Evaluation of healthcare professionals' experiences of taking telephone calls from parents of children with congenital heart disease. A risky business.

The Congenital Heart Disease Standards for England indicate that parents and children should have access to a 24-h telephone advice service, however, little is known about existing services. This paper presents phase two of a mixed-methods service evaluation, which aimed to evaluate staff experiences of telephone communication with these parents. All nursing and support staff in a single specialist children's cardiac surgical centre were invited to participate in an online survey during July-November 2019. Data were descriptively and thematically analysed. Participants (N = 39) were predominantly nurses (n = 32, 82%) with 64.1% (n = 25) working in the speciality >10 years. Positive experiences included: signposting and preventing further deterioration; supporting families to get expert advice quickly; providing reassurance. Challenging experiences included: offering advice without being able to see the child, dealing with telephone calls alongside busy workload; and parents running out of medications and telephoning out of hours. In conclusion, taking telephone calls were perceived to be time consuming and are potentially high risk. A standardised approach to assessment, intervention and documentation was deemed necessary. Implementation of an updated parental early warning tool was recommended, along with staff and parental education.

What works in advocating for food advertising policy change across an english region - a realist evaluation.

BACKGROUND: With increasing recognition of the role of commercial determinants of health, local areas in England have sought to restrict the advertising of products high in fat, salt and sugar (HFSS) on council-owned spaces, as part of wider strategies to reduce obesity. While there is some evidence of the impact of such policy change on behaviour, little is known about what works in the process of implementing this policy change. METHODS: Guided by a realist evaluation framework that explores the interaction between context, mechanism and outcomes, this study aims to investigate the factors that influence the restriction of outdoor advertising of HFSS products in one region in England. It refines a programme theory co-produced with stakeholders from 14 local authorities within a region and uses multiple data sources from each area with an in-depth examination of four case study sites. Data sources include longitudinal realist interviews, focus groups and surveys with policy advocates and policy stakeholders. Data were analysed retroductively to understand the causal link between context, mechanism and outcomes. RESULTS: Outcomes were driven by five dominant mechanisms: a strategic and staggered approach to stakeholder engagement, gathering intelligence, identifying policy champions, building relationships, reframing the issue; and two secondary mechanisms of amplifying the issue and increasing public will. These led to varied outcomes with no changes in formal policy position within the evaluation period but draft policy guidance in place and changes in political will demonstrated. Dominant context factors influencing change included having a named and resourced policy advocate in place supported by an external Community of Improvement and having existing aligned local objectives. Organisational complexity and change, financial concerns, lack of local examples, ideological positions and the pandemic were also influencing contextual factors. CONCLUSION: Effecting policy change in this area requires the commitment of an extended period and the valuing of short-term policy outcomes, such as increasing political will. The importance of a resourced and well-supported policy advocate to lead this work is fundamental and the commercially sensitive nature of this policy change means that a complex interplay of mechanisms is required which may be dominated by a strategically staggered approach to stakeholder engagement.

Application of an evaluation tool for mega-hospital site sustainability. Assessment of public private partnership large sized healthcare infrastructures in European context.

BACKGROUND AND AIM: Healthcare facilities are large and complex infrastructures designed to respond to a growing need of sanitary services in specialized environments to serve an increasing population number while containing costs. New financial and design models emerged for large sized Hospital -Facilities (Mega-hospitals) but their site sustainability is questioned. METHODS: The paper focuses on a comparison -between European region case studies of Public Private Partnership (PPP) Mega-Hospitals. A total of 21 large sized hospitals in operation after 2010 have been compared with the application of the Assessment Tool for -Hospital Site Sustainability (ATHOSS). A specific focus on Turkish Hospitals has been also provided as the PPP model is widely adopted in this country. RESULTS: This analysis shows that Turkish cases gets general lower scores than European ones in terms of Construction Density and Community Connectivity (28%;50%), Alternative Transportation (18%; 50%), Site Development (26%; 38%). Connection to Natural World (30%; 52%) and Heat Island Effect (33%; 43%). Only in Development Density criteria (30%; 16%) the score was higher. It also emerged that gross floor area per bed ratio is much larger for Turkish cases (334m2/bed; 198 m2/bed) which can be interpreted as one of the weaknesses related to oversizing such infrastructures. CONCLUSIONS: The tool application highlighted some point of attention to be considered when designing and planning Mega-hospital facilities and improvement strategies for site sustainability are -suggested.

Safety and effectiveness of ambrisentan in real clinical practice in pulmonary arterial hypertension: Results from the Korean post-marketing surveillance.

PURPOSE: This regulatory post-marketing surveillance (PMS) was organized to identify the safety and effectiveness of ambrisentan in the Korean population. METHOD: This was an open-label, multi-center PMS conducted from 31 institutions in Korea for 6 years from August 2015 to 2021, to evaluate the use of ambrisentan for the treatment of pulmonary arterial hypertension (PAH). Inclusion criteria are Korean subjects with the World Health Organization functional classification (WHO Fc) II or III PAH who are new users or repeated users with ambrisentan (Volibris®) Tablet 5 or 10 mg per day (age >18 years old). RESULTS: A total of 293 cases were analyzed. The overall incidence of adverse events (AE) was 52.22% and adverse drug reactions (ADR) was 10.92%. Severe AEs occurred in 20.82% of patients. However, only 2 subjects (0.68%) reported serious ADR. The difference in AE incidence was statistically significant for concomitant medications other than PAH medications in the safety analysis and the new users (p = 0.0041 and p = 0.0299, respectively) and elderly population in the repeated users (p = 0.0319). Among the long-term 223 subjects, the WHO Fc II and III were 41.26% and 58.74% before ambrisentan, and changed after treatment to 3.09%, 66.05%, and 30.86% for Fc I/II/III, respectively. 217 of 249 subjects (87.15%) considered their symptoms to have 'improved' after the last administration. CONCLUSION: In real-world practice, ambrisentan demonstrated tolerable safety and favorable effectiveness in PAH patients in Korea. Age and concomitant drug use can affect the occurrence of AE.

Evaluation of the introduction of a healthy food and drink policy in 13 community recreation centres on the healthiness and nutrient content of customer purchases and business outcomes: An observational study.

INTRODUCTION: This observational study assessed the introduction of a comprehensive healthy food and drink policy across 13 community organisation managed aquatic and recreation centres in Victoria, Australia, and the associated changes on business outcomes, and the healthiness of purchases. The policy, based on state government guidelines, mandated that food and drink availability be based on healthiness classification: 'red' (limit) <10%, and 'green' (best choice) >50%, and the remainder 'amber' (choose carefully). METHODS: Six years of monthly sales data were split into three periods, prior to (1/01/2013-31/12/2014), during (1/01/2015-31/12/2016) and post (1/1/2017-31/12/2018), policy implementation. Using point-of-sale data, food and drink nutrient content, and state guidelines, items were classified as 'red'/'amber'/'green'. Linear models with Newey West standard errors were fitted to compare the mean value of outcomes between post- to pre-policy implementation periods, for each outcome and centre; and were pooled using random effect meta-analyses. RESULTS: Comparing post- to pre-policy implementation periods, total food sales did not change (mean percentage difference: -3.2% (95% confidence interval (CI) -21% to 14%), though total drink sales declined -27% (CI -37% to -17%). The mean percentage of 'red' foods sold declined by -15% (CI -22% to -7.7%), 'amber' food sales increased 11% (CI 5.5% to 16%). 'Green' food sales did not change (3.3%, CI -1.4% to 8.0%). The mean percentage of 'red' drinks sold declined -37% (CI -43% to -31%), 'amber' and 'green' drink sales increased by 8.8% (CI 3.6% to 14%) and 28% (CI 23% to 33%), respectively. The energy density and sugar content (percentage of total weight/volume) of both food and drinks decreased. CONCLUSIONS: This study has shown that the implementation of a policy to improve the health of retail food environments can result in a shift towards healthier purchases. Sales revenue from foods did not decline, though revenue from drinks did, indicating future research needs to explore mitigation of this.

The mediating role of big five traits and self-efficacy on the relationship between entrepreneurship education and entrepreneurial behavior: Study of Tunisian university graduate employees.

The present paper aimed to explore the mediating roles of entrepreneurial self-efficacy and the big five personality traits in the relationship between entrepreneurship education and university graduate employees' entrepreneurial behavior. Structural equations modeling was applied to data collected through a survey questionnaire among 300 Tunisian employees with a university degree working in the private sector who participated in 2021 in an entrepreneurship education program provided by the Sfax Business Center, a Public-Private organization. The results demonstrate that entrepreneurship education, entrepreneurial self-efficacy, and the big five personality traits affect entrepreneurial behavior positively. Moreover, entrepreneurship education has a positive effect on self-efficacy and the big five personality traits. The findings also show a significant partial mediation of self-efficacy and the big five personality traits on the relationships between entrepreneurship education and entrepreneurial behavior.

Safety and effectiveness of empagliflozin in clinical practice as monotherapy or with other glucose-lowering drugs in Japanese patients with type 2 diabetes: subgroup analysis of a 3-year post-marketing surveillance study.

BACKGROUND: Sodium-glucose co-transporter-2 (SGLT2) inhibitors such as empagliflozin are increasingly prescribed as initial glucose-lowering drugs for type 2 diabetes (T2D), based on their cardiorenal benefits. However, information regarding the safety and the effectiveness of monotherapy with SGLT2 inhibitors in routine clinical practice is limited. RESEARCH DESIGN AND METHODS: We analyzed data from a prospective, 3-year, post-marketing surveillance study of empagliflozin in Japan. We evaluated adverse drug reactions (ADRs) (the primary endpoint) and glycemic effectiveness with or without other glucose-lowering drugs. RESULTS: 7931 T2D patients were treated with empagliflozin. At baseline, mean age was 58.7 years, 63.0% were male, and 1835 (23.14%) were not receiving other glucose-lowering drugs. ADRs occurred in 141 (7.68%) and 875 (14.62%) patients initiating empagliflozin as monotherapy or combination therapy, respectively. The most frequent ADRs of special interest with empagliflozin as monotherapy or combination therapy were urinary tract infections (0.82% and 1.14% of patients, respectively) and excessive/frequent urination (0.65%, 1.50%). At last observation, glycated hemoglobin level was reduced by a mean of 0.78% with empagliflozin monotherapy (from baseline mean of 7.55%) and 0.74% with combination therapy (baseline 8.16%). CONCLUSIONS: Empagliflozin is well tolerated and effective in clinical practice in Japan when initiated as monotherapy or combination therapy.

Internationalizing the business school: A comparative analysis of English-medium and Spanish-medium instruction impact on student performance.

Business degrees have been pioneers in adopting the internationalization of Higher Education Institutions with the option of English as Medium of Instruction (EMI). Research has grown about the EMI versus non-EMI lecturers and students' performance measured through perception, motivation, discursive analysis or satisfaction measures. However, results have not been conclusive in the scarce number of papers comparing quantitative course grades of EMI versus non-EMI students. The aim of this research paper is to prove that there is no difference in attaining learning objectives among students within a Business Administration Degree in Spain regardless the language of instruction. The present observational study considers all enrolled freshman throughout a horizon of six consecutive years allowing more reliable results not affected by the specificities of courses or years. All 212 students in the EMI track were matched to non-EMI track counterparts taking into account all available covariates. Results not only show that there is no difference in the attained learning objectives between the two tracks, but also that EMI students' grades are in fact better than their non-EMI counterparts, which might help to remove the believe many still have on the lower academic attainment of those following an EMI track.

Conhecimento de cirurgiões-dentistas e acadêmicos de Odontologia sobre publicidade e propaganda odontológica / Conocimiento de los cirujanos dentistas y estudiantes de odontología sobre publicidad y marketing dental / Dentists' and undergraduate dental students' knowledge of dental advertising and publicity campaigns

A publicidade e a propaganda em Odontologia são ferramentas importantes para o mercado de trabalho, tendo em vista a quantidade de profissionais existentes no setor e a disputa por espaço profissional. Porém, para uma publicidade ética e adequada, são de grande relevância o conhecimento e a aplicação dos princípios existentes no Código de Ética Odontológico (CEO) e nas resoluções atuais sobre o assunto. O objetivo do estudo foi avaliar a percepção e o conhecimento dos cirurgiões-dentistas e acadêmicos de Odontologia de Porto Velho, estado de Rondônia, sobre os aspectos éticos e legais relacionados com publicidade e propaganda em Odontologia, de acordo com as normas atuais. Para realização do estudo observacional descritivo, foi aplicado um questionário com 25 questões sobre o tema a cirurgiões-dentistas e acadêmicos de Odontologia matriculados no sétimo ou no oitavo período de instituições de ensino superior do munícipio de Porto Velho, Rondônia. A amostra foi constituída por 151 indivíduos, dos quais 69 eramcirurgiões-dentistas e 82 acadêmicos de Odontologia. O presente estudo permitiu identificar as principais dúvidas dos acadêmicos e dos profissionais de Odontologia que participaram da pesquisa, evidenciando a falta de esclarecimento sobre alguns pontos do tema, além de ressaltara importância do conhecimento das diretrizes éticas profissionais do CEO (AU).

La publicidad y lo marketing en Odontología son herramientas importantes para el mercado laboral, dado el número de profesionales del sector y la competencia por el espacio profesional. Sin embargo, para una publicidad ética y adecuada, es de gran importancia el conocimiento y aplicación de los principios existentes en el Código de Ética Dental (CEO) y las resoluciones vigentes en la materia. El objetivo del estudio fue evaluar la percepción y el conocimiento de los cirujanos dentistas y estudiantes de odontología de Porto Velho, estado de Rondônia, sobre los aspectos éticos y legales relacionados con la publicidad y el marketing en Odontología, de acuerdo con las normas vigentes. Para realizar el estudio observacional descriptivo, se aplicó un cuestionario con 25 preguntas sobre el tema a cirujanos dentistas y estudiantes de odontología matriculados en el séptimo u octavo período de instituciones de educación superior de la ciudad de PortoVelho, Rondônia. La muestra estuvo compuesta por 151 individuos, de los cuales 69 eran cirujanos dentistas y 82 estudiantes de odontología. El presente estudio permitió identificar las principales dudas de académicos y profesionales de la odontología que participaron de la investigación, destacando la falta de aclaración sobre algunos puntos sobre el tema, además de resaltar la importancia de conocer las pautas éticas profesionales del CEO (AU).

Advertising and publicity are important tools for the dental job market due to the number of professionals in the industry and the competition for professional space. Nevertheless, dentists must know and apply the principles outlined in the Brazilian Dental Code of Ethics (CEO) and current resolutions to ensure ethical and appropriate advertising. This study aimed to evaluate the perception and knowledge of dental surgeons and students in Porto Velho, state of Rondônia, Brazil, about the current standards of ethical and legal aspects related to advertising and publicity in dentistry. To carry out this descriptive observational study, a questionnaire with 25 questions was administered to dentists and dental students enrolled in the seventh or eighth semester of higher education institutions in Porto Velho. The sample consisted of 151 subjects, of which 69 were dentists and 82 were dental students. This study enabled us to identify the main questions of the dental students and professionals who participated in the survey, highlighting the lack of clarification on certain aspects of the subject and emphasizingthe importance of knowing the CEO professional ethical guidelines (AU).

Effectiveness of Regulatory Policies on Online/Digital/Internet-Mediated Alcohol Marketing: a Systematic Review.

BACKGROUND: The rapid growth of social networking sites and video sharing platforms has created an opportunity for the alcohol industry to employ advanced advertising and marketing approaches to target their audiences, increasingly blurring the lines between commercial marketing and user-generated content, which poses a challenge for effective regulation. METHODS: We conducted a systematic search through three peer-reviewed journal databases (WoS, PubMed, Scopus). Studies were included if published in English, after 2004, and assessed statutory regulation or voluntary industry codes, enacted by an EU or nation's governmental agency or private entity, and with the intent to restrict digital alcohol advertising. In addition, we conducted a manual search of gray literature. RESULTS: A total of 4690 records were identified. After duplicate removal and full-text assessment, 14 articles were examined. Our findings indicate that children and adolescents may often be exposed to alcohol advertisements on social media and websites due to industry's self-regulatory age-affirmation systems being largely ineffective at preventing under-aged access. Cases of self-regulatory violations by the alcohol industry, and increasingly innovative 'gray-area' advertising approaches have also been noted. Additionally, research illustrates a lack of developed statutory restrictions of digital alcohol advertising and instead continued reliance on voluntary industry self-regulation. CONCLUSIONS: There is a substantial need for further research to examine the effectiveness of digital alcohol advertising restrictions in social media, websites and image/video sharing platforms. Moreover, there is a necessity for countries to develop comprehensive statutory frameworks, which would effectively restrict and monitor rapidly advancing digital alcohol advertising practices on new digital media.

A non-interventional, post-marketing surveillance study evaluating the safety and effectiveness of biosimilar rituximab (CT-P10) during routine clinical practice in the Republic of Korea.

BACKGROUND: CT-P10 was the first licensed rituximab biosimilar. This Korean post-marketing surveillance study evaluated CT-P10 safety and effectiveness in approved indications. RESEARCH DESIGN AND METHODS: This prospective, open-label, observational, phase 4 study collected routine clinical practice data across 27 centers in the Republic of Korea. Patients received their first CT-P10 treatment, per prescribing information, for non-Hodgkin's lymphoma (NHL), chronic lymphocytic leukemia (CLL), rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA) during the surveillance period (16 November 2016-15 November 2020). Safety (including adverse events [AEs] and adverse drug reactions [ADRs]) and disease-specific clinical response (by best overall response [NHL/CLL], Disease Activity Score in 28-joints [RA], or Birmingham Vasculitis Activity Score for Wegener's Granulomatosis [GPA/MPA]) were assessed for ≤1 year (NHL/CLL) or ≤24 weeks (RA/GPA/MPA). RESULTS: The safety population comprised 677 patients (604 NHL, 16 CLL, 42 RA, 7 GPA, 8 MPA). AEs/ADRs were reported for 68.4%/27.7% (NHL/CLL), 31.0%/14.3% (RA), and 86.7%/13.3% (GPA/MPA) of patients. Serious AEs and unexpected ADRs did not raise new safety signals. Pneumonia was the most frequent serious ADR overall. Positive effectiveness outcomes were observed. CONCLUSIONS: Findings were consistent with the known CT-P10/reference rituximab safety profile, with high effectiveness observed in NHL/CLL and RA.

Safety and Effectiveness of Lenvatinib in Patients with Unresectable Hepatocellular Carcinoma in Real-World Clinical Practice: An Observational Post-Marketing Study in Japan.

BACKGROUND: Lenvatinib was approved for use in unresectable hepatocellular carcinoma (uHCC) in Japan in 2018. Patients with diverse clinical characteristics receive lenvatinib treatment in clinical practice. Thus, it is crucial to evaluate the safety and effectiveness of lenvatinib in real-world clinical settings. OBJECTIVE: This study aimed to evaluate the real-world safety and effectiveness of lenvatinib for uHCC in clinical practice in Japan. PATIENTS AND METHODS: Between July 2018 and January 2019, patients with uHCC who were administered lenvatinib for the first time were enrolled in this prospective, multicenter, observational post-marketing study (NCT03663114). Patients were orally administered lenvatinib and followed up for 12 months. For safety, adverse drug reactions (ADRs) were evaluated. For effectiveness, the objective response rate (ORR) was calculated to evaluate tumor response. Overall survival (OS) was estimated using the Kaplan-Meier method. RESULTS: Data of 703 patients (median age, 73 years; 80.2% males) were analyzed. The median (range) treatment duration was 25.3 (0.3-68.9) weeks. The mean ± standard deviation initial dose was 7.37 ± 1.65 mg in patients with body weight < 60 kg and 10.43 ± 2.49 mg in those with body weight ≥ 60 kg. ADRs (any grade) were reported in 84.9% of the patients, with Grade ≥ 3 ADRs reported in 42.5% of the patients. The most common ADRs (> 10%) were decreased appetite, fatigue, hypertension, proteinuria, palmar-plantar erythrodysesthesia, hypothyroidism, and diarrhea. The median OS of the 703 patients was 498.0 days. In 494 patients assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST), the ORR was 39.5% (95% confidence interval: 35.1-43.9%). Patients with better liver or renal function at baseline achieved significantly higher ORR than those with worse liver or renal function. CONCLUSIONS: In patients with uHCC in real-world clinical practice in Japan, treatment with lenvatinib was generally well tolerated, and no new safety concerns were identified. The ORR and median OS were similar to or better than the results of the Japanese subset of the global Phase III REFLECT trial. Our results demonstrated that clinically meaningful treatment responses were achieved with lenvatinib in real-world clinical practice.

Social marketing program for dating violence bystander intervention on university campus: analyzing its effectiveness and sociocultural feasibility.

The purpose of this study was to test the effectiveness and sociocultural feasibility of a dating violence (DV) bystander intervention program, called With-Us, implemented on university campus in South Korea. Participants were recruited from two universities, some as part of an intervention group (n = 99) and the others as part a comparison group (n = 67). The participants were assessed pre- and post-interventions in terms of their readiness and intention to help, as well as their efficacy. Analyses show that the program increased the readiness in bystanders to help victims. Contrarily, it was observed that older participants, males, and those having higher patriarchal gender stereotypes, were less likely to pay attention to the program. Based on the findings, we provided several suggestions to promote its effectiveness and sociocultural feasibility so that it could be efficiently applied in further studies.

Exploring strategies to promote health services online: The role of contextual priming, digital ad type, and health threat orientation in determining the effectiveness of health service ads.

Contextual congruence, health threat orientation, and digital advertisement type can influence the effectiveness of online health service ads. To examine these effects, a 2 × 2 × 2 online experiment was conducted with contextual similarity as a within-subjects factor. Results suggest that contextual similarity was positively associated with both attitude toward ads and purchase intention. The data also revealed an interaction effect between digital advertising type and health threat orientation: health ads to address issues of immediate concerns enhanced purchase intention, but only in the incongruent context. Implications of the study were also discussed.

Safety and effectiveness of baricitinib for rheumatoid arthritis in Japanese clinical practice: 24-week results of all-case post-marketing surveillance.

OBJECTIVES: To assess the safety and effectiveness of baricitinib treatment for rheumatoid arthritis (RA) in real-world clinical practice. METHODS: This ongoing all-case post-marketing surveillance study (starting September 2017) includes all patients with RA treated with baricitinib in Japan. Safety and effectiveness (disease activity) were assessed for 24 weeks. RESULTS: Safety analyses to February 2021 included 4731 patients (initial baricitinib dose: 4 mg/day, n = 3058; 2 mg/day, n = 1661; other, n = 12); 1059 (22.38%) were ≥75 years and 3362 (71.06%) previously received biologic therapy. The overall observational period was 1863.14 patient-years; 1174 (24.82%) patients discontinued baricitinib before Week 24, mostly for lack of effectiveness (n = 478; 10.10%). Adverse events occurred in 1271 (26.87%) patients [serious: 203 (4.29%); death: 18 (0.38%)]. The incidence of herpes zoster, hepatic function disorder, and serious infection was 3.09%, 2.77%, and 1.90%, respectively. Malignancy occurred in 17 patients (0.36%) and major adverse cardiovascular events in seven patients (0.15%). Among patients with effectiveness data, at least 26.57% (Boolean) achieved remission at Week 24. CONCLUSIONS: This large nationwide surveillance study evaluated the safety and effectiveness of 24 weeks of baricitinib for RA in real-world clinical practice. Continued surveillance of long-term safety is ongoing.

Evaluation of Financial and Nonfinancial Conflicts of Interest and Quality of Evidence Underlying Psoriatic Arthritis Clinical Practice Guidelines: Analysis of Personal Payments From Pharmaceutical Companies and Authors' Self-Citation Rate in Japan and the United States.

OBJECTIVE: To assess financial conflicts of interest (COI) and nonfinancial COI among psoriatic arthritis (PsA) clinical practice guideline (CPG) authors in Japan and the US, and to evaluate the quality of evidence and strength of recommendations of PsA CPGs. METHODS: We performed a retrospective analysis using payment data from major Japanese pharmaceutical companies and the US Open Payments Database from 2016 to 2018. All authors of PsA CPGs issued by the Japanese Dermatological Association (JDA) and American College of Rheumatology (ACR) were included. RESULTS: Of 23 CPG authors in Japan, 21 (91.3%) received at least 1 payment, with a combined total of $3,335,413 between 2016 and 2018. Regarding 25 US authors, 21 (84.0%) received at least 1 payment, with a combined total of $4,081,629 during the same period. The 3-year combined mean ± SD payment per author was $145,018 ± $114,302 in Japan and $162,825 ± $259,670 in the US. A total of 18 authors (78.3%) of the JDA PsA CPG and 12 authors (48.0%) of the ACR PsA CPG had undisclosed financial COI worth $474,663 and $218,501, respectively. The percentage of citations with at least 1 CPG author relative to total citations was 3.4% in Japan and 33.6% in the US. In sum, 71.4% and 88.8% of recommendations for PsA in the JDA and ACR were supported by low or very low quality of evidence. CONCLUSION: More rigorous cross-checking of information disclosed by pharmaceutical companies and self-reported by physicians and more stringent and transparent COI policies are necessary.

Economic performance evaluation of community health service centers: a DEA-based cross-efficiency study.

Health is a basic need for human survival and development. To achieve the goal of access to basic medical and health services for everyone, the operational performance of the health industry should be improved, and the allocation of resources in the health industry should be optimized. Because of this, we conduct an empirical analysis to evaluate the performance of community health service centers using cross-evaluation. In this study, we apply the data envelopment analysis (DEA) cross-efficiency model to empirically analyze the performance of 9 local community health service centers in Hefei, China. Through the empirical study, we obtain the following research results. (1) Haitang has the best performance among all community health service centers, whereas Sanxiaokou is the worst. (2) The performance of more than half of the community health service centers is significantly imbalanced. (3) Bozhoulu and Lindian do not perform well in all dimensions, that is, they have an imbalanced development. (4) Shuanggang is balanced but does not perform well in all dimensions. We conduct an empirical analysis with real-world data from 9 local community health service centers using the classical DEA cross-efficiency model and compare the results of the cross-efficiency (cross-evaluation) and CCR efficiency (self-evaluation) to better understand each community health service center's performance.

Does environmental responsible effect human resources management practice on firm effectiveness and green technology innovation?

The research uses human resources management ability and practice, opportunity and motivation (AMO) concept and CSR, environmental responsibility and corporate social. How (ER-HRM) environmental responsible human resources management practices affect energy intensive manufacturing. Organizational effectiveness and green technology innovation and firms have several objectives, including competitiveness, long-term survival, and high profit. To test the hypotheses in this research model, a self-completed questionnaire was collected from 220 managers of energy-intensive manufacturing for analysis. The ability ER-HRM practice has the highest influence on green technology innovation and organizational effectiveness. It is worth noting firm effectiveness relationship between ER-HRM practice and green technology innovation. The finding indicates a strong straight positive impact of the motivation, environmental ability, and opportunity ER-HRM practice on green technology innovation and organizational effectiveness. Research also proves that green technology innovation plays a partial mediation link (ER-HRM) with organizational effectiveness. Our research supports the further development of ER-HRM for understanding the drivers of green technology innovation and organizational effectiveness. This research is expected to identify the influence of ER-HRM in energy-intensive manufacturing to achieve innovation and performance through reducing emissions. We recommend to the manager to give due attention.

Evaluation of financial conflicts of interest and quality of evidence in Japanese gastroenterology clinical practice guidelines.

BACKGROUND: Clinical practice guidelines assist healthcare professionals in providing evidence-based care. However, pharmaceutical companies' financial interests often influence guideline content. This study aimed to elucidate the magnitude of financial ties among Japanese gastroenterology guideline authors and the pharmaceutical industry. METHODS: Using pharmaceutical company disclosed payment data, we evaluated financial conflicts of interest (COI) among Japanese Society of Gastroenterology guideline authors between 2016 and 2021. Additionally, we assessed the evidence quality supporting guideline recommendations and associations with financial COI. Finally, we evaluated author COI management during guideline development against global standards. RESULTS: Overall, 88.2% (231/262) of guideline authors received a median of $12 968 (interquartile range [IQR]: $1839-$70 374) in payments between 2016 and 2019 for lectures, writings, and consulting. Chairpersons received significantly higher payments (median: $86 444 [IQR: $15 455-$165 679]). Notably, 41 (15.6%) authors had undeclared payments exceeding declaration requirements. Low or very low-quality evidence supported 41.0% of recommendations. There was a negative association between the median 4-year payment per author and the proportion of recommendations based on low-quality evidence (odds ratio: 0.966 [95% confidence interval [95% CI]: 0.945-0.987], P = 0.002) and positive association with moderate-quality evidence (odds ratio: 1.018 [95% CI: 1.011-1.025], P < 0.001). Still, the Japanese Society of Gastroenterology guideline development process remains less transparent, with insufficient COI policies relative to global standards. CONCLUSION: There were extensive financial COI between pharmaceutical companies and guideline authors, and more than 40% of recommendations were based on low-quality evidence. More rigorous and transparent COI policies for guideline development adhering to global standards are warranted.

Safety and effectiveness of dulaglutide 0.75 mg in Japanese patients with type 2 diabetes in real-world clinical practice: 36 month post-marketing observational study.

AIMS/INTRODUCTION: This study evaluated the safety and effectiveness of dulaglutide in patients with type 2 diabetes in the real-world setting in Japan. MATERIALS AND METHODS: This prospective, observational post-marketing surveillance study was conducted for 36 months (July 2016 to July 2021) in Japan. Investigators reported data via an electronic data capture system. Data were analyzed by overall population and age group (<65, ≥65 to <75, and ≥75 years). RESULTS: The analysis population (N = 3,136) included 1,538 (49.04%), 869 (27.71%), and 729 (23.25%) patients aged <65 years, ≥65 to <75 years, and ≥75 years, respectively. Overall, 231 patients (7.37%) experienced ≥1 adverse drug reactions, with the highest frequency in the ≥75 years group. The most common adverse drug reactions were gastrointestinal disorders (n = 106; 3.38%). Severe hypoglycemia (n = 4; 0.13%), major adverse cardiovascular events (n = 4; 0.13%), and acute pancreatitis (n = 1; 0.03%) were uncommon. The mean glycated hemoglobin and bodyweight were reduced from baseline by -0.76% and -1.6 kg, respectively (last observation carried forward). The rate of dulaglutide continuation at 36 months was 58.03% overall and 59.43%, 63.13%, and 48.88% in the <65, ≥65 to <75, and ≥75 years groups, respectively. A factor analysis showed age ≥65 years was associated with a greater incidence of gastrointestinal adverse drug reactions as well as larger reductions in glycated hemoglobin and bodyweight. CONCLUSIONS: The current real-world data are in accordance with clinical trial findings and further confirm the safety and effectiveness of dulaglutide for elderly patients, whose numbers were limited in the clinical trials.