Understanding the Technical Implementation of a Clinical Decision Support SmartApp: A Qualitative Analysis

CONCERN is a SmartApp that identifies patients at risk for deterioration. This study aimed to understand the technical components and processes that should be included in our Implementation Toolkit. In focus groups with technical experts five themes emerged: 1) implementation challenges, 2) implementation facilitators, 3) project management, 4) stakeholder engagement, and 5) security assessments. Our results may aid other teams in implementing healthcare SmartApps.

Simulation in airway management teaching and training

There is a gradual shift in training and teaching methods in the medical field. We are slowly moving from the traditional model and adopting active learning methods like simulation-based training. Airway management is an essential clinical skill for any anaesthesiologist, and a trained anaesthesiologist must perform quick and definitive airway management using various techniques. Airway simulations have been used for the past few decades. It ensures active involvement, upgrading the trainees' airway management knowledge and skills, including basic airway skills, invasive procedures, and difficult clinical scenarios. Trainees also learn non-technical skills such as communication, teamwork, and coordination. A wide range of airway simulators are available. However, texture surface characteristics vary from one type to another. The simulation-based airway management training requires availability, understanding, faculty development, and a structured curriculum for effective delivery. This article explored the available evidence on simulation-based airway management teaching and training.

Musculoskeletal ultrasound: a technical and historical perspective

During the past four decades, musculoskeletal ultrasound has become popular as an imaging modality due to its low cost, accessibility, and lack of ionizing radiation. The development of ultrasound technology was possible in large part due to concomitant advances in both solid-state electronics and signal processing. The invention of the transistor and digital computer in the late 1940s was integral in its development. Moore's prediction that the number of microprocessors on a chip would grow exponentially, resulting in progressive miniaturization in chip design and therefore increased computational power, added to these capabilities. The development of musculoskeletal ultrasound has paralleled technical advances in diagnostic ultrasound. The appearance of a large variety of transducer capabilities and rapid image processing along with the ability to assess vascularity and tissue properties has expanded and continues to expand the role of musculoskeletal ultrasound. It should also be noted that these developments have in large part been due to a number of individuals who had the insight to see the potential applications of this developing technology to a host of relevant clinical musculoskeletal problems. Exquisite high-resolution images of both deep and small superficial musculoskeletal anatomy, assessment of vascularity on a capillary level and tissue mechanical properties can be obtained. Ultrasound has also been recognized as the method of choice to perform a large variety of interventional procedures. A brief review of these technical developments, the timeline over which these improvements occurred, and the impact on musculoskeletal ultrasound is presented below.

Anatomical and Technical Considerations of Robot-Assisted Cervical Pedicle Screw Placement: A Cadaveric Study

STUDY DESIGN

Cadaver study.

OBJECTIVES

Assess the feasibility of robot-assisted cervical pedicle screw (RA-CPS) placement and understand the anatomical considerations of this technique.

METHODS

Four cadaver specimens free from bony pathology were acquired. Anatomical considerations, such as pedicle width (PW) and height (PH), transverse pedicle angle (TPA), and maximal screw length (MSL), were recorded from preoperative computational tomography (CT) scans. Intraoperative cone-beam CT was acquired and registered to the robotic system. After cervical levels were segmented, screw sizes and trajectories were planned, and RA-CPS were placed. Accuracy was assessed using Gertzbein and Robbin's classification on postoperative CT scans.

RESULTS

Thirty-five RA-CPS were placed. Major breaches (≥Grade C) occurred in 28.57% screws. Grade A or B accuracy was found in 71.43% of screws, with the most common direction of breach being medial (81.3%). The greatest proportion of breach per level occurred in the upper subaxial levels, (C3:71.4%, C4 66.6%, C5:50%) which had the smallest PW (C3: 4.34 ± .96 mm, C4: 4.48 ± .60, C5: 5.76 ± 1.11). PH was greatest at C2 (8.14 ± 1.89 mm) and ranged subaxial from 6.36 mm (C3) to 7.48 mm (C7). The mean PW was 5.37 mm and increased caudally from 4.34 mm (C3) to 6.31 mm (C7). The mean TPA was 39.9° and decreased moving caudally 46.9°) to C7 (34.4°). The MSL was 37.1 mm and increased from C2 (26.3 mm) to C7 (41.0 mm).

CONCLUSION

RA-CPS has the potential to be feasible, but technological and instrument modifications are necessary to increase the accuracy in the cervical region.

Mental Fatigue Impairs Tackling Technique in Amateur Rugby Union Players

PURPOSE

To test the effects of mental fatigue (MF) on tackling technique on the dominant and nondominant shoulders in rugby union.

METHODS

Twenty male amateur rugby union players and a total of 953 tackles were analyzed. A randomized crossover counterbalanced design was used across a non-MF (control) and an MF condition. During each condition, each player performed 24 tackles, divided into 4 sets of 6 tackles (3 tackles on each shoulder). In the MF condition, players performed the Stroop Task between each set of tackles. A video recording of each tackle was used to evaluate each player's technical proficiency. A score of 1 point was awarded if a specific technique was performed correctly, and 0 point was given if not. The total score, measured in arbitrary units (AU) out of 11, represents the player's overall tackling proficiency.

RESULTS

Overall, players displayed a significantly lower technical proficiency score in the MF condition compared to control (set 2: control 7.30 [7.04-7.57] AU vs MF 6.91 [6.70-7.12] AU, P = .009, effect size (ES) = 0.30 small and set 3: control 7.34 [7.11-7.57] AU vs MF 6.88 [6.66-7.11] AU, P = .002, ES = 0.37 small). For the nondominant shoulder, players had a significantly lower technical proficiency score during the MF condition at set 2 (control 7.05 [6.68-7.41] AU vs MF 6.69 [6.42-6.96] AU, P = .047, ES = 0.29 small) and set 3 (control 7.14 [6.83-7.45] AU vs MF 6.61 [6.35-6.87] AU, P = .007, ES = 0.49 small).

CONCLUSIONS

MF can diminish a player's overall tackling proficiency, especially when tackling on the nondominant shoulder. The physiological mechanism for this finding may be impaired executive function and suboptimal functioning of neural signals and pathways, which result in less skillful coordination of movement. To further understand and explain MF-induced physiological changes in tackling, the feasibility of monitoring brain activity (such as electroencephalogram) and neuromuscular function (such as electromyogram) needs to be investigated. The findings from this study may also contribute to the development of more effective tackle training programs for injury prevention and performance.

13-year follow-up of a randomized controlled study on zirconia and titanium abutments

OBJECTIVES

To assess survival rates and compare technical, biological, and esthetic outcomes of customized zirconia and titanium abutments at 13 years post loading.

MATERIALS AND METHODS

Initially, 22 patients with 40 implants in posterior regions were included. The sites were randomly assigned to 20 customized zirconia abutments with cemented all ceramic crowns (ACC) and 20 customized titanium abutments with cemented metal ceramic crowns (MCC). At a mean follow-up of 13.4 years, patients were examined and implants/restorations assessed for survival and technical complications, as well as biological and esthetic outcomes (pocket probing depth [PPD], bleeding on probing [BOP], plaque control record [PCR], bone level [BL], papilla index [PAP], mucosal thickness, and recession (distance of the margo mucosae [MM]/margo gingivae MG)). Descriptive analyses were performed for all outcome measures.

RESULTS

Fifteen patients with 21 abutments (13 zirconia, 8 titanium) were examined at 13 years. The drop-out rate was 25% (patient level). The technical survival rate of the abutments was 100%. The survival rate on the restorative level (crowns) was 100%. The assessed biological outcomes (PPD, PCR, BOP, BL) and esthetic outcomes (MG, PAP) were similar.

CONCLUSIONS

Zirconia and titanium abutments supporting single implant-borne restorations rendered a high survival rate and minimal differences in terms of technical, biological, and esthetic outcomes at 13 years of follow-up.

Incidental scan findings in cardiac amyloid scintigraphy

When interpreting amyloid scintigraphy the nuclear cardiology physician should be aware of incidental image findings that may interfere with scan interpretation and may be of potential clinical significance. As for other nuclear cardiac imaging it is important to inspect the entire field of view of the planar and SPECT images. Correlation with the patient's history and physical examination is crucial in interpretation of these incidental findings.

Need for implementation of safe medication practice to avoid medication errors - A journey through case series

Patient safety is seriously threatened by medication errors. Pharmacological therapy aims to accomplish particular therapeutic objectives that improve patient quality of life while reducing patient risk. To develop a clear plan for minimizing medication errors and establishing safe and effective medication practices, the study's major goal is to identify the key locations at which medication errors usually occur. The five scenarios presented here demonstrate the frequent errors that took place, including communication problems, technical errors, rule-based errors, and knowledge-based errors. Patients' quality of life must be improved by educating both patients and healthcare workers on safe medication practices. This involves monitoring for and recognizing errors, reporting them in a blame-free environment, analyzing their root causes, changing procedures on the lessons learned, and ongoing monitoring.

A Digital Platform and Smartphone App to Increase Physical Activity in Patients With Type 2 Diabetes: Overview Of a Technical Solution

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12889-018-5026-4.

Understanding Transgender and Gender-Diverse Youth's Experiences Receiving Care via Telemedicine: Qualitative Interview Study

BACKGROUND

Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender-diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine.

OBJECTIVE

The purpose of this study was to explore these experiences to (1) inform necessary changes to the provision of pediatric gender-affirming care and (2) help providers and health systems determine if and how telemedicine should be made available post pandemic.

METHODS

Youth (aged 14-17 years) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semistructured interview exploring perceived advantages or disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by 2 research team members using an inductive thematic analysis framework.

RESULTS

A total of 15 TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (ie, initial vs return and complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care.

CONCLUSIONS

Given the variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care.

A holistic analysis of collective behaviour and team performance in Australian Football via structural equation modelling

Despite awareness of the importance of quantifying technical, tactical, and physical characteristics of match play, few studies have examined the structural relationship of these aspects in professional sport. Accordingly, this study concurrently examined these components in relation to quarter outcome (n = 272) in Australian Football. The study followed a retrospective longitudinal case study design where one teams' cooperative passing network, skill counts, physical loads, and spatiotemporal behaviours during official Australian Football League games were collected from a period spanning four seasons (2016-2019). A principal components analysis (PCA) and structural equation modelling were used to explore the structural relationships between components and examine the influence on quarter outcome as determined by the point differential (quarter margin). Scoring opportunity and ball movement had direct associations with quarter margin, while unpredictability, uncontested behaviour and physical behaviour did not. Negative associations between uncontested behaviour and scoring opportunity suggest that elevated high-pressure success and a lack of synchrony may positively influence scoring opportunity, a determinant of quarter margin. Further, negative associations between physical behaviour and ball movement suggest that with less physical work, a team's collective ability to transfer possession between teammates is facilitated, offering an interesting dichotomy between skill and physical demands of Australian Football. While hundreds of different metrics are available, the present study was the first to concurrently examine the influence of a variety of match play components on performance outcomes in Australian Football. These results may provide direction for coaches and practitioners when contemplating practice design, tactical strategies, or the development of behaviour through specific training exercises. Game plans and training drills that focus on optimising attacking and low-pressure ball movement coupled with high levels of mutual interaction between teammates may be beneficial for performance.

Cardiac lymphoma with early response to chemotherapy: A case report and review of the literature

Cardiac tumors are rare and benign masses account for the most part of the diagnosis. When malignant cancer is detected, primary or secondary cardiac lymphoma are quite frequent. Cardiac lymphoma may present as an intra or peri-cardiac mass or, rarely, it may diffusely infiltrate the myocardium. Although often asymptomatic, patients can have non-specific symptoms. Acute presentations with cardiogenic shock, unstable angina, or acute myocardial infarction are also described. Modern imaging techniques can help the clinicians not only in the diagnostic phase but also during administration of chemotherapy. A multidisciplinary counseling and serial multi-parametric assessment (echocardiography, cardiac troponin) seem to be the most effective approach to prevent possible fatal complications (i.e., cardiac rupture). Currently, only chemo- and radiotherapy are available options for treatment, but the prognosis remains poor. This is a case of secondary cardiac lymphoma presenting as a mediastinal mass with large infiltration of the heart and the great vessels with a good improvement after only one cycle of chemotherapy. It demonstrates the importance of an early diagnosis to modify the natural history of the disease.

Development and validation of the information security attitude questionnaire (ISA-Q) for nurses

AIM

The aim of the study was to understand nurses' information security attitudes towards patient information. This study developed the Information Security Attitude Questionnaire (ISA-Q) to measure the physical, technical and administrative aspects of information security for nurses and assessed its validity and reliability.

DESIGN

Cross-sectional study and scale development.

METHODS

Exploratory and confirmatory factor analyses and correlation analyses were performed to assess construct, discriminant and convergent validity; Cronbach's α and test-retest reliability were examined.

RESULTS

Exploratory and confirmatory factor analyses yielded a 6-factor, 30-item solution. Six factors accounted for 60.19% of the total variance. The confirmatory factor analysis was achieved through structural equation modelling. Discriminant and convergent validity were confirmed. The internal consistency of the ISA-Q was 0.94, and the test-retest reliability was 0.74. The ISA-Q is an appropriate questionnaire for identifying information security attitudes of nurses, making it useful for developing systematic performance methods to enhance nurses' information security levels.

Conventional, Speed Sintering and High-Speed Sintering of Zirconia: A Systematic Review of the Current Status of Applications in Dentistry with a Focus on Precision, Mechanical and Optical Parameters

The aim of this systematic review was to provide an overview of the technical and clinical outcomes of conventional, speed sintering and high-speed sintering protocols of zirconia in the dental field. Data on precision, mechanical and optical parameters were evaluated and related to the clinical performance of zirconia ceramic. The PICOS search strategy was applied using MEDLINE to search for in vitro and in vivo studies using MeSH Terms by two reviewers. Of 66 potentially relevant studies, 5 full text articles were selected and 10 were further retrieved through a manual search. All 15 studies included in the systematic review were in vitro studies. Mechanical, precision and optical properties (marginal and internal fit, fracture strength and modulus, wear, translucency and opalescence, aging resistance/hydrothermal aging) were evaluated regarding 3-, 4- and 5-YTZP zirconia material and conventional, high- and high-speed sintering protocols. Mechanical and precision results were similar or better when speed or high-speed sintering methods were used for 3-, 4- and 5-YTZP zirconia. Translucency is usually reduced when 3 Y-TZP is used with speed sintering methods. All types of zirconia using the sintering procedures performed mechanically better compared to lithium disilicate glass ceramics but glass ceramics showed better results regarding translucency.

Prosthetic failures in dental implant therapy

Both fixed and removable implant‐supported prostheses are well‐established methods for replacing missing teeth in partially or fully edentulous patients. Numerous systematic reviews have been performed in recent years to evaluate the survival and complication rates of implant‐retained fixed dental prostheses and implant‐retained overdentures, displaying high 5‐year survival rates ranging from 97.1% for fixed dental prostheses to 95%‐100% for implant‐retained overdentures. However, the survival rates only represent the prostheses remaining in use for a defined follow‐up time, and do not account for the potential prosthetic complications that may have arisen and influence the general success of the implant treatment. The most common technical complications of fixed implant‐retained single crowns are crown fracture, fractures of ceramic implant abutments, and esthetic problems. The predominant technical complication at multiple‐unit, implant‐retained fixed dental prostheses is fracture/chipping of the veneering ceramic. Reported technical complications for implant‐retained overdentures are overdenture fracture or chipping of the veneer materials, whereas mechanical complications include implant fracture, attachment failure, and attachment housing or insert complications. To reduce the risk of such failures, a comprehensive pretreatment diagnostic work‐up is essential, including defining the prosthetic goal with the aid of a wax‐up or set‐up and the associated ideal, prosthetically oriented three‐dimensional implant position. Furthermore, selection of the ideal type of prosthesis, including the respective implant components and materials, is important for clinical long‐term treatment success.

A systematic review and meta-analysis evaluating the survival, the failure, and the complication rates of veneered and monolithic all-ceramic implant-supported single crowns

Objective

To assess the survival, failure, and complication rates of veneered and monolithic all‐ceramic implant‐supported single crowns (SCs).

Methods

Literature search was conducted in Medline (PubMed), Embase, and Cochrane Central Register of Controlled Trials until September 2020 for randomized, prospective, and retrospective clinical trials with follow‐up time of at least 1 year, evaluating the outcome of veneered and/or monolithic all‐ceramic SCs supported by titanium dental implants. Survival and complication rates were analyzed using robust Poisson's regression models.

Results

Forty‐nine RCTs and prospective studies reporting on 57 material cohorts were included. Meta‐analysis of the included studies indicated an estimated 3‐year survival rate of veneered‐reinforced glass‐ceramic implant‐supported SCs of 97.6% (95% CI: 87.0%–99.6%). The estimated 3‐year survival rates were 97.0% (95% CI: 94.0%–98.5%) for monolithic‐reinforced glass‐ceramic implant SCs, 96.9% (95% CI: 93.4%–98.6%) for veneered densely sintered alumina SCs, 96.3% (95% CI: 93.9%–97.7%) for veneered zirconia SCs, 96.1% (95% CI: 93.4%–97.8%) for monolithic zirconia SCs and only 36.3% (95% CI: 0.04%–87.7%) for resin‐matrix‐ceramic (RMC) SCs. With the exception of RMC SCs (p < 0.0001), the differences in survival rates between the materials did not reach statistical significance. Veneered SCs showed significantly (p = 0.017) higher annual ceramic chipping rates (1.65%) compared with monolithic SCs (0.39%). The location of the SCs, anterior vs. posterior, did not influence survival and chipping rates.

Conclusions

With the exception of RMC SCs, veneered and monolithic implant‐supported ceramic SCs showed favorable short‐term survival and complication rates. Significantly higher rates for ceramic chipping, however, were reported for veneered compared with monolithic ceramic SCs.

[Primary repair with bioabsorbable anchor of anterior cruciate ligament in post-traumatic tibial avulsion at 2 years of follow-up]

INTRODUCTION

Anterior cruciate ligament injuries are common, however, tibial avulsions in adults are rare. The gold standard continues to be reconstruction. In recent years, primary repairs have been reported in femoral side lesions by bioabsorbable anchorage.

CLINICAL CASE

We present the case of a primary repair of the anterior cruciate ligament in tibial avulsion in a patient 19 years old after presenting direct trauma with added injuries of the posterior cruciate ligament and posterolateral corner. Primary repair was performed by transtendon portal with suture of the anterior cruciate ligament with FiberTape and FiberWire and fixed with 4.75 mm SwiveLock anchor in tibial footprint.

RESULTS

At 24 months of surgery he is with independent gait, complete range of motion, with clinical assessment scales, Tegner before the injury and after the injury at a level 6, Lysholm scale 91, subjective International Knee Documentation Committee (IKDC) 73.6, objective IKDC in C and EQ-5D 0.79.

CONCLUSION

The avulsion of ACL on its tibial side can be repaired in certain conditions with adequate evolution and satisfaction for the patient.

How body composition techniques measure up for reliability across the age-span

BACKGROUND

Reliability of body composition measurement techniques is essential to the accurate reporting of intervention outcomes. However, the between-day precision error of commonly used techniques, as well as the reference multi-compartment model, in a population-representative sample are currently unknown.

OBJECTIVES

To quantify technical and biological precision error of body composition techniques in comparison to the referent 4-compartment (4C) model.

METHODS

Men and women (1:1 ratio; 18-85 years old; n = 90) completed 2 consecutive-day body composition testing sessions, including individual components of the referent 4C model. Testing was undertaken in accordance with best practice guidance for each technique, including standardized presentation and a consistent time of day. Repeat measurements were conducted on day 1 for technical precision, and between-day measurements were conducted for biological precision quantification.

RESULTS

On average, all measurements met acceptable error limits and presented typically low technical and biological error [<2% fat-free mass (FFM) and < 3% fat mass (FM) precision error]. For technical precision of FFM, all techniques met a priori cut points (80%; CV = 0.45-0.81%). For FM, all techniques were equivalent to the best-rating method on average (CV = 0.78-1.35%), except air displacement plethysmography (CV = 2.13%). For biological precision, only 3-compartment (3C) and 4C equations sufficiently met the a priori determined cut point for estimates for FFM (CV = 0.77-0.79%), and only DXA met the 80% cut point (CV = 1.17%) for FM.

CONCLUSIONS

The primary purpose of a study design is imperative when deciding on body composition assessment techniques used for longitudinal measurements. If reliable longitudinal assessments of FFM are central, a 3C or 4C model may be indicated. If FM is a primary outcome, DXA may be preferable. However, considering the low error rates presented within the current study across a broad age span of healthy adults with implementation of best-practice guidelines, any technique assessed here may be used, provided that strict protocols are adhered to.

Financial benchmarking on dairy farms: Exploring the relationship between frequency of use and farm performance

The importance of financial benchmarking has increased in recent years as European Union milk quota abolition has facilitated rapid change in the dairy sector. This study evaluates the association between usage frequency of a financial benchmarking tool [Profit Monitor (PM)] and farm changes on spring-calving pasture-based dairy farms. To this end, physical and financial data for 5,945 dairy farms, representing 20,132 farm years, for the years 2010 to 2018 were used. Farms were categorized by frequency of annual financial benchmarking over the 9-yr period into frequent PM users (7-9 yr), infrequent PM users (4-6 yr), low PM users (1-3 yr), and nonusers. We use a mixed model framework and econometric models to characterize farms and to explore characteristics and determinants of economic performance and user groups. The most frequent users of the financial benchmarking tool had the greatest increase in intensification (measured by change in farm stocking rate), productivity (measured by change in milk production per hectare), and financial performance (measured by change in farm gross output and net profit per hectare) across the study period. Infrequent and low PM users of the benchmarking tool were intermediate for all variables measured, whereas nonusers had the least change. Empirical results indicated that economic performance was positively associated with dairy specialization and pasture utilization for all groups. Despite considerable fluctuations over the observation period, the overall change in total farm net profit between 2010 and 2018 was greatest for the frequent PM users (an increase of 70%, or €37,639), followed by farms in the infrequent PM user category (a 71% increase corresponding to an increase of €28,008 in net profit); meanwhile, low PM user and nonuser categories showed increases of 69% (€26,270) and 42% (€10,977), respectively. The results of this study also clearly indicated the existence of a strong positive association between frequency of financial benchmarking and greater technical and financial efficiency. The econometric analysis revealed that financial benchmarking users are more likely than nonusers to have larger herds, and that regional differences exist in usage rates. Finally, the study concludes by suggesting that the development of simplified financial benchmarking technologies and their support are required to increase benchmarking frequency, which may also help to facilitate a more sustainable and resource efficient dairy industry.

Effects of manipulating player numbers on technical and physical performances participating in an Australian football small-sided game

In Australian Football (AF), small-sided games (SSGs) are used extensively to replicate particular technical, tactical or physiological responses. Whilst research on SSGs has been extensive in soccer, in AF it has been limited to agility demands and exploring the effect of field dimensions on technical skill (i.e., handballing) and physical responses of senior athletes. Therefore, this study investigated the effect of four different SSG player number conditions (5v5, 5v6, 6v6, 7v7) on the technical (e.g., kicking) and physical (i.e., odometer, m-min-1, max velocity and percentage of high intensity running) performance outcomes in 22 sub-elite youth AF players. Particular constraints were applied to the SSG to ensure the focus was on kicking (i.e., after each handball a kick must be performed). The results of this study demonstrate when more technical events are required under more pressured situations (i.e., physical and time) the 5v6 condition appears to be most appropriate. However, when the focus is on kicking to a contested possession (i.e., kicking to leading or covered players) balanced player numbers (e.g., 6v6) would appear optimal. Alternatively, when the SSG focus is on increasing physiological demands (i.e., m.min-1) lower player density conditions (i.e., 5v5) appear more suitable.

Ultimate Full Contact: Fight Outcome Characterization Concerning Their Methods, Occurrence Times and Technical-Tactical Developments

Fight analysis produces relevant technical-tactical information. However, this knowledge is limited in hybrid full-contact combat sports. Therefore, this study aimed to characterize the results of the fights' outcomes through the winners at the World Ultimate Full Contact (WUFC) Championships between 2008 and 2017. Methods: 170 combats between senior male fighters (master class) from 38 countries were observed; all fight outcome methods, their occurrence times, inherent skills and their development forms were analyzed through frequencies, percentages, crosstabs and chi-square test, considering a Fisher's exact value of p < 0.05. The fight outcome methods were, in decreasing order, as follows: submission; decision and technical knockout (TKO); knockout (KO); and doctor stoppage. Only 19.4% fights completed the regular time 10 min (600 s), and 68.8% fight outcomes occurred in the first 5 min (300 s). Chokes were more used than joint locks, primarily developed in single actions. Head punches and kicks were the skills most responsible for KO, developed more in combinations and counter-attacks, while TKO was always through combination attacks and mostly by ground and pound. Ground fighting is most effective. In stand-up fighting, combination attacks and counter-attack are most effective. It is important to increase the technical-tactical capacities and adjustable decision-making to perform the regular fight time.

Appreciating Factors Beyond the Physical in Talent Identification and Development: Insights From the FC Barcelona Sporting Model

FC Barcelona is a multi-sport organization that adopts a talent identification approach that emphasizes the technical, psychological, and perceptual-cognitive attributes. It is unclear within this type of sporting selection model whether the relative age effect (RAE) exists. Consequently, the aim of the study was to evaluate the RAE across multiple sports and age groups at FC Barcelona. The birthdates of all players (n = 6,542) affiliated to each sport [male basketball (n = 1,013), male (n = 3,012) and female (n = 449) soccer, male futsal (n = 761), male handball (n = 999), and male indoor roller hockey (n = 308)] across all age groups from U10 to Senior were recorded. These were then categorized into quartiles from the start of the selection year (Q1 = Jan-Mar; Q2 = Apr-Jun; Q3 = Jul-Sep; Q4 = Oct-Dec) and analyzed for (a) each sport; (b) each age group, irrespective of the sport; and (c) each age group within each sport, using Chi-squared statistics and odds ratios (ORs) with 95% confidence intervals (CIs). Birthdates across the entire club revealed a RAE (Q1 = 46.1%, Q2 = 27.1%, Q3 = 17.1%, and Q4 = 9.7%, χ² = 29.8, P < 0.01), with OR in Q1, Q2, and Q3 representing a 4.76 (95% CIs: 1.96-11.57), 2.80 (1.12-7.03), and 1.77 (0.67-4.63) increased likelihood for selection when compared to Q4, respectively. Despite FC Barcelona's approach to talent identification and development, the RAE was still present within youth age groups (<18 years old). The current findings provide support that the RAE is more prevalent within regionally popular sports and reduces with increasing age; however, given the talent identification processes within FC Barcelona's sporting model, additional factors beyond the physical attributes, such as enhanced psychological and perceptual-cognitive attributes, in those born earlier in the selection year might further influence the RAE. Consequently, current results provide indirect evidence to suggest that sociological and psychological determinants might be a greater influence on the presence of RAE in sporting environments that prefer to consider technical and perceptual-cognitive attributes in their talent development programs.

Per oral endoscopic myotomy with fundoplication is a technically feasible NOTES for achalasia cardia

Background: Per-oral endoscopic myotomy (POEM) has become the standard of care for the endoscopic management of achalasia but its major long-term adverse effect has been the development of reflux-associated symptoms and sequelae.Aim: This study was conducted to assess the feasibility and reproducibility of the technique of POEM with fundoplication (POEM + F), a pure Natural Orifice Transluminal Endoscopic Surgery (NOTES) procedure in achalasia.Material and methods: Between November 2019 and January 2020, three patients with achalasia cardia were subjected to POEM + F. Various parameters such as technical feasibility, procedure time, adverse events and post-procedure follow-up were noted.Results: POEM + F was successfully completed in all three patients. Other than intra-operative capno-peritoneum, no major adverse events were noted. On follow-up at one month, maintenance of wrap was noted.Conclusion: POEM + F is a technically feasible and a reproducible pure NOTES procedure.

Clinical Applied Anatomy in Trans-Areolar Endoscopic Thyroidectomy: Crucial Anatomical Landmarks

Introduction: Endoscopic thyroidectomy (ET) has been successfully established as an excellent surgical approach. This study summarizes and describes the crucial anatomical landmarks for clinical applied anatomy in trans-areolar ET, which may help further improve the quality and safety of trans-areolar ET. Materials and Methods: Five hundred forty patients who underwent trans-areolar ET from January 2015 to June 2018 at our institution were evaluated. Several crucial anatomical landmarks were described during the surgical procedures. The surgical outcomes, including the operative time, conversion, intraoperative blood loss, postoperative complications, and postoperative stay, were collected. Results: All patients successfully underwent trans-areolar ET without conversion. The mean operative time was 142.18 ± 49.91 minutes (150.84 ± 50.32 minutes for total thyroidectomy and 110.20 ± 32.4 for lobectomy with isthmusectomy). The mean intraoperative blood loss was 20.45 ± 10.89 mL. The postoperative stay was 5.42 ± 1.49 days. The postoperative complication rate was 7.78%, including transient hypocalcemia in 30 patients, transient recurrent laryngeal nerve palsy in 3 patients, and skin ecchymosis in 9 patients. Conclusions: An understanding of crucial anatomical landmarks for clinical applied anatomy may improve the quality and safety of trans-areolar ET and subsequently help promote the development of ET.

Performance Indicators in Young Elite Beach Volleyball Players

Purpose

The aim of this study was to analyze tactical and technical behavior across different ages and genders in young, elite beach volleyball players.

Methods

Forty teams from the Under-18, Under-20, Under-21, and Under-22 from semifinals and finals of the 2016 World Championships and the 2016 European Championship were analyzed. The sample was composed of 69 sets. The variables studied included: Rally time, set time, match time, serve efficacy (standing serve, floating serve, and jump serve), setting efficacy (forearm, overhand, other, and 2nd attack), attack efficacy, and block efficacy. Student's t and Mann-Whitney U-tests were used to analyze specific differences between categories.

Results

Significant differences (p < 0.05) in the pass performance, forearm pass in men (from 78.2 to 49.1%), and overhand pass in men (from 12.2 to 40.45%). In addition, in women forearm pass (from 88.5 to 76.3%) and overhand pass in women (from 1.2 to 9.35%). No significant differences in the effectiveness of attack, rally time, serve, and block efficacy.

Conclusion

Tactical considerations and gender-specific differences in technical variables may be important for training in young players.

Feasibility of HIV self-testing: experiences of people seeking HIV testing in rural and urban KwaZulu-Natal, South Africa

HIV status awareness is a rate limiting step in HIV treatment and prevention initiatives aimed at addressing the global HIV epidemic. Uptake of HIV testing remains suboptimal despite global campaigns aimed at improving uptake. HIV self-testing (HIVST) displays the potential to increase uptake of HIV testing in public health care facilities, which are the main access points for HIV testing, but evidence to support this notion is limited. Therefore, this study determined the factors that influence the feasibility of introducing HIVST into public facilities in KwaZulu-Natal, South Africa, through a mixed method crossover study design, implemented among 40 consenting adults who were either regular HIV testers or HIV testing naïve. Qualitative assessments were conducted using a topic guide centred on the feasibility of HIVST. Usability of HIVST was quantitatively assessed by means of a HIVST usability assessment checklist. Technical, environmental and economic factors were found to influence HIVST feasibility. The majority of participants were able to conduct unsupervised HIVST but training may be required for those unable to follow instructions. Accessibility of HIVST was associated with affordability and convenience. Environmental factors such as storage and location to perform the test and a disposal kit require further consideration in limited resource settings due to lack of privacy and confidentiality. While we demonstrated that HIVST is feasible, and identified factors that may influence its feasibility, these factors require further consideration in primary health care facilities in resource limited settings prior to scale-up.

A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic single crowns

OBJECTIVES

The aim of the present systematic review was to analyze the survival and complication rates of zirconia-based and metal-ceramic implant-supported single crowns (SCs).

MATERIALS AND METHODS

An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective cohort and retrospective case series on implant-supported SCs with a mean follow-up time of at least 3 years. Patients had to have been clinically examined at the follow-up visit. Assessment of the identified studies and data extraction was performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson's regression models to obtain summary estimates of 5-year proportions.

RESULTS

The search provided 5,263 titles and 455 abstracts, full-text analysis was performed for 240 articles, resulting in 35 included studies on implant-supported crowns. Meta-analysis revealed an estimated 5-year survival rate of 98.3% (95% CI: 96.8-99.1) for metal-ceramic implant supported SCs (n = 4,363) compared to 97.6% (95% CI: 94.3-99.0) for zirconia implant supported SCs (n = 912). About 86.7% (95% CI: 80.7-91.0) of the metal-ceramic SCs (n = 1,300) experienced no biological/technical complications over the entire observation period. The corresponding rate for zirconia SCs (n = 76) was 83.8% (95% CI: 61.6-93.8). The biologic outcomes of the two types of crowns were similar; yet, zirconia SCs exhibited less aesthetic complications than metal-ceramics. The 5-year incidence of chipping of the veneering ceramic was similar between the material groups (2.9% metal-ceramic, 2.8% zirconia-ceramic). Significantly (p = 0.001), more zirconia-ceramic implant SCs failed due to material fractures (2.1% vs. 0.2% metal-ceramic implant SCs). No studies on newer types of monolithic zirconia SCs fulfilled the simple inclusion criteria of 3 years follow-up time and clinical examination of the present systematic review.

CONCLUSION

Zirconia-ceramic implant-supported SCs are a valid treatment alternative to metal-ceramic SCs, with similar incidence of biological complications and less aesthetic problems. The amount of ceramic chipping was similar between the material groups; yet, significantly more zirconia crowns failed due to material fractures.

A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic multiple-unit fixed dental prostheses

OBJECTIVES

The aim of the present review was to compare the outcomes, that is, survival and complication rates of zirconia-ceramic and/or monolithic zirconia implant-supported fixed dental prostheses (FDPs) with metal-ceramic FDPs.

MATERIALS AND METHODS

An electronic MEDLINE search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective cohort studies and retrospective case series on implant-supported FDPs with a mean follow-up of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data extraction was performed independently by two reviewers. Failure and complication rates were analyzed using robust Poisson regression models to obtain summary estimates of 5-year proportions.

RESULTS

The search provided 5,263 titles and 455 abstracts. Full-text analysis was performed for 240 articles resulting in 19 studies on implant FDPs that met the inclusion criteria. The studies reported on 932 metal-ceramic and 175 zirconia-ceramic FDPs. Meta-analysis revealed an estimated 5-year survival rate of 98.7% (95% CI: 96.8%-99.5%) for metal-ceramic implant-supported FDPs, and of 93.0% (95% CI: 90.6%-94.8%) for zirconia-ceramic implant-supported FDPs (p < 0.001). Thirteen studies including 781 metal-ceramic implant-supported FDPs estimated a 5-year rate of ceramic fractures and chippings to be 11.6% compared with a significantly higher (p < 0.001) complication rate for zirconia implant-supported FDPs of 50%, reported in a small study with 13 zirconia implant-supported FDPs. Significantly (p = 0.001) more, that is, 4.1%, of the zirconia-ceramic implant-supported FDPs were lost due to ceramic fractures compared to only 0.2% of the metal-ceramic implant-supported FDPs. Detailed analysis of factors like number of units of the FDPs or location in the jaws was not possible due to heterogeneity of reporting. No studies on monolithic zirconia implant-supported FDPs fulfilled the inclusion criteria of the present review. Furthermore, no conclusive results were found for the aesthetic outcomes of both FDP-types.

CONCLUSION

For implant-supported FDPs, conventionally veneered zirconia should not be considered as material selection of first priority, as pronounced risk for framework fractures and chipping of the zirconia veneering ceramic was observed. Monolithic zirconia may be an interesting alternative, but its clinical medium- to long-term outcomes have not been evaluated yet. Hence, metal ceramics seems to stay the golden standard for implant-supported multiple-unit FDPs.

A systematic review of the influence of the implant-abutment connection on the clinical outcomes of ceramic and metal implant abutments supporting fixed implant reconstructions

OBJECTIVES

The objective of this systematic review was to assess the influence of implant-abutment connection and abutment material on the outcome of implant-supported single crowns (SCs) and fixed dental prostheses (FDPs).

METHODS

An electronic Medline search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective and retrospective studies with a mean follow-up time of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using robust Poisson regression, and comparisons were made with multivariable Poisson regression models.

RESULTS

The search provided 1511 titles and 177 abstracts. Full-text analysis was performed for 147 articles resulting in 60 studies meeting the inclusion criteria. Meta-analysis of these studies indicated an estimated 5-year survival rate of 97.6% for SCs and 97.0% for FDPs supported by implants with internal implant-abutment connection and 95.7% for SCs and 95.8% for FDPs supported by implants with external connection. The 5-year abutment failure rate ranged from 0.7% to 2.8% for different connections with no differences between the types of connections. The total number of complications was similar between the two connections, yet, at external connections, abutment or occlusal screw loosening was more predominant. Ceramic abutments, both internally and externally connected, demonstrated a significantly higher incidence of abutment fractures compared with metal abutments.

CONCLUSION

For implant-supported SCs, both metal and ceramic abutments with internal and external connections exhibited high survival rates. Moreover, implant-supported FDPs with metal abutments with internal and external connections for also showed high survival rates.

American Clinical Neurophysiology Society Guideline 5: Minimum Technical Standards for Pediatric Electroencephalography

This revision to the EEG Guidelines is an update incorporating the current electroencephalography technology and practice. It was previously published as Guideline 2. Similar to the prior guideline, it delineates the aspects of Guideline 1 that should be modified for neonates and young children. Recording conditions for photic stimulation and hyperventilation are revised to enhance the provocation of epileptiform discharges. Revisions recognize the difficulties involved in performing an EEG under sedation in young children. Recommended neonatal EEG montages are displayed for the reduced set of electrodes only since the montages in Guideline 3 should be used for a 21-electrode 10-20 system array. Neonatal documentation is updated to use current American Academy of Pediatrics term "postmenstrual age" rather than "conceptional age." Finally, because therapeutic hypothermia alters the prognostic value of neonatal EEG, the necessity of documenting the patient's temperature at the time of recording is emphasized.

A Retrospective Study of Peroral Endoscopic Full-Thickness Myotomy in Patients with Severe Achalasia

OBJECTIVES

Selective circular myotomy (CM) is recommended in peroral endoscopic myotomy (POEM) for achalasia, but completeness of myotmoy is the prerequisite for excellent long-term results of conventional surgical myotomy. The aim of our study was to compare the efficacy and safety between peroral endoscopic full-thickness and simple CM for the treatment of severe achalasia.

MATERIALS AND METHODS

A total of 123 severe achalasia patients who underwent POEM from August 2011 to May 2013 were included. They were divided into circular or full-thickness myotomy (FTM) groups according to the depth of myotomy. Demographics, Eckardt score, procedure-related parameters, perioperative adverse events, pre- and postoperative esophageal diameter, esophageal manometry, and follow-up results were retrospectively collected and compared between the two groups.

RESULTS

All the 123 patients underwent POEM successfully, and the mean operation time was significantly shorter in FTM group compared with CM group (57.4 ± 8.2 minutes versus 63.2 ± 12.3 minutes, P < .05). There was no significant difference between the two groups in terms of treatment success, pre- and postoperative Eckardt score, esophageal diameter, esophageal manometry, and perioperative adverse events (P > .05). Twenty-four-hour pH monitoring was performed in 19 patients (11 in FTM, 8 in CM). Although no statistical difference was detected in rate of abnormal esophageal acid exposure between groups, this rate was higher in FTM group than CM group (60% versus 40%, P > .05).

CONCLUSION

Treatment efficacy in short-to-medium term are comparable between circular or FTM. FTM significantly reduce the operative duration, but it may increase potential risk of gastroesophageal reflux disease incidence.

Allograft Pancreatectomy: Indications and Outcomes

This study evaluated the indications, surgical techniques, and outcomes of allograft pancreatectomy based on a single center experience. Between 2003 and 2013, 47 patients developed pancreas allograft failure, excluding mortality with a functioning pancreas allograft. Early graft loss (within 14 days) occurred in 16, and late graft loss in 31. All patients with early graft loss eventually required allograft pancreatectomy. Nineteen of 31 patients (61%) with late graft loss underwent allograft pancreatectomy. The main indication for early allograft pancreatectomy included vascular thrombosis with or without severe pancreatitis, whereas one recipient required urgent allograft pancreatectomy for gastrointestinal hemorrhage secondary to an arterioenteric fistula. In cases of late allograft pancreatectomy, graft failure with clinical symptoms such as abdominal discomfort, pain, and nausea were the main indications (13/19 [68%]), simultaneous retransplantation without clinical symptoms in 3 (16%), and vascular catastrophes including pseudoaneurysm and enteric arterial fistula in 3 (16%). Postoperative morbidity included one case each of pulmonary embolism leading to mortality, formation of pseudoaneurysm requiring placement of covered stent, and postoperative bleeding requiring relaparotomy eventually leading to femoro-femoral bypass surgery 2 years after allograftectomy. Allograft pancreatectomy can be performed safely, does not preclude subsequent retransplantation, and may be lifesaving in certain instances.

Technical Considerations in Brain Amyloid PET Imaging with 18F-Florbetapir

Technical factors play a critical role in the production of best-quality amyloid PET images for interpretation. This article provides specific instructions and general technical information about PET brain scanning of β-amyloid neuritic plaques. The focus of tracer-specific information will be on (18)F-florbetapir (indications, contraindications, dosing, administration, uptake time, scanning time, acquisition, processing, biodistribution, radiation dose, adverse events, and display). General scanning information relevant to all amyloid-imaging agents will be also be presented (e.g., mechanism of uptake, safe handling, positioning, prevention of patient motion, processing, and artifacts).

Implantable cardioverter defibrillator and inappropriate therapy: "black box" examination yielded both human and technical causes

We report on a 70-year-old male patient who was recipient of GEM III DR 7275 Cardioverter Defibrillator, and who presented with inappropriate shocks. The patient had a documented slow ventricular tachycardia (VT), and the device was programmed to detect VT at rates >100 bpm, fast VT (FVT, via VT) at rates >150 bpm, and ventricular fibrillation (VF) at rates >188 bpm. After detection of FVT, efficient therapy was delivered; however, this was immediately followed by multiple inappropriate therapies. Inappropriate therapies were discussed, with a focus on programming features.

Technical tips for stoma creation in the challenging patient

Stoma creation is a mental and technical exercise, often straightforward without any difficulty. However, creation of a protruding, tension free, well-vascularized stoma in an obese individual with a thick abdominal wall and short, thickened mesentery can be a substantial challenge. Preoperative planning including stoma site marking, thoughtful consideration of all alternatives, and attention to technical detail will help create a stoma that will serve the ostomate well. The technical tips provided in this article should facilitate the process of selecting the appropriate intestinal segment, identifying the correct stoma site, and creating a functional stoma even in the most challenging situations.

Technical and technological skills assessment in laparoscopic surgery

OBJECTIVES

Surgical appraisal and revalidation are key components of good surgical practice and training. Assessing technical skills in a structured manner is still not widely used. Laparoscopic surgery also requires the surgeon to be competent in technological aspects of the operation.

METHODS

Checklists for generic, specific technical, and technological skills for laparoscopic cholecystectomies were constructed. Two surgeons with >12 years postgraduate surgical experience assessed each operation blindly and independently on DVD. The technological skills were assessed in the operating room.

RESULTS

One hundred operations were analyzed. Eight trainees and 10 consultant surgeons were recruited. No adverse events occurred due to technical or technological skills. Mean interrater reliability was kappa=0.88, P=<0.05. Construct validity for both technical and technological skills between trainee and consultant surgeons were significant, Mann-Whitney P=<0.05.

CONCLUSIONS

Our study demonstrates that technical and technological skills can be measured to assess performance of laparoscopic surgeons. This technical and technological assessment tool for laparoscopic surgery seems to have face, content, concurrent, and construct validities and could be modified and applied to any laparoscopic operation. The tool has the possibility of being used in surgical training and appraisal. We aim to modify and apply this tool to advanced laparoscopic operations.