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Hausarztbasierte Interventionen zur Verringerung von Krankenhausaufenthalten bei zu Hause lebenden multimorbiden Patienten – ein Rapid Review
No full textBackground: Multimorbidity is a common health problem among patients treated in GP practices and often associated with an increased risk of hospitalization. The aim of this review was to identify GP-based interventions to reduce hospitalization in patients with multimorbidity who were evaluated in randomized controlled trials. Methods: For the rapid review, the databases Medline and CENTRAL were systematically searched for randomized controlled trials evaluating an effect of GP-based interventions on the duration or frequency of hospitalization in adult patients with multimorbidity living at home. The interventions and their effects were described narratively. Results: From 2,260 hits in the database searches, 15 studies could be included. The interventions identified included, amongst others, interdisciplinary cooperation, training of GPs and other practice staff, and increased patient centeredness. Hospital admissions were reported in 13 studies, and the number of days spent in hospital was reported in six studies. Two studies found a significant reduction in hospitalization. Conclusions: While most interventions were not effective, there were also two GP-based interventions for patients with multimorbidity which focused on the patients’ individual situation and contributed to avoiding hospitalization. However, more studies are needed to make reliable statements on the effectiveness of various measures
Defining Clinically Meaningful Thresholds for 12-Month Patient-Reported Outcomes in Total Hip Arthroplasty; Toward Improving Threshold Accuracy
No full textBackground: Clinically meaningful thresholds for patient-reported outcomes are relevant to define and predict success of total hip arthroplasties (THAs). Defining and offering thresholds must consider preoperative symptom severity. Methods: In this retrospective study of 40,213 primary total hip replacements registered in the Dutch Arthroplasty Register (2016-2018), receiver operating curve analysis was used to define minimal clinically important changes and patient-acceptable symptom states with the anchor transition in function. Subgroups were identified for which independent thresholds should be defined. Patient-reported outcome measures were symptoms (pain, Oxford Hip Score [OHS], Hip disability and Osteoarthritis Outcome Score) and quality of life (European Quality of Life 5 Dimensions 3L questionnaire). Results: 94.6% completed the anchor questions, of whom 80.1% reporting “much improved function” 1 year after surgery. Discriminative abilities of thresholds were not good (area under the curve < 0.8). Tercile-specific determination of thresholds improved discrimination and reliability (+10%). Minimal clinically important change values were higher for all outcomes (eg, change in OHS = 24.5 vs = 10.5) in patients with more severe preoperative symptoms. Patient-acceptable symptom state scores for European Quality of Life 5 Dimensions index (= 0.809) and OHS (= 40.5) showed good discrimination (area under the curve > 0.8). Patients with less symptoms required lower postoperative scores for reporting “much improved function” (postoperative OHS = 38.5 vs 42.5). Tercile-specific thresholds did not improve accuracy of thresholds (Cohens kappa 42%). Conclusions: The present study demonstrates that patients with more severe preoperative symptoms require greater change scores to achieve clinically relevant improvements than patients with less severe preoperative symptoms. This study suggests that current one-size-fits-all thresholds for success of THA should be replaced with more nuanced thresholds. Level of evidence: Level III, Therapeutic Study
A perfused iPSC-derived proximal tubule model for predicting drug-induced kidney injury
No full textThe kidney is frequently exposed to high levels of drugs and their metabolites, which can injure the kidney and the proximal tubule (PT) in particular. In order to detect nephrotoxicity early during drug development, relevant in vitro models are essential. Here, we introduce a robust and versatile cell culture insert-based iPSC-derived PT model, which can be maintained in a microphysiological system for at least ten days. We demonstrate the model's ability to predict drug-induced PT injury using polymyxin B, cyclosporin A, and cisplatin, and observe that perfusion distinctly impacts our model's response to xenobiotics. We observe that the upregulation of metallothioneins that is described in vivo after treatment with these drugs is reliably detected in dynamic, but not static in vitro PT models. Finally, we use our model to alleviate polymyxin-induced nephrotoxicity by supplementing the antioxidant curcumin. Together, these findings illustrate that our perfused iPSC-derived PT model is versatile and well-suited for in vitro studies investigating nephrotoxicity and its prevention. Reliable and user-friendly in vitro models like this enable the early detection of nephrotoxic potential, thereby minimizing adverse effects and reducing drug attrition
From Theory to Practice:The Impact of Team-Based Learning on Medical Students’ Communication Skills
No full textIntroduction: Developing communication skills is essential for medical students to work in modern medical practice. A collaborative learning environment, such as Team-Based Learning (TBL), is a promising environment for developing communication skills. In this study, we investigated 1) how medical students self-report their communication skills in a TBL environment and 2) to what extent students perceive a TBL environment as contributing to their communication skills development. Method: We conducted a quantitative study with a qualitative element involving Brazilian undergraduate medical students from one Medical School. Participants completed the Interpersonal Communication Competence Scale and the Team-Based Learning Environment Scale, including an open-ended question. We used ANOVA to compare responses across the seven semesters and thematic analysis for the open-ended responses. Results: Of the 416 students invited, 307 (74%) responded to both scales. Students had high scores on communication skills. Students highly valued the contribution of five domains of the TBL learning environment: teachers’ decisions, teachers’ attitudes, students’ characteristics, team characteristics, and contextual factors. The sixth domain, formative assessment, was highly valued by first-year students with a downward trend across semesters. Key factors contributing to communication skills development were teachers’ alignment with the educational methodology and students’ attitudes within teams. Additionally, students noted that their perception of safety and trust to provide feedback influenced their communication skills development. Conclusion: These findings suggest that a TBL environment can maintain students’ communication skills. Various elements of the TBL environment play a role here, particularly teachers’ alignment, students’ attitudes, and a supportive classroom atmosphere
Social Media as Input for Recruiment:Does Women's Relationship History Affect Candidate Evaluations?
No full textWe examine whether information about a female candidate's relationship history, obtained from social media profiles, affects evaluations of her suitability for a student union board position. Moreover, we investigate whether it is possible to mitigate any bias against women with multiple partners by providing information about the origins of prejudice. We utilized a 2 (relationship history: multiple vs. one partner(s)) X 2 (mitigating information: explaining prejudice against promiscuous women vs. explaining prejudice against outgroups) experimental design across two studies. Participants were female students (Study 1: n = 209 American students; Study 2; n = 119 European students), who indicated whether they would hire the applicant for a job, and evaluated this applicant. Results show that generally, participants tended to evaluate the candidate with multiple partners less positively than the candidate with only one partner: They were less likely to hire her (Study 1), evaluated her less positively (Study 1), and considered her less of a fit with the organization (Study 1 and 2). The results regarding providing additional information were not consistent. Our findings suggest that private social media information can influence applicant evaluations and hiring decisions, and therefore organizations should be careful when utilizing social information in recruitment processes. </p
Incidence of premature battery depletion in subcutaneous cardioverter-defibrillator patients: insights from a multicenter registry
No full textBackground: The subcutaneous ICD established its role in the prevention of sudden cardiac death in recent years. The occurrence of premature battery depletion in a large subset of potentially affected devices has been a cause of concern. The incidence of premature battery depletion has not been studied systematically beyond manufacturer-reported data. Methods: Retrospective data and the most recent follow-up data on S-ICD devices from fourteen centers in Europe, the US, and Canada was studied. The incidence of generator removal or failure was reported to investigate the incidence of premature S-ICD battery depletion, defined as battery failure within 60 months or less. Results: Data from 1054 devices was analyzed. Premature battery depletion occurred in 3.5% of potentially affected devices over an observation period of 49 months. Conclusions: The incidence of premature battery depletion of S-ICD potentially affected by a battery advisory was around 3.5% after 4 years in this study. Premature depletion occurred exclusively in devices under advisory. This is in line with the most recently published reports from the manufacturer. Trial registration: ClinicalTrials.gov Identifier: NCT04767516.</p
‘It’s like two different worlds’:The multifaceted nature of social support in students’ transition from high school to a problem-based learning undergraduate programme
No full textThe transition from high school to university often amounts to a muddled process, making it both an exciting and challenging time for many undergraduate students. Integrating both academically and socially is key in this respect. Social support from peers and teaching staff, but also from family and friends, can have a decisive impact. A learning environment in which one would expect social support to be more evident, is Problem-Based Learning (PBL). Here, learning revolves around small, collaborative groups, with closer ties between students and teaching staff. We explore the role of social support in a PBL environment by looking at students’ experiences in- and outside the classroom. Based on fourteen in-depth student interviews, we find that the requirements of a PBL environment – particularly in terms of self-regulated learning, workload, and pace – can be a source of stress. As such, students encounter familiar transition problems concerning the inter-related issues of independence, structure, and well-being, and family and friends play a key role in dealing with these issues. However, PBL can also stimulate social support and help students integrate, especially through its emphasis on work in smaller groups and the structure offered by regular meetings
Brief Report:Determinants of Potential Sexual Activity Reduction in the Face of the Mpox Epidemic
Get PDFBackground: The current mpox epidemic is most prevalent among men-who-have-sex-with-men (MSM). Vaccination programs are being rolled-out to curb the epidemic. Behavioural measures have been called for as well, for example, by the WHO and national public health authorities to reduce the number of sexual partners and sexual activity. We investigated intentions and determinants among Dutch MSM to follow such behavioural measures. Methods: Early in July 2022, in the context of a dynamic ongoing epidemic, 394 MSM answered an online questionnaire investigating concepts such as perceived mpox risk, vaccination and behavioural change intentions and collecting socio-demographic and sexual behaviour information. Results: The overall intentions to reduce number of partners and sexual activity were high, but only a minority had developed definite intentions. Determinant analysis revealed that dating/open relationship status was a positive predictor; vaccination intentions did not predict sexual behaviour change; those not on PrEP were more likely to change their sexual behaviour. Mpox infection concern was the main predictor for behaviour change intentions. Conclusions: Our results show that behavioural measures to avoid an mpox infection are present in majority of participants in our survey, but high intentions are held by a minority. Taking the historic complexity of behavioural change pleas among MSM into account sensitive, additional public health measures are necessary to reach and to inform MSM about potential benefits of sexual behaviour change
Gender differences in collaboration and career progression in physics
No full textWe examine gender differences in collaboration networks and academic career progression in physics. We use the likelihood and time to become a principal investigator (PI) and the length of an author’s career to measure career progression. Utilizing logistic regression and accelerated failure time models, we examine whether the effect of collaboration behaviour varies by gender. We find that, controlling for the number of publications, the relationship between collaborative behaviour and career progression is almost the same for men and women. Specifically, we find that those who eventually reach PI status tend to have published with more unique collaborators. In contrast, publishing repeatedly with the same highly interconnected collaborators and/or larger number of co-authors per publication is characteristic of shorter career lengths and not attaining PI status. We observe that women tend to collaborate in more tightly connected and larger groups than men. Finally, we observe that women are less likely to attain the status of PI throughout their careers and have a lower survival probability compared to men, which calls for policies to close this crucial gap
