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Healthcare, Volume 7, Issue 3 (September 2019)

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Open AccessReview
A New Therapeutic Strategy for Recurrent Ovarian Cancer―Bevacizumab beyond Progressive Disease
Healthcare 2019, 7(3), 109; https://doi.org/10.3390/healthcare7030109 - 19 Sep 2019
Viewed by 123
Abstract
Treatment beyond progressive disease (PD) is a concept that even after drugs become ineffective, their continued use is more beneficial for patients than their discontinuation. In recent years, a concept of bevacizumab beyond PD (BBP) has attracted attention in the treatment of various [...] Read more.
Treatment beyond progressive disease (PD) is a concept that even after drugs become ineffective, their continued use is more beneficial for patients than their discontinuation. In recent years, a concept of bevacizumab beyond PD (BBP) has attracted attention in the treatment of various cancers, and the usefulness of this concept has been evaluated. BBP has been proven to prolong overall survival (OS) in recurrent colorectal cancer and progression-free survival (PFS) in recurrent breast and lung cancers. With regard to the treatment of ovarian cancer, the MITO16/MaNGO-OV2B study (the Multicenter Phase III Randomized Study with Second Line Chemotherapy Plus or Minus Bevacizumab in Patients with Platinum Sensitive Epithelial Ovarian Cancer Recurrence After a Bevacizumab/Chemotherapy First Line) was conducted in patients with platinum-sensitive recurrence and the JGOG3023 study (the Open-Label, Randomized, Phase II Trial Evaluating the Efficacy and Safety of Standard of Care with or Without Bevacizumab in Platinum-Resistant Ovarian Cancer Patients Previously Treated with Bevacizumab for Front-Line or Platinum-Sensitive Ovarian Cancer) was conducted in patients with platinum-resistant recurrence. The MITO16/MaNGO-OV2B study, reported in the 2018 annual meeting of the American Society of Clinical Oncology, showed that BBP achieved prolonged PFS. In the JGOG3023 study, enrollment of patients was completed in December 2018, and the follow-up period has been initiated. Proving the effectiveness of BBP in the treatment of ovarian cancer may provide a new therapeutic strategy and contribute to improved treatment outcomes in patients with poor prognosis and limited therapeutic options. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)
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Open AccessFeature PaperReview
Immunotherapy for Uterine Cervical Cancer
Healthcare 2019, 7(3), 108; https://doi.org/10.3390/healthcare7030108 - 17 Sep 2019
Viewed by 162
Abstract
Cervical cancer is a malignant neoplastic disease that is the fourth most commonly occurring cancer in women worldwide. Since the introduction of angiogenesis inhibitors, treatments for recurrent and advanced cervical cancers have improved significantly in the past five years. However, the median overall [...] Read more.
Cervical cancer is a malignant neoplastic disease that is the fourth most commonly occurring cancer in women worldwide. Since the introduction of angiogenesis inhibitors, treatments for recurrent and advanced cervical cancers have improved significantly in the past five years. However, the median overall survival in advanced cervical cancer is 16.8 months, with a 5-year overall survival rate of 68% for all stages, indicating that the effects of the treatment are still unsatisfactory. The development of a new treatment method is therefore imperative. Recently, in the clinical oncology field, remarkable progress has been made in immunotherapy. Immunotherapy is already established as standard therapy in some fields and in some types of cancers, and its clinical role in all areas, including the gynecology field, will change further based on the outcomes of currently ongoing clinical trials. This manuscript summarizes the results from previous clinical trials in cervical cancer and describes the ongoing clinical trials, as well as future directions. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)
Open AccessArticle
Correlation of Clinicopathological Characteristics of Breast Carcinoma and Depression
Healthcare 2019, 7(3), 107; https://doi.org/10.3390/healthcare7030107 - 12 Sep 2019
Viewed by 141
Abstract
The prevalence of depression among women with breast cancer (BC) is extremely variable in research studies. The aim of this study was to determine the prevalence of depressive disorder in women suffering from BC as well as to examine its relationship with clinical–pathological [...] Read more.
The prevalence of depression among women with breast cancer (BC) is extremely variable in research studies. The aim of this study was to determine the prevalence of depressive disorder in women suffering from BC as well as to examine its relationship with clinical–pathological and immunophenotypic characteristics of BC. The study included 194 patients with BC who were diagnosed with the disease between 2009 and 2015 in the Clinical Center Kragujevac, Serbia. Pathohistological and immunohistochemical analyses was used on the material obtained after the surgical removal of breast tumors, determining all significant clinical and morphological parameters. The level of depression among the examinees confirmed that the differences in the level of depression between the histological grades were statistically significant. According to the univariate binary logistic regression, the depression of a patient correlates with the category of molecular tumor subtype/Luminal A (p < 0.0005), PR expression (p = 0.050) and lymphatic invasion (p = 0.025). Multivariate binary logistic regression showed that the onset of depression associated with the present molecular subtype of the tumor of a worse prognostic character (p = 0.019). Depression is a common disorder in women with breast cancer. The level of depression is correlates with some of the clinicоmorphological and immunophenotypic characteristics of BC. Full article
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Open AccessArticle
Unconscious Weight Bias Among Nursing Students: A Descriptive Study
Healthcare 2019, 7(3), 106; https://doi.org/10.3390/healthcare7030106 - 12 Sep 2019
Viewed by 112
Abstract
There has been both an increase in obesity and anti-obesity bias in the United States. The Harvard Weight Implicit Association Test (IAT) is a reliable, valid test that can measure unconscious weight bias. First semester Bachelor of Science in Nursing (BSN) students were [...] Read more.
There has been both an increase in obesity and anti-obesity bias in the United States. The Harvard Weight Implicit Association Test (IAT) is a reliable, valid test that can measure unconscious weight bias. First semester Bachelor of Science in Nursing (BSN) students were surveyed anonymously mid-semester and at the end of the semester after completing the Harvard Weight IAT. Sixty-nine out of 77 students completed pre- and post-surveys. Weight preference towards others was not shown to be related to the respondent’s own self-reported body mass index (BMI). The majority of respondents exhibited more weight-related bias on the IAT than they realized. The three qualitative themes that emerged included Awareness of Personal Beliefs and Stereotypes, Reminder to be Impartial, and Skepticism about the IAT. It is important for undergraduate nursing students to be aware of possible unconscious weight bias in order to provide high-quality care to patients. Full article
(This article belongs to the Section Nursing Care)
Open AccessReview
Proposed Lyme Disease Guidelines and Psychiatric Illnesses
Healthcare 2019, 7(3), 105; https://doi.org/10.3390/healthcare7030105 - 09 Sep 2019
Viewed by 1027
Abstract
The Infectious Disease Society of America, American Academy of Neurology, and American Academy of Rheumatology jointly proposed Lyme disease guidelines. Four areas most relevant to psychiatry were reviewed—the disclaimer, laboratory testing, and adult and pediatric psychiatric sections. The disclaimer and the manner in [...] Read more.
The Infectious Disease Society of America, American Academy of Neurology, and American Academy of Rheumatology jointly proposed Lyme disease guidelines. Four areas most relevant to psychiatry were reviewed—the disclaimer, laboratory testing, and adult and pediatric psychiatric sections. The disclaimer and the manner in which these guidelines are implemented are insufficient to remove the authors and sponsoring organizations from liability for harm caused by these guidelines. The guidelines and supporting citations place improper credibility upon surveillance case definition rather than clinical diagnosis criteria. The guidelines fail to address the clear causal association between Lyme disease and psychiatric illnesses, suicide, violence, developmental disabilities and substance abuse despite significant supporting evidence. If these guidelines are published without very major revisions, and if the sponsoring medical societies attempt to enforce these guidelines as a standard of care, it will directly contribute to increasing a national and global epidemic of psychiatric illnesses, suicide, violence, substance abuse and developmental disabilities and the associated economic and non-economic societal burdens. The guideline flaws could be improved with a more appropriate disclaimer, an evidence-based rather than an evidence-biased approach, more accurate diagnostic criteria, and recognition of the direct and serious causal association between Lyme disease and psychiatric illnesses. Full article
(This article belongs to the Special Issue Lyme Disease and Related Tickborne Infections)
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Open AccessReview
The Mediterranean Diet and Breast Cancer: A Personalised Approach
Healthcare 2019, 7(3), 104; https://doi.org/10.3390/healthcare7030104 - 09 Sep 2019
Viewed by 326
Abstract
There have been many original and review articles summarizing the impact of nutrition and diet on breast cancer risk. However, very few consider the implication of genetic background and the effect of personalised nutrition on the risk and prognosis of breast cancer. A [...] Read more.
There have been many original and review articles summarizing the impact of nutrition and diet on breast cancer risk. However, very few consider the implication of genetic background and the effect of personalised nutrition on the risk and prognosis of breast cancer. A literature search was performed using the following databases: MEDLINE (Ovid), PubMed, Scopus and EMBASE (Ovid). The ensuing search terms were selected: genomics, nutrigenomics, breast cancer, breast neoplasms, cancer, nutrigenetics, diet–gene interaction, and Mediterranean, nutrition, polyphenols and diet. In this review, we discuss the Mediterranean-style diet and associated nutrients, evidence of benefit, impact on gene expression and evidence of interactions with genotype and how this interaction can modify breast cancer risk and progression. In addition, the impact of nutrients commonly associated with a Mediterranean-style diet, on breast cancer treatment, and synergistic effects are mentioned when modified by genotype. Some evidence exists around the benefit of a gene-based personalised diet based on a Mediterranean-style dietary pattern, but further evidence in the form of clinical trials is required before such an approach can be comprehensively implemented. Full article
(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)
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Open AccessArticle
A Collaborative and Ubiquitous System for Fabricating Dental Parts Using 3D Printing Technologies
Healthcare 2019, 7(3), 103; https://doi.org/10.3390/healthcare7030103 - 06 Sep 2019
Viewed by 230
Abstract
Three-dimensional (3D) printing has great potential for establishing a ubiquitous service in the medical industry. However, the planning, optimization, and control of a ubiquitous 3D printing network have not been sufficiently discussed. Therefore, this study established a collaborative and ubiquitous system for making [...] Read more.
Three-dimensional (3D) printing has great potential for establishing a ubiquitous service in the medical industry. However, the planning, optimization, and control of a ubiquitous 3D printing network have not been sufficiently discussed. Therefore, this study established a collaborative and ubiquitous system for making dental parts using 3D printing. The collaborative and ubiquitous system split an order for the 3D printing facilities to fulfill the order collaboratively and forms a delivery plan to pick up the 3D objects. To optimize the performance of the two tasks, a mixed-integer linear programming (MILP) model and a mixed-integer quadratic programming (MIQP) model are proposed, respectively. In addition, slack information is derived and provided to each 3D printing facility so that it can determine the feasibility of resuming the same 3D printing process locally from the beginning without violating the optimality of the original printing and delivery plan. Further, more slack is gained by considering the chain effect between two successive 3D printing facilities. The effectiveness of the collaborative and ubiquitous system was validated using a regional experiment in Taichung City, Taiwan. Compared with two existing methods, the collaborative and ubiquitous 3D printing network reduced the manufacturing lead time by 45% on average. Furthermore, with the slack information, a 3D printing facility could make an independent decision about the feasibility of resuming the same 3D printing process locally from the beginning. Full article
(This article belongs to the Special Issue Mobile Health Care with Smart Technology Applications)
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Open AccessArticle
An Exercise Program Designed for Children with Attention Deficit/Hyperactivity Disorder for Use in School Physical Education: Feasibility and Utility
Healthcare 2019, 7(3), 102; https://doi.org/10.3390/healthcare7030102 - 04 Sep 2019
Viewed by 356
Abstract
Moderate to high intensity exercise can improve cognitive function and behavior in children including those with attention-deficit/hyperactivity disorder (ADHD). However, exercise with long periods of the same activity, or inactivity can fail to engage or maintain their attention. This study examined the effect [...] Read more.
Moderate to high intensity exercise can improve cognitive function and behavior in children including those with attention-deficit/hyperactivity disorder (ADHD). However, exercise with long periods of the same activity, or inactivity can fail to engage or maintain their attention. This study examined the effect of exercise sessions developed to engage children with ADHD. Twelve children (10–11 years), six with a diagnosis of ADHD and six with no diagnosis, undertook 40-min sessions of short-duration, mixed activities bi-weekly for eleven weeks. ADHD symptoms and exercise enjoyment were recorded before six and eleven weeks of intervention. Teacher-reported data showed ADHD symptoms were significantly decreased in the children with ADHD, with a moderate to large effect size. There were no changes in the control group. All children indicated equal enjoyment of the exercise sessions. Specially designed exercise sessions stimulate and maintain engagement by children with ADHD and may reduce ADHD symptom levels in the school environment. The method that supports inclusive practice in physical education (PE) was successfully transferred to the study school and led by the usual class teacher. Children evaluated the exercises as acceptable and enjoyable for those with and without ADHD. This inclusive exercise method might help children manage ADHD symptoms. Full article
(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)
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Open AccessReview
Development and Themes of Diagnostic and Treatment Procedures for Secondary Leg Lymphedema in Patients with Gynecologic Cancers
Healthcare 2019, 7(3), 101; https://doi.org/10.3390/healthcare7030101 - 27 Aug 2019
Viewed by 466
Abstract
Patients with leg lymphedema sometimes suffer under constraint feeling leg heaviness and pain, requiring lifelong treatment and psychosocial support after surgeries or radiation therapies for gynecologic cancers. We herein review the current issues (a review of the relevant literature) associated with recently developed [...] Read more.
Patients with leg lymphedema sometimes suffer under constraint feeling leg heaviness and pain, requiring lifelong treatment and psychosocial support after surgeries or radiation therapies for gynecologic cancers. We herein review the current issues (a review of the relevant literature) associated with recently developed diagnostic procedures and treatments for secondary leg lymphedema, and discuss how to better manage leg lymphedema. Among the currently available diagnostic tools, indocyanine green lymphography (ICG-LG) can detect dermal lymph backflow in asymptomatic legs at stage 0. Therefore, ICG-LG is considered the most sensitive and useful tool. At symptomatic stage ≥1, ultrasonography, magnetic resonance imaging-lymphography/computed tomography-lymphography (MRI-LG/CT-LG) and lymphosintiography are also useful. For the treatment of lymphedema, complex decongestive physiotherapy (CDP) including manual lymphatic drainage (MLD), compression therapy, exercise and skin care, is generally performed. In recent years, CDP has often required effective multi-layer lymph edema bandaging (MLLB) or advanced pneumatic compression devices (APCDs). If CDP is not effective, microsurgical procedures can be performed. At stage 1–2, when lymphaticovenous anastomosis (LVA) is performed, lymphaticovenous side-to-side anastomosis (LVSEA) is principally recommended. At stage 2–3, vascularized lymph node transfer (VLNT) is useful. These ingenious procedures can help maintain the patient’s quality of life (QOL) but unfortunately cannot cure lymphedema. The most important concern is the prevention of secondary lymphedema, which is achieved through approaches such as skin care, weight control, gentle limb exercises, avoiding sun and heat, and elevation of the affected leg. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)
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Open AccessReview
Drug-Induced Sleep Endoscopy: Clinical Application and Surgical Outcomes
Healthcare 2019, 7(3), 100; https://doi.org/10.3390/healthcare7030100 - 25 Aug 2019
Viewed by 421
Abstract
The visualization of the level and pattern of apnea and hypopnea events is of pivotal importance in the diagnosis and therapeutic decision-making for sleep-disordered breathing (SDB). There are numerous techniques available to assess upper airway obstruction, which include imaging, acoustic analysis, pressure transducer [...] Read more.
The visualization of the level and pattern of apnea and hypopnea events is of pivotal importance in the diagnosis and therapeutic decision-making for sleep-disordered breathing (SDB). There are numerous techniques available to assess upper airway obstruction, which include imaging, acoustic analysis, pressure transducer recording, and endoscopic evaluation. Drug-induced sleep endoscopy (DISE) is a diagnostic tool that allows the dynamic, three-dimensional evaluation of the patterns of vibration and collapse of the upper airway of SDB patients. DISE may change the initial surgical planning in a high percentage of cases. A universally accepted and methodologically standardized DISE could provide significant insight into its role to improve surgical outcomes. However, up to now the ideal DISE protocol remains an open question. Full article
(This article belongs to the Special Issue Management of Obstructive Sleep Apnoea)
Open AccessArticle
Family Economic Burden of Elderly Chronic Diseases: Evidence from China
Healthcare 2019, 7(3), 99; https://doi.org/10.3390/healthcare7030099 - 21 Aug 2019
Viewed by 487
Abstract
Chronic diseases among the elderly and their huge economic burden on family have caught much attention from economists and sociologists over the past decade in China. This study measured the economic burden of elderly chronic disease (ECD) in families using the China Health [...] Read more.
Chronic diseases among the elderly and their huge economic burden on family have caught much attention from economists and sociologists over the past decade in China. This study measured the economic burden of elderly chronic disease (ECD) in families using the China Health and Retirement Longitudinal Study (CHARLS) data set from Peking University (China). We studied some aspects of this burden, including health-service utilization, out-of-pocket expenditure on inpatient and outpatient, total family expenditures on items, and labor force participation rates of family members, etc. Some interesting things were found, for example, the additional annual expenditure on inpatient care (per member) in ECD-families was 37 to 45 percent of the annual expenditure in the control group; the labor-force participation rate in ECD-families was 2.4 to 3.3 percent of points lower than in the control group. Full article
(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)
Open AccessFeature PaperArticle
Perspectives of Healthcare Professionals on Meaningful Activities for Persons with Dementia in Transition from Home to a Nursing Home: An Explorative Study
Healthcare 2019, 7(3), 98; https://doi.org/10.3390/healthcare7030098 - 19 Aug 2019
Viewed by 685
Abstract
Meaningful activities can enhance quality of life, a sense of connectedness, and personhood for persons with dementia. Healthcare professionals play an important role in maintaining meaningful activities, but little is currently known about the impact of the transition from home to nursing home [...] Read more.
Meaningful activities can enhance quality of life, a sense of connectedness, and personhood for persons with dementia. Healthcare professionals play an important role in maintaining meaningful activities, but little is currently known about the impact of the transition from home to nursing home on these activities. This study explored the experiences of professionals in four Dutch nursing homes, identifying facilitators and barriers to the maintenance of meaningful activities during the transition. A qualitative explorative design was used. Data were collected using focus groups and analyzed using thematic analysis. Twenty-two professionals participated in four focus groups, and three themes were identified: (1) a lack of awareness and attention for meaningful activities; (2) activities should be personalized and factors such as person characteristics, interests, the social and physical environment, and specific information such as roles, routines, activities, and personal issues play an important role in maintaining activities; (3) in the organization of care, a person-centered care vision, attitudes of professionals and interdisciplinary collaboration facilitate maintenance of meaningful activities. Healthcare professionals felt that meaningful activities are difficult to maintain and that improvements are needed. Our study provides suggestions on how to maintain meaningful activities for persons with dementia prior, during and after the transition. Full article
(This article belongs to the Special Issue Creating Age-friendly Communities: Housing and Technology)
Open AccessFeature PaperReview
Minimally Invasive Radiofrequency Surgery in Sleep-Disordered Breathing
Healthcare 2019, 7(3), 97; https://doi.org/10.3390/healthcare7030097 - 18 Aug 2019
Viewed by 475
Abstract
Sleep-disordered breathing encompasses a spectrum of conditions ranging from simple snoring to obstructive sleep apnoea (OSA). Radiofrequency surgery represents a relatively new technique available to surgeons involved in managing this condition. Its principal advantage relates to its minimally invasive nature resulting in a [...] Read more.
Sleep-disordered breathing encompasses a spectrum of conditions ranging from simple snoring to obstructive sleep apnoea (OSA). Radiofrequency surgery represents a relatively new technique available to surgeons involved in managing this condition. Its principal advantage relates to its minimally invasive nature resulting in a reduced morbidity when compared to traditional sleep surgery. The presence of good-quality research evaluating the long-term outcomes is currently scarce, although the short-term data is promising. Careful patient selection appears to be paramount in obtaining a sustained improvement. The role of radiofrequency surgery in sleep-disordered breathing has been reviewed. Full article
(This article belongs to the Special Issue Management of Obstructive Sleep Apnoea)
Open AccessReview
Mobile Self-Monitoring ECG Devices to Diagnose Arrhythmia that Coincide with Palpitations: A Scoping Review
Healthcare 2019, 7(3), 96; https://doi.org/10.3390/healthcare7030096 - 16 Aug 2019
Viewed by 727
Abstract
The use and deployment of mobile devices across society is phenomenal with an increasing number of individuals using mobile devices to track their everyday health. However, there is a paucity of academic material examining this recent trend. Specifically, little is known about the [...] Read more.
The use and deployment of mobile devices across society is phenomenal with an increasing number of individuals using mobile devices to track their everyday health. However, there is a paucity of academic material examining this recent trend. Specifically, little is known about the use and deployment of mobile heart monitoring devices for measuring palpitations and arrhythmia. In this scoping literature review, we identify the contemporary evidence that reports the use of mobile heart monitoring to assess palpitations and arrhythmia across populations. The review was conducted between February and March 2018. Five electronic databases were searched: Association for Computing Machinery (ACM), CINHAL, Google Scholar, PubMed, and Scopus. A total of 981 records were identified and, following the inclusion and exclusion criteria, nine papers formed the final stage of the review. The results identified a total of six primary themes: purpose, environment, population, wearable devices, assessment, and study design. A further 24 secondary themes were identified across the primary themes. These included detection, cost effectiveness, recruitment, type of setting, type of assessment, and commercial or purpose-built mobile device. This scoping review highlights that further work is required to understand the impact of mobile heart monitoring devices on how arrhythmias and palpitations are assessed and measured across all populations and ages of society. A positive trend revealed by this review demonstrates how mobile heart monitoring devices can support primary care providers to deliver high levels of care at a low cost to the service provider. This has several benefits: alleviation of patient anxiety, lowering the risk of morbidity and mortality, while progressively influencing national and international care pathway guidelines. Limitations of this work include the paucity of knowledge and insight from primary care providers and lack of qualitative material. We argue that future studies consider qualitative and mixed methods approaches to complement quantitative methodologies and to ensure all actors’ experiences are recorded. Full article
(This article belongs to the Special Issue Creating Age-friendly Communities: Housing and Technology)
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Open AccessArticle
Parenting When Children Have Lyme Disease: Fear, Frustration, Advocacy
Healthcare 2019, 7(3), 95; https://doi.org/10.3390/healthcare7030095 - 08 Aug 2019
Viewed by 1262
Abstract
Increasing numbers of Canadians, including children and adolescents, are being infected with Borrelia burgdorferi and contracting Lyme disease. In the present study, we provided a qualitative analysis of written correspondence produced by 23 parents of children and adolescents with Lyme disease. The goal [...] Read more.
Increasing numbers of Canadians, including children and adolescents, are being infected with Borrelia burgdorferi and contracting Lyme disease. In the present study, we provided a qualitative analysis of written correspondence produced by 23 parents of children and adolescents with Lyme disease. The goal of this study was to investigate how medical and psychological issues were highlighted by parents describing their family’s Lyme disease experiences. The results suggest a series of four stages in these families where satisfactory treatment had not been obtained over months or years. The experiences of parents evolved from feelings of worry for the child to frustration with the lack of a helpful treatment, to mistrust of physicians’ actions, and, in some case, to a rejection of the conventional health care system as a whole. Improved diagnostic testing and treatment guidelines, as well as family-centered practices of medical care were proposed as important features for improving the experiences of families living with Lyme disease. Full article
(This article belongs to the Special Issue Lyme Disease and Related Tickborne Infections)
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Open AccessReview
Current Position of the Molecular Therapeutic Targets for Ovarian Clear Cell Carcinoma: A Literature Review
Healthcare 2019, 7(3), 94; https://doi.org/10.3390/healthcare7030094 - 30 Jul 2019
Viewed by 855
Abstract
Ovarian clear cell carcinoma (OCCC) shows low sensitivity to conventional chemotherapy and has a poor prognosis, especially in advanced stages. Therefore, the development of innovative therapeutic strategies and precision medicine for the treatment of OCCC are important. Recently, several new molecular targets have [...] Read more.
Ovarian clear cell carcinoma (OCCC) shows low sensitivity to conventional chemotherapy and has a poor prognosis, especially in advanced stages. Therefore, the development of innovative therapeutic strategies and precision medicine for the treatment of OCCC are important. Recently, several new molecular targets have been identified for OCCC, which can be broadly divided into four categories: (a) downstream pathways of receptor tyrosine kinases, (b) anti-oxidative stress molecules, (c) AT-rich interactive domain 1A-related chromatin remodeling errors, and (d) anti-programmed death ligand 1/programmed cell death 1 agents. Several inhibitors have been discovered for these targets, and the suppression of OCCC cells has been demonstrated both in vitro and in vivo. However, no single inhibitor has shown a sufficient effectiveness in clinical pilot studies. This review outlines recent progress regarding the molecular biological characteristics of OCCC to identify future directions for the development of precision medicine and combinatorial therapies to treat OCCC. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)
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Open AccessReview
Drug-Induced Sleep Endoscopy: Technique, Indications, Tips and Pitfalls
Healthcare 2019, 7(3), 93; https://doi.org/10.3390/healthcare7030093 - 24 Jul 2019
Viewed by 947
Abstract
Drug-induced sleep endoscopy (DISE) is a diagnostic tool to assess the upper airway of snorers and obstructive sleep apnea patients in conditions that mimic natural sleep. Although DISE appears simple and similar to awake endoscopy, there are many aspects that need to be [...] Read more.
Drug-induced sleep endoscopy (DISE) is a diagnostic tool to assess the upper airway of snorers and obstructive sleep apnea patients in conditions that mimic natural sleep. Although DISE appears simple and similar to awake endoscopy, there are many aspects that need to be standardized in order to obtain reliable and reproducible information. In this article, we will recommend how to reliably perform DISE, its indications, and how to obtain and interpret the information of the upper airway. Full article
(This article belongs to the Special Issue Management of Obstructive Sleep Apnoea)
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Open AccessReview
What Is the Evidence for Early Mobilisation in Elective Spine Surgery? A Narrative Review
Healthcare 2019, 7(3), 92; https://doi.org/10.3390/healthcare7030092 - 18 Jul 2019
Viewed by 987
Abstract
Early mobilisation is a cornerstone of Enhanced Recovery after Surgery (ERAS) and is encouraged following spinal procedures. However, evidence of its implementation is limited and there are no formal guidelines on optimal prescription. This narrative review aimed to evaluate the evidence for the [...] Read more.
Early mobilisation is a cornerstone of Enhanced Recovery after Surgery (ERAS) and is encouraged following spinal procedures. However, evidence of its implementation is limited and there are no formal guidelines on optimal prescription. This narrative review aimed to evaluate the evidence for the effect of early mobilisation following elective spinal surgery on length of stay, postoperative complications, performance-based function and patient-reported outcomes. Four trials (five articles) that compared a specific protocol of early in-hospital mobilisation to no structured mobilisation or bed rest were selected for inclusion. Nine studies that investigated the implementation of a multimodal intervention that was inclusive of an early mobilisation protocol were also included. Results suggest that goal-directed early mobilisation, delivered using an evidence-based algorithm with a clear, procedure-specific inclusion and exclusion criteria, may reduce length of stay and complication rate. In addition, there is evidence to suggest improved performance-based and patient-reported outcomes when compared to bed rest following elective spinal surgery. Whilst this review reveals a lack of evidence to determine the exact details of which early mobilisation protocols are most effective, mobilisation on the day of surgery and ambulation from the first postoperative day is possible and should be the goal. Future work should aim to establish consensus-based, best practice guidelines on the optimal type and timing of mobilisation, and how this should be modified for different spinal procedures. Full article
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Open AccessArticle
Long-Term Care Admissions Following Hospitalization: The Role of Social Vulnerability
Healthcare 2019, 7(3), 91; https://doi.org/10.3390/healthcare7030091 - 15 Jul 2019
Viewed by 956
Abstract
We sought to understand the association between social vulnerability and the odds of long-term care (LTC) placement within 30 days of discharge following admission to an acute care facility and whether this association varied based on age, sex, or pre-admission frailty. Patients admitted [...] Read more.
We sought to understand the association between social vulnerability and the odds of long-term care (LTC) placement within 30 days of discharge following admission to an acute care facility and whether this association varied based on age, sex, or pre-admission frailty. Patients admitted to hospital with acute respiratory illness were enrolled in the Canadian Immunization Research Network’s Serious Outcomes Surveillance Network during the 2011/2012 influenza season. Participants (N = 475) were 65 years or older (mean = 78.6, SD = 7.9) and over half were women (58.9%). Incident LTC placement was rare (N = 15); therefore, we used penalized likelihood logistic regression analysis. Social vulnerability and frailty indices were built using a deficit accumulation approach. Social vulnerability interacted with frailty and age, but not sex. At age 70, higher social vulnerability was associated with lower odds of LTC placement at high levels of frailty (frailty index (FI) = 0.35; odds ratio (OR) = 0.32, 95% confidence interval (CI) = 0.09–0.94), but not at lower levels of frailty. At age 90, higher social vulnerability was associated with greater odds of LTC placement at lower levels of frailty (FI = 0.05; OR = 14.64, 95%CI = 1.55, 127.21 and FI = 0.15; OR = 7.26, 95%CI = 1.06, 41.84), but not at higher levels of frailty. Various sensitivity analyses yielded similar results. Although younger, frailer participants may need LTC, they may not have anyone advocating for them. In older, healthier patients, social vulnerability was associated with increased odds of LTC placement, but there was no difference among those who were frailer, suggesting that at a certain age and frailty level, LTC placement is difficult to avoid even within supportive social situations. Full article
(This article belongs to the Special Issue Aging, Chronic Disease, and the Impact of Long Term Care)
Open AccessArticle
Learning in Practice: Collaboration Is the Way to Improve Health System Outcomes
Healthcare 2019, 7(3), 90; https://doi.org/10.3390/healthcare7030090 - 09 Jul 2019
Viewed by 1251
Abstract
Evidence suggests that it is challenging for universities to develop workplace-relevant content and curricula by themselves, and this can lead to suboptimal educational outcomes. This paper examines the development, implementation, and evaluation of Australia’s first tertiary graduate course in healthcare redesign, a partnership [...] Read more.
Evidence suggests that it is challenging for universities to develop workplace-relevant content and curricula by themselves, and this can lead to suboptimal educational outcomes. This paper examines the development, implementation, and evaluation of Australia’s first tertiary graduate course in healthcare redesign, a partnership initiative between industry and university. The course not only provides students with an understanding of person-centered sustainable healthcare but also the skills and confidence to design, implement, and evaluate interventions to improve health service delivery. Increasing students’ application of new knowledge has been through work-integrated learning, a pedagogy that essentially integrates theory with the practice of workplace application within a purposely designed curriculum. The specific aim of this study was to examine the outcomes of the course after two years, utilizing an anonymous online survey of graduates. Sixty-two graduates (48%) completed the survey. Kirkpatrick’s four-level evaluation model was used to analyze the data. The analysis revealed high satisfaction levels in relation to the course content and delivery. Through successful completion of the innovative course, students had increased their knowledge of health system redesign methods and, importantly, the ability to translate that knowledge into everyday practice. Graduates of the clinical redesign course reported that they had been able to transfer their skills and knowledge to others in the workplace and lead further improvement projects. Full article
(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)
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Open AccessReview
Pancreatic Cancer Cachexia: The Role of Nutritional Interventions
Healthcare 2019, 7(3), 89; https://doi.org/10.3390/healthcare7030089 - 09 Jul 2019
Viewed by 1281
Abstract
Pancreatic cancer is a cancer with one of the highest mortality rates and many pancreatic cancer patients present with cachexia at diagnosis. The definition of cancer cachexia is not consistently applied in the clinic or across studies. In general, it is “defined as [...] Read more.
Pancreatic cancer is a cancer with one of the highest mortality rates and many pancreatic cancer patients present with cachexia at diagnosis. The definition of cancer cachexia is not consistently applied in the clinic or across studies. In general, it is “defined as a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass with or without loss of fat mass that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment.” Many regard cancer cachexia as being resistant to dietary interventions. Cachexia is associated with a negative impact on survival and quality of life. In this article, we outline some of the mechanisms of pancreatic cancer cachexia and discuss nutritional interventions to support the management of pancreatic cancer cachexia. Cachexia is driven by a combination of reduced appetite leading to reduced calorie intake, increased metabolism, and systemic inflammation driven by a combination of host cytokines and tumour derived factors. The ketogenic diet showed promising results, but these are yet to be confirmed in human clinical trials over the long-term. L-carnitine supplementation showed improved quality of life and an increase in lean body mass. As a first step towards preventing and managing pancreatic cancer cachexia, nutritional support should be provided through counselling and the provision of oral nutritional supplements to prevent and minimise loss of lean body mass. Full article
(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)
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Open AccessReview
The Effects of the Dietary and Nutrient Intake on Gynecologic Cancers
Healthcare 2019, 7(3), 88; https://doi.org/10.3390/healthcare7030088 - 07 Jul 2019
Viewed by 1438
Abstract
The contribution of diet to cancer risk has been considered to be higher in advanced countries than in developing countries. In this paper, I review the current issues (a review of the relevant literature), and the effects of the dietary and nutrient intake [...] Read more.
The contribution of diet to cancer risk has been considered to be higher in advanced countries than in developing countries. In this paper, I review the current issues (a review of the relevant literature), and the effects of the dietary and nutrient intake on three types of gynecologic cancer (cervical, endometrial and ovarian cancers). In cervical cancer, the most important roles of diet/nutrition in relation to cancer are prophylaxis and countermeasures against human papillomavirus (HPV) infection. The main preventive and reductive factors of cervical cancer are antioxidants, such as vitamin A, C, D and E, carotenoids, vegetables and fruits. These antioxidants may have different abilities to intervene in the natural history of diseases associated with HPV infection. For endometrial cancer, the increase in peripheral estrogens as a result of the aromatization of androgens to estrogens in adipose tissue in obese women and insulin resistance are risk factors. Thus, we must mainly take care to avoid the continuous intake of fat energy and sugar. In ovarian cancer, the etiology has not been fully understood. To the best of our knowledge, the long-term consumption of pro-inflammatory foods, including saturated fat, carbohydrates and animal proteins is a risk factor. The intake of acrylamide is also a risk factor for both endometrial and ovarian cancer. Most papers have been epidemiological studies. Thus, further research using in vitro and in vivo approaches is needed to clarify the effects of the dietary and nutrient intake in detail. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)
Open AccessArticle
Using Phenomenological Hermeneutics to Understand the Experiences of Managers Working with Quality Improvement Strategies in an Assisted Living Facility
Healthcare 2019, 7(3), 87; https://doi.org/10.3390/healthcare7030087 - 07 Jul 2019
Viewed by 1091
Abstract
This qualitative research project aimed to gain an understanding of the experiences of managers who participated in the implementation of quality improvement projects in an assisted living facility. This study employed hermeneutic phenomenology as a research methodology, whereby managers working in an assisted [...] Read more.
This qualitative research project aimed to gain an understanding of the experiences of managers who participated in the implementation of quality improvement projects in an assisted living facility. This study employed hermeneutic phenomenology as a research methodology, whereby managers working in an assisted living facility were invited to participate in a 60–75 min semi-structured interview. Six managers participated in the interviews. Five themes were developed from data analysis: (1) Quality improvement (QI) and resident-centered care go hand-in-hand; (2) Constant on-going commitment to continuous improvement is needed to implement QI; (3) Learning to communicate with team-members and residents/caregivers is important to implement QI; (4) Feedback is essential for the implementation of QI initiatives; and (5) Implementing new QI initiatives can be challenging. The managers emphasized the need for leadership commitment, the usage of standardized communication methods, and feedback strategies to ensure the success of QI initiatives. Additionally, the managers indicated that QI is directly related to resident-centered care and that efforts should be made to collect feedback from residents to further improve processes. Additionally, challenges surrounding the implementation of QI have been described. Since there is a scarcity of research on the implementation of QI methods in assisted living facilities, this study can provide practical tips to leaders and administrators. Full article
Open AccessFeature PaperArticle
Older Adults’ Perceptions of ICT: Main Findings from the Technology In Later Life (TILL) Study
Healthcare 2019, 7(3), 86; https://doi.org/10.3390/healthcare7030086 - 04 Jul 2019
Viewed by 1514
Abstract
Technology is entwined in 21st Century society, and within the lives of people across all ages. The Technology In Later Life (TILL) study is the first piece of work contributing to the impact, behavior, and perception of technology use, by adults aged ≥70 [...] Read more.
Technology is entwined in 21st Century society, and within the lives of people across all ages. The Technology In Later Life (TILL) study is the first piece of work contributing to the impact, behavior, and perception of technology use, by adults aged ≥70 years, residing in rural and suburban areas. TILL is an international, multi-centred, multi-methods study investigating and conceptualizing how various technologies impact the lives of older adults; residing in urban and rural locations in the United Kingdom (UK) and Canada. This in-depth study recruited 37 participants via a multi-methods approach. Analysis of the findings ascertained two overarching themes: facilitators of technology use (i.e., sharing of information and feeling secure), and detractors of technology (i.e., feelings of apprehension of use). Proposed recommendations include promotion of technology from a strengths-based perspective focusing on positive opportunities technology to improve health and wellbeing, creating a peer support network to assist with learning of new technology, and the need to examine further how intergenerational relationships may be enhanced through the use of technology. The distinction of these themes narrates to the originality of this initial study and milieu of recruited participants, intersecting across the fields of gerontology, geography, social sciences, and gerontechnology. Full article
(This article belongs to the Special Issue Creating Age-friendly Communities: Housing and Technology)
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Open AccessArticle
Clinical Factors Associated with Longer Hospital Stay Following Ovarian Cancer Surgery
Healthcare 2019, 7(3), 85; https://doi.org/10.3390/healthcare7030085 - 03 Jul 2019
Viewed by 1091
Abstract
Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. [...] Read more.
Background: Ovarian cancer (OC) is the leading cause of death from gynecologic malignancy and is treated with a combination of cytoreductive surgery and platinum-based chemotherapy. Extended length of stay (LOS) after surgery can affect patient morbidity, overall costs, and hospital resource utilization. The primary objective of this study was to identify factors contributing to prolonged LOS for women undergoing surgery for ovarian cancer. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify women from 2012–2016 who underwent hysterectomy for ovarian, fallopian tube and peritoneal cancer. The primary outcome was LOS >50th percentile. Preoperative and intraoperative variables were examined to determine which were associated with prolonged LOS. Results: From 2012–2016, 1771 women underwent elective abdominal surgery for OC and were entered in the ACS-NSQIP database. The mean and median LOS was 4.6 and 4.0 days (IQR 0–38), respectively. On multivariate analysis, factors associated with prolonged LOS included: American Society of Anesthesiologists (ASA) Classification III (aOR 1.71, 95% CI 1.38–2.13) or IV (aOR 1.88, 95% CI 1.44–2.46), presence of ascites (aOR 1.88, 95% CI 1.44–2.46), older age (aOR 1.23, 95% CI 1.13–1.35), platelet count >400,000/mm3 (aOR 1.74, 95% CI 1.29–2.35), preoperative blood transfusion (aOR 11.00, 95% CI 1.28–94.77), disseminated cancer (aOR 1.28, 95% CI 1.03–1.60), increased length of operation (121–180 min, aOR 1.47, 95% CI 1.13-1.91; >180 min, aOR 2.78, 95% CI 2.13–3.64), and postoperative blood transfusion within 72 h of incision (aOR 2.04, 95% CI 1.59–2.62) (p < 0.05 for all). Conclusions: Longer length of hospital stay following surgery for OC is associated with many patient, disease, and treatment-related factors. The extent of surgery, as evidenced by perioperative blood transfusion and length of surgical procedure, is a factor that can potentially be modified to shorten LOS, improve patient outcomes, and reduce hospital costs. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Gynecologic Cancers)
Open AccessArticle
Power and Design Issues in Crossover-Based N-Of-1 Clinical Trials with Fixed Data Collection Periods
Healthcare 2019, 7(3), 84; https://doi.org/10.3390/healthcare7030084 - 02 Jul 2019
Viewed by 977
Abstract
“N-of-1,” or single subject, clinical trials seek to determine if an intervention strategy is more efficacious for an individual than an alternative based on an objective, empirical, and controlled study. The design of such trials is typically rooted in a simple crossover strategy [...] Read more.
“N-of-1,” or single subject, clinical trials seek to determine if an intervention strategy is more efficacious for an individual than an alternative based on an objective, empirical, and controlled study. The design of such trials is typically rooted in a simple crossover strategy with multiple intervention response evaluation periods. The effect of serial correlation between measurements, the number of evaluation periods, the use of washout periods, heteroscedasticity (i.e., unequal variances among responses to the interventions) and intervention-associated carry-over phenomena on the power of such studies is crucially important for putting the yield and feasibility of N-of-1 trial designs into context. We evaluated the effect of these phenomena on the power of different designs for N-of-1 trials using analytical theory based on standard likelihood principles assuming an autoregressive lag 1, i.e., AR(1), serial correlation structure among the measurements as well as simulation studies. By evaluating the power to detect effects in many different settings, we show that the influence of serial correlation and heteroscedasticity on power can be substantial, but can also be mitigated to some degree through the use of appropriate multiple evaluation periods. We also show that the detection of certain types of carry-over effects can be heavily influenced by design considerations as well. Full article
(This article belongs to the Special Issue N-of-1 Trials in Healthcare)
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Open AccessReview
End-of-Life Care Challenges from Staff Viewpoints in Emergency Departments: Systematic Review
Healthcare 2019, 7(3), 83; https://doi.org/10.3390/healthcare7030083 - 29 Jun 2019
Viewed by 1055
Abstract
The hospital emergency department (ED) is the place where people most commonly seek urgent care. The initial diagnosis of an end-of-life (EOL) condition may occur in the ED. In this review we described the challenges; from the staff members’ perspectives, to safe, appropriate, [...] Read more.
The hospital emergency department (ED) is the place where people most commonly seek urgent care. The initial diagnosis of an end-of-life (EOL) condition may occur in the ED. In this review we described the challenges; from the staff members’ perspectives, to safe, appropriate, and high quality end-of-life care (EOLC) for people who are diagnosed with non-malignant diseases who present to ED settings internationally. We conducted a systematic review of peer-reviewed literature. PubMed, Scopus, CINAHL, Medline, and Web of Science were searched from 2007 to 2017. In this review the challenges in providing quality EOLC from staff viewpoints, for EOL people who are diagnosed with non-malignant progressive diseases in ED settings, were classified into eight themes: (1) EOLC education and training, (2) ED design, (3) Lack of family support, (4) Work Load, (5) ED staff communication and decision making, (6) EOLC quality in ED, (7) resource availability (time, space, appropriate interdisciplinary personnel) and (8) integrating palliative care (PC) in ED. The formulation of EOLC using this review result may help to improve the quality of life for dying people by providing ED staff with clear guidelines that can guide them in their daily practice Full article
(This article belongs to the Special Issue Aging, Chronic Disease, and the Impact of Long Term Care)
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Open AccessArticle
The Power of Music: Enhancing Muscle Strength in Older People
Healthcare 2019, 7(3), 82; https://doi.org/10.3390/healthcare7030082 - 27 Jun 2019
Viewed by 1238
Abstract
Sarcopenia is a major problem occurring in the aging population. Based on previous research, music appears to have a positive influence on many aspects of life, including physical performance. This led to the question of whether listening to self-selected favorite music could improve [...] Read more.
Sarcopenia is a major problem occurring in the aging population. Based on previous research, music appears to have a positive influence on many aspects of life, including physical performance. This led to the question of whether listening to self-selected favorite music could improve peripheral muscle strength in older people. In this crossover study, community-dwelling people aged 65 and older were included. All participants performed handgrip strength measurements in three different circumstances: while listening to their favorite music, their most disliked music, and no music at all. As the primary outcome measurement, the within-person differences in maximum handgrip strength between the three music conditions were analyzed. A total of 153 participants (aged 73.0 ± 6 years) were included. Listening to favorite music resulted in an increase in maximum handgrip strength of +0.87 kgf (0.54–1.21, p < 0.001) compared to no music, and of +0.97 kgf (0.56–1.37, p < 0.001) compared to least favorite music. Thus, listening to favorite music has a positive effect on handgrip strength in older people. Apart from its implications for scientific grip strength measurements, this effect may be used as a fun and innocent stimulant in rehabilitation and workout classes with seniors, which could be further tested in a range of older people. Full article
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Open AccessArticle
Assessing the Penetrance of Dementia Services
Healthcare 2019, 7(3), 81; https://doi.org/10.3390/healthcare7030081 - 27 Jun 2019
Viewed by 960
Abstract
Introduction: This scoping review aims to identify studies that assess dementia case finding programs (such as memory clinics) on a population basis and specifically assess the impacts that these services have on the diagnosis and management of dementia within a specific population. Methods: [...] Read more.
Introduction: This scoping review aims to identify studies that assess dementia case finding programs (such as memory clinics) on a population basis and specifically assess the impacts that these services have on the diagnosis and management of dementia within a specific population. Methods: We conducted a literature review using the PubMed database, Ovid search engine, and records identified from external sources. This review assessed studies that contained data on patients diagnosed with dementia within a set population, reviewed the impact of specialty services on the diagnosis and management of such patients, and evaluated how this compared to data estimates for that population catchment. Results: The literature review yielded 1106 unique studies, of which only five were determined to be relevant based on the inclusion criteria. There was considerable variation between the primary outcome measures of the five studies included, and a quantitative meta-analysis could not be performed. Discussion: There are currently limited data on the fraction of the total population of people with dementia that are diagnosed and managed by specialised dementia assessment services within a set population. Further studies investigating how these services impact the incidence and prevalence of dementia diagnosis and ongoing management are required. Full article
(This article belongs to the Special Issue Feature Papers in Healthcare in 2019)
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