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Kruse, Clemens Scott, Nicole Krowski, Blanca Rodriguez, Lan Tran, Jackeline Vela, and Matthew Brooks. "Telehealth and patient satisfaction: a systematic review and narrative analysis." BMJ Open 7, no. 8 (August 2017): e016242. http://dx.doi.org/10.1136/bmjopen-2017-016242.
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BackgroundThe use of telehealth steadily increases as it has become a viable modality to patient care. Early adopters attempt to use telehealth to deliver high-quality care. Patient satisfaction is a key indicator of how well the telemedicine modality met patient expectations.ObjectiveThe objective of this systematic review and narrative analysis is to explore the association of telehealth and patient satisfaction in regards to effectiveness and efficiency.MethodsBoolean expressions between keywords created a complex search string. Variations of this string were used in Cumulative Index of Nursing and Allied Health Literature and MEDLINE.Results2193 articles were filtered and assessed for suitability (n=44). Factors relating to effectiveness and efficiency were identified using consensus. The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences.ConclusionThis review identified a variety of factors of association between telehealth and patient satisfaction. Knowledge of these factors could help implementers to match interventions as solutions to specific problems.
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Najm, Aurélie, Alessia Alunno, Xavier Mariette, Benjamin Terrier, Gabriele De Marco, Jenny Emmel, Laura Mason, Dennis G. McGonagle, and Pedro M. Machado. "Pathophysiology of acute respiratory syndrome coronavirus 2 infection: a systematic literature review to inform EULAR points to consider." RMD Open 7, no. 1 (February 2021): e001549. http://dx.doi.org/10.1136/rmdopen-2020-001549.
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BackgroundThe SARS-CoV-2 pandemic is a global health problem. Beside the specific pathogenic effect of SARS-CoV-2, incompletely understood deleterious and aberrant host immune responses play critical roles in severe disease. Our objective was to summarise the available information on the pathophysiology of COVID-19.MethodsTwo reviewers independently identified eligible studies according to the following PICO framework: P (population): patients with SARS-CoV-2 infection; I (intervention): any intervention/no intervention; C (comparator): any comparator; O (outcome) any clinical or serological outcome including but not limited to immune cell phenotype and function and serum cytokine concentration.ResultsOf the 55 496 records yielded, 84 articles were eligible for inclusion according to question-specific research criteria. Proinflammatory cytokine expression, including interleukin-6 (IL-6), was increased, especially in severe COVID-19, although not as high as other states with severe systemic inflammation. The myeloid and lymphoid compartments were differentially affected by SARS-CoV-2 infection depending on disease phenotype. Failure to maintain high interferon (IFN) levels was characteristic of severe forms of COVID-19 and could be related to loss-of-function mutations in the IFN pathway and/or the presence of anti-IFN antibodies. Antibody response to SARS-CoV-2 infection showed a high variability across individuals and disease spectrum. Multiparametric algorithms showed variable diagnostic performances in predicting survival, hospitalisation, disease progression or severity, and mortality.ConclusionsSARS-CoV-2 infection affects both humoral and cellular immunity depending on both disease severity and individual parameters. This systematic literature review informed the EULAR ‘points to consider’ on COVID-19 pathophysiology and immunomodulatory therapies.
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Kılınçarslan, Mehmet Göktuğ, Erkan Melih Şahin, and Başak Korkmazer. "Prevalence and associated factors of inappropriate repeat test." Postgraduate Medical Journal 95, no. 1129 (July 24, 2019): 596–600. http://dx.doi.org/10.1136/postgradmedj-2019-136696.
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BackgroundThe rate of laboratory test utilisation has been increasing unsustainably. Evaluating inappropriately repeated laboratory tests is promising because objective criteria are available to measure the rates while causes can be manipulated easily. In this study, we aimed to evaluate the prevalence, associated factors and financial burden of inappropriate repeat tests.MethodsA cross-sectional study was conducted on the results of 26 types of laboratory tests recorded in a laboratory database of a tertiary hospital between 1 July 2014 and 30 June 2017. Minimum retest intervals were determined from the literature for each type of tests. If the time interval between the two tests was shorter than the minimum retest interval, then the later test was accepted an inappropriate repeat test. Binary logistic regression was performed after univariate analyses.ResultsOf a total of 673 794 tests, 109 370 (16.2%) were inappropriate repeat tests. Male gender, being ≥65 years old, being an inpatient, high-volume test and surgical clinic as the test-requesting clinic were associated with inappropriate repeat tests. Also, it was determined that US$66 761.3 had been wasted on inappropriate repeat tests for 3 years.DiscussionThere are several factors that increase the rate of inappropriate repeat tests. They should be considered during health policy making or planning interventions to reduce inappropriate repeat tests.
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Lunny, Carole, Jesmin Antony, Patricia Rios, Chantal Williams, Naveeta Ramkissoon, Sharon E. Straus, and Andrea C. Tricco. "Safety and effectiveness of dose-sparing strategies for intramuscular seasonal influenza vaccine: a rapid scoping review." BMJ Open 11, no. 9 (September 2021): e050596. http://dx.doi.org/10.1136/bmjopen-2021-050596.
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BackgroundThe objective of this rapid scoping review was to identify studies of dose-sparing strategies for administration of intramuscular seasonal influenza vaccines in healthy individuals of all ages.MethodsComprehensive literature searches were executed in MEDLINE, Embase and the Cochrane library. The grey literature was searched via international clinical trial registries for relevant studies published in English in the last 20 years. We included studies in healthy humans of any age that used any dose-sparing strategy to administer intramuscular seasonal influenza vaccines. Title/abstract and full-text screening were carried out by pairs of reviewers independently. Data extraction was conducted by a single reviewer and verified by a second reviewer. Our outcomes were influenza infections, intensive care unit admission, pneumonia, hospitalisations, adverse events and mortality. Results were summarised descriptively.ResultsA total of 13 studies with 10 351 participants were included in the review and all studies were randomised controlled trials (RCTs) conducted between 2006 and 2019. The most common interventions were the trivalent influenza vaccine (n=10), followed by the quadrivalent influenza vaccine (n=4). Nine studies included infants/toddlers 6–36 months old and one of these studies also included children and adolescents. In these nine studies, no clinical effectiveness outcomes were reported. Of the four adult studies (≥18 years), two studies reported on effectiveness outcomes, however, only one RCT reported on laboratory-confirmed influenza.ConclusionsDue to the low number of studies in healthy adults and the lack of studies assessing confirmed influenza and influenza-like illness, there remains a need for further evaluation.
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Fiorella, David, Larry Gache, Diana Frame, and Adam S. Arthur. "How safe and effective are flow diverters for the treatment of unruptured small/medium intracranial aneurysms of the internal carotid artery? Meta-analysis for evidence-based performance goals." Journal of NeuroInterventional Surgery 12, no. 9 (January 31, 2020): 869–73. http://dx.doi.org/10.1136/neurintsurg-2019-015535.
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BackgroundThe objective of this meta-analysis was to establish safety and effectiveness benchmarks for endovascular therapy of unruptured small-to-medium internal carotid artery (ICA) aneurysms using flow diverters.MethodsA systematic literature review and subsequent meta-analysis were performed using best research methods. Studies of any design with at least 10 patients treated with flow diverters for predominantly (≥90%) unruptured small/medium ICA aneurysms and ≥6 month follow-up were included. The primary effectiveness endpoint was complete aneurysm occlusion rate at 12 months. The primary safety endpoint was a composite measure of cumulative events that could indicate a stroke or neurologic death: any death, stroke, intracranial hemorrhage, or worsening on the modified Rankin Scale.Results41 studies (2614 patients) met eligibility criteria for the meta-analysis. The core lab adjusted complete occlusion rate was 74.9% (95% CI 69.6% to 79.8%) at 12 months for studies using any flow diverter. With an aim of generating performance goals for a US Investigational Device Exemption (IDE) study, a pre-specified analysis was conducted using only studies with flow diverters commercially available in the USA. In this cohort, 12 month complete occlusion was 74.6% (95% CI 66.8% to 81.7%). The primary safety event rate for flow diverters commercially available in the USA was 7.8% (95% CI 4.8% to 11.4%).ConclusionsThe treatment of small and medium-sized aneurysms with flow diverters is effective in achieving curative reconstruction in most cases and is associated with low rates of morbidity and mortality. This meta-analysis informs robust performance goals for evaluating new flow diverters in small/medium unruptured carotid aneurysms.
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Middleton, Lesley, Diana Dowdle, Luis Villa, Jonathon Gray, and Jacqueline Cumming. "Saving 20 000 Days and Beyond: a realist evaluation of two quality improvement campaigns to manage hospital demand in a New Zealand District Health Board." BMJ Open Quality 8, no. 4 (December 2019): e000374. http://dx.doi.org/10.1136/bmjoq-2018-000374.
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BackgroundThe current paper reports on a realist evaluation of two consecutive quality improvement campaigns based on the Institute for Healthcare Improvement’s Breakthrough Series. The campaigns were implemented by a District Health Board to manage hospital demand in South Auckland, New Zealand. A realist evaluation design was adopted to investigate what worked in the two campaigns and under what conditions.MethodsA mixed-methods approach was used, involving three phases of data collection. During the first phase, a review of campaign materials and relevant literature, as well as key informant interviews were undertaken to generate an initial logic model of how the campaign was expected to achieve its objective. In phase II, the model was tested against the experiences of participants in the first campaign via a questionnaire to all campaign participants, interviews with campaign sponsors and collaborative team leaders and a review of collaborative team dashboards. In phase III, the refined model was tested further against the experiences of participants in the second campaign through interviews with collaborative team leaders, case studies of four collaborative teams and a review of the overall system-level dashboard.ResultsThe evaluation identified four key mechanisms through which the campaigns’ outcomes were achieved. These were characterised as ‘an organisational preparedness to change’, ‘enlisting the early adopters’, ‘strong collaborative teams’ and ‘learning from measurement’. Contextual factors that both enabled and constrained the operation of these mechanisms were also identified.ConclusionsBy focusing on the explication of a theory of how the campaigns achieved their outcomes and under what circumstances, the realist evaluation reported in this paper provides some instructive lessons for future evaluations of quality improvement initiatives.
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Phonsuk, Payao, Vuthiphan Vongmongkol, Suladda Ponguttha, Rapeepong Suphanchaimat, Nipa Rojroongwasinkul, and Boyd Anthony Swinburn. "Impacts of a sugar sweetened beverage tax on body mass index and obesity in Thailand: A modelling study." PLOS ONE 16, no. 4 (April 29, 2021): e0250841. http://dx.doi.org/10.1371/journal.pone.0250841.
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BackgroundThe World Health Organization (WHO) recommends sugar-sweetened beverage (SSB) taxes to address obesity. Thailand has just launched the new tax rates for SSB in 2017; however, the existing tax rate is not as high as the 20% recommended by the WHO. The objective for this study was to estimate the impacts of an SSB tax on body mass index (BMI) and obesity prevalence in Thailand under three different scenarios based on existing SSB and recommended tax rates.MethodsA base model was built to estimate the impacts of an SSB tax on SSB consumption, energy intake, BMI, and obesity prevalence. Literature review was conducted to estimate pass on rate, price elasticity, energy compensation, and energy balance to weight change. Different tax rates (11%, 20% and 25%) were used in the model. The model assumed no substitution effects, model values were based on international data since there was no empirical Thai data available. Differential effects by income groups were not estimated.FindingsWhen applying 11%, 20%, and 25% tax rates together with 100% pass on rate and an -1.30 own-price elasticity, the SSB consumption decreased by 14%, 26%, and 32%, respectively. The 20% and 25% price increase in SSB price tended to reduce higher energy intake, weight status and BMI, when compared with an 11% increase in existing price increase of SSB. The percentage changes of obesity prevalence of 11%, 20% and 25% SSB tax rates were estimated to be 1.73%, 3.83%, and 4.91%, respectively.ConclusionsA higher SSB tax (20% and 25%) was estimated to reduce consumption and consequently decrease obesity prevalence. Since Thailand has already endorsed the excise tax structure, the new excise tax structure for SSB should be scaled up to a 20% or 25% tax rate if the SSB consumption change does not meet a favourable goal.
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Schenkel, L., and U. von Mandach. "P87 The Swiss Association of Perinatal Pharmacology, SAPP: goals." Archives of Disease in Childhood 104, no. 6 (May 17, 2019): e53.2-e53. http://dx.doi.org/10.1136/archdischild-2019-esdppp.125.
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BackgroundThe medicine of pregnant women practices to a targeted personalized approach, tailored to the specific characteristics and needs the implications of interdisciplinary work between healthcare stakeholders. Perinatal pharmacology comprises the impact of substances (drugs, medications and others) in pregnant women, nursing mothers, the unborn child, the premature, the newborn baby and the breastfed baby. Most of the drugs are off-label used. In this field grand challenge for Frontiers in Medicine emphasizes the importance of translational medicine.AimThe primary goal of SAPP has always been and remains the same: it is the link between medicine and pharmacy, between practice, clinic, research and health authorities, in order to increase the safety of medicines in the population of pregnant and breastfeeding women and their newborns.1MethodsOn December 6, 2007, an interdisciplinary team of 8 physicians and pharmacists founded the Swiss Association of Perinatal Pharmacology, SAPP. It collects and promotes new findings in the field of perinatal pharmacology.ResultsSpecialists from all areas of perinatal pharmacology work together in a scientific committee to develop and update evidence-based principles for work in everyday clinical practice (hospitals, doctor´s surgeries, pharmacies). Today, around 200 members benefit from this, who can orient themselves in regular further training courses and basic documents (monographs of active substances, therapy recommendations based on original literature). The SAPP thus closes the gap resulting from the predominant off-label use and the resulting lack of information on drugs in this population.ConclusionThe primary objective of SAPP has been achieved - it provides guidance for the practioners in the broad field of perinatal pharmacology and bridges the gap caused by the lack of drug approvals in this population. Long-term survival will be ensured by measures anchored in law.Referencewww.sappinfo.chDisclosure(s)Nothing to disclose
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Zabotti, A., G. De Marco, L. Gossec, X. Baraliakos, J. Emmel, D. Aletaha, A. Iagnocco, J. S. Smolen, and D. Mcgonagle. "POS1079 CLINICAL CHARACTERIZATION OF PRODROMAL AND VERY EARLY PSORIATIC ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW FOR THE DEFINITION OF CLINICAL AND IMAGING SUSPICIOUS FEATURES FOR PROGRESSION TO PSORIATIC ARTHRITIS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 865.1–865. http://dx.doi.org/10.1136/annrheumdis-2022-eular.2340.
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BackgroundThe transition from psoriasis (PsO) to psoriatic arthritis (PsA) is a focus of considerable scientific interest: is it possible to target pre-PsA and very early PsA, in particular for physiopathology and drug studies? Recently, a EULAR taskforce has been set up in this area (1).ObjectivesTo characterize the prodromal and the very early PsA through a systematic literature review (SLR).MethodsA SLR explored MEDLINE, EMBASE and CENTRAL, up to 22 October 2021. The objective was to identify the symptoms, objective signs, lab tests, imaging features and other characteristics of patients later diagnosed as “new onset” PsA in two key populations: 1) patients with PsO and 2) patients with early undifferentiated arthritis (UA). Studies of adult patients published in English were included, if they reported characteristics of pre-PsA or new onset PsA patients, and data were extracted by 2 readers. Meta-analysis was not done due to data heterogeneity (PsA classification criteria, outcome measures and length of observation). Results are reported semi-quantitatively.ResultsOf 31449 references, 22 studies were included of which 12 were prospective; 7 retrospective and 3 cross-sectional. Eighteen studies reported on patients with PsO (n=95828) later diagnosed as PsA (n=2136) with a mean duration of follow up of 5.2 (±3.9) years. Seven out of 18 (38.8%) studies were informative regarding the clinical features of the new onset PsA. Four studies on early UA patients (n=492) later diagnosed as PsA (n=49) were included. Progression to PsA was associated with the presence of musculoskeletal (MSK) complaints (mainly joint tenderness) and the presence of subclinical MSK inflammation detected by imaging. Peripheral oligo-arthritis was the prevalent clinical presentation of new onset PsA.ConclusionAs expected, joint pain and imaging evidence of MSK inflammation were associated with PsA development in PsO patients. The SLR highlights the lack of robust evidence regarding data associated with the development of PsA. More prospective studies focusing on transition from PsO to PsA are needed.Table 1.FeaturesTransition from PsO to PsA (n = 18 studies)Transition from UA to PsA (n = 4 studies)Clinical characterization of New Onset PsA (n = 5 studies)Patient reported symptomsVAS pain+++NAEntheseal pain+NAMorning stiffness+NAFatigue+NAHAQ more compromised++NAArthralgia+++NAClinical examinationJoint tenderness+++++++Swelling joints++++Entheseal tendernessMajor domain of pattern presentationPeripheral arthritis (more frequent)+++PolyarthritisMono-oligoarthritis++Inflammatory marker(s)CRP++ImagingMSK inflammation detected by imaging++++Radiographic evidence of specific damage++Legend:PsO = psoriasis (affecting skin); PsA = psoriatic arthritis; UA = undifferentiated inflammatory arthritis; VAS = visual-analogue scale; NA = not applicable; HAQ = health assessment questionnaire; CRP = C-reactive protein; MSK = musculoskeletal+ = 1 study for positive association; ++ = 2 studies for positive association; +++ >= 3 studies for positive associationReferences[1]https://www.eular.org/ongoing_initiatives.cfmDisclosure of InterestsAlen Zabotti Speakers bureau: Amgen, Lilly, Janssen, Novartis, UCB, Paid instructor for: Amgen, Janssen, Grant/research support from: Novartis, Gabriele De Marco: None declared, Laure Gossec Speakers bureau: AbbVie, Amgen, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, Samsung Bioepis, Sanofi-Aventis, UCB, Grant/research support from: Amgen, Galapagos, Lilly, Pfizer, Sandoz, Xenofon Baraliakos: None declared, Jenny Emmel: None declared, Daniel Aletaha Speakers bureau: Abbvie, Amgen, Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Grant/research support from: Abbvie, Amgen, Lilly, Novartis, Roche, SoBi, Sanofi, Annamaria Iagnocco: None declared, Josef S. Smolen: None declared, Dennis McGonagle Speakers bureau: Janssen, Lilly, UCB, Abbvie, Pfizer, Celgene, Grant/research support from: Janssen
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Richards, Zoe T., and Jon C. Day. "Biodiversity of the Great Barrier Reef—how adequately is it protected?" PeerJ 6 (May 8, 2018): e4747. http://dx.doi.org/10.7717/peerj.4747.
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BackgroundThe Great Barrier Reef (GBR) is the world’s most iconic coral reef ecosystem, recognised internationally as a World Heritage Area of outstanding significance. Safeguarding the biodiversity of this universally important reef is a core legislative objective; however, ongoing cumulative impacts including widespread coral bleaching and other detrimental impacts have heightened conservation concerns for the future of the GBR.MethodsHere we review the literature to report on processes threatening species on the GBR, the status of marine biodiversity, and evaluate the extent of species-level monitoring and reporting. We assess how many species are listed as threatened at a global scale and explore whether these same species are protected under national threatened species legislation. We conclude this review by providing future directions for protecting potentially endangered elements of biodiversity within the GBR.ResultsMost of the threats identified to be harming the diversity of marine life on the GBR over the last two–three decades remain to be effectively addressed and many are worsening. The inherent resilience of this globally significant coral reef ecosystem has been seriously compromised and various elements of the biological diversity for which it is renowned may be at risk of silent extinction. We show at least 136 of the 12,000+ animal species known to occur on the GBR (approximately 20% of the 700 species assessed by the IUCN) occur in elevated categories of threat (Critically Endangered, EndangeredorVulnerable) at a global scale. Despite the wider background level of threat for these 136 species, only 23 of them are listed as threatened under regional or national legislation.DiscussionTo adequately protect the biodiversity values of the GBR, it may be necessary to conduct further targeted species-level monitoring and reporting to complement ecosystem management approaches. Conducting a vigorous value of information analysis would provide the opportunity to evaluate what new and targeted information is necessary to support dynamic management and to safeguard both species and the ecosystem as a whole. Such an analysis would help decision-makers determine if further comprehensive biodiversity surveys are needed, especially for those species recognised to be facing elevated background levels of threat. If further monitoring is undertaken, it will be important to ensure it aligns with and informs the GBRMPA Outlook five-year reporting schedule. The potential also exists to incorporate new environmental DNA technologies into routine monitoring to deliver high-resolution species data and identify indicator species that are cursors of specific disturbances. Unless more targeted action is taken to safeguard biodiversity, we may fail to pass onto future generations many of the values that comprise what is universally regarded as the world’s most iconic coral reef ecosystem.
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Conroy, Simon Paul, Martin Bardsley, Paul Smith, Jenny Neuburger, Eilís Keeble, Sandeepa Arora, Joshua Kraindler, et al. "Comprehensive geriatric assessment for frail older people in acute hospitals: the HoW-CGA mixed-methods study." Health Services and Delivery Research 7, no. 15 (April 2019): 1–174. http://dx.doi.org/10.3310/hsdr07150.
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BackgroundThe aim of this study was to provide high-quality evidence on delivering hospital-wide Comprehensive Geriatric Assessment (CGA).Objective(s)(1) To define CGA, its processes, outcomes and costs in the published literature, (2) to identify the processes, outcomes and costs of CGA in existing hospital settings in the UK, (3) to identify the characteristics of the recipients and beneficiaries of CGA in existing hospital settings in the UK and (4) to develop tools that will assist in the implementation of hospital-wide CGA.DesignMixed-methods study combining a mapping review, national survey, large data analysis and qualitative methods.ParticipantsPeople aged ≥ 65 years in acute hospital settings.Data sourcesLiterature review – Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE and EMBASE. Survey – acute hospital trusts. Large data analyses – (1) people aged ≥ 75 years in 2008 living in Leicester, Nottingham or Southampton (development cohort,n = 22,139); (2) older people admitted for short stay (Nottingham/Leicester,n = 825) to a geriatric ward (Southampton,n = 246) or based in the community (Newcastle,n = 754); (3) people aged ≥ 75 years admitted to acute hospitals in England in 2014–15 (validation study,n = 1,013,590). Toolkit development – multidisciplinary national stakeholder group (co-production); field-testing with cancer/surgical teams in Newcastle/Leicester.ResultsLiterature search – common outcomes included clinical, operational and destinational, but not patient-reported, outcome measures. Survey – highly variable provision of multidisciplinary assessment and care across hospitals. Quantitative analyses – in the development cohort, older people with frailty diagnoses formed a distinct group and had higher non-elective hospital use than older people without a frailty diagnosis. Patients with the highest 20% of hospital frailty risk scores had increased odds of 30-day mortality [odds ratio (OR) 1.7], long length of stay (OR 6.0) and 30-day re-admission (OR 1.5). The score had moderate agreement with the Fried and Rockwood scales. Pilot toolkit evaluation – participants across sites were still at the beginning of their work to identify patients and plan change. In particular, competing definitions of the role of geriatricians were evident.LimitationsThe survey was limited by an incomplete response rate but it still provides the largest description of acute hospital care for older people to date. The risk stratification tool is not contemporaneous, although it remains a powerful predictor of patient harms. The toolkit evaluation is still rather nascent and could have meaningfully continued for another year or more.ConclusionsCGA remains the gold standard approach to improving a range of outcomes for older people in acute hospitals. Older people at risk can be identified using routine hospital data. Toolkits aimed at enhancing the delivery of CGA by non-specialists can be useful but require prolonged geriatrician support and implementation phases. Future work could involve comparing the hospital-based frailty index with the electronic Frailty Index and further testing of the clinical toolkits in specialist services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Dutta, Nirjhar, and Mark A. Pereira. "Effects of Active Video Games on Energy Expenditure in Adults: A Systematic Literature Review." Journal of Physical Activity and Health 12, no. 6 (June 2015): 890–99. http://dx.doi.org/10.1123/jpah.2013-0168.
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Background:The objective of this study was to estimate the mean difference in energy expenditure (EE) in healthy adults between playing active video games (AVGs) compared with traditional video games (TVGs) or rest.Methods:A systematic search was conducted on Ovid MEDLINE, Web of Knowledge, and Academic Search Premier between 1998 and April 2012 for relevant keywords, yielding 15 studies. EE and heart rate (HR) data were extracted, and random effects meta-analysis was performed.Results:EE during AVG play was 1.81 (95% CI, 1.29–2.34; I2 = 94.2%) kcal/kg/hr higher, or about 108 kcal higher per hour for a 60-kg person, compared with TVG play. Mean HR was 21 (95% CI, 13.7–28.3; I2 = 93.4%) beats higher per minute during AVG play compared with TVG play. There was wide variation in the EE and HR estimates across studies because different games were evaluated. Overall metabolic equivalent associated with AVG play was 2.62 (95% CI, 2.25–3.00; I2 = 99.2%), equivalent to a light activity level. Most studies had low risk of bias due to proper study design and use of indirect calorimetry to measure EE.Conclusion:AVGs may be used to replace sedentary screen time (eg, television watching or TVG play) with light activity in healthy adults.
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Bories, E., S. DE Almeida Chaves, T. Porel, L. Alric, L. Astudillo, F. Gaches, M. Michaud, et al. "POS0884 DESCRIPTIVE EPIDEMIOLOGY OF SEVERE CARDIAC INVOLVEMENT IN SYSTEMIC SCLEROSIS: A BICENTRIC RETROSPECTIVE STUDY ON 459 PATIENTS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 738.1–738. http://dx.doi.org/10.1136/annrheumdis-2022-eular.2842.
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BackgroundThe prevalence of cardiac involvement in systemic sclerosis (SSc) varies in the literature between 3% and 44% and represents a leading cause of mortality in this disease. The incidence of severe cardiac involvement and the factors associated with the occurrence of severe cardiac involvement are not known in the literature.ObjectivesThe objective of this study was to evaluate the incidence, prognosis and factors associated with the occurrence of severe cardiac involvement during SSc course.MethodsWe conducted a retrospective, bi-centric study from January 1, 1966 to December 31, 2018. The patients included had a diagnosis of SS according to the ACR/EULAR 2013 criteria. The primary endpoint was the occurrence of severe cardiac involvement. Cardiac involvement was defined by the presence of at least one of the following elements: death of cardiovascular origin, left ventricular ejection fraction less than or equal to 50%, abnormality of at least 3 measurement parameters of diastolic function, global longitudinal strain less than or equal to 18 in absolute value, ventricular tachycardia, ventricular extrasystoles requiring intervention or elevated troponin. Patients with associated myositis and whose only criterion for cardiac involvement was elevated troponin were not included in the group with cardiac involvement. Severe cardiac involvement was defined by the occurrence of hospitalization for cardiovascular reasons or by death of cardiovascular origin. Univariable and multivariable Cox proportional hazards models were used to determine variables associated with severe cardiac involvement occurrence. Survival analysis was performed using the Kaplan-Meier method with comparisons performed using the log rank test.ResultsFour hundred and fifty-nine patients with SSc were included and were followed for a median of 7.1 years [3.1; 13.3]. The median age of our population was 54 years old. There were 81% of women, 77% of patients had limited cutaneous SSc, 15% diffuse cutaneous SSc and 8% SSc sine scleroderma. Of the 459 patients, 105 (23%) had cardiac involvement and 56 (12%) severe cardiac involvement. The incidence of severe cardiac involvement was 2.42 per 100 patient years. Ninety-six hospitalizations were recorded, including 40 (42%) for acute heart failure, 19 (20%) for arrhythmia, 5 (5%) for acute pericarditis, 6 (6%) for acute myocarditis and 14 (15 %) for coronary artery disease (acute coronary syndrome, myocardial infarction or coronary revascularization). The independent factors associated with severe cardiac involvement in SSc were age over 54 years at SSc-diagnosis (OR = 3.21 95% CI [1.73; 5.95], p < 0.001), the presence of myositis (OR = 5.01 95% CI [1.89; 13.28], p = 0.001), pericardial involvement (OR = 3.79 95% CI [2.05; 7.03]; p < 0.001) or scleroderma renal crisis (OR = 4.72 95% CI [2.05; 10.92], p < 0.001). The survival rate of patients with severe cardiac involvement was 70% at 5 years and 53% at 10 years. Patients with severe cardiac involvement had a mortality risk three times greater than patients without severe cardiac involvement, HR = 3.1 (95% CI [1.7; 5.7], p<0.0001) (Figure 1). Pericardial involvement was an independent risk factor for mortality, HR = 2.0 (95% CI [1.02; 4.0], p=0.04).Figure 1.Survival of patients with severe cardiac involvement of systemic scleroderma. HR: Hazard ratio; 95% CI: 95% Confidence interval; Nb at risk: Number at riskConclusionWe need to focus our clinical attention on diagnosing and manage cardiac involvement in SSc, as severe cardiac involvement is not uncommon and is responsible for a poor prognosis.Disclosure of InterestsNone declared
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Ben Nessib, D., M. Yasmine, H. Ferjani, W. Triki, K. Maatallah, D. Kaffel, and W. Hamdi. "AB1128 MAINTENANCE THERAPY FOR PATIENTS WITH RHEUMATIC DISEASES DURING THE COVID-19." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1681.2–1681. http://dx.doi.org/10.1136/annrheumdis-2022-eular.3120.
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BackgroundThe Covid-19 pandemic has been raging for more than a year in a pandemic mode. Since then, many questions have been raised regarding the management of patients with rheumatic diseases (RD). In this context, the maintenance therapy of conventional, biologic and targeted synthetic disease-modifying antirheumatic drugs (Cs DMARDs, bDMARDs and tsDMARDs respectively) during the Covid-19 infection remains a subject of debate given their immunosuppressive effects as well as their potential generation of lung fibrosis. While the EULAR 2020 guidelines emphasize that discontinuation or maintenance should be discussed on a case-by-case basis, the ACR guidelines advocate discontinuation of all therapies except for the anti-interleukin-6 [1,2].ObjectivesThe objective of our work was to report our real-life experience of therapeutic maintenance during the covid-19 pandemic.MethodsWe conducted a cross-sectional study of patients with RD: rheumatoid arthritis (RA) and spondyloarthritis (SpA) recruited from the rheumatology department of the Kassab Institute of Orthopedics. All the patients were asked to complete a questionnaire about their disease management in the era of the Covid-19. The questionnaire included sociodemographic data, treatment modalities, as well as data related to the infection with the Covid-19 (severe forms defined by the need for oxygen therapy or hospitalization), and changes in treatment during the infection.ResultsThe study included 102 patients with RA (65.3%) and SpA (34.7%). The mean age was 52.4 ± 13 [19-77] years. There was a female predominance with a sex ratio of 0.4. The mean duration of the disease was 7.8 ± 5 years [1-35]. Fifteen percent of patients were on corticosteroids with a mean dose of 6.7±4.5 mg/L [2-20] of prednisone equivalent. A CsDMARD was prescribed alone in 36.3% of cases and combined with a biologic in 18% of cases. A Covid-19 infection was occurred at least once in 25.5% of cases, of which 19.2% had a severe form (hospitalization (15.4%), oxygen therapy (19.2%)). No deaths were observed. The treatments received during the covid-19 infection were: corticosteroids (n=5), heparin therapy (n=6) and antibiotic therapy (n=10). No patient tapered treatment dosage of DMARDs but discontinuation was reported by 4 patients with a mean time between discontinuation and resumption of 2.1 ± 2 months [0.5-5 months]. The cessation of the treatment was dictated by the treating physician in 2 cases and involved csDMARD in 3 cases (Methotrexate (n=2), Leflunomide (n=1)) and biologics in only one patient. There were no cases of clinical pulmonary worsening upon resumption of the treatments. We found no statistically significant association between severe forms of the infection and the type of RD (p=0.925), as well as the presence of comorbidities (p=0.825). Similarly, the presence of severe forms was not associated with the use of long-term NSAIDs (p=0.29), corticosteroids (p=0.85), or biological treatment (p=0.7). However, maintenance therapy was significantly associated with a lower risk of severe forms (p=0.013).ConclusionOur work showed that the maintenance of conventional treatment during Covid-19 infection was associated with a lower risk of severe forms. Our results, along with those of other studies in the literature, support the maintenance of antirheumatic treatments.References[1]Landewé RB, Machado PM, Kroon F, et al. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis. 2020;79(7):851-8.[2]Roongta R, Ghosh A. Managing rheumatoid arthritis during COVID-19. Clin Rheumatol. 2020 Nov;39(11):3237-44.Disclosure of InterestsNone declared
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Jodeh, Diana S., Nima Khavanin, James J. Cray, Gerald F. Tuite, Jordan P. Steinberg, and S. Alex Rottgers. "Postoperative Drain Use in Cranial Vault Remodeling: A Survey of Craniofacial Surgeon Practices and a Review of the Literature." Cleft Palate-Craniofacial Journal 56, no. 8 (March 18, 2019): 1001–7. http://dx.doi.org/10.1177/1055665619836509.
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Background:The use of subgaleal drains following primary cranioplasty for craniosynostosis has undergone limited investigation. Proposed benefits include prevention of seroma, detection of postoperative bleeding, and cerebrospinal fluid leak. We conducted a systematic review of the literature and surveyed craniofacial surgeons to ascertain the current evidence pertaining to drain use following primary cranioplasty for craniosynostosis and to determine surgical practice patterns.Methods:PubMed and Embase databases were searched to identify relevant articles. Abstracts were reviewed by 2 investigators, and a Cohen κ statistic was calculated. Patient demographic and outcome data were extracted and compared. A 9-question survey was e-mailed to active and associate members of the American Society of Craniofacial Surgeons.Results:A total of 7395 unique citations were identified. Only 2 retrospective chart reviews met inclusion criteria. All objective parameters demonstrated no difference between patients with and without drains. A subjective benefit of limiting facial swelling was proposed without objective analysis. Fifty (32.5%) of the 154 craniofacial surgeons responded to the survey. Forty-two percent used postoperative drains. A significant association ( P = .01) was found between the belief that drains limited facial swelling and their use.Conclusions:The literature examining postoperative drain use in primary cranioplasty for craniosynostosis is restricted. The current studies show no definite benefit to drain use but are limited in their assessment of key outcomes. There is wide variability among surgeons regarding drain use, and this seems to be motivated by belief and tradition.
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Roman-Viñas, Blanca, Jorge Marin, Mairena Sánchez-López, Susana Aznar, Rosaura Leis, Raquel Aparicio-Ugarriza, Helmut Schroder, et al. "Results From Spain’s 2016 Report Card on Physical Activity for Children and Youth." Journal of Physical Activity and Health 13, s2 (November 2016): S279—S283. http://dx.doi.org/10.1123/jpah.2016-0308.
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Background:The first Active Healthy Kids Spanish Report Card aims to gather the most robust information about physical activity (PA) and sedentary behavior of children and adolescents.Methods:A Research Working Group of experts on PA and sport sciences was convened. A comprehensive data search, based on a review of the literature, dissertations, gray literature, and experts’ nonpublished data, was conducted to identify the best sources to grade each indicator following the procedures and methodology outlined by the Active Healthy Kids Canada Report Card model.Results:Overall PA (based on objective and self-reported methods) was graded as D-, Organized Sports Participation as B, Active Play as C+, Active Transportation as C, Sedentary Behavior as D, School as C, and Family and Peers as Incomplete, Community and the Built Environment as Incomplete, and Government as Incomplete.Conclusions:Spanish children and adolescents showed low levels of adherence to PA and sedentary behavior guidelines, especially females and adolescents. There is a need to achieve consensus and harmonize methods to evaluate PA and sedentary behavior to monitor changes over time and to evaluate the effectiveness of policies to promote PA.
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D’Huart, Elise, Jean Vigneron, and Béatrice Demoré. "Physical Compatibility of Intravenous Drugs Commonly Used in Intensive Care Units: An Observational Study and Physical Compatibility Laboratory Tests on Anti-Infective Drugs." Pharmaceutical Technology in Hospital Pharmacy 4, no. 1 (May 2, 2019): 29–40. http://dx.doi.org/10.1515/pthp-2019-0005.
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Abstract BackgroundThe objectives were to perform an observation of the administration of injectable drugs in three ICUs, to identify injectable drugs administered by Y-site infusion or mixed in the same container, to compare with physical compatibility data available in the literature and to test the physical compatibility for missing data. MethodsAn observational study was realised over two weeks and patients receiving more than one injectable drug in the same line simultaneously were included. Physical compatibilities were assessed in pairs by comparing with three databases. For some missing data, three tests were realised for pairs including an anti-infective drug. Visual and subvisual evaluations were performed after the preparation, 1 and a 4-hour storage. ResultsA total of 389 combinations between two injectable drugs was observed for Y-site infusions and 31 mixtures in the same container. According to the literature, 21.1 % associations were physically compatible, 1.8 % as physically compatible potentially, 8.0 % as physically incompatible, 6.4 % have divergent data according to the databases and 62.7 % have no data. Two mixtures were documented. 37 pairs were tested and 70.3 % were physically compatible, 8.1 % were physically incompatible after visual evaluation and 21.6 % after subvisual evaluation. ConclusionsIn the majority of cases, no compatibility data are available in the literature. Laboratory tests give additional information.
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van Meurs, Hannah, Otto Visser, Marrije R. Buist, Fibo J. W. ten Kate, and Jacobus van der Velden. "Frequency of Pelvic Lymph Node Metastases and Parametrial Involvement in Stage IA2 Cervical Cancer: A Population-Based Study and Literature Review." International Journal of Gynecologic Cancer 19, no. 1 (2009): 21–26. http://dx.doi.org/10.1111/igc.0b013e318197f3ef.
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Background:The frequency of lymph node metastases in stage IA2 cervical cancer is reported to range from 0% to 9.7%. Treatment recommendations vary likewise from a cone biopsy to a Wertheim radical hysterectomy and pelvic lymph node dissection. The objective of this study was to get insight into the true frequency of lymph node metastases and/or parametrial involvement in stage IA2 cervical cancer.Methods:The hospital records of 48 patients with stage IA2 cervical carcinoma who registered from 1994 to 2006 were reviewed, and a literature search was performed.Results:Of 48 registered patients, 14 were confirmed to have stage IA2. No lymph node metastases or parametrial invasion and recurrences were found. The collated literature data showed a risk of lymph node metastases of 4.8% (range, 0%-9.7%). The presence of adenocarcinoma and the absence of lymph vascular space invasion resulted in a low risk on lymph node metastases (0.3% and 1.3%, respectively). Parametrial involvement has not been reported.Conclusions:The risk of the selected patients with stage IA2 cervical cancer on lymph node metastases is low. In patients with stage IA2 squamous cell cancer with lymph vascular space invasion, a standard pelvic lymph node dissection should be recommended. Parametrectomy should be included if the nodes are positive. In the other patients, the treatment can be individualized and does not have to include lymph node dissection or parametrectomy.
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Gutiérrez-Recacha, P., A. Martorell, and A. Pereda. "Comparison of Family Burden Experienced by Caregivers to People with Intellectual Disability and Caregivers to People with Mental Disorders." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71376-8.
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Background:The term ‘family burden’ has been introduced to describe the adverse consequences of life with severely disturbed psychiatric patients. Literature has established a distinction between the intensity of worry and appraisals experienced by caregivers (subjective burden) and the real amount of resources (time, money, health, etc.) spent on the care (objective burden). the use has been extended to people with intellectual disability (ID).Aims:To compare the burden experienced by a group of caregivers to patients diagnosed with schizophrenia and a group of caregivers to people with ID.Methodology:179 adults with intellectual disability clients of the Carmen Pardo-Valcarce Foundation's sheltered workshop in Madrid (Spain) and 356 adults diagnosed of schizophrenia in the Gavá Mental Health Centre in Barcelona (Spain) were asked to participate in the present study along with their main caregivers. Burden experienced by caregivers was assessed with the ECFOS-II / SOFBI-II scale (Entrevista de Carga Familiar Objetiva y Subjetiva / Objective and Subjective Family Burden Interview). the tool hasan introductory section plus 8 modules which assess different domains of family burden.Results:Significant differences were found between both groups in all scales except two: Assistance in everyday activities and Effects perceived on the caregiver's health. Total scores also showed significant differences for both groups (p< 0.05).Discussion:Results indicate that, despite similar scores in some domains associated to subjective burden, caregivers to people with ID experience a lower level of objective burden than caregivers to patients diagnosed of schizophrenia.
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Quartuccio, Natale, Giorgio Treglia, Marco Salsano, Maria Vittoria Mattoli, Barbara Muoio, Arnoldo Piccardo, Egesta Lopci, and Angelina Cistaro. "The role of Fluorine-18-Fluorodeoxyglucose positron emission tomography in staging and restaging of patients with osteosarcoma." Radiology and Oncology 47, no. 2 (June 1, 2013): 97–183. http://dx.doi.org/10.2478/raon-2013-0017.
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Background.The objective of this study is to systematically review the role of positron emission tomography (PET) and PET/computed tomography (PET/CT) with Fluorine-18-Fluorodeoxyglucose (FDG) in patients with osteosarcoma (OS).Methods. A comprehensive literature search of published studies through October 10th, 2012 in PubMed/MEDLINE, Embase and Scopus databases regarding whole-body FDG-PET and FDG-PET/CT in patients with OS was performed.Results. We identified 13 studies including 289 patients with OS. With regard to the staging and restaging of OS, the diagnostic performance of FDG-PET and PET/CT seem to be high; FDG-PET and PET/CT seem to be superior to bone scintigraphy and conventional imaging methods in detecting bone metastases; conversely, spiral CT seems to be superior to FDG-PET in detecting pulmonary metastases from OSConclusions.Metabolic imaging may provide additional information in the evaluation of OS patients. The combination of FDG-PET or FDG-PET/CT with conventional imaging methods seems to be a valuable tool in the staging and restaging of OS and may have a relevant impact on the treatment planning.
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Yim, Ga Won, Sang Wun Kim, Eun Ji Nam, and Young Tae Kim. "Role of Robot-Assisted Surgery in Cervical Cancer." International Journal of Gynecologic Cancer 21, no. 1 (2011): 173–81. http://dx.doi.org/10.1097/igc.0b013e318200f7a7.
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Background:The development of robotic technology has facilitated the application of minimally invasive techniques for complex operations in gynecologic oncology.Objectives:The objective of the study was to assess and summarize the current literature on the role of robot-assisted surgery in cervical cancer in terms of its utility and outcome.Methods:Literature review concerning the use of robot-assisted technology in the management of cervical cancer, including radical hysterectomy, trachelectomy, parametrectomy, pelvic and aortic lymphadenectomy, and pelvic exenteration, was performed.Results:To date, 12 articles addressing radical hysterectomy, 5 articles of radical trachelectomy, and 6 articles of surgical procedure in advanced or recurrent cervical cancer, all performed robotically, are published in the literature. The advantages of the robotic system include 3-dimensional vision, tremor reduction, motion downscaling, improved ergonomics, and greater dexterity with instrument articulation. Because of these benefits, the robotic technology seems to facilitate the surgical approach for technically challenging operations performed to treat primary, early or advanced, and recurrent cervical cancer as evidenced by the current literature.Conclusions:Surgical management of cervical cancer may be one of the gynecologic oncology surgeries that can take full advantage of robotic assistance in a minimally invasive manner. Continued research and clinical trials are needed to further elucidate the equivalence or superiority of robot-assisted surgery to conventional methods in terms of oncological outcome and patient's quality of life.
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Zebis, Mette K., Susan Warming, Maria B. Pedersen, Marie H. Kraft, S. Peter Magnusson, Martin Rathcke, Michael Krogsgaard, Simon Døssing, and Tine Alkjær. "Outcome Measures After ACL Injury in Pediatric Patients: A Scoping Review." Orthopaedic Journal of Sports Medicine 7, no. 7 (July 2019): 232596711986180. http://dx.doi.org/10.1177/2325967119861803.
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Background:The incidence of anterior cruciate ligament (ACL) injuries in children is increasing. However, no standardized core set of outcome measures exists for evaluating pediatric ACL injuries.Purpose:To perform a scoping review of the literature to identify patient-reported outcome measures (PROMs) and objective outcome measures used to evaluate pediatric patients after ACL injury and to classify these in accordance with the International Classification of Functioning, Disability, and Health (ICF) domains.Study Design:Systematic review; Level of evidence, 4.Methods:The literature was systematically searched with the PubMed, EMBASE, CINAHL, and PEDro databases. The inclusion criteria were Danish, Norwegian, Swedish, German, or English language; publication between 2010 and 2018; pediatric ACL injury (patients ≤15 years old); and outcome measures. The selected papers were screened for title, abstract, and full text in accordance with predefined inclusion and exclusion criteria.Results:A total of 68 papers (4286 patients; mean ± SD age, 12.2 ± 2.3 years) were included. Nineteen PROMs and 11 objective outcome measures were identified. The most frequently reported PROMs were the International Knee Documentation Committee (IKDC) Subjective Knee Form (51% of studies), Lysholm scoring scale (46% of studies) and Tegner activity rating scale (37% of studies). Additionally, return to sport was reported in 41% of studies. The most frequent objective measures were knee laxity (76% of studies), growth disturbances (69% of studies), range of motion (41% of studies), and muscle strength (21% of studies). With respect to the ICF domains, the IKDC covered all 3 ICF health domains, the Lysholm score covered the Body Structure and Function and the Activity Limitation domains, while the Tegner score covered the Participation Restriction domain. Objectively measured knee joint laxity, range of motion, and muscle strength covered 1 domain (Body Structure and Function).Conclusion:Pediatric patients with ACL injury were mainly evaluated subjectively with the IKDC and objectively by knee joint laxity. No consensus exists in the evaluation of children after ACL injury. The majority of applied outcome measures are developed for adults. To cover the ICF health domains, future research needs to consider reliable and valid outcome measures relevant for pediatric patients with ACL injury.
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Gutiérrez-Recacha, P., A. Martorell, and A. Pereda. "Gender Differences in Family Burden Experienced by Caregivers to People with Intellectual Disability." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71105-8.
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Background:The term ‘family burden’ has been introduced to describe the adverse consequences of life with severely disturbed psychiatric patients. Its use has been extended to people with intellectual disability (ID). Literature has established a distinction between the intensity of worry and appraisals experienced by caregivers (subjective burden) and the real amount of resources (time, money, health, etc.) spent on the care (objective burden).Aims:To compare the possible effect of gender on the burden experienced by a group of caregivers to people with ID in Spain.Methodology:179 adults with intellectual disability clients of the Carmen Pardo-Valcarce Foundation's sheltered workshop in Madrid (Spain) were asked to participate in the present study along with their main caregivers. Burden experienced by caregivers was assessed with the ECFOS-II / SOFBI-II scale (Entrevista de Carga Familiar Objetiva y Subjetiva / Objective and Subjective Family Burden Interview). The tool has been validated for people with ID. It hasan introductory section plus 8 modules which assess different domains of burden.Results:Only two modules of the scale showed significant differences depending on the gender of the user. These modules refer to the need of assistance in everyday activities and motives for concern for the caregiver (p< 0.05).Discussion:In overall terms, caregivers experience the same level of burden when caring either for a son or for a daughter with ID. However, gender differences arise when considering specific domains, showing that social stereotypes can account for a higher level of subjective burden associated to female gender.
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Vasanthanathan, A., S. Menaga, and K. Rosemi. "A Comprehensive Review of Smart Systems through Smart Materials." Current Materials Science 12, no. 1 (August 5, 2019): 77–82. http://dx.doi.org/10.2174/2212797612666190408141830.
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Background:The vital role of smart materials in the field of aircraft, spacecraft, defence, electronics, electrical, medical and healthcare industries involve sensing and actuating for monitoring and controlling applications. The class of smart materials are also named as active materials or intelligent materials or adaptive materials. These materials act intelligently based upon the environmental conditions. Structures incorporated with smart materials are named as smart structures.Methods:The principal objective of the present paper is to explore a comprehensive review of various smart materials viz. piezoelectric materials, Shape Memory Alloy, micro sensors and fibre optic sensors. The significance of these intelligent materials in various fields are also deliberately presented in this work from the perspective of Patents and literatures test data.Results:Smart Materials possesses multifunctional capabilities. The smart materials viz. piezoelectric materials, Shape Memory Alloy, micro sensors and fibre optic sensors are embedded with structures like aircraft, spacecraft, automotive, bridges, and buildings for the purpose of exhibiting Structural Health Monitoring system. Smart materials are finding increasing applications in the present aircraft, spacecraft, automotive, electronics and healthcare industries.Conclusion:Innovative ideas would become reality by integrating the any structure with Smart Materials.
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Cromwell, Elizabeth A., Sharon Roy, Dieudonne P. Sankara, Adam Weiss, Jeffrey Stanaway, Ellen Goldberg, David M. Pigott, et al. "Slaying little dragons: the impact of the Guinea Worm Eradication Program on dracunculiasis disability averted from 1990 to 2016." Gates Open Research 2 (June 18, 2018): 30. http://dx.doi.org/10.12688/gatesopenres.12827.1.
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Background:The objective of this study was to document the worldwide decline of dracunculiasis (Guinea worm disease, GWD) burden, expressed as disability-adjusted life years (DALYs), from 1990 to 2016, as estimated in the Global Burden of Disease study 2016 (GBD 2016). While the annual number of cases of GWD have been consistently reported by WHO since the 1990s, the burden of disability due to GWD has not previously been quantified in GBD.Methods:The incidence of GWD was modeled for each endemic country using annual national case reports. A literature search was conducted to characterize the presentation of GWD, translate the clinical symptoms into health sequelae, and then assign an average duration to the infection. Prevalence measures by sequelae were multiplied by disability weights to estimate DALYs.Results:The total DALYs attributed to GWD across all endemic countries (n=21) in 1990 was 50,725 (95% UI: 35,265–69,197) and decreased to 0.9 (95% UI: 0.5–1.4) in 2016. A cumulative total of 12,900 DALYs were attributable to GWD from 1990 to 2016.Conclusions:Using 1990 estimates of burden propagated forward, this analysis suggests that between 990,000 to 1.9 million DALYs have been averted as a result of the eradication program over the past 27 years.
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Choi, Hyo Joung, Min Joung Lee, Chang-Min Choi, JaeHo Lee, Soo-Yong Shin, Yungman Lyu, Yu Rang Park, and Soyoung Yoo. "Establishing the role of honest broker: bridging the gap between protecting personal health data and clinical research efficiency." PeerJ 3 (December 17, 2015): e1506. http://dx.doi.org/10.7717/peerj.1506.
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Background.The objective of this study is to propose the four conditions for the roles of honest brokers through a review of literature published by ten institutions that are successfully utilizing honest brokers. Furthermore, the study aims to examine whether the Asan Medical Center’s (AMC) honest brokers satisfy the four conditions, and examine the need to enhance their roles.Methods.We analyzed the roles, tasks, and types of honest brokers at 10 organizations by reviewing the literature. We also established a Task Force (TF) in our institution for setting the roles and processes of the honest broker system and the honest brokers. The findings of the literature search were compared with the existing systems at AMC—which introduced the honest broker system for the first time in Korea.Results.Only one organization employed an honest broker for validating anonymized clinical data and monitoring the anonymity verifications of the honest broker system. Six organizations complied with HIPAA privacy regulations, while four organizations did not disclose compliance. By comparing functions with those of the AMC, the following four main characteristics of honest brokers were determined: (1) de-identification of clinical data; (2) independence; (3) checking that the data are used only for purposes approved by the IRB; and (4) provision of de-identified data to researchers. These roles were then compared with those of honest brokers at the AMC.Discussion.First, guidelines that regulate the definitions, purposes, roles, and requirements for honest brokers are needed, since there are no currently existing regulations. Second, Korean clinical research institutions and national regulatory departments need to reach a consensus on a Korean version of Limited Data Sets (LDS), since there are no lists that describe the use of personal identification information. Lastly, satisfaction surveys on honest brokers by researchers are necessary to improve the quality of honest brokers.
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Hooper, Lisa M., Sara Tomek, Debra Roter, Kathryn A. Carson, George Mugoya, and Lisa A. Cooper. "Depression, patient characteristics, and attachment style: correlates and mediators of medication treatment adherence in a racially diverse primary care sample." Primary Health Care Research & Development 17, no. 02 (July 30, 2015): 184–97. http://dx.doi.org/10.1017/s1463423615000365.
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BackgroundThe depth and breadth of problems related to depressive symptomatology and optimal treatment outcomes, including medication treatment adherence, have long been documented in the literature. Missing are clear explanations as to what factors and patient characteristics may account for lack of medication treatment adherence.ObjectivesThe two objectives of the current study were to examine the predictive strength of depression, patient characteristics, and patient attachment style regarding medication treatment adherence and to consider the extent to which attachment styles mediate the relation between depression and medication treatment adherence.MethodParticipants in the present study were 237 racially diverse American primary care patients with a diagnosis of hypertension who were participants in a clinical trial. Depression, patient characteristics, attachment style, and medication treatment adherence were assessed.ResultsPartly consistent with our four hypotheses, the following results were found: (a) Black American, younger, never married, and poorer patients had lower medication treatment adherence (b) depression was significantly associated with lower self-reported medication adherence; (c) insecure–dismissing attachment style was related to lower medication adherence; and (d) insecure–dismissing attachment style mediates the relation between depression and medication treatment adherence by exacerbating the negative association.ConclusionPhysicians and other primary care providers should consider how depressive symptomatology, patient characteristics, and attachment style may inform the treatment plans they put forward and the extent to which patients may adhere to those treatment plans.
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Almomen, Ali, Zainab Alshuhayb, Hussain Alsheef, Salma Alhammad, Balsam Alawami, Amirah Aldhurais, Hussain Almulla, Zahra Almoumen, and Sarah Alkishi. "The Endoscopic Management of Different Pediatric Frontal Sinus Pathologies." International Journal of Otolaryngology 2022 (February 10, 2022): 1–8. http://dx.doi.org/10.1155/2022/1078178.
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Background.The paranasal sinuses in pediatrics can harbor a wide variety of pathologies. With the present literature being composed of case studies only, this entity is quite understudied. Objectives. This article aims to study the clinical presentation, diagnosis, and endoscopic management of six different rare frontal sinus pathologies in pediatrics, which include extensive allergic fungal sinusitis, mucoceles, osteoma, superior sagittal sinus thrombosis, CSF leak, and subdural empyema. Methods. We retrospectively studied all pediatric patients with frontal sinus pathologies presenting to our center, King Fahad Specialist Hospital, Dammam, Saudi Arabia, from the period of 2006 to 2020. Results. A total of 8 patients presented to our hospital with different frontal sinus pathologies. 5 of them were males, and 3 were females with an age of presentation ranging from 7 to 17 years. The diagnosis and localization were performed through computerized tomography without contrast and magnetic resonance imaging, when indicated. All cases were primarily managed with endonasal endoscopic approaches successfully without complications and with no recurrence evident upon follow-up. Conclusion. In this case series, six different frontal sinus pathologies were managed by an endoscopic approach, with excellent recovery and no recurrence upon follow-up demonstrated. This approach enabled excellent visualization of the pathologies, accurate localization, adequate drainage, and repair or grafting when needed.
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Valencia Mora, María, Miguel Ángel Ruiz Ibán, Jorge Diaz Heredia, Juan Carlos Gutiérrez-Gómez, Raquel Ruiz Diaz, Mikel Aramberri, and Carlos Cobiella. "Physical Exam and Evaluation of the Unstable Shoulder." Open Orthopaedics Journal 11, no. 1 (August 31, 2017): 946–56. http://dx.doi.org/10.2174/1874325001711010946.
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Background:The clinical evaluation of the patient with shoulder instability can be challenging. The pathological spectrum ranges from the straightforward “recurrent anterior dislocation” patient to the overhead athlete with a painful shoulder but not clear instability episodes. Advances in shoulder arthroscopy and imaging have helped in understanding the anatomy and physiopathology of the symptoms. The aim of this general article is to summarize the main examination manoeuvres that could be included in an overall approach to a patient with a suspicion of instability.Material and Methods:In order to achieve the above-mentioned objective, a thorough review of the literature has been performed. Data regarding sensibility and specificity of each test have been included as well as a detailed description of the indications to perform them. Also, the most frequent and recent variations of these diagnostic tests are included.Results:Laxity and instability should be considered separately. For anterior instability, a combination of apprehension, relocation and release tests provide great specificity. On the other hand, multidirectional or posterior instability can be difficult to diagnose especially when the main complain is pain.Conclusion:A detailed interview and clinical examination of the patient are mandatory in order to identify a shoulder instability problem. Range of motion of both shoulders, clicking of catching sensations as well as pain, should be considered together with dislocation and subluxation episodes. Specific instability and hyperlaxity tests should be also performed to obtain an accurate diagnosis.
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Martinez, María del Pilar Rodriguez, Karla I. Galaviz, Edtna Jauregui Ulloa, Ines Gonzalez-Casanova, and Juan Ricardo Lopez y. Taylor. "Results from Mexico’s 2014 Report Card on Physical Activity for Children and Youth." Journal of Physical Activity and Health 11, s1 (January 2014): S74—S78. http://dx.doi.org/10.1123/jpah.2014-0172.
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Background:The Mexican Report Card on Physical Activity in children and youth was first developed in 2012 as a tool aimed at informing policy and practice. The objective of this paper is to update the Report Card to reflect the current situation in Mexico.Methods:A literature search was conducted in Spanish and English using major databases, and complemented with government documents and national health surveys. Information on the 9 indicators outlined in the Global Matrix of Report Card Grades was extracted. Experts from Mexico and Canada met to discuss and assign a grade on each indicator.Results:The physical activity indicator was assigned a C+, which was higher than in the previous report card. Sedentary behavior was assigned a D, which was lower than the previous report card. Organized Sports and Active Transportation, which were not graded in the previous report card, were assigned grades of D and B-, respectively. Government and Built Environment were assigned grades of C and F, respectively. Family and Peers and Active Play were not graded (INC).Conclusions:Levels of PA and sedentary behaviors among Mexican children and youth were below the respective recommended references. The implementation and effectiveness of current government strategies need to be determined. The Mexican Report Card is a promising knowledge translation tool that can serve to inform policies and programs related to physical activity.
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Wilson, Caitlin, Jonathan Benn, Gillian Janes, and Rebecca Lawton. "106 The types and effects of feedback received by emergency ambulance staff: A systematic mixed studies review with narrative synthesis." Emergency Medicine Journal 37, no. 12 (November 23, 2020): 842.1–842. http://dx.doi.org/10.1136/emj-2020-rcemabstracts.34.
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Aims/Objectives/BackgroundThe phenomenon of feedback is well-researched within the wider healthcare context, where it is suggested that feedback can improve patient care and patient safety by enhancing clinical performance and staff mental health. Within prehospital care, reviews have been conducted for automated feedback from defibrillators and debrief after simulation, but not on the wider concept of feedback. The aim of this systematic review is to identify, describe and synthesize the published literature on the types and effects of feedback received by emergency ambulance staff. PROSPERO CRD42020162600.Methods/DesignThe search strategy consisted of three facets: ambulance staff synonyms, feedback synonyms and feedback content. Databases searched from inception were MEDLINE, EMBASE, AMED, PsycInfo, HMIC, CINAHL and Web of Science. Studies were included if they were qualitative or quantitative empirical research exploring the concept of feedback, i.e. the systematised provision of information to emergency ambulance staff regarding their performance within prehospital practice. Study quality was appraised using the Mixed Methods Appraisal Tool and data analysed using narrative synthesis.Results/ConclusionsThe search strategy yielded 2424 articles excluding duplicates. 94 studies met the inclusion criteria after full-text review, of which 36 fleetingly mentioned increased feedback as a solution to improving specific circumstances (e.g. decision-making, burnout). The remaining 58 studies consisted of 48 interventional prehospital feedback studies, 8 non-interventional studies and 2 feasibility studies. Narrative synthesis revealed a wide range of prehospital feedback types with the majority of studies focusing on performance or patient outcome feedback. The effects of feedback encompassed both personal and professional development, such as improved decision-making, reflection and closure. Mechanisms of providing prehospital feedback varied from electronic dashboards to case reviews and performance appraisals. Further empirical research is required to explore whether the published literature reflects current prehospital practice, as well as to determine the when, what, how and why of ambulance staff desiring feedback.
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Davies, Huw TO, Alison E. Powell, and Sandra M. Nutley. "Mobilising knowledge to improve UK health care: learning from other countries and other sectors – a multimethod mapping study." Health Services and Delivery Research 3, no. 27 (June 2015): 1–190. http://dx.doi.org/10.3310/hsdr03270.
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BackgroundThe past two decades have seen rich conceptual development and a wide variety of practical initiatives around research use or ‘knowledge mobilisation’, but so far there has been little systematic effort to map, conceptualise and learn from these initiatives, or to investigate the degree to which they are underpinned by contemporary thinking as set out in the literature. This gap is particularly apparent when looking at knowledge mobilisation at the ‘macro’ level, that is the strategies and activities of major research funders, major research producers and key research ‘intermediaries’.Aims and objectivesThe study had three key objectives with associated research questions: to map the knowledge mobilisation landscape in health care (in the UK and internationally) and in social care and education within the UK; to understand the models, theories and frameworks that underpin the approaches to knowledge mobilisation; and to learn from the success or otherwise of the strategies and approaches in use.MethodsThe study was multimethod and multiphased, with considerable interactivity between the different strands. Data were collected through a review of 71 published reviews on knowledge mobilisation; website review of the knowledge mobilisation activities of 186 agencies; in-depth interviews (n = 52) with key individuals in agencies; a web survey (response rate 57%;n = 106); and two stakeholder workshops (at months 6 and 16).FindingsWe identified a wide range of models, theories and frameworks used to describe knowledge mobilisation and created a conceptual map that highlights six domains of thinking and debate in the literature. The interview and survey data showed three broad, overlapping roles undertaken by agencies: developing and sharing research-based products; emphasising brokering; and focusing on implementation. The knowledge mobilisation approaches in use had been shaped by many factors but there was only limited use of the models, theories and frameworks from the literature. Participants saw formal evaluation of knowledge mobilisation activities as important but highly challenging. Rich formative experience was described but formal evaluation was relatively rare. Few agencies involved service users or members of the public in knowledge mobilisation activities. Working inductively from the study data we derived eight key archetypes or ‘bundles of knowledge mobilisation activities’ that could be used by agencies to explore their knowledge mobilisation activities, future strategies and stakeholder perspectives.ConclusionsKnowledge mobilisation could be enhanced by providing support to enable cross-sector and interagency learning, reflection on the conceptual basis of approaches and increased evaluation of knowledge mobilisation activities. Further research is needed to evaluate approaches to assessing research use and impact, on systems approaches to knowledge mobilisation, on sustaining and scaling-up approaches, and on applying a wider range of literatures to knowledge mobilisation. Further research would also be useful on the knowledge mobilisation archetypes and how they can work in complementary ways.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Chu, Kelly, Batool Alharahsheh, Naveen Garg, and Payal Guha. "Evaluating risk stratification scoring systems to predict mortality in patients with COVID-19." BMJ Health & Care Informatics 28, no. 1 (September 2021): e100389. http://dx.doi.org/10.1136/bmjhci-2021-100389.
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BackgroundThe COVID-19 pandemic has necessitated efficient and accurate triaging of patients for more effective allocation of resources and treatment.ObjectivesThe objectives are to investigate parameters and risk stratification tools that can be applied to predict mortality within 90 days of hospital admission in patients with COVID-19.MethodsA literature search of original studies assessing systems and parameters predicting mortality of patients with COVID-19 was conducted using MEDLINE and EMBASE.Results589 titles were screened, and 76 studies were found investigating the prognostic ability of 16 existing scoring systems (area under the receiving operator curve (AUROC) range: 0.550–0.966), 38 newly developed COVID-19-specific prognostic systems (AUROC range: 0.6400–0.9940), 15 artificial intelligence (AI) models (AUROC range: 0.840–0.955) and 16 studies on novel blood parameters and imaging.DiscussionCurrent scoring systems generally underestimate mortality, with the highest AUROC values found for APACHE II and the lowest for SMART-COP. Systems featuring heavier weighting on respiratory parameters were more predictive than those assessing other systems. Cardiac biomarkers and CT chest scans were the most commonly studied novel parameters and were independently associated with mortality, suggesting potential for implementation into model development. All types of AI modelling systems showed high abilities to predict mortality, although none had notably higher AUROC values than COVID-19-specific prediction models. All models were found to have bias, including lack of prospective studies, small sample sizes, single-centre data collection and lack of external validation.ConclusionThe single parameters established within this review would be useful to look at in future prognostic models in terms of the predictive capacity their combined effect may harness.
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Khalil Salman, Ahmed, Mahmood M. Rida Sadagah, Shami Abdullah Aloqayli, Rakan Masoud Al Tuwayr, Reaah Ibrahim Aseery, Ghada Shaker Alobaidi, Shahd Mohammed Alqarni, et al. "PREVALENCE OF POSTOPERATIVE BARIATRIC SURGERY COMPLICATIONS SPECIALLY GALLSTONE." International Journal of Advanced Research 10, no. 12 (December 31, 2022): 417–23. http://dx.doi.org/10.21474/ijar01/15856.
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Background:The natural history of gallstone formation after bariatric surgery, the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established.This research is being done to bring awareness to one particular postoperative consequence of bariatric surgery: gallstone development. Methods:This study was retrospective cross-sectional study to achieve the objectives of the study. A cross-sectional study because of the capture information based on data gathered for a specific point in time. Obese population who were surgically managed aby one of the bariatric surgeries. The sampling type was a non-probability convenient sample. Sample size was determined according to 95% confidence level using Epi Info software. Results: Researches filled the questionnaire from 843 participants. Among them, 15.5% had bariatric surgery (n= 131). Age at time of bariatric surgery was more than 25 years among most of participants. Male to female ratio was almost 1:1 among study participants who underwent bariatric surgery. The mean body mass index among study participants was 39.18 + 11.77 kg/m2 while the median BMI was 40.74 kg/m2. This indicates that most of study participants are morbidly obese. The most frequent type of bariatric surgery was gastrectomy operation (n= 101, 77.1%). There were a number of participants who reported having gallstone after the surgery (n= 24, 18.3%). The timing of gallstone formation varied among study participants Conclusion: The incidence of gallstone formation following bariatric surgery was relatively less that other literature. All of study participants who underwent bariatric surgery reported having complications following the surgery.
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Jorge, B., C. Pedro, J. Carvalho, S. Carneiro, and M. Mangas. "428 - Reflections on geriatric psychopharmacology in Portugal." International Psychogeriatrics 33, S1 (October 2021): 48–49. http://dx.doi.org/10.1017/s1041610221001873.
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Background:The most common psychiatric illnesses include depressive and anxiety disorders. However, the gap between therapeutic indication and pharmacological consumption is evident, with anxiolytics and antidepressants being some of the most prescribed drugs for the general population and, in particular, for the elderly. However, several of these psychotropic drugs are part of the list of potentially inappropriate medications for the elderly. Thus, the question arises: is the appropriate care being given to older patients, in this domain?Research objective:This work aims to reflect on the current structure of the mental health care network for elderly patients, focusing on consumption patterns among thevarious categories of psychotropic drugs and their physiological impact, taking into account the particularities of the target population.Method:A non-systematic review of the literature is presented. Bibliographic selection was carried out through keyword research in MEDLINE, Google Scholar and also by cross-referencing between articles.Results:In Portugal it was possible to infer that the consumption of anxiolytics and antidepressants increased ans was in line with the European trend. On the other hand, there has been a downward trend in the consumption of sedatives and hypnotics, opposite to the general trend in Europe. Due to changes related to pharmacokinetics and pharmacodynamics, older patients are more susceptible to the development of adverse reactions, the prevalence of potentially inappropriate medications is high in the context of mental health care. Switching drugs such as benzodiazepines, certain antipsychotics, tricyclic antidepressants and first-generation antihistamines significantly reduced the risk of adverse reactions.Discussion:Mental health care policies must be aligned with the conscious use of psychotropic drugs in the elderly population, at risk of the main objective, their well- being and care, being compromised.
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Jitsumura, Maki, Andrew Laurence Cunningham, Matthew David Hitchings, Saiful Islam, Angharad P. Davies, Paula E. Row, Andrew D. Riddell, et al. "Protocol for faecal microbiota transplantation in ulcerative colitis (FMTUC): a randomised feasibility study." BMJ Open 8, no. 10 (October 2018): e021987. http://dx.doi.org/10.1136/bmjopen-2018-021987.
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BackgroundThe interaction of the gut microbiota with the human host is implicated in the pathogenesis of inflammatory and immunological diseases including ulcerative colitis (UC). Faecal microbiota transplantation (FMT) as a method of restoring gut microbial diversity is of increasing interest as a therapeutic approach in the management of UC. The current literature lacks consensus about the dose of FMT, route of administration and duration of response.Methods and analysisThis single-blinded randomised trial will explore the feasibility of FMT in 30 treatment-naïve patients with histologically confirmed distal UC limited to the recto-sigmoid region (up to 40 cm from the anal verge). This study aims to estimate the magnitude of treatment response to FMT under controlled conditions. The intervention (FMT) will be administered by rectal retention enema. It will test the feasibility of randomising patients to: (i) single FMT dose, (ii) five daily FMT doses or (iii) control (no FMT dose). All groups will receive standard antibiotic gut decontamination and bowel preparation before FMT. Recruitment will take place over a 24-month period with a 12-week patient follow-up. Trial objectives include evaluation of the magnitude of treatment response to FMT, investigation of the clinical value of metabolic phenotyping for predicting the clinical response to FMT and testing the recruitment rate of donors and patients for a study in FMT. This feasibility trial will enable an estimate of number of patients needed, help determine optimal study conditions and inform the choice of endpoints for a future definitive phase III study.Ethics and disseminationThe trial is approved by the regional ethics committee and is sponsored by Abertawe Bro Morgannwg University’s Health Board. Written informed consent from all patients will be obtained. Serious adverse events will be reported to the sponsor. Trial results will be disseminated via peer review publication and shared with trial participants.Trial registration numberISRCTN58082603; Pre-results.
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Smaggus, Andrew, Marko Mrkobrada, Alanna Marson, and Andrew Appleton. "Effects of efforts to optimise morbidity and mortality rounds to serve contemporary quality improvement and educational goals: a systematic review." BMJ Quality & Safety 27, no. 1 (September 29, 2017): 74–84. http://dx.doi.org/10.1136/bmjqs-2017-006632.
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BackgroundThe quality and safety movement has reinvigorated interest in optimising morbidity and mortality (M&M) rounds. We performed a systematic review to identify effective means of updating M&M rounds to (1) identify and address quality and safety issues, and (2) address contemporary educational goals.MethodsRelevant databases (Medline, Embase, PubMed, Education Resource Information Centre, Cumulative Index to Nursing and Allied Health Literature, Healthstar, and Global Health) were searched to identify primary sources. Studies were included if they (1) investigated an intervention applied to M&M rounds, (2) reported outcomes relevant to the identification of quality and safety issues, or educational outcomes relevant to quality improvement (QI), patient safety or general medical education and (3) included a control group. Study quality was assessed using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. Given the heterogeneity of interventions and outcome measures, results were analysed thematically.ResultsThe final analysis included 19 studies. We identified multiple effective strategies (updating objectives, standardising elements of rounds and attaching rounds to a formal quality committee) to optimise M&M rounds for a QI/safety purpose. These efforts were associated with successful integration of quality and safety content into rounds, and increased implementation of QI interventions. Consistent effects on educational outcomes were difficult to identify, likely due to the use of methodologies ill-fitted for educational research.ConclusionsThese results are encouraging for those seeking to optimise the quality and safety mission of M&M rounds. However, the inability to identify consistent educational effects suggests the investigation of M&M rounds could benefit from additional methodologies (qualitative, mixed methods) in order to understand the complex mechanisms driving learning at M&M rounds.
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Steley, Zoe, Sandy Robertson, and Martin Farley. "1673 Environmental leadership and the ‘green’ ED." Emergency Medicine Journal 39, no. 12 (November 22, 2022): A991.1—A991. http://dx.doi.org/10.1136/emermed-2022-rcem2.52.
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Aims, Objectives and BackgroundThe climate crisis is the biggest health threat facing humanity and healthcare accounts for approximately 5% of the UK’s carbon footprint. To address this, the NHS has set the ambitious target of achieving net-zero emissions by 2040. This raises the question as to how emergency departments – sites of resource-intensive clinical activity – can be engaged appropriately on environmental sustainability. Can a standardised approach be developed to hasten and consolidate efforts? To test this, we developed the GreenED framework. The aim was to trial a set of actionable criteria that could be implemented by any ED seeking to measure and reduce impacts, and increase staff engagement. It is designed to be easy to implement in the context of the emergency care crisis, and administered by RCEM. To our knowledge, this is the first framework in the world specifically designed for use in EDs.Method and DesignThe framework is modelled on UCL’s successful LEAF programme for sustainable laboratories. Criteria were drafted based on a review of literature in healthcare sustainability relevant to emergency care, and structured into bronze, silver and gold levels based on anticipated feasibility. ED staff in 8 departments across England were then recruited to pilot bronze level. Following an induction session, participants were engaged via monthly meetings, providing updates on progress and sharing approaches and challenges. Verbal feedback and written submissions were collected.Results and ConclusionSites attempted as many actions as possible; most achieved at least 3 criteria. Identified obstacles were lack of senior support, guidance on how to implement changes, and time for sustainability work. Through both measurable impacts and qualitative feedback, this pilot has shown a clear demand for reducing environmental impacts, but significant challenges impeding progress. To continue leading in this we need to ensure senior buy-in and dedicate resources towards improving the sustainability of everyday departmental practices.
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Chawla, Jaya, Nour Houbby, Sarah Davies, and Charles Stewart. "1655 The ‘CCHILDS’ screen: a practical guide to a consultation with refugee and asylum seeking children within the Paediatric Emergency Department (PED)." Emergency Medicine Journal 39, no. 12 (November 22, 2022): A979.2—A980. http://dx.doi.org/10.1136/emermed-2022-rcem2.31.
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Aims, Objectives and BackgroundThe number of refugees worldwide has increased, especially in recent times, due to wars, political instability and economic insecurity with Iran, Eritrea, Albania, Iraq and Syria being the top five countries for asylum applications. Consequently, there are increasing numbers of refugee and asylum-seeking children entering the United Kingdom who face significant barriers to accessing healthcare services. These children often face health risks and therefore have complex health needs. Hence, it is vital for healthcare professionals in the emergency department to adopt a holistic approach to their care as this can have widespread positive implications beyond their clinical presentation and may shape their transition into a new country. This opinion article was undertaken with the aim of highlighting and summarising current best practice recommendations for addressing the needs of this complex patient group.Method and DesignA step-by-step screening tool (figure 1), CCHILDS (Communication, Communicable diseases, Health – physical and mental, Immunisation, Look after (safeguarding), Deficiencies, Sexual health) was formulated. This was created following a review of the literature, consultation with paediatric emergency clinicians and the use of current protocols in related disciplines (e.g. HEADDSS assessment tool). This tool can be used in the emergency setting by healthcare professionals in the assessment of refugee and asylum-seeking children and can serve as an aide memoire to cover the key aspects of a consultation.Abstract 1655 Figure 1Results and ConclusionThis opinion article summarises three main aspects in the assessment of a refugee or asylum-seeking child in the paediatric emergency department. Firstly, the key considerations regarding the child’s background prior to entering the UK and the barriers they may encounter to accessing healthcare. Secondly, the healthcare assessment upon arrival to the emergency department and a framework that could be used for clinical assessment. Finally, the consideration of their long-term healthcare needs and the importance of empowering these young individuals to lead a healthy lifestyle.
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Boico, Vasile, Susan Humblestone, Michael Moutoussis, and Caroline Selai. "19 Group psychotherapy/guided self help for patients with FNSD awaiting in-patient MDT programme treatment: a pilot study." Journal of Neurology, Neurosurgery & Psychiatry 93, no. 12 (November 14, 2022): e3.11. http://dx.doi.org/10.1136/jnnp-2022-bnpa.19.
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BackgroundThe 4-week in-patient Multi-Disciplinary Team Service at Queen Square for patients with Functional Neurological Symptom Disorder (FNSD) has input from Neuropsychiatrists, Occupational Therapists, Physiotherapists, Cognitive Behavioural Therapists, and specialist nursing staff.The Queen Square Guided Self-Help (QGSH) was developed as a brief therapeutic intervention, which aims to ensure that, prior to admission, the patient understands (a) the diagnosis of FNSD and how their own diagnosis has been reached; (b) rehabilitation therapy, both physical and psychological, and (c) the use of goal setting in rehabilitation.The QGSH is a course of Internet-based guided self-help. It runs for up to 12 weeks and includes original videos and patient worksheets, as well as signposting to existing published resources. It involves therapists guiding the patient to use a range of psychoeducational resources and facilitating therapy activities, supported by one-to-one contact via email or phone-calls.With the emergence of the covid pandemic and the first lockdown (March 2020) plus the growing patient waiting lists, we decided to offer the QGSH (i) remotely via zoom (ii) to groups of patients instead of individuals. This required a complete review of the QGSH goals, format, aims and objectives which resulted in a number of modifications including extensive revisions to the current materials.Aim of this studyWe present a service evaluation of the first 8 months of running QGSH therapy groups remotely on zoom.Results(1) We present the modifications we made to the existing QGSH materials which were finalised in April 2021.(2) In the period 11-May-2021 to 31-Jan-2022 we ran three groups with a total of 16 participants.(3) We present challenges and advantages from the perspective of the patients and from the perspective of the QGSH therapists.(4) Drawing on the published literature (Rogers, Yalom) plus our experiences as senior therapists, we outline the specialist knowledge, skills and competencies required to run a therapeutic group with patients with FNSD.DiscussionFeedback from the patients who participated in the groups was overwhelmingly positive. From the patients’ comments, the group furnished 8/11 of Yalom’s curative factors. We outline our plans for the future development of the QGSH preparatory therapy and a new initiative: the development of a ‘stand-alone’ group therapy for patients with FNSD.
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Carey, Luke C., Serina Stretton, Charlotte A. Kenreigh, Linda T. Wagner, and Karen L. Woolley. "High nonpublication rate from publication professionals hinders evidence-based publication practices." PeerJ 4 (May 10, 2016): e2011. http://dx.doi.org/10.7717/peerj.2011.
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Background.The need for timely, ethical, and high-quality reporting of clinical trial results has seen a rise in demand for publication professionals. These publication experts, who are not ghostwriters, work with leading medical researchers and funders around the world to plan and prepare thousands of publications each year. Despite the involvement of publication professionals in an increasing number of peer-reviewed publications, especially those that affect patient care, there is limited evidence-based guidance in the peer-reviewed literature on their publication practices. Similar to the push for editors and the peer-review community to conduct and publish research on publication ethics and the peer-review process, the International Society for Medical Publication Professionals (ISMPP) has encouraged members to conduct and publish research on publication planning and practices. Our primary objective was to investigate the publication rate of research presented at ISMPP Annual Meetings.Methods.ISMPP Annual Meeting abstract lists (April 2009–April 2014) were searched in November 2014 and data were extracted into a pilot-tested spreadsheet. MEDLINE was searched in December 2014 to determine the publication rate (calculated as the % of presented abstracts published as full papers in peer-reviewed journals). Data were analyzed using the Cochran-Armitage trend test (significance:P< .05) by an independent academic statistician.Results.From 2009 to 2014, there were 220 abstracts submitted, 185 accepted, and 164 presented. There were four corresponding publications (publication rate 2.4%). Over time, ISMPP’s abstract acceptance rate (overall: 84.1%) did not change, but the number of abstracts presented increased significantly (P= .02). Most abstracts were presented as posters (81.1%) and most research was observational (72.6%). Most researchers came from the US (78.0%), followed by Europe (17.7%), and the Asia-Pacific region (11.2%).Discussion.Research presented at ISMPP Annual Meetings has rarely been published in peer-reviewed journals. The high rate of nonpublication by publication professionals has now been quantified and is of concern. Publication professionals should do more to contribute to evidence-based publication practices, including, and especially, their own. Unless the barriers to publication are identified and addressed, the practices of publication professionals, which affect thousands of peer-reviewed publications each year, will remain hidden and unproven.
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Sabir, Brahim, Bouzekri Touri, and Mohamed Moussetad. "Development of a Minimum Protocol for the Assessment of Communication Disorders within Moroccan Students." Open Public Health Journal 9, no. 1 (August 31, 2016): 38–50. http://dx.doi.org/10.2174/1874944501609010038.
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Background:The present paper aims at establishing a minimum assessment protocol to estimate the prevalence of communication disorders, their severity and the correlation between identified communication disorders and oral communication activities among students.Material and Methods:A questionnaire was built using assessments published in current literature, which consists of 14 sections.The first section gathers demographic information such as age, gender, and level of education as well as history of speech therapy services (e.g.“do you consult a speech therapist?”).The second section asks about the ability to communicate verbally in public in social situations and the possible causes that impact a student’s ability to communicate effectively.The third section deals with the attitudes of the student before, during and after communicating, specifically focusing on questions related to stuttering.The proposed assessment also identified the severity of stuttering as well as any secondary behaviours associated with stuttering (e.g.eye blinking, tics, face spasms,etc.).Sections 4 through 13 are concerned with questions related to communication disorders such as: articulation disorders, language delays, dysphasia, swallowing disorders, hearing loss, cleft lip or palate, aphasia, attention disorders, dyslexia, and dysphonia.The last section deals with acoustic analysis, using Praat Software, where a recording of the sustained vowel /a/ is performed by each participant in order to have an overview of the following acoustic parameters: pitch, harmonics to noise ratio, shimmer and jitter.Participants included in this study were between 18 and 22 years of age who were in their 1stor 2ndyear of department of science of the Ben M’Sik College -University Hassan II Mohammedia.Results:The questionnaire was completed by 170 students, which insures a confidence interval of 4 and confidence level of 95%.Among the sample, 58% of students are male, and 42% are female.The studied sample demonstrated that 75% of the students do not feel comfortable when engaging in verbal communication in social situation, which was highly correlated with stuttering.Lack of self-confidence, stage fright, lack of experience, shyness and the presence of an important group are 80% of the causes students do not feel at ease when publicly speaking in front of an unfamiliar group.The study revealed that 20% of students had fluency disorders, 15% had articulation disorders, 21% had swallowing disorders, 19% had dysphasia, 1% of the students had hearing loss, 14% had attention disorders, 10% had dyslexia, and 6% had dysphonia.The major finding of the present paper was that 54% of the students studied were identified as having a language delay.Subjective assessments of the communication disorders are complemented with objective assessments based on acoustic analysis of the sustained vowel /a/ recorded from the studied sample.Based on the conducted research, we found that communication disorders impact the oral communication activities with a percent of 27%.By using objective assessments to analyse the threshold of acoustic parameters such as jitter, shimmer, mean harmonic to noise ratio and minimum and maximum pitch, we can determine the presence or absence of a voice disorder.Conclusion:The present paper proposes a ready-to-use assessment of communication disorders.The proposed model can be used with large groups as well as with individual students.Subjective assessment used in combination with objective assessments allow for a complete evaluation of communication disorders.
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Kip, Hanneke, Saskia M. Kelders, Yvonne H. A. Bouman, and Lisette J. E. W. C. van Gemert-Pijnen. "The Importance of Systematically Reporting and Reflecting on eHealth Development: Participatory Development Process of a Virtual Reality Application for Forensic Mental Health Care." Journal of Medical Internet Research 21, no. 8 (August 19, 2019): e12972. http://dx.doi.org/10.2196/12972.
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BackgroundThe use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable development methods is necessary to create a tool kit that guides researchers in choosing development methods that are appropriate for their context and users. In addition, there is a need for reflection on the existing frameworks for eHealth development to be able to constantly improve them.ObjectiveThe two main objectives of this case study were to present and reflect on the (1) methods used in the development process of a virtual reality application for forensic mental health care and (2) development model that was used: the CeHRes Roadmap (the Centre for eHealth Research Roadmap).MethodsIn the development process, multiple methods were used to operationalize the first 2 phases of the CeHRes Roadmap: the contextual inquiry and value specification. To summarize the most relevant information for the goals of this study, the following information was extracted per method: (1) research goal, (2) explanation of the method used, (3) main results, (4) main conclusions, and (5) lessons learned about the method.ResultsInformation on 10 methods used is presented in a structured manner. These 10 methods were stakeholder identification, project team composition, focus groups, literature study, semistructured interviews, idea generation with scenarios, Web-based questionnaire, value specification, idea generation with prototyping, and a second round of interviews. The lessons learned showed that although each method added new insights to the development process, not every method appeared to be the most appropriate for each research goal.ConclusionsReflection on the methods used pointed out that brief methods with concrete examples or scenarios fit the forensic psychiatric patients the best, among other things, because of difficulties with abstract reasoning and low motivation to invest much time in participating in research. Formulating clear research questions based on a model’s underlying principles and composing a multidisciplinary project team with prospective end users appeared to be important in this study. The research questions supported the project team in keeping the complex development processes structured and prevented tunnel vision. With regard to the CeHRes Roadmap, continuous stakeholder involvement and formative evaluations were evaluated as strong points. A suggestion to further improve the Roadmap is to explicitly integrate the use of domain-specific theories and models. To create a tool kit with a broad range of methods for eHealth development and further improve development models, studies that report and reflect on development processes in a consistent and structured manner are needed.
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Sadosky, A., P. Schepman, S. Thakkar, R. Robinson, and C. Beck. "AB0035 A REVIEW OF THE CLINICAL AND ECONOMIC BURDEN OF OSTEOARTHRITIS PAIN BY SEVERITY IN THE UNITED STATES." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1050.2–1051. http://dx.doi.org/10.1136/annrheumdis-2021-eular.534.
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Background:The development of new therapies to treat symptomatic osteoarthritis (OA) often requires targeting patient subgroups such as mild and/or moderate and/or severe. Multiple assessments for pain are used in clinical and research settings, yet to quantify patient burden with increasing pain severity it is important to understand the potential variability in outcomes based on definitions of severity used1.Objectives:The objective of this study was to examine studies in the published literature that report the burden of OA pain by severity to assess similarities and/or differences across study methodologies and outcomes.Methods:A targeted literature review of PubMed and Google Scholar was conducted January 2021 and included search terms: osteoarthritis, severity, United States (US), burden, quality of life, medication/treatment, and healthcare resource utilization. The search was limited to the English language, full-text articles, and no restriction on publication date. Results included a recent study of the burden of symptomatic OA pain respondents by severity level in the US2,3. Over 100 publication titles were reviewed. Comparison of findings was descriptive in nature.Results:Nine publications were identified representing 7 unique studies, 6 being patient and/or healthcare provider surveys. Two studies focused on OA severity: the remaining 5 stratified patients by pain severity, and all but 2 of the 5 identified and confirmed pain as OA-related. Pain measures included numeric rating scales (generic 0-10, Western Ontario and McMaster Universities Arthritis Index [WOMAC] NRS 3.1), visual analog scales (generic 0-100, Short-Form McGill Pain Questionnaire Visual Analog Scale [SF-MPQ-VAS]) or Pain Interference with Activities (PIA) scale derived from the 12-Item Short Form Health Survey [SF-12v2] developed for the Medical Outcomes Study, with recall periods varying from 48 hours to 7 days to 4 weeks. Only one study exclusively assessed symptomatic patients only i.e., patients with pain scores of 0 were excluded; the remainder compared cohorts of no/mild pain with increasing severity cohorts. Four of the 7 studies examined pairwise differences among mild, moderate, and severe patients (1 study vs. a non-OA cohort); 2 compared no/mild vs. moderate-to-severe OA pain and 1 study compared mild to moderate-to-severe OA pain. For most outcomes examined like clinical comorbidities, quality of life, and healthcare resource utilization, increasing burden was observed with increasing OA and/or pain severity despite study variability.Conclusion:Pain severity levels represent an important and distinguishing factor that contributes to health outcomes in OA patients in the US. Considerable heterogeneity across studies may impact how OA pain is defined, perceived by patients, and treated. Selecting appropriate OA pain severity assessments, including cut-points, may contribute to the successful monitoring of outcomes or comparisons of therapies to manage symptomatic OA pain, especially those that target specific pain severity subgroups.References:[1]Hawker GA, Mian S, Kendzerska T et al. Arthritis Care and Research. 2011; 63(11):S240-S252.[2]Schepman P, Robinson RL, Thakkar S, et al. International Society of Pharmacoeconomics and Outcomes Research (ISPOR) Virtual Annual Meeting; May 2020.[3]Schepman P, Thakkar S, Robinson RL, et al. PAINWeek 2020 Virtual Meeting; September 2020.Disclosure of Interests:Alesia Sadosky Shareholder of: Own stock in Pfizer Inc, Consultant of: I am an employee with the consulting firm Apperture Health, Employee of: I am retired from Pfizer Inc, Patricia Schepman Shareholder of: Owns shares in Pfizer Inc, Employee of: Employee of Pfizer Inc, Sheena Thakkar Shareholder of: Owns shares of Pfizer Inc, Employee of: Employee of Pfizer Inc, Rebecca Robinson Shareholder of: Owns shares of Eli Lilly and Company, Employee of: Employee of Eli Lilly and Company, Craig Beck Shareholder of: Owns shares of Pfizer Inc, Employee of: Employee of Pfizer Inc
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Williams, Mark A., Peter J. Heine, Esther M. Williamson, Francine Toye, Melina Dritsaki, Stavros Petrou, Richard Crossman, et al. "Active Treatment for Idiopathic Adolescent Scoliosis (ACTIvATeS): a feasibility study." Health Technology Assessment 19, no. 55 (July 2015): 1–242. http://dx.doi.org/10.3310/hta19550.
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BackgroundThe feasibility of conducting a definitive randomised controlled trial (RCT) evaluating the clinical effectiveness and cost-effectiveness of scoliosis-specific exercises (SSEs) for adolescent idiopathic scoliosis (AIS) is uncertain.ObjectivesThe aim of this study was to assess the feasibility of conducting a large, multicentre trial of SSE treatment for patients with AIS, in comparison with standard care, and to refine elements of the study design. The objectives were to (1) update a systematic review of controlled trials evaluating the efficacy of SSE in AIS; (2) survey UK orthopaedic surgeons and physiotherapists to determine current practice, patient populations and equipoise; (3) randomise 50 adolescents to a feasibility trial of either usual care or SSE interventions across a range of sites; (4) develop, document and assess acceptability and adherence of interventions; (5) assess and describe training requirements of physiotherapists; and (6) gain user input in all relevant stages of treatment and protocol design.DesignMulticomponent feasibility study including UK clinician survey, systematic literature review and a randomised feasibility trial.SettingThe randomised feasibility study involved four secondary care NHS trusts providing specialist care for patients with AIS.ParticipantsThe randomised feasibility study recruited people aged 10–16 years with mild AIS (Cobb angle of < 50°).InterventionsThe randomised study allocated participants to standard practice of advice and education or a physiotherapy SSE programme supported by a home exercise plan. Our choice of intervention was informed by a systematic review of exercise interventions for AIS.Main outcome measuresThe main outcome was feasibility of recruitment to the randomised study. Other elements were to inform choice of outcomes for a definitive trial and included curve severity, quality of life, requirement for surgery/brace, adverse events, psychological symptoms, costs and health utilities.ResultsA UK survey of orthopaedic consultants and physiotherapists indicated a wide variation in current provision of exercise therapy through physiotherapy services. It also found that clinicians from at least 15 centres would be willing to have their patients involved in a full study. A systematic review update found five new studies that were generally of low quality but showed some promise of effectiveness of SSE. The randomised study recruited 58 patients from four NHS trusts over 11 months and exceeded the pre-specified target recruitment rate of 1.4 participants per centre per month, with acceptable 6-month follow-up (currently 73%). Adherence to treatment was variable (56% of participants completed treatment offered). The qualitative study found the exercise programme to be highly acceptable. We learnt important lessons from patient and public involvement during the study in terms of study and intervention presentation, as well as practical elements such as scheduling of intervention sessions.ConclusionsA definitive RCT evaluating clinical effectiveness and cost-effectiveness of SSE for idiopathic scoliosis is warranted and feasible. Such a RCT is a priority for future work in the area. There is a sufficiently large patient base, combined with willingness to be randomised within specialist UK centres. Interventions developed during the feasibility study were acceptable to patients, families and physiotherapists and can be given within the affordability envelope of current levels of physiotherapy commissioning.Trial registrationCurrent Controlled Trials ISRCTN90480705.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 55. See the NIHR Journals Library website for further project information.
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Freier, D., E. Wiebe, R. Biesen, T. Buttgereit, S. Hermann, T. Gaber, and F. Buttgereit. "SAT0372 PATIENTS WITH PSORIATIC ARTHRITIS SHOW HIGHER BONE DENSITY COMPARED TO AGE AND GENDER MATCHED PATIENTS WITH ANKYLOSING SPONDYLITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1133.2–1134. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3566.
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Background:The prevalence of osteoporosis in inflammatory rheumatic diseases such as psoriatic arthritis (PsA) has not been sufficiently clarified yet, and the data in the literature are heterogeneous. In addition, it is still unclear to what extent patients with PsA differ in terms of bone density from patients with other forms of spondyloarthritis such as ankylosing spondylitis (AS).Objectives:In an interim analysis of the Rh-GIOP Study (ClinicalTrials.gov IdentifierNCT02719314), we observed that PsA patients demonstrated more frequently normal bone density than any other patient group analyzed (suffering from e.g. rheumatoid arthritis or systemic sclerosis). The main objective of this investigation was to compare bone density data from patients with PsA and AS, as both diseases belong to the spondyloarthritis group. 1100 patients with inflammatory rheumatic diseases provided the basis of Rh-GIOP, a prospective study monitoring glucocorticoid (GC)-induced osteoporosis in patients with rheumatic diseases. Rh-GIOP was established in 2015 at the Charité University Hospital. Bone mineral density data were measured by dual x-ray absorptiometry (DXA).Methods:92 patients with PsA (65% female) were compared with 51 patients suffering from AS (35% female). Potential risk and protective factors (e.g. data on GC treatment, anti-rheumatic therapy), laboratory parameters (e.g. Vitamin D, alkaline phosphatase, calcium and inflammatory markers) and functional status (e.g. Health Assessment Questionnaire, sporting activities, back pain) were compared between these groups. Statistical analysis was performed descriptively using mean and standard deviation, t-tests for metric variables, and chi-square tests for nominal variables. Due to the heterogeneous gender distribution, an additional statistical matching was performed to compare patients matched by age and gender.Results:Patients with PsA displayed significantly higher minimal T-scores than patients with AS (p=0.003) even though patients with AS were younger and more often male (p<0.001). AS patients showed a higher frequency of osteopenic bone densities (p<0.05), however, no differences in the frequency of osteoporotic bone densities were found. Body-mass-index (BMI) was significantly higher (p<0.001) in PsA patients. PsA patients demonstrated a higher frequency of csDMARD use (p<0.001). Additional analyses among PsA patients with and without csDMARDs revealed also significantly higher minimal T-scores in PsA patients taking csDMARDs (90% Methotrexate), and both groups showed the same average of age and gender distribution. Furthermore, AS patients complained significantly more often of back pain (96 % vs. 74%, p=0.001) than PsA patients. No differences in GC use or cumulative GC dose were found. All results could be confirmed when groups were matched by age and gender.Conclusion:Our results demonstrate that patients with PsA display higher bone density compared to age and gender matched patients with ankylosing spondylitis. Possible influencing factors could be the higher frequency of csDMARD use, higher BMI or the lower frequency of back pain in PsA patients. Multivariate tests and additional biomarker investigations in larger cohorts are necessary to corroborate these findings and to identify underlying pathogenic differences which could serve for an explanation.Disclosure of Interests:Desiree Freier: None declared, Edgar Wiebe: None declared, Robert Biesen: None declared, Thomas Buttgereit: None declared, Sandra Hermann: None declared, Timo Gaber: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.
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Smeele, H. T., L. F. Perez-Garcia, J. M. J. Cornette, M. W. Schreurs, and R. Dolhain. "POS0541 LOW PREVALENCE OF SSA (anti-Ro) AND SSB (anti-La) AUTOANTIBODIES IN FEMALE RHEUMATOID ARTHRITIS PATIENTS WITH A WISH TO CONCEIVE." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 504.2–505. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2435.
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Background:The presence of SSA (anti-Ro) and SSB (anti-La) autoantibodies has important clinical implications for female patients with a wish to conceive. The association between maternal levels of these autoantibodies and complete congenital heart block and neonatal Lupus syndrome is well established. Currently guidelines advise to test for these antibodies in all Rheumatoid Arthritis (RA) patients with a wish to conceive (1).Objectives:The objective was to determine the prevalence and titers of SSA and SSB autoantibodies in female patients with rheumatoid arthritis and a wish to conceive or who are pregnant.Methods:Patients were derived from 2 large prospective cohorts on RA and pregnancy (PARA-cohort and PreCARA-cohort). The presence and titers of SSA and SSB were tested using Phadia, an automated system which uses fluorescence enzyme immunoassays (FEIA) (Thermo-Fisher Scientific).Results:We included a total of 647 patients with RA and a wish to conceive, 417 (64.5%) conceived during the follow-up period. A detailed description of the study population, stratified for the presence of SSA and SSB antibodies autoantibodies is presented in table 1. A total of 25 out of 647 patients had detectable SSA or SSB antibodies: SSA n = 25 (SSA-52 n = 17, SSA-60 n = 19), SSB n = 7. This corresponds with a prevalence of 3.9% for SSA antibodies and 1.1% for SSB antibodies. 13 (52% of the SSA positive patients, 2.0% of the total population) patients had a titer of >240 units/ml of SSA antibodies, and 3 (42.9% of the SSB positive patients, 0.46% of the total population) patients had a titers >340 units/ml of SSB antibodies. The percentage of patients positive for RF antibodies was higher in SSA and/or SSB positive patients (p = 0.01).Table 1.Clinical and demographic features from 647 patients with rheumatoid arthritis and a wish to conceive.VariableSSA and SSB antibodies [-], n = 622Positive SSA and/or SSB antibodies [+], n = 25p-valueAge at inclusion in the cohort (y, SD)32.3 (4.0)32.3 (4.4)0.98Median disease duration at first visit, years (IQR)5.2 (2.2 – 9.8)4.9 (2.1 – 11.4)0.77ACPA positive, n (%)408/614 (66.5)16 (69.6)0.75Rheumatoid Factor positive, n (%)426/617 (69.0)23 (92.0)0.01Conclusion:Our study shows an overall low prevalence of SSA and SSB autoantibodies in female RA patients with a wish to conceive. Moreover, about half of the patients positive for SSA or SSB had, based on literature, moderate or low titers of these antibodies (2). Especially for RF negative patients, the current advise to test for SSA and SSB antibodies in all RA patients with a wish to conceive should be reconsidered.References:[1]Sammaritano LR et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Care Res (Hoboken). 2020 Apr; 72(4):461-488.[2]Jaeggi E et al. The Importance of the Level of Maternal Anti-Ro/SSA Antibodies as a Prognostic Marker of the Development of Cardiac Neonatal Lupus Erythematosus: A Prospective Study of 186 Antibody-Exposed Fetuses and Infants. Journal of the American College of Cardiology. 2010 2010/06/15/; 55(24):2778-2784Disclosure of Interests:Hieronymus TW Smeele: None declared, Luis Fernando Perez-Garcia Consultant of: Yes, Galapagos, J.M.J. Cornette: None declared, Marco WJ Schreurs: None declared, Radboud Dolhain Speakers bureau: Yes UCB, Roche, Abbvie, Genzyme, Novartis, Consultant of: Yes, Galapagos, Grant/research support from: Yes, UCB
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Li, Xia, Xiuling Wang, and Chenming Wei. "Antecedents of continuance intention in online learning systems among vocational college students: The moderating effect of gender." Frontiers in Psychology 13 (December 22, 2022). http://dx.doi.org/10.3389/fpsyg.2022.1088270.
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BackgroundThe primary objective of this study is to ascertain whether the Expectation Confirmation Model can be expanded by external variables including computer anxiety, social interaction, and self-efficacy to better understand the intention to continue using online learning systems in the post-pandemic era among vocational college students. Moreover, this research argues that the intention to continue using online learning systems among students may be gender-sensitive.MethodsThe researchers surveyed 482 students from eight vocational colleges in Jiangxi Province using a structured questionnaire. Partial Least Squares Structural equation modeling is used to verify the research model.ResultsThe outcomes demonstrate that the proposed model adequately explains the continuous use intention for online learning systems at a 76.6% confidence level. All of the newly introduced variables in the ECM are shown to be significant and relevant to explicate continuous use intention. Our survey results show that gender differences in intention to continue using online learning systems exist objectively, but this difference is not a natural difference.ConclusionThis research fills a void in the current literature on online learning and probes into how learning may be made more long-lasting in intricate environments.
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Alzar-Teruel, María, Agustín Aibar-Almazán, Fidel Hita-Contreras, María del Carmen Carcelén-Fraile, Antonio Martínez-Amat, José Daniel Jiménez-García, Raquel Fábrega-Cuadros, and Yolanda Castellote-Caballero. "High-intensity interval training among middle-aged and older adults for body composition and muscle strength: A systematic review." Frontiers in Public Health 10 (September 29, 2022). http://dx.doi.org/10.3389/fpubh.2022.992706.
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BackgroundThe aging of population is leading to the investigation of new options to achieve healthy aging. One of these options is high-intensity interval training (HIIT), although its effects on body composition and muscle strength are currently unclear. The objective of this systematic review is to examine the scientific publications on the effects of HIIT on the body composition and muscle strength of middle-aged and older adults.MethodsThe search was carried out in the PubMed, Cochrane Plus, Web of Science, CINAHL and SciELO databases without limitation of publication dates. The literature search, data extraction and systematic review were performed following the PRISMA standards and the risk of bias of the selected studies was assessed using the Cochrane Collaboration Risk-of-Bias.ResultsInitially 520 publications were identified, out of which a total of 8 articles were finally selected to be included in this systematic review. Improvements in body composition were seen in six of the selected items and an increase in muscle strength in seven of the eight. Regarding physical function, improvements were found in both gait speed and balance.ConclusionsThis systematic review found that HIIT is effective in improving body composition and increasing muscle strength. However, when comparing HIIT to moderate-intensity continuous training, it is not clear that HIIT is more beneficial; a firm conclusion cannot be drawn due to the scarcity of published studies, their variety in methodology and the ambiguity of their results, so it is suggested to carry out more research in this area.
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Stassen, Gerrit, Lukas Baulig, Ole Müller, and Andrea Schaller. "Attention to Progression Principles and Variables of Exercise Prescription in Workplace-Related Resistance Training Interventions: A Systematic Review of Controlled Trials." Frontiers in Public Health 10 (March 25, 2022). http://dx.doi.org/10.3389/fpubh.2022.832523.
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BackgroundThe workplace is an important setting for adult health promotion including exercise training such as resistance training (RT). Since the reporting of exercise training interventions is generally inconsistent, the objective of this systematic review was to investigate the attention to principles of RT progression and variables of RT exercise prescription in workplace-related RT interventions.MethodsA systematic literature search was conducted in the databases LIVIVO, PubMed, SPORTDiscus, and Web of Science (2000–2020). Controlled trials with apparently healthy “employees” and a main focus on RT were included. RT principles and variables were extracted and rated by two reviewers (reported, not reported, or unclear). Sum scores for each RT intervention and percentages regarding each principle and variable were calculated.ResultsOverall, 21 articles were included (18 primary studies, 3 protocols). Summarized narratively, the interventions showed different positive effects on strength- or performance-related and/or health- or complaint-related outcomes. The reporting of the RT principles and variables was varied [progressive overload: 94% of the studies, specificity: 78%, variation (periodization): 39%, muscle action: 94%, loading: 94%, volume; 67%, exercise selection: 89%, exercise order: 47%, rest periods between sets: 33%, rest periods between exercises: 27%, repetition velocity: 44%, and frequency: 100%].ConclusionSeveral key RT principles and variables were reported inconsistently, reducing reproducibility and pointing to the need for standardized RT intervention reporting in workplace-related interventions. Exercise science and workplace promotion should be further linked, since accurate reporting is a prerequisite for transferring robust findings into practice.