bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical impact of preservation fluid contamination on kidney transplant patients
Authors: Picola Brau Natalia , Fiol Riera Maria , Etcheverry Giadrosich Begoña , Riera Canals Lluis , Melilli Edoardo , Sabé Fernández Núria , Castells Esteve Manel , Vigués Julià Francesc
Published: December 2023

Background

Kidney transplantation is associated with a high risk of infectious complications due to immunosuppressive therapy. Although infections may be transmitted from donor to transplant recipient through contaminated preservation solution (PS), the clinical impact of this is not well‐understood.

Methods

We retrospectively evaluated PS contamination rates in a series of 339 patients who underwent cadaveric renal transplant at our centre. All patients with a positive culture received targeted preemptive therapy (PET).

Results

Of the 339 PS samples, 136 (40.1%) were positive for a microorganism, mainly coagulase‐negative staphylococci (CoNS; n = 89;60.5%), gram‐negative bacilli (n = 31;21.1%), non‐CoNS gram‐positive cocci (n = 18;12.2%), and Candida spp (n = 2;1.4%). Of the 136 positive cases, 42 (30.9%) received PET (12.4% of the cohort). No cases of urinary tract infection, surgical site infection, or graft loss were observed. Overall, our findings indicate that PS contamination, mainly by saprophytic skin flora (CoNS) is common. Only 8% of patients required antibiotic or antifungal therapy.

Conclusion

The infection transmission rate from donors to recipients was negligible (0%), perhaps due to the early initiation of a targeted PET after isolation of a recognized pathogen. More data from large, prospective studies are needed to confirm these findings.

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The burden of travelling for cervical cancer treatment in Uganda: A mixed‐method study
Authors: Dau Hallie , Zhou Chuanlin , Nankya Esther , Naguti Priscilla , Basemera Miriam , Payne Beth A. , Vidler Marianne , Singer Joel , McNair Avery , AboMoslim Maryam , Mithani Nadia , Smith Laurie , Orem Jackson , Nakisige Carolyn , Ogilvie Gina
Published: December 2023

Background

Uganda has one of the highest rates of cervical cancer in the world. Many women are diagnosed and treated with advanced stages of the disease. With only one facility offering comprehensive cervical cancer care in Uganda, many women are required to travel significant distances and spend time away from their homes to receive cervical cancer care. It is important to understand the burden of time away from home while attending treatment because it can inform the expansion of cervical cancer treatment programmes. The aim of this mixed‐methods paper is to describe how the distance to cervical cancer treatment locations impacts women in Uganda.

Methods

Women were recruited from 19 September, 2022, to 17 January, 2023, at the Uganda Cancer Institute (UCI) and the cancer clinic at Jinja Regional Referral Hospital (JRRF). Women were eligible for the study if they were (i) aged ≥18 years with a histopathologic diagnosis of cervical cancer; (ii) being treated at the UCI or JRRF for cervical cancer; and (iii) able to provide consent to participate in the study in English, Luganda, Lusoga, Luo, or Runyankole. All participants completed a quantitative survey and a selected group was sampled for semi‐structured interviews. Data were analysed using the convergent parallel mixed‐methods approach. Descriptive statistics were reported for the quantitative data and qualitative data using an inductive‐deductive thematic analysis approach.

Results

In all, 351 women participated in the quantitative section of the study and 24 in the qualitative. The quantitative and qualitative findings largely aligned and supported one another. Women reported travelling up to 14 h to receive treatment and 20% noted that they would spend three or more nights away from home during their current visit. Major themes of the qualitative include means of transportation, spending the night away from home, and financial factors.

Conclusion

Our findings show that travelling to obtain cervical cancer care can be a significant burden for women in Uganda. Approaches should be considered to reduce this burden such as additional satellite cervical cancer clinics or subsidised transportation options.
Euvolemic automated transfusion to treat severe anemia in sickle cell disease patients at risk of circulatory overload
Authors: Mercure‐Corriveau Nicolas , Crowe Elizabeth P. , Vozniak Sonja , Feng Xinyi , Rai Herleen , Van Denakker Tayler , Zakieh Abdulhafiz , Grabowski M. Kate , Lanzkron Sophie , Tobian Aaron A. R. , Bloch Evan M.
Published: December 2023

Background

Red blood cell (RBC) transfusion remains a major treatment for sickle cell disease (SCD). Patients with SCD have a high prevalence of renal impairment and cardiorespiratory disease, conferring risk of transfusion‐associated circulatory overload (TACO).

Study Design and Methods

We describe an approach, titled euvolemic automated transfusion (EAT), to transfuse SCD patients with severe anemia who are at risk of TACO. In EAT, plasmapheresis is performed using donor RBCs, rather than albumin or plasma, as replacement fluid. Euvolemia is maintained. A retrospective analysis was conducted of patients with SCD who underwent EAT at our institution over a 10‐year period, to evaluate the efficacy and safety of EAT.

Results

Eleven SCD patients underwent 109 EAT procedures (1–59 procedures per patient). The median age was 42 years (IQR = [30–49]) and 82% (n = 9) were female. Most (82%; n = 9) patients had severe chronic kidney disease and 55% (n = 6) had heart failure. One (9%) patient had a history of life‐threatening TACO. Mean pre‐ and post‐procedure Hct values were 19.8% (SD ± 1.6%) and 29.1% (SD ± 1.4%), respectively. The average Hct increment was 3.2% per RBC unit. Only two EAT‐related complications were recorded during the 109 procedures: central line‐associated infection and citrate toxicity (muscle cramping). EAT used an average of two RBC units less than that projected for standard automated RBC exchange.

Conclusion

Our findings suggest that EAT is safe and effective to treat patients with SCD and severe anemia, who are at risk for TACO. EAT requires fewer RBC units compared to automated RBC exchange.
Hyperproliferation of Elschnig pearl‐type posterior capsule opacification and spontaneous regression in two pseudophakic canine eyes
Authors: Lee Eunji , Kim Hyun‐ah , Seo Kangmoon , Kang Seonmi
Published: December 2023

Objective

To describe the hyperproliferation of Elschnig pearl‐type posterior capsule opacification and concurrent uveitis in two canine eyes after phacoemulsification, followed by spontaneous resolution of the Elschnig pearls.

Animal Studied

A 10‐year‐old castrated male Spitz (Case 1) and a 4‐year‐old spayed female Bichon Frise (Case 2).

Procedure

Elschnig pearls proliferating beyond the anterior capsulotomy site were observed in the right eye 10 months after bilateral diabetic cataract surgery (Case 1) and 7 months after unilateral cataract surgery (Case 2). In both cases, hyperproliferation occurred where the anterior capsule did not overlap with the intraocular lens (IOL), and was accompanied by aqueous flare. In Case 1, the pearls extended from the anterior capsule and adhered to the iris, causing focal posterior synechia. No other possible causes of uveitis were apparent.

Results

Initially, uveitis severity improved after the administration of topical and systemic anti‐inflammatory drugs. However, uveitis recurred when the dosage of anti‐inflammatory treatment was reduced. The Elschnig pearls underwent morphological changes throughout the follow‐up period. In both cases, the pearls beyond the anterior capsulotomy resolved spontaneously after 5 months. Only a few pearls remained between the IOL and posterior capsule, and no recurrence of pearl proliferation was observed at the last follow‐up.

Conclusions

To the best of our knowledge, this is the first report of spontaneous Elschnig pearl regression in dogs. Lens‐induced uveitis (LIU) may have been caused by anterior chamber hyperproliferative pearls. LIU associated with hyperproliferative pearls may be managed with appropriate anti‐inflammatory treatment and monitoring.
Configuration of Organic Rankine Cycles for Geothermal Applications: An Industrial Perspective
Authors: Pettinari Matteo , Dago Gnandjuet Gaston Brice , Frate Guido Francesco , Baccioli Andrea , Ferrari Lorenzo , Desideri Umberto , Amidei Simone , Cosi Lorenzo
Published: December 2023

Geothermal resources represent a valuable option to reduce fossil fuel-based power production because they feature an unmatched capacity factor among other renewable energy sources (RES). Geothermal resource availability reduces with the temperature. Therefore, developing cost-effective solutions to exploit low-temperature geothermal energy is mandatory to expand technology utilization. The standard solution for converting low-temperature thermal sources into power is organic rankine cycles (ORCs). ORC basic layout (subcritical) is well-known, but the more advanced alternatives, such as transcritical and two-pressure level cycles, are much less widespread, and it is unclear whether the higher efficiency justifies the higher capital cost. The paper focuses on the exploitation with ORC of geothermal resources (hot water) with a temperature lower than 200 °C and mass flow rates between 200 and 1400 m3/h for a target power production ranging from 3 to 30 MW. The paper compares three ORC layouts, subcritical, transcritical, and two pressure-level, from thermodynamic and economic points of view to map the most cost-effective solutions in the investigated size ranges. The techno-economic comparison considers the impact of the operating conditions and fluid on the machine's expected performance and the heat exchangers' size. As expected, more complicated layouts yield higher conversion efficiencies, with the two pressure-level cycles achieving the highest power output for the same geothermal source conditions. However, the economic analysis showed that the most efficient solutions are not always preferable when considering the cost-efficiency tradeoff.
Ultrasound guided injection with Collagen-based Medical Device: real-life evaluation of efficacy and safety in hip osteoarthritis
Authors: Damjanov Nemanja , Micu Mihaela C
Published: December 2023

Aims: Data regarding the treatment of hip osteoarthritis (OA) with collagen-based extracellular bio-scaffolds are lacking. We evaluated the treatment of hip OA with ultrasound guided intraarticular injections of Collagen-based Medical Device (CMD).Material and methods: Forty-four patients with Kellgren-Lawrence grade (KLG) I or II were selected, and 20/44 randomly selected patients (CMD group), were treated with 2 weekly consecutive ultrasound guided intraarticular injections of CMD (MD-HIP, Guna S.p.a. Milan, Italy). An additional 24/44 patients were treated with oral non-steroidal anti-inflammatory drugs (NSAIDs) daily (NSAIDs group). Clinical assessment, X-rays and ultrasound evaluation were performed at baseline, and after 1 month in both groups, and after 3 months in the CMD group. Outcome measures were general pain VAS (0-10), the whole WOMAC score, and the WOMAC specific subscores.Results: CMD and NSAIDs group were homogenous for age, gender, VAS pain and WOMAC scores. The CMD group had significant improvement of the VAS pain (p<0.0001), global WOMAC score (p<0.0001) and WOMAC function (p<0.0001) from baseline to the 1st month, with further improvement from the 1st to the 3rd month (p<0,001; p<0.01; p<0.03, respectively). Significant improvement in WOMAC pain (p<0.0001) and WOMAC stiffness (p<0.0001) was detected at 1st month, with no significant change at 3rd month. In the NSAIDs group significant improvement in WOMAC function was detected after 1 month (p=0.021) only. No adverse events were recorded in the CMD and NSAIDs group.Conclusion: The ultrasound guided intraarticular hip injections of CMD resulted in significant improvement in VAS pain and WOMAC scores compared to treatment with oral NSAIDs
Cranial ultrasound performance assessment tool: development and validation
Authors: Tanaanantarak Pattama , Kritsaneepaiboon Supika , Charoonratana Vorawan , Chittchang Chomanad , Chutiwongthanaphat Kanokporn , Pacharn Preeyacha , Iemsawatdikul Kriengkrai , Amornsitthiwat Ramida , Ruangwattanapaisarn Nichanan , Eng-Chuan Suwadee , Junhasavasdikul Thitiporn , Mahayosnond Atchara , Tewattanarat Nipaporn , Kitpraphasiri Piyaporn , Phewplung Teerasak , Tangsiwong Thipsumon , Sangsupawanich Pasuree
Published: December 2023

Aim: A standard assessment tool for direct evaluation of procedural skills to ensure proficiency of trainees is necessary for cranial ultrasound (US) in clinical practice. This study created and validated an assessment tool for cranial US performance by radiologists.Material and methods: An initial evaluation tool for cranial US using criteria was developed based on existing literature. The assessment form was modified using a three-round Delphi process by an expert panel, conducted between January 2021 and April 2021. Rubric scales for grading were added once consensus regarding generated items was reached. Experts confirmed the final assessment tool using a rubric scale. Two raters evaluated cranial US performance of 27 residents in video clips using the tool. Reliability and percent agreement were assessed.Results: Seventeen pediatric radiologists working in different settings participated in the expert panel. The content validation of the proposed evaluation tool was enabled by expert pediatric radiologists. Following three rounds of the Delphi process, the initial 14-item assessment form became a final 15-item form. A three-part rubric scale was used in the final form (preparation, US machine operation, and cranial US performance). Interrater reliability was evaluated with Cohen’s Kappa. The Kappa value and percent interrater agreement for most items was moderate to almost perfect (0.42–0.93 and 77.8–100%, respectively). The Cronbach’s alpha values for both raters were 0.856 and 0.891.Conclusions: This study produced the first validated cranial US assessment tool using a modified Delphi method. The final assessment form is a simple and reliable tool.
Neurocognitive Hop Performance in Patients With Chronic Ankle Instability
Authors: Choi Ji Yeon , Vogel Colleen , Burcal Christopher J. , Remski Lindsey E. , Knarr Brian A. , Rosen Adam B.
Published: December 2023

The purpose of this study was to determine differences in neurocognitive hop function among individuals with chronic ankle instability, ankle sprain copers, and control participants and identify the relationship between the self-reported function and neurocognitive hop performance; 61 participants across control, ankle sprain coper, and chronic ankle instability groups completed the Cumberland Ankle Instability Tool and the Choice-Reaction Hop Test. There was no significant difference in neurocognitive hop performance among groups. However, there was a large correlation between the Cumberland Ankle Instability Tool and the Choice-Reaction Hop Test. Those with chronic ankle instability with worse self-reported disability concurrently demonstrated decreased performance during the Choice-Reaction Hop Test, reflecting poorer neurocognitive hop performance.
Removal of a left ventricular thrombus complicated by cardiac sarcoidosis using a 3D microscope system
Authors: Watanabe Saeki , Morimoto Hironobu , Futagami Daisuke , Mukai Shogo
Published: December 2023

A woman in her 60s was brought to the previous hospital with respiratory distress. She was referred for the treatment of severe cardiac dysfunction and a mobile mass in the left ventricle. Echocardiography revealed the mass to be of 20×11 mm in size, mobile and slightly attached to the left ventricle by a stalk. As MRI had already revealed a small cerebral infarction, we have decided to perform emergency thrombectomy of the left ventricle. As the left ventricular contractility was diffusely impaired, we were able to remove the mass without any residuals using a transseptal approach without a left ventricular incision using a three-dimensional microscope system. The pathological diagnosis of the mass was thrombus, and subsequent close examination led to the diagnosis of cardiac sarcoidosis. We report the surgical technique and removal of a left ventricular thrombus complicated by cardiac sarcoidosis.
Small saphenous vein aneurysm diagnosis and treatment
Authors: Kamel Mohamed K , Blebea John
Published: December 2023

Venous aneurysms are rare, particularly those arising from the superficial venous system. Current limited evidence suggests that congenital weakness of the vein wall, degenerative changes, trauma and inflammation are among potential causes. Surgical management has been the mainstay treatment modality of venous aneurysms. Surgical approaches and techniques should be tailored on a case-by-case basis, taking into consideration aneurysm location, size, shape and presence of complications (ie, rupture or thrombosis). In this report, we present a male patient in his late thirties who presented with right leg swelling and achiness 2 years following right lower extremity blunt trauma and was found to have a 3 cm small saphenous vein aneurysm extending to the saphenopopliteal junction. The patient was successfully treated with excision of the aneurysm via a posterior approach. This case report adds to the current literature and may help to define future treatment recommendations.
Chiari III malformation in a neonate
Authors: Kalra Riya , Bamashmous Eman Omar , Krishnan Anant
Published: December 2023

Chiari malformation (CM) is a group of complex deformities of the posterior fossa and hindbrain, of which CMIII is the rarest. We report a term neonate, with an antenatal diagnosis of occipital encephalocele, who underwent resection of the encephalocele and ligation of vessels, with repair of a large scalp defect and dural reconstruction on day 4 of life. The parents of the child had been counselled for a guarded and poor prognosis on initial diagnosis. The child has had a good postoperative course without complications but suffers from cortical visual impairment and global developmental delay.
Great mimicker: definite isolated cardiac sarcoidosis masquerading as hypertrophic cardiomyopathy
Authors: Pham Tuan , Abraham Jacob , Sheikh Farooq H
Published: December 2023

A healthy man in his 50s was hospitalised after presenting with chest pain and dyspnoea. An echocardiogram revealed asymmetrical septal hypertrophy, leading to a diagnosis of hypertrophic cardiomyopathy. Due to progressive conduction abnormalities during his hospitalisation, further evaluation was performed. Cardiac MRI revealed dense late gadolinium enhancement of the septum in the area of hypertrophy. Additionally, fluorodeoxyglucose-positron emission tomography demonstrated increased uptake within the same region, suggestive of active inflammation. Subsequent endomyocardial biopsy showed non-caseating granulomatous inflammation, consistent with cardiac sarcoidosis. Treatment with prednisone and methotrexate was initiated, and an implantable cardioverter-defibrillator was placed following thorough risk stratification. This case highlights the importance of multimodality imaging and the pursuit of a tissue diagnosis in the evaluation of cardiomyopathy.
Large supralevator haematoma: a dilemma in diagnosis and management
Authors: Sarma Nipasa , Hebbar Shripad , Kundoor Ruthvika
Published: December 2023

This is a case of postpartum haemorrhage following vaginal delivery of a primigravida in her late 20s resulting from a supralevator haematoma. She delivered in a low-resource hospital setting, with a late diagnosis of severe pre-eclampsia and haemolysis, elevated liver enzymes and low platelet count (HELLP), subsequently developed traumatic postpartum haemorrhage and vaginal haematoma, and was referred to our hospital for further management. She was constantly monitored, and serial ultrasonography revealed an expanding paravaginal haematoma. CT, 4 hours after admission, showed a large ill-defined collection with hyperdense areas of blood attenuation measuring ~8.0×6.2×12.2 cm in toto in the vaginal canal and right paravaginal region with supralevator extension, abutting the rectum posteriorly. The expanding haematoma caused gradual hypovolaemic shock, and hence, she was taken up for vaginal evacuation of supralevator haematoma with drainage tube insertion under ultrasound guidance. She received multiple blood product transfusion. Drain tube was removed on postoperative day 3. Follow-up scan was done and resolving haematoma noted. The patient was discharged on postoperative day 5 in a stable condition. She was followed up in outpatient department, and there was complete resolution of haematoma by 4 weeks.
Successful treatment of prolonged cholestasis following hepatitis A infection in a child with oral steroid therapy
Authors: Chirag Ravi , Arun Babu Thirunavukkarasu
Published: December 2023

Hepatitis A is a common cause of acute infectious hepatitis in children, transmitted through the faeco-oral route. Although mostly self-limiting, cholestasis is a rare but known complication of acute hepatitis A in children. This report presents an adolescent girl who developed cholestatic features following hepatitis A infection and successful treatment with oral steroid therapy. Prolonged cholestasis jaundice (PCJ) is a known manifestation of hepatitis A infection, characterised by prolonged fever, pruritus and jaundice. While the exact mechanisms causing PCJ are not fully understood, immunological-mediated responses could play a role. Treatment options for PCJ are limited, and there is no currently accepted standard of care. Steroids have shown promise in treating PCJ, as observed in this case and a few other reported cases. When other therapies fail to alleviate symptoms, corticosteroids should be considered as a potential treatment option. However, further studies are required to conclusively establish their efficacy.
Gallstone ileus 30 years after cholecystectomy and hepaticojejunostomy
Authors: Todd Chloe , Wong Rachael , Covin Brianna , Keith Stacey
Published: December 2023

Gallstone ileus occurs when the small or large intestine is obstructed by a gallstone and is a rare occurrence in a post-cholecystectomy patient. Non-specific clinical symptoms and inconsistent imaging results often lead to a delay in diagnosis. Complex anatomy, such as a Roux-en-Y biliary-enteric anastomosis, can increase the risk of stone formation and further confound a potential case of gallstone ileus. Here, we present a rare case of gallstone ileus at the anastomosis site of a Roux-en-Y hepaticojejunostomy done 30 years prior for a common bile duct injury during a cholecystectomy. The possibility of negative CT findings, pattern of presentation on imaging as intussusception, and potential pathomechanism of gallstone formation in post-cholecystectomy patients are discussed. Through this case and review of similar cases, we emphasise the need for further study of post-cholecystectomy gallstone ileus and the importance of clinical suspicion during diagnosis.
Designing intervention prototypes to improve infant and young child nutrition in Peru: a participatory design study protocol
Authors: Rousham Emily , Pareja Rossina G , Creed-Kanashiro Hilary M , Bartolini Rosario , Pradeilles Rebecca , Ortega-Roman Deysi , Holdsworth Michelle , Griffiths Paula , Verdezoto Nervo
Published: December 2023

Introduction

Nutrition during the complementary feeding period (6–23 months) is critical to ensure optimal growth and reduce the risk of diet-related disease across the life course. Strategies to reduce multiple forms of malnutrition (stunting, overweight/obesity and anaemia) in infants and young children (IYC) are a key priority in low-income and middle-income countries, including Peru. This study aims to co-design and develop prototypes for interventions to address the multiple forms of malnutrition in IYC in urban Peru, using a participatory design approach.

Methods and analysis

The study will be based within peri-urban communities in two areas of Peru (Lima and Huánuco city). Following the identification of key nutritional challenges for IYC aged 6–23 months through formative research (phase I), we will conduct a series of workshops bringing together healthcare professionals from government health centres and caregivers of IYC aged 6–23 months. Workshops (on idea generation; creating future scenarios; storyboarding and early implementation and feedback) will take place in parallel in the two study areas. Through these workshops, we will engage with community participants to explore, experiment, co-design and iteratively validate new design ideas to address the challenges around IYC complementary feeding from phase I. Workshop outputs and transcripts will be analysed qualitatively using affinity diagramming and thematic analyses. The intervention prototypes will be evaluated qualitatively and piloted with the participating communities.

Ethics and dissemination

Ethical approval for this study was obtained from the Ethical Review Committee of the Instituto de Investigación Nutricional (IIN) Peru (388-2019/CIEI-IIN), Loughborough University (C19-87) and confirmed by Cardiff University. Findings of the participatory design process will be disseminated through a deliberative workshop in Lima, Peru with national and regional government stakeholders, as well as participants and researchers involved in the design process. Further dissemination will take place through policy briefs, conferences and academic publications.
Latin American Cerebral Palsy Register (LATAM-CPR): study protocol to develop a collaborative register with surveillance of children with cerebral palsy in Latin American countries
Authors: Ruiz Brunner Maria de las Mercedes , Jahan Israt , Cuestas Eduardo , Cieri Maria Elisabeth , Escobar Zuluaga Johana , Condinanzi Ana Laura , Sanchez Federico , McIntyre Sarah , Smithers-Sheedy Hayley , Muhit Mohammad , Badawi Nadia , Díaz Raul , Diaz Agripina , Carranza Jorge , Durán Claudia , Quintero Valencia Carlos Alberto , Melaragno Mariana , Khandaker Gulam
Published: December 2023

Introduction

Cerebral palsy (CP) is one of the leading causes of childhood disability globally with a high burden in low-income and middle-income countries (LMICs). Preliminary findings from the global LMIC CP Register (GLM CPR) suggest that the majority of CP in LMICs are due to potentially preventable causes. Such data are lacking in the Latin American region. Generating comparable epidemiological data on CP from this region could enable translational research and services towards early diagnosis and early intervention. We aim to establish a Latin American multicountry network and online data repository of CP called Latin American Cerebral Palsy Register (LATAM-CPR).

Methods and analysis

The LATAM-CPR will be modelled after the GLM CPR and will support new and emerging Latin American CP registers following a harmonised protocol adapted from the GLM CPR and piloted in Argentina (ie, Argentine Register of Cerebral Palsy). Both population-based and institution-based surveillance mechanisms will be adopted for registration of children with CP aged less than 18 years to the participating CP registers. The data collection form of the LATAM-CPR will include risk factors, clinical profile, rehabilitation, socioeconomical status of children with CP. Descriptive data on the epidemiology of CP from each participating country will be reported, country-specific and regional data will be compared.

Ethics and dissemination

Individual CP registers have applied ethics approval from respective national human research ethics committees (HREC) and/or institutional review boards prior to the establishment and inclusion into the LATAM-CPR. Ethical approval for LATAM-CPR has already been obtained from the HREC in the two countries that started (Argentina and Mexico). Findings will be disseminated and will be made publicly available through peer-reviewed publications, conference presentations and social media communications.
Predictive value of machine learning on fracture risk in osteoporosis: a systematic review and meta-analysis
Authors: Wu Yanqian , Chao Jianqian , Bao Min , Zhang Na
Published: December 2023

Objectives

Early identification of fracture risk in patients with osteoporosis is essential. Machine learning (ML) has emerged as a promising technique to predict the risk, whereas its predictive performance remains controversial. Therefore, we conducted this systematic review and meta-analysis to explore the predictive efficiency of ML for the risk of fracture in patients with osteoporosis.

Methods

Relevant studies were retrieved from four databases (PubMed, Embase, Cochrane Library and Web of Science) until 31 May 2023. A meta-analysis of the C-index was performed using a random-effects model, while a bivariate mixed-effects model was used for the meta-analysis of sensitivity and specificity. In addition, subgroup analysis was performed according to the types of ML models and fracture sites.

Results

Fifty-three studies were included in our meta-analysis, involving 15 209 268 patients, 86 prediction models specifically developed for the osteoporosis population and 41 validation sets. The most commonly used predictors in these models encompassed age, BMI, past fracture history, bone mineral density T-score, history of falls, BMD, radiomics data, weight, height, gender and other chronic diseases. Overall, the pooled C-index of ML was 0.75 (95% CI: 0.72, 0.78) and 0.75 (95% CI: 0.71, 0.78) in the training set and validation set, respectively; the pooled sensitivity was 0.79 (95% CI: 0.72, 0.84) and 0.76 (95% CI: 0.80, 0.81) in the training set and validation set, respectively; and the pooled specificity was 0.81 (95% CI: 0.75, 0.86) and 0.83 (95% CI: 0.72, 0.90) in the training set and validation set, respectively.

Conclusions

ML has a favourable predictive performance for fracture risk in patients with osteoporosis. However, most current studies lack external validation. Thus, external validation is required to verify the reliability of ML models.

PROSPERO registration number

CRD42022346896.
Self-care behaviour and associated factors among heart failure patients in Ethiopia: a systematic review and meta-analysis
Authors: Wondmieneh Adam , Getie Addisu , Bimerew Melaku
Published: December 2023

Objective

This study aimed to estimate the pooled level of self-care behaviour among heart failure patients in Ethiopia.

Design

Systematic review and meta-analysis.

Data source

PubMed/MEDLINE, HINARI, Web of Sciences, Scopus, Google Scholar, Science Direct, African journals online and University repositories were searched from 1 January 2000 to 1 November 2023.

Eligibility criteria

We include studies that examined self-care behaviour among heart failure patients, studies that report factors associated with self-care behaviour and observational studies (cross-sectional, case-control and cohort) with full text available.

Data extraction and synthesis

The data were extracted with Microsoft Excel and analysed by using STATA V.11 software. The weighted inverse variance random-effects model at 95% CI was used to estimate the pooled level of self-care behaviour and its associated factors among heart failure patients. Tests of heterogeneity, test of publication bias and subgroup analyses were also employed.

Results

Thirteen cross-sectional studies with 4321 study participants were included; and the pooled level of good self-care behaviour among heart failure patients in Ethiopia was found to be 38.3% (95% CI 31.46 to 45.13). Only 68.8% of heart failure patients were knowledgeable about heart failure. Knowledge about heart failure (Adjusted Odds Ratio (AOR)=3.39; 95% CI 2.42 to 4.74) and absence of comorbidity (AOR=2.69; 95% CI 1.35 to 5.37) were significantly associated with good self-care behaviour among heart failure patients in Ethiopia.

Conclusion

The majority of heart failure patients in Ethiopia did not adhere to the recommended self-care behaviours. Nearly one-third of heart failure patients were not knowledgeable about heart failure. Knowledge about heart failure and the absence of comorbidities were significantly associated with good self-care behaviour. Therefore, efforts should be devoted to increasing knowledge and preventing comorbidities among heart failure patients.

PROSPERO registration number

CRD42023394373.
Influence of physical fitness components on personality factors and risk perception of children and adolescents: a cross-sectional study
Authors: González-Gálvez Noelia , Vaquero-Cristobal Raquel , Maciá-Andreu María José , García-Tascon Marta , Soler-Marín Antonio , Gallardo-Guerrero Ana María
Published: December 2023

Objectives

To examine the associations of cardiorespiratory fitness (VO2max) and muscular strength with indicators related to the risk scale, such as perceived competence, sensation seeking, competitiveness, risk taking and risk perception in sports.

Design

Cross-sectional study.

Setting

High schools from the Region of Murcia (Spain).

Participants

Three-hundred-and-seventeen adolescents participated (mean age: 13.69±1.2 years old).

Primary and secondary outcome measures

Body mass, body height, Course-Navette test, upper limb strength and psychoeducational factors that determine the propensity towards sports accidents in school children, the Sports Accident Propensity Scale were evaluated. It was performance t-test for independent samples, stepwise multiple linear regression models and a multiple mediation analysis.

Results

The analysis showed significant differences with respect to sex in height, VO2max, handgrip strength and in all factors of the questionnaire (p=0.02-<0.01). Adolescents who presented greater VO2max, strength in the handgrip test and age showed a higher score in factors 1 and 3. Higher scores in factor 2 were associated with better VO2max and strength in handgrip test. Youngers and better values of strength in the handgrip showed higher score in factors 4 and 5. The mediation analysis with two mediating variables (handgrip strength and VO2max) showed a significant indirect effect. When handgrip strength and VO2max were included in the equations, the association between sex and each factor ceased to be significant.

Conclusion

This study highlights the potential benefits of muscular strength (handgrip) and VO2max in the perceived risk scale, and the variable of age on this.

Trial registration number

Clinical trial:NCT05544370(pre-results).
How surgical Trainee Research Collaboratives achieve success: a mixed methods study to develop trainee engagement strategies
Authors: Clement Clare , Coulman Karen , Heywood Nick , Pinkney Tom , Blazeby Jane , Blencowe Natalie S , Cook Jonathan Alistair , Bulbulia Richard , Arenas-Pinto Alejandro , Snowdon Claire , Hilton Zoe , Magill Laura , MacLennan Graeme , Glasbey James , Nepogodiev Dmitri , Hardy Victoria , Lane J Athene
Published: December 2023

Objectives

This study aimed to understand the role of surgical Trainee Research Collaboratives (TRCs) in conducting randomised controlled trials and identify strategies to enhance trainee engagement in trials.

Design

This is a mixed methods study. We used observation of TRC meetings, semi-structured interviews and an online survey to explore trainees’ motivations for engagement in trials and TRCs, including barriers and facilitators. Interviews were analysed thematically, alongside observation field notes. Survey responses were analysed using descriptive statistics. Strategies to enhance TRCs were developed at a workshop by 13 trial methodologists, surgical trainees, consultants and research nurses.

Setting

This study was conducted within a secondary care setting in the UK.

Participants

The survey was sent to registered UK surgical trainees. TRC members and linked stakeholders across surgical specialties and UK regions were purposefully sampled for interviews.

Results

We observed 5 TRC meetings, conducted 32 semi-structured interviews and analysed 73 survey responses. TRCs can mobilise trainees thus gaining wider access to patients. Trainees engaged with TRCs to improve patient care, surgical evidence and to help progress their careers. Trainees valued the TRC infrastructure, research expertise and mentoring. Challenges for trainees included clinical and other priorities, limited time and confidence, and recognition, especially by authorship. Key TRC strategies were consultant support, initial simple rapid studies, transparency of involvement and recognition for trainees (including authorship policies) and working with Clinical Trials Units and research nurses. A 6 min digital story on YouTube disseminated these strategies.

Conclusion

Trainee surgeons are mostly motivated to engage with trials and TRCs. Trainee engagement in TRCs can be enhanced through building relationships with key stakeholders, maximising multi-disciplinary working and offering training and career development opportunities.
Relationship between mental health, sleep status and screen time among university students during the COVID-19 pandemic: a cross-sectional study
Authors: Wang Wei , Jiang Jingfeng , Qi Lerong , Zhao Fanqi , Wu Jingying , Zhu Xiaoqi , Wang Bei , Hong Xiang
Published: December 2023

Objective

On 20 July 2021, after the outbreak of COVID-19 at Nanjing Lukou International Airport, several universities started closed management and online teaching. This had a large impact on students’ daily life and study, which may lead to mental health problems. The purpose of this study is to study the effect of screen time on mental health status of university students and the possible mediating effect of sleep status.

Methods

This was a cross-sectional study. A web-based questionnaire survey was employed that included demographic characteristics, sleep status and mental health status (depression, anxiety and loneliness). The Pittsburgh Sleep Quality Index scale was used to assess sleep status, while the Centre for Epidemiologic Studies Depression (CES-D) scale, Generalised Anxiety Disorder-7 (GAD-7) scale and Emotional versus Social Loneliness Scale (ESLS) were used to assess depression, anxiety and loneliness, respectively. Linear and logistic regression models were developed and adjusted for confounding factors, and finally the mediating effects were tested using the Karlson-Holm-Breen method.

Results

Finally, 1070 valid questionnaires were included. Among these, 604 (56.45%) indicated depressive symptoms (CES-D score ≥16) and 902 (84.30%) indicated anxiety symptoms (GAD-7 score ≥10). The mean ESLS score (for loneliness) was 26.51±6.64. The relationship between screen time and depressive symptoms (OR 1.118, 95% CI 1.072 to 1.166) and anxiety symptoms (OR 1.079, 95% CI 1.023 to 1.138) remained significant after adjusting for confounding factors. Meanwhile, sleep status plays an intermediary role in screen time and mental health status (depression and anxiety) and accounts for 13.73% and 19.68% of the total effects, respectively. We did not find a significant association between screen time and loneliness.

Conclusion

During the outbreak of COVID-19, screen time is inevitably prolonged among university students. There is a relationship between mental health and screen time, and sleep status plays a mediating role.
Hospital-based caregiver intervention for people following hip fracture surgery (HIP HELPER): multicentre randomised controlled feasibility trial with embedded qualitative study in England
Authors: Smith Toby O , Khoury Reema , Hanson Sarah , Welsh Allie , Grant Kelly , Clark Allan B , Ashford Polly-Anna , Hopewell Sally , Pfeiffer K , Logan Phillipa , Crotty Maria , Costa Matthew L , Lamb Sarah
Published: December 2023

Objectives

To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery.

Design

Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study.

Setting

National Health Service (NHS) providers in five English hospitals.

Participants

Community-dwelling adults, aged 60 years and over, who undergo hip fracture surgery and their informal caregivers.

Intervention

Usual care: usual NHS care. Experimental: usual NHS careplusa caregiver–patient dyad training programme (HIP HELPER). This programme comprised three, 1 hour, one-to-one training sessions for a patient and caregiver, delivered by a nurse, physiotherapist or occupational therapist in the hospital setting predischarge. After discharge, patients and caregivers were supported through three telephone coaching sessions.

Randomisation and blinding

Central randomisation was computer generated (1:1), stratified by hospital and level of patient cognitive impairment. There was no blinding.

Main outcome measures

Data collected at baseline and 4 months post randomisation included: screening logs, intervention logs, fidelity checklists, acceptability data and clinical outcomes. Interviews were conducted with a subset of participants and health professionals.

Results

102 participants were enrolled (51 patients; 51 caregivers). Thirty-nine per cent (515/1311) of patients screened were eligible. Eleven per cent (56/515) of eligible patients consented to be randomised. Forty-eight per cent (12/25) of the intervention group reached compliance to their allocated intervention. There was no evidence of treatment contamination. Qualitative data demonstrated the trial and HIP HELPER programme was acceptable.

Conclusions

The HIP HELPER programme was acceptable to patient–caregiver dyads and health professionals. The COVID-19 pandemic impacting on site’s ability to deliver the research. Modifications are necessary to the design for a viable definitive RCT.

Trial registration number

ISRCTN13270387.
Impact of smoking cessation on non-alcoholic fatty liver disease prevalence: a systematic review and meta-analysis
Authors: Zhang Shengan , Liu Zhidong , Yang Qinghua , Hu Zichun , Zhou Wenjun , Ji Guang , Dang Yanqi
Published: December 2023

Objectives

The negative effects of smoking on numerous cardiovascular and metabolic diseases have been widely acknowledged. However, the potential effect of smoking cessation is relatively unelucidated. The objective of this study is to explore whether the prevalence of non-alcoholic fatty liver disease (NAFLD) in former smokers differs from the prevalence in current smokers.

Design

Systematic review and meta-analysis.

Data sources

Four databases, that is, PubMed, Web of Science, Journal@Ovid and Scopus were searched from inception to 31 January 2023.

Eligibility criteria

Population-based cross-sectional studies, including the baseline data of cohort studies with identified NAFLD diagnostic methods, and smoking status (current smoker or former smoker) of participants were included.

Data extraction and synthesis

Two reviewers independently extracted the data including cigarette smoking status, country/region of studies, NAFLD diagnostic methods, sex, the average age and body mass index (BMI) of NAFLD participants and assessed the risk of bias with Agency for Healthcare Research and Quality (AHRQ) methodology checklist. Risk ratio (RR) of NAFLD prevalence in former smokers was pooled using the random-effects model.

Results

28 studies involving 4 465 862 participants were included. Compared with current smokers, the RR of overall NAFLD prevalence in former smokers was 1.13 (95% CI: 1.08 to 1.19, prediction interval: 0.92–1.39). This result persisted after adjustment for diagnostic methods, country/region, sex, age and BMI. Sensitivity analysis and risk of bias assessment indicated a stable conclusion.

Conclusions

NAFLD prevalence in former smokers was at least not lower than that in current smokers and was partially related to increased BMI after smoking cessation, indicating that smoking cessation was possibly not a protective factor against NAFLD. Although the meta-analysis based on cross-sectional studies cannot conclude the causal relationships between smoking cessation and NAFLD onset, the potential onset of NAFLD associated with smoking cessation should be highlighted.

PROSPERO registration number

CRD42023394944.
What is the current global health participation and future interest of healthcare students and National Health Service (NHS) staff? A cross-sectional research study of healthcare students and NHS staff in England
Authors: Goldstone Ross , Hinds Rachael , McCarthy Rose , Byrne Ged , Keen David
Published: December 2023

Objectives

This research aimed to understand the prior and current global health participation, current availability of and future interest in participating in global health activities healthcare students and National Health Service (NHS) staff.

Design

An online survey was conducted on NHS staff and healthcare students in England between July and November 2021. The survey was disseminated to all secondary care providers in the English NHS and universities in England. A volunteer sample of 3955 respondents, including 2936 NHS staff, 683 healthcare students, 172 individuals combining NHS working and study and 164 respondents classified as other.

Results

Most (80%) respondents had not participated in a global health activity before, with 6% having previously participated, a further 3% currently participating and 11% unsure. Among those who had participated, the most common types of activity were attending global health events (75%). The most common reason for not participating was a limited knowledge of opportunities (78%). When asked about their future interest in global health participation, more than half of respondents (53%) indicated an interest and 8% were not interested. There was an significant proportion (39%) answering unsure, indicating a possible lack of understanding about global health participation.

Conclusions

Global health has gathered increasing significance in recent years, both in policy and in education and training for healthcare professionals. Despite recognition of the role global learning plays in knowledge enhancement, skill development and knowledge exchange, this study suggests that global health participation remains low among NHS staff and healthcare students.
Patients’ perspectives on tapering programmes for prescription opioid use disorder: a qualitative study
Authors: Davies Lisa Eveline Maria , Koster Ellen S , Damen Katinka FM , Beurmanjer Harmen , van Dam Vivienne WT , Bouvy Marcel L , Schellekens Arnt FA
Published: December 2023

Objectives

Approximately 10% of chronic pain patients who receive opioids develop an opioid use disorder (OUD). Tapering programmes for these patients show high drop-out rates. Insight into chronic pain patients’ experiences with tapering programmes for prescription OUD could help improve such programmes. Therefore, we investigated the perspectives of chronic pain patients with prescription OUD to identify facilitators and barriers to initiate and complete a specialised OUD tapering programme.

Design

A qualitative study using semi-structured interviews on experiences with initiation and completion of opioid tapering was audio recorded, transcribed and subject to directed content analysis.

Setting

This study was conducted in two facilities with specialised opioid tapering programmes in the Netherlands.

Participants

Twenty-five adults with chronic pain undergoing treatment for prescription OUD participated.

Results

Participants indicated that tapering is a personal process, where willingness and motivation to taper, perceived (medical) support and pain coping strategies have an impact on the tapering outcome. The opportunity to join a medical-assisted tapering programme, shared decision-making regarding tapering pace, tapering location, and receiving medical and psychological support facilitated completion of an opioid tapering programme.

Conclusions

According to patients, a successful treatment of prescription OUD requires a patient-centred approach that combines personal treatment goals with shared decision-making on opioid tapering. Referral to a specialised tapering programme that incorporates opioid rotation, non-judgmental attitudes, and psychological support can create a safe and supportive environment, fostering successful tapering and recovery.