51628 research outputs found
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Teams in Transition
No full textResearch has shown that team reflection is a critical transition process for coordination processes and team performance, but our understanding of its dynamics and relationship to action processes and performance is incomplete. The goal of the present study was to examine the long-term change in reflection in teams over time and explore whether these changes are related to implicit and explicit coordination processes and performance improvement. Drawing on the recurring phase model of team processes and team reflexivity theory, we hypothesized that team reflection is at least stable or increases over time for dissimilar tasks, that reflection trajectories are positively associated with implicit and negatively associated with explicit coordination in the later phases, and that implicit coordination mediates the relationship between team reflection and performance improvement. This model was tested in a three-wave longitudinal study (N = 175 teams) over a 2-months period. Results from growth curve modeling and structural equation modeling provided support for our hypotheses.</p
Nationwide treatment and outcomes of perihilar cholangiocarcinoma
No full textBackground: Perihilar cholangiocarcinoma (pCCA) is a rare tumour that requires complex multidisciplinary management. All known data are almost exclusively derived from expert centres. This study aimed to analyse the outcomes of patients with pCCA in a nationwide cohort. Methods: Data on all patients diagnosed with pCCA in the Netherlands between 2010 and 2018 were obtained from the Netherlands Cancer Registry. Data included type of hospital of diagnosis and the received treatment. Outcomes included the type of treatment and overall survival. Results: A total of 2031 patients were included and the median overall survival for the overall cohort was 5.2 (95% CI 4.7-5.7) months. Three-hundred-ten (15%) patients underwent surgical resection, 271 (13%) underwent palliative systemic treatment, 21 (1%) palliative local anti-cancer treatment and 1429 (70%) underwent best supportive care. These treatments resulted in a median overall survival of 29.6 (95% CI 25.2-34.0), 12.2 (95% CI 11.0-13.3), 14.5 (95%CI 8.2-20.8) and 2.9 (95% CI 2.6-3.2) months respectively. Resection rate was 13% in patients who were diagnosed in non-academic and 32% in academic centres (P <.001), which resulted in a survival difference in favour of academic centres. Median overall survival was 9.7 (95% CI 7.7-11.7) months in academic centres compared to 4.9 (95% CI 4.3-5.4) months in non-academic centres (P <.001). Conclusions: In patients with pCCA, resection rate and overall survival were higher for patients who were diagnosed in academic centres. These results show population-based outcomes of pCCA and highlight the importance of regional collaboration in the treatment of these patients.</p
Dupilumab treatment in patients with atopic dermatitis
No full textBackground: Dupilumab was equally effective among all racial subgroups in clinical trials, but a direct comparison in daily practice is lacking. Objectives: To investigate the effectiveness of dupilumab in patients with atopic dermatitis (AD) in the Netherlands and Japan over 80 weeks of treatment. Methods: A longitudinal comparative cohort study was conducted in patients with AD who were treated with dupilumab in daily practice. We used linear mixed-effects models to determine changes over time. Results: We found statistically significant differences in sex, disease onset, body mass index and therapeutic history between Dutch (n = 208) and Japanese (n = 153) patients. The baseline Eczema Area and Severity Index (EASI) score was higher in Japanese patients (23·8 vs. 14·8), while baseline Patient-Reported Outcome Measures (PROMs) were higher in Dutch patients. EASI scores decreased quickly to a level indicating ‘mild disease’ (EASI < 7), and remained low in both countries. However, PROMs showed different trajectories with better scores in Japan. Conclusions: Dupilumab showed significant, comparable and sustained improvement of EASI scores in Japanese and Dutch patients. However, we found striking differences in the effect on PROMs between the countries, with a better outcome in Japanese patients.</p
Whole-body movements increase arm use outcomes of wrist-worn accelerometers in stroke patients
No full textWrist-worn accelerometers are often applied to measure arm use after stroke. They measure arm movements during all activities, including whole-body movements, such as walking. Wholebody movements may influence clinimetric properties of arm use measurements—however, this has not yet been examined. This study investigates to what extent arm use measurements with wrist-worn accelerometers are affected by whole-body movements. Assuming that arm movements during whole-body movements are non-functional, we quantify the effect of whole-body movements by comparing two methods: Arm use measured with wrist-worn accelerometers during all wholebody postures and movements (P&M method), and during sitting/standing only (sit/stand method). We have performed a longitudinal observational cohort study with measurements in 33 stroke patients during weeks 3, 12, and 26 poststroke. The P&M method shows higher daily paretic arm use outcomes than the sit/stand method (p < 0.001), the mean difference increased from 31% at week three to 41% at week 26 (p < 0.001). Differences in daily paretic arm use between methods are strongly related to daily walking time (r = 0.83–0.92). Changes in the difference between methods are strongly related to changes in daily walking time (r = 0.89). We show that not correcting arm use measurements for whole-body movements substantially increases arm use outcomes, thereby threatening the validity of arm use outcomes and measured arm use changes.</p
Associations of thrombus perviousness derived from entire thrombus segmentation with functional outcome in patients with acute ischemic stroke
No full textThrombus perviousness is strongly associated with functional outcome and intravenous alteplase treatment success in patients with acute ischemic stroke. Accuracy of thrombus attenuation increase (TAI) assessment may be compromised by a heterogeneous thrombus composition and interobserver variations of currently used manual measurements. We hypothesized that TAI is more strongly associated with clinical outcomes when evaluated on the entire thrombus. In 195 patients, five TAI measures were performed: one manual by placing three regions of interest (TAImanual) and four automated ones assessing densities from the entire thrombus. The automated TAI measures were calculated by comparing quartiles; Q1, Q2, and Q3 of the non-contrast and contrast enhanced thrombus density distribution and using the lag of the maximum of the cross correlations (MCC). Associations with functional outcome (mRS at 90 days) were assessed with univariate and multivariable analyses. All entire TAI measures were significantly associated with functional outcome with odd ratios (OR) of 1.63(95 %CI:1.19–2.25, p = 0.003) for Q1, 1.56(95 %CI:1.16–2.10, p = 0.003) for Q2, 1.24(95 %CI:1.00–1.54, p = 0.045) for Q3, and 1.70(95 %CI:1.24–2.34, p = 0.001) for MCC per 10 HU increase in univariate models. TAImanual was not significantly associated with functional outcome (p = 0.055). In the multivariable logistic regression models including age, NIHSS, and recanalization, only TAI measures derived from the entire thrombus were independently associated with favorable outcome; OR of 1.64(95 %CI:1.01–2.66, p = 0.048) for Q2 and 1.82(1.13–2.95, p = 0.014) for MCC per 10 HU increase of thrombus attenuation. The novel perviousness measures of the entire thrombus are more strongly associated with functional outcome than the traditional manual perviousness assessments.</p
Transcatheter Repair and Replacement Technologies for Mitral Regurgitation
No full textPurpose of Review: We aimed to picture the contemporary landscape of available catheter-based repair and replacement solutions for mitral regurgitation (MR) in Europe. Recent Findings: Edge-to-edge repair remains the dominant technique for transcatheter mitral valve repair especially in the context of secondary mitral regurgitation. Two recent randomized trials reported seemingly contradicting clinical results with transcatheter edge-to-edge repair for patients with heart failure and severe secondary MR. A proportionality framework related to secondary MR was proposed to help explain inconsistencies but requires further research. (In)Direct annuloplasty primarily aims to correct secondary MR; however, the scientific basis seems less robust. One dedicated transcatheter heart valve has the CE mark for mitral valve replacement but requires transapical access. Balloon-expandable transcatheter aortic valve platforms are emerging for transvenous transseptal mitral replacement in the context of mitral annular calcification, a failing surgical mitral bioprosthesis, or annuloplasty. Advanced computed tomography imaging techniques improved pre-procedural planning and introduced the option for modeling and simulation. Summary: Development of a toolbox of catheter-based technologies, complementary imaging modalities, and refined patient selection offer novel perspectives to high-risk patients with primary or secondary MR. Clinical trials are required to help formulate evidence-based guidelines for the management of mitral valve disease.</p
Effect of a Radiotherapeutic Megavoltage Beam on Ultrasound Contrast Agents
No full textCollateral damage to healthy surrounding tissue during conventional radiotherapy increases when deviations from the treatment plan occur. Ultrasound contrast agents (UCAs) are a possible candidate for radiation dose monitoring. This study investigated the size distribution and acoustic response of two commercial formulations, SonoVue/Lumason and Definity/Luminity, as a function of dose on clinical megavoltage photon beam exposure (24 Gy). SonoVue samples exhibited a decrease in concentration of bubbles smaller than 7 µm, together with an increase in acoustic attenuation and a decrease in acoustic scattering. Definity samples did not exhibit a significant response to radiation, suggesting that the effect of megavoltage photons depends on the UCA formulation. For SonoVue, the influence of the megavoltage photon beam was especially apparent at the second harmonic frequency, and can be captured using pulse inversion and amplitude modulation (3.5-dB decrease for the maximum dose), which could eventually be used for dosimetry in a well-controlled environment.</p
Prognostic Factors in Open Triangular Fibrocartilage Complex (TFCC) Repair
No full textPurpose: Patients with triangular fibrocartilage complex (TFCC) injury report ulnar-sided wrist pain and impaired function. Open TFCC repair aims to improve the condition of these patients. Patients have shown reduction in pain and improvement in function at 12 months after surgery; however, results are highly variable. The purpose of this study was to relate patient (eg, age and sex), disease (eg, trauma history and arthroscopic findings), and surgery factors (type of bone anchor) associated with pain and functional outcomes at 12 months after surgery. Methods: This study included patients who underwent an open TFCC repair between December 2011 and December 2018 in various Xpert Clinics in the Netherlands. All patients were asked to complete Patient-Rated Wrist Evaluation (PRWE) questionnaires at baseline as well as at 12 months after surgery. Patient, disease, and surgery factors were extracted from digital patient records. All factors were analyzed by performing a multivariable hierarchical linear regression. Results: We included 274 patients who had received open TFCC repair and completed PRWE questionnaires. Every extra month of symptoms before surgery was correlated with an increase of 0.14 points on the PRWE total score at 12 months after surgery. In addition, an increase of 0.28 points in the PRWE total score at 12 months was seen per extra point of PRWE total score at baseline. Conclusions: Increased preoperative pain, less preoperative function, and a longer duration of complaints are factors that were associated with more pain and less function at 12 months after open surgery for TFCC. This study arms surgeons with data to predict outcomes for patients undergoing open TFCC repair. Type of study/level of evidence: Prognostic II.</p
Prevalence and clinical features of hepatitis E virus infection in pregnant women
No full textBackground and aim: Hepatitis E virus (HEV) infection causes severe maternal and fetal outcomes in pregnant women. These patients are exclusively from resource-limited regions with genotype 1 HEV infection, but not from western countries with genotype 3 prevalence. Since the circulating strains in China have evolved from the waterborne genotype 1 to the zoonotic genotype 4 HEV in the past decades, this study aims to evaluate the prevalence and clinical features of HEV infection in a large cohort of pregnant women in Inner Mongolia, China. Methods: A total of 3278 pregnant women who visited the Inner Mongolia Maternal and Child Care hospital during 2018 were enrolled. Serum samples were examined for anti-HEV IgG and anti-HEV IgM antibodies using ELISA. Demographic information, results of clinical biochemical tests, maternal and neonatal outcomes were collected. Results: Among the recruited 3278 pregnant women, 6.0% were anti-HEV IgG antibody positive, 0.3% were anti-HEV IgM antibody positive and 0.3% were positive for both anti-HEV IgG and anti-HEV IgM antibodies. HEV viral RNA was not detected. Pregnant women with recent/ongoing HEV infection indicated by anti-HEV IgM positivity have slightly higher ALT level, and potential risk of developing hyperlipidemia, preterm delivery and neonatal jaundice. Conclusions: These findings indicated that HEV infection is associated with a possible increase in adverse maternal, fetal and neonatal outcomes in our cohort. Thus, the burden of HEV infection in pregnant women in China appears distinct from resource-limited regions and western countries. Nevertheless, future studies are required to confirm and extend our findings.</p
Concave/convex weighting and utility functions for risk
No full textThis paper analyzes concave and convex utility and probability distortion functions for decision under risk (law-invariant functionals). We characterize concave utility for virtually all existing models, and concave/convex probability distortion functions for rank-dependent utility and prospect theory in complete generality, through an appealing and well-known condition (convexity of preference, i.e., quasiconcavity of the functional). Unlike preceding results, we do not need to presuppose any continuity, let be differentiability. An example of a new light shed on classical results: whereas, in general, convexity/concavity with respect to probability mixing is mathematically distinct from convexity/concavity with respect to outcome mixing, in Yaari's dual theory (i.e., Wang's premium principle) these conditions are not only dual, as was well-known, but also logically equivalent, which had not been known before.</p