Recently, there has been increased interest in patient satisfaction measures such as Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. In this ...systematic review, the spine surgery literature is analyzed to evaluate factors predictive of patient satisfaction as measured by these surveys.
A thorough literature search was performed in PubMed/MEDLINE, Google Scholar, and Cochrane databases. All English-language articles from database inception to July 2020 were screened for study inclusion according to PRISMA guidelines.
Twenty-four of the 1899 published studies were included for qualitative analysis. There has been a statistically significant increase in the number of publications across years (P = 0.04). Overall, the studies evaluated the relationship between patient satisfaction and patient demographics (71%), preoperative and intraoperative clinical factors (21%), and postoperative factors (33%). Top positive predictors of patient satisfaction were patient and nursing/medical staff relationship (n = 4; 17%), physician–patient relationship (n = 4; 17%), managerial oversight of received care (n = 3; 13%), same sex/ethnicity between patient and physician (n = 2; 8%), and older age (n = 2; 8%). Top negative predictors of patient satisfaction were high Charlson Comorbidity Index/high disability/worse overall health functioning (n = 7; 29%), increased length of hospital stay (n = 4; 17%), high rating for pain/complications/readmissions (n = 4; 17%), and psychosocial factors (n = 3; 13%).
There is heterogeneity in terms of different factors, both clinical and nonclinically related, that affect patient satisfaction ratings. More research is warranted to investigate the role of hospital consumer surveys in the spine surgical patient population.
The therapeutic potential of Wnt proteins has long been recognized but challenges associated with in vivo stability and delivery have hindered their development as drug candidates. By exploiting the ...hydrophobic nature of the protein we provide evidence that exogenous Wnt3a can be delivered in vivo if it is associated with a lipid vesicle. Recombinant Wnt3a associates with the external surface of the lipid membrane; this association stabilizes the protein and leads to prolonged activation of the Wnt pathway in primary cells. We demonstrate the consequences of Wnt pathway activation in vivo using a bone marrow engraftment assay. These data provide validation for the development of WNT3A as a therapeutic protein.
Diabetes mellitus (DM) is a metabolic disease frequently associated with impaired bone healing. Despite its increasing prevalence worldwide, the molecular etiology of DM-linked skeletal complications ...remains poorly defined. Using advanced stem cell characterization techniques, we analyzed intrinsic and extrinsic determinants of mouse skeletal stem cell (mSSC) function to identify specific mSSC niche-related abnormalities that could impair skeletal repair in diabetic (Db) mice. We discovered that high serum concentrations of tumor necrosis factor-α directly repressed the expression of Indian hedgehog (Ihh) in mSSCs and in their downstream skeletogenic progenitors in Db mice. When hedgehog signaling was inhibited during fracture repair, injury-induced mSSC expansion was suppressed, resulting in impaired healing. We reversed this deficiency by precise delivery of purified Ihh to the fracture site via a specially formulated, slow-release hydrogel. In the presence of exogenous Ihh, the injury-induced expansion and osteogenic potential of mSSCs were restored, culminating in the rescue of Db bone healing. Our results present a feasible strategy for precise treatment of molecular aberrations in stem and progenitor cell populations to correct skeletal manifestations of systemic disease.
Since the discovery of scarless fetal skin wound healing, research in the field has expanded significantly with the hopes of advancing the finding to adult human patients. There are several ...differences between fetal and adult skin that have been exploited to facilitate scarless healing in adults including growth factors, cytokines, and extracellular matrix substitutes. However, no one therapy, pathway, or cell subtype is sufficient to support scarless wound healing in adult skin. More recently, products that contain or mimic fetal and adult uninjured dermis were introduced to the wound healing market with promising clinical outcomes. Through our review of the major experimental targets of fetal wound healing, we hope to encourage research in areas that may have a significant clinical impact. Additionally, we will investigate therapies currently in clinical use and evaluate whether they represent a legitimate advance in regenerative medicine or a vulnerary agent. WIREs Dev Biol 2018, 7:e309. doi: 10.1002/wdev.309 This article is categorized under: Adult Stem Cells, Tissue Renewal, and Regeneration > Regeneration Plant Development > Cell Growth and Differentiation Adult Stem Cells, Tissue Renewal, and Regeneration > Environmental Control of Stem Cells.
A comment on an article about liquid dynamics is presented. It has been established from data on more than 100 liquids and polymers that the relaxation time and other dynamic quantities superimpose ...when plotted is a material constant. The known exception to this density scaling is H-bonded and other associated liquids. Deviations from an invariance have been observed in molecular dynamic simulations for substantial density changes where density scaling has been verified for pressures as high as 10 GPa in diamond anvil measurements.
ABSTRACT
Introduction
The purpose of this study was to determine if improvement in pain impact and functional performance following a functional restoration (FR) program was sustained up to 6 months ...posttreatment and to identify predictors of sustained improvement.
Materials and Methods
Secondary analysis of data collected during randomized clinical trial. Study population included 108 US active duty service members who completed an FR program, as well as 3- and/or 6-month follow-up assessments. Primary outcome measure was the NIH Research Task Force (pain) impact score (PIS). Secondary outcome was a composite functional performance measure of treadmill, lifting, and carrying tolerances. Variables analyzed to determine their predictive value included demographics; treatment hours; measures of pain intensity, function, mood, sleep, social satisfaction, pain catastrophizing, kinesiophobia, self-efficacy, pain acceptance, patient activation, functional performance, and neuropathic pain.
Results
Mean PIS and functional performance improved significantly immediately following FR, but after 6 months, only improvement in functional performance sustained. Responder analysis showed that 6 months after FR, 42% of participants reported improvement that exceeded the minimal clinically important difference in PIS or functional performance. Predictors of sustained PIS improvement included younger age, absence of neuropathic pain features, less self-rated disability, better baseline functional performance, and worse baseline PIS. Predictors of sustained functional performance improvement included more treatment hours, lower baseline pain catastrophizing, and lower baseline functional performance.
Conclusions
This study supports the investment of treatment time in FR to yield sustained clinically meaningful improvement, as observed in over 40% of this study’s military participants. Pretreatment predictors of sustained response included lower pain catastrophizing and absence of neuropathic pain. Further research is needed to determine if treatments that improve pain catastrophizing and neuropathic pain will result in sustained improvement in pain impact and functional performance following FR program participation.
We follow the development of staged resection from its first description by Walter E. Dandy, one of the founding fathers of neurosurgery, in 1925 in which he removed a large vestibular ...schwannoma.This historical vignette cites neurosurgical case reports and literature to demonstrate the evolution of staged resection of intracranial lesions, from Dandy's initial use to its becoming a more viable and safe option for the treatment of meningiomas, vestibular schwannomas, and skull base lesions (among numerous other intracranial pathologies). We also discuss the current advancements and future perspectives of staged resection that may show promise in effectively treating a wide range of pathologies while simultaneously reducing morbidity rates—a warrant for further exploration of staged cranial surgery as an important tool in neurosurgery.
The
lncRNA mediates X chromosome inactivation (XCI). Here we show that Spen, an
-binding repressor protein essential for XCI , binds to ancient retroviral RNA, performing a surveillance role to ...recruit chromatin silencing machinery to these parasitic loci. Spen loss activates a subset of endogenous retroviral (ERV) elements in mouse embryonic stem cells, with gain of chromatin accessibility, active histone modifications, and
RNA transcription. Spen binds directly to
RNAs that show structural similarity to the A-repeat of
, a region critical for
-mediated gene silencing.
RNA and
A-repeat bind the RRM domains of Spen in a competitive manner. Insertion of an ERV into an A-repeat deficient Xist rescues binding of
RNA to Spen and results in strictly local gene silencing in
. These results suggest that
may coopt transposable element RNA-protein interactions to repurpose powerful antiviral chromatin silencing machinery for sex chromosome dosage compensation.
This book explores the possibilities that exist within educational spaces for Black male students when teachers care for these students while also acknowledging the intersectionality of Black male ...identity and the potential oppression and resilience that they experience as the result.
Maintaining nutrient availability in organic orchards presents challenges. Diverse litter sources may increase nutrient cycling and the efficiency by which microbes utilize carbon (C). Two tree-row ...treatments: ‘straw-mulch’ (
Triticum aestivum
L.) and ‘living-mulch’ (
Lobularia maritima
(L.) Desv.), and two alleyway groundcovers: ‘grass’ (
Festuca rubra
with
Lolium perenne
L.) and a legume, ‘Birdsfoot trefoil’ (
Lotus corniculatus
L.) were compared to an industry standard, tillage with a grass alleyway. Tree-row deposited trefoil biomass contributed 0.2 kg additional total nitrogen (N) per tree annually. Soil from tree-rows with trefoil alleyways had 23% greater organic C (+ 3.1 g kg
−1
), 17% greater total N (+ 0.3 g kg
−1
), up to 53% greater microbial biomass (+ 204 mg CO
2
–C kg
−1
), 32, 34 and 31% greater dehydrogenase (+ 2.3 µg TPF g
−1
), alkaline (+ 55.9 µg p-nitrophenol g
−1
) and acid (+ 106.7 µg p-nitrophenol g
−1
) phosphomonoesterase enzyme activity, 62% greater soil NO
3
−
N (+ 2.05 µg NO
3
−1
g
−1
), and 51% higher nitrification rates (+ 0.22 µg NO
2
−
–N + NO
3
−
–N g
−1
soil h
−1
) than tree-row soils adjacent to grass alleyways. Straw-mulch and living-mulch soils did not differ. Metabolic CO
2
quotient (qCO
2
) values were lowest in trefoil (0.0032) and living-mulch with grass treatments (0.0036), indicating greater microbial growth efficiency. Tillage and straw-mulch with grass alleyway treatments had the highest qCO
2
(0.0053 and 0.0048) and the lowest microbial biomass (246.3 and 297.6 mg CO
2
–C kg
−1
soil). Higher potential biochemical activity, and total C and N, suggests orchards with trefoil alleyways cut and deposited into tree-rows, enhances soil organic matter and promotes balanced nutrient cycling and retentive processes.
PDF
