bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the safety and efficacy of a biosimilar abobotulinum toxin type A in treating moderate‐to‐severe glabellar lines: A non‐inferiority double blinded randomized controlled trial
Authors: Afshani Seyyedeh Maryam , Samadi Aniseh , Ayatollahi Azin , Kashani Mansour Nassiri , Ahmad Nasdrollahi Saman , Hosseini Hamed , Rezagholi Zahra , Hedayatjoo Behnaz , Hazegh Fetratjoo Delara , Ghobadi Mohammad Amin , Anari AmirHossein , Saeedifar Sajjad , Firooz Alireza
Published: March 2022

Background

Injection of botulinum toxin for cosmetic purposes is a well‐established practice.

Objectives

This study was conducted to compare the safety and efficacy of Dyston® (investigational biosimilar abobotulinumtoxinA) with Dysport® (abobotulinumtoxinA, Ipsen) in the treatment of moderate‐to‐severe glabellar lines.

Methods

Out of 193 screened subjects, 126 volunteers with moderate‐to‐severe glabellar lines fulfilling eligibility criteria were randomized in a 1:1 ratio to receive either an intramuscular injection of 40–60 units of Dyston® or Dysport®. The primary objective was to test the non‐inferiority of Dyston® compared with Dysport® as measured by the percentage of volunteers who achieved no or mild glabellar lines at maximum frown assessed by the physicians based on the Glabellar Line Severity Score (GLSS) at Day 30. Secondary endpoints included the improvement in the glabellar lines at maximum frown and rest states at Days 14, 60, 90, and 120 as well as the side effects of the treatment.

Results

Response rates at maximum frown were 75.44% (43/57) in the Dyston® group and 76.67% (46/60) in the Dysport® group on Day 30 (p value: 0.88, 95% CI: −14.24 to 16.70, diff: 1.23) as per‐protocol set, and were 75.81% (47/62) and 76.19 (48/63) (p value: 0.96, 95% CI: −14.59 to 15.35, diff: 0.3) in the Dyston® and the Dysport® groups, respectively, based on modified intention to treat population. Adverse events were similar in both groups and mostly mild and well‐tolerated.

Conclusion

Treatment of moderate‐to‐severe glabellar lines with Dyston® was effective, tolerable, and non‐inferior compared with Dysport®.
TNF‐α gene ‐238G>A polymorphism is associated with psoriasis patients
Authors: Akcılar Raziye , Dizen Namdar Nazlı , Yükcü Fulya , Arslan Utku Selve
Published: March 2022

Background

Tumor necrosis factor‐alpha (TNF‐α) is a protein that plays a key role in the pathophysiology of chronic inflammatory disorders like psoriasis.

Aims

The goal of this study was to see whether the TNF‐α gene ‐238G>A polymorphism was linked to psoriasis susceptibility.

Methods

This study comprised 90 psoriasis patients and ninety healthy controls. For the TNF‐α gene ‐238G>A polymorphism, genomic DNA was extracted and genotyped using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) studies.

Results

Psoriasis patients had higher frequencies of the A allele and the AA genotype than the control group, and psoriasis was linked to the AA genotype (OR = 4.25, 95% CI = 1.37–13.1, p = 0.008) and the A allele (OR = 1.55, 95% CI = 1.01–2.34, p = 0.04). Patients with a family history of psoriasis showed an increase in the frequency of the AA genotype compared with GG and GA genotypes (46.7%, 36.7%, and 16.7%, p = 0.003, respectively). Furthermore, psoriasis patients with the AA genotype were discovered more commonly among those under 30 years of age and male patients than those with the GG and GA genotypes, but the differences were not statistically significant.

Conclusion

The TNF‐α gene ‐238G>A polymorphism has been related to an increased incidence of psoriasis.
Original and Ongoing Dispossessions: Settler Capitalism and Indigenous Resistance in British Columbia
Authors: Paulson Justin , Tomiak Julie
Published: March 2022

This paper draws on archival research and theoretical work to articulate the specific histories, processes, and structures of primitive accumulation in British Columbia. Such processes of accumulation appear differently here than in the comparably more well‐theorized contexts of imperial colonialisms. As we highlight the agents and infrastructures of dispossession, our research also aims to foreground the importance of agents and infrastructures of resistance. Different dispossessions generate different antagonisms, and we argue that Indigenous subjects are situated antagonistically to capital not only as laborers partially or wholly subsumed into capitalist social relations, but as Indigenous peoples as such, whose Indigeneity has been ‘in the way’ of development from the 1850s onward. Private property requires before all else the deterritorialization of those whose relations with the land do not revolve around its commodification. Violence against Indigenous nations, and especially Indigenous women, is not incidental to capitalist development but is a prerequisite to capitalist subsumption in the settler‐colonial context. In requiring the death of either Indigeneity or the person, capital constitutes Indigenous struggle as an antagonist, interrupting both the subsumption of labor and the circulation of capital (even as such struggles may also self‐constitute themselves in a variety of ways).
“I Ain’t Even Gonna Cap to It”: Ethnography‐as‐Surveillance and Dark Sousveillance in the Classroom
Authors: Pannell Justin Lance
Published: March 2022

This article theorizes classroom ethnography in the socio‐historical context of the U.S. as a form of racialized surveillance which is calibrated by anti‐Black colonial discourses, racially saturated perception, and one’s vulnerability to interpellation. Focusing on the interaction of “Dominic,” a Black focal student, which was documented through ethnographic fieldwork, I conduct a frame analysis to investigate how ethnographic surveillance, as a racialized technology of power, becomes relevant to the frames Dominic negotiated. The analysis demonstrates that a surveillance frame was consequential to Dominic’s interaction and that Dominic’s verbal behavior was sensitive to the racialized element of surveillance generally and to anti‐blackness specifically. The analysis further shows how Dominic engaged in “dark sousveillance” (Browne 2015) as a form of ethnographic refusal, and the ensuing discussion considers aspects of reflexive practice by which ethnographer‐surveillers in education may engage in “abolitionist” (Shange 2019) ethnography.
Validity of patient self‐reports and clinical signs in the assessment of sleep bruxism based on home‐recorded electromyographic/electrocardiographic data
Authors: Ohlmann Brigitte , Rathmann Friederike , Bömicke Wolfgang , Behnisch Rouven , Rammelsberg Peter , Schmitter Marc
Published: March 2022

Background

Reliable and suitable bruxism assessment would be desirable, but available studies presented heterogeneous results.

Objective

To determine the agreement of patient self‐reports and clinical signs of sleep bruxism (SB) with electromyographic/electrocardiographic data.

Methods

Two hundred individuals from a German dental clinic population (120 women and 80 men) participated in the study. Participants completed different SB questionnaires, had a clinical examination to evaluate bruxism signs and used the Bruxoff® device to record electromyographic/electrocardiographic data for five nights. To investigate interrater reliability for clinical diagnosis of bruxism, 126 of the 200 participants were assessed for clinical signs of bruxism by two independent uncalibrated examiners. Statistical evaluation included calculation of sensitivity, specificity and accuracy and of Cohen's kappa.

Results

Based on the Bruxoff® data, 106 participants were identified as bruxers and 94 as non‐bruxers. The 106 bruxers were further classified into 47 moderate and 59 intense bruxers. The highest accuracy and sensitivity values were recorded for the overall score for clinical bruxism signs (accuracy: 72.0% and sensitivity: 70.8%). The best specificity (96.8%) was seen for the question regarding tooth grinding in the last two weeks reported by others, but concurrent sensitivity was very low (3.8%). Analysis of interrater reliability revealed a substantial agreement (Cohen's kappa of 0.6).

Conclusion

The study results indicate that self‐report questionnaires and clinical signs have moderate sensitivity, specificity and accuracy for diagnosing bruxism comparing with an ambulatory device for current SB (Bruxoff®). Regarding interrater reliability for clinical signs of SB, substantial agreement was found between the two examiners.

Clinical trial no. NCT03039985.
Pediatric vascular anomalies with airway compromise
Authors: Gorostidi François , Glasson Nicolas , Salati Victoria , Sandu Kishore
Published: March 2022

Vascular anomalies are rare lesions of diverse nature that may affect the head and neck region. Any mass in or around the upper airway has the potential to obstruct or compromise it. The absolute priority, before etiologic treatment, is the evaluation of the risk for the airway and its management. Prenatal diagnosis of an upper airway obstruction requires a planned delivery in a center having a specialized team experienced in managing a compromised feto‐neonatal airway, and who could perform an ex‐utero intrapartum treatment to secure the airway. Even after birth, the airway remains central in the patient's overall management. Signs and symptoms of airway compromise must be evaluated keeping in mind the specific requirements of infants and small children and being aware that rapid worsening may occur. The treatment is then tailored to the patient and his lesion with the goal of improving symptoms while avoiding treatment‐related complications. Maintaining reasonable expectations by the patient and families are part of a successful management. Cure is achievable for small and localized lesions, but symptom relief and mitigation of functional, esthetic and psychological impairments is the goal for large and complex lesions. If a tracheotomy was required, decannulation is one of the primary management goals.
Which objective itch‐assessment tools are applicable to patients with advanced cognitive impairments? A scoping review
Authors: Nitta Shiori , Maeda Tomonori , Koudounas Sofoklis , Minematsu Takeo , Tobe Hiromi , Weller Carolina , Sanada Hiromi
Published: March 2022

Background

Itching is an irritating and uncomfortable sensation that has a profound effect on patients' physical and mental health. It is a major under‐recognised problem in older patients who cannot express their pain due to advanced cognitive impairment. Therefore, objective itch‐assessment tools that do not rely on patients' reports of itching may be of value for this patient group.

Objective

To summarise the characteristics of validated objective itch‐assessment tools for patients with advanced cognitive impairment.

Methods

This scoping review was conducted according to the PRISMA extension for scoping reviews checklist. The PubMed, CINAHL and Cochrane Library databases were searched, via database‐specific search strategies, for articles published in English between January 1, 1990 and March 11, 2020. Based on the eligibility criteria, two authors independently screened the articles for inclusion. Thereafter, the lead author performed data extraction and analysis.

Results

Three validated scratch‐monitoring using accelerometers and a sound sensor and one validated scratch‐mark assessment have been reported. The Actiwatch Plus, ActiTrac®, body‐conducted sound sensor and Scoring Atopic Dermatitis index for scratching (SCORAD‐scratch) had positive criterion validity outcomes. The Actiwatch Plus, ActiTrac® and body‐conducted sound sensor were significantly correlated with scratch behaviour (r = 0.91, p < 0.001; r = 0.71, p = 0.042; r = 0.99, and p‐value not shown, respectively). The SCORAD‐scratch was significantly correlated with subjective itch‐assessment scores (r = 0.78–0.80, p = <0.0001–0.010).

Conclusions

This scoping review summarises the characteristics of validated objective itch‐assessment tools to investigate which of these are applicable to older patients with advanced cognitive impairments. Although there are limitations and further verification is required, the ActiTrac®, Actiwatch Plus and body‐conducted sound sensor may be useful for measuring scratch movements and itching.

Implications for practice

Nurses and patients' families may better understand the characteristics and validity of each objective itch‐assessment tool and select the optimal tool for patients with advanced cognitive impairment who cannot express their discomfort caused due to itching.
Atypical sites of twin atrioventricular nodes in a rare form of univentricular heart
Authors: Chiba Yuki , Izumi Gaku , Takeda Atsuhito
Published: March 2022

Twin atrioventricular nodes (AVNs) associated with complex tachycardias has been described in a heart with discordant atrioventricular (AV) connection. The present case had twin AVNs (approximately 3 o'clock and 8 o'clock position) of sole AV annulus with absent right AV connection. It is a first report demonstrated the twin AVNs identified at atypical sites associated with a univentricular heart with single inlet connection.
Risk of pain disorders in offspring of parents with substance use disorders
Authors: Li Dian‐Jeng , Chen Mu‐Hong , Bai Ya‐Mei , Tsai Shih‐Jen , Cheng Chih‐Ming , Su Tung‐Ping , Chen Tzeng‐Ji , Yeh Ta‐Chuan , Liang Chih‐Sung
Published: March 2022

Aims

Individuals with substance use disorders (SUD) have higher risk of developing pain disorders. This study aimed to investigate the risk of major psychiatric disorders (MPD), SUD, and pain disorders among their offspring.

Methods

This study used data from the Taiwan National Health Research Database. The case cohort included participants who had a parent diagnosed with SUD. The matched control cohort was offspring of parents without any SUD or major psychiatric disorder (MPD). Poisson regression was applied to estimate the risk of MPD, SUD, and pain disorder between case and control cohorts.

Results

We recruited 13,840 cases and 138,400 matched controls. After adjusting for demographic characteristics and family history of psychiatric disorder, the offspring of parents with SUD had higher risk for bipolar disorder (reported as risk ratio with 95% confidence interval: 2.48, 1.79–3.43), depressive disorder (2.22, 1.94–2.52), SUD (2.53, 2.18–2.92), and alcohol use disorder (1.43, 1.16–1.76) than controls. With adjustments of demographic characteristics, individual MPD, and family history of psychiatric disorder, they also presented higher risk than controls for several pain disorders, including migraine (1.43, 1.15–1.78), fibromyalgia (1.21, 1.03–1.42), dorsopathies (1.20, 1.06–1.37), dysmenorrhea (1.16, 1.04–1.29), irritable bowel syndrome (1.26, 1.11–1.43), and dyspepsia (1.14, 1.02–1.27).

Conclusions

Clinicians should be aware of the influence of parental SUD on the elevated risk for MPD, SUD, and pain disorders in their offspring.
Use of a donor‐derived cell‐free DNA assay to monitor treatment response in pediatric renal transplant recipients with allograft rejection
Authors: Steggerda Justin A. , Pizzo Helen , Garrison Jonathan , Zhang Xiaohai , Haas Mark , Kim Irene K. , Jordan Stanley C. , Puliyanda Dechu P.
Published: March 2022

Background

Detection of donor‐derived cell‐free DNA (dd‐cfDNA) reliably identifies allograft rejection in pediatric and adult kidney transplant (KT) recipients. Here, we evaluate the utility of dd‐cfDNA for monitoring response to treatment among pediatric renal transplant recipients suffering graft rejection.

Methods

58 pediatric transplant recipients were enrolled between April 2018 and March 2020 and underwent initial dd‐cfDNA testing to monitor for rejection. Allograft biopsy was performed for dd‐cfDNA scores >1.0%. Patients with histologically proven rejection formed the study cohort and underwent appropriate treatment. Results of dd‐cfDNA, serum creatinine (SCr), biopsy findings, and treatment outcomes were evaluated. Standard statistical analyses were applied.

Results

Nineteen of 58 (31%) patients had dd‐cfDNA score >1.0%, of which 18 (94.7%) had biopsy‐proven rejection. Median dd‐cfDNA value was 1.90% (interquartile range 1.43%–3.23%), and biopsy results showed 11 patients (61.1%) with antibody‐mediated rejection (AMR), 2 patients (11.1%) with T‐cell mediated rejection (TCMR), and 5 patients (27.7%) with mixed AMR/TCMR. SCr at time of biopsy was 1.28 ± 1.09 mg/dl. Following treatment, dd‐cfDNA scores decreased for all types of rejection but still remained >1.0% in both AMR (1.50% [0.90%–3.10%]) and mixed (1.40% [0.95%–4.15%]) groups. Repeat dd‐cfDNA values were <1.0% for patients with TCMR (0.20%–0.28%). SCr showed minimal change from pre‐treatment levels regardless of rejection subtype.

Conclusions

Patients with TCMR may be reliably followed by dd‐cfDNA; however, it remains unclear whether persistently elevated dd‐cfDNA levels in AMR is a reflection of ongoing subclinical rejection or an inherent limitation of the assay's utility.
Comparison of dermoscopy and reflectance confocal microscopy accuracy for the diagnosis of psoriasis and lichen planus
Authors: Wang Zi‐Yi , Fei Wen‐Min , Li Cheng‐Xu , Cui Yong
Published: March 2022

Background

Dermoscopy and reflectance confocal microscopy (RCM) as noninvasive tools are gaining increasing importance in the diagnosis of inflammatory skin disorders. The purpose of our study was to calculate and compare the diagnostic accuracy of dermoscopy and RCM in common inflammatory skin diseases.

Materials and Methods

We retrospectively collected clinical, dermoscopic, and RCM images of psoriasis and lichen planuscases from March 2018 to February 2021 in China‐Japan Friendship Hospital. There were 10 experts evaluated dermoscopic and RCM images independently. Sensitivity, specificity, positive predict value, and negative predictive value for each and all investigators were calculated. The diagnostic accuracy was also measured by the area under the curve (AUC) for the Receiver Operator Characteristic (ROC) Curves.

Results

We collected 82 psoriasis and 47 lichen planus cases. Dermoscopy was more sensitive than RCM in the diagnosis of psoriasis, and overall diagnostic accuracy of dermoscopy was also higher than RCM measured by AUC (0.879 vs. 0.835, p = 0.0001). For lichen planus, RCM had higher sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy than dermoscopy (AUC 0.916 vs. 0.813, p<0.0001).

Conclusion

Dermoscopy and RCM play a significant role in assisting the diagnosis of psoriasis and lichens planus. These two noninvasive diagnostic tools have their own advantages and disadvantages for the evaluation of different inflammatory skin diseases, and they can be combined in clinical practice to improve the accuracy of the diagnosis of inflammatory skin diseases.
Characterization of two new alleles: HLA‐B*51:363 and HLA‐DRB1*13:322N
Authors: Loginova Maria , Smirnova Daria , Druzhinina Svetlana , Paramonov Igor , Zarubin Maksim
Published: March 2022

Two new HLA alleles were identified during routine next generation sequencing.
Visual, Vestibular, and Proprioceptive Dependency of the Control of Posture in Chronic Neck Pain Patients
Authors: Alizadeh Alireza , Jafarpisheh Amir Salar , Mohammadi Maryam , Kahlaee Amir H.
Published: March 2022

Sensory reweighting of postural control was compared in participants with and without neck pain. Center of pressure variables of 60 volunteers, the same in each group, were calculated under four standing conditions: (a) eyes open, neutral head posture; (b) foam interface, eyes open; (c) cervical extension, eyes open; and (d) cervical extension, eyes closed. All center of pressure variables except anterior posterior range/velocity increased significantly in Condition 2 compared with Conditions 1 and 3 (p < .001) and in Condition 4 compared with Conditions 1 and 3. The mediolateral range/velocity and path length in both groups, anterior posterior range in patients, and center of pressure area in the control group were significantly different between Conditions 2 and 4 (p < .001). No overweighting was observed on the vestibular or visual afferents in patients. Compensatory strategies seem to lie within the proprioceptive system.
Effects of an integrated mindfulness intervention for veterans with diabetes distress: a randomized controlled trial
Authors: DiNardo Monica M , Greco Carol , Phares Angela D , Beyer Nicole M , Youk Ada O , Obrosky D Scott , Morone Natalia E , Owen Jason E , Saba Shaddy K , Suss Stephen J , Siminerio Linda
Published: March 2022

Introduction

US military veterans have disproportionately high rates of diabetes and diabetes-related morbidity in addition to being at risk of comorbid stress-related conditions. This study aimed to examine the effects of a technology-supported mindfulness intervention integrated into usual diabetes care and education on psychological and biobehavioral outcomes.

Research design and methods

Veterans (N=132) with type 1 or 2 diabetes participated in this two-arm randomized controlled efficacy trial. The intervention arm received a one-session mindfulness intervention integrated into a pre-existing program of diabetes self-management education and support (DSMES) plus one booster session and 24 weeks of home practice supported by a mobile application. The control arm received one 3-hour comprehensive DSMES group session. The primary outcome was change in diabetes distress (DD). The secondary outcomes were diabetes self-care behaviors, diabetes self-efficacy, post-traumatic stress disorder (PTSD), depression, mindfulness, hemoglobin A1C (HbA1C), body weight, and blood pressure. Assessments were conducted at baseline, 12 weeks, and 24 weeks. Participant satisfaction and engagement in home practice were assessed in the intervention group at 12 and 24 weeks.

Results

Intention-to-treat group by time analyses showed a statistically significant improvement in DD in both arms without significant intervention effect from baseline to 24 weeks. Examination of distal effects on DD between weeks 12 and 24 showed significantly greater improvement in the intervention arm. Improvement in DD was greater when baseline HbA1C was <8.5%. A significant intervention effect was also shown for general dietary behaviors. The secondary outcomes diabetes self-efficacy, PTSD, depression, and HbA1C significantly improved in both arms without significant intervention effects. Mindfulness and body weight were unchanged in either group.

Conclusions

A technology-supported mindfulness intervention integrated with DSMES showed stronger distal effects on DD compared with DSMES control. Examination of longer-term outcomes, underlying mechanisms, and the feasibility of virtual delivery is warranted.

Trial registration number

NCT02928952.
Insulin treatment in patients with diabetes mellitus and heart failure in the era of new antidiabetic medications
Authors: Staszewsky Lidia , Baviera Marta , Tettamanti Mauro , Colacioppo Pierluca , Robusto Fabio , D'Ettorre Antonio , Lepore Vito , Fortino Ida , Bisceglia Lucia , Attolini Ettore , Graps Elisabetta Anna , Caldo Gianluca , Roncaglioni Maria Carla , Garattini Silvio , Latini Roberto
Published: March 2022

Background

Coexistent heart failure (HF) and diabetes mellitus (DM) are associated with marked morbidity and mortality. Optimizing treatment strategies can reduce the number and severity of events. Insulin is frequently used in these patients, but its benefit/risk ratio is still not clear, particularly since new antidiabetic drugs that reduce major adverse cardiac events (MACEs) and renal failure have recently come into use. Our aim is to compare the clinical effects of insulin in a real-world setting of first-time users, with sodium-glucose cotransporter-2 inhibitor (SGLT-2i), glucagon-like peptide-1 receptor agonist (GLP-1RA) and the other antihyperglycemic agents (other-AHAs).

Methods

We used the administrative databases of two Italian regions, during the years 2010–2018. Outcomes in whole and propensity-matched cohorts were examined using Cox models. A meta-analysis was also conducted combining the data from both regions.

Results

We identified 34 376 individuals ≥50 years old with DM and HF; 42.0% were aged >80 years and 46.7% were women. SGLT-2i and GLP-1RA significantly reduced MACE compared with insulin and particularly death from any cause (SGLT-2i, hazard ratio (95% CI) 0.29 (0.23 to 0.36); GLP-1RA, 0.482 (0.51 to 0.42)) and first hospitalization for HF (0.57 (0.40 to 0.81) and 0.67 (0.59 to 0.76)).

Conclusions

In patients with DM and HF, SGLT-2i and GLP-1RA significantly reduced MACE compared with insulin, and particularly any cause of death and first hospitalization for HF. These groups of medications had high safety profiles compared with other-AHAs and particularly with insulin. The inadequate optimization of HF and DM cotreatment in the insulin cohort is noteworthy.
Effects of pericapsular nerve group (PENG) block on postoperative recovery in elderly patients with hip fracture: study protocol for a randomised, parallel controlled, double-blind trial
Authors: Luo Wei , Liang Jianhui , Wu Jieting , Luo Quehua , Wu Huiyi , Ou Yanhua , Li Yuhui , Ma WuHua
Published: March 2022

Introduction

Hip fracture is a common and serious emergency in the elderly, and it is associated with severe pain, significant morbidity and mortality. The use of peripheral nerve block can relieve pain effectively and reduce opioid requirements, which may accelerate patient’s recovery. The pericapsular nerve group (PENG) block has been found to provide an effective blockade to the hip joint with a potential motor-sparing effect, so we hypothesised that the PENG block may be an effective tool to enhance the recovery in elderly patients after hip fracture surgery.

Methods and analysis

This study is a single-centred, randomised, parallel controlled, double-blind trial. A total of 92 elderly patients scheduled for hip fracture surgery will be divided into two groups at random to receive either ultrasound-guided femoral nerve block or ultrasound-guided PENG block. The primary outcome will be to compare the Quality of Recovery-15 scores at 24 hours postoperatively between the two groups. The secondary outcomes will include measuring and comparing the strength of the quadriceps, the visual analogue scale at rest and on movement, the total morphine consumption, the rescue analgesic, the first time of postoperative out-of-bed mobilisation and complications.

Ethics and dissemination

This study was approved by the Institutional Review Board of the Ethics Committee of The First Affiliated Hospital of Guangzhou University of Chinese Medicine on 15 December 2020 (reference K2020-110). The results of this study will be published in peer-reviewed international journals.

Trial registration number

ChiCTR2100042341.
Disparities in prevalence of heart failure according to age, multimorbidity level and socioeconomic status in southern Sweden: a cross-sectional study
Authors: Scholten Mia , Midlöv Patrik , Halling Anders
Published: March 2022

Objective

The aim of this study was to compare the prevalence of heart failure (HF) in relation to age, multimorbidity and socioeconomic status of primary healthcare centres in southern Sweden.

Design

A cross-sectional study.

Setting

The data were collected concerning diagnoses at each consultation in all primary healthcare centres and secondary healthcare in the southernmost county of Sweden at the end of 2015.

Participants

The individuals living in southern Sweden in 2015 aged 20 years and older. The study population of 981 383 inhabitants was divided into different categories including HF, multimorbidity, different levels of multimorbidity and into 10 CNI (Care Need Index) groups depending on the socioeconomic status of their listed primary healthcare centre.

Outcomes

Prevalence of HF was presented according to age, multimorbidity level and socioeconomic status. Logistic regression was used to further analyse the associations between HF, age, multimorbidity level and socioeconomic status in more complex models.

Results

The total prevalence of HF in the study population was 2.06%. The prevalence of HF increased with advancing age and the multimorbidity level. 99.07% of the patients with HF fulfilled the criteria for multimorbidity. The total prevalence of HF among the multimorbid patients was only 5.30%. HF had a strong correlation with the socioeconomic status of the primary healthcare centres with the most significant disparity between 40 and 80 years of age: the prevalence of HF in primary healthcare centres with the most deprived CNI percentile was approximately twice as high as in the most affluent CNI percentile.

Conclusion

The patients with HF were strongly associated with having multimorbidity. HF patients was a small group of the multimorbid population associated with socioeconomic deprivation that challenges efficient preventive strategies and health policies.
Fighting COVID-19: a qualitative study into the lives of intensive care unit survivors in Wuhan, China
Authors: Wu Dong , Ding Hanyue , Lin Jiaye , Xiao Meng , Xie Jing , Xie Feng , Zhang Shuyang
Published: March 2022

Objectives

We aimed to provide an insight into the life of survivors of critical COVID-19 in China.

Methods

We conducted an online survey and qualitative interviews among intensive care unit survivors of critical COVID-19 between November and December 2020 in Wuhan, China. Eligible participants were asked to complete the EQ-5D-5L and the Short Form 36-Item Survey, and invited to participate in a semistructured face-to-face interview. Descriptive analyses and phenomenological approach were adopted to analyse quantitative and qualitative data, respectively.

Results

Of 10 survivors who completed the questionnaire, 8 participated in the interview. The mean scores±SD of EuroQol-5 Dimensions-5 Level utility and EuroQol-Visual Analogue Scale were 0.88±0.15 and 80.9±14.2, respectively. The qualitative interview identified four themes, namely poor physical health, post-traumatic stress, social stigma and family support.

Conclusions

COVID-19 survivors continue fighting physical and psychological impacts. Despite strong family support, these patients are struggling with social stigma. It is a long, challenging journey to recovery for patients and society.
Technology-based group exercise interventions for people living with dementia or mild cognitive impairment: a scoping review protocol
Authors: Hung Lillian , Levine Hannah , Randhawa Paavan , Park Juyoung
Published: March 2022

Introduction

More than 50 million people worldwide are living with dementia in 2020, and this number is expected to double every 20 years. Physical exercise is a growing field in non-pharmacological interventions for dementia care. Due to public health measures during the COVID-19 pandemic, more people have considered adapting to technology-based exercise via digital devices. This scoping review will explore evidence relating to the use of technology-based group exercise by people with dementia or mild cognitive impairment.

Methods and analysis

This review will follow the Joanna Briggs Institute scoping review methodology to review literature published between June and December 2021. This review is designed to identify existing types of technology-based group exercise interventions for people with dementia. The review will provide a synthesis of current evidence on the outcome and impacts of technology-based group exercise. The context of this review will include homes, assisted living facilities and memory care services but exclude hospitals. The review will include a three-step search strategy: (a) identify keywords from MEDLINE and Embase, (b) search using the identified keywords in databases (MEDLINE/PubMed, CINAHL, Web of Science, Embase, Cochrane Library, PsychInfo and Google) and (c) review references from included studies to identify additional studies. Only studies in English will be included. Four researchers will independently assess titles and abstracts and then review the full text of the selected articles, applying the inclusion criteria. The extracted data will be presented in tables and summarised narratively.

Ethics and dissemination

Scoping review data will be collected from publicly available articles; research ethics approval is not required. The findings will be disseminated to healthcare practitioners and the public through a peer-reviewed publication and conference presentations.
Australian general practice experiences of implementing a structured approach to initiating advance care planning and palliative care: a qualitative study
Authors: Vilapakkam Nagarajan Srivalli , Lewis Virginia , Halcomb Elizabeth J , Rhee Joel , Tieman Jennifer , Clayton Josephine M
Published: March 2022

Objectives

Initiation of advance care planning (ACP) and palliative care (PC) assessments in general practice is key to quality end-of-life care. The Advance Project promotes a team-based approach to initiating ACP and PC needs assessment in general practices through training, resources and practical support for implementation from local primary health networks (PHNs). This paper aims to understand: (1) general practice participants’ experiences of undertaking Advance Project training and implementing the Advance Project resources in their practices; (2) barriers and facilitators to implementation of Advance Project resources; and (3) PHN staff experiences of supporting general practices through training and practical support for implementation of the Advance Project resources.

Design

Qualitative study using semistructured interviews and thematic analysis.

Setting

Twenty-one general practices and four PHNs from three Australian states were recruited between June 2019 and May 2020.

Participants

General practitioners (GPs), general practice nurses, practice managers (PMs) and PHN staff.

Results

45 participants comprising 13 GPs, 13 general practice nurses, 9 PMs, 3 allied health staff and 7 PHN staff were interviewed. The general practice participants generally agreed that the Advance Project training/resources led to changes in their own behaviour and increased their awareness of the importance of ACP/PC discussion with their patients. Participants reported the following benefits for patients: increased awareness of ACP; engagement with families/carers and peace of mind. Key facilitators for successful implementation were a team-based approach, the role of the PHN, the role of practice champions, training facilitators’ ability to influence peers and facilitate change, and mentoring support. Barriers to implementation included issues related to workplace culture, cost, time/workload, patients and health system.

Conclusion

Findings suggest that the Advance Project approach facilitated successful implementation of ACP and PC needs assessment into usual care in general practices that encouraged teamwork among GPs and general practice nurses. The ability of the practice to make the best use of practical support and guidance available to them through their local PHN both before and during implementation was a key factor in integration of Advance Project resources into routine practice.
LAMP4yaws:Treponema pallidum,Haemophilus ducreyiloop mediated isothermal amplification − protocol for a cross-sectional, observational, diagnostic accuracy study
Authors: Handley Becca Louise , González-Beiras Camila , Tchatchouang Serges , Basing Laud Antony , Hugues Kouadio Aboh , Bakheit Mohammed , Becherer Lisa , Ries Christina , Njih Tabah Earnest , Crucitti Tania , Borst Nadine , Lüert Simone , Frischmann Sieghard , Haerpfer Tamara , Landmann Emelie , Amanor Ivy , Sylla Aboubacar , Kouamé-Sina Mireille S , Ndzomo-Ngono Jean P , Tano Adingra , Arhinful Daniel , Awondo Patrick , Ngazoa Kakou Solange , Eyangoh Sara , Addo Kennedy Kwasi , Harding-Esch Emma Michele , Knauf Sascha , Mitjà Oriol , Marks Michael
Published: March 2022

Introduction

Yaws, caused by the bacteriumTreponema pallidumsubsp.pertenue,is a neglected tropical disease targeted for eradication by 2030. Improved diagnostics will be essential to meet this goal. Diagnosis of yaws has relied heavily on clinical and serological tools. However, the presence of coendemic cutaneous skin ulcer diseases, such as lesions caused byHaemophilus ducreyi(HD), means these techniques do not provide a reliable diagnosis. Thus, new diagnostic tools are needed. Molecular tools such as PCR are ideal, but often expensive as they require trained technicians and laboratory facilities, which are often not available to national yaws programmes.

Methods and analysis

The LAMP4yaws project is a cross-sectional, observational, diagnostic accuracy study of a combinedTreponema pallidum(TP) andHDloop mediated isothermal amplification (TPHD-LAMP) test performed under real world conditions in three endemic countries in West Africa. Individuals with serologically confirmed yaws will be recruited in Cameroon, Côte d’Ivoire and Ghana. Each participant will provide paired swabs, one of which will be sent to the respective national reference laboratory for yaws quantitative PCR and the other will be tested for bothTPandHDusing the TPHD-LAMP test at local district laboratories. Sensitivity and specificity of the TPHD-LAMP test will be calculated against the reference standard qPCR. We will also assess the acceptability, feasibility and cost-effectiveness of the test. We anticipate that results from this study will support the adoption of the TPHD-LAMP test for use in global yaws eradication efforts.

Ethics and dissemination

We have received ethical approval from all relevant institutional and national ethical committees. All participants, or their parents or guardians, must provide written informed consent prior to study enrolment. Study results will be published in an open access journal and disseminated with partners and the World Health Organization.

Trial registration number

NCT04753788.
How do type of preoperative P2Y12receptor inhibitor and withdrawal time affect bleeding? Protocol of a systematic review and individual patient data meta-analysis
Authors: Schoerghuber Michael , Pregartner Gudrun , Berghold Andrea , Lindenau Ines , Zweiker Robert , Voetsch Andreas , Mahla Elisabeth , Zirlik Andreas
Published: March 2022

Introduction

In order to reduce the risk of bleeding in patients on P2Y12receptor inhibitors presenting for non-emergent coronary artery bypass grafting (CABG), current guidelines recommend a preoperative discontinuation period of at least three, five and seven days for ticagrelor, clopidogrel and prasugrel, respectively, to allow for recovery of platelet function. However, there is still substantial interinstitutional variation in preoperative management and relevant covariates of CABG-related bleeding are largely elusive so far.

Methods and analysis

We will search PubMed (July 2013 to November 2021) and EMBASE (January 2014 to November 2021) using the following terms, MeSH terms and their synonyms: clopidogrel, prasugrel, ticagrelor, dual antiplatelet, P2Y12receptor inhibitor, CABG, bleeding, haemorrhage. Two independent reviewers will screen all abstracts and full papers for eligibility. Disagreements will be solved by consulting with a third reviewer.

The primary outcome is the incidence of Bleeding Academic Research Consortium type-4 bleeding depending on type of P2Y12receptor inhibitor and preoperative withdrawal period. The secondary outcomes are mortality and ischaemic events according to the Academic Research Consortium 2 Consensus Document. We will perform an individual patient data meta-analysis (IPD-MA) with drug-specific preoperative withdrawal time and adjust for demographic and procedural variables. Subgroup analyses will be performed for anaemic patients and patients undergoing non-emergent versus urgent/emergent surgery.

Ethics and dissemination

This IPD-MA consists of secondary analyses of existing non-identifiable data and meets the criteria for waiver of ethics review by the local Research Ethics Committee. Data sharing and transfer will be subject to a confidentiality agreement and a data use agreement. Findings will be disseminated through peer-reviewed publication and conference presentation.

PROSPERO registration number

CRD42022291946.
Assessment of the readability and quality of online patient education materials for the medical treatment of open-angle glaucoma
Authors: Crabtree Lois , Lee Edward
Published: March 2022

Objective

Patient adherence to glaucoma medications is poor, and is linked to low literacy levels. Patients commonly use the internet to access health information, and it is recommended that patient information is written at an 11-year-old reading level. The aim of this study is to assess the readability and quality of online patient education materials for the medical management of open angle glaucoma.

Methods and analysis

The top 10 relevant Google searches for nine glaucoma medications (timolol, brimonidine, apraclonidine, dorzolamide, latanoprost, bimatoprost, travoprost, tafluprost and brinzolamide) and three generic searches were analysed for readability and accountability. Readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI) and Simple Measure of Gobbledygook Index (SMOG). Webpages were classified by source and assessed using Journal of the American Medical Association (JAMA) benchmarks of accountability.

Results

111 articles were included in the analysis. Mean readability scores were: FRES 55.5 (95% CI 53.4 to 57.5); FKGL 9.7 (95% CI 9.3 to 10.0); GFI 12 (95% CI 11.6 to 12.4) and SMOG 9.3 (95% CI 8.9 to 9.6). One-way analysis of variance demonstrated no significant difference in readability score between source type. 9% of the webpages satisfied all 4 JAMA benchmarks. Pearson’s correlation coefficient showed a correlation between the FRES and accountability score (r=0.19, p=0.045).

Conclusion

The majority of online patient education materials for the medical treatment of glaucoma are written at a level too difficult for the general population and fail to meet accountability standards.
Influence of context on quality improvement priorities: a qualitative study of three facility types in Lagos State, Nigeria
Authors: Olaniran Abimbola Ayodele , Oludipe Modupe , Hill Zelee , Ogunyemi Adedoyin , Umar Nasir , Ayorinde Rebecca , Ohiri Kelechi , Schellenberg Joanna , Marchant Tanya
Published: March 2022

Background

Quality improvement (QI) collaboratives are increasingly popular. However, there is a need for an in-depth understanding of the influence of context on its implementation. We explored the influence of context on the change concepts considered by public primary (primary health centres), public secondary (public hospitals) and private (private facilities) collaboratives established to improve maternal and newborn health outcomes in Lagos State, Nigeria.

Methods

Between February 2019 and January 2020, we conducted a qualitative study using meeting reports, key informant interviews and participant observation. Data were analysed using the high-quality health system framework for assessing health system and user experience that distinguished three quality domains: quality impacts, processes of care and health system foundations.

Results

Nineteen change concepts and 158 change ideas were observed across 28 facility QI teams. Change concepts and ideas prioritised were influenced by government and non-governmental leaders but ultimately shaped by facility QI capacity, time allocated for QI activities and availability of local data. Of the three quality domains, process of care, including patient satisfaction, received the most attention across facility types. There was considerable variation in the change concepts considered across domains. For example, more public hospitals focused on complication management because of a relatively high prevalence of and capacity to manage maternal complications; primary health centres focused more on complication referrals, while private facilities prioritised revenue generation. Problems with availability of resources were particularly highlighted in primary health centres which had relatively less financial commitment from stakeholders.

Conclusion

Our findings provide insights into QI collaboratives’ mechanism of change in which external stakeholders, including government, drove QI priorities for action but the ultimate decisions depended on local realities of facilities. Our findings underscore the need for strong QI leadership and sufficient resources to enable facility QI teams to prioritise change concepts for greater health impact.
Risk calculator for advanced neonatal resuscitation
Authors: Szyld Edgardo , Anderson Michael P , Shah Birju A , Roehr Charles C , Schmölzer Georg M , Fabres Jorge G , Weiner Gary M
Published: March 2022

In order to predict which newborns will require advanced resuscitation (ANR), we developed an ANR risk calculator (calculator.) using a bootstrap sample size of 52 973 from a case–control study of newborns ≥34 weeks gestation. Multivariable logistic regression coefficients were obtained for the 10 original risk factors and two interaction terms. The area under the receiving-operating characteristic curve predicting ANR was 0.9243. ANR prediction is improved by accounting for perinatal variables, beyond factors known prenatally. Prospective validation of this model is warranted in a clinical setting.
Transcatheter aortic valve implantation in patients with rheumatic aortic stenosis
Authors: Okuno Taishi , Tomii Daijiro , Buffle Eric , Lanz Jonas , Ryffel Christoph , Demirel Caglayan , Hashemi Suliman , Hagemeyer Daniel , Papadis Athanasios , Heg Dik , Praz Fabien , Stortecky Stefan , Windecker Stephan , Pilgrim Thomas
Published: March 2022

Background

Rheumatic heart disease (RHD) accounts for the highest number of deaths from valvular heart disease globally. Yet, rheumatic aortic stenosis (AS) was excluded from landmark studies investigating the safety and efficacy of transcatheter aortic valve implantation (TAVI). We aimed to describe the clinical and anatomical characteristics of patients with rheumatic AS undergoing TAVI, and to compare procedural and clinical outcomes with patients undergoing TAVI for degenerative AS.

Methods

In a prospective TAVI registry, patients with rheumatic AS were identified based on International Classification of Diseases version 10 codes and/or a documented history of acute rheumatic fever and/or the World Heart Federation criteria for echocardiographic diagnosis of RHD, and were propensity score-matched in a 1:4 ratio to patients with degenerative AS.

Results

Among 2329 patients undergoing TAVI, 105 (4.5%) had rheumatic AS. Compared with patients with degenerative AS, patients with rheumatic AS were more commonly female, older, had higher surgical risk and more commonly suffered from multivalvular heart disease. In the unmatched cohort, both technical success (85.7% vs 85.9%, p=0.887) and 1-year cardiovascular mortality (10.0% vs 8.6%; HR 1.16, 95% CI 0.61 to 2.18, p=0.656) were comparable between patients with rheumatic and degenerative AS. In contrast, patients with rheumatic AS had lower rates of 30-day and 1-year cardiovascular mortality compared with matched patients with degenerative AS (1.9% vs 8.9%, adjusted HR (HRadj) 0.18, 95% CI 0.04 to 0.80, p=0.024; and 10.0% vs 20.3%, HRadj0.44, 95% CI 0.24 to 0.84, p=0.012, respectively).

Conclusion

TAVI may be a safe and effective treatment strategy for selected elderly patients with rheumatic AS.

Trial registration number

NCT01368250.