Prioritised challenges in the management of acute knee dislocations are stiffness, obesity, treatment delays and associated limb-threatening injuries: a global consensus study

ObjectivesHeterogeneous patient factors and injury mechanisms result in a great variety of injury patterns encountered in knee dislocations (KD). Attempts to improve outcome can focus on a wide range of challenges. The aim of this study was to establish and prioritise a list of challenges encountered when treating patients with acute KD.MethodsA modified Delphi consensus study was conducted with international knee specialists who generated a prioritised list of challenges. Selected priorities were limited to half of the possible items. Agreement of more than 70% was defined as consensus on each of these items a priori.ResultsNinety-one international surgeons participated in the first round. The majority worked in public hospitals and treated patients from low-income and middle-income households. Their propositions were prioritised by 27 knee surgeons from Europe, Africa, Asia, as well as North and South America, with a mean of 15.3 years of experience in knee surgery (SD 17.8). Consensus was reached for postoperative stiffness, obesity, delay to presentation and associated common peroneal nerve injuries. Challenges such as vascular injuries, ipsilateral fractures, open injuries as well as residual laxity were also rated high. Most of these topics with high priority are key during the initial management of a patient with KD, at presentation. Topics with lower priority were postsurgical challenges, such as patient insight, expectations and compliance, rehabilitation programme, and pain management.ConclusionThis consensus study has a wide geographical footprint of experts around the world practising in various settings. These participants prioritised stiffness, obesity, treatment delays and associated limb-threatening injuries as the most important challenges when managing a patient with acute KD. This list calls for applicable and feasible solutions for these challenges in a global setting. It should be used to prioritise research efforts and discuss treatment guidelines.Level of evidenceV.

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The Fight against Idleness

10.1093/oso/9780198805489.003.0006 ◽

2018 ◽

Author(s):

Anthony F. Heath ◽

Elisabeth Garratt ◽

Ridhi Kashyap ◽

Yaojun Li ◽

Lindsay Richards

Keyword(s):

Young People ◽

Labour Market ◽

Ethnic Minorities ◽

Unemployment Rate ◽

Low Income ◽

Young Men ◽

Dark Side ◽

Educational Expansion ◽

Left Behind ◽

Wide Range

Unemployment has a wide range of adverse consequences over and above the effects of the low income which people out of work receive. In the first decades after the war Britain tended to have a lower unemployment rate than most peer countries but this changed in the 1980s and 1990s, when Britain’s unemployment rate surged during the two recessions—possibly as a result of policies designed to tackle inflation. The young, those with less education, and ethnic minorities have higher risks of unemployment and these risks are cumulative. The evidence suggests that the problems facing young men with only low qualifications became relatively worse in the 1990s and 2000s. This perhaps reflects the dark side of educational expansion, young people with low qualifications being left behind and exposed in the labour market.

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Applied sport science and medicine of women’s rugby codes: a systematic-scoping review and consensus on future research priorities protocol

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2021-001108 ◽

2021 ◽

Vol 7 (3) ◽

pp. e001108

Author(s):

Omar Heyward ◽

Stacey Emmonds ◽

Gregory Roe ◽

Sean Scantlebury ◽

Keith Stokes ◽

...

Keyword(s):

Scoping Review ◽

Research Priorities ◽

Consensus Method ◽

Future Research ◽

Delphi Consensus ◽

Medicine Research ◽

Sport Science ◽

Priority Areas ◽

Wide Range ◽

Scoping Reviews

Women’s rugby (rugby league, rugby union and rugby sevens) has recently grown in participation and professionalisation. There is under-representation of women-only cohorts within applied sport science and medicine research and within the women’s rugby evidence base. The aims of this article are: Part 1: to undertake a systematic-scoping review of the applied sport science and medicine of women’s rugby, and Part 2: to develop a consensus statement on future research priorities. This article will be designed in two parts: Part 1: a systematic-scoping review, and Part 2: a three-round Delphi consensus method. For Part 1, systematic searches of three electronic databases (PubMed (MEDLINE), Scopus, SPORTDiscus (EBSCOhost)) will be performed from the earliest record. These databases will be searched to identify any sport science and medicine themed studies within women’s rugby. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews will be adhered to. Part 2 involves a three-round Delphi consensus method to identify future research priorities. Identified experts in women’s rugby will be provided with overall findings from Part 1 to inform decision-making. Participants will then be asked to provide a list of research priority areas. Over the three rounds, priority areas achieving consensus (≥70% agreement) will be identified. This study has received institutional ethical approval. When complete, the manuscript will be submitted for publication in a peer-reviewed journal. The findings of this article will have relevance for a wide range of stakeholders in women’s rugby, including policymakers and governing bodies.

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Is there a standardized practice for the development of international ulcerative colitis and Crohn’s disease treatment guidelines?

Gastroenterology Report ◽

10.1093/gastro/goab009 ◽

2021 ◽

Author(s):

Alexander Goldowsky ◽

Rohan Sen ◽

Gila Hoffman ◽

Joseph D Feuerstein

Keyword(s):

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Treatment Guidelines ◽

Conflicts Of Interest ◽

Level Of Evidence ◽

Evidence Quality ◽

Chi Squared ◽

Linear Regression Modeling ◽

Management Recommendations

Abstract Background Guidelines are published by international gastroenterology societies regarding the management of ulcerative colitis (UC) and Crohn’s disease (CD) to help clinicians to provide high-quality patient care. We examined the guidelines for the quality and strength of evidence used to develop the recommendations, methods for grading evidence, differences in disease-specific recommendations, conflicts of interest, and plans for guideline updates. Methods A systematic search was performed on PubMed using “ulcerative colitis,” “Crohn’s disease,” and “guidelines” in April 2019. International gastroenterology society websites were searched for UC- and CD-specific guidelines. Guidelines from 12 societies were examined by two authors. Chi-squared tests were used for comparing evidence-level grades, strength of recommendations, and reported conflicts of interest. Linear-regression modeling was used to evaluate the relationship between the number of authors and the number of recommendations in a given guideline. Results Of 28 guidelines reviewed, 25 (89%) used a total of three different systems to grade the level of evidence and 2 (7%) used an unknown system. Three (11%) reviewed guidelines did not provide a conflict-of-interest statement, while three (11%) provided a timeline for guideline updates. Of 1,265 total statements examined, 246 (19%) reported no grade of evidence quality or explicitly stated that the recommendation was based on “expert opinion.” One hundred and thirty-five (22%) UC recommendations were noted to be “weak/conditional” and 95 (16%) did not have a recommendation strength. Two hundred and forty-two (37%) CD recommendations were noted to be “weak/conditional” and 151 (23%) did not have a recommendation strength. Conclusion The majority of UC and CD guidelines are based on a low/very low quality of evidence and are further weakened due to the lack of homogeneity in specific aspects of management recommendations as well as conflicts of interest.

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Immigration and economic mobility

Journal of Population Economics ◽

10.1007/s00148-021-00851-4 ◽

2021 ◽

Author(s):

Maria F. Hoen ◽

Simen Markussen ◽

Knut Røed

Keyword(s):

Labor Market ◽

Low Income ◽

Labor Market Outcomes ◽

Lower Class ◽

Low Income Countries ◽

Market Outcomes ◽

Wide Range ◽

Class Background ◽

The Rich ◽

Relative Prime

AbstractWe examine how immigration affects natives’ relative prime-age labor market outcomes by economic class background, with class background established on the basis of parents’ earnings rank. Exploiting alternative sources of variation in immigration patterns across time and space, we find that immigration from low-income countries reduces intergenerational mobility and thus steepens the social gradient in natives’ labor market outcomes, whereas immigration from high-income countries levels it. These findings are robust with respect to a wide range of identifying assumptions. The analysis is based on high-quality population-wide administrative data from Norway, which is one of the rich-world countries with the most rapid rise in the immigrant population share over the past two decades. Our findings suggest that immigration can explain a considerable part of the observed relative decline in economic performance among natives with a lower-class background.

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Health Policy in Cambodia: To What Extent Is an Aid-Dependent Country Able to Determine Its Own Policy?

Journal of Social Policy ◽

10.1017/s0047279414000543 ◽

2014 ◽

Vol 44 (1) ◽

pp. 171-187 ◽

Cited By ~ 4

Author(s):

VIRGINIE DIAZ PEDREGAL ◽

BLANDINE DESTREMAU ◽

BART CRIEL

Keyword(s):

Health Care ◽

Health Policy ◽

Low Income ◽

Access To Health Care ◽

Implementation Process ◽

Health Care Provision ◽

Care Provision ◽

Low Income Country ◽

Access To Health ◽

Wide Range

AbstractThis article analyses the design and implementation process of arrangements for health care provision and access to health care in Cambodia. It points to the complexity of shaping a coherent social policy in a low-income country heavily dependent on international aid.At a theoretical level, we confirm that ideas, interests and institutions are all important factors in the construction of Cambodian health care schemes. However, we demonstrate that trying to hierarchically organise these three elements to explain policy making is not fruitful.Regarding the methodology, interviews with forty-eight selected participants produced the qualitative material for this study. A documentary review was also an important source of data and information.The study produces two sets of results. First, Cambodian policy aimed at the development of health care arrangements results from a series of negotiations between a wide range of stakeholders with different objectives and interests. International stakeholders, such as donors and technical organisations, are major players in the policy arena where health policy is constructed. Cambodian civil society, however, is rarely involved in the negotiations.Second, the Cambodian government makes political decisions incrementally. The long-term vision of the Cambodian authorities for improving health care provision and access is quite clear, but, nevertheless, day-to-day decisions and actions are constantly negotiated between stakeholders. As a result, donors and non-government organisations (NGOs) working in the field find it difficult to anticipate policies.To conclude, despite real autonomy in the decision-making process, the Cambodian government still has to prove its capacity to master a number of risks, such as the (so far under-regulated) development of the private health care sector.

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Consequences of Elder Abuse and Neglect: A Systematic Review of Observational Studies

Trauma Violence & Abuse ◽

10.1177/1524838017692798 ◽

2017 ◽

Vol 20 (2) ◽

pp. 197-213 ◽

Cited By ~ 34

Author(s):

Raudah Mohd Yunus ◽

Noran Naqiah Hairi ◽

Wan Yuen Choo

Keyword(s):

Systematic Review ◽

Health Care ◽

Low Income ◽

Observational Studies ◽

Elder Abuse ◽

Care Utilization ◽

Health Care Consumption ◽

Elder Abuse And Neglect ◽

Wide Range ◽

Abuse And Neglect

This article presents the results of a systematic review of the consequences of elder abuse and neglect (EAN). A systematic search was conducted in seven electronic databases and three sources of gray literature up to January 8, 2016, supplemented by scanning of citation lists in relevant articles and contact with field experts. All observational studies investigating elder abuse as a risk factor for adverse health outcomes, mortality, and health-care utilization were included. Of 517 articles initially captured, 19 articles met our inclusion criteria and were analyzed. Two reviewers independently performed abstract screening, full-texts appraisal, and quality assessment using the Newcastle–Ottawa Scale. Across 19 studies, methodological heterogeneity was a prominent feature; seven definitions of EAN and nine measurement tools for abuse were employed. Summary of results reveals a wide range of EAN outcomes, from premature mortality to increased health-care consumption and various forms of physical and psychological symptoms. Higher risks of mortality emerged as the most credible outcome, while the majority of morbidity outcomes originated from cross-sectional studies. Our findings suggest that there is an underrepresentation of older adults from non-Western populations and developing countries, and there is a need for more population-based prospective studies in middle- and low-income regions. Evidence gathered from this review is crucial in upgrading current practices, formulating policies, and shaping the future direction of research.

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Pharmacogenetics to Avoid Adverse Reactions in Cardiology: Ready for Implementation?

Journal of Personalized Medicine ◽

10.3390/jpm11111180 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1180

Author(s):

Xandra García-González ◽

Sara Salvador-Martín

Keyword(s):

Adverse Reactions ◽

Treatment Guidelines ◽

Heart Association ◽

Level Of Evidence ◽

The Past ◽

Working Groups ◽

Causes Of Mortality ◽

European Society Of Cardiology ◽

Guidelines And Recommendations

Cardiovascular Diseases (CVs) are one of the main causes of mortality and disability around the world. Advances in drug treatment have greatly improved survival and quality of life in the past decades, but associated adverse events remain a relevant problem. Pharmacogenetics can help individualize cardiovascular treatment, reducing associated toxicities and improving outcomes. Several scientific societies and working groups periodically review available studies and provide consensus recommendations for those gene-drug pairs with a sufficient level of evidence. However, these recommendations are rarely mandatory, and the indications on how to adjust treatment can vary between different guidelines, which limits their clinical applicability. The aim of this review is to compile, compare and discuss available guidelines and recommendations by the main Pharmacogenetics Consortiums (Clinical Pharmacogenetics Implementation Consortium (CPIC); Dutch Pharmacogenetics Working Group (DPWG); the French Network of Pharmacogenetics (Réseau national de pharmacogénétique (RNPGx) and The Canadian Pharmacogenomics Network for Drug Safety (CPNDS) regarding how to apply pharmacogenetic results to optimize pharmacotherapy in cardiology. Pharmacogenetic recommendations included in European or American drug labels, as well as those included in the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) and the American Heart Association (AHA) treatment guidelines are also discussed.

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Challenges Facing Financial Inclusion Due to the COVID-19 Pandemic

European Journal of Marketing and Economics ◽

10.26417/523jma34n ◽

2020 ◽

Vol 3 (2) ◽

pp. 50

Author(s):

Tea Kasradze

Keyword(s):

Low Income ◽

Small And Medium Enterprises ◽

Financial Inclusion ◽

Financial Resources ◽

Financial Products ◽

The Poor ◽

Wide Range ◽

Medium Enterprises ◽

The Impact ◽

Poor Population

Financial inclusion is often considered as an access to financial resources for the wide public and small and medium-sized businesses, although it is a much broader concept and includes a wide range of access to quality financial products and services, including loans, deposit services, insurance, pensions and payment systems. Mechanisms for protecting the rights of consumers of financial products and services are also considered to be subject to financial inclusion. Financial inclusion acquires great importance during the pandemic and post-pandemic period. The economic crisis caused by the pandemic is particularly painful for low-income vulnerable population. A large part of the poor population who were working informally has lost source of income due to lockdown from the pandemic. Remittances have also been reduced / minimized, as the remitters had also lost jobs and are unable to send money home. Today, when people die from Coronavirus disease, it may be awkward to talk about the financial side of a pandemic, but the financial consequences can be far-reaching if steps are not taken today to ensure access to and inclusion of financial resources. The paper examines the impact of the pandemic on financial inclusion and the responses of the governments and the financial sectors to the challenge of ensuring the financial inclusion of the poor population and small and medium enterprises.

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Distal rectus femoris surgery in children with cerebral palsy: results of a Delphi consensus project

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210044 ◽

2021 ◽

pp. 1-9

Author(s):

Robert M. Kay ◽

Kristan Pierz ◽

James McCarthy ◽

H. Kerr Graham ◽

Henry Chambers ◽

...

Keyword(s):

Cerebral Palsy ◽

Rectus Femoris ◽

Delphi Consensus ◽

Level Of Evidence ◽

Modified Delphi ◽

International Panel ◽

Children With Cerebral Palsy ◽

Stiff Knee ◽

Paediatric Orthopaedic ◽

Gmfcs Level

Purpose The purpose of this study was for an international panel of experts to establish consensus indications for distal rectus femoris surgery in children with cerebral palsy (CP) using a modified Delphi method. Methods The panel used a five-level Likert scale to record agreement or disagreement with 33 statements regarding distal rectus femoris surgery. The panel responded to statements regarding general characteristics, clinical indications, computerized gait data, intraoperative techniques and outcome measures. Consensus was defined as at least 80% of responses being in the highest or lowest two of the five Likert ratings, and general agreement as 60% to 79% falling into the highest or lowest two ratings. There was no agreement if neither threshold was reached. Results Consensus or general agreement was reached for 17 of 33 statements (52%). There was general consensus that distal rectus femoris surgery is better for stiff knee gait than is proximal rectus femoris release. There was no consensus about whether the results of distal rectus femoris release were comparable to those following distal rectus femoris transfer. Gross Motor Function Classification System (GMFCS) level was an important factor for the panel, with the best outcomes expected in children functioning at GMFCS levels I and II. The panel also reached consensus that they do distal rectus femoris surgery less frequently than earlier in their careers, in large part reflecting the narrowing of indications for this surgery over the last decade. Conclusion This study can help paediatric orthopaedic surgeons optimize decision-making for, and outcomes of, distal rectus femoris surgery in children with CP. Level of evidence V

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Assessment of Job Stress of Clinical Pharmacists in Ho Chi Minh City, Vietnam: A Cross-Sectional Study

Frontiers in Psychology ◽

10.3389/fpsyg.2021.635595 ◽

2021 ◽

Vol 12 ◽

Author(s):

Hai-Yen Nguyen-Thi ◽

Minh-Thu Do-Tran ◽

Thuy-Tram Nguyen-Ngoc ◽

Dung Van Do ◽

Luyen Dinh Pham ◽

...

Keyword(s):

Job Stress ◽

Low Income ◽

Training Programs ◽

Cross Sectional Study ◽

Public Hospitals ◽

Ho Chi Minh City ◽

Sectional Study ◽

Cross Sectional ◽

Clinical Pharmacists ◽

Clinical Ward

Objectives: The official implementation of clinical pharmacy in Vietnam has arrived relatively late, resulting in various stressors. This study aims to evaluate job stress level and suggest viable solutions.Methods: A cross-sectional study was conducted on clinical pharmacists (CPs) in 128 hospitals in Ho Chi Minh City (HCMC). Job stress questions were derived from the Healthcare Profession Stress Inventory (HPSI).Results: A total of 197 CPs participated, giving a response rate of 82.4%. Participants were found to have moderate job stress with an overall mean stress score of 1.5 (0.4) and stress rate of 52.8%. The sample size was statistically adequate and the HPSI was valid and reliable. Patient care responsibility was the main stressor, especially in public hospitals, followed by job conflicts. Lack of experience, low income, and inability to participate in clinical ward rounds caused significant stress to CPs regarding job recognition and job uncertainty. More practice-oriented training programs in bachelor curricula and clinical practice should be applied to help CPs gain more experience, self-confidence, and diminish job stress.Conclusion: CPs in HCMC have moderate stress. More practice-oriented training programs should be prioritized to lessen stress for CPs.

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