bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel hyperparallel optical coherence tomography for angle closure assessment: comparison with swept-source OCT and gonioscopy
Authors: Porporato Natalia , Xu Benjamin Y , Tan Bingyao , Chang Yu Q , Tun Tin A , Perera Shamira , Husain Rahat , Ho Ching Lin , Sultana Rehena , Aung Tin , Schmetterer Leopold
Published: August 2024

Aim

To evaluate reproducibility and agreement of angle closure assessment by a novel hyperparallel optical coherence tomography (OCT) system (HP-OCT, Cylite Optics, Melbourne, Australia), in comparison with swept-source OCT (SS-OCT, CASIA SS-1000, Tomey Corporation, Nagoya, Japan) and gonioscopy.

Methods

Cross-sectional study. Phakic subjects >40 years, with no relevant ophthalmic history were consecutively recruited from the glaucoma clinic. Subjects underwent same-day evaluation with HP-OCT, SS-OCT and gonioscopy. The primary outcome was the presence of angle closure, defined as iridotrabecular contact in HP-OCT and SS-OCT images at 0°−180° meridional and as non-visibility of the posterior trabecular meshwork (TM) by gonioscopy. Visibility of TM was also assessed (secondary outcome). Intra and interdevice agreement analysis (Gwet AC1) and logistic regression analysis were performed for primary and secondary outcomes, respectively.

Results

154 sectors from horizontal scans of 77 subjects were analysed. The reproducibility of angle closure assessment by HP-OCT was excellent (AC1 of 0.95 for temporal angle and 1.00 for nasal). Agreement for angle closure detection was very good between HP-OCT and SS-OCT (AC1 of 0.88 for temporal and 0.81 for nasal angle) and good between HP-OCT and gonioscopy (AC1 of 0.71 for temporal and 0.78 for nasal angle). TM was identifiable in 64.4% (94/146) of unprocessed HP-OCT images (both open and closed angles), however not visible in any of the SS-OCT unprocessed images.

Conclusions

HP-OCT showed excellent reproducibility for angle closure assessment and good agreement with SS-OCT and gonioscopy. HP-OCT technology also provides a unique capability to visualise regions around TM and Schlemm’s canal, opening new avenues for clinical research of distal outflow pathways.
Nutrition Users’ Guides: RCTs Part 2 – structured guide for interpreting and applying study results from randomised controlled trials on therapy or prevention questions
Authors: Bala Malgorzata M , Agarwal Arnav , Klatt Kevin C , Vernooij Robin W M , Alonso-Coello Pablo , Steen Jeremy P , Guyatt Gordon H , Duque Tiffany , Johnston Bradley C
Published: August 2024

This article continues from a prior commentary on evaluating the risk of bias in randomised controlled trials addressing nutritional interventions. Having provided a synopsis of the risk of bias issues, we now address how to understand trial results, including the interpretation of best estimates of effect and the corresponding precision (eg, 95% CIs), as well as the applicability of the evidence to patients based on their unique circumstances (eg, patients’ values and preferences when trading off potential desirable and undesirable health outcomes and indicators (eg, cholesterol), and the potential burden and cost of an intervention). Authors can express the estimates of effect for health outcomes and indicators in relative terms (relative risks, relative risk reductions, OR or HRs)—measures that are generally consistent across populations—and absolute terms (risk differences)—measures that are more intuitive to clinicians and patients. CIs, the range in which the true effect plausibly lies, capture the precision of estimates. To apply results to patients, clinicians should consider the extent to which the study participants were similar to their patients, the extent to which the interventions evaluated in the study are applicable to their patients and if all patient-important outcomes of potential benefit and harm were reported. Subsequently, clinicians should consider the values and preferences of their patients with respect to the balance of the benefits, harms and burdens (and possibly the costs) when making decisions about dietary interventions.
The effectiveness of intratympanic injections with methylPREDnisolon versus placebo in the treatment of vertigo attacks in MENière’s disease (PREDMEN trial): a study protocol for a phase-3 multicentre, double-blinded, randomised, placebo-controlled trial
Authors: Boreel Maud Martina Emilie , van Esch Babette , Schermer Tjard R , Mol Berber M , van Benthem Peter Paul , Bruintjes Tjasse D
Published: August 2024

Introduction

Intratympanic corticosteroids are commonly used in the treatment of Menière’s disease (MD). However, few and small randomised controlled trials (RCT) on the effectiveness of intratympanic corticosteroids have been performed. A recent Cochrane review suggested that a well-conducted placebo-controlled RCT with a large study population is required to evaluate the effectiveness of the use of intratympanic corticosteroids in MD. The following protocol describes a phase-3 multicentre, double-blinded, randomised, placebo-controlled trial to compare the effectiveness of methylprednisolone (62.5 mg/mL) to a placebo (sodium chloride 0.9%).

Methods and analysis

We aim to recruit 148 patients with unilateral MD from six hospitals in the Netherlands. Patients will be randomly assigned to either the methylprednisolone or the placebo group. Two injections will be given, one at baseline and one after 2 weeks. Follow-up assessments will be done at 3, 6, 9 and 12 months. The primary outcome will be the frequency of vertigo attacks. Attacks will be evaluated daily with the DizzyQuest app. Secondary outcomes include hearing loss, tinnitus, health-related quality of life, use of co-interventions and escape medication, (serious) adverse events and cost-effectiveness. These will be evaluated with audiometry and multiple commonly used, validated questionnaires. For the primary and secondary outcomes mixed model analysis, generalised estimating equation analysis and logistic regression analysis will be used.

Ethics and dissemination

This study was submitted via the Clinical Trials Information System, reviewed and approved by the Medical Research Ethics Committee Leiden The Hague Delft and the local institutional review board of each participating centre. All data will be presented ensuring the integrity and anonymity of patients. Results will be published in scientific journals and presented on (inter)national conferences.

Trial registration number

This study is registered at ClinicalTrials.gov Protocol Registration and Results System, with the registration ID:NCT05851508.
Validation of the Employment Precariousness Scale and its associations with mental health outcomes: results from a prospective community-based study of pregnant women and their partners in Dresden, Germany
Authors: Karl Marlene , Staudt Andreas , Vives Alejandra , Kopp Marie , Weise Victoria , Mack Judith T , Steudte-Schmiedgen Susann , Seidler Andreas , Garthus-Niegel Susan
Published: August 2024

Objective

To translate the Employment Precariousness Scale (EPRES) from Spanish into German (EPRES-Ge), adapt it to the German context, assess the psychometric properties and show prospective associations with mental health outcomes within the peripartum period.

Design

Analyses encompassed descriptive statistics, exploratory factor analysis, confirmatory factor analysis (CFA) to validate the structure of the EPRES, and multivariate regression analyses with mental health outcomes 8 weeks after birth.

Participants

Self-report data from 3,455 pregnant women and their partners within the Dresden Study on Parenting, Work, and Mental Health prospective longitudinal cohort study were used.

Results

The EPRES-Ge with five dimensions and 20 items showed good internal consistency (Cronbach’s α=0.77). All scales showed good reliability coefficients of α=0.73–0.85 and good item-subscale correlations of r=0.63–0.98, with the exception of subscale rights, which showed poor reliability of α=0.30 and item-subscale correlations of r=0.45–0.68. Exploratory analysis and CFA confirmed the proposed five-dimensional structure, explaining 45.08% of the cumulative variance. Regression analyses with mental health outcomes after birth revealed statistically significant associations (β=0.12–0.20).

Conclusions

The EPRES-Ge is a valuable tool for assessing employment precariousness as a multidimensional construct. The scales could be adapted to the German working context. Precarious employment, as measured by the EPRES-Ge, is a determinant of mental health problems in young families.
Prevention and care of adult enterostomy with high output: a scoping review protocol
Authors: Che Ying , Wang Tianming , Gao Caifeng , Sun Fei , Li Shangke , Luo Zhanlin
Published: August 2024

Introduction

The purpose of this protocol is to investigate the risk factors, critical evaluation contents and preventive measures of high-output enterostomy.

Methods and analysis

This scoping review will follow the Joanna Briggs Institute guidelines for scoping reviews. PubMed, EMBASE, CINAHL, the Chinese Biological Literature Database and the Cochrane Library will be searched for relevant literature published from January 2015 to January 2024. The Grading of Recommendations, Assessment, Development and Evaluation and the Risk Of Bias In Non-randomised Studies of Interventions will be used to assess the reliability of the evidence.

Ethics and dissemination

As this scoping review involves database searches for literature analysis, informed consent and ethical approval from patients will not be required. The findings will provide essential decision-making information for researchers, clinicians and ostomy nursing staff. The results of the review will be presented at a scientific conference and published in a peer-reviewed journal.
Comparing long-term prognosis following different surgical methods in patients with early stage breast cancer and obesity: a retrospective cohort study in China
Authors: Li Lun , Pang Jian , Yan Yiqing , Zhang Qi , Zheng Shuyue , Chen Ming , Yi Wenjun , Wu Jiong
Published: August 2024

Objective

Breast-conserving therapy (BCT) includes breast-conserving surgery (BCS) combined with radiation therapy (RT). RT plays a crucial role in improving the prognosis of patients who undergo BCS. However, obesity is a potential risk factor for resistance to radiation. The aim of this study was to evaluate any difference in the long-term prognosis of patients with early stage breast cancer and obesity treated with BCT or total mastectomy (TM).

Design, setting and participants

This was a retrospective cohort study involving 1125 patients diagnosed with early stage breast cancer and obesity at the Shanghai Cancer Center of Fudan University from 2013 to 2016.

Outcome measures

Obesity in the Chinese population was defined as a body mass index ≥28 kg/m2. Surgical options included BCT and TM. The primary survival outcomes were overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS). Inverse probability of treatment weighting (IPTW) was used to control for the impact of confounding factors on prognosis.

Results

The median follow-up times in the BCT group and TM group without postoperative RT were 51.1 months (IQR of 40.6–68.1 months) and 61.8 months (IQR of 46.5–76.7 months), respectively. After IPTW, the baseline data were balanced. Compared with those in the TM cohort, patients in the whole IPTW cohort in the BCT cohort had worse DFS (HR 4.280, 95% CI 2.180 to 8.400; p<0.001), RFS (HR 4.380, 95% CI 2.370 to 8.120; p<0.001) and OS (HR 3.590, 95% CI 1.620 to 7.950; p=0.002).

Conclusion

In patients with early stage breast cancer and obesity, TM is associated with better survival outcomes than BCT.
Machine learning-derived phenotypic trajectories of asthma and allergy in children and adolescents: protocol for a systematic review
Authors: Lisik Daniil , Milani Gregorio Paolo , Salisu Michael , Özuygur Ermis Saliha Selin , Goksör Emma , Basna Rani , Wennergren Göran , Kankaanranta Hannu , Nwaru Bright I
Published: August 2024

Introduction

Development of asthma and allergies in childhood/adolescence commonly follows a sequential progression termed the ‘atopic march’. Recent reports indicate, however, that these diseases are composed of multiple distinct phenotypes, with possibly differential trajectories. We aim to synthesise the current literature in the field of machine learning-based trajectory studies of asthma/allergies in children and adolescents, summarising the frequency, characteristics and associated risk factors and outcomes of identified trajectories and indicating potential directions for subsequent research in replicability, pathophysiology, risk stratification and personalised management. Furthermore, methodological approaches and quality will be critically appraised, highlighting trends, limitations and future perspectives.

Methods and analyses

10 databases (CAB Direct, CINAHL, Embase, Google Scholar, PsycInfo, PubMed, Scopus, Web of Science, WHO Global Index Medicus and WorldCat Dissertations and Theses) will be searched for observational studies (including conference abstracts and grey literature) from the last 10 years (2013–2023) without restriction by language. Screening, data extraction and assessment of quality and risk of bias (using a custom-developed tool) will be performed independently in pairs. The characteristics of the derived trajectories will be narratively synthesised, tabulated and visualised in figures. Risk factors and outcomes associated with the trajectories will be summarised and pooled estimates from comparable numerical data produced through random-effects meta-analysis. Methodological approaches will be narratively synthesised and presented in tabulated form and figure to visualise trends.

Ethics and dissemination

Ethical approval is not warranted as no patient-level data will be used. The findings will be published in an international peer-reviewed journal.

PROSPERO registration number

CRD42023441691.
Risk factors for acute kidney injury and impact of earlier anticoagulation on renal function in patients with normotensive pulmonary embolism: a retrospective cohort study
Authors: Wang Dingyi , Fan Guohui , Lyu Yanshuang , Xu Xiaomao , Luo Qin , Wan Jun , Liu Xin , Chen Yinong , Zhang Yu , Yang Peiran , Zhai Zhenguo
Published: August 2024

Objective

We aimed to investigate the risk factors for acute kidney injury (AKI) after normotensive pulmonary embolism (PE) and the impact of anticoagulation on renal recovery.

Design

Multicentred, retrospective cohort study.

Setting

Data from four tertiary hospitals in China were captured. All available measurements of serum creatinine (SCr) during hospitalisation and follow-up were collected.

Participants

Patients with acute PE and those without haemodynamic instability were enrolled. All recruited patients were followed up for up to 2 years.

Primary and secondary outcome measures

The primary outcome was the occurrence of AKI, defined by the Kidney Disease Improving Global Outcomes criteria. The secondary outcome was the recovery of renal function. The time interval between PE onset and the initiation of anticoagulation was analysed to obtain its influence on the recovery of renal function.

Results

A total of 461 patients with acute normotensive PE were enrolled. A transient elevation of SCr during hospitalisation was observed. The incidence of AKI among normotensive patients was 18.9%. Brain natriuretic peptide (BNP) NT-proBNP elevation (adjusted HR (aHR) 2.27, 95% CI 1.33 to 3.86) and history of chronic kidney disease (aHR 4.81, 95% CI 2.44 to 9.48) were associated with the development of AKI during hospitalisation. Earlier initiation of anticoagulation therapy (within 5 days after PE onset, compared with over 6 days) promoted an early recovery of renal function (adjusted OR 0.26, 95% CI 0.08 to 0.84, p=0.025).

Conclusions

Renal impairment and AKI were highly prevalent among patients with normotensive patients. The occurrence of AKI was associated with right heart function. Patients who developed AKI after PE would benefit from earlier anticoagulation therapy for an early recovery of renal function.
Antihypertensive deprescribing in frail long-term care residents (OptimizeBP): protocol for a prospective, randomised, open-label pragmatic trial
Authors: Kraut Roni Y , Youngson Erik , Sadowski Cheryl A , Bakal Jeffrey A , Faulder Douglas , Korownyk Christina S , Vucenovic Ana , Eurich Dean T , Manca Donna P , Lundby Carina , Kivi Paul , Manville Margaret , Garrison Scott R
Published: August 2024

Introduction

Although antihypertensive medication use is common among frail older adults, observational studies in this population suggest blood pressure (BP) lowering may convey limited benefit and perhaps even harm. This protocol describes an antihypertensive deprescribing trial in frail older adults powered for mortality and morbidity outcomes.

Methods and analysis

Design:Prospective, parallel, randomised, open-label pragmatic trial.

Participants:Long-term care (LTC) residents ≥70 years of age, diagnosed with hypertension, with mean systolic BP <135 mm Hg, ≥1 daily antihypertensive medication and no history of congestive heart failure.

Setting:18 LTC facilities in Alberta, Canada, with eligible residents identified using electronic health services data.

Intervention:All non-opted-out eligible residents are randomised centrally by a provincial health data steward to either usual care, or continually reducing antihypertensives provided an upper systolic threshold of 145 mm Hg is not exceeded. Deprescribing is carried out by pharmacists/nurse practitioners, using an investigator-developed algorithm.

Follow-up:Provincial healthcare databases tracking hospital, continuing care and community medical services.

Primary outcome:All-cause mortality.

Secondary outcome:Composite of all-cause mortality or all-cause unplanned hospitalisation/emergency department visit.

Tertiary outcomes:All-cause unplanned hospitalisation/emergency department visit, non-vertebral fracture, renal insufficiency and cost of care. Also, as assessed roughly 135-days postrandomisation, fall in the last 30 days, worsening cognition, worsening activities of daily living and skin ulceration.

Process outcomes:Number of daily antihypertensive medications (broken down by antihypertensive class) and average systolic and diastolic BP over study duration.

Primary outcome analysis:Cox proportional hazards survival analysis.

Sample size:The trial will continue until observation of 247 primary outcome events has occurred.

Current status:Enrolment is ongoing with ~400 randomisations to date (70% female, mean age 86 years).

Ethics and dissemination

Ethics approval was obtained from the University of Alberta Health Ethics Review Board (Pro00097312) and results will be published in a peer-reviewed journal.

Trial registration number

NCT05047731.
Using nicotine replacement therapy for smoking reduction in pregnancy: a qualitative study of pregnant women in the UK who smoke
Authors: Thomson Ross , Phillips Lucy , Orton Sophie , Naughton Felix , Coleman Tim
Published: August 2024

Objectives

To explore the acceptability and perceived motivations and barriers of using nicotine replacement therapy (NRT) to reduce the number of daily cigarettes smoked in pregnancy, rather than for stopping completely.

Design

Telephone, semi-structured interviews, audio-recorded and transcribed verbatim. Transcripts were analysed using an inductive thematic analysis.

Participants

Eighteen pregnant women in the UK, who were smoking or had recently stopped smoking, were recruited.

Results

Half of interviewees reported having used NRT to reduce smoking during their current pregnancy, and there was overwhelming support for the UK National Health Service to recognise this as a potentially useful way to use these products. The cost and stigma associated with purchasing NRT products when pregnant were seen as barriers to using NRT in this way. The early offer of NRT for reduction along with a tailored, structured approach to support was seen as important.

Conclusions

Using NRT to help women, who are unable to stop smoking, to reduce their smoking may be acceptable to pregnant women. This study found women were already using NRT alongside ad hoc strategies to reduce their smoking. Further research evaluating structured smoking reduction support, alongside concurrent NRT use is needed.
Estimating the value of new antibiotic treatment strategies in Zhejiang province, China: cost-effectiveness analysis based on a validated dynamic model
Authors: Yang Wenqianzi , Zhen Xuemei , Sun Xueshan , Khatiwada Shikha Upadhyaya , Yang Danhong , Chen Yixi , Dong Peng , Al-Taie Amer , Gordon Jason , Dong Hengjin
Published: August 2024

Objectives

This analysis aims to better reflect the value of new antibiotic treatment strategies, thereby informing clinical antibiotic use, antimicrobial reimbursement and/or hospital formulary decision-making in China.

Design

We adapted a published and validated dynamic disease transmission and cost-effectiveness model to evaluate the clinical and economic outcomes of introducing a new antibiotic, ceftazidime/avibactam (CAZ-AVI) for treating resistant infections in Zhejiang province, China. Outcomes were assessed over a 10-year infectious period and an annual discount rate of 5%. Costs were extracted from the hospital’s Health Information System (HIS) and obtained after data cleaning, aggregation and discounting.

Setting

The Chinese healthcare system perspective.

Participants

10 905 patients in a Chinese tier-3 hospital from 2018 to 2021 with any of the three common infections (complicated intra-abdominal infection (cIAI), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) and infections with limited treatment options (LTO)) caused by three common resistant pathogens (Escherichia coli, Klebsiellaspp.and Pseudomonas aeruginosa).

Interventions

(1) Current treatment strategy (piperacillin-tazobactam (pip/taz) and meropenem); (2) CAZ-AVI at the third line; (3) CAZ-AVI at the second line; (4) CAZ-AVI at the first line; (5) CAZ/AVI first line, two lines diversified (i.e., equal pip/taz and CAZ-AVI at the first line; meropenem at the last line) and (6) CAZ/AVI first line, all-lines diversified.

Primary outcome measures

Quality-adjusted life years (QALYs) lost, hospitalisation costs and incremental net monetary benefit (INMB) were used to assess cost-effectiveness.

Results

Over 10 years, the introduction of CAZ-AVI to the current treatment strategy led to lower hospitalisation costs and more QALYs across all five treatment strategies, with between 68 284 and 78 571 QALYs gained whilst saving up to US$236.37 for each additional QALY gained. The INMB of introducing CAZ-AVI is estimated up to US$3 550 811 878.

Conclusions

Introducing CAZ-AVI had a positive impact on clinical and economic outcomes for treating antimicrobial resistance, and diversifying the antibiotics use early in the treatment might yield the best benefits.
Comparison of outcomes of open, laparoscopic and robot-assisted laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: protocol for a systematic review and meta-analysis
Authors: Nikolinakos Panagiotis , Chatzikrachtis Nikolaos , Chatterjee Abhisekh , Donkov Ivo , Bishara Samuel , Kotsi Elisavet , Alexandrou Ioannis , Zavras Nikolaos , Norris Joseph M
Published: August 2024

Introduction

The treatment of children with pelviureteric junction obstruction (PUJO) has naturally progressed from open, to minimally invasive approaches, including laparoscopic pyeloplasty and robot-assisted laparoscopic pyeloplasty (RALP). The RALP is now considered to be the gold standard for paediatric patients with PUJO, except for smaller infants due to size limitations. Our systematic review aims to synthesise all the available evidence regarding key postoperative outcomes for the three surgical approaches to pyeloplasties in children. Our outcomes of interest include, but are not limited to, the reoperation rate, length of hospital stay and postoperative complications as classified by the Clavien-Dindo grading system. A comprehensive assessment of all three methods in paediatric patients has yet to be conducted in the literature to date.

Methods and analysis

A systematic search of the MEDLINE, PubMed, EMBASE and Cochrane databases will be conducted. Screening, data extraction, statistical analysis and reporting will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included papers will be full-text manuscripts written between 1947 and March 2024, comparing the outcomes and complications of open, laparoscopic and RALP. Quality and study bias will be assessed using the Newcastle-Ottawa score and, if relevant, the Cochrane risk of bias tool for randomised trials. This present protocol is written in accordance with the PRISMA Protocol 2015 checklist, ensuring that the highest methodological standards are adhered to.

Ethics and dissemination

No ethical approval shall be required, as this is a review of already published literature. Findings will be disseminated through publications in peer-reviewed journals and presentations at international and national conferences.

PROSPERO registration number

CRD42023456779.
Family-centred interventions for people with substance use disorders in low-income and middle-income country settings: a scoping review protocol
Authors: Sharma Ashley , Mita Carol , Kumar Satish , Mayer Kenneth , O’Cleirigh Conall , Solomon Sunil S , Bagley Sarah , Batchelder Abigail , Sullivan Matthew C , Hassan Areej , Ganapathi Lakshmi
Published: August 2024

Introduction

Substance use disorder (SUD) and problematic substance use are global public health concerns with significant multifaceted implications for physical health and psychosocial well-being. The impact of SUD extends beyond the individual to their family while imposing financial and social burdens on the community. Though family-centred interventions have shown promise in addressing SUD, their implementation and impact in low-income and middle-income countries (LMICs) remain underexplored.

Methods and analysis

Per Joanna Briggs Institute’s scoping review protocol, a systematic search strategy was employed across OVID Medline, Embase, PsycINFO, Web of Science–Core Collection, Global Health and CINAHL from 22 February 2024 to 26 February 2024, to identify relevant studies focused on family-centred interventions for SUD in LMIC, devoid of publication time and language constraints. Two independent reviewers will screen the titles, abstracts and full texts, with discrepancies resolved through discussion or third-party reviews. The extracted data charted in a structured form will be visualised by diagrams or tables, focusing on the feasibility and impact of family-centred interventions for SUD in LMIC. For qualitative studies, the findings will be synthesised and presented in thematic clusters, and for studies that report quantitative outcomes, specific health, including SUD and psychosocial, outcomes will be synthesised, aligning with the Population, Concept and Context framework.

Ethics and dissemination

These data on substance use, psychosocial outcomes and perspectives of individuals with SUD and their families will be presented in narrative format, highlighting patterns and identifying research gaps. This review aims to synthesise the existing evidence on family-centred interventions for improving substance use and/or psychosocial outcomes in individuals with SUD in LMIC and seeks to inform future policy and practice. Ethics approval is not required for this scoping review, and modifications to the review protocol will be disclosed. Findings will be disseminated through conference proceedings and peer-reviewed publication.
Implementation of the WHO Standards to assess quality of paediatric care at the facility level using service users’ perspective as source of data: a multicentre quality improvement study in Italy
Authors: Bressan Silvia , Sartor Giada , Dalena Paolo , Balestra Elia , Madera Anna , Marchetti Federico , Finocchiaro Maria Carla , Tirelli Francesca , Felici Enrico , Marcellino Alessia , Fasoli Silvia , Cogo Paola , Parrino Roberta , Castaldo Benmario , Santangelo Rosa , Toniutti Maristella , De Rosa Giuseppina , Baltag Valentina , Lazzerini Marzia
Published: August 2024

Objectives

There is little experience in the use of the WHO Standards for improving the quality of care (QOC) for children at the facility level. We describe the use of 75 WHO Standard based Quality Measures to assess paediatric QOC, using service users as a source of data, in Italy.

Study design

In a cross-sectional study including 12 hospitals, parents/caregivers of admitted children completed a validated questionnaire including 75 Quality Measures: 40 pertinent to the domain of experience of care; 25 to physical/structural resources; 10 to COVID-19 reorganisational changes. Univariate and multivariate analyses were conducted.

Results

Answers from 1482 service users were analysed.Physical resourceswas the domain with the higher frequency of reported gaps in QOC, with key gaps (higher rates of responders reporting need for improvement and low variability across centres) being: (1) quality of meals (48.1%; range across facilities: 35.3%–61.7%); (2) presence of cooking areas (50.9%; range: 34.6%–70.0%); (3) spaces for family/friends (51.3%; range: 31.8%–77.4%). Forexperience of care, the most critical gap was the information on the rights of the child (76.6%; range: 59.9%–90.4%), with most other Quality Measures showing an overall frequency of reported need for improvement ranging between 5% and 35%. Forreorganisational changes due to COVID-19an improvement was felt necessary by <25% of responders in all Quality Measures, with low variability across centres. At the multivariate analyses, factors significantly associated with the QOC Index largely varied by QOC domain.

Conclusions

The use of the 75 prioritised Quality Measures, specific to service users’ perspective, enabled the identification of both general and facility-specific gaps in QOC. Based on these findings, quality improvement initiatives shall focus on a core list of selected Quality Measures common to all facilities, plus on an additional list of Quality Measures as more relevant in each facility.
Design of the 18-year follow-up of the Danish COPSAC2000birth cohort
Authors: Mølbæk-Engbjerg Trine , Vahman Nilo , Mikkelsen Marianne , Fink Nadia Rahman , Christensen Emil Dalgaard , Brustad Nicklas , Sass Lærke , Løvenhøj Hedda , Strandberg-Larsen Katrine , Groot Jonathan , Andersen Anne-Marie Nybo , Vinding Rebecca , Schoos Ann-Marie Malby , Stokholm Jakob , Bønnelykke Klaus , Chawes Bo
Published: August 2024

Background

Atopic diseases, obesity and neuropsychiatric disorders are lifestyle-related and environmental-related chronic inflammatory disorders, and the incidences have increased in the last years.

Objective

To outline the design of the 18-year follow-up of the Copenhagen Prospective Study on Asthma in Childhood (COPSAC2000) birth cohort, where risk factors of atopic diseases, obesity and neuropsychiatric disorders are identified through extensive characterisation of the environment, along with deep clinical phenotyping and biosampling for omics profiling.

Methods

COPSAC2000is a Danish prospective clinical birth cohort study of 411 children born to mothers with asthma who were enrolled at 1 month of age and closely followed at the COPSAC clinical research unit through childhood for the development of atopic diseases. At the 18-year follow-up visit, biomaterial (hair, blood, urine, faeces, throat, and skin swabs, nasal lining fluid and scraping, and hypopharyngeal aspirates) and extensive information on environmental exposures and risk behaviours were collected along with deep metabolic characterisation and multiorgan investigations including anthropometrics, heart, lungs, kidneys, intestines, bones, muscles and skin. Neuropsychiatric diagnoses were captured from medical records and registers accompanied by electronic questionnaires on behavioural traits and psychopathology.

Results

A total of 370 (90%) of the 411 cohort participants completed the 18-year visit. Of these, 25.1% had asthma, 23.4% had a body mass index >25 kg/m2and 16.8% had a psychiatric diagnosis in childhood. A total of 68.7% drank alcohol monthly, and when drinking, 22.2% drank >10 units. Of the participants, 31.4% were currently smoking, and of these, 24.1% smoked daily. A total of 23.8% had tried taking drugs, and 19.7% reported having done self-destructive behaviour. The mean screen time per day was 6.0 hours.

Conclusion

This huge dataset on health and habits, exposures, metabolism, multiorgan assessments and biosamples from COPSAC2000by age 18 provides a unique opportunity to explore risk factors and underlying mechanisms of atopic disease and other lifestyle-related, non-communicable diseases such as obesity and neuropsychiatric disorders, which are highly prevalent in the community and our cohort.
Lysosomal physiology and pancreatic lysosomal stress in diabetes mellitus
Authors: Hao Meihua , Sebag Sara C , Qian Qingwen , Yang Ling
Published: August 2024

Endocrine and exocrine functions of the pancreas control nutritional absorption, utilisation and systemic metabolic homeostasis. Under basal conditions, the lysosome is pivotal in regulating intracellular organelles and metabolite turnover. In response to acute or chronic stress, the lysosome senses metabolic flux and inflammatory challenges, thereby initiating the adaptive programme to re-establish cellular homeostasis. A growing body of evidence has demonstrated the pathophysiological relevance of the lysosomal stress response in metabolic diseases in diverse sets of tissues/organs, such as the liver and the heart. In this review, we discuss the pathological relevance of pancreatic lysosome stress in diabetes mellitus. We begin by summarising lysosomal biology, followed by exploring the immune and metabolic functions of lysosomes and finally discussing the interplay between lysosomal stress and the pathogenesis of pancreatic diseases. Ultimately, our review aims to enhance our understanding of lysosomal stress in disease pathogenesis, which could potentially lead to the discovery of innovative treatment methods for these conditions.
Percutaneous coronary intervention plus medical therapy versus medical therapy alone in chronic coronary syndrome: a propensity score-matched analysis from the Swedish Coronary Angiography and Angioplasty Registry
Authors: von Koch Sacharias , Koul Sasha , Grimfjärd Per , Andersson Jonas , Jernberg Tomas , Omerovic Elmir , Fröbert Ole , Erlinge David , A Mohammad Moman
Published: August 2024

Background

Percutaneous coronary intervention (PCI) is frequently used for patients with chronic coronary syndrome (CCS). However, the role of PCI beyond symptom relief in CCS remains controversial. The objective of this study was to determine whether PCI is associated with better outcomes, compared with medical therapy (MT) alone.

Methods

We conducted a retrospective cohort study. Using the Swedish Coronary Angiography and Angioplasty Registry, we included all patients with CCS undergoing coronary angiography in Sweden between 2010 and 2020. Two groups were formed based on treatment strategy: PCI+MT versus MT alone. One-to-one propensity score (PS) matching was used to address confounding. Outcome was assessed using matched win ratio analysis, a statistical method that ranks the components of the composite by clinical importance. The primary outcome was net adverse clinical event (NACE) within 5 years. In the win ratio analysis, the components of NACE were ranked as follows: (1) all-cause mortality, (2) myocardial infarction (MI), (3) bleeding and (4) urgent revascularisation. Secondary outcomes were the individual components of NACE, major adverse cardiovascular events (MACE) and cardiovascular mortality.

Results

After PS matching, two groups of 7220 patients each were formed. The hierarchical outcome analysis of NACE and MACE showed that PCI was associated with improved outcome (matched win ratio: 1.28 (95% CI 1.20 to 1.36, p<0.001) and matched win ratio: 1.38 (95% CI 1.29 to 1.48, p<0.001), respectively). The use of PCI was associated with higher win ratio of MI (matched win ratio: 1.15, 95% CI 1.04 to 1.28, p=0.008), urgent revascularisation (matched win ratio: 1.85, 95% CI 1.69 to 2.03, p<0.001) and cardiovascular mortality (matched win ratio: 1.15, 95% CI 1.00 to 1.34, p=0.044). No difference in win ratio was observed for all-cause mortality or bleeding.

Conclusions

In this study, which sought to evaluate the outcomes of patients with CCS using a hierarchical approach, patients selected for revascularisation with PCI experienced better outcome compared with MT alone.
System-level trends in ischemic stroke admissions after adding endovascular stroke capabilities in community hospitals
Authors: Kumar Prateek , Salazar-Marioni Sergio , Dhanjani Saagar , Iyyangar Ananya , Abdelkhaleq Rania , Tariq Muhammad Bilal , Niktabe Arash , Ballekere Anjan N , Le Ngoc Mai , Azeem Hussain , McCullough Louise , Sheth Sunil A , Lee Eunyoung
Published: August 2024

Background

There is substantial interest in adding endovascular stroke therapy (EST) capabilities in community hospitals. Here, we assess the effect of transitioning to an EST-performing hospital (EPH) on acute ischemic stroke (AIS) admissions in a large hospital system including academic and community hospitals.

Methods

From our prospectively collected multi-institutional registry, we collected data on AIS admissions at 10 hospitals in the greater Houston area from January 2014 to December 2022: one longstanding EPH (group A), three community hospitals that transitioned to EPHs in November 2017 (group B), and six community non-EPHs that remained non-EPH (group C). Primary outcomes were trends in total AIS admissions, large vessel occlusion (LVO) and non-LVO AIS, and tissue plasminogen activator (tPA) and EST use.

Results

Among 20 317 AIS admissions, median age was 67 (IQR 57–77) years, 52.4% were male, and median National Institutes of Health Stroke Scale (NIHSS) was 4 (IQR 1–10). During the first 12 months after EPH transition, AIS admissions increased by 1.9% per month for group B, with non-LVO stroke increasing by 4.2% per month (P<0.001). A significant change occurred for group A at the transition point for all outcomes with decreasing rates in admissions for AIS, non-LVO AIS and LVO AIS, and decreasing rates of EST and tPA treatments (P<0.001).

Conclusion

Upgrading to EPH status was associated with a 2% per month increase in AIS admissions during the first year post-transition for the upgrading hospitals, but decreasing volumes and treatments at the established EPH. These findings quantify the impact on AIS admissions in hospital systems with increasing EST access in community hospitals.
MSKI reduction strategies: evidence-based interventions to reduce musculoskeletal injuries in military service members
Authors: Tingelstad Hans Christian , Robitaille E , O'Leary TJ , Laroche M-A , Larsen P , Reilly T
Published: August 2024

Musculoskeletal injuries (MSKI) are one of the biggest challenges for military services globally, contributing to substantial financial burdens and lost training and working days. Effective evidence-based intervention strategies are essential to reduce MSKI incidence, and research has shown the positive effect of both nutritional interventions and physical training (PT) interventions on reducing MSKI incidence. Levels of vitamin D metabolites have been associated with MSKI and bone stress fracture risk, while calcium and vitamin D supplementation has been shown to reduce the incidence of stress fractures during military training. Protein and carbohydrate supplementation during arduous military training (high volume, high intensity) has also been shown to reduce MSKI risk and the number of limited/missed duty days. PT has played a key role in soldier development to meet the occupational demands of serving in the armed forces. Paradoxically, while PT is fundamental to enhancing soldier readiness, PT can also be a major contributor to MSKI; emerging evidence suggests that the nature of the PT being performed is a risk factor for MSKI. However, strategies like reducing training load and implementing PT programmes using evidence-based training principles can reduce MSKI incidence among military service members by 33–62%, and reduce the financial burdens for military services. This review provides a summary of effective MSKI reduction interventions and provides strategies to enhance the success and adoption of such interventions.
Dexamethasone as a perineural adjuvant to a ropivacaine popliteal sciatic nerve block for pediatric foot surgery: a randomized, double-blind, placebo-controlled trial
Authors: Reysner Malgorzata , Reysner Tomasz , Janusz Piotr , Kowalski Grzegorz , Shadi Milud , Daroszewski Przemysław , Wieczorowska-Tobis Katarzyna , Kotwicki Tomasz
Published: August 2024

Background

This study assessed the effect of perineural dexamethasone on block duration, opioid requirement, blood glucose levels, and stress response to surgery as measured by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), following pediatric foot and ankle surgery.

Methods

In this parallel, double-blinded randomized controlled trial, 90 children (ages 2–5 years, >5 kg) scheduled for foot or ankle surgery under spinal anesthesia with ultrasound-guided single-shot popliteal sciatic nerve block were randomized into 3 groups: 0.5% ropivacaine with saline (control), 0.5% ropivacaine plus dexamethasone 0.1 mg/kg (DEX0.1), and 0.5% ropivacaine plus dexamethasone 0.05 mg/kg (DEX0.05). Primary outcome was the time to first rescue opioid analgesia. Secondary outcomes included motor block duration, pain scores, NLR, PLR, and blood glucose levels.

Results

Time to first rescue opioid analgesia was significantly longer in the DEX0.1 group compared with the DEX0.05 group (18.4 hours, SD 2.6 hours vs 16 hours, SD 2.8 hours), with a mean difference of 2.2 hours (95% CI 0.7 to 3.6), p<0.01; and the control group (8.5 hours, SD 1.5 hours), with a mean difference of −9.9 (95% CI −11.4 to −8.4), p<0.001. Motor block was significantly longer in the DEX0.1 group (17.3 hours, SD 2.5 hours) compared with the DEX0.05 (15.2 hours, SD 2.7 hours; p<0.01) and control groups (7.8±1.1, p<0.001). Total opioid consumption was significantly lower in the DEX0.1 group compared with the control group (p=0.01). NLR, PLR, and glucose levels did not differ significantly between the groups at baseline, 24 hours, and 48 hours post surgery.

Conclusions

Perineural dexamethasone significantly prolonged postoperative motor block duration and did not influence blood glucose, NLR, or PLR levels.

Trial registration number

NCT06086418.
Anti-fibrinolytics for mucosal bleeding in adults with life-limiting illnesses: a systematic review
Authors: Hooson Emma , Hargreaves Fiona , Holdsworth Emily , Longwell Sarah , Pullinger Alice , Gill Andrew
Published: August 2024

Introduction

Patients with life-limiting illnesses are at increased risk of mucosal bleeding. Usual management includes anticipatory planning and sedation, alongside anti-fibrinolytics, despite a lack of evidence for their use. Anti-fibrinolytic agents (tranexamic acid and aminocaproic acid) produce effective haemostasis in different clinical settings. Our aim was to synthesise the evidence for anti-fibrinolytic medication use in adult patients with life-limiting illnesses at risk of, or experiencing, mucosal bleeding.

Methods

We searched MEDLINE, Embase, CINAHL, Web of Science Conference Proceedings Citation Index, Cochrane Library databases and clinical trial registries (inception to January 2024) to identify studies investigating the use of anti-fibrinolytics in patients with life-limiting illnesses. Results were screened against a priori inclusion criteria, data ere extracted, and quality was appraised using a CASP (Critical Appraisal Skills Programme) checklist or BMJ risk of bias assessment. Data were analysed using narrative synthesis.

Results

Five studies meeting our search criteria (one cohort and four case series) were included. Data relating from 87 patients were used in narrative synthesis. Anti-fibrinolytic therapy was used for active mucosal bleeding in 37 patients, of whom 30 achieved total bleeding cessation. Fifty patients received prophylactic anti-fibrinolytics, of whom 32 experienced no bleeding events. Adverse events were reported in 3 of 87 patients (arterial thrombus, severe thrombocytopenia and stomach cramps). Mortality and quality of life were not reported.

Conclusion

Anti-fibrinolytics are generally well tolerated within this population and may prevent and reduce mucosal bleeding. Further high-quality research is suggested to investigate current practice and to compare anti-fibrinolytic with placebo in the management of bleeding in patients with life-limiting illnesses.

PROSPERO registration number

CRD42022325529.
Deciphering the complete plastid genome of an endemic monotypic species Kostermansia malayana (Malvaceae) from Peninsular Malaysia: structural comparative genomics and phylogenomic placement
Authors: Wong Xue Jing , Ramaiya Shiamala Devi , Cheng Wan Hee , Faizal Ahmad , Syazwan Samsuddin Ahmad , Lee Shiou Yih
Published: August 2024

Kostermansia malayana Soegeng, a species of Malvaceae endemic to the Malay Peninsula, is threatened by its rare flowering rate and habitat loss due to agriculture land conversion. The species is currently listed as “Vulnerable” on the International Union for Conservation of Nature Red List of Threatened Species. To expand genomic information, the study characterised its plastid genome (plastome) and conducted genome comparative and phylogenetic analyses with other selected species of Malvaceae. The quadripartite-structured plastome was 161 750 bp long and contained 83 protein-coding genes (PCGs), 37 tRNA genes, and eight rRNA genes. The overall GC content was 36.3%. Repeat analyses revealed 49 large repeats and 205 simple sequence repeats. A high preference for A/U-ended amino acids was found. Eight and nine PCGs were positively selected when compared to Coelostegia griffithii Benth. & Hook.f. and Reevesia thyrsoidea Lindl., respectively. A notable degree of collinearity was identified between the plastomes of K. malayana and six selected taxa of Helicteroideae. The phylogenetic tree reconstruction based on the concatenated PCG dataset showed a nearly well-resolved relationship within Malvaceae, with K. malayana placed under the Helicteroideae clade. The genomic data will provide a basis for future studies on the genetic conservation, phylogenetics, and evolutionary patterns of Durioneae and Malvaceae.
Antimicrobial resistance in Klebsiella pneumoniae: an overview of common mechanisms and a current Canadian perspective
Authors: Braun Hannah G , Perera Sumudu R , Tremblay Yannick DN , Thomassin Jenny-Lee
Published: August 2024

Klebsiella pneumoniae is a ubiquitous opportunistic pathogen of the family Enterobacteriaceae. K. pneumoniae is a member of the ESKAPEE pathogens ( Enterococcus faecium, Staphylococcus aureus, K. pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli), a group of bacteria that cause nosocomial infections and are able to resist killing by commonly relied upon antimicrobial agents. The acquisition of antimicrobial resistance (AMR) genes is increasing among community and clinical isolates of K. pneumoniae, making K. pneumoniae a rising threat to human health. In addition to the increase in AMR, K. pneumoniae is also thought to disseminate AMR genes to other bacterial species. In this review, the known mechanisms of K. pneumoniae AMR will be described and the current state of AMR K. pneumoniae within Canada will be discussed, including the impact of the coronavirus disease-2019 pandemic, current perspectives, and outlook for the future.