Access in all areas? A round up of developments in market access and HTA: part 5.

In this latest update, we explore the recent announcement by Canada's Drug Agency (CDA-AMC, formerly CADTH) on their pilot to include the societal perspective in the evaluation of certain new medicines; a recent Office of Health Economics (OHE) report on the evaluation of HTA agency methods over time; and publications examining the impact of Project Orbis on patient access to oncology treatments.

Improvement of thermal environment in the outdoor atrium by employing the spray system.

Outdoor atriums have recently been applied with increasing frequency for natural illumination, but they produce a harsh thermal environment easily in summer. Moreover, overheating of the outdoor atrium necessitates air-conditioning to moderate indoor thermal comfort. Simultaneously, the substantial heat emissions from air-conditioning outdoor units worsen the outdoor thermal environment, creating a vicious cycle. Traditional passive evaporative methods involving water and greenery, while capable of regulating the thermal environment, suffer from low evaporative efficiency and pose significant challenges. To improve thermal environment in outdoor atriums, the spray system was employed due to its high cooling efficiency, especially in open or semi-open spaces. In this study, a comparative experiment was conducted to evaluate the effectiveness of using a spray system for evaporative cooling in open outdoor spaces. Furthermore, employing high-efficiency evaporative cooling through spraying to disrupt the vicious cycle of indoor and outdoor thermal environments. The dual goals include regulating indoor and outdoor thermal conditions while also mitigating the local heat island effect. Temperature and humidity distribution within the atrium and adjacent hallways were monitored, along with the impact on air-conditioning operation consumption in neighboring offices. Results showed that the spray system significantly improved the thermal environment in the outdoor atrium, reducing the average and peak air temperatures by 0.94-2.83 °C and 2.92-5.21 °C, respectively. It also resulted in a drop in the average temperature by 0.56-1.62 °C and the peak temperature by 2.31-3.25 °C in adjacent hallways. This effectively eased the issue of overheating in these areas while raising the comfort level in adjacent office spaces. The predicted mean vote decreased from 1.46 to 0.87, indicating a significant improvement in thermal environment in neighboring offices. Furthermore, the daily energy consumption was reduced by 10.6-12.4% in neighboring offices. This study provided the valuable guidance for improving thermal environments within outdoor atrium.

Ureteric stenting outside of the operation theatre: challenges and opportunities.

OBJECTIVE: To evaluate the safety, efficacy, tolerability, and cost-effectiveness of bedside or office-based ureteric stent insertion. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 guidelines, we searched PubMed/the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and Dimensions for English-language studies from 1978 to April 2023. Inclusion criteria focused on primary ureteric stent placements outside of the operating theatre (OT). RESULTS: A total of 15 studies involving 2072 stents were included. Success rates for correctly positioned stents in bedside or office-based insertions ranged from 60% to 95.8%, with most studies reporting ≥80% success rates. Common failure reasons included impacted stones and difficulty identifying the ureteric orifice. Pain and tolerability were assessed using various methods, with validated tools indicating moderate pain levels, but most patients would undergo the procedure again under local anaesthesia. Complication rates were generally low, with minor complications such as haematuria or postoperative fever being the most common. Procedural costs were significantly lower in non-OT settings, with estimates indicating savings of up to four-fold. CONCLUSION: Bedside or office-based ureteric stent insertion is a viable alternative to OT procedures, offering high success rates, manageable pain levels, low complication rates, and substantial cost savings. This approach is particularly advantageous in settings with limited OT access, highlighting its potential for broader adoption in urological practice. Future research should focus on standardising pain assessment methods and randomised studies.

Assessing Public-Reported Perceptions of Low-Risk Hand Surgery Provided in the Office Versus an Ambulatory Surgery Center: Survey Study.

Purpose: There is growing evidence for the safety of wide-awake, office-based, low-risk hand surgery. However, there is limited insight into patient receptiveness to these procedures. Here, we evaluate the public perceptions and degree of tolerance of low-risk, office-based hand surgery. Methods: A prospective study was performed using a 26-question, paid survey via a clinically validated, public, online marketplace. Participants were divided based on (pre-education) perceptions of in-office hand surgery into three cohorts as follows: in-office surgery (IOS), no in-office surgery, or no preference (NP). Educational material was then presented comparing three surgical settings and anesthetic types. Then, participants selected their setting/anesthetic preferences for the following four procedures: trigger finger release, cyst excision, carpal tunnel release, and distal radius fracture. Statistical analyses with unpaired t tests and chi-square tests were performed. P < .05 was significant. Results: There were 509 respondents-266 in the IOS group, 104 in the no in-office surgery group, and 139 in the NP group. Previous outpatient surgery was most frequent in the IOS cohort. In-office surgery and NP cohorts were more likely to believe that surgical procedures could be performed in the clinic setting. The remaining demographics were similar across cohorts. After reviewing the education graphic, 50 of the 139 in the NP group switched to prefer IOS. For procedure-specific questioning, 40.6% (207/509) were amenable to in-office trigger finger release and 58.3% (297/509) for cyst excision, unlike more invasive procedures (carpal tunnel release: 25.6% (130/509); distal radius fracture: 9.8% (50/509). The most influential factors determining surgical location were comfort during the procedure and total encounter time. The IOS group favored location to be at the surgeon's discretion more than the no in-office surgery group. Conclusions: In-office, low-risk, hand surgery appears desirable to select patients. If presented with the option for in-office trigger finger release or cyst excision, approximately 40.6% (207/509) and 58.3% (297/509), respectively, may be amenable to IOS. Type of study/level of evidence: Prospective IB.

Clinical Impact of 3- versus 5-Minute Delay and 30- versus 60-Second Intervals on Unattended Automated Office Blood Pressure Measurements.

BACKGROUND: Guidelines advise automated office blood pressure (AOBP) with an initial 5-minute delay and multiple measurements at least 60 seconds apart. Recent studies suggest that AOBP may be accurate with shorter delays or intervals, but evidence in clinical settings is limited. METHODS: Patients referred to one hypertension (HTN) center underwent 24-hour ambulatory blood pressure monitoring (ABPM) and one of four non-randomized, unattended AOBP protocols: a 3- or 5-minute delay with a 30 or 60-second interval, i.e., 3 min/30 sec/30 sec, 3/60/60, 5/30/30 and 5/60/60 protocols. HTN was defined as systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg. RESULTS: We compared differences in mean blood pressure and HTN classification between average AOBP and awake-time ABPM by t-tests and Fisher's exact test. Among 212 participants (mean 58.9 years, 61% women, 25% Black), there was substantial overlap in the probability distributions of awake-time ABPM and each of the three AOBP measures. Systolic blood pressure means were similar between the 5/60/60 and 3/30/30 protocols and 5/30/30 and 3/60/60 protocols. The 5/30/30 was associated with a higher proportion of systolic HTN, while the 3/60/60 protocol was associated with a higher proportion of diastolic HTN. There were no significant differences in systolic or diastolic HTN between 5/60/60 and 3/30/30 protocols with respect to awake-time ABPM. CONCLUSIONS: In this quality improvement study, the shortest AOBP protocol did not differ significantly from the longest protocol. The time savings of shorter protocols may improve AOBP adoption in clinical practice without meaningfully compromising accuracy.

Effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers: a secondary analysis of a randomized controlled trial.

BACKGROUND: Neck and low back pain are prevalent issues among office workers due to prolonged sitting, necessitating effective interventions. Dynamic seat cushion, designed to promote postural shifts, have emerged as promising solutions to address this concern. This study aims to evaluate the effectiveness of a dynamic seat cushion on recovery and recurrence of neck and/or low back pain in office workers. METHODS: This study used 6-month follow-up data of a randomized controlled trial, involving 66 office workers who reported neck and/or low back pain during the trial. At baseline, participants were cluster-randomized into an intervention group, which received a dynamic seat cushion designed to encourage postural shifts, or a control group, which received a placebo seat pad. Health outcomes included recovery duration and recurrence of pain. Analyses utilized log rank test and Cox proportional hazard models. RESULTS: The recovery rate from neck and/or low back pain was 100% for the intervention group, and 86% for the control group. The median recovery duration of participants who reported pain during the 6-month period was 1 month in the intervention group and 3 months in the control group. The intervention group had a higher probability of recovery compared to the control group (HRadj 4.35, 95% CI 1.87-10.11; p < 0.01). The recurrence rate of neck and low back pain was 27% in the intervention group, which was 75% in the control group. The Hazard Ratio, after adjustment, for the intervention group compared to the control group was 0.50 (95% CI = 0.11-2.12). CONCLUSIONS: A dynamic seat cushion that encourages postural shifts shortened recovery duration of neck and low back pain among office workers. Due to small numbers, a potentially relevant reduction in the recurrence of neck and low back pain could not be statistically confirmed. A power analysis was not conducted for this secondary analysis, and future studies should be designed with adequate sample sizes to explore the recurrence of pain with greater statistical power. TRIAL REGISTRATION: This trial is retrospectively registered under the Thai Clinical Trials Registry: TCTR20230623002 (23/06/2023).

Perspectives on the Regional Strategy for Implementation of National Action Plans on Antimicrobial Resistance in the WHO African Region.

Background: The WHO Regional Office for Africa developed a Member States (MS)-endorsed regional strategy to fast-track the implementation of MS' national action plans (NAP) on Antimicrobial resistance (AMR). This study explored the perspectives of AMR's national focal points in MS on the implementation of the priority interventions of the regional strategy in their countries. Methods: An online survey consisting of ratings and discussions covering the implementation of the six priority interventions was conducted. Sums of the scores per priority intervention were obtained, and their percentage to the total possible scores were calculated to categorize the implementation as inadequate (0-25%), basic (26-50%), intermediate (51-75%), or advanced (76-100%). Results: Thirty-six of the forty-seven national AMR focal points responded to the survey between 12 November 2023 and 8 January 2024. The implementations were rated as 37-62% (basic-to-intermediate), with the multisectoral coordination and collaboration committee receiving the highest overall rating (62%, 421/684), while the promotion of sustainable investment for the NAP on AMR received the least overall rating (37%, 257/700). The focal points mainly recommended awareness campaigns, capacity building, and regulations and guidelines to improve the implementation of the AMR strategy. Conclusions: The survey revealed a need to enhance awareness campaigns, support the establishment and functioning of AMR evaluation and monitoring systems, and build the capacity of AMR staff with cost-benefit analysis and budgeting skills. It also showed the necessity to improve awareness and conduct education on AMR, streamline evidence generation through One Health Surveillance systems, integrate initiatives to reduce hospital-acquired infections in the antimicrobial stewardship programs, and enhance regulations and guidelines to optimize the use of antimicrobials.

Office-based risk equation of Globorisk for prediction of ten-years cardiovascular risk among Iranian population: findings from Fasa PERSIAN cohort study.

BACKGROUND: Globorisk is one of the prediction tools for 10-year risk assessment of cardiovascular disease, featuring an office-based (non-laboratory-based) version. This version does not require laboratory tests for determining the CVD risk. The present study aims to determine the 10-year CVD risk using the office-based Globorisk model and factors associated with the 10-year CVD risk. METHODS: In this study, baseline data from 6810 individuals participating in the Fasa cohort study, with no history of CVD or stroke, were utilized. The risk equation of the office-based Globorisk model incorporates age, sex, systolic blood pressure (SBP), body mass index (BMI), and smoking status. The Globorisk model categorizes the risk into three groups: low risk (< 10%), moderate risk (10% to < 20%), and high risk (≥ 20%). To identify factors associated with the 10-year CVD risk, the predicted risk was categorized into two groups: <10% and ≥ 10%. Multivariable logistic regression analysis was employed to determine factors associated with an increased CVD risk. RESULTS: According to the 10-year CVD risk categorization, 78.3%, 16.4%, and 5.3% of men were in the low, moderate, and high risk groups, respectively, while 85.8%, 10.0%, and 4.2%, of women were in the respective risk groups. Multivariable logistic regression results indicated that in men, the 10-year CVD risk decreases with being an opium user, and increases with being illiterate, having abdominal obesity, and low or moderate physical activity compared to high physical activity. In women, being married, and higher fiber consumption decrease the 10-year CVD risk, while being illiterate, low or moderate physical activity compared to high physical activity, having abdominal obesity, opium use, and being in wealth quintiles 1 to 4 compared to quintile 5 increase the risk. CONCLUSIONS: Considering the factors associated with increased CVD risk, there is a need to enhance awareness and modify lifestyle to mitigate and reduce the risk of CVD. Additionally, early identification of individuals at moderate to high risk is essential for preventing disease progression. The use of the office-based Globorisk model can be beneficial in settings where resources are limited for determining the 10-year CVD risk.

Cost-Effectiveness Analysis of Operating Room and In-Office Reconstruction of Skin Cancer Defects.

OBJECTIVE: Reconstruction of skin cancer and Mohs micrographic surgery (MMS) defects of the head and neck is performed in both in-office and operating room (OR). This study intends to understand cost differences between reconstructive surgery for skin cancer defects in the OR and clinic to perform a cost-effectiveness analysis with single-institution patient satisfaction data. STUDY DESIGN: Population-based retrospective analysis of cost data and an institutional, prospective survey of patient satisfaction. SETTING: National insurance database and institutional survey. METHODS: The Merative® MarketScan database was queried to identify claims involving the reconstruction of skin cancer defects of the head/neck between 2013 and 2020 for cost-analysis by setting (OR vs clinic). Patients undergoing operative and clinic-based reconstruction of MMS defects by 3 different surgeons at a single institution in 2023 were surveyed for satisfaction using a 5-point Likert scale. Data was coupled for cost-benefit analysis. Analysis was performed using propensity-matched samples. RESULTS: Using Marketscan, 1206 patients were analyzed for cost data. OR cases had a higher median baseline cost of $2308 (interquartile range [IQR]: 1484-3889) compared to procedures in the office (median $987, IQR: 784-1454, P < .001). Survey data from 116 patients revealed no significant difference in scores between OR and clinic cases (clinic: 4.57 vs OR: 4.60, P = .8752). Using propensity-matched subsets, providers incur an additional $4744 for a reduction in satisfaction of 0.083 when performing cases in the OR. CONCLUSION: Lower cost is associated with reconstructive procedures performed in the office. This study is the first cost analysis of head and neck skin cancer reconstruction based on procedural settings and will be valuable to surgeons in considering practice patterns and resource utilization.

The HYsteroscopic Miscarriage MaNagement (HYMMN) pilot randomized-controlled trial.

OBJECTIVE: To evaluate the feasibility of performing a full-scale, adequately powered, multi-center randomized controlled trial (RCT) assessing the effectiveness of office hysteroscopy (OH) for the treatment of retained pregnancy tissue (RPT) after miscarriage, compared with standard treatment (ST) (expectant/medical/surgical), on future pregnancy outcome. STUDY DESIGN: Single-center pilot RCT performed at Birmingham Women's Hospital, UK. Patients opting for non-surgical miscarriage management at ≤14 weeks gestation who wanted to conceive as soon as possible were recruited and offered a transvaginal ultrasound scan (TVUS) eight weeks later to check for the presence of RPT. Patients with RPT were randomized in a 1:1 ratio using a computer-generated online random allocation sequence to either OH (performed using the TruClear 5.0 hysteroscopic tissue retrieval system) or ST (the type of which was recommended based on symptoms, urinary pregnancy test and scan findings). RESULTS: 158 participants were approached for inclusion into the trial, of which 149 (94.3%) agreed. Of the 126 that underwent TVUS, RPT were diagnosed in 42 patients (33.3%). 21 patients were randomized to OH, of whom 18 underwent the procedure because three fell pregnant after their TVUS. OH was deemed acceptable to all patients without any serious complications. 21 patients were randomized to ST where 16 patients (76%) were recommended expectant management and five (24%) were recommended surgical management. 115 patients (91%) were able to provide pregnancy data, however, the study was not powered to show a clinically significant difference. CONCLUSION: A full-scale, adequately powered, randomized clinical trial investigating OH against ST for the treatment of RPT following miscarriage is clinically relevant and feasible owing to high rates of participation, acceptability and satisfaction and low rates of attrition associated with the proposed interventions.

An In-Vitro Study on the Impact of Light-Emitting Diode (LED) and Laser-Activated Bleaching Techniques on the Color Change of Artificially Stained Teeth at Varying Time Intervals.

Introduction Tooth color is a key factor in the perception of an attractive smile, making bleaching a widely sought-after cosmetic dental procedure. Valued for its minimally invasive approach, this technique effectively lightens teeth to achieve desired aesthetic outcomes. As the desire for immediate results grows among patients, various bleaching agents, and energy sources have been developed to expedite the bleaching process. The study aims to evaluate and compare the efficacy of 35% hydrogen peroxide activated by light-emitting diode (LED) and laser on artificially stained teeth, assessing color changes at different time intervals. Methodology Sixty maxillary central incisors with intact crowns were selected for the study. An artificial staining solution was prepared, and the samples were immersed in it for 15 days to simulate staining. After this period, the teeth were removed from the solution, rinsed with water, and dried. Baseline photographs of each tooth were taken for comparison. The teeth were then divided into two groups, one treated with LED activation and the other with laser activation of 35% hydrogen peroxide as the bleaching agent. The color changes were measured and recorded at different time intervals. Data were presented as mean and standard deviation, with statistical analysis conducted using independent sample t-test and repeated measures ANOVA to compare the efficacy of the two methods. Results Both LED and laser activation of 35% hydrogen peroxide demonstrated significant color changes in the stained teeth. The initial color improvement was noticeable in both groups, with LED and laser treatments producing comparable whitening effects. The mean color change values indicated that both activation sources were effective in enhancing the bleaching process, providing immediate and substantial results. Statistical analysis showed no significant difference between the two methods, suggesting their equivalency in clinical efficacy for tooth bleaching. Conclusion The study concludes that both LED and laser activation of 35% hydrogen peroxide are efficient methods for in-office tooth bleaching, providing immediate and enhanced whitening effects. The comparable results between the two energy sources indicate that can be effectively used to meet the increasing demand for rapid aesthetic improvements in a clinical setting. This finding supports the adoption of both LED and laser bleaching techniques as viable options for dental practitioners aiming to achieve optimal patient satisfaction with minimal invasiveness.

National Trends in Laryngeal Laser Surgery: Comparison of Operative Versus Office-Based Procedures.

OBJECTIVE: To analyze national trends in the prevalence of office-based laryngeal ablative procedures and compare those with traditional operative excisional procedures utilizing direct laryngoscopy. METHODOLOGY: For years 2013-2022, the US Medicare Part B claims database was searched for Current Procedural Terminology (CPT) codes 31572 (flexible laryngoscopy with laser ablation of lesion), 31540 (operative direct laryngoscopy with excision of lesion), 31541 (operative direct microlaryngoscopy with excision of lesion), and 31545 (operative direct microlaryngoscopy with excision of lesion and local tissue flap reconstruction). For each CPT code, the total number of charges billed to the Medicare database in each calendar year was recorded and annual trends were analyzed. Biopsy procedures were not included. RESULTS: The annual number of office-based laser procedures (CPT 31572) remained relatively constant since the CPT code was introduced in 2017 (range: 18887-25241 procedures annually, trendline slope = +16, R2:0.02). Office-based laser procedures comprised a small portion of total laryngeal excisional procedures (range: 8.4%-12.1%). The total number of operative laryngeal excisions, billed by CPT 31540 and 31541, declined over the studied time frame (Trendline slope = -132, R2:0.93; Trendline slope = -950, R2: 0.93 respectively). CONCLUSIONS: Office-based laser procedures comprise a small fraction of procedures to remove laryngeal lesions. The number of office-based laser procedures has been relatively stable over the last 5 years. This finding contrasts with the prevailing health care trend toward office-based procedures. Further research is needed to understand the decrease in operative laryngeal lesion excision procedures observed over the last 10 years. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

Correlation Between Anxiety, Depression and Hemodynamic Changes in Office-Based Laryngeal Surgery.

OBJECTIVE: To investigate the correlation between anxiety, depression, and hemodynamic changes during office-based laryngeal surgery (OBLS). METHODS: All patients undergoing OBLS between February 2024 until July 2024 were invited to participate in the study. Participants had their vital signs recorded throughout the procedure at a 5-min interval. They also had to fill the Generalized Anxiety Disorder scale-7 (GAD-7) to assess anxiety severity and the Patient Health Questionnaire-9 (PHQ-9) to assess depression severity. Demographic data included age, gender, history of smoking, history of reflux disease, history of cardiovascular diseases, type and duration of procedure. RESULTS: A total of 45 patients were recruited in the study. During OBLS, 35.5% of patients developed hypertension and 28.9% developed tachycardia. There was a significant increase in mean systolic blood pressure (SBP) by 30.16 mmHg (p < 0.001), in mean diastolic blood pressure (DBP) by 31.44 mmHg (p < 0.001), and in mean heart rate (HR) by 14.2 beats per minute (p < 0.001). There was also a significant decrease in the mean O2 saturation by 0.4% (p = 0.001). There was no correlation between anxiety and SBP, DBP, HR, and O2 (r < 0.1). There was also no correlation between depression levels and SBP, DBP, HR, O2 (r < 0.1). CONCLUSION: There was a significant increase in the mean SBP, DP, and HR and a significant decrease in the O2 saturation in patients undergoing OBLS. However, there was no correlation between anxiety, depression and the changes in these vital signs. Future investigations are needed to understand the causes of hemodynamic instability in OBLS. LEVEL OF EVIDENCE: 2 Laryngoscope, 2024.

Flexible Endoscopic Approach to Glottic Carcinoma: Five-Year Oncological Outcomes.

OBJECTIVE: The objective of this study was to demonstrate the long-term oncologic efficacy of flexible endoscopic laryngeal surgery (FELS) in treating T1-T2 glottic carcinoma. METHODS: From 134 patients who underwent FELS, 90 patients (males-82, females-8), aged 18-83 (mean-56.9 ± 10.7) with early glottic carcinoma (T1a-27, T1b-24, and T2-39) were included in the study. Fifty-seven patients (63.3%) underwent FELS under local anesthesia with spontaneous ventilation, the rest of the patients were operated on under general anesthesia with superimposed high-frequency jet ventilation (SHFJV). Tumor ablation by Nd:YAG laser was performed in all the cases, preceded by diathermy snare excision in one-third of cases. In 20 of the T2 cases, adjuvant radiotherapy (RT) was performed. RESULTS: Five-year overall survival and ultimate disease control, including salvage treatment, was obtained in 82/90 patients (91.1%), cure with larynx preservation-in 88.9% of cases, disease-free survival-in 83.3% of cases, and ultimate local control with FELS alone-in 86.7% of cases. The best 5-year oncological results were obtained in the T1a group of treated patients, all the patients being alive and free of disease with the preserved larynx due to FELS alone. There was no evidence of better oncological results by FELS under general anesthesia with SHFJV over FELS under local anesthesia with spontaneous ventilation. Anterior commissure (AC) involvement worsened the treatment results. Adjuvant RT did not demonstrate an improvement of oncological results in the T2 group of patients. CONCLUSIONS: FELS demonstrates oncological outcomes that are comparable to RT and transoral laser microsurgery and can be considered an oncologically efficient method of treatment of T1-T2 glottic carcinoma. Awake FELS is not inferior to FELS under general anesthesia with SHFJV concerning oncological efficacy. More studies on a bigger clinical material are necessary for definitive conclusions concerning the impact of AC affection and adjuvant RT on the oncological results.

Impact of a 6-month sit-stand desk-based intervention on regional musculoskeletal discomfort and overall post-work fatigue in office workers: a cluster randomised controlled trial.

Evaluate the impact of a 6-month sit-stand desk (SSD) intervention on office workers' regional musculoskeletal discomfort (MD) and overall post-work fatigue (PWF) compared to a control group. A two-arm (1:1) clustered randomised controlled trial including 38 participants (aged 24-60 years, 77% women) assigned to intervention or control groups. The intervention, spanning 6 months, involved psychoeducation, motivational prompts, and SSD. The control group maintained standard working conditions. MD was assessed using the Nordic Musculoskeletal Questionnaire, and PWF with the Need for Recovery Scale. ANCOVA was employed to compare groups, adjusting for covariates, with 5% significance. The intervention group reduced overall MD (p = 0.018) and PWF (p = 0.013), while the control group showed no changes. However, no time*group interactions were found (p > 0.05). A 6-month SSD intervention alleviated office workers' MD and PWF, suggesting benefits from increasing standing time by at least 30 minutes/day. Future investigations must explore individual heterogeneity in response to SSD. TRIAL REGISTRATION: https://doi.org/10.17605/OSF.IO/JHGPW.

A 6-month SSD intervention alleviated workers' musculoskeletal discomfort.A 6-month SSD intervention improved workers' post-work fatigue.Increasing standing time may benefit low back pain.A need to explore individual heterogeneity to SSD interventions.

Maximizing Ancillary Opportunities.

In the face of increasing overhead and declining reimbursement for hand surgery services, ancillary services provide additional opportunities for revenue capture outside the standard stream of office visits and surgical billing. These additional revenue streams may allow hand surgeons to practice with less stress, improve efficiency, and create more financial security overall. Hand surgery practices are quite diverse. There are solo practitioners, hand surgery group practice, hand surgery within a specialty group (most often orthopedic surgery), multispecialty clinics, and those who are incorporated within a health system. Each of these types of practices may provide different suites of ancillary services.

Systemic Effects and Absorption of Subepithelial Dexamethasone Vocal Fold Injections.

OBJECTIVE/HYPOTHESIS: To compare the systemic changes following two office-based procedures-subepithelial vocal fold steroid injections (VFSI) and vocal fold augmentation (VFA), and to characterize the magnitude and chronicity of the effects observed. STUDY DESIGN: Prospective, controlled before-after comparative study. METHODS: Patients prospectively underwent VFSI with 0.8-2 mg of dexamethasone or VFA. Serum cortisol, white cell count (WCC), and C-reactive protein (CRP) were measured at day 0 (pre-procedure), 1 and 7. Salivary cortisol was measured at baseline and daily for 7 days post-procedure. RESULTS: Fourteen patients underwent VFSI and 36 VFA. At baseline serum cortisol measured 304.6 ± 116.6 nmol/L and fell significantly to 48.1 ± 41.8 nmol/L 1 day following dexamethasone injection (p = 0.001) and recovered by day 7 to 303.7 ± 78.7 nmol/L. Salivary cortisol demonstrated a similar pattern with significant recovery demonstrated by day 3 (p = 0.001). White cell counts were affected by the systemic absorption of exogenous steroid and normalized by day 7. Patients who underwent VFA demonstrated no significant change in their serum or salivary cortisol and no significant change in their WCC. No significant changes in CRP or patient's physiological parameters were observed in either procedure. CONCLUSION: Our findings demonstrate systemic absorption of dexamethasone following VFSI, with acute hypothalamic-pituitary-adrenal (HPA) axis suppression which normalizes day 3 post-procedurally. LEVEL OF EVIDENCE: 3 Laryngoscope, 2024.

The harassment of parliamentarians and judicial officers: a South Australian perspective.

An anonymous electronic survey was distributed to the members of the South Australian parliament and judiciary. Data was analysed to determine whether there were meaningful differences between parliamentarians and judicial officers in their experiences as victims of harassment. Responses were received from 28% of all members surveyed with 96% of participants reporting at least one form of harassment. Parliamentarians reported a higher prevalence of more serious forms of harassment relative to judicial officers. Parliamentarians reported experiencing harassment in both private and professional contexts whereas judicial officers almost exclusively experienced harassment in a professional context. Harassment caused significant psychological harm and social disruption across both cohorts. There were minor differences in the sources of help utilised by both cohorts; however, judicial officers reported greater satisfaction with help received relative to parliamentarians. The majority of respondents were in favour of receiving advice from a specialised service to mitigate future harassment behaviour.

Patent output and patent transfer network in China universities: Moderating roles of absorptive capacity and desorptive capacity.

Although absorptive capacity and desorptive capacity has been widely present in university-industry relationships, there has been no research on their potential impact on the relationship between university patent output and university patent transfer network. We constructed datasets of patent applications and patent transfers to firms from 383 universities between 2002 and 2021 in China, and empirically demonstrated the effect of the patent output on university patent transfer network using negative binomial regression models. We also examined the moderating effects of absorptive capacity and desorptive capacity. The results reveal that university patent output positively affects the size and the connection strength of the university patent transfer network. Technology transfer offices and satellite institutions, for desorptive capacity in universities, negatively moderate the relationship between the university patent output and the university patent transfer network, respectively. For absorptive capacity in firms, research and development intensity of new products and the level of research and development personnel input, respectively, have a positively moderate effect on the relationship between the university patent output and the university patent transfer network. Our research provides insights into the dynamics of the university patent transfer network; especially against the backdrop of a sharp increase in university patent output and insufficient development of the university patent transfer network, this study provides evidence to the substitution effect of desorptive capacity in universities and the bidirectional effect of absorptive capacity in firms.