 ± 5.7; waist: height ratios in HN 14% lower than mean measures for DR and ES. BMI and WC were closely correlated (r = 0.70, P ≤ 0.01). Self-reported data on physical activity, weekly household income, health insurance and level of education provided insight on factors contributing to nutritional status. Conclusions BMI and WC measures were convenient, noninvasive, inexpensive and available for comparative assessments. Pre-testing data indicate subjects, the majority in their 20’s and 30’s in all three countries, had BMI and waist measures higher than recommended indicating greater risk for disease. Physical activity and socioeconomic factors highlight disparities, particularly the lack of health insurance. Our findings support the need for country specific educational interventions in future research protocols to support weight management programs. This study highlights the valuable uniqueness of the VCOM international service area clinic model. Funding Sources VCOM REAP Program FY19.
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Pilli, Devi Nagini, and Triveni Shetty. "Ab. No. 139 Exploration of Physical Fitness Attributes and Kinanthropometric Measurements in Mallakhamb Players." Journal of Society of Indian Physiotherapists 8, no. 1 (January 2024): 85. http://dx.doi.org/10.4103/jsip.jsip_abstract_79.

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Introduction: Mallakhamb, an ancient sport against gravity combines yoga, gymnastics and martial arts. In a competitive set-up, Mallakhamb players showcase their skills in dynamic 90-second routines which demands various physical fitness attributes and kinanthropometric measurements. The purpose is to explore the physical fitness and kinanthropometric measurements of the Pole Mallakhamb players, the association between (1) The physical fitness and kinanthropometric measurements. (2) physical fitness and injury profile of players, as the literature related to this is scare. Physiotherapists can design effective exercise regimens and injury prevention program addressing biomechanical imbalances and performance enhancement of Mallakhamb players through evidence-based interventions. Methods: 41 elite and sub-elite mallakhamb players (male and female, age- 18-40 years) were randomly selected for the study. Descriptive data was employed to analyse the kinanthropometric measurements and physical fitness. Pearson’s correlation for Associations between kinanthropometric measurements, physical fitness, and injury profiles. Result: Agility was poor, UE and LE strength was good in male players. Whereas in female players, endurance, flexibility and balance was good, agility was poor, UE and LE strength was fair. Arm and Thigh circumstance was greater as compared to normal individuals whereas waist circumference was less. The BMI of both male and female players was normal (acc WHO). Conclusion: Understanding physical fitness and kinanthropometric aspects in Pole Mallakhamb players helps to form the basis for tailored training, improving overall performance and guiding coaches to focus more on domains like agility. Implications: Research findings can guide the development of skill-specific training protocols.
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Zhang, Shaolei, Yang Feng, and Liangyou Li. "Future-Guided Incremental Transformer for Simultaneous Translation." Proceedings of the AAAI Conference on Artificial Intelligence 35, no. 16 (May 18, 2021): 14428–36. http://dx.doi.org/10.1609/aaai.v35i16.17696.

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Simultaneous translation (ST) starts translations synchronously while reading source sentences, and is used in many online scenarios. The previous wait-k policy is concise and achieved good results in ST. However, wait-k policy faces two weaknesses: low training speed caused by the recalculation of hidden states and lack of future source information to guide training. For the low training speed, we propose an incremental Transformer with an average embedding layer (AEL) to accelerate the speed of calculation of the hidden states during training. For future-guided training, we propose a conventional Transformer as the teacher of the incremental Transformer, and try to invisibly embed some future information in the model through knowledge distillation. We conducted experiments on Chinese-English and German-English simultaneous translation tasks and compared with the wait-k policy to evaluate the proposed method. Our method can effectively increase the training speed by about 28 times on average at different k and implicitly embed some predictive abilities in the model, achieving better translation quality than wait-k baseline.
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Chen, Xinjie, Kai Fan, Wei Luo, Linlin Zhang, Libo Zhao, Xinggao Liu, and Zhongqiang Huang. "Divergence-Guided Simultaneous Speech Translation." Proceedings of the AAAI Conference on Artificial Intelligence 38, no. 16 (March 24, 2024): 17799–807. http://dx.doi.org/10.1609/aaai.v38i16.29733.

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To achieve high-quality translation with low latency, a Simultaneous Speech Translation (SimulST) system relies on a policy module to decide whether to translate immediately or wait for additional streaming input, along with a translation model capable of effectively handling partial speech input. Prior research has tackled these components separately, either using ``wait-k'' policies based on fixed-length segments or detected word boundaries, or dynamic policies based on different strategies (e.g., meaningful units), while employing offline models for prefix-to-prefix translation. In this paper, we propose Divergence-Guided Simultaneous Speech Translation (DiG-SST), a tightly integrated approach focusing on both translation quality and latency for streaming input. Specifically, we introduce a simple yet effective prefix-based strategy for training translation models with partial speech input, and develop an adaptive policy that makes read/write decisions for the translation model based on the expected divergence in translation distributions resulting from future input. Our experiments on multiple translation directions of the MuST-C benchmark demonstrate that our approach achieves a better trade-off between translation quality and latency compared to existing methods.
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Thirlwall, Kerstin, Peter J. Cooper, Jessica Karalus, Merryn Voysey, Lucy Willetts, and Cathy Creswell. "Treatment of child anxiety disorders via guided parent-delivered cognitive–behavioural therapy: Randomised controlled trial." British Journal of Psychiatry 203, no. 6 (December 2013): 436–44. http://dx.doi.org/10.1192/bjp.bp.113.126698.

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BackgroundPromising evidence has emerged of clinical gains using guided self-help cognitive–behavioural therapy (CBT) for child anxiety and by involving parents in treatment; however, the efficacy of guided parent-delivered CBT has not been systematically evaluated in UK primary and secondary settings.AimsTo evaluate the efficacy of low-intensity guided parent-delivered CBT treatments for children with anxiety disorders.MethodA total of 194 children presenting with a current anxiety disorder, whose primary carer did not meet criteria for a current anxiety disorder, were randomly allocated to full guided parent-delivered CBT (four face-to-face and four telephone sessions) or brief guided parent-delivered CBT (two face-to-face and two telephone sessions), or a wait-list control group (trial registration: ISRCTN92977593). Presence and severity of child primary anxiety disorder (Anxiety Disorders Interview Schedule for DSM-IV, child/parent versions), improvement in child presentation of anxiety (Clinical Global Impression –Improvement scale), and change in child anxiety symptoms (Spence Children's Anxiety Scale, child/parent version and Child Anxiety Impact scale, parent version) were assessed at post-treatment and for those in the two active treatment groups, 6 months post-treatment.ResultsFull guided parent-delivered CBT produced superior diagnostic outcomes compared with wait-list at post-treatment, whereas brief guided parent-delivered CBT did not: at post-treatment, 25 (50%) of those in the full guided CBT group had recovered from their primary diagnosis, compared with 16 (25%) of those on the wait-list (relative risk (RR) 1.85, 95% CI 1.14–2.99); and in the brief guided CBT group, 18 participants (39%) had recovered from their primary diagnosis post-treatment (RR = 1.56, 95% CI 0.89–2.74). Level of therapist training and experience was unrelated to child outcome.ConclusionsFull guided parent-delivered CBT is an effective and inexpensive first-line treatment for child anxiety.
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Irham, Muhamad, and Febi Kurniawan. "Pengembangan model latihan wasit sepakbola untuk meningkatkan kebugaran." Sepakbola 1, no. 2 (November 20, 2021): 56. http://dx.doi.org/10.33292/sepakbola.v1i2.95.

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Penelitian ini bertujuan untuk menghasilkan model latihan wasit sepakbola yang layak dan efektif, yang diharapkan dapat digunakan untuk meningkatkan kebugaran (physical fitness) wasit dalam persiapan tes kebugaran wasit, sesuai dengan kebutuhan gerak dari seorang wasit saat memimpin pertandingan sepakbola di lapangan, yang dikemas dalam bentuk modul dan video panduan latihan beserta penjelasan mengenai fungsi dan tujuan latihan. Penelitian ini mengadaptasi langkah-langkah penelitian pengembangan Borg & Gall sebagai berikut: (1) pengumpulan informasi, (2) menganalisis hasil informasi, (3) pengembangan produk awal, (4) validasi ahli dan revisi tahap pertama, (5) uji coba skala kecil dan revisi, (6) uji coba skala besar dan revisi, (7) pembuatan produk final, (8) uji efektivitas produk. Uji coba skala kecil dilakukan terhadap enam orang dari korps wasit Asosiasi PSSI Kota Yogyakarta. Uji coba skala besar dilakukan terhadap enam belas orang dari korps wasit Asosiasi Provinsi PSSI Daerah Istimewa Yogyakarta. Instrumen yang digunakan untuk mengumpulkan data adalah pedoman observasi, pedoman wawancara, catatan lapangan, skala nilai, dan lembar penilaian uji efektivitas model latihan. Hasil penelitian berupa model latihan kebugaran wasit sepakbola terdiri dari pemanasan, inti, dan pendinginan. Model disusun dalam modul pedoman berjudul ”Model Latihan Wasit Sepakbola untuk Meningkatkan Kebugaran (Physical Fitness)”. Berdasarkan penilaian ahli materi dan praktisi dapat disimpulkan bahwa model latihan kebugaran yang dikembangkan berkategori baik sehingga layak, efektif, dan sesuai untuk digunakan dalam latihan kebugaran wasit sepakbola. Developing a physical fitness exercise model for football referees AbstractThis research aims to develop and increase the diversity of a model of physical fitness for football referees, which effective and can be used by referees to improve fitness in order to prepare for physical fitness test and maintain fitness in daily life according to the needs of the motion of a referee when refereeing football matches, packaged in the form of books and video guides or training module with an explanation of its function and purpose. This research adapted the steps of research and development by Borg & Gall, consisting of: (1) the collection of information, (2) analysis of the information gathered, (3) initial product development, (4) validation by experts and revision, (5) small-scale field trial and revision, (6) large-scale field trials and revisions, (7) the manufacture of the final products. (8) testing the effectiveness of the product. The small-scale trials were conducted on six referees from refereeing corp of Indonesian Football Association of Yogyakarta City. The large-scale trial was conducted on sixteen referees from refereeing corp of Indonesian football Association of Yogyakarta Province. The instrument used to collect data included interview guides, field notes, evaluation sheet, the value scale questionnaire validation, assessment rubrics, observation guidelines, and sheet of the effectiveness of the exercise. The result of the research is a model of physical fitness for football referees consisting of warming up models, core, and cooling models. The model guidelines are compiled in a module titled "Physical Fitness Training Model for Football Referees". Based on the evaluation of the subject matter experts and practitioners, it can be concluded that the developed model of physical fitness for football referees is categorized as good, so that it is adequate, effective, and suitable for use in physical fitness exercise for football referees.
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Eaton, Jacqueline, Sarah Neller, Moroni Fernandez Cajavilca, Julene Johnson, and Lee Ellington. "A COMMUNITY-BASED APPROACH TO REFINING THE ENHANCING ACTIVE CAREGIVER TRAINING (ENACT) INTERVENTION." Innovation in Aging 7, Supplement_1 (December 1, 2023): 46. http://dx.doi.org/10.1093/geroni/igad104.0152.

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Abstract Several interventions for dementia caregivers target the negative effects of behavioral symptoms. Evidence suggests that actively engaging caregivers in training and preparation improves outcomes, such as reduced caregiver burden, depression, and improved subjective well-being. However, there is little information on the best approaches to optimize active engagement. Enhancing Active Caregiver Training (EnACT) is an arts-based intervention that facilitates active engagement using participant-informed vignettes that portray caregiving experiences. This presentation will describe the process of partnering with dementia caregivers to iteratively develop the EnACT intervention in preparation for a randomized controlled trial (RCT). We conducted three iterative focus groups in partnership with dementia caregivers (n=9). Feedback was incorporated into intervention design and materials following each meeting. During focus group one we reviewed and identified video vignettes for inclusion. In focus group two, we tested intervention activities. In focus group three, participants provided feedback on the facilitator guide developed during this process. Focus groups were audio-recorded, transcribed, and analyzed in three cycles using structural, descriptive, and pattern coding. Across all focus groups, we coded 679 items as what went well and 358 items as needing to change. Intervention revisions focused on narrowing vignette topics, removing confusing components (such as engagement activities that were too burdensome), enhancing accessibility, simplifying instructions, and adding facilitator training. A facilitator guide was developed with four main components: Letter to facilitator, Introduction, Preparation to Begin, and Instructions. Partnering with caregivers improved our ability to enhance acceptability and fidelity in preparation for future testing in a wait-list RCT.
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Raman, Maitreyi, Eldon Shaffer, and Jocelyn Lockyear. "Gastroenterology Fellowship Training: Approaches to Curriculum Assessment and Evaluation." Canadian Journal of Gastroenterology 22, no. 6 (2008): 559–64. http://dx.doi.org/10.1155/2008/583190.

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BACKGROUND: Medical education requires ongoing curriculum development and evaluation to incorporate new knowledge and competencies. The Kern model of curricular development is a generic model to guide curriculum design, whereas the Royal College of Physicians and Surgeons of Canada (RCPSC) has a specific model for curriculum development through its accreditation structure.OBJECTIVE: To apply the Kern model to an assessment of a residency program in gastroenterology.METHODS: A case study was used, which is a method of qualitative research designed to help researchers understand people and the societal contexts in which they live.RESULTS: The six steps involved in the Kern model of curricular development include problem identification; needs assessment; establishing objectives; establishing educational strategies; implementation; and evaluation. The steps of the RCPSC model of curriculum development include establishing an administrative structure for the program; objectives; structure and organization of the program; resources; clinical, academic and scholarly content of the program; and evaluation. Two differences between the models for curriculum development include the ability of the Kern model to conduct problem identification and learner needs assessment. Identifying problems that exist suggests a need for an educational program, such as the long wait times for gastroenterology referrals. Assessing learner needs allows for the development of a tailored curriculum for the trainee.CONCLUSIONS: The Kern model and RCPSC model for curriculum development are complementary. Consideration by the RCPSC should be provided to add the missing elements of curriculum design to the accreditation structure for completeness.
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Zeng, Yan, Xin Wang, Junfeng Yuan, Jilin Zhang, and Jian Wan. "Local Epochs Inefficiency Caused by Device Heterogeneity in Federated Learning." Wireless Communications and Mobile Computing 2022 (January 6, 2022): 1–15. http://dx.doi.org/10.1155/2022/6887040.

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Federated learning is a new framework of machine learning, it trains models locally on multiple clients and then uploads local models to the server for model aggregation iteratively until the model converges. In most cases, the local epochs of all clients are set to the same value in federated learning. In practice, the clients are usually heterogeneous, which leads to the inconsistent training speed of clients. The faster clients will remain idle for a long time to wait for the slower clients, which prolongs the model training time. As the time cost of clients’ local training can reflect the clients’ training speed, and it can be used to guide the dynamic setting of local epochs, we propose a method based on deep learning to predict the training time of models on heterogeneous clients. First, a neural network is designed to extract the influence of different model features on training time. Second, we propose a dimensionality reduction rule to extract the key features which have a great impact on training time based on the influence of model features. Finally, we use the key features extracted by the dimensionality reduction rule to train the time prediction model. Our experiments show that, compared with the current prediction method, our method reduces 30% of model features and 25% of training data for the convolutional layer, 20% of model features and 20% of training data for the dense layer, while maintaining the same level of prediction error.
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Salah Mohammed Al-Darraji, Sabah. "تطبيق مربي الأسماك للتوصيات العلمية في مجال تربية الأسماك في محافظة واسط." Journal of Education College Wasit University 1, no. 18 (January 19, 2018): 471–86. http://dx.doi.org/10.31185/eduj.vol1.iss18.300.

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The research aims to determine the level of Application breeder fish of scientific recommendations in the field of fish farming in Wasit province, and to identify the level of Application breeder fish of scientific recommendations in the field of fish breeding for each axis of the following themes (feeding fish, creating fish ponds, the follow-up health status of the fish). The research covered all fish farmers in Wasit province's (143) educator. Chosen proportionally stratified random sample of 35% and a way for random sampling of the number of individuals who have undergone research procedures (50) educator. The results showed that the level of Application breeder fish of scientific recommendations in each of the areas of focus of breeding fish (fish feed, creating fish ponds, the follow-up health status of the fish) was average tends to decline. Based on the results suggest the need to intensify efforts to inform educators about the importance and the need to use the correct methods in fish breeding and giving priority when planning programs guide way own jam fish and the emphasis on the use of successful management in the management of fish farms through the application of sound scientific recommendations that lead to the lifting of fish farm productivity, and the establishment of continuous training courses for
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Moore, Cindi. "An Emergency Department Nurse-Driven Ultrasound-Guided Peripheral Intravenous Line Program." Journal of the Association for Vascular Access 18, no. 1 (March 2013): 45–51. http://dx.doi.org/10.1016/j.java.2012.12.001.

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Background: Ultrasound-guided peripheral intravenous (USGPIV) technology is being utilized more frequently in emergency department settings. Traditionally, physicians have performed this procedure to gain vascular access in patients for whom standard intravenous line procedures are unsuccessful. Nurses at Wexner Medical Center at The Ohio State University have shown that a nurse-driven ultrasound program can be successfully implemented in an emergency department. Methods: Standardized training for registered nurses includes a 4-hour didactic and hands-on course and 24 hours of 1-on-1 individualized instruction with a nurse champion. Emphasis is placed on avoiding the larger upper arm veins. Results: A peripheral intravenous line database has been maintained since the beginning of the program in 2009. This database shows a significant percentage of admitted patients received USGPIV service. In 2010, USGPIVs were successfully placed 90% to 98% of the time. Conclusions: Utilizing UGSPIV can expedite treatment and disposition in an emergency department. Ultimately, throughput and wait time for an emergency department bed can thus be similarly affected, positively affecting customer service.
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Sutrisna, Eris, and Franciskus Antonius Alijoyo. "Optimization of the e-learning system for efficiency of participant registration times at training institutions: Case study at an ESAS management institute." Gema Wiralodra 15, no. 1 (January 13, 2024): 10–18. http://dx.doi.org/10.31943/gw.v15i1.619.

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Application e-learning technology has become integral to management education and training in various institutions. One of the aspect keys in context is the efficiency of time registration of participants. This article documents studies of cases carried out at the ESAS Management Institute, which aims to optimize the e-learning system to increase efficiency in the time registration of participants. This study integrates qualitative and quantitative methodology to comprehensively understand changes that occur in participants' registration process after the implementation of the e-learning system. Research results show significant improvement in speed registration participants. Queues and times wait participants are reduced, and e-learning systems provide 24/7 availability, eliminating limited time in the registration process. Verification documents become more accurate, reducing the risk of error, man. In evaluating sustainability, participants and staff administration give bait to come back optimistic about change. This article also highlights the importance of data collection and evaluation sustainability in maintaining and improving the efficiency system. This study gives a strong foundation for institutions with other training to optimize their e-learning system for efficient time registration participants. Thus, the article gives a valuable guide in adopting e-learning technology to increase the experience of participants and the efficiency of administrative processes in institutional training.
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Ebenfeld, Lara, Dirk Lehr, David Daniel Ebert, Stefan Kleine Stegemann, Heleen Riper, Burkhardt Funk, and Matthias Berking. "Evaluating a Hybrid Web-Based Training Program for Panic Disorder and Agoraphobia: Randomized Controlled Trial." Journal of Medical Internet Research 23, no. 3 (March 4, 2021): e20829. http://dx.doi.org/10.2196/20829.

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Background Previous studies provide evidence for the effectiveness of web-based interventions for panic disorder with and without agoraphobia. Smartphone-based technologies hold significant potential for further enhancing the accessibility and efficacy of such interventions. Objective This randomized controlled trial aims to evaluate the efficacy of a guided, hybrid web-based training program based on cognitive behavioral therapy for adults with symptoms of panic disorder. Methods Participants (N=92) with total scores in the Panic and Agoraphobia Scale ranging from 9 to 28 were recruited from the general population and allocated either to a hybrid intervention (GET.ON Panic) or to a wait-list control group. The primary outcome was the reduction in panic symptoms, as self-assessed using a web-based version of the Panic and Agoraphobia Scale. Results Analysis of covariance-based intention-to-treat analyses revealed a significantly stronger decrease in panic symptoms posttreatment (F=9.77; P=.002; Cohen d=0.66; 95% CI 0.24-1.08) in the intervention group than in the wait-list control group. Comparisons between groups of the follow-up measures at 3 and 6 months yielded even stronger effects (3-month follow-up: F=17.40, P<.001, Cohen d=0.89, 95% CI 0.46-1.31; 6-month follow-up: F=14.63, P<.001, Cohen d=0.81, 95% CI 0.38-1.24). Conclusions Hybrid web-based training programs may help reduce the symptoms of panic disorder and hence play an important role in improving health care for patients with this debilitating disorder. Trial Registration German Clinical Trial Register DRKS00005223; https://tinyurl.com/f4zt5ran International Registered Report Identifier (IRRID) RR2-10.1186/1745-6215-15-427
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Lound, Adam, Jane Bruton, Kathryn Jones, Nira Shah, Barry Williams, Jamie Gross, Benjamin Post, Sophie Day, Stephen J. Brett, and Helen Ward. "“I’d rather wait and see what’s around the corner”: A multi-perspective qualitative study of treatment escalation planning in frailty." PLOS ONE 18, no. 9 (September 21, 2023): e0291984. http://dx.doi.org/10.1371/journal.pone.0291984.

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Introduction People living with frailty risk adverse outcomes following even minor illnesses. Admission to hospital or the intensive care unit is associated with potentially burdensome interventions and poor outcomes. Decision-making during an emergency is fraught with complexity and potential for conflict between patients, carers and clinicians. Advance care planning is a process of shared decision-making which aims to ensure patients are treated in line with their wishes. However, planning for future care is challenging and those living with frailty are rarely given the opportunity to discuss their preferences. The aim of the ProsPECT (Prospective Planning for Escalation of Care and Treatment) study was to explore perspectives on planning for treatment escalation in the context of frailty. We spoke to people living with frailty, their carers and clinicians across primary and secondary care. Methods In-depth online or telephone interviews and online focus groups. The topic guide explored frailty, acute decision-making and planning for the future. Data were thematically analysed using the Framework Method. Preliminary findings were presented to a sample of study participants for feedback in two online workshops. Results We spoke to 44 participants (9 patients, 11 carers and 24 clinicians). Four main themes were identified: frailty is absent from treatment escalation discussions, planning for an uncertain future, escalation in an acute crisis is ‘the path of least resistance’, and approaches to facilitating treatment escalation planning in frailty. Conclusion Barriers to treatment escalation planning include a lack of shared understanding of frailty and uncertainty about the future. Emergency decision-making is focussed on survival or risk aversion and patient preferences are rarely considered. To improve planning discussions, we recommend frailty training for non-specialist clinicians, multi-disciplinary support, collaborative working between patients, carers and clinicians as well as broader public engagement.
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Moritz, Steffen, Chantal Dietl, Jan Felix Kersten, Frederick Aardema, and Kieron O’Connor. "Evaluation of Inference-Based Therapy (Doubt Therapy) as a Self-Help Tool for Obsessive-Compulsive Disorder." Journal of Cognitive Psychotherapy 29, no. 4 (2015): 315–30. http://dx.doi.org/10.1891/0889-8391.29.4.315.

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Introduction: Inference-based therapy (IBT) is a novel therapeutic approach aimed at reducing obsessive-compulsive symptoms. For this study, the original therapist-guided protocol was adapted for self-help administration. Method: Fifty patients with obsessive-compulsive disorder who had been recruited via specialized online fora were randomly allocated to either IBT or a wait-list control condition. At baseline and 4 weeks later, questionnaires tapping into psychopathology, quality of life, and faulty reasoning were administered. Results: The completion rate was acceptable (74%) and not significantly different across groups. Relative to controls, patients in the IBT group showed modest but significant symptom decline on obsessions (Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] self-report and Obsessive–Compulsive Inventory—Revised [OCI-R]) and washing compulsions (OCI-R) across time. No significant differences emerged for depression, quality of life, and inferential confusion. Ratings at the post-assessment suggest that the training was well accepted among patients. Test–retest reliability was high indicating good quality of the data. Discussion: This study confirms prior research suggesting that IBT is effective as a stand-alone technique. Follow-up studies are needed to elucidate the long-term effects of the training and whether positive effects are maintained if IBT is introduced as an add-on to standard treatment (i.e., cognitive behavioral therapy/medication).
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Minari, Tatiana Palotta, Gerardo Maria de Araújo-Filho, Lúcia Helena Bonalume Tácito, Louise Buonalumi Tácito Yugar, Tatiane de Azevedo Rubio, Antônio Carlos Pires, José Fernando Vilela-Martin, et al. "Effects of Mindful Eating in Patients with Obesity and Binge Eating Disorder." Nutrients 16, no. 6 (March 19, 2024): 884. http://dx.doi.org/10.3390/nu16060884.

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Introduction: Binge eating disorder (BED) is a psychiatric illness related to a high frequency of episodes of binge eating, loss of control, body image dissatisfaction, and suffering caused by overeating. It is estimated that 30% of patients with BED are affected by obesity. “Mindful eating” (ME) is a promising new eating technique that can improve self-control and good food choices, helping to increase awareness about the triggers of binge eating episodes and intuitive eating training. Objectives: To analyze the impact of ME on episodes of binge eating, body image dissatisfaction, quality of life, eating habits, and anthropometric data [weight, Body Mass Index (BMI), and waist circumference] in patients with obesity and BED. Method: This quantitative, prospective, longitudinal, and experimental study recruited 82 patients diagnosed with obesity and BED. The intervention was divided into eight individual weekly meetings, guided by ME sessions, nutritional educational dynamics, cooking workshops, food sensory analyses, and applications of questionnaires [Body Shape Questionnaire (BSQ); Binge Eating Scale (BES); Quality of Life Scale (WHOQOL-BREF)]. There was no dietary prescription for calories, carbohydrates, proteins, fats, and fiber. Patients were only encouraged to consume fewer ultra-processed foods and more natural and minimally processed foods. The meetings occurred from October to November 2023. Statistical analysis: To carry out inferential statistics, the Shapiro–Wilk test was used to verify the normality of variable distribution. All variables were identified as non-normal distribution and were compared between the first and the eighth week using a two-tailed Wilcoxon test. Non-Gaussian data were represented by median ± interquartile range (IQR). Additionally, α < 0.05 and p < 0.05 were adopted. Results: Significant reductions were found from the first to the eighth week for weight, BMI, waist circumference, episodes of binge eating, BSQ scale score, BES score, and total energy value (all p < 0.0001). In contrast, there was a significant increase in the WHOQOL-BREF score and daily water intake (p < 0.0001). Conclusions: ME improved anthropometric data, episodes of binge eating, body image dissatisfaction, eating habits, and quality of life in participants with obesity and BED in the short-term. However, an extension of the project will be necessary to analyze the impact of the intervention in the long-term.
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Vîrgolici, Oana, and Laura Gabriela Tănăsescu. "The Applicability of Some Machine Learning Algorithms in the Prediction of Type 2 Diabetes." Proceedings of the International Conference on Business Excellence 18, no. 1 (June 1, 2024): 246–57. http://dx.doi.org/10.2478/picbe-2024-0021.

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Abstract Type 2 diabetes is a metabolic disease that causes abnormal high levels of glucose in the blood. The pancreas is healthy, but the body doesn’t respond properly to its own insulin. The principal culprit is obesity, too much high fat tissue. So, measuring the body mass index or the waist circumference is a step to estimate the risk for this disease. Many people have no symptoms and the disease develops silently, causing serious problems with eyes, feet, heart and nerves. The prediction of diabetes is a very topical problem. In addition to medical guides, more and more machine learning models appear, trained on different databases. The purpose of these models is to predict diabetes, based on different parameters, not all of them coming from medical analyses. In the paper we present four diabetes prediction models, respectively based on the decision tree, support vector machine, logistic regression and k-nearest neighbors’ algorithms. All models are trained and tested on a database with approximately 65,000 records (divided into 70% for training and 30% for testing), which contains two blood markers (haemoglobin A1c and glucose), an anthropometric parameter (body mass index), age, gender and three categorical parameters (smoking status, hypertension, heart disease). We identify that Haemoglobin A1C and glucose are the most influential predictors. The models are evaluated in terms of accuracy score and confusion matrix and a ranking is presented at the end. The results obtained are very encouraging for all the presented models.
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EÉk, Niels, Karin Romberg, Ola Siljeholm, Magnus Johansson, Sven Andreasson, Tobias Lundgren, Claudia Fahlke, Stina Ingesson, Lisa Bäckman, and Anders Hammarberg. "Efficacy of an Internet-Based Community Reinforcement and Family Training Program to Increase Treatment Engagement for AUD and to Improve Psychiatric Health for CSOs: A Randomized Controlled Trial." Alcohol and Alcoholism 55, no. 2 (January 8, 2020): 187–95. http://dx.doi.org/10.1093/alcalc/agz095.

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Abstract Aims Community Reinforcement Approach and Family Training (CRAFT) is a support program for concerned significant others (CSOs) to identified persons (IPs) with alcohol use disorders, with the purpose of engaging IPs to treatment and to improve CSO functioning. The purpose of the present study was to investigate the efficacy of an internet-based version of CRAFT (iCRAFT). Methods Randomized controlled trial comparing iCRAFT with a wait-list (WL) condition with a nation-wide uptake in Sweden. A total of 94 CSOs to a treatment refusing IP, who described the IP according to DSM-IV criteria for alcohol dependence or abuse, were included in the study. iCRAFT consisted of five weekly administered therapist-guided modules with the following content: (a) improve CSOs’ own mental health, (b) improve the CSOs skills in asking the IP to seek treatment, (c) positive communication skills training, (d) contingency management of IP drinking behavior. Main outcome measure was IPs initiative to seek treatment measured at 24 weeks. Secondary outcomes were IP’s daily alcohol consumption, CSOs mental health, quality of life and relational satisfaction. Results Of 94 participants, 15 CSOs reported IP treatment initiative during the study period. Of these, 10 belonged to the iCRAFT condition and five to the WL condition. The difference between conditions was nonsignificant, and the results were inconclusive. Participants in iCRAFT showed short-term improvements regarding depressive symptoms, quality of life and relational happiness. Conclusion This study was unable to demonstrate substantial changes in the iCRAFT program regarding IP treatment seeking or CSO mental health.
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Rolvien, Lara, Lisa Buddeberg, Josefine Gehlenborg, Swantje Borsutzky, and Steffen Moritz. "A Self-Guided Internet-Based Intervention for the Reduction of Gambling Symptoms." JAMA Network Open 7, no. 6 (June 21, 2024): e2417282. http://dx.doi.org/10.1001/jamanetworkopen.2024.17282.

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ImportanceMost individuals with problem gambling or gambling disorder remain untreated due to barriers to treatment. Limited research exists on alternative treatments.ObjectiveTo investigate the efficacy of a self-guided internet-based intervention for individuals with gambling problems and to identify potential outcome moderators.Design, Setting, and ParticipantsThis single-center randomized clinical trial was conducted from July 13, 2021, to December 31, 2022, at the University Medical Center Hamburg-Eppendorf. Participants were recruited across Germany for 2 assessments (before intervention [t0] and 6 weeks after intervention [t1]). Eligible participants were individuals aged 18 to 75 years with gambling problems, internet access, German proficiency, and willingness to participate in 2 online assessments.InterventionThe self-guided internet-based intervention was based on cognitive behavioral therapy, metacognitive training, acceptance and commitment therapy, and motivational interviewing.Main Outcome and MeasuresThe primary outcome was change in gambling-related thoughts and behavior as measured with the pathological gambling adaption of the Yale-Brown Obsessive-Compulsive Scale. Secondary outcomes were change in depressive symptoms, gambling severity, gambling-specific dysfunctional thoughts, attitudes toward online interventions, treatment expectations, and patient satisfaction.ResultsA total of 243 participants (154 [63.4%] male; mean [SD] age, 34.73 [10.33] years) were randomized to an intervention group (n = 119) that gained access to a self-guided internet-based intervention during 6 weeks or a wait-listed control group (n = 124). Completion at t1 was high (191 [78.6%]). Results showed a significantly greater reduction in gambling-related thoughts and behavior (mean difference, −3.35; 95% CI, −4.79 to −1.91; P &amp;lt; .001; Cohen d = 0.59), depressive symptoms (mean difference, −1.05; 95% CI, −1.87 to −0.22; P = .01; Cohen d = 0.33), and gambling severity (mean difference, −1.46; 95% CI, −2.37 to −0.54; P = .002; Cohen d = 0.40) but not in gambling-specific dysfunctional thoughts (mean difference, −1.62; 95% CI, −3.40 to 0.15; P = .07; Cohen d = 0.23) favoring the intervention group. Individuals in the intervention group who had a positive treatment expectation and more severe gambling-specific dysfunctional thoughts and gambling symptoms benefited more on the primary outcome relative to the control group.Conclusions and RelevanceIn this randomized clinical trial, the effectiveness of a self-guided internet-based intervention for individuals with self-reported problematic gambling behavior was demonstrated when measured 6 weeks after start of the intervention. The study’s findings are particularly relevant given the increasing need for accessible and scalable solutions to address problematic gambling.Trial Registrationbfarm.de Identifier: DRKS00024840
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Gordon, Gemma, Timo Brockmeyer, Ulrike Schmidt, and Iain C. Campbell. "Combining cognitive bias modification training (CBM) and transcranial direct current stimulation (tDCS) to treat binge eating disorder: study protocol of a randomised controlled feasibility trial." BMJ Open 9, no. 10 (October 2019): e030023. http://dx.doi.org/10.1136/bmjopen-2019-030023.

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IntroductionBinge eating disorder (BED) is a common mental disorder, closely associated with obesity. Existing treatments are only moderately effective with high relapse rates, necessitating novel interventions. This paper describes the rationale for, and protocol of, a feasibility randomised controlled trial (RCT), evaluating the combination of transcranial direct current stimulation (tDCS) and a computerised cognitive training, namely approach bias modification training (ABM), in patients with BED who are overweight or obese. The aim of this trial is to obtain information that will guide decision-making and protocol development in relation to a future large-scale RCT of combined tDCS+ABM treatment in this group of patients, and also to assess the preliminary efficacy of this intervention.Methods and analysis66 participants with Diagnostic and Statistical Manual-5 diagnosis of BED and a body mass index (BMI) of ≥25 kg/m2will be randomly allocated to one of three groups: ABM+real tDCS; ABM+sham tDCS or a wait-list control group. Participants in both intervention groups will receive six sessions of ABM+real/sham tDCS over 3 weeks; engaging in the ABM task while simultaneously receiving bilateral tDCS to the dorsolateral prefrontal cortex. ABM is based on an implicit learning paradigm in which participants are trained to enact an avoidance behaviour in response to visual food cues. Assessments will be conducted at baseline, post-treatment (3 weeks) and follow-up (7 weeks post-randomisation). Feasibility outcomes assess recruitment and retention rates, acceptability of random allocation, blinding success (allocation concealment), completion of treatment sessions and research assessments. Other outcomes include eating disorder psychopathology and related neurocognitive outcomes (ie, delay of gratification and inhibitory control), BMI, other psychopathology (ie, mood), approach bias towards food and surrogate endpoints (ie, food cue reactivity, trait food craving and food intake).Ethics and disseminationThis study has been approved by the North West-Liverpool East Research Ethics Committee. Results will be published in peer-reviewed journals.Trial registration numberISRCTN35717198
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Apostol, Enya Marie D., Michelle S. Villan, Toby Tyler M. Jose, and Kristelle Marjori M. Pasco. "Customer Experience (Cx) Design in the View of Managers: An Analysis of the Impact of Pandemic in the Local Hospitality and Tourism Industry." American Journal of Tourism and Hospitality 1, no. 1 (July 17, 2023): 16–26. http://dx.doi.org/10.54536/ajth.v1i1.1749.

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Hospitality and tourism are among the worst-affected industries during this pandemic, with a global drop in demand. These industries are operating under strict restrictions, and a “new normal” needs to be defined. Because of its disruptive effects, hospitality and tourism providers must redesign the customer experience (CX), which is considered the core of the tourism and hospitality sector. Thus, this study sought to measure the views of the managers on customer experience (CX) design as an analysis of the impact of the pandemic in the local hospitality and tourism industry. This study emploa yed a descriptive method to identify the different variables of the study and presents quantitative research that utilized online survey method to gather data information from the respondents. Top-level managers from different hotels, resorts, restaurants and tourism sites in the prime hospitality and tourism towns in the province of Oriental Mindoro were the respondents (n=26) of this study. Results showed that the view of the managers on the measures designed to create safe customer experiences in terms of hygiene and protection, internal work reorganization, services cape reorganization, technology and digital innovations, customer wait time reduction, staff training and communication were all positively affirmative. As a result, these measures positively affected the intended experience in terms of reassurance, quickness and intimacy. It is recommended that the managers adopt and implement the proposed CX framework to enhance the customers’ experience in various hospitality and tourism service providers despite the threats of the pandemic and to guide the managers to transition to post-pandemic situations.
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Brue, Ethan J., and Derek C. VanderLeest Schuurman. "A Christian Field Guide to Technology for Engineers and Designers." Perspectives on Science and Christian Faith 75, no. 1 (March 2023): 71–72. http://dx.doi.org/10.56315/pscf3-23brue.

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A Christian Field Guide to Technology for Engineers and Designers by Ethan J. Brue, Derek C. Schuurman, and Steven H. VanderLeest. Downers Grove, IL: IVP Academic, 2022. 226 pages including discussion questions, endnotes, credits, and indices. Paperback; $28.00. ISBN: 9781514001004. *Finally! The long-awaited update to Responsible Technology: A Christian Perspective (Stephen V. Monsma, ed., Eerdmans, 1986) is here, and this new book is well worth the wait. Framed as a practical field guide for engineers, it is also adept at illuminating some of the philosophical issues that swirl around the interface of technology and Christian faith. Hearty pats-on-the-back to Ethan Brue, Derek Schuurman, and Steven VanderLeest for undertaking and completing this grand project in such fine fashion. *It begins with an inspiring discussion of the connections between humankind's technological hopes and dreams and our ultimate hope in our Maker. Historical accounts and personal stories by each author will surely be an encouragement to young people who are curious about technology from a Christian perspective. Indeed, this book would make a good text for a university-level "Introduction to Engineering" course. The book continues with an insightful survey of how technology relates to the biblical story. This includes a discussion of humanity's first great commission to steward the earth, as well as the influence of fall, redemption, and re-creation on our engineering enterprises. *It gets even more interesting (and philosophical) as the authors next address the popular false narrative that all technology is inherently neutral. Several examples help to expose myths about the universal usefulness and neutrality of tools, the ends justifying the means, and forms of technological determinism. This is followed by a discussion of what constitutes responsible and discerning design, including technological mediation and unintended consequences. This naturally leads into the real "meat" of the book, which deals with design norms, or guiding principles that designers should seek to follow. *The authors extend the original list of norms in Responsible Technology to include categories of analytical, cultural, clarity, social, stewardship, harmony, justice, caring, and faithfulness. Common ethical frameworks are then presented that build on these design norms. This is excellent background knowledge that will greatly benefit engineering students, as well as practitioners. Although a Christian worldview pervades the entire book, it is explicitly addressed in "Modern Towers of Babel" (chapter 6) which explores the results of sin on engineering and resulting technologies. A helpful distinction between finiteness and fallenness illuminates this discussion. *The engineering of electric vehicles provides a fascinating example of how important historical context and past industry contribute to understanding in current designs. With this background, the design norms are then applied to envision the responsible development of a future electric vehicle. A chapter on technology and the future follows, with discussions of technological optimism, pessimism, and transhumanism. A biblical view of the future of technology concludes this section by framing it all in a Christian perspective. I imagine this section will be exciting for young engineers as they envision how God is calling them to use future technologies to influence the world for good and not for ill.. *However, I found the second-to-last chapter (on technology for evangelism and missions) to be the most interesting. Here we are reminded that technological work is a legitimate Christian calling, since "Our worship does not start and stop with the formal service in a church building … worship can and should be an ever-present mindset and continuous act" (p. 175). And training as a technologist not only enables one to use technology in serving others physically, but it also provides access to the technological community where one can have an even more profound influence. The authors emphasize that "While Christians from a wide variety of vocational backgrounds can serve as missionaries in developing countries, only those with a highly technical education can serve as missionaries to this corporate mission field. Technical expertise opens doors" (p. 168). Readers are encouraged to develop their own unique and creative ways to use technology to love their neighbor. But this is about as close as the authors get to discussing what may be an important calling for many Christian engineers, that of the evangelist/apologist. I would like to have seen more discussion on how the expertise of engineers enables them to answer questions on science and faith apparent disagreements, questions asked by both skeptics and believers. Engineers are uniquely qualified to serve as mediators and peacemakers in the science and faith conversation, and unfortunately, perhaps due to size constraints, this aspect was not mentioned in the book. *Finally, I hope that readers make it to the last chapter since I found it particularly meaningful. It consists of a series of emails between a young engineer and his former engineering professor and mentor at a Christian university. Although the letters are fictional, they raise many questions that often arise within the first years of an engineering career. And the good professor dispenses his wisdom with keen insight and grace. Overall, I found this book to be a much-needed addition to the conversation on technology and Christian faith. And I think it should be widely considered as required reading in the first year of engineering programs at Christian universities. The questions for reflection and discussion at the end of each chapter are very thoughtful and provide a helpful resource in this regard. *Reviewed by Dominic Halsmer, Senior Professor of Engineering, Oral Roberts University, Tulsa, OK 74171.
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Bakhai, Smita, Aishwarya Bhardwaj, Parteet Sandhu, and Jessica L. Reynolds. "Optimisation of lipids for prevention of cardiovascular disease in a primary care." BMJ Open Quality 7, no. 3 (August 2018): e000071. http://dx.doi.org/10.1136/bmjoq-2017-000071.

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The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines focus on atherosclerotic cardiovascular disease (ASCVD) risk reduction, using a Pooled Cohort Equation to calculate a patient’s 10-year risk score, which is used to guide initiation of statin therapy. We identified a gap of evidence-based treatment for hyperlipidaemia in the Internal Medicine Clinic. Therefore, the aim of this study was to increase calculation of ASCVD risk scores in patients between the ages of 40 and 75 years from a baseline rate of less than 1% to 10%, within 12 months, for primary prevention of ASCVD. Root cause analysis was performed to identify materials/methods, provider and patient-related barriers. Plan-Do-Study-Act cycles included: (1) creation of customised workflow in electronic health records for documentation of calculated ASCVD risk score; (2) physician education regarding guidelines and electronic health record workflow; (3) refresher training for residents and a chart alert and (4) patient education and physician reminders. The outcome measures were ASCVD risk score completion rate and percentage of new prescriptions for statin therapy. Process measures included lipid profile order and completion rates. Increase in patient wait time, and blood test and medications costs were the balanced measures. We used weekly statistical process control charts for data analysis. The average ASCVD risk completion rate was 14.2%. The mean ASCVD risk completion rate was 4.0%. In eligible patients, the average lipid profile completion rate was 18%. ASCVD risk score completion rate was 33% 1-year postproject period. A team-based approach led to a sustainable increase in ASCVD risk score completion rate. Lack of automation in ASCVD risk score calculation and physician prompts in electronic health records were identified as major barriers. Furthermore, the team identified multiple barriers to lipid blood tests and treatment of increased ASCVD risk based on ACC/AHA guidelines.
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Knode, Tom, and David King. "Guest Editorial: More Than Just Talk What Senior Leaders Must Do To Drive Safety Performance Improvement." Journal of Petroleum Technology 74, no. 09 (September 1, 2022): 12–14. http://dx.doi.org/10.2118/0922-0012-jpt.

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_ Over the past few decades, the upstream oil and gas industry has demonstrated marked improvement in safety performance as measured by traditional lagging indicators. This success has been supported by the development of safety management systems, improved training and equipment, as well as numerous guides on the most critical component: safety leadership. Organizations such as the International Association of Oil and Gas Producers (IOGP), Step Change in Safety, and Center for Offshore Safety (COS), to name a few, provide guidance and encourage leadership to actively participate in driving the message and expectations around leadership engagement on safety. The SPE Technical Report Getting to Zero and Beyond: The Path Forward (March 2018) states that to achieve a culture of perfection, actions must be led from the top. In the context referenced in this article, leaders are those individuals in senior positions who are recognized by their organization as having responsibility for operations and can commit financial resources to reduce risk (the US Federal Aviation Administration would call this person an “accountable executive” per the regulations). Many leaders commit to the aspiration of no harm to people, but they may need help on the substance and actions that will make a difference. The guidance documents from the organizations and technical report listed above provide sound foundations for messaging, as well as what follows in this article. The authors have had robust experience in safety culture and performance improvement, and where it succeeds or fails. Start With the Basics The first thing leaders must do is provide a Statement of Organizational Intent (SOI). An SOI starts with, but goes well beyond, the aspiration of No Harm. The SOI should cover what operational leaders will do to help improve the safety culture. This should be specific to the needs of the organization and include an honest assessment of the current state of safety. It is vital to understand what is going on at the front lines: (a) why are incidents occurring, and (b) what are the trends of the failures. The SOI will move past the superficial view that “incident rates are too high and therefore, we must do better.” There is a need for more information on performance beyond the traditional lagging indicators of incident rates. A good starting point is adding near misses, observations, and incidents with a high potential for serious outcome. Beyond that, leaders need to identify measures of inputs that make a difference in performance. Traditionally this may have meant something like training hours, but that assumes the training is effective. The measures must include a view of strategic plans and implementation progress. A means of tracking and verification of progress is needed as well. Senior leadership then must routinely, and personally, follow up on the progress and hold the organization accountable for following through to completion. If not, there can be elements within the organization who will simply wait out the strategies, knowing there is no consequence for lack of participation.
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Melssen, Maria. "Indigenous Traditional Medical Practitioners’ Lack of Formal Medical Education Impacts their Choices of Information Resources for the Treatment of Sickle Cell Anemia." Evidence Based Library and Information Practice 6, no. 2 (June 24, 2011): 45. http://dx.doi.org/10.18438/b8s332.

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Objective – To determine the information seeking behaviours of traditional medical practitioners who treat sickle cell anemia patients. Design – Qualitative, interviewer-administered, structured questionnaire. Setting – City and surrounding rural area of Ibadan, Nigeria. Subjects – The researchers selected for this study 160 indigenous traditional medical practitioners who specialize in the treatment of sickle cell anemia. The majority of the subjects were male, with 96 male and 64 female. The practitioners were selected from four traditional medical practitioner associations in Ibadan, Nigeria. The researchers met with the leaders of the four organizations and identified which of the 420 members specialize in the treatment of sickle cell anemia. Methods – The subjects were asked survey questions orally during face-to-face interviews. The decision to conduct interviews and ask the survey questions orally (rather than having the subjects complete the survey questions on their own) was based on the perceived low literacy level of the traditional medical practitioners. Survey questions were written using the analytical framework of Taylor’s information use environment model. According to the authors, the premise of Taylor’s information use environment model is that individuals can be grouped according to their “professional and/or social characteristics” (p. 124). The group is then characterized by the members’ approach to problem solving: the type of problems they encounter, the setting they find themselves in during the problem, and how the group as a whole determines what course of action needs to be taken in order to solve the problem. The problem solving strategy of the group impacts its need for information and how that information is located and used. The questions asked by the researchers fell into one of five research areas: • the environment of the group • the diagnosis and treatment methods of traditional medical practitioners and how they obtain information that shapes their diagnosis and treatment choices • sources of information for the treatment of sickle cell anemia and the factors that encourage or discourage the use of those sources • how information about sickle cell anemia is communicated amongst the traditional medical practitioners • the extent to which orthodox and traditional approaches to the treatment of sickle cell anemia are integrated. All 160 subjects completed the interview and all of the surveys were determined to be usable. Main Results – The main sources of professional knowledge and training of the traditional medical practitioners are their fathers (55%) and master healers (42.5%). This knowledge is orally preserved: none of the respondents completed a formal training program at a university. The information used to select the best treatment options for patients with sickle cell anemia is the patient’s diet or eating habits (62%) and new traditional remedies (55%). New traditional remedies are defined by the authors as “the location and potency of herbs, roots, bark and parts of animals used to compound drugs or make ritual sacrifices” (p. 128). The information found least useful by the traditional practitioners is the authenticity of new remedies (20%). The traditional practitioners would wait for their patients to report back regarding the success or failure of the treatment they were provided. The researchers also discovered that traditional practitioners rarely, if ever, share their diagnosis and treatment methodologies with other practitioners. The diagnostic tests for sickle cell anemia used most often by traditional practitioners are visual observation (32.5%) and history taking (48%). Only a fraction of the practitioners (10%) utilize “orthodox methods” which include Hb electrophoresis. The treatment option of choice by the majority of practitioners is concoctions (62.5%). The traditional practitioners favour informal sources of information over formal sources. The informal sources most commonly used are local associations (55%), colleagues (55%), and master healers (52.5%). Such formal resources as medical journals, seminars or workshops, the Internet, and libraries are rarely if ever used. The factors influencing the practitioners’ resource choice include relevance (87.8%), suitability (70%), and availability (67.5%). Many practitioners also refer their patients to other traditional medical practitioners; however, very few (27.5%) refer patients to orthodox physicians. The traditional practitioners felt that they can treat their patients on their own and do not need the orthodox physician’s help. The traditional practitioners also feel that there is little or no information sharing between the traditional practitioners and the orthodox physicians: the only time information is exchanged between the two groups is when the orthodox physicians want to conduct research on traditional medical practices. Conclusion – The traditional practitioners rely heavily on information from local experts to guide their treatment plans for sickle cell anemia patients. The success or failure of a given treatment plan is also based on what did or did not work in the past. These practitioners do not have a formal education and have a low literacy level. This group is not recognized by western medical culture as a result of their lack of professional, western medical training. Another issue is that there is not a solid documentation system of the treatment and management of sickle cell anemia by this group. This is due to their fears of having their methods “stolen” by fellow practitioners. Recommendations by the authors include having the association leaders document and track the treatment and disease management methods used by their members and implementing a training program for the indigenous traditional medicine practitioners. Further research needed includes exploring the various ways to integrate western medical practices with traditional practices as well as investigating ways to encourage collaboration and sharing of information between indigenous medical practitioners.
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Shrestha, Jitendra. "Clinical Research and Medical Journal." Nepal Medical Journal 1, no. 01 (August 21, 2018): 5–6. http://dx.doi.org/10.37080/nmj.3.

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Health system should be supported by health research to deliver quality, accountable, equitable, fairer, better health care to target population.1 Earlier; defenseless people like prisoners, soldiers, poor and mentally ill along with animals were subjected to medical research without taking consent. As time pass by, new emerging health problems, shifting of epidemiological trends in disease patterns, rapid increase in population, new and emerging health problems, increasing commercial interests of private health sector and shrinking resources all contribute in inequity to health care.2 Hence it is extremely important that research addresses priorities and focuses on the most important health issues and conditions. Research must serve as a driver for health system, policies and practice. For this to happen, the health research systems should be fully accountable for sake of transparency and also have to be capable of delivering the desired returns. We are fortune to take benefit from documented experiences from history. The main goal of medical research article is to share one’s valuable experience so as to contribute to the progress of science.3 Conducting a medical research and publishing it in a medical journal, is sharing an important knowledge and experience to the world. A physician from one part of the world may have significant load of certain disease and sharing management experience in that particular disease may help doctors of other part of the world treat such kind of patient. Furthermore, author may also have individual benefits, like higher positions in academic hierarchy.4 The Journal of the institution reflects the academics wealth of the institute. Earlier, only few used to grab opportunities for professional growth via publication, majority of them suffer to lack of publication culture in the institution resulting in fossilization of their professional caliber.5 In developing countries like ours, to do quality medical research is often difficult. Furthermore, getting the article published in medical journal is another challenge. Leading international medical journals underreport on health research priorities for developing countries because of improper material, methods quality. Many factors play role in the paucity of inclusion of research papers from developing countries. Lack of resources like funding, proper man power and less access to scientific literature in similar setting leading to poor research output, faulty manuscript preparation and language proficiency may be the common problems. Inadequate laboratory facilities and training may be the other cause. Hence, researchers in developing countries should be supported and encouraged to produce material of the quality by proper guidance and required trainings. Open access journal is the window to the research world. It is one of the tools to increase publications. These journals facilitate the publication of local research output and may play defining role in helping researcher to improve their publication records, and make it accessible to other researchers. This type of open access journal is an important entity in national publishing that will hopefully gain broader prominence as awareness increases and the above efforts are implemented. To make our journal an index and of international stature is strenuous but with the help from our fraternity, we will surely reach the goal soon. Our journal will surely serve as a medium to access information, updated knowledge and a symbol of ideal journal in Nepal. This journal is the result of hard work, dedication and sacrifice. We apologize for taking this extra long time to publish but as they say ‘good things come to those who wait’ we proudly present you our journal, our masterpiece. No one is to be blamed for the delay of this process. Working with teachers, selecting experts for review, suggesting authors, verifying manuscripts, editing and proof reading was an arduous job but was done meticulously. We run out of words to express our gratitude to the reviewers who reviewed and upgraded the journal’s contents. It is very hard to imagine this journal with their crucial help and guidance. We apologize for not being able to incorporate all the articles due to some academic standards and expectations. I would also like to take this opportunity to thank Dr. Angel Magar, without whom this journal would be impossible. His valuable guidence help us shape the journal. We shall forever the indebted to him for his support. Dr. Bibek Rajbhandari is another individual we need to thank. His hard work and dedication can be seen in our journal. We are grateful for his help and support. We appreciate everything he has done selflessly and for the betterment of the journal. We would like to acknowledge Dr. Krishna Rana (JNMA Assistant Editor) and JNMA Trainees (Asmita Neupane, Rakshya Pandey, Suzit Bhusal, Suraj Shrestha, Nabin Sundas, Prastuti Shrestha, Riyaz Shrestha, Prabha Bhandari, Nita Lohala, Samiksha Lamichhane, Sushmita Bhattarai, Laxman Aryal, Barsha Karki and Kajol Ghimire, Sushil Dahal, Shraddha Bhattarai) for the consistent support during the phase of publication. REFERENCES Inis C. The WHO Strategy on research for Health. France:WHO,2012. Santosa A, Wall S,Fottrell E,Hogberg U, Byass P.The Deveopment and experience of epidemological transition theory over four decades: a systematic review. Glob Health Action.2014;7:10. Mohmoud F, Mohamed F. A practical guide for health researchers. Eastern Mediteranean:WHO Regional Publications, 2004. Clauset A, Arbesmans, Larremore D. Systematic inequtiy and hierarcy i faculty hiring networks. Sci.Adv.2015;1:e 1400005. Koul B, Kanwar A (ed.). Toward a Culture of Quality. Vancouver:Common Wealth of Learning, 2006.
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29

Morgan, Lucy, Christine Merkel, Leo I. Gordon, John Buscombe, Suzanne Wait, Martin H. Dreyling, Erik Mittra, and Ajay K. Gopal. "System-Level Barriers to Uptake of Existing and Novel Radioimmunotherapy for People with Lymphoma." Blood 138, Supplement 1 (November 5, 2021): 3006. http://dx.doi.org/10.1182/blood-2021-144904.

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Abstract:
Abstract Introduction: Radioimmunotherapy is a targeted approach to cancer care. It has been shown to improve progression-free survival and quality of life in people with specific types of non-Hodgkin's lymphoma, including CD20- and CD37-positive B-cell lymphoma (Barr et al., 2018 NCT00770224; Green & Press, 2017; Kolstad et al., 2018 NCT01796171; Witzig et al., 2002). It has also been shown to increase the proportion of people who achieve complete response to therapy (Green & Press, 2017). Although CD20-targeted therapy has been approved in the US and Europe for nearly two decades, its use remains limited. At its peak in the UK in 2007, only 57 people with lymphoma were treated with the therapy (Rojas et al., 2019). However, research is ongoing; a PubMed search for 'radioimmunotherapy' and 'lymphoma' produces 1,097 articles in the past 20 years, including over 300 articles in the past ten years. With novel applications (CD37- and CD22-targeted) currently under investigation, it is increasingly important to understand potential system and policy barriers to uptake, such that existing roadblocks are overcome. Tackling these challenges is essential to ensuring that radioimmunotherapy is appropriately integrated into relevant clinical guidelines and care pathways. Aim: To better understand the policy and system barriers to integration of existing and novel radioimmunotherapy into lymphoma care in the US and the UK. Methodology: We conducted a structured literature review, taking a systems approach, to explore each of the five domains of the health system as outlined in the Radioligand Therapy Readiness Assessment Framework (Figure 1. Five core domains of the health system, with subdomains; The Health Policy Partnership, 2021). This approach allowed us to gain a holistic understanding of what integration of radioimmunotherapy involves and identify potential barriers, from clinical development through to patient care. We also conducted semi-structured interviews with lymphoma experts in the US (N=5) and UK (N=6), including clinicians and nurses ('clinical experts', N=8) and patient advocates ('advocates', N=3). Our work was guided by national expert advisory groups in each country. Results: While the US and UK health systems are organized and funded very differently, the literature and expert interviews revealed many common strategic challenges to the integration of radioimmunotherapy. These were: 1) low awareness and understanding of radioimmunotherapy among newly licensed healthcare professionals (an issue raised by n=8 clinical experts); 2) limited awareness by patient advocates, patients and policymakers (n=3 advocates); 3) caution around uptake of new radioimmunotherapy agents based on limited access to and use of older treatments (n=7 clinical experts); 4) nonexistent referral pathways and unclear models of working which discourage shared care and hinder multidisciplinary coordination (n=4 clinical experts); 5) lack of recent clinical data and research to support evidence-based use (n=5 clinical experts); 6) reimbursement concerns (n=5 clinical experts). Policy implications: Taking a systems approach to explore potential barriers to integration of radioimmunotherapy has allowed us to explore potential adaptations needed to achieve multisectoral and multidisciplinary working. Our findings reveal that professional societies, policymakers and patient advocacy groups will need to work together to overcome these barriers by: 1) reaching consensus on timing and eligibility criteria for use of radioimmunotherapy; 2) creating accurate and consistent patient-friendly information; 3) efficiently updating clinical training and treatment guidelines to include approved radioimmunotherapy; 4) developing evidence-based and personalized referral and treatment pathways which ensure consistency of care; and 5) investing in data collection and analysis to continually inform practice. Figure 1 Figure 1. Disclosures Morgan: Nordic Nanovector: Consultancy; Advanced Accelerator Applications: Consultancy. Merkel: Advanced Accelerator Applications: Consultancy; Amgen: Consultancy; AstraZeneca: Consultancy; Bayer: Consultancy; Bristol-Myers Squibb: Consultancy; Curium: Consultancy; Johnson & Johnson: Consultancy; MSD: Consultancy; Nordic Nanovector: Consultancy; Novartis: Consultancy. Gordon: Zylem Biosciences: Patents & Royalties: Patents, No royalties; Bristol Myers Squibb: Honoraria, Research Funding. Buscombe: Advanced Accelerator Applications Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Wait: Bayer: Consultancy; Curium: Consultancy; Johnson & Johnson: Consultancy; MSD: Consultancy; Advanced Accelerator Applications: Consultancy; Nordic Nanovector: Consultancy; Shionogi: Consultancy; Bristol-Myers Squibb: Consultancy; Amgen: Consultancy; AstraZeneca: Consultancy. Dreyling: Genmab: Consultancy; Celgene: Consultancy, Research Funding, Speakers Bureau; Amgen: Speakers Bureau; Astra Zeneca: Consultancy, Speakers Bureau; Bayer HealthCare Pharmaceuticals: Consultancy, Research Funding, Speakers Bureau; BeiGene: Consultancy; Gilead/Kite: Consultancy, Research Funding, Speakers Bureau; Incyte: Consultancy, Speakers Bureau; Janssen: Consultancy, Research Funding, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Roche: Consultancy, Research Funding, Speakers Bureau; Abbvie: Research Funding. Mittra: Advanced Accelerator Applications Novartis: Consultancy, Honoraria, Research Funding; Curium: Consultancy, Honoraria; Nordic Nanovector: Research Funding. Gopal: Janssen: Consultancy, Honoraria, Research Funding; Cellectar: Consultancy, Honoraria; Bristol Meyers Squibb: Research Funding; SeaGen: Consultancy, Honoraria, Research Funding; I-Mab bio: Consultancy, Honoraria, Research Funding; Incyte: Honoraria; MorphoSys: Honoraria; Servier: Consultancy, Honoraria; Genetech: Consultancy, Honoraria, Research Funding; IGM Biosciences: Research Funding; Astra-Zeneca: Research Funding; Karyopharm: Consultancy, Honoraria; Takeda: Research Funding; Teva: Research Funding; Agios: Research Funding; Kite: Consultancy, Honoraria; ADC Therapeutics: Consultancy, Honoraria; Acrotech: Consultancy, Honoraria; Merck: Consultancy, Honoraria, Research Funding; Epizyme: Consultancy, Honoraria; Nurix Inc: Consultancy, Honoraria; Beigene: Consultancy, Honoraria; Gilead: Consultancy, Honoraria, Research Funding.
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30

Sharma, Santosh Kumar. "Failed Nerve Blocks: Prevention and Management." Journal of Anaesthesia and Critical Care Reports 4, no. 3 (2018): 3–6. http://dx.doi.org/10.13107/jaccr.2018.v04i03.101.

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Abstract:
“The secret of success is constancy of purpose” – Benjamin Disraeli, British politician Success and failure go side by side in regional anesthesia. No anesthesiologist can claim a 100% success record while giving nerve blocks. Hence, it is always better to focus on how to prevent causes of block failure rather than focusing on managing a failed block. Abdallah and Brull did a comprehensive literature hunt to find out the meaning of block “success” which were used by various authors in their studies and found that it was highly variable and there was lack of consensus regarding its meaning [1]. The most common definition of block success was an achievement of a surgical block within a designated period. There are essentially four stakeholders for defining success criteria: Namely the patient, the anesthesiologist, the surgeon, and the hospital administrator. The various parameters of success for a patient which included post-operative pain and patient satisfaction were evaluated in four trials only. The anesthesiologist-related indicators such as block onset time and complications were reported most frequently. The surgeon and hospital administrator-related indicators were not collected in any trial. For all practical purposes, especially from our perspective, a block failure may be accepted when complying with any one of the following after giving an adequate time of approximately 30 min: Conversion to general anesthesia (GA) after surgical incision. Use of intravenous (IV) opioid analgesics ≥100 μg fentanyl or equivalent after incision. Rescue peripheral nerve block given (a second block after completion of an initial block). Infiltration of local anesthetic agent (LA) into the surgical site. The above four criteria are routinely recorded in medical records and have also been accepted in previous research papers. We may have (a) a total failure which is defined as block where bolus of LA completely misses its target and surgery cannot proceed, (b) an incomplete block where patient has numbness in the area of nerve distribution but not adequate for incision, (c) a patchy block in which some areas in distribution of plexus usually have escaped, (d) a wear off block or secondary failure seen when surgery outlasts the duration of block, and (e) a misdirected block is when part or whole of the drug is injected into the neighboring structures, for example, into a different fascial or muscular plane or a vessel. Morgan had stated that “Regional anesthesia always works – provided you put the right dose of the right drug in the right place.” Failure occurs due to blocking the wrong nerve or not blocking all the nerves for planned surgery. Three primary keys to successful regional anesthesia are, therefore, nerve location, nerve location, and nerve location! – N.M. Denny. Every anesthesiologist must “pause” just before placing the needle at the site of nerve block. While doing so, he re-confirms the patient’s identity, the intended procedure and the correct side of the intended nerve block. There are numerous factors which play a crucial role in the success or failure of a peripheral nerve block. The operator’s technical skills and experience play a substantial role. An unskilled anesthesiologist is perhaps the biggest cause of failure. It has been found that exposure to multiple techniques at the same time is confusing for the beginner. A pearl of wisdom is that one should avoid “over-selling” regional anesthesia (RA) techniques in the initial days of their independent practice. Dr. Gaston Labat in 1924 had wisely sermoned that “A thorough knowledge of the descriptive and topographic anatomy with regard to nerve distribution is a condition which anyone desirous of attempting to study regional anesthesia should fulfill.” If ultrasound (US) is being used, then knowledge of sono-anatomy is equally essential. Gross anatomic distortion will, however, remain a challenge to the success of nerve blocks. It is essential to give appropriate blocks for appropriate surgery. According to Hilton’s Law, the nerve trunk innervating a joint also supplies the overlying skin and the muscles that move that joint, and one must block all the nerves for a successful block. On the contrary, one must also understand the limitations of a particular nerve plexus block and the most common nerves that may be spared in a plexus block. It is better to choose one technique, become familiar, confident and comfortable with it and stay with the technique for a reasonable time, rather than trying unfamiliar nerve block techniques at the first go. Sub-optimal placement of LA in landmark-based technique leads to the highly variable success rate of these blocks. Using proper equipment is always advisable, and both peripheral nerve stimulator (PNS) and US have been validated to increase success rates in multiple studies. Block success rates are similar between US and PNS when the block was performed by experts [2]. Whatever the equipment, knowing and familiarizing with it is a bare minimum requirement. While using a nerve stimulator, the current intensity is essentially the most important factor. An evoked motor response at a current of ≤0.5 mA (0.3–0.5 mA) ensures a successful nerve block. Knowledge of an appropriate motor response of the innervating nerve is crucial for the success of the nerve block, and any non-ideal motor responses will increase the failure rates. In recent times, everybody is laying emphasis in US-guided blocks and the target nerve is no longer invisible. Does US-guided blocks lead to a 100% success? Sites et al. identified 398 of 520 peripheral nerve block errors committed by the US novices during their performance [3]. The crux is that the US may not eliminate failures completely. The major limitation of US technology is the dependence on the operator. One needs adequate training and has a definite curve in honing the skills. The most common errors during US-guided blocks are too much of hand motions while holding the needle or probe, poor choice of needle-insertion site and angle, difficulty in aligning needle with the US-beam thus preventing needle visualization, failure to recognize needle tip before injection, anatomic artifacts (tissue resembling target nerve), and failure to recognize maldistribution of LA [4]. Combination of US and PNS (Dual guidance), for nerve identification and blockade, has also been proposed. Using both facilitates learning, improve trainee performance and provide an increased level of confidence and comfort. For superficial blocks, US alone is usually sufficient and PNS may be used to monitor for an overlooked intraneural placement. For deep or anatomically challenging US-guided blocks with inadequate images, PNS can be used to identify the nerve structures of interest. Multi-stimulation, a technique where each component of the nerve plexus is stimulated separately has been proved to increase the success rate and reduce the dose of LA. It, however, requires multiple passes or multiple skin punctures with the block needle. The best results are seen for the infra-clavicular block, mid-humeral block, axillary block, popliteal or sciatic block, and most US-guided nerve blocks. No additional risk of nerve injury during redirection of the needle through partially anesthetized nerves has been reported. Excessively anxious or an uncooperative patient, patients with any mental illness are not the ideal candidates for RA. The patient’s anxiety may affect the anesthesiologist adversely making him anxious, denting his confidence, and consequently ruining his chances of a successful nerve block (Table 1) [5]. Underlying comorbidities in the patient such as obesity, arthritis, and diabetes may affect positioning, access, nerve localization, and identification. A history of a good previous experience of anesthesia or surgery is predictive of a more relaxed patient and a successful block. The management in such patients comprises good pre-operative counseling with a gentle, unhurried patient handling. Subsequent management may include use of a light anxiolytic premedication, followed with lifting drapes off patient’s eyes, shielding of the ears from noise, and applying headphones with soft music in the operation theaters (OT) (Fig. 1). Patients may still claim that their block has failed due to the conscious awareness of OT settings and “sensations” transmitted through unblocked nerve fibers. IV analgesia or sedation with appropriate monitoring for relieving anxiety and pain is essential and considered “standard care” and should not be considered as a failure. Drugs are an important factor for the success of nerve blocks. Usage of a sufficient volume and appropriate concentration of LA solution is the key to a successful nerve block. Too much of volume or concentration of LA may lead to an enhanced risk of side effects rather than increasing efficacy. Likewise, too less of volume or concentration of LA increase chances of failure. The anesthesiologist should always check for wrong dispensing and expiry date of drug personally, before proceeding with the nerve block. Mixing of LA is often misinterpreted to provide significant advantages such as prolongation of the block duration and decreased toxicity; instead, they provide effects which only mimic an intermediate acting agent with higher chances of toxicity. Isolated case reports professing very low volumes of LA must be taken in the right context and should not be made the universal rule. Perineural opioid and non-opioid adjuvants prolong the duration of the block, but none have prolonged duration >24 h. Alkalinization does not improve the block success rate. The adjuvants allow only dose reductions of LA, rather than preventing block failure. The environment where anaesthesiologists who are in a hurry or work under undue pressure, often face higher failure rates . Organizational changes like instituting a “block room” for RA will improve success. Indirectly it will lead to standardization of block procedures in that institution as well. In addition, an area separate from the operation table allows adequate time to test and top up ineffective blocks. Block rooms are a novel way of pooling of expertise, thus allowing excellent teaching opportunities for trainees. Poor ergonomics lead to increased fatigue and poor performance, especially among anesthesia residents and novice operators using US-guided blocks [6]. Our teammates (specifically surgeon’s) personality and their technical skills play a role in the selection of the type of anesthesia, nerve block technique, choice of drug, and need of adjuvants. An uncooperative surgeon is a strong predictor of failure of the nerve blocks. One should always discuss with the surgeon about the surgical plan, site of incision, area to be operated, and position of the patient during surgery. A clinical pearl is not to allow surgeons and OT staff to interrupt while one is giving the block as it will invariably increase the anxiety level. Once a patient is in the OT, the momentum shifts in favor of performing the surgery and only a few surgeons (including mine) have the patience to wait for the block to work. Allowing adequate “soak time” (time for a block to take effect) is mandatory for a block to be successful. 30 min are considered the minimum waiting time before calling any block a failure. Once an incomplete block has been diagnosed preoperatively, the management options are re-block, additional injections or rescue blocks, a different nerve block, spinal, or combined spinal-epidural anesthesia in lower limb surgeries, systemic analgesia with opioids or adjuvants, local infiltration anesthesia, and GA success and failure go side by side in regional anesthesia. No anesthesiologist can claim a 100% success record while giving nerve blocks. Hence, it is always better to focus on how to prevent causes of block failure rather than focusing on managing a failed block. Abdallah and Brull did a comprehensive literature hunt to find out the meaning of block “success” which were used by various authors in their studies and found that it was highly variable and there was lack of consensus regarding its meaning [1]. The most common definition of block success was an achievement of a surgical block within a designated period. There are essentially four stakeholders for defining success criteria: Namely the patient, the anesthesiologist, the surgeon, and the hospital administrator. The various parameters of success for a patient which included post-operative pain and patient satisfaction were evaluated in four trials only. The anesthesiologist-related indicators such as block onset time and complications were reported most frequently. The surgeon and hospital administrator-related indicators were not collected in any trial. For all practical purposes, especially from our perspective, a block failure may be accepted when complying with any one of the following after giving an adequate time of approximately 30 min: Conversion to general anesthesia (GA) after surgical incision. Use of intravenous (IV) opioid analgesics ≥100 μg fentanyl or equivalent after incision. Rescue peripheral nerve block given (a second block after completion of an initial block). Infiltration of local anesthetic agent (LA) into the surgical site. The above four criteria are routinely recorded in medical records and have also been accepted in previous research papers. We may have (a) a total failure which is defined as block where bolus of LA completely misses its target and surgery cannot proceed, (b) an incomplete block where patient has numbness in the area of nerve distribution but not adequate for incision, (c) a patchy block in which some areas in distribution of plexus usually have escaped, (d) a wear off block or secondary failure seen when surgery outlasts the duration of block, and (e) a misdirected block is when part or whole of the drug is injected into the neighboring structures, for example, into a different fascial or muscular plane or a vessel. Morgan had stated that “Regional anesthesia always works – provided you put the right dose of the right drug in the right place.” Failure occurs due to blocking the wrong nerve or not blocking all the nerves for planned surgery. Three primary keys to successful regional anesthesia are, therefore, nerve location, nerve location, and nerve location! – N.M. Denny. Every anesthesiologist must “pause” just before placing the needle at the site of nerve block. While doing so, he re-confirms the patient’s identity, the intended procedure and the correct side of the intended nerve block. There are numerous factors which play a crucial role in the success or failure of a peripheral nerve block. The operator’s technical skills and experience play a substantial role. An unskilled anesthesiologist is perhaps the biggest cause of failure. It has been found that exposure to multiple techniques at the same time is confusing for the beginner. A pearl of wisdom is that one should avoid “over-selling” regional anesthesia (RA) techniques in the initial days of their independent practice. Dr. Gaston Labat in 1924 had wisely sermoned that “A thorough knowledge of the descriptive and topographic anatomy with regard to nerve distribution is a condition which anyone desirous of attempting to study regional anesthesia should fulfill.” If ultrasound (US) is being used, then knowledge of sono-anatomy is equally essential. Gross anatomic distortion will, however, remain a challenge to the success of nerve blocks. It is essential to give appropriate blocks for appropriate surgery. According to Hilton’s Law, the nerve trunk innervating a joint also supplies the overlying skin and the muscles that move that joint, and one must block all the nerves for a successful block. On the contrary, one must also understand the limitations of a particular nerve plexus block and the most common nerves that may be spared in a plexus block. It is better to choose one technique, become familiar, confident and comfortable with it and stay with the technique for a reasonable time, rather than trying unfamiliar nerve block techniques at the first go. Sub-optimal placement of LA in landmark-based technique leads to the highly variable Agree n (%) Disagree n (%) Patients’ anxiety is common during regional anesthesia 36 (33) 74 (67) Anxiety is mostly pre-operative 69 (62) 41 (38) Patients’ anxiety concerns me a lot 25 (23) 85 (77) I underestimate patients’ anxiety 49 (44) 61 (55) I am always prepared to manage patients’ anxiety 66 (60) 44 (40) Patients’ anxiety may affect my anxiety 59 (53) 51 (46) Patients’ anxiety affects my confidence in performing regional anesthesia 39 (35) 71 (65) Patients’ anxiety may affect block success 63 (57) 47 (43) Differing advice from surgeon and anesthesiologist increases patient anxiety 100 (90) 10 (9) n: Number of respondents who agree/disagree with the statements; %: Percentages Table 1: Anesthesiologists perception of patients’ anxiety, its frequency and effects during regional anesthesia. (Adapted from Jlala et al., Anaesthesiologists’ perception of patients’ anxiety under regional anesthesia. Local and Regional Anesthesia 2010 success rate of these blocks. Using proper equipment is always advisable, and both peripheral nerve stimulator (PNS) and US have been validated to increase success rates in multiple studies. Block success rates are similar between US and PNS when the block was performed by experts [2]. Whatever the equipment, knowing and familiarizing with it is a bare minimum requirement. While using a nerve stimulator, the current intensity is essentially the most important factor. An evoked motor response at a current of ≤0.5 mA (0.3–0.5 mA) ensures a successful nerve block. Knowledge of an appropriate motor response of the innervating nerve is crucial for the success of the nerve block, and any non-ideal motor responses will increase the failure rates. In recent times, everybody is laying emphasis in US-guided blocks and the target nerve is no longer invisible. Does US-guided blocks lead to a 100% success? Sites et al. identified 398 of 520 peripheral nerve block errors committed by the US novices during their performance [3]. The crux is that the US may not eliminate failures completely. The major limitation of US technology is the dependence on the operator. One needs adequate training and has a definite curve in honing the skills. The most common errors during US-guided blocks are too much of hand motions while holding the needle or probe, poor choice of needle insertion site and angle, difficulty in aligning needle with the US-beam thus preventing needle visualization, failure to recognize needle tip before injection, anatomic artifacts (tissue resembling target nerve), and failure to recognize maldistribution of LA [4]. Combination of US and PNS (Dual guidance), for nerve identification and blockade, has also been proposed. Using both facilitates learning, improve trainee performance and provide an increased level of confidence and comfort. For superficial blocks, US alone is usually sufficient and PNS may be used to monitor for an overlooked intraneural placement. For deep or anatomically challenging US-guided blocks with inadequate images, PNS can be used to identify the nerve structures of interest. Multi-stimulation, a technique where each component of the nerve plexus is stimulated separately has been proved to increase the success rate and reduce the dose of LA. It, however, requires multiple passes or multiple skin punctures with the block needle. The best results are seen for the infra-clavicular block, mid-humeral block, axillary block, popliteal or sciatic block, and most US-guided nerve blocks. No additional risk of nerve injury during redirection of the needle through partially anesthetized nerves has been reported. Excessively anxious or an uncooperative patient, patients with any mental illness are not the ideal candidates for RA. The patient’s anxiety may affect the anesthesiologist adversely making him anxious, denting his confidence, and consequently ruining his chances of a successful nerve block (Table 1) [5]. Underlying comorbidities in the patient such as obesity, arthritis, and diabetes may affect positioning, access, nerve localization, and identification. A history of a good previous experience of anesthesia or surgery is predictive of a more relaxed patient and a successful block. The management in such patients comprises good pre-operative counseling with a gentle, unhurried patient handling. Subsequent management may include use of a light anxiolytic premedication, followed with lifting drapes off patient’s eyes, shielding of the ears from noise, and applying headphones with soft music in the operation theaters (OT) (Fig. 1). Patients may still claim that their block has failed due to the conscious awareness of OT settings and “sensations” transmitted through unblocked nerve fibers. IV analgesia or sedation with appropriate monitoring for relieving anxiety and pain is essential and considered “standard care” and should not be considered as a failure. Drugs are an important factor for the success of nerve blocks. Usage of a sufficient volume and appropriate concentration of LA solution is the key to a successful nerve block. Too much of volume or concentration of LA may lead to an enhanced risk of side effects rather than increasing efficacy. Likewise, too less of volume or concentration of LA increase chances of failure. The anesthesiologist should always check for wrong dispensing and expiry date of drug personally, before proceeding with the nerve block. Mixing of LA is often misinterpreted to provide significant advantages such as prolongation of the block duration and decreased toxicity; instead, they provide effects which only mimic an intermediate-acting agent with higher chances of toxicity. Isolated case reports professing very low volumes of LA must be taken in the right context and should not be made the universal rule. Perineural opioid and non-opioid adjuvants prolong the duration of the block, but none have prolonged duration >24 h. Alkalinization does not improve the block success rate. The adjuvants allow only dose reductions of LA, rather than preventing block failure. The environment where anaesthesiologists who are in a hurry or work under undue pressure, often face higher failure rates . Organizational changes like instituting a “block room” for RA will improve success. Indirectly it will lead to standardization of block procedures in that institution as well. In addition, an area separate from the operation table allows adequate time to test and top up ineffective blocks. Block rooms are a novel way of pooling of expertise, thus allowing excellent teaching opportunities for trainees. Poor ergonomics lead to increased fatigue and poor performance, especially among anesthesia residents and novice operators using US-guided blocks [6]. Our teammates (specifically surgeon’s) personality and their technical skills play a role in the selection of the type of anesthesia, nerve block technique, choice of drug, and need of adjuvants. An uncooperative surgeon is a strong predictor of failure of the nerve blocks. One should always discuss with the surgeon about the surgical plan, site of incision, area to be operated, and position of the patient during surgery. A clinical pearl is not to allow surgeons and OT staff to interrupt while one is giving the block as it will invariably increase the anxiety level. Once a patient is in the OT, the momentum shifts in favor of performing the surgery and only a few surgeons (including mine) have the patience to wait for the block to work. Allowing adequate “soak time” (time for a block to take effect) is mandatory for a block to be successful. 30 min are considered the minimum waiting time before calling any block a failure. Once an incomplete block has been diagnosed preoperatively, the management options are re-block, additional injections or rescue blocks, a different nerve block, spinal, or combined spinal-epidural anesthesia in lower limb surgeries, systemic analgesia with opioids or adjuvants, local infiltration anesthesia, and GA. “It is not a failure to fail, it is a failure not to have a plan in case you fail” (unknown). The decision to re-block depends on the dose already administered and time allowed to initiate surgery. A lower volume of LA required in US-guided blocks allows for a repeat block to be performed within the maximum permissible dose of LA. Once the surgical procedure has already begun, we are left with very limited options for the management of a failed block. We may still be able to successfully conduct the surgery with analgesic supplementation in the form of opioids and anesthesthetic drug supplementation such as ketamine or propofol in incremental doses in situations where we face partial effect or are expecting the block to take its effect with time. Local infiltration anesthesia (LIA) must be considered as one of the options [7]. The volume of LA is dependent on the extent of the incision, and one should not exceed the upper dose limit. It may be noted that incisional infiltration comprises not only a subcutaneous injection but also intramuscular, interfascial and as deep tissue injections. LIA is also an integral component of multimodal analgesia. If all feasible efforts have been unsuccessful and the patient continues to have persistent pain, then GA is the last resort. Surgical manipulation should then be stopped momentarily, and GA with rapid sequence induction and intubation is to be followed without further delays. Alternatively, GA may be continued with a face mask or a laryngeal mask airway and spontaneous ventilation. When patients having no or little pain during blocks starts having pain when the block has worn off is defined as Rebound pain [8]. Various interventions may be tried for preventing rebound failure [9]. During pre-anesthetic check-up patients must be educated regarding what to expect when block wears off. This remains the most useful strategy. Continuous peripheral nerve block (CPNB) using perineural catheters (PNCs) is most efficacious. Other options are wound catheter infusion, oral or IV multimodal analgesics and IV or perineural adjuvants. A secondary failure is seen in CPNB, where a repeat dose of LA fails to provide effective analgesia after the initial primary block has resolved. If faced with PNCs failures, it may be addressed by usage of US guidance which improves the success of catheter insertion compared to NS. Sub-circumneural space is considered the ideal space for catheter placement. Tunneling improves catheter security and prevents inadvertent misplacements. Tissue glue may be applied to puncture sites to stop leakage of LA. Intermittent bolus doses are better than continuous basal infusion. Stimulating catheters available in the market have been reported to decrease secondary failure rates. Multimodal analgesia should be provided in all cases, more so in case of a nonfunctioning catheter. There is an ongoing debate on whether blocks should be done after GA. Melissa et al. have rightly questioned – “Nerve Blocks Under GA: Time to liberalize Indications?” [10] Marhofer has tried to demystify the myths related to regional blocks carried out during GA or deep sedation [11]. So how ready are we to change the rules? Taking a lead from our past successful experiences in pediatric patients and truncal or chest blocks, it is advantageous to use a combination of GA with low-volume, lowconcentration single-shot or CPNB [12]. Thus, there will be no risk of failure, no delays and all stakeholders (surgeon, anesthesiologist, patient, and hospital administrator) will be satisfied. As healthcare systems continue to move toward patient-centered parameters, the patient criteria for success of a nerve block will become foremost. Broader questions will emerge beyond mere pain relief. In the attainment of success, there will always remain barriers for nerve blocks (Fig. 2). All effort should be made to encourage every anesthesiologist to practice RA and not utilizing it is probably the biggest failure.
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Hayashi, Haruo. "Long-term Recovery from Recent Disasters in Japan and the United States." Journal of Disaster Research 2, no. 6 (December 1, 2007): 413–18. http://dx.doi.org/10.20965/jdr.2007.p0413.

Full text
Abstract:
In this issue of Journal of Disaster Research, we introduce nine papers on societal responses to recent catastrophic disasters with special focus on long-term recovery processes in Japan and the United States. As disaster impacts increase, we also find that recovery times take longer and the processes for recovery become more complicated. On January 17th of 1995, a magnitude 7.2 earthquake hit the Hanshin and Awaji regions of Japan, resulting in the largest disaster in Japan in 50 years. In this disaster which we call the Kobe earthquake hereafter, over 6,000 people were killed and the damage and losses totaled more than 100 billion US dollars. The long-term recovery from the Kobe earthquake disaster took more than ten years to complete. One of the most important responsibilities of disaster researchers has been to scientifically monitor and record the long-term recovery process following this unprecedented disaster and discern the lessons that can be applied to future disasters. The first seven papers in this issue present some of the key lessons our research team learned from the studying the long-term recovery following the Kobe earthquake disaster. We have two additional papers that deal with two recent disasters in the United States – the terrorist attacks on World Trade Center in New York on September 11 of 2001 and the devastation of New Orleans by the 2005 Hurricane Katrina and subsequent levee failures. These disasters have raised a number of new research questions about long-term recovery that US researchers are studying because of the unprecedented size and nature of these disasters’ impacts. Mr. Mammen’s paper reviews the long-term recovery processes observed at and around the World Trade Center site over the last six years. Ms. Johnson’s paper provides a detailed account of the protracted reconstruction planning efforts in the city of New Orleans to illustrate a set of sufficient and necessary conditions for successful recovery. All nine papers in this issue share a theoretical framework for long-term recovery processes which we developed based first upon the lessons learned from the Kobe earthquake and later expanded through observations made following other recent disasters in the world. The following sections provide a brief description of each paper as an introduction to this special issue. 1. The Need for Multiple Recovery Goals After the 1995 Kobe earthquake, the long-term recovery process began with the formulation of disaster recovery plans by the City of Kobe – the most severely impacted municipality – and an overarching plan by Hyogo Prefecture which coordinated 20 impacted municipalities; this planning effort took six months. Before the Kobe earthquake, as indicated in Mr. Maki’s paper in this issue, Japanese theories about, and approaches to, recovery focused mainly on physical recovery, particularly: the redevelopment plans for destroyed areas; the location and standards for housing and building reconstruction; and, the repair and rehabilitation of utility systems. But the lingering problems of some of the recent catastrophes in Japan and elsewhere indicate that there are multiple dimensions of recovery that must be considered. We propose that two other key dimensions are economic recovery and life recovery. The goal of economic recovery is the revitalization of the local disaster impacted economy, including both major industries and small businesses. The goal of life recovery is the restoration of the livelihoods of disaster victims. The recovery plans formulated following the 1995 Kobe earthquake, including the City of Kobe’s and Hyogo Prefecture’s plans, all stressed these two dimensions in addition to physical recovery. The basic structure of both the City of Kobe’s and Hyogo Prefecture’s recovery plans are summarized in Fig. 1. Each plan has three elements that work simultaneously. The first and most basic element of recovery is the restoration of damaged infrastructure. This helps both physical recovery and economic recovery. Once homes and work places are recovered, Life recovery of the impacted people can be achieved as the final goal of recovery. Figure 2 provides a “recovery report card” of the progress made by 2006 – 11 years into Kobe’s recovery. Infrastructure was restored in two years, which was probably the fastest infrastructure restoration ever, after such a major disaster; it astonished the world. Within five years, more than 140,000 housing units were constructed using a variety of financial means and ownership patterns, and exceeding the number of demolished housing units. Governments at all levels – municipal, prefectural, and national – provided affordable public rental apartments. Private developers, both local and national, also built condominiums and apartments. Disaster victims themselves also invested a lot to reconstruct their homes. Eleven major redevelopment projects were undertaken and all were completed in 10 years. In sum, the physical recovery following the 1995 Kobe earthquake was extensive and has been viewed as a major success. In contrast, economic recovery and life recovery are still underway more than 13 years later. Before the Kobe earthquake, Japan’s policy approaches to recovery assumed that economic recovery and life recovery would be achieved by infusing ample amounts of public funding for physical recovery into the disaster area. Even though the City of Kobe’s and Hyogo Prefecture’s recovery plans set economic recovery and life recovery as key goals, there was not clear policy guidance to accomplish them. Without a clear articulation of the desired end-state, economic recovery programs for both large and small businesses were ill-timed and ill-matched to the needs of these businesses trying to recover amidst a prolonged slump in the overall Japanese economy that began in 1997. “Life recovery” programs implemented as part of Kobe’s recovery were essentially social welfare programs for low-income and/or senior citizens. 2. Requirements for Successful Physical Recovery Why was the physical recovery following the 1995 Kobe earthquake so successful in terms of infrastructure restoration, the replacement of damaged housing units, and completion of urban redevelopment projects? There are at least three key success factors that can be applied to other disaster recovery efforts: 1) citizen participation in recovery planning efforts, 2) strong local leadership, and 3) the establishment of numerical targets for recovery. Citizen participation As pointed out in the three papers on recovery planning processes by Mr. Maki, Mr. Mammen, and Ms. Johnson, citizen participation is one of the indispensable factors for successful recovery plans. Thousands of citizens participated in planning workshops organized by America Speaks as part of both the World Trade Center and City of New Orleans recovery planning efforts. Although no such workshops were held as part of the City of Kobe’s recovery planning process, citizen participation had been part of the City of Kobe’s general plan update that had occurred shortly before the earthquake. The City of Kobe’s recovery plan is, in large part, an adaptation of the 1995-2005 general plan. On January 13 of 1995, the City of Kobe formally approved its new, 1995-2005 general plan which had been developed over the course of three years with full of citizen participation. City officials, responsible for drafting the City of Kobe’s recovery plan, have later admitted that they were able to prepare the city’s recovery plan in six months because they had the preceding three years of planning for the new general plan with citizen participation. Based on this lesson, Odiya City compiled its recovery plan based on the recommendations obtained from a series of five stakeholder workshops after the 2004 Niigata Chuetsu earthquake. <strong>Fig. 1. </strong> Basic structure of recovery plans from the 1995 Kobe earthquake. <strong>Fig. 2. </strong> “Disaster recovery report card” of the progress made by 2006. Strong leadership In the aftermath of the Kobe earthquake, local leadership had a defining role in the recovery process. Kobe’s former Mayor, Mr. Yukitoshi Sasayama, was hired to work in Kobe City government as an urban planner, rebuilding Kobe following World War II. He knew the city intimately. When he saw damage in one area on his way to the City Hall right after the earthquake, he knew what levels of damage to expect in other parts of the city. It was he who called for the two-month moratorium on rebuilding in Kobe city on the day of the earthquake. The moratorium provided time for the city to formulate a vision and policies to guide the various levels of government, private investors, and residents in rebuilding. It was a quite unpopular policy when Mayor Sasayama announced it. Citizens expected the city to be focusing on shelters and mass care, not a ban on reconstruction. Based on his experience in rebuilding Kobe following WWII, he was determined not to allow haphazard reconstruction in the city. It took several years before Kobe citizens appreciated the moratorium. Numerical targets Former Governor Mr. Toshitami Kaihara provided some key numerical targets for recovery which were announced in the prefecture and municipal recovery plans. They were: 1) Hyogo Prefecture would rebuild all the damaged housing units in three years, 2) all the temporary housing would be removed within five years, and 3) physical recovery would be completed in ten years. All of these numerical targets were achieved. Having numerical targets was critical to directing and motivating all the stakeholders including the national government’s investment, and it proved to be the foundation for Japan’s fundamental approach to recovery following the 1995 earthquake. 3. Economic Recovery as the Prime Goal of Disaster Recovery In Japan, it is the responsibility of the national government to supply the financial support to restore damaged infrastructure and public facilities in the impacted area as soon as possible. The long-term recovery following the Kobe earthquake is the first time, in Japan’s modern history, that a major rebuilding effort occurred during a time when there was not also strong national economic growth. In contrast, between 1945 and 1990, Japan enjoyed a high level of national economic growth which helped facilitate the recoveries following WWII and other large fires. In the first year after the Kobe earthquake, Japan’s national government invested more than US$ 80 billion in recovery. These funds went mainly towards the repair and reconstruction of infrastructure and public facilities. Now, looking back, we can also see that these investments also nearly crushed the local economy. Too much money flowed into the local economy over too short a period of time and it also did not have the “trickle-down” effect that might have been intended. To accomplish numerical targets for physical recovery, the national government awarded contracts to large companies from Osaka and Tokyo. But, these large out-of-town contractors also tended to have their own labor and supply chains already intact, and did not use local resources and labor, as might have been expected. Essentially, ten years of housing supply was completed in less than three years, which led to a significant local economic slump. Large amounts of public investment for recovery are not necessarily a panacea for local businesses, and local economic recovery, as shown in the following two examples from the Kobe earthquake. A significant national investment was made to rebuild the Port of Kobe to a higher seismic standard, but both its foreign export and import trade never recovered to pre-disaster levels. While the Kobe Port was out of business, both the Yokohama Port and the Osaka Port increased their business, even though many economists initially predicted that the Kaohsiung Port in Chinese Taipei or the Pusan Port in Korea would capture this business. Business stayed at all of these ports even after the reopening of the Kobe Port. Similarly, the Hanshin Railway was severely damaged and it took half a year to resume its operation, but it never regained its pre-disaster readership. In this case, two other local railway services, the JR and Hankyu lines, maintained their increased readership even after the Hanshin railway resumed operation. As illustrated by these examples, pre-disaster customers who relied on previous economic output could not necessarily afford to wait for local industries to recover and may have had to take their business elsewhere. Our research suggests that the significant recovery investment made by Japan’s national government may have been a disincentive for new economic development in the impacted area. Government may have been the only significant financial risk-taker in the impacted area during the national economic slow-down. But, its focus was on restoring what had been lost rather than promoting new or emerging economic development. Thus, there may have been a missed opportunity to provide incentives or put pressure on major businesses and industries to develop new businesses and attract new customers in return for the public investment. The significant recovery investment by Japan’s national government may have also created an over-reliance of individuals on public spending and government support. As indicated in Ms. Karatani’s paper, individual savings of Kobe’s residents has continued to rise since the earthquake and the number of individuals on social welfare has also decreased below pre-disaster levels. Based on our research on economic recovery from the Kobe earthquake, at least two lessons emerge: 1) Successful economic recovery requires coordination among all three recovery goals – Economic, Physical and Life Recovery, and 2) “Recovery indices” are needed to better chart recovery progress in real-time and help ensure that the recovery investments are being used effectively. Economic recovery as the prime goal of recovery Physical recovery, especially the restoration of infrastructure and public facilities, may be the most direct and socially accepted provision of outside financial assistance into an impacted area. However, lessons learned from the Kobe earthquake suggest that the sheer amount of such assistance may not be effective as it should be. Thus, as shown in Fig. 3, economic recovery should be the top priority goal for recovery among the three goals and serve as a guiding force for physical recovery and life recovery. Physical recovery can be a powerful facilitator of post-disaster economic development by upgrading social infrastructure and public facilities in compliance with economic recovery plans. In this way, it is possible to turn a disaster into an opportunity for future sustainable development. Life recovery may also be achieved with a healthy economic recovery that increases tax revenue in the impacted area. In order to achieve this coordination among all three recovery goals, municipalities in the impacted areas should have access to flexible forms of post-disaster financing. The community development block grant program that has been used after several large disasters in the United States, provide impacted municipalities with a more flexible form of funding and the ability to better determine what to do and when. The participation of key stakeholders is also an indispensable element of success that enables block grant programs to transform local needs into concrete businesses. In sum, an effective economic recovery combines good coordination of national support to restore infrastructure and public facilities and local initiatives that promote community recovery. Developing Recovery Indices Long-term recovery takes time. As Mr. Tatsuki’s paper explains, periodical social survey data indicates that it took ten years before the initial impacts of the Kobe earthquake were no longer affecting the well-being of disaster victims and the recovery was completed. In order to manage this long-term recovery process effectively, it is important to have some indices to visualize the recovery processes. In this issue, three papers by Mr. Takashima, Ms. Karatani, and Mr. Kimura define three different kinds of recovery indices that can be used to continually monitor the progress of the recovery. Mr. Takashima focuses on electric power consumption in the impacted area as an index for impact and recovery. Chronological change in electric power consumption can be obtained from the monthly reports of power company branches. Daily estimates can also be made by tracking changes in city lights using a satellite called DMSP. Changes in city lights can be a very useful recovery measure especially at the early stages since it can be updated daily for anywhere in the world. Ms. Karatani focuses on the chronological patterns of monthly macro-statistics that prefecture and city governments collect as part of their routine monitoring of services and operations. For researchers, it is extremely costly and virtually impossible to launch post-disaster projects that collect recovery data continuously for ten years. It is more practical for researchers to utilize data that is already being collected by local governments or other agencies and use this data to create disaster impact and recovery indices. Ms. Karatani found three basic patterns of disaster impact and recovery in the local government data that she studied: 1) Some activities increased soon after the disaster event and then slumped, such as housing construction; 2) Some activities reduced sharply for a period of time after the disaster and then rebounded to previous levels, such as grocery consumption; and 3) Some activities reduced sharply for a while and never returned to previous levels, such as the Kobe Port and Hanshin Railway. Mr. Kimura focuses on the psychology of disaster victims. He developed a “recovery and reconstruction calendar” that clarifies the process that disaster victims undergo in rebuilding their shattered lives. His work is based on the results of random surveys. Despite differences in disaster size and locality, survey data from the 1995 Kobe earthquake and the 2004 Niigata-ken Chuetsu earthquake indicate that the recovery and reconstruction calendar is highly reliable and stable in clarifying the recovery and reconstruction process. <strong>Fig. 3.</strong> Integrated plan of disaster recovery. 4. Life Recovery as the Ultimate Goal of Disaster Recovery Life recovery starts with the identification of the disaster victims. In Japan, local governments in the impacted area issue a “damage certificate” to disaster victims by household, recording the extent of each victim’s housing damage. After the Kobe earthquake, a total of 500,000 certificates were issued. These certificates, in turn, were used by both public and private organizations to determine victim’s eligibility for individual assistance programs. However, about 30% of those victims who received certificates after the Kobe earthquake were dissatisfied with the results of assessment. This caused long and severe disputes for more than three years. Based on the lessons learned from the Kobe earthquake, Mr. Horie’s paper presents (1) a standardized procedure for building damage assessment and (2) an inspector training system. This system has been adopted as the official building damage assessment system for issuing damage certificates to victims of the 2004 Niigata-ken Chuetsu earthquake, the 2007 Noto-Peninsula earthquake, and the 2007 Niigata-ken Chuetsu Oki earthquake. Personal and family recovery, which we term life recovery, was one of the explicit goals of the recovery plan from the Kobe earthquake, but it was unclear in both recovery theory and practice as to how this would be measured and accomplished. Now, after studying the recovery in Kobe and other regions, Ms. Tamura’s paper proposes that there are seven elements that define the meaning of life recovery for disaster victims. She recently tested this model in a workshop with Kobe disaster victims. The seven elements and victims’ rankings are shown in Fig. 4. Regaining housing and restoring social networks were, by far, the top recovery indicators for victims. Restoration of neighborhood character ranked third. Demographic shifts and redevelopment plans implemented following the Kobe earthquake forced significant neighborhood changes upon many victims. Next in line were: having a sense of being better prepared and reducing their vulnerability to future disasters; regaining their physical and mental health; and restoration of their income, job, and the economy. The provision of government assistance also provided victims with a sense of life recovery. Mr. Tatsuki’s paper summarizes the results of four random-sample surveys of residents within the most severely impacted areas of Hyogo Prefecture. These surveys were conducted biannually since 1999,. Based on the results of survey data from 1999, 2001, 2003, and 2005, it is our conclusion that life recovery took ten years for victims in the area impacted significantly by the Kobe earthquake. Fig. 5 shows that by comparing the two structural equation models of disaster recovery (from 2003 and 2005), damage caused by the Kobe earthquake was no longer a determinant of life recovery in the 2005 model. It was still one of the major determinants in the 2003 model as it was in 1999 and 2001. This is the first time in the history of disaster research that the entire recovery process has been scientifically described. It can be utilized as a resource and provide benchmarks for monitoring the recovery from future disasters. <strong>Fig. 4.</strong> Ethnographical meaning of “life recovery” obtained from the 5th year review of the Kobe earthquake by the City of Kobe. <strong>Fig. 5.</strong> Life recovery models of 2003 and 2005. 6. The Need for an Integrated Recovery Plan The recovery lessons from Kobe and other regions suggest that we need more integrated recovery plans that use physical recovery as a tool for economic recovery, which in turn helps disaster victims. Furthermore, we believe that economic recovery should be the top priority for recovery, and physical recovery should be regarded as a tool for stimulating economic recovery and upgrading social infrastructure (as shown in Fig. 6). With this approach, disaster recovery can help build the foundation for a long-lasting and sustainable community. Figure 6 proposes a more detailed model for a more holistic recovery process. The ultimate goal of any recovery process should be achieving life recovery for all disaster victims. We believe that to get there, both direct and indirect approaches must be taken. Direct approaches include: the provision of funds and goods for victims, for physical and mental health care, and for housing reconstruction. Indirect approaches for life recovery are those which facilitate economic recovery, which also has both direct and indirect approaches. Direct approaches to economic recovery include: subsidies, loans, and tax exemptions. Indirect approaches to economic recovery include, most significantly, the direct projects to restore infrastructure and public buildings. More subtle approaches include: setting new regulations or deregulations, providing technical support, and creating new businesses. A holistic recovery process needs to strategically combine all of these approaches, and there must be collaborative implementation by all the key stakeholders, including local governments, non-profit and non-governmental organizations (NPOs and NGOs), community-based organizations (CBOs), and the private sector. Therefore, community and stakeholder participation in the planning process is essential to achieve buy-in for the vision and desired outcomes of the recovery plan. Securing the required financial resources is also critical to successful implementation. In thinking of stakeholders, it is important to differentiate between supporting entities and operating agencies. Supporting entities are those organizations that supply the necessary funding for recovery. Both Japan’s national government and the federal government in the U.S. are the prime supporting entities in the recovery from the 1995 Kobe earthquake and the 2001 World Trade Center recovery. In Taiwan, the Buddhist organization and the national government of Taiwan were major supporting entities in the recovery from the 1999 Chi-Chi earthquake. Operating agencies are those organizations that implement various recovery measures. In Japan, local governments in the impacted area are operating agencies, while the national government is a supporting entity. In the United States, community development block grants provide an opportunity for many operating agencies to implement various recovery measures. As Mr. Mammen’ paper describes, many NPOs, NGOs, and/or CBOs in addition to local governments have had major roles in implementing various kinds programs funded by block grants as part of the World Trade Center recovery. No one, single organization can provide effective help for all kinds of disaster victims individually or collectively. The needs of disaster victims may be conflicting with each other because of their diversity. Their divergent needs can be successfully met by the diversity of operating agencies that have responsibility for implementing recovery measures. In a similar context, block grants made to individual households, such as microfinance, has been a vital recovery mechanism for victims in Thailand who suffered from the 2004 Sumatra earthquake and tsunami disaster. Both disaster victims and government officers at all levels strongly supported the microfinance so that disaster victims themselves would become operating agencies for recovery. Empowering individuals in sustainable life recovery is indeed the ultimate goal of recovery. <strong>Fig. 6.</strong> A holistic recovery policy model.
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Fayez, R., A. AlMuntashery, G. Bodie, A. Almamar, R. S. Gill, I. Raîche, C. L. Mueller, et al. "Canadian Surgery Forum1 Is laparoscopic sleeve gastrectomy a reasonable stand-alone procedure for super morbidly obese patients?2 Postoperative monitoring requirements of patients with obstructive sleep apnea undergoing bariatric surgery3 Role of relaparoscopy in the diagnosis and treatment of bariatric complications in the early postoperative period4 Changes of active and total ghrelin, GLP-1 and PYY following restrictive bariatric surgery and their impact on satiety: comparison of sleeve gastrectomy and adjustable gastric banding5 Prioritization and willingness to pay for bariatric surgery: the patient perspective6 Ventral hernia at the time of laparoscopic gastric bypass surgery: Should it be repaired?7 Linear stapled gastrojejunostomy with transverse handsewn enterotomy closure significantly reduces strictures for laparoscopic Roux-en-Y bypass8 Laparoscopic biliopancreatic diversion with duodenal switch as second stage for super super morbidly obese patients. Do all patients benefit?9 Sleeve gastrectomy in the super super morbidly obese (BMI > 60 kg/m2): a Canadian experience10 Laparoscopic gastric bypass for the treatment of refractory idiopathic gastroparesis: a report of 2 cases11 Duodeno-ileal switch as a primary bariatric and metabolic surgical option for the severely obese patient with comorbidities: review of a single-institution case series of duodeno-ileal intestinal bypass12 Management of large paraesophageal hernias in morbidly obese patients with laparoscopic sleeve gastrectomy: a case series13 Early results of the Ontario bariatric surgical program: using the bariatric registry14 Improving access to bariatric surgical care: Is universal health care the answer?15 Early and liberal postoperative exploration can reduce morbidity and mortality in patients undergoing bariatric surgery16 Withdrawn17 Identification and assessment of technical errors in laparoscopic Roux-en-Y gastric bypass18 A valid and reliable tool for assessment of surgical skill in laparoscopic Roux-en-Y gastric bypass19 Psychiatric predictors of presurgery drop-out following suitability assessment for bariatric surgery20 Predictors of outcomes following Roux-en-Y gastric bypass surgery at The Ottawa Hospital21 Prophylactic management of cholelithiasis in bariatric patients: Is routine cholecystectomy warranted?22 Early outcomes of Roux-en-Y gastric bypass in a publicly funded obesity program23 Similar incidence of gastrojejunal anastomotic stricture formation with hand-sewn and 21 mm circular stapler techniques during Roux-en-Y gastric bypass24 (CAGS Basic Science Award) Exogenous glucagon-like peptide-1 improves clinical, morphological and histological outcomes of intestinal adaptation in a distal-intestinal resection piglet model of short bowel syndrome25 (CAGS Clinical Research Award) Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial26 Negative-pressure wound therapy (iVAC) on closed, high-risk incisions following abdominal wall reconstruction27 The impact of seed granting on research in the University of British Columbia Department of Surgery28 Quality of surgical care is inadequate for elderly patients29 Recurrence of inguinal hernia in general and hernia specialty hospitals in Ontario, Canada30 Oncostatin M receptor deficiency results in increased mortality in an intestinal ischemia reperfusion model in mice31 Laparoscopic repair of large paraesophageal hernias with anterior gastropexy: a multicentre trial32 Response to preoperative medical therapy predicts success of laparoscopic splenectomy for immune thrombocytopenic purpura33 Perioperative sepsis, but not hemorrhagic shock, promotes the development of cancer metastases in a murine model34 Measuring the impact of implementing an acute care surgery service on the management of acute biliary disease35 Patient flow and efficiency in an acute care surgery service36 The relationship between treatment factors and postoperative complications after radical surgery for rectal cancer37 Risk of ventral hernia after laparoscopic colon surgery38 Urinary metabolomics as a tool for early detection of Barrett’s and esophageal cancer39 Construct validity of individual and summary performance metrics associated with a computer-based laparo-scopic simulator40 Impact of a city-wide health system reorganization on emergency department visits in hospitals in surrounding communities41 Transcatheter aortic valve implantation for the nonoperative management of aortic stenosis: a cost-effectiveness analysis42 Breast cancer: racial differences in age of onset. A potential confounder in Canadian screening recommendations43 Risk taking in surgery: in and out of the comfort zone44 A tumour board in the office: Track those cancer patients!45 Increased patient BMI is not associated with advanced colon cancer stage or grade on presentation: a retrospective chart review46 Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies. Report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict47 Learning the CanMEDS role of professional: a pilot project of supervised discussion groups addressing the hidden curriculum48 Assessing the changing scope of training in Canadian general surgery programs: expected versus actual experience49 Predicting need for surgical management for massive gastrointestinal hemorrhage50 International health care experience: using CanMEDS to evaluate learning outcomes following a surgical mission in Mampong, Ghana51 The open abdomen: risk factors for mortality and rates of closure52 How surgeons think: an exploration of mental practice in surgical preparation53 The surgery wiki: a novel method for delivery of under-graduate surgical education54 Understanding surgical residents’ postoperative practices before implementing an enhanced recovery after surgery (ERAS) guideline at the University of Toronto55 From laparoscopic transabdominal to posterior retroperitoneal adrenalectomy: a paradigm shift in operative approach56 A retrospective audit of outcomes in patients over the age of 80 undergoing acute care abdominal surgery57 Canadian general surgery residents’ perspectives on work-hour regulations58 Timing of surgical intervention and its outcomes in acute appendicitis59 Preparing surgical trainees to deal with adverse events. An outline of learning issues60 Acute care surgical service: surgeon agreement at the time of handover61 Predicting discharge of elderly patients to prehospitalization residence following emergency general surgery62 Morbidity and mortality after emergency abdominal surgery in octo- and nonagenarians63 The impact of acute abdominal illness and urgent admission to hospital on the living situation of elderly patients64 A comparison of laparoscopic versus open subtotal gastrectomy for antral gastric adenocarcinoma: a North American perspective65 Minimally invasive excision of ectopic mediastinal parathyroid adenomas66 Perioperative outcomes of laparoscopic hernia repair in a tertiary care centre: a single institution’s experience67 Evaluation of a student-run, practical and didactic curriculum for preclerkship medical students68 Joseph Lister: Father of Modern Surgery69 Comparisons of melanoma sentinel lymph node biopsy prediction nomograms in a cohort of Canadian patients70 Local experience with myocutaneous flaps after extensive pelvic surgery71 The treatment of noncirrhotic splanchnic vein thrombosis: Is anticoagulation enough?72 Implementation of an acute care surgery service does not affect wait-times for elective cancer surgeries: an institutional experience73 Use of human collagen mesh for closure of a large abdominal wall defect, after colon cancer surgery, a case report74 The role of miR-200b in pulmonary hypoplasia associated with congenital diaphragmatic hernia75 Systematic review and meta-analysis of electrocautery versus scalpel for incising epidermis and dermis76 Accuracy of sentinel lymph node biopsy for early breast cancer in the community setting in St. John’s, New-foundland: results of a retrospective review77 Acute surgical outcomes in the 80 plus population78 The liberal use of platelets transfusions in the acute phase of trauma resuscitation: a systematic review79 Implementation of an acute care surgical on call program in a Canadian community hospital80 Short-term outcomes following paraesophageal hernia repair in the elderly patient81 First experience with single incision surgery: feasibility in the pediatric population and cost evaluation82 The impact of the establishment of an acute care surgery unit on the outcomes of appendectomies and cholecystectomies83 Description and preliminary evaluation of a low-cost simulator for training and evaluation of flexible endoscopic skills84 Tumour lysis syndrome in metastatic colon cancer: a case report85 Acute care surgery service model implementation study at a single institution86 Colonic disasters approached by emergent subtotal and total colectomy: lessons learned from 120 consecutive cases87 Acellular collagen matrix stent to protect bowel anastomoses88 Lessons we learned from preoperative MRI-guided wire localization of breast lesions: the University Health Network (UHN) experience89 Interim cost comparison for the use of platinum micro-coils in the operative localization of small peripheral lung nodules90 Routine barium esophagram has minimal impact on the postoperative management of patients undergoing esophagectomy for esophageal cancer91 Iron deficiency anemia is a common presenting issue with giant paraesophageal hernia and resolves following repair92 A randomized comparison of different ventilation strategies during thoracotomy and lung resection93 The Canadian Lung Volume Reduction Surgery study: an 8-year follow-up94 A comparison of minimally invasive versus open Ivor-Lewis esophagectomy95 A new paradigm in the follow-up after curative resection for lung cancer: minimal-dose CT scan allows for early detection of asymptomatic cancer activity96 Predictors of lymph node metastasis in early esophageal adenocarcinoma: Is endoscopic resection worth the risk?97 How well can thoracic surgery residents operate? Comparing resident and program director opinions98 The impact of extremes of age on short- and long-term outcomes following surgical resection of esophageal malignancy99 Epidermal growth factor receptor targeted gold nanoparticles for the enhanced radiation treatment of non–small cell lung cancer100 Laparoscopic Heller myotomy results in excellent outcomes in all subtypes of achalasia as defined by the Chicago classification101 Neoadjuvant chemoradiation versus surgery in managing esophageal cancer102 Quality of life postesophagectomy for cancer!103 The implementation, evolution and translocation of standardized clinical pathways can improve perioperative outcomes following surgical treatment of esophageal cancer104 A tissue-mimicking phantom for applications in thoracic surgical simulation105 Sublobar resection compared with lobectomy for early stage non–small cell lung cancer: a single institution study106 Not all reviews are equal: the quality of systematic reviews and meta-analyses in thoracic surgery107 Do postoperative complications affect health-related quality of life after video-assisted thoracoscopic lobectomy for patients with lung cancer? A cohort study108 Thoracoscopic plication for palliation of dyspnea secondary to unilateral diaphragmatic paralysis: A worthwhile venture?109 Thoracic surgery experience in Canadian general surgery residency programs110 Perioperative morbidity and pathologic response rates following neoadjuvant chemotherapy and chemoradiation for locally advanced esophageal carcinoma111 An enhanced recovery pathway reduces length of stay after esophagectomy112 Predictors of dysplastic and neoplastic progression of Barrett’s esophagus113 Recurrent esophageal cancer complicated by tracheoesophageal fistula: management by means of palliative airway stenting114 Pancreaticopleural fistula-induced empyema thoracis: principles and results of surgical management115 Prognostic factors of early postoperative mortality following right extended hepatectomy116 Optimizing steatotic livers for transplantation using a cell-penetrating peptide CPP-fused heme oxygenase117 Video outlining the technical steps for a robot-assisted laparoscopic pancreaticoduodenectomy118 Establishment of a collaborative group to conduct innovative clinical trials in Canada119 Hepatic resection for metastatic malignant melanoma: a systematic review and meta-analysis120 Acellular normothermic ex vivo liver perfusion for donor liver preservation121 Pancreatic cancer and predictors of survival: comparing the CA 19–9/bilirubin ratio with the McGill Brisbane Scoring System122 Staged liver resections for bilobar hepatic colorectal metastases: a single centre experience123 Economic model of observation versus immediate resection of hepatic adenomas124 Resection of colorectal liver metastasis in the elderly125 Acceptable long-term survival in patients undergoing liver resection for metastases from noncolorectal, non-neuroendocrine, nonsarcoma malignancies126 Patient and clinicopathological features and prognosis of CK19+ hepatocellular carcinomas: a case–control study127 The management of blunt hepatic trauma in the age of angioembolization: a single centre experience128 Liver resections for noncolorectal and non-neuroendocrine metastases: an evaluation of oncologic outcomes129 Developing an evidence-based clinical pathway for patients undergoing pancreaticoduodenectomy130 Hepatitis C infection and hepatocellular carcinoma in liver transplant: a 20 year experience131 The effect of medication on the risk of post-ERCP pancreatitis132 Temporal trends in the use of diagnostic imaging for patients with hepato-pancreato-biliary (HPB) conditions: How much ionizing radiation are we really using?196 A phase II study of aggressive metastasectomy for intra-and extrahepatic metastases from colorectal cancer133 Why do women choose mastectomy for breast cancer treatment? A conceptual framework for understanding surgical decision-making in early-stage breast cancer134 Synoptic operative reporting: documentation of quality of care data for rectal cancer surgery135 Learning curve analysis for cytoreductive surgery: a useful application of the cumulative sum (CUSUM) method136 Pancreatic cancer is strongly associated with a unique urinary metabolomic signature137 Concurrent neoadjuvant chemo/radiation in locally advanced breast cancer138 Impact of positron emission tomography on clinical staging of newly diagnosed rectal cancer: a specialized single centre retrospective study139 An evaluation of intraoperative Faxitron microradiography versus conventional specimen radiography for the excision of nonpalpable breast lesions140 Comparison of breast cancer treatment wait-times in the Southern Interior of British Columbia in 2006 and 2010141 Factors affecting lymph nodes harvest in colorectal carcinoma142 Laparoscopic adrenalectomy for metastases143 You have a message! Social networking as a motivator for fundamentals of laparoscopic surgery (FLS) training144 The evaluation and validation of a rapid diagnostic and support clinic for women assessment for breast cancer145 Oncoplastic breast surgery: oncologic benefits and limitations146 A qualitative study on rectal cancer patients’ preferences for location of surgical care147 The effect of surgery on local recurrence in young women with breast cancer148 Elevated IL-6 and IL-8 levels in tumour microenvironment is not associated with increased serum levels in humans with Pseudomyxoma peritonei and peritoneal mesothelioma149 Conversion from laparoscopic to open approach during gastrectomy: a population-based analysis150 A scoping review of surgical process improvement tools (SPITs) in cancer surgery151 Splenectomy during gastric cancer surgery: a population-based study152 Defining the polo-like kinase 4 (Plk4) interactome in cancer cell protrusions153 Neoadjuvant imatinib mesylate for locally advanced gastrointestinal stromal tumours154 Implementing results from ACOSOG Z0011: Practice-changing or practice-affirming?155 Should lymph node retrieval be a surgical quality indicator in colon cancer?156 Long-term outcomes following resection of retroperitoneal recurrence of colorectal cancer157 Clinical research in surgical oncology: an analysis of clinicaltrials.gov158 Radiation therapy after breast conserving surgery: When are we missing the mark?159 The accuracy of endorectal ultrasound in staging rectal lesions in patients undergoing transanal endoscopic microsurgery160 Quality improvement in gastrointestinal cancer surgery: expert panel recommendations for priority research areas161 Factors influencing the quality of local management of ductal carcinoma in situ: a cohort study162 Papillary thyroid microcarcinoma: Does size matter?163 Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: systematic review of clinical efficacy and quality assessment of reported trials164 Adherence to antiestrogen therapy in seniors with breast cancer: How well are we doing?165 Parathyroid carcinoma: Challenging the surgical dogma?166 A qualitative assessment of the journey to delayed breast reconstruction195 The role of yoga therapy in breast cancer patients167 Outcomes reported in comparative studies of surgical interventions168 Enhanced recovery pathways decrease length of stay following colorectal surgery, but how quickly do patients actually recover?169 The impact of complications on bed utilization after elective colorectal resection170 Impact of trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study171 Complex fistula-in-ano: Should the plug be abandoned in favour of the LIFT or BioLIFT?172 Prognostic utility of cyclooxygenase-2 expression by colon and rectal cancer173 Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is complex and time-consuming: analysis of learning curves for a novice minimally invasive surgeon174 Intraoperative quality assessment following double stapled circular colorectal anastomosis175 Improving patient outcomes through quality assessment of rectal cancer care176 Are physicians willing to accept a decrease in treatment effectiveness for improved functional outcomes for low rectal cancer?177 Turnbull-Cutait delayed coloanal anastomosis for the treatment of distal rectal cancer: a prospective cohort study178 Preoperative high-dose rate brachytherapy in preparation for sphincter preservation surgery for patients with advanced cancer of the lower rectum179 Impact of an enhanced recovery program on short-term outcomes after scheduled laparoscopic colon resection180 The clinical results of the Turnbull-Cutait delayed coloanal anastomosis: a systematic review181 Is a vertical rectus abdominus flap (VRAM) necessary? An analysis of perineal wound complications182 Fistula plug versus endorectal anal advancement flap for the treatment of high transsphincteric cryptoglandular anal fistulas: a systematic review and meta-analysis183 Maternal and neonatal outcomes following colorectal cancer surgery184 Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option185 Trends in colon cancer in Ontario: 2002–2009186 Validation of electronically derived short-term outcomes in colorectal surgery187 A population-based assessment of transanal and endoscopic resection for adenocarcinoma of the rectum188 Laparoscopic colorectal surgery in the emergency setting: trends in the province of Ontario from 2002 to 2009189 Prevention of perineal hernia after laparoscopic and robotic abdominoperineal resection: review with case series of internal hernia through pelvic mesh which was placed in attempt to prevent perineal hernia190 Effect of rectal cancer treatments on quality of life191 The use of antibacterial sutures as an adjunctive preventative strategy for surgical site infection in Canada: an economic analysis192 Impact of socioeconomic status on colorectal cancer screening and stage at presentation: preliminary results of a population-based study from an urban Canadian centre193 Initial perioperative results of the first transanal endoscopic microsurgery (TEM) program in the province of Quebec194 Use of negative pressure wound therapy decreases perineal wound infections following abdominal perineal resection." Canadian Journal of Surgery 55, no. 4 Suppl 1 (August 2012): S63—S135. http://dx.doi.org/10.1503/cjs.016712.

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Leung, P., E. Lester, A. G. Doumouras, A. G. Doumouras, F. Saleh, S. Bennett, C. Fulton, et al. "2015 Canadian Surgery Forum02 The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks03 The association of change in body mass index and health-related quality of life in severely obese patients04 Inpatient cost of bariatric surgery within a regionalized centre of excellence system05 Regional variations in the public delivery of bariatric surgery: an evaluation of the centre of excellence model06 The effect of distance on short-term outcomes after bariatric surgery07 The role of preoperative upper endoscopy in bariatric surgery: a systematic review08 Outcomes of a dedicated bariatric revision surgery clinic10 Quality of follow-up: a systematic review of the research in bariatric surgery14 Bariatric surgery improves weight loss and cardiovascular disease compared with medical management alone: an Alberta multi-institutional early outcomes study16 Diabetic control after laparoscopic gastric bypass and sleeve gastrectomy: a short-term prospective study17 Knowledge and perception of bariatric surgery among primary care physicians: a survey of family doctors in Ontario19 Is early discharge of patients post laparoscopic sleeve gastrectomy safe?22 A comparison of outcomes between bariatric centres of excellence within Ontario02 Closure methods for laparotomy incisions: a cochrane review03 Closing the audit cycle: Are we consenting correctly now?05 Regional variation in the use of surgery in Ontario06 Quitting general surgery residency: attitudes and factors in Canada07 Nipple-sparing mastectomy: utility of intraoperative frozen section analysis of retroareolar tissue08 Withdrawn09 Reliable assessment of operative performance10 Video assessment as a method of assessing surgical competence: the difference in video-rating skills after 4 years of residency11 Burnout among academic surgeons13 Increased health services use by severely obese patients undergoing emergency surgery: a retrospective cohort study14 Novel models for advanced laparoscopic suturing: taking it to the next level16 Pectoral nerve block in breast and axillary surgery17 Predictors for positive resection margins in gastric adenocarcinoma: a population-based analysis18 Predictors of malignancy in thyroid nodules19 Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature20 Informed consent for surgery21 Meconium ileus: 20 years of experience22 Paraesophageal hernia repair in the elderly: outcomes in a 10-year retrospective study23 The changing face of breast cancer: younger age and aggressive disease in Filipino Canadians24 A systematic review of intraoperative blood loss estimation methods for major noncardiac surgery: a 50-year perspective25 The AVATAR trial: applying vacuum to accomplish reduced wound infections in laparoscopic pediatric surgery27 Indications for use of damage control surgery in civilian trauma patients: a content analysis and expert appropriateness rating study28 Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: a content analysis and expert appropriateness rating study29 The impact of health care contact and invasive procedures on Staphylococcus aureus bacteremia: a 5-year retrospective cohort study30 Acute care surgery — positive impact on gallstone pancreatitis31 Safety and efficacy of a step-up approach to management of severe, refractory Clostridium difficile infection32 Clinical and operative outcome of patients with acute cholecystitis who are treated initially with image-guided cholecystostomy34 Assessment of preoperative carbohydrate loading and blood glucose concentration in patients with diabetes35 Impact of pre-emptive lidocaine infiltration at trocar sites (PLITS) and intraoperative ketorolac administration on postoperative pain and narcotics consumption after endocholecystectomy: a randomized-controlled trial36 Expert intraoperative judgment and decision-making: defining the cognitive competencies for safe laparoscopic cholecystectomy37 Teaching clinical anatomy to postgraduate surgical trainees38 Investigating the role of TNFR1 in gastric adenocarcinoma peritoneal metastasis39 Selective outcome reporting and publication biases in surgical randomized controlled trials40 Definitive percutaneous management of symptomatic cholelithiasis41 Peer-based coaching: an innovative method to teach faculty an advanced laparoscopic technique42 Improving teaching and learning in the operating room: Does the surgical procedure feedback rubric support learning?43 Withdrawn44 Mislabelling study designs as case–control in surgical literature45 Measured resting energy expenditure in patients with open abdomens: preliminary data of a prospective pilot study46 Open abdomen management and primary abdominal closure in a surgical abdominal sepsis cohort: a retrospective review47 The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: a systematic review49 Program directors and trainees attitudes toward the introduction of multi-source feedback as part of surgical residents’ formative assessment process at the University of Calgary: a qualitative study50 Outcomes associated with alternate blunt cerebrovascular injury detection strategies in major trauma patients: a systematic review and meta-analysis51 Assessing the effect of preoperative nutrition on the surgical recovery of elderly patients53 Why is the percentage of medical students selecting a general surgery career different between Canadian medical schools?54 Colorectal cancer patient perspectives of preoperative repeat endoscopy: a qualitative study55 Staphylococcus aureus bacteremia in a pediatric population: a retrospective study in a tertiary-care referral centre56 The impact of postoperative complications on the recovery of elderly surgical patients57 Withdrawn58 The economics of recovery after pancreatic surgery: detailed cost minimization analysis of a postoperative clinical pathway for patients undergoing pancreaticoduodenectomy59 2015 CJS Editor’s Choice Award Recipient: Achalasia-specific quality of life after pneumatic dilation and laparoscopic Heller myotomy with partial fundoplication: a randomized clinical trial60 NSAID use is associated with an increased risk of anastomotic leak after colorectal surgery: results of a frequentist and Bayesian meta-analysis61 Miracles for babies with abnormal lungs: the story of miR-10a and lung development62 Investigating hospital readmissions and unplanned ED visits following general surgical procedures at a tertiary care centre63 Remote FLS testing: ready for prime time64 Contrast blush (CB) significance on computed tomography (CT) and correlation with noninterventional management (NIM) failure for blunt splenic injury (BSI) in children65 Bridging the gap on the surgical ward: enhancing resident–nurse communication through a CUSP pilot project66 A prospective interim analysis of microbiological gene expression profile of Staphyloccocus aureus bacteremia and its clinical implications67 Outcomes of selective nonoperative management of civilian abdominal gunshot wounds: a systematic review and meta-analysis68 Does rater training improve the reliability of surgical skill assessments? A randomized control trial69 Parallel or divergent? The evolution of emergency general surgery service delivery at 3 Canadian teaching hospitals70 Surgeon satisfaction in the era of dedicated emergency general surgery services: a multicentre study74 Withdrawn76 Timing of cholecystectomy after gallstone pancreatitis: Are we meeting the standards?77 Management of traumatic occult hemothorax, a survey of trauma providers in Canada78 Withdrawn01 Extent of lymph node involvement after esophagectomy with extended lymphadenectomy for esophageal adenocarcinoma predicts recurrence: a large North American cohort study02 A randomized comparison of electronic versus handwritten daily notes in thoracic surgery03 Is tissue still the issue? Lobectomy for suspected lung nodules without preoperative or intraoperative confirmation of malignancy04 Incidence of pulmonary embolism and deep vein thrombosis following major lung resection: a prospective multicentre incidence study05 Venous thromboembolism (VTE) prophylaxis in thoracic surgery: a Canadian national delphi consensus survey06 Preoperative chemoradiation therapy v. chemotherapy in patients undergoing modified en bloc esophagectomy for locally advanced esohageal adenocarcinoma: Does radiation add value?07 Comparative outcomes following tracheal resection for benign versus malignant conditions08 Combined clinical staging for resectable lung cancer: clinicopathological correlations and the role of brain MRI10 A retrospective cohort evaluation of non–small cell lung cancer recurrence detection11 Health-related quality of life measure distinguishes between low and high T stages in esophageal cancer12 Transition from multiport to single-port anatomic lung resection is feasible13 Survival rates in patients with N3 esophageal adenocarcinoma treated with neoadjuvant chemotherapy and esophagectomy with en-bloc lymphadenectomy14 Impact of a dedicated outpatient clinic on the management of malignant pleural effusions16 Has the quality of reporting of randomized controlled trials in thoracic surgery improved?17 Clinical features distinguishing malignant from benign esophageal diagnoses in patients referred to an esophageal diagnostic assessment program18 Concordance with invasive mediastinal staging guidelines19 Current lung-protective ventilation strategies may not be protective during one-lung ventilation surgery20 National practice variation in pneumonectomy perioperative care — results from a survey of the Canadian Association of Thoracic Surgeons21 Outcomes after multimodal treatment of esophagogastric neuroendocrine carcinoma: Is there a role for resection?22 Clinical results of treatment for isolated axillary and plantar hyperhidrosis: a single centre experience23 The role of pneumonectomy after neoadjuvant chemotherapy for N2 non–small cell lung cancer24 Time delays in the management of non–small cell lung cancer: a comparison between high-volume designated and low-volume community hospitals25 Regionalization and outcomes of lung cancer surgery in Ontario, Canada26 Robotic pulmonary resection for lung cancer: the first Canadian series01 The effect of early postoperative nonsteroidal anti-inflammatory drugs on pancreatic fistula following pancreaticoduodenectomy02 Laparoscopic ultrasound still has a role in the staging of pancreatic cancer: a systematic review of the literature03 Impact of portal vein embolization on morbidity and mortality of major liver resection in patients with colorectal metastases: experience of a small single tertiary care centre04 A decision model and cost analysis of intraoperative cell salvage during hepatic resection05 The impact of portal pedicle clamping on survival from colorectal liver metastases in the contemporary era of liver resection: a matched cohort study06 Clinical and pathological features of intraductal papillary neoplasms of the biliary tract and gallbladder07 International practice patterns among ALPPS surgeons: Do we need a consensus?08 Omental flaps to protect pancreaticojejunostomy in pancreatoduodenectomy11 Preoperative diagnostic angiogram and endovascular aortic stent placement for appleby resection candidates: a novel surgical technique in the management of locally advanced pancreatic cancer12 Recurrence following initial hepatectomy for colorectal liver metastases: a multi-institutional analysis of patterns, prognostic factors and impact on survival13 The influence of the multidisciplinary cancer conference era on the management of colorectal liver metastases14 Monosegment ALPPS hepatectomy: extending resectability by rapid hypertrophy15 How does simultaneous resection of colorectal liver metastases impact chemotherapy administration?16 Preoperative liver volumetry for surgical planning: a systematic review and evaluation of current modalities17 Surgical planning of hepatic metastasectomy using radiologist performed intraoperative ultrasound21 Surgical resection and perioperative chemotherapy for colorectal cancer liver metastases: a population-based study22 Management and outcome of colorectal cancer (CRC) liver metastases in the elderly: a population-based study23 Outcomes following repeat hepatic resection for recurrent metastatic colorectal cancer: a population-based study24 A clinical pathway after pancreaticoduodenectomy standardizes postoperative care and may decrease postoperative complications25 Significance of regional lymph node involvement in patients undergoing liver resection and lymphadenectomy for colorectal cancer metastases26 NSAID use and risk of postoperative pancreatic fistulas following pancreaticoduodenectomy: a retrospective cohort study27 Minimally invasive HPB surgery in Canada: What are we doing and do we want to do more?28 2015 CJS Editor’s Choice Award Recipient: Predictors of actual survival in resected pancreatic adenocarcinoma: a population-level analysis29 Predictors of receipt of adjuvant therapy following pancreatic adenocarcinoma resection: a population-based analysis30 Effect of surgical wait time on oncological outcomes in periampullary cancer31 Does surgical assist expertise affect resectability in periampullary malignancies?32 The impact of tranexamic acid on fibrinolytic activity during major liver resection33 Colorectal cancer with synchronous hepatic metastases: a national survey of opinions on treatment sequencing and multidisciplinary cooperation34 Outcomes associated with a matched series of patients undergoing sequential resections of colorectal cancer and hepatic metastases compared with synchronous surgical therapy of the primary and hepatic metastases35 The impact of anesthetic inhalational agent on short-term outcomes after liver resection38 The impact of perioperative blood transfusions on posthepatectomy short-term outcomes: an analysis from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)39 Associations between pancreatic cancer quality indicators and outcomes in Nova Scotia40 Developing a national quality agenda in hepato-pancreato-biliary surgery: key priority areas for study02 Withdrawn03 Histological features and clinical implications of polypropylene degradation04 A rare case of primary hernia of the perineum05 Migration of polypropylene mesh in the development of late complications06 Laparoscopic hernia repair — Has this procedure run its course?07 Mesh materials used for hernia repair: Why do they shrink?08 The role of pure tissue repairs in a tailored concept for inguinal hernia repair09 Recurrent inguinal hernias a persistent problem in hernia surgery: analysis of 14 640 recurrent cases in the German hernia database, Herniamed10 Open circular intra-abdominal ventral herniorrhaphy: a new technique in ventral hernia repair01 Misrepresentation or “spin” is common in robotic colorectal surgical studies02 Postoperative pelvic sepsis rates following complete pathologic response to neoadjuvant therapy in rectal cancer03 Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery04 Impact of hospital volume on quality indices for rectal cancer surgery in British Columbia, Canada07 The effect of laparoscopy on inpatient cost after elective colectomy for colon cancer08 Predictors of variation in neighbourhood access to laparoscopic colectomy for colon cancer09 Predictors of 30-day readmission after elective colectomy for colon cancer10 Neutrophil-to-lymphocyte ratio predicts major perioperative complications in patients with colorectal cancer12 Sessile serrated adenoma (SSA) detection-predictive factors13 Diverticular abscess managed with long-term definitive nonoperative intent is safe14 Long-term outcomes of conservative management following successful nonoperative treatment of acute diverticulitis with abscess: a systematic review15 Incidence of ischemic colitis after abdominal aortic aneurysm repair: results from the national surgical quality improvement program database16 Sigmoid colectomy for acute diverticulitis in immunosuppressed v. immunocompetent patients: outcomes from the ACS-NSQIP database17 A cross-sectional survey of health and quality of life of patients awaiting colorectal surgery in Canada19 Self-expanding metal stents versus emergent surgery in acute malignant large bowel obstruction20 Combined laparoscopic and TAMIS LAR in a morbidly obese patient after open right hepatectomy21 Safety and feasibility of laparoscopic rectal cancer resection in morbidly obese patients22 Factors associated with morbidity following sacral neurostimulation for fecal incontinence: beware of the high risk groups23 Hyperglycemia increases surgical site infections following colorectal resections for malignancy in a standardized patient cohort24 Implementing an enhanced recovery program after colorectal surgery in elderly patients: Is it feasible?25 From laparoscopic-assisted to total laparoscopic right colectomy with intracorporeal anastomosis: Is the shift in technique justified?26 Surgical site infection rates following implementation of a “colorectal closure bundle” in elective colorectal surgeries27 Quality of life and anorectal function of rectal cancer patients in long-term recovery28 Combined laparoscopic/transanal endoscopic microsurgery approach to radical resection for rectal tumours29 Transanal endoscopic microsurgery resection of rectal neuroendocrine tumours: a single centre Canadian experience30 Abdominoperineal reconstruction with a myocutaneous flap32 Comparison of robotic and laparoscopic colorectal surgery with respect to 30-day perioperative morbidity33 Definitive management of fistula-in-ano using draining setons35 Oncologic outcomes following complete pathologic response to neoadjuvant therapy in rectal cancer36 Laparoscopic total mesorectal excision in obese patients with rectal cancer: What is the oncological impact?38 Improving the enhanced recovery programs in laparoscopic colectomy: liposomal bupivacaine may not be the answer39 Fistulae related to colonic diverticular disease: a single institution experience41 Laparoscopic colectomy for malignancy provides similar pathologic outcomes and improved survival outcomes compared with open approaches42 MRI utilization and completeness of reporting in rectal cancer: a population-based study43 Supporting quality assurance initiatives for rectal cancer: Is the CAP protocol enough?44 Accuracy and predictive ability of preoperative MRI for rectal adenocarcinoma: room for improvement47 A population-based study of colorectal cancer in patients ≤ 40: Does the extent of resection affect outcomes?48 Transanal minimally invasive surgery (TAMIS) for rectal neoplasms01 The impact of blood transfusion on perioperative outcomes following resection of gastric cancer: an analysis of the ACS-NSQIP02 Association of wait time to surgical management with overall survival in Ontarians with melanoma04 General surgeons’ attitudes toward breast reconstruction in the province of Quebec06 Neoadjuvant chemotherapy for breast cancer: Is practice changing? A population-based review of current surgical trends07 Robotic versus laparoscopic versus open gastrectomy for gastric adenocarcinoma15 Influence of preoperative MRI on the surgical management of breast cancer patients17 Adverse events related to lymph node dissection for cutaneous melanoma: a systematic review and meta-analysis19 Regional variations in survival, case volume and intraoperative margin assessment in resected gastric cancer20 Comparison of clinical and economic outcomes between robotic, laparoscopic and open rectal cancer surgery: early experience at a tertiary care centre21 Outcomes and clinicopathologic features of patients with Angiosarcoma of the breast23 Postmastectomy radiation: Should subtype factor in to the decision?24 Omission of axillary staging in elderly patients with early stage breast cancer impacts regional control but not survival: a systematic review and meta-analysis25 Objective pathological assessment of CRCLM by MALDI26 Identification of predictive tumour markers in breast cancer tissue — a pilot study research plan27 Reframing women’s risk: counselling on contralateral prophylactic mastectomy in non–high risk women with early breast cancer28 Withdrawn30 Comparison of different methods of immediate breast reconstructions for breast cancer patients: Is “single stage” really better?32 Is lymph node ratio a more accurate prognostic factor in stage III colon cancer than standard nodal staging?33 Costs associated with reoperation in the setting of attempted breast-conserving surgery: a decision analysis34 Polo-like kinase 4 (Plk4) activates Cdc42, stimulates cell invasion and enhances cancer progression in vivo35 Negative predictive value of preoperative abdominal CT in determining gastric cancer resectability on a population level36 2015 CJS Editor’s Choice Award Recipient: (18)F-fluoroazomycin arabinoside positron emission tomography (FAZA-PET) imaging predicts response to chemoradiation and evofosfamide (TH-302) in a preclinical xenograft model of rectal cancer37 Impact of a regional guideline on the surgical treatment of the axilla in patients with breast cancer: a population-based study39 Recent trends in port-site metastasis following laparoscopic resection of gallbladder cancer: a systematic review40 Real-time electromagnetic navigation for breast tumour resection: pilot study on palpable tumours41 Neoadjuvant imatinib for primary gastrointestinal stromal tumour (GIST): mutational status and timing of resection42 Adherence to osteoporosis screening guidelines in seniors with breast cancer treated with anti-estrogen therapy: a population-based study43 Automated robot interventions for enhanced clinical outcomes in breast biopsy44 Preoperative pregabalin or gabapentin for postoperative acute and chronic pain among patients undergoing breast cancer surgery: a systematic review and meta-analysis of randomized controlled trials46 Uptake and impact of synoptic reporting on breast cancer operative reports in a community care setting47 Withdrawn." Canadian Journal of Surgery 58, no. 4 Suppl 2 (August 2015): S169—S238. http://dx.doi.org/10.1503/cjs.008615.

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Brière, Raphaëlle, Rogeh Habashi, Shaila Merchant, Lina Cadili, Zainab Alhumoud, Rebecca Lau, Nada Gawad, et al. "2023 Canadian Surgery Forum01. Evaluation of physicians’ practices and knowledge regarding the treatment of acute uncomplicated diverticulitis03. What is the effect of rurality on outcomes for parathyroidectomy in a large North American jurisdiction?05. Characteristics of opioid providers for patients undergoing same-day breast surgery in Ontario, Canada06. Improving the management and outcomes of complex non-pedunculated colorectal polyps at a regional hospital in British Columbia10. Actinomycosis presenting as an anterior abdominal mass after laparoscopic cholecystectomy12. Prioritizing melanoma surgeries to prevent wait time delays and upstaging of melanoma during the COVID-19 pandemic13. Trust me, I know them: assessing interpersonal bias in general surgery residency interviews14. Current state of female and BIPOC representation in Canadian academic surgical societies15. Harnessing a province-wide network of surgical excellence and diverse talents for the continuous improvement of surgical care in BC16. Massive stone or is it glass: a curious case of porcelain gallbladder17. Choosing your endoscopist: a retrospective single-centre cohort study18. The local experience with endoscopic ampullectomy for noninvasive ampullary lesions at a single tertiary care centre19. Defining appropriate intraoperative patient blood management strategies in noncardiac surgery: the Ottawa Intraoperative Transfusion Consensus20. Postoperative gastrointestinal dysfunction after neuromuscular blockade reversal with sugammadex versus cholinesterase inhibitors in patients undergoing gastrointestinal surgery: a systematic review and meta-analysis21. Factors influencing recurrence in medial breast cancer after skin-sparing mastectomy and immediate breast reconstruction22. What is the role of fit in medical education? A scoping review23. The obesity paradox revisited: Is obesity still a protective factor for patients with severe comorbidities or in high-risk operations?24. Planetary health education for residents — an integrative approach through quality improvement25. A rare case of concurrent primary malignancies: adrenal cortical carcinoma and metastatic colon cancer26. Effect of video-based self-assessment on intraoperative skills: a pilot randomized controlled trial28. A cost–utility study of elective hemorrhoidectomies in Canada30. Opioid-free hernia repair using local anesthetic: an assessment of postoperative pain and recovery31. Mitigating the environmental burden of surgical and isolation gowns33. The evolution and contributions of theCanadian Journal of Surgery: a bibliometric study34. Clinical and oncologic outcomes of patients with rectal cancer and past radiotherapy for prostate cancer: a case–control study35. Antibiotic prophylaxis and mechanical bowel preparation in elective colorectal surgery: a survey of Quebec general surgeons36. Identifying core deficiencies and needs in the surgical knot-tying curriculum: a single-centre qualitative analysis37. Spleen-preserving surgery for symptomatic benign splenic cyst: video case report38. Learning to manage power differentials and navigate uncertainty: a qualitative interview study about decision-making in surgery39. Surgical education checklist: a novel tool to improve uptake of Competence By Design in a residency program and surgical resident experience40. A comparative evaluation of management strategies and patient outcomes for acute appendicitis in the post-COVID era41. External benchmarking of colorectal resection outcomes using ACS-NSQIP: accurately categorizing procedures at risk of morbidity42. Role of thymectomy in surgical treatment of secondary and tertiary hyperparathyroidism43. Starting position during colonoscopy: a systematic review and meta-analysis of randomized controlled trials44. Enhanced Recovery After Surgery protocols following emergency intra-abdominal surgery reduces length of stay and postoperative morbidity: a systematic review and meta-analysis45. Competencies, privileging and geography: preparing general surgery residents for rural practice in British Columbia46. Holographic surgical skills training: Can we use holograms to teach hand ties and is it comparable to in-person learning?47. The association between gender and confidence in UBC general surgery residents48. Quality improvement in timeliness of EPA completion in general surgery residency49. Gastrointestinal system surgical outcomes in the highly active antiretroviral therapy (HAART)-era HIV-positive patient: a scoping review50. Joint rounds as a method to partner surgical residency programs and enhance global surgical training52. Preoperative frailty and mortality in medicare beneficiaries undergoing major and minor surgical procedures53. What’s going on out there? Evaluating the scope of rural general surgery in British Columbia54. Short-stay compared with long-stay admissions for loop ileostomy reversals: a systematic review and meta-analysis55. General surgeons’ right hemicolectomy costs proficiency and preferences56. Staple line with bioabsorbable reinforcement for gastropexy in hiatal hernia repair57. Impact of enhanced recovery pathways on patient-reported outcomes after abdominal surgery: a systematic review58. Evaluation of outcomes between rural, northern/remote, and urban surgical patients diagnosed with moderate to severe acute pancreatitis: a retrospective study59. Outcome of preoperative percutaneous drainage of intraabdominal abscess versus initial surgery in patients with Crohn disease60. Preliminary analysis: dexamethasone-supplemented TAP blocks may reduce opioid requirements after colorectal surgery: a multi-centre randomized controlled trial61. Preoperative skin preparation with chlorhexidine alcohol versus povidone–iodine alcohol for the prevention of surgical site infections: a systematic review and meta-analysis of randomized controlled trials62. “Why didn’t you call me?” Factors junior learners consider when deciding whether to call their supervisor63. Cost savings associated with general surgical consultation within remote Indigenous communities in Quebec: a costing evaluation64. Right lateral decubitis patient position during colonoscopy increases endoscopist’s risk of musculoskeletal injury65. Reducing re-visit to hospital rates among pediatric post-appendectomy patients: a quality-improvement project66. Exploring gender diversity in surgical residency leadership across Canada67. Operating room sustainability project: quantifying the surgical environmental footprint for a laparoscopic cholecystectomy in 2 major surgical centres68. ERCP under general anesthesia compared with conscious sedation (EUGACCS) study69. Complications requiring intervention following gastrostomy/gastrojejunostomy tube insertion: a retrospective analysis70. Equity, diversity and inclusion (EDI) in underrepresented in medicine (URiM) residents: Where are we and what now?71. Association between complications and death within 30 days after general surgery procedures: a Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) substudy72. What is the long-term impact of gastrograffin on adhesive small bowel obstruction? A systematic narrative review73. TRASH-CAN: Trainee-Led Research and Sudit for Sustainability in Healthcare Canada74. Representation and reporting of sociodemographic variables in BREAST-Q studies: a systematic review75. A scoping review: should tap water instead of sterile water be used for endoscopy of the colon and rectum?76. Laparoscopic revision of Nissen fundoplication with EndoFLIP intraoperative assistance: a video presentation77. Environmental sustainability in the operating room: perspectives and practice patterns of general surgeons in Canada78. The impact of COVID-19 on medical students applying to general surgery in the CaRMS matching process79. Novel approach to laparoscopic gastrostomy tube placement80. Using prucalopride for prevention of postoperative ileus in gastrointestinal surgery: a systematic review and meta-analysis of randomized controlled trials81. Assessment of environmental and economic sustainability of perioperative patient warming strategies83. Development of a Canadian colorectal robotic surgery program: the first three years84. Patient safety and quality improvement lessons from review of Canadian thyroid and parathyroid surgery malpractice litigation case law01. Changes in sarcopenia status predict survival among patients with resectable esophageal cancer02. The feasibility of near-infrared fluorescence-guided robotic-assisted minimally invasive esophagectomy using indocyanine green dye03. Does patient experience with robotic thoracic surgery influence their willingness to pay for it?04. Artificial intelligence–augmented endobronchial ultrasound-elastography is a useful adjunct for lymph node staging for lung cancer05. Preoperative mediastinal staging in early-stage lung cancer: targeted nodal sampling is not inferior to systematic nodal sampling06. The application of an artificial intelligence algorithm to predict lymph node malignancy in non-small cell lung cancer07. Pneumonectomy for non-small cell lung cancer: long-term overall survival from a 15-year experience09. Primary spontaneous pneumothorax occurred in pectus excavatum patients10. Optimizing management for early-stage esophageal adenocarcinoma: longitudinal results from a multidisciplinary program11. Needle decompressions in post-traumatic tension pneumothorax: boon or bane12. 10-year follow-up of endoscopic mucosal resection versus esophagectomy for esophageal intramucosal adenocarcinoma in the setting of Barrett esophagus: a Canadian experience13. Outcomes after thoracic surgery for malignancy in patients with severe and persistent mental illness15. Stage II/III esophageal cancer patients with complete clinical response after neoadjuvant chemoradiotherapy: a Markov decision analysis16. Development of a surgical stabilization of rib fractures program at a Level I trauma centre in Qatar: initial report17. Screening Criteria Evaluation for Expansion in Pulmonary Neoplasias (SCREEN) II18. Multi-centre study evaluating the risks and benefits of intraoperative steroids during pneumonectomy19. Prediction of esophageal cancer short-term survival using a pretreatment health-related quality of life measure20. Evaluating the impact of virtual care in thoracic surgery: patients’ perspective21. Virtual thoracic surgical outpatient encounters are non-inferior to in-person visits for overall patient care satisfaction in the post-COVID-19 era22. Concurrent minimally invasive esophagectomy and laparoscopic right hemicolectomy23. Assessing the impact of robotic-assisted thoracic surgery on direct carbon dioxide emissions — a retrospective analysis of a prospective cohort24. Young’s modulus of human lung parenchyma and tumours25. Thoracic surgery trauma: nail gun v. SVC26. Thymomatous myasthenia gravis after total thymectomy at a tertiary care surgical centre: a 15-year retrospective review27. Effectiveness of 18F-FDG-PET/CT in the stage diagnosis of non-small cell lung cancer (NSCLC): a diagnostic test accuracy systematic review and meta-analysis01. Emergency colon resection in the geriatric population: the modified frailty score as a risk factor of early mortality02. Laparoscopic ovarian transposition prior to pelvic radiation in young female patients with anorectal malignancies: a systematic review and meta-analysis of prevalence03. Using preoperative C-reactive protein levels to predict anastomotic leaks and other complications after elective colorectal surgery: a systematic review and meta-analysis04. Perioperative intravenous dexamethasone for patients undergoing colorectal surgery: a systematic review and meta-analysis05. Population-based study comparing time from presentation to diagnosis and treatment between younger and older adults with colorectal cancer06. The role of warmed-humidified CO2insufflation in colorectal surgery: a meta-analysis07. Total abdominal colectomy versus diverting loop ileostomy and antegrade colonic lavage for fulminantClostridioidescolitis: analysis of the national inpatient sample 2016–201908. Cutting seton for the treatment of cryptoglandular fistula-inano: a systematic review and meta-analysis09. Prognostic value of routine stain versus elastic trichrome stain in identifying venous invasion in colon cancer10. Anastomotic leak rate following the implementation of a powered circular stapler in elective colorectal surgeries11. Surgical technique and recurrence of Crohn disease following ileocolic resection12. Implementation of synoptic reporting for endoscopic localization of complex colorectal neoplasms: Can we reduce rates of repeat preoperative colonoscopy?13. Effects of diet and antibiotics on anastomotic healing: a mouse model study with varied dietary fibre and fat, and preoperative antibiotics14. Assessment of rectal surgery–related physical pain and conditioning: a national survey of Canadian rectal surgeons15. Does specimen extraction incision and transversus abdominis plane block affect opioid requirements after laparoscopic colectomy?16. Colorectal and therapeutic GI working together: What is the role for TAMIS for benign lesions?17. Impact of the COVID-19 pandemic on readmission rates following colorectal surgery18. More than the sum of its parts: the benefits of multidisciplinary conferences extend beyond patient care19. Multidisciplinary conference for rectal cancer — measuring patient care impact20. Patient outcomes in emergency colorectal cancer resections: a 15-year cohort analysis21. Enhanced Recovery after Surgery (ERAS) protocols in colorectal cancer resection: a 15-year analysis of patient outcomes22. Laparoscopic to open conversion in colorectal cancer resection: a 15-year analysis of postoperative outcomes23. Management of postoperative ileus in colorectal cancer resections: a 15-year evaluation of patient outcomes24. Timing of ostomy reversal and associated outcomes: a systematic review25. Fragility of statistically significant outcomes in colonic diverticular disease randomized trials26. Postoperative day 1 and 2 C-reactive protein values for predicting postoperative morbidity following colorectal surgery27. Bariatric surgery before colorectal surgery reduces postoperative morbidity and health care resource utilization: a propensity score matched analysis28. Ileocolic Crohn disease: a video vignette of the Kono-S anastomosis29. Association between patient activation and postoperative outcomes in rectal cancer survivors30. Understanding surgeon and nurse perspectives on the use of patient-generated data in the management of low anterior resection syndrome31. Characteristics of interval colorectal cancer: a Canadian retrospective population-level analysis from Newfoundland and Labrador32. Current rectal cancer survivorship care: unmet patient needs and fragmented specialist and family physician care33. Local excision for T1 rectal cancer: a population-based study of practice patterns and oncological outcomes34. Can nonoperative management of acute complicated diverticulitis be successfully treated with a future hospital at home program? A retrospective cohort study35. Does patient activation impact remote digital health follow-up and same-day discharge after elective colorectal surgery36. Parastomal hernia prevention, assessment and management: best practice guidelines37. Anastomotic leak rates in circular powered staplers versus manual circular staplers in left sided colorectal anastomoses: a systematic review38. The Gips procedure for pilonidal disease: a video presentation39. Local recurrence-free survival after transanal total mesorectal excision: a Canadian institutional experience40. The impact of operative approach for obese colorectal cancer patients: analysis of the national inpatient sample (2015–2019)41. Safety and feasibility of discharge within 24 hours of colectomy: a systematic review and meta-analysis42. Laparoscopic lateral lymph node dissection for an advanced rectal cancer: a video abstract43. “Dear diary”: challenges in adopting routine operative recording in surgical training44. Rectal cancer in the very young (age < 40) — more treatment, worse survival: a population-based study45. Surveillance following treatment for stage I–III rectal cancer in Ontario — a population-based descriptive study46. A 15-year institutional experience of trananal endoscopic microsurgery for local excision of benign and malignant rectal neoplasia47. Robotic approach to reoperative pelvic surgery48. A mucosa-adherent bacterium impairs colorectal anastomotic healing by upregulating interleukin-17: the role of low-grade inflammation as a driver of anastomotic leak49. High uptake of total neoadjuvant therapy for rectal cancer in Canada despite surgeon concerns for possible overtreatment and treatment-related toxicity50. Safety and feasibility of discharge within 24 hours of ileostomy reversal: a systematic review and meta-analysis51. Safety and efficacy of intravenous antifibrinolytic use in colorectal surgery: systematic review and meta-analysis52. Impact of ileal pouch anal anastomosis on fertility in female patients with uulcerative colitis: a systemic review53. Modulation of the gut microbiota with fermentable fibres and 5-aminosalicylate to prevent peri-anastomotic and metastatic recurrence of colorectal cancer54. Patients with locally advanced rectal cancer and a non-threatened circumferential resection margin may go straight to surgery and avoid radiation toxicities: the QuickSilver Trial55. Colonoscopies during the COVID-19 pandemic recovery period: Are we caught up on colorectal cancer detection and prevention? A single-institution experience56. Interim results of a phase II study evaluating the safety of nonoperative management for locally advanced low rectal cancer57. Assessing a tailored curriculum for endoscopic simulation for general surgery residency programs in Canada58. Modified Frailty Index for patients undergoing surgery for colorectal cancer: analysis of the National Inpatient Sample (2015–2019)59. Reducing postoperative bloodwork in elective colorectal surgery: a quality-improvement initiative60. A Nationwide Readmission Database (NRD) analysis assessing timing of readmission for complications following emergency colectomy: why limiting follow-up to postoperative day 30 underserves patients61. The same but different: clinical and Enhanced Recovery After Surgery outcomes in right hemicolectomy for colon cancer versus ileocecal resection in Crohn disease01. How reliable are postmastectomy breast reconstruction videos on YouTube?02. Knowledge, perceptions, attitudes, and barriers to genetic literacy among surgeons: a scoping review03. Exploring neutrophil-to-lymphocyte ratio as a predictor of postoperative breast cancer overall survival04. High β integrin expression is differentially associated with worsened pancreatic ductal adenocarcinoma outcomes05. Epidemiology of undifferentiated carcinomas06. An evidence-based approach to the incorporation of total neoadjuvant therapy into a standardized rectal cancer treatment algorithm07. Pushing the boundaries: right retroperitoneoscopic adrenalectomy after laparoscopic right nephrectomy08. The role of caspase-1 in triple negative breast cancer, the immune tumour microenvironment and response to anti-PD1 immunotherapy09. Perioperative neutrophil-to-lymphocyte ratio is associated with survival in patients undergoing colorectal cancer surgery10. Achievement of quality metrics in older adults undergoing elective colorectal cancer surgery11. Opportunities to improve the environmental sustainability of breast cancer surgical care12. Does margin status after biopsy matter in melanoma? A cohort study of micro- and macroscopic margin status and their impact on residual disease and survival13. Demonstration of D2 Lymph node stations during laparoscopic total gastrectomy14. Incidence of metastatic tumours to the ovary (Krukenberg) versus primary ovarian neoplasms associated with colorectal cancer surgery15. Spatial biomarkers in cancer16. How informed is the consent process for complex cancer resections?17. Adjuvant radiation therapy among immigrant and Canadian-born/long-term resident women with breast cancer18. Human peritoneal explant model reveals genomic alterations that facilitate peritoneal implantation of gastric cancer cells19. Preoperative breast satisfaction association with major complications following oncologic breast surgery20. Impact of geography on receipt of medical oncology consultation and neoadjuvant chemotherapy for triple negative andHER2positive breast cancer21. Comparison of radiation, surgery or both in women with breast cancer and 3 or more positive lymph nodes22. Impact of synoptic operative reporting as a quality indicator for thyroid surgery: a Canadian national study01. The Toronto management of initially unresectable liver metastases from colorectal cancer in a living donor liver transplant program02. Dissection of a replaced right hepatic artery arising from the superior mesenteric artery during a laparoscopic Whipple03. Implementing the HIBA index: a low-cost method for assessing future liver remnant function04. Oncologic outcomes after surgical resection versus thermoablation in early-stage hepatocellular carcinoma: a systematic review of randomized controlled trials with meta-analysis05. Robotic pancreatic necrosectomy and internal drainage for walled-off pancreatic necrosis06. Predicting diabetes mellitus after partial pancreatectomy: PRIMACY, a pilot study07. Bleed and save: patient blood management in hepatectomy08. Defining standards for hepatopancreatobiliary cancer surgery in Ontario, Canada: a population-based cohort study of clinical outcomes09. Laparoscopic choledochoduodenostomy for recurrent choledocholithiasis10. A comparison of daytime versus evening versus overnight liver transplant from a single Canadian centre11. Pilot study validating the line of safety as a landmark for safe laparoscopic cholecystectomy using indocyanine green and near-infrared imagine12. Effect of transversus abdominis plane catheters on postoperative opioid consumption in patients undergoing open liver resections — a single-centre retrospective review13. Comparing the RETREAT score to the Milan criteria for predicting 5-year survival in post-liver transplant hepatocellular carcinoma patients: a retrospective analysis14. Characterizing the effect of a heat shock protein-90 inhibitor on porcine liver for transplantation using ex-vivo machine perfusion15. Modulation by PCSK9 of the immune recognition of colorectal cancer liver metastasis17. Implementation of a preoperative ketogenic diet for reduction of hepatic steatosis before hepatectomy19. Trends in the incidence and management of hepatocellular carcinoma in Ontario20. Canadian coaching program leads to successful transition from open to laparoscopic hepatopancreatobiliary surgery21. The impact of a positive pancreatic margin analyzed according to LEEPP on the recurrence and survival of patients with pancreatic head adenocarcinoma22. Armed oncolytic virus VSV-LIGHT/TNFSF14 promotes survival and results in complete pathological and radiological response in an immunocompetent model of advanced pancreatic cancer23. Comparing the efficacy of cefazolin/metronidazole, piperacillin-tazobactam, or cefoxitin as surgical antibiotic prophylaxis in patients undergoing pancreaticoduodenectomy: a retrospective cohort study01. Not just jumping on the bandwagon: a cost-conscious establishment of a robotic abdominal wall reconstruction program in a publicly funded health care system02. Shouldice method brief educational video03. Laparoscopic recurrent hiatal hernia repair with mesh gastropexy04. Robotic transabdominal preperitoneal Grynfeltt lumbar hernia repair with mesh01. Substance abuse screening prior to bariatric surgery: an MBSAQIP cohort study evaluating frequency and factors associated with screening02. MBSAQIP risk calculator use in elective bariatric surgery is uncommon, yet associated with reduced odds of serious complications: a retrospective cohort analysis of 210 710 patients03. Short-term outcomes of concomitant versus delayed revisional bariatric surgery after adjustable gastric band removal04. Safety and outcomes of bariatric surgery in patients with inflammatory bowel disease: a systematic review and meta-analysis08. Prescription drug usage as measure of comorbidity resolution after bariatric surgery — a population-based cohort study09. Experiences and outcomes of Indigenous patients undergoing bariatric surgery: a mixed-methods scoping review10. Bariatric surgery reduces major adverse kidney events in patients with chronic kidney disease: a multiple-linked database analysis in Ontario11. Inter-rater reliability of indocyanine green fluorescence angiography for blood flow visualization in laparoscopic Roux-en-Y gastric bypass12. Characterization of small bowel obstructions following elective bariatric surgery13. Revision of bariatric surgery for gastroesophageal reflux disease: characterizing patient and procedural factors and 30-day outcomes for a retrospective cohort of 4412 patients14. Duodenal-jejunal bypass liners are superior to optimal medical management in ameliorating metabolic dysfunction: a systematic review and meta-analysis15. Characteristics and outcomes for patients undergoing revisional bariatric surgery due to persistent obesity: a retrospective cohort study of 10 589 patients01. Collateral damage: the impact of the COVID-19 pandemic on the severity of abdominal emergency surgery at a regional hospital02. Pseudoaneurysms after high-grade penetrating solid organ injury and the utility of delayed CT angiography03. Pseudoaneurysm screening after pediatric high-grade solid organ injury04. Witnessed prehospital traumatic arrest: predictors of survival to hospital discharge05. A tension controlled, noninvasive device for reapproximation of the abdominal wall fascia in open abdomens08. Delayed vs. early laparoscopic appendectomy (DELAY) for adult patients with acute appendicitis: a randomized controlled trial09. Days at home after malignant bowel obstructions: a patient-centred analysis of treatment decisions10. Polytrauma and polyshock: prevailing puzzle11. National emergency laparotomy audit: a 9-year evaluation of postoperative mortality in emergency laparotomy13. A comparison of stress response in high-fidelity and low-fidelity trauma simulation14. ASA versus heparin in the treatment of blunt cerebrovascular injury — a systematic review and meta-analysis15. Comparison of complication reporting in trauma systems: a review of Canadian trauma registries16. Benefits of the addition of a nurse practitioner to a high-volume acute care surgery service: a quantitative survey of nurses, residents and surgery attendings17. Examining current evidence for trauma recurrence preventions systems18. Disparities in access to trauma care in Canada: a geospatial analysis of Census data19. Fast-track pathway to accelerated cholecystectomy versus standard of care for acute cholecystitis: the FAST pilot trial20. Using the modified Frailty Index to predict postoperative outcomes in patients undergoing surgery for adhesive small bowel obstruction: analysis of the National Inpatient Sample, 2015–201921. Adequacy of thromboprophylaxis in trauma patients receiving conventional versus higher dosing regimens of low-molecular-weight heparin: a prospective cohort study22. The hidden epidemiology of trauma in Nunavik: a comparison of trauma registries as a call to action23. Mapping surgical services in rural British Columbia: an environmental scan." Canadian Journal of Surgery 66, no. 6 Suppl 1 (December 8, 2023): S53—S136. http://dx.doi.org/10.1503/cjs.014223.

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35

"Evaluation of the Grenada Sports for Health Program." Journal of Clinical Review & Case Reports 3, no. 5 (June 15, 2018). http://dx.doi.org/10.33140/jcrc/03/05/00004.

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Objective: The study served to measure basic health outcome measures to help guide the continued implementation of the community exercise component of the Grenada Sports for Health program. Design & Methods: The study population consisted of Grenadian citizens enrolled in three different community exercise programs as part of the Royal Grenada Police Force, Point Saline and La Sagesse, Grenville, Gouyave and Tanteen community exercise program. Initial data collection for this prospective cohort study began during March of 2011 and continued data collection through quarterly assessments was continued to June/July 2014 and June/July 2016. The health indicators for the Sports for Health program were designed to monitor and analyse program participants’ physical health indicators, such as Body Mass Index (BMI), Waist to Hip ratio over time to determine if their participation in the community training program was promoting health benefits by reducing risk factors for non-communicable chronic diseases. Results: During the baseline evaluation period in March, 2011, complete data sets were obtained for 427 participants. During the evaluation period of March 2014, 337 complete data sets were collected from participants from 2011 and during June/July 2016 evaluation, 264 complete data sets were obtained. The BMI, Waist, hip, and waist: hip ratio is presented in Table 1. BMI and Waist: Hip ratio using a Student’s T-test (α=0.05) demonstrated a significant difference between 2011 and 2016 measures. Conclusion: Participants have demonstrated a significant and positive difference in physical health indicators over three years of participation in the Sports for Health program.
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Ibe, Chidinma A., Danielle R. Haywood, Ciana Creighton, Yidan Cao, Angel Gabriel, Hossein Zare, Wehmah Jones, et al. "Study protocol of a randomized controlled trial evaluating the Prime Time Sister Circles (PTSC) program's impact on hypertension among midlife African American women." BMC Public Health 21, no. 1 (March 29, 2021). http://dx.doi.org/10.1186/s12889-021-10459-8.

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Abstract Background The Prime-Time Sister Circles® (PTSC) program is a multifaceted, community-based peer support intervention targeting African American women who are 40 to 75 years of age. It aims to reduce hypertension disparities observed among African American women by promoting adherence to antihypertensive therapies, including lifestyle modification and therapeutic regimens. Methods The PTSC randomized controlled trial will evaluate the effectiveness of the PTSC Program on improved blood pressure control, healthcare utilization attributed to cardiovascular events, and healthcare costs. The study began in 2016 and will end in 2022. African American women who are 40–75 years old, have been diagnosed with hypertension, reside in Washington, D.C. or Baltimore, Maryland, and receive their care from Unity Health Care, a federally qualified health center in Washington, D.C., or Baltimore Medical System, a federally qualified health center in Baltimore, Maryland, are eligible to participate. Those randomized to the intervention group participate in the PTSC Program, which spans 13 weeks and comprises facilitator-led discussions, didactic training about hypertension management, and peer-based problem-solving concerning CVD risk factors and their amelioration. Blood pressure, weight, body mass index, waist circumference, self-reported adherence, physical activity, dietary practices, stress, and healthcare utilization data are collected at baseline, 13 weeks (end of the intervention), 9 months (months post-intervention), and 15 months (one year after the intervention). Healthcare costs will be computed at the end of the study. The study’s design is reported in the present manuscript, wherein we employed the SPIRIT checklist to guide its construction. Discussion Disparities in hypertension prevalence and management observed among mid-life African American women exist as a result of a confluence of structural determinants of health. Consequently, there is a need to develop, implement, and evaluate culturally appropriate and relevant interventions that are tailored to their lived experiences. The PTSC Trial aims to assess the impact of the program on participants’ cardiovascular, psychosocial, and cost outcomes. Its results have implications for advancing the science of designing and implementing culturally relevant interventions for African American women. Trial registration Unique identifier: NCT04371614. Retrospectively registered on April 30, 2020.
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Alvarez, Alexandra, Ashley Montgomery, Nhu Thao Nguyen Galván, Eileen D. Brewer, and Abbas Rana. "Predicting wait time for pediatric kidney transplant: a novel index." Pediatric Nephrology, January 12, 2024. http://dx.doi.org/10.1007/s00467-023-06232-1.

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Abstract Background Over one thousand pediatric kidney transplant candidates are added to the waitlist annually, yet the prospective time spent waiting is unknown for many. Our study fills this gap by identifying variables that impact waitlist time and by creating an index to predict the likelihood of a pediatric candidate receiving a transplant within 1 year of listing. This index could be used to guide patient management by giving clinicians a potential timeline for each candidate’s listing based on a unique combination of risk factors. Methods A retrospective analysis of 3757 pediatric kidney transplant candidates from the 2014 to 2020 OPTN/UNOS database was performed. The data was randomly divided into a training set, comprising two-thirds of the data, and a testing set, comprising one-third of the data. From the training set, univariable and multivariable logistic regressions were used to identify significant predictive factors affecting wait times. A predictive index was created using variables significant in the multivariable analysis. The index’s ability to predict likelihood of transplantation within 1 year of listing was validated using ROC analysis on the training set. Validation of the index using ROC analysis was repeated on the testing set. Results A total of 10 variables were found to be significant. The five most significant variables include the following: blood group, B (OR 0.65); dialysis status (OR 3.67); kidney disease etiology, SLE (OR 0.38); and OPTN region, 5 (OR 0.54) and 6 (OR 0.46). ROC analysis of the index on the training set yielded a c-statistic of 0.71. ROC analysis of the index on the testing set yielded a c-statistic of 0.68. Conclusions This index is a modest prognostic model to assess time to pediatric kidney transplantation. It is intended as a supplementary tool to guide patient management by providing clinicians with an individualized prospective timeline for each candidate. Early identification of candidates with potential for prolonged waiting times may help encourage more living donation including paired donation chains. Graphical Abstract
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Guo, Zhenxu, Qinge Wang, Chunyan Peng, Sunning Zhuang, and Biao Yang. "Willingness to accept metaverse safety training for construction workers based on extended UTAUT." Frontiers in Public Health 11 (January 5, 2024). http://dx.doi.org/10.3389/fpubh.2023.1294203.

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Safety training (ST) is essential in avoiding unsafe behavior of construction workers. With the rise of metaverse technology, metaverse safety training (MST) has gradually become a new model to guide construction workers in safety production. An in-depth study of construction workers’ willingness to accept the metaverse safety training (WAMST) helps improve its effectiveness, but studies need to pay more attention to it. This study constructs a conceptual model of WAMST for construction workers, and the influencing factors of WAMST are explained based on the extended Unified Theory of Acceptance and Use of Technology (UTAUT). It established a Structural equation modeling to verify the relationship between influencing factors. An example verifies the feasibility of the model. The results show that the framework significantly contributes to the willingness of construction workers to participate and improves safety awareness. Specifically, performance expectancy, effort expectancy, social influence, and convenient conditions significantly affect the construction workers’ willingness to accept. Convenient conditions have a direct effect on actual behavior. Willingness to accept plays a mediating role between performance expectancy and actual behavior. Perceived trust moderates the effect between willingness to accept and actual behavior, and the force of positive interpretation increases proportionally. It confirms how to improve the safety capacity of construction workers and provides references for governments, enterprises, and projects to formulate ST strategies.
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Martínez, Dormar David Barrios. "Thoracentesis Guided By Focused Ultrasonography Performed By the Intensivist Physician in Malignant Pleural Effusion: A Safe Strategy." Journal of Oncology Research Review & Reports, June 30, 2021, 1–3. http://dx.doi.org/10.47363/jonrr/2021(2)141.

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The wide use of pulmonary and cardiac ultrasound in critical medicine allows early diagnoses and the performance of certain procedures that achieve a prompt intervention in a type of patient who does not wait. Thoracentesis is a percutaneous procedure for collecting pleural fluid, and it has diagnostic utility and therapeutic applications. The use of ultrasound to perform an evacuative and diagnostic thoracentesis has proven to be a simple, safe, low-cost, and especially reproducible procedure in personnel under training and with training already established. We present an algorithm on the realization of a successful Thoracentesis Guided by Focused Ultrasonography Performed by the Intensivist Physician in Malignant Pleural Effusion, which is based on different protocols of daily practice in intensive care units. This algorithm follows certain steps and with good performance for the identification of pleural effusion, catheter passage and drainage of the effusion.
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Ovadia-Blechman, Zehava, Ricardo Tarrasch, Maria Velicki, and Hila Chalutz Ben-Gal. "Reducing Test Anxiety by Device-Guided Breathing: A Pilot Study." Frontiers in Psychology 13 (May 23, 2022). http://dx.doi.org/10.3389/fpsyg.2022.678098.

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Test anxiety remains a challenge for students and has considerable physiological and psychological impacts. The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions. This paper addresses the effectiveness of using DGB as a self-treatment clinical tool for test anxiety reduction. This pilot study sample included 21 healthy men and women, all college students, between the ages of 20 and 30. Participants were randomly assigned to two groups: DGB practice (n = 10) and wait-list control (n = 11). At the beginning and the end of 3-weeks DGB training, participants underwent a stress test, followed by measures of blood pressure and reported anxiety. Anxiety reduction in the DGB group as compared to controls was not statistically significant, but showed a large effect size. Accordingly, the clinical outcomes suggested that daily practice of DGB may lead to reduced anxiety. We assume that such reduction may lead to improved test performance. Our results suggest an alternative treatment for test anxiety that may also be relevant for general anxiety, which is likely to increase due to the ongoing COVID-19 pandemic.
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Gajewski, Patrick D., Catharina Stahn, Joachim Zülch, Edmund Wascher, Stephan Getzmann, and Michael Falkenstein. "Effects of cognitive and stress management training in middle-aged and older industrial workers in different socioeconomic settings: a randomized controlled study." Frontiers in Psychology 14 (September 12, 2023). http://dx.doi.org/10.3389/fpsyg.2023.1229503.

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IntroductionThe demographic change requires longer working lifetime. However, fear of job loss may lead to chronic stress whereas aging and unchallenging work may accelerate cognitive decline and early retirement. Long-time repetitive work led to impairments of cognitive functions in middle-aged and older employees, as demonstrated in a previous study conducted in a large car manufacturer. In the present study, a training concept was implemented to enhance the cognitive and emotional competence of these employees.MethodsA first group of employees received a trainer-guided cognitive training only, whereas a wait list control group received a cognitive training and stress management training. This design was applied in two independent samples separated by one year either during or after a socioeconomically tense situation of the factory.ResultsIn sample 1, with a tense occupational situation, the cognitive training effects occurred with a delay of three months. In contrast, in sample 2, with less critical socioeconomic situation, the training effects occurred immediately and persisted three months later. Stress management training showed reduction of subjectively and objectively measured stress level.DiscussionThe results indicate that effects of cognitive interventions are diminished under chronic stress which can be reduced after a short stress management training. This leads also to enhanced attention and memory in daily life. In contrast, in Sample 2 with less chronic stress, effects of cognitive training were stronger and persisted at least three months later, whereas stress management training had less impact. This suggests that cognitive learning in occupational settings is only efficient at lower stress levels.
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Radhawi, Saad Naeem. "Wasit University management of the educational process in accordance with the requirements of sustainable development in light of the Corona pandemic (COVID-19)." Journal of Sustainability Perspectives 2 (August 1, 2022). http://dx.doi.org/10.14710/jsp.2022.15533.

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The current working paper aimed to reveal the efforts of Wasit University in its management of the educational process in accordance with the requirements of sustainable development in light of the Corona pandemic ((COVID-19), where the university administration invested during the state of emergency all its energies and capabilities and worked to facilitate the tasks, which achieved the superiority of the university in experiencing the transformation experience. To e-learning during the pandemic period the university worked gradually and comprehensively within the emergency plan that came into existence in cooperation between the Board of Directors, the Deans Council and emergency committees and was implemented in cooperation with various authorities. The university adopts a fixed e-learning methodology that is characterized by flexibility, where the teacher records the lecture in video form, whether using PowerPoint with audio recording or screen recording of lectures every week and holding at least one interactive meeting at the same time as the lecture on the academic schedule so that students can watch the lectures at the appropriate times For them or the teacher holds all his lectures interactively directly with the students, provided that all lectures are Interactive at the time of the lecture according to the study schedule, and ways were provided to add solutions to raise the level of security for the content available on Zoom and One drive. A guide was provided for using Zoom not only for interactive meetings, but also for recording off-line lectures and making them available to students on the Moodle platform, and other important guides. The team viewer program was also used to gain access to the computers of teachers who find it difficult to deal with issues related to e-learning and explain it step by step directly, and this method was very effective. The university is now working on developing a specific mechanism to prepare for final exams using e-learning, taking into account the process of remote monitoring and answering students’ inquiries during exams while maintaining the highest levels of academic standards and enhancing quality in education, thus making Wasit University the pioneer in adopting the electronic exam method. It was also revealed in the working paper about the effectiveness of e-learning in light of the spread of the Corona virus from the point of view of the faculty members at Wasit University, and the researcher conducted a survey and to achieve the objectives of the study, the descriptive analytical approach was relied on, and the study sample consisted of (300) faculty members. At the University of Wasit who taught during the period of the spread of the Corona virus through the e-learning system, the necessary data were collected using a questionnaire whose reliability coefficient reached (0.804) and was applied to the study sample. The results of the study revealed that the study sample’s evaluation of the effectiveness of e-learning in light of the spread of the Corona virus from their point of view was average, and their evaluation of the field of e-learning continuity and the field of interaction of faculty members with e-learning, and the field of students’ interaction in the use of e-learning was average, and the researcher recommended holding training courses In the field of e-learning for both teachers and students, and help in benefiting from the e-learning system in higher education institutions in the future.Keyword: Wasit University, management , Educational, Process Corona pandemic (COVID-19)
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Baluyot, Abigail, Cynthera McNeill, and Susan Wiers. "Improving Communication From Hospital to Skilled Nursing Facility Through Standardized Hand-Off: A Quality Improvement Project." Patient Safety, December 16, 2022, 18–25. http://dx.doi.org/10.33940/med/2022.12.2.

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Background: Inadequate hand-off communication from hospital to skilled nursing facility (SNF) hinders SNF nurses’ ability to prepare for specific patient needs, including prescriptions for critical medications, such as controlled medications and intravenous (IV) antibiotics, resulting in delayed medication administration. This project aims to improve hand-off communication from hospital to SNF by utilizing a standardized hand-off tool. This project was conducted in an inpatient, 50-bed, post-hospital skilled nursing care unit of a local SNF. The participants included all 32 staff nurses employed by the SNF. Methods: Lewin’s change management theory (CMT) guided this quality improvement (QI) project. Baseline assessment included a one-month chart review of 76 patient charts that was conducted to assess the disparities related to ineffective hand-off and medication delays in the SNF before intervention. The wait time for the availability of prescriptions for controlled medications and IV antibiotics, and delays in medication administration were assessed. Intervention: Multiple randomly selected hospital-to-SNF hand-offs were observed. Semistructured interviews with all staff nurses were conducted using open-ended questions about hand-off structure and process matters. Data gathered from observation and interviews were used to create the standardized hand-off tool used in this project. In-service training on hand-off tool utilization for SNF nurses was conducted. Champions for each shift were cultivated to assist with project implementation. Results: After six weeks of implementation, a chart review of 101 patient charts was conducted to evaluate the effects of the hand-off tool on the wait time on the availability of prescriptions for controlled medications and IV antibiotics, and medication administration. The wait time of prescriptions availability during the hospital-to-SNF transition was decreased by 79% for controlled medications, with an associated 52.9% reduction in late administration, and decreased by 94% for IV antibiotics, with a 77.8% reduction in late administration. Conclusion: The use of standardized hand-off resulted in improved communication during the hospital-to-SNF hand-off and significantly decreased the wait time for the availability of prescriptions for controlled medications and IV antibiotics. Integrating standardized hand-off into the SNF policies can help sustain improved communication, medication management, and patient transition from hospital to SNF.
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44

Richards, Katie L., Matthew Phillips, Luiza Grycuk, Lucy Hyam, Karina Allen, and Ulrike Schmidt. "Clinician perspectives of the implementation of an early intervention service for eating disorders in England: a mixed method study." Journal of Eating Disorders 12, no. 1 (April 5, 2024). http://dx.doi.org/10.1186/s40337-024-01000-4.

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Abstract Background The First Episode Rapid Early Intervention for Eating Disorders (FREED) service has been shown to reduce the wait for care and improve clinical outcomes in initial evaluations. These findings led to the national scaling of FREED in England. To support this scaling, we conducted a mixed method evaluation of the perceptions and experiences of clinicians in the early phases of scaling. The Normalisation Process Theory (NPT) was used as a conceptual lens to understand if and how FREED becomes embedded in routine practice. Methods The convergent mixed method evaluation included 21 semi-structured interviews with clinicians from early adopter sites and 211 surveys administered to clinicians before, immediately after and 3 months after the FREED training. The interview guide and survey included questions evaluating attitudes towards early intervention for eating disorders (EDs) and NPT mechanisms. Interview data were analysed using an inductive thematic analysis. The NPT was applied to the inductively derived themes to evaluate if and how NPT domains impacted the implementation. Survey data were analysed using multilevel growth models. Results Six themes and 15 subthemes captured barriers and facilitators to implementation at the patient, clinician, service, intervention, implementation and wider system levels. These interacted with the NPT mechanisms to facilitate or hinder the embedding of FREED. Overall, clinicians were enthusiastic and positive towards early intervention for EDs and FREED, largely because of the expectation of improved patient outcomes. This was a considerable driver in the uptake and implementation of FREED. Clinicians also had reservations about capacity and the potential impact on other patients, which, at times, was a barrier for its use. The FREED training led to significant improvements in positive attitudes and NPT mechanisms that were largely maintained at the 3-month follow-up. However, negative attitudes did not significantly improve following training. Conclusions Positive attitudes towards early intervention for EDs increased enthusiasm and engagement with the model. Features of the model and its implementation were effective at developing adopter commitment and capabilities. However, there were aspects of the model and its implementation which require attention in the future (e.g., capacity and the potential impact on the wider service).
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Panthong, S., K. Takkavatakarn, and P. Sitticharoenchai. "Clinical risk factors and prediction model for infective endocarditis in patients with gram-positive bacteremia." European Heart Journal 44, Supplement_2 (November 2023). http://dx.doi.org/10.1093/eurheartj/ehad655.1774.

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Abstract Introduction Gram-positive bacteremia (GPB) is a common condition in clinical practice that potentially leads to infective endocarditis (IE), a high morbidity and mortality disease. Clinicians still encounter challenges in determining the likelihood of developing IE in GPB patients. Comprehensive and invasive cardiac investigations in every patient with GPB for IE could be unnecessary and potentially harmful while missing proper investigations might result in the delay or misdiagnosis of this fatal condition. Objective We aimed to determine the significant clinical risk factors and develop the prediction model for IE in patients with GPB. Methods Data were obtained from medical records of hospitalized adult patients with GPB in our hospital from January 2016 to December 2020. IE was defined by the ‘definite’ group according to modified Duke criteria. The cohort was divided into training (80%) and test (20%) sets. We identified the association between clinical risk factors and the development of IE by logistic regression analyses. Significantly associated clinical risk factors in multivariate analysis were used in the prediction model. The area under the receiver operating characteristic curve (AUROC) was utilized to evaluate model performances. Results A total of 794 patients with GPB were included in the study. IE was diagnosed in 89 patients (11.2%). Among 21 selected clinical risk factors from univariate analysis, 10 variables, including the unknown origin of bacteremia, mechanical and bioprosthetic heart valve, duration of symptoms more than 7 days, presence of Roth spot, neurological symptoms, murmur, heart failure, number of positive hemoculture more than 2 specimens, and Staphylococcus aureus septicemia, were significantly associated with IE in multivariate analysis (Figure 1) and were utilized in the prediction model. The AUROC of prediction models were 0.943 and 0.865 in training and test sets, respectively. Conclusions Our prediction model based on clinical risk factors can precisely predict IE in patients with GPB. Using this model allows clinicians to address patients at risk and guide decision-making in which cases need an urgent and comprehensive workup for IE or a wait-and-see strategy.Figure 1
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Le, Lisa, Jesse Aguilar, Tracy Hill, Carlie Brewer, Cesar Gonzalez de Alba, Richard Friesen, Benjamin S. Frank, Dale Burkett, and Pei-ni Jone. "Abstract 8880: Utility of Telemedicine 3d Transesophageal Echocardiography in Interventional Procedures in Covid-19 Pandemic and Its Impact on Physician Learning." Circulation 144, Suppl_1 (November 16, 2021). http://dx.doi.org/10.1161/circ.144.suppl_1.8880.

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Background: Three-dimensional transesophageal echocardiography (3DTEE) is a diagnostic tool in cardiac procedures, but COVID-19 has made utility challenging. Training junior (JR) attendings and fellows in 3DTEE guidance cases in procedural rooms make it tough to maintain adequate social distance. Collaboration Live (CL) is an application on the ultrasound machine that allows for live communication and access to real time images with a remote user. The study aims were to assess the usefulness of CL during 3DTEE guided procedures and its impact on physician learning. Methods: 3DTEE was obtained in 8 cohorts ranging 4 - 52 years of age on the EPIQ ultrasound machine. CL was used in transcatheter atrial/ventricular septal defect closures, transvenous pacemaker lead placement, and Fontan fenestration closure. 3DTEE was directed by a senior (SR) 3D attending over CL at a remote workstation while a JR attending, cardiac fellow, and echocardiographer performed 3DTEE in the procedural room. A CL post survey was given . Wait time from received page to the start of TEE, TEE duration, fluoroscopy time, absorbed X-ray dose, and saved amount of personal protective equipment (PPE) was noted. Results: A JR attending was in 8/8 cases. CL decreased reliance on SR attending and improved independence in 86% of cases, and no change in 14%. A fellow was in 6/8 cases. CL decreased reliance on SR 3D attending and increased independence in 67% of cases, and no change in 33%. A SR attending was remotely present in all cases. CL allowed flexibility for SR attending in 89% of cases and no flexibility in 11%. Preferred learning skill, comfort performing/giving results over CL, learning/teaching impact, remote user wait time, reduced radiation exposure, and saved amount of PPE are shown in Table 1. Conclusions: CL is valuable in 3DTEE guidance procedures. It increases cost savings by reducing PPE and promotes learner independence. CL allows flexibility and reduces radiation exposure for remote users.
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Bruce, D., A. Ashdown, F. Focacci, and N. Stain. "Quality assurance in cardio-pulmonary exercise testing." European Journal of Cardiovascular Nursing 23, Supplement_1 (July 2024). http://dx.doi.org/10.1093/eurjcn/zvae098.116.

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Abstract Introduction Quality assurance (QA) ensures agreed standards are being met and facilitates service improvement. Recent government initiatives aiming to increase diagnostic activity to reduce wait times emphasises the importance of a robust framework to assess standards and drive improvement. Quality frameworks exist for other areas of cardiac diagnostics but there is limited information on assessing quality in cardio-pulmonary exercise testing (CPET). Purpose We aim to develop and pilot a quality assurance framework for CPET. This will facilitate further QA development in this area and drive continuous service improvement. Methods Data were collected from June to November 2023. A random sample of 10% of tests were selected each month. A total of 39 tests were included. Our framework consisted of 30 checks across four domains: Requesting, data quality, reporting, and documentation. Checks were assessed for compliance using a Red, Amber, Green (RAG) rating system. Green - compliant. Amber - minor deviation (e.g., minor deviation from spirometry repeatability criteria). Red - significant deviation (e.g., incorrectly plotted VO2 peak). An overall test rating was then given: Green (≤ 3 amber), Amber (4 – 5 amber) and Red (&gt; 5 amber or any red). Results The analysis comprised of individual domain checks and an overall test rating (OTR). Domain results (figure 1.) were: Requesting 95%; Data Quality; 89%, Reporting 96%; and Documentation 98%. OTRs (figure 2.) were as follows: Green (85%), Amber (13%) and Red (2%). Tests with a red OTR led to supportive discussions with operators, additional training and follow up QA. Protocol selection and spirometry repeatability were the most common individual check deviations (41% amber and 31% amber respectively). Conclusions Our QA framework showed that overall CPETs were being conducted to a high standard. There were however some variances identified which led to targeted staff training and additional audits to guide service improvement. Qualitative and subjective aspects of CPET make QA complex and a patient focused model should be employed. It is also salient to note that QA in CPET should be developed to be pragmatic and scalable to the service to ensure sustainability.Figure 1:Domain resultsFigure 2:Overall test rating
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48

Petrovic, Zvezdana, Olivia Clayton, Jan Matthews, Catherine Wade, Lina Tan, Denny Meyer, Antony Gates, Alex Almendingen, and Warren Cann. "Building the skills and confidence of early childhood educators to work with parents: study protocol for the Partnering with Parents cluster randomised controlled trial." BMC Medical Research Methodology 19, no. 1 (October 24, 2019). http://dx.doi.org/10.1186/s12874-019-0846-1.

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Abstract Background In the early years of life, the benefits of parental engagement in children’s learning are well documented. Early childhood educators are a potentially effective source of support, having opportunity to engage with parents on key issues related to children’s learning and development. Educators report a need for more practical strategies for building positive partnerships with the parents of children in their care. To address this need, we have developed a practice support system, Partnering with Parents, to guide educators in Early Childhood Education and Care (ECEC) through practical strategies for working with parents. Partnering with Parents is designed to be embedded in everyday service delivery. Methods Using a cluster randomised controlled trial (cRCT) with intervention and wait-list control groups, we aim to evaluate the effectiveness of the Partnering with Parents practice support system under normal service conditions. The intervention is being trialled in ECEC services across Victoria, Australia. Services in the intervention group implemented the 10-week intervention before the control group commenced the intervention. Educators and parents of children attending the participating services are taking part in evaluating the intervention by completing questionnaires online at three time points (before, immediately after, and 3 months after the intervention group received the intervention). Results One hundred eighteen educators and 302 parents recruited from 19 participating ECEC services have consented to take part in the trial. Conclusions There is considerable potential for ECEC services to improve everyday interactions with parents and potentially child outcomes, by implementing this practice support model. Future research in this field can examine long-term effects of improving the parent-educator relationship. The intervention has potential to be widely embedded in educator training or professional development. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000488101. Prospectively registered 25 March 2019.
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Goshtasbi, Khodayar, Brandon M. Lehrich, Mehdi Abouzari, Dariush Bazyani, Arash Abiri, Peter Papagiannopoulos, Bobby A. Tajudeen, and Edward C. Kuan. "Academic Rhinologists’ Online Rating and Perception, Scholarly Productivity, and Industry Payments." American Journal of Rhinology & Allergy, September 11, 2020, 194589242095836. http://dx.doi.org/10.1177/1945892420958366.

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Introduction The emergence of popular online rating websites, social media platforms, and public databases for industry payments and scholarly outputs provide a complete physician online presence which may guide choice and satisfaction. Methods Websites of all U.S. otolaryngology academic institutions were queried for fellowship-trained rhinologists. Additional well-known and academically active rhinologists were identified by the senior author. Online ratings and comments were collected from Google, Healthgrades, Vitals, and RateMD websites, and weighted rating scores (RS) were calculated on a 1–5 scale. Results A total of 210 rhinologists with 16 ± 9 years of practice were included, where 6901 online ratings (33 ± 47 per rhinologist) provided an average RS of 4.3 ± 0.6. RS was not different according to gender ( p = 0.58), geographic quartile ( p = 0.48), social media presence ( p = 0.41), or attending top-ranked medical school ( p = 0.86) or residency programs ( p = 0.89). Years of practice negatively correlated with RS (R = –0.22, p<0.01), and academic ranking significantly influenced RS, with professors, associate professors, and assistant professors scoring 4.1 ± 0.6, 4.3 ± 0.4, and 4.4 ± 0.6, respectively ( p = 0.03). Of the 3,304 narrative comments analyzed (3.1 ± 11.6 per rhinologist), 76% (positive) and 7% (negative) had elements of clinical knowledge/outcomes, 56% (positive) and 7% (negative) of communication/bedside manner, and 9% (positive) and 7% (negative) of office staff, cost, and wait-time. All negative comment categories had moderate negative correlation with RS, while positive comment categories regarding knowledge/competence and bedside manner weakly correlated with higher RS. Number of publications (48 ± 54) positively correlated with 2018 industry payments ($11,384 ± $19,025) among those receiving industry compensation >$300 (n = 113). Attending a top-ranked medical school was associated with higher industry payments ( p<0.01) and H-index ( p = 0.02). Conclusion Academic rhinologists’ online RS was not associated with gender, geographic location, or attending a top-ranked training program, and their scholarly productivity was significantly correlated with total industry payments.
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Santos, Carina Mota, Maria Emília Costa, Brian Jensen Higginbotham, and Mariana Veloso Martins. "A web-based psychoeducational simulation game for adults in stepfamilies (GSteps)—study protocol for a randomized controlled feasibility trial." Frontiers in Psychology 13 (November 24, 2022). http://dx.doi.org/10.3389/fpsyg.2022.1020979.

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BackgroundStepfamilies are a prevalent family form. However, less stable than nuclear, first marriage families due to the presence of risk factors such as the absence of social norms and the presence of stepchildren. Stepfamilies have unique educational needs regarding stepparenting and co-parenting issues. The development and documentation of psychoeducational intervention strategies can facilitate dissemination of ongoing studies and promote transparency. This article describes the background, design and protocol of a randomized controlled trial (RCT) evaluating the eficacy and feasibility of a web-based Psychoeducational Simulation Game (GSteps). Behavior-modeling video training (BMT) is used to demonstrate and promote relational skills, stepparenting and co-parenting effective strategies for adults in stepfamilies. A mental health professional will be available within the GSteps platform for clarification or emotional support.Methods/designA RCT design is presented to evaluate the outcomes of a self-administered, interactive and web-based psychoeducational Game targeting dyadic marital adjustment and interpersonal skills as the primary outcomes and remarriage beliefs, family function and stepparenting and co-parenting attitudes as the secondary outcomes. Other outcome measures include satisfaction with GSteps, participants’ knowledge learned after the intervention and a purposive sampling method will be used to access feasibility. The minimum required sample size is 112 participants (56 per condition) randomly allocated either to an experimental group (EG), receiving GSteps intervention, or to a wait-list control group (CG). A survey is conducted electronically. Assessments take place at baseline (T0), after the intervention (T1) and 1-month follow-up (T2).DiscussionThis protocol presents a RCT aimed at evaluating the efficacy of a web-based psychoeducational intervention (GSteps) designed for improving marital, stepparenting and co-parenting skills in adults who live in stepfamilies. The use of the protocol and results of intervention studies may guide the use and refinement of web-based psychoeducational intervention for stepfamilies. Additionally, GSteps may become a tool for health professionals to enhance stepfamily functioning, stepparenting skills, and marital adjustment of remarried adults.
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