bluuebunny/crossref_metadata_2025 huggingface dataset:
Accuracy of two-dimensional transverse wave elastography of salivary glands in diagnosis of Sjögren’s disease: a systematic review and meta-analysis
Authors: Liu Jie , Xia Guangsha , Dai Zhaoqiu , Wang Ruirui , Feng Zhe , Ma Guquan , Zeng Liang , He Xiaojin
Published: August 2024

Objectives

Two-dimensional shear wave elastography (2D-SWE) is a non-invasive technique for the evaluation of Sjögren’s disease (SjD). This study investigated the diagnostic accuracy of 2D-SWE in assessing major salivary gland involvement in SjD.

Design

A systematic review and meta-analysis.

Data sources

Data were obtained by searching PubMed, MEDLINE, EMBASE, Scopus, Cochrane library and CNKI from 1999 to 26 September 2022, which includes randomised clinical trial of 2D-SWE for the diagnosis of SjD.

Eligibility criteria

(1) Patients (≥18 years old) diagnosed with SjD following the international classification in 2002 or 2016 American College of Rheumatology-European League Against Rheumatism classification criteria for SjD; (2) The purpose of this study was to evaluate the diagnostic value of 2D-SWE in SjD; (3) The evaluation parameters for the diagnosis of SjD can be extracted or indirectly obtained in this article, including sensitivity, specificity, true positive, false positive, false negative, true negative, diagnostic point (Young’s modulus) and other data.

Data extraction and synthesis

Four authors independently screened and assessed the literature and extracted the data. RevMan V.5.3 and StataMP V.18 software were used for quality assessment and meta-analysis.

Results

We included 8 studies with a total of 912 cases, including 509 patients with SjD. The high-risk bias in the quality evaluation focused on patient selection and index test. The pooled sensitivity, specificity and summary area under the curve of 2D-SWE were 0.75 (95% CI 0.62 to 0.84), 0.89 (95% CI 0.80 to 0.94) and 0.90 (95% CI 0.87 to 0.92), respectively.

Conclusions

2D-SWE has an acceptable diagnostic accuracy for SjD patients and is an effective tool for auxiliary diagnosis of SjD.

PROSPERO registration number

CRD42022365766.
New triple therapy for the diagnosis of CKD-MBD: a cross-sectional study in Shanxi province
Authors: Zhao Zhi , Gao Yuanyuan , Sui WenDong , Zhang ZiTong , Feng Li , Wang Zhi , Yang Daihe , Zhou Yun , Li Rongshan , Huang Bo
Published: August 2024

Objectives

To seek a triple combination of biomarkers for early diagnosis of chronic kidney disease-mineral and bone metabolic disorder and to explore the diagnostic efficacy of β2-microglobulin, parathyroid hormone and blood urea nitrogen in chronic kidney disease-mineral and bone metabolic disorder.

Participants

We collected medical records of 864 patients with chronic kidney disease (without direct contact with patients) and divided them into two groups based on the renal bone disease manifestations of all patients.

Primary and secondary outcome measures

There were 148 and 716 subjects in the Chronic kidney disease-mineral and bone metabolic disorder and the control groups, respectively. The aggregated data included basic information and various clinical laboratory indicators, such as blood lipid profile, antibody and electrolyte levels, along with renal function-related indicators.

Results

It was observed that most renal osteopathy occurs in the later stages of chronic kidney disease. In the comparison of two clinical laboratory indicators, 16 factors were selected for curve analysis and compared. We discovered that factors with high diagnostic values were β2-microglobulin, parathyroid hormone and blood urea nitrogen.

Conclusions

The triple combination of β2-microglobulin+parathyroid hormone+blood urea nitrogen indicators can play the crucial role of a sensitive indicator for the early diagnosis of chronic kidney disease-mineral and bone metabolic disorder and in preventing or delaying the progress of chronic kidney disease-mineral and bone metabolic disorder.
Depressive and anxiety symptoms in caregivers of children with congenital ectopia lentis: a prospective cross-sectional study
Authors: Liang Xiaolin , Zhang Xinyu , Young Charlotte Aimee , Ma Yiyuan , Ye Qian , Zheng Danying , Jin Guangming
Published: August 2024

Objectives

To evaluate the frequency and severity of depressive and anxiety symptoms and explore possible risk factors among caregivers of children with congenital ectopia lentis (CEL).

Design

A prospective cross-sectional study was conducted.

Participants

108 patients and 108 informal caregivers (mainly parents) were included. Participants were grouped based on whether patients had systemic abnormalities: group 1 were children without systemic abnormalities and group 2 were children with systemic abnormalities.

Outcome measures

The 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7) were used to assess depressive and anxiety symptoms, respectively.

Results

More than half of caregivers (51.9%) have depressive or anxiety symptoms of some degree. 38.0% of caregivers suffered from both depressive and anxiety symptoms. 19.4% of caregivers had moderate to severe depressive symptoms (PHQ-9 score ≥10) while 16.7% reported moderate to severe anxiety symptoms (GAD-7 score ≥10). Between the two groups, the mean PHQ-9 and GAD-7 scores significantly differed (p=0.026 in PHQ-9; p=0.018 in GAD-7). The proportion of caregivers with moderate to severe symptoms was greater in group 2 than in group 1. In addition, there was a significant positive correlation between PHQ-9 and GAD-7 scores (r=0.827; p<0.001). Furthermore, best corrected visual acuity in the better eye of patients was positively correlated with both the PHQ-9 and GAD-7 scores (r=0.314, p<0.05 in PHQ-9; r=0.325, p<0.05 in GAD-7).

Conclusions

Depressive and anxiety symptoms were common in caregivers of children with CEL, especially among those whose children had other systemic disease manifestations or low vision. This study illustrates the importance of depressive and anxiety symptom screening for these caregivers to implement effective psychological interventions and support strategies.
Efficacy of Qigong Baduanjin on nutritional status and quality of life in patients on haemodialysis: study protocol for a prospective randomised controlled trial
Authors: Zhou Jiayue , Hu Shouci , Zhang Xiang , Xia Cong , Wan Songyan , Yang Xiuyan , Yu Yajuan , Chen Han , Chen Hongbo
Published: August 2024

Introduction

Haemodialysis (HD) patients usually engage in a low level of physical activities, which could impact the prognosis and mortality of this group. Fitness Qigong Baduanjin, a physical exercise from traditional Chinese Medicine, is known to have benefit in chronic heart failure patients and peritoneal dialysis patients. However, researches about Baduanjin in HD patients are currently limited. So, the aim of the study is to investigate the current exercise intensity of HD patients and its influencing factors, and to explore the effects of Baduanjin on HD patients.

Methods and analysis

This prospective, non-blinded, randomised controlled trial will enrol patients with end-stage kidney disease who were stable on HD for more than 3 months. All eligible participants will be randomly divided into the intervention group undergoing Baduanjin and the control group without Baduanjin in a 1:1 ratio. The intervention group is required to perform Baduanjin two times per day, starting 30 min after breakfast and dinner, 45 min per session for a total of a 6 month, starting from 10 June 2024. Information such as laboratory biochemical examination indicators, radiological examination results and related scales and questionnaires will be collected at baseline, 1 month follow-up, 3 month follow-up and 6 month follow-up. All statistical tests are conducted through the two-tailed test, and a p-value≤0.05 will be considered statistically significant for the difference being tested. The description of quantitative indicators will be used in calculating the number of cases, mean, SD, median and IQR method. The classification indicators will be used to describe the number of cases and percentages (frequency and frequency rate).

Ethics and dissemination

The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (V20230521). The results will be reported in a peer-reviewed journal and a relevant academic conference.

Trail registration

ChiCTR2300074659.
Cohort profile: the CARTaGENE Cohort Nutrition Study (Quebec, Canada)
Authors: Ho Vikki , Csizmadi Ilona , Boucher Beatrice A , McInerney Maria , Boileau Catherine , Noisel Nolwenn , Payette Yves , Awadalla Philip , Koushik Anita
Published: August 2024

Purpose

To address emerging nutritional epidemiological research questions, data from contemporary cohorts are needed. CARTaGENE is the largest ongoing prospective cohort study of men and women in Québec, Canada. Dietary information was collected making it a rich resource for the exploration of diet in the aetiology of many health outcomes.

Participants

CARTaGENE recruited over 43 000 men and women aged 40–69 in two phases (A and B). In phase A, a total of 19 784 men and women were enrolled between 2009 and 2010. In 2011–2012, phase A participants of CARTaGENE were recontacted and invited to complete the self-administered Canadian Diet History Questionnaire II, which assessed usual intake over the past 12 months of a comprehensive array of foods, beverages and supplements; 9379 participants with non-missing age and sex data and with plausible total energy intake comprise the CARTaGENE Cohort Nutrition Study (4212 men; 5167 women).

Findings to date

Available dietary data include intake of total energy, macronutrients and micronutrients, food group equivalents and a measure of diet quality based on the Canadian Healthy Eating Index 2005 (C-HEI 2005). Intake and diet quality varied among participants though they generally met the recommended dietary reference intakes for most nutrients. The mean C-HEI 2005 score was 61.5 (SD=14.0; max score=100), comparable to the general Canadian population. The mean (SD) scores for men and women separately were 57.0 (14.1) and 65.2 (12.8), respectively. C-HEI scores were higher for never smokers (61.6), those who had attained more than a high school education (61.4) and those with high physical activity (60.4) compared with current smokers (55.8), less than high school education level (56.2) and low physical activity (57.6), respectively (p values<0.01).

Future plans

The CARTaGENE Cohort Nutrition Study is an additional resource of the CARTaGENE platform and is available internationally to examine research questions related to diet and health among contemporary populations. Starting in 2024, annual diet assessments using two 24-hour dietary recalls over a 30-day period will take place, further expanding the cohort as a resource for dietary research.
Wider health needs in attention deficit hyperactivity disorder from lived and professional experience: a qualitative framework analysis
Authors: Ward John , McBride Audrey , Gudka Rebecca , Becker Kieran , Newlove-Delgado Tamsin , Price Anna
Published: August 2024

Objectives

This study aimed to explore the perspectives of people with attention deficit hyperactivity disorder (ADHD), their supporters and primary care professionals (PCPs), on the wider physical and mental health needs of people with ADHD and the support currently available.

Design

Qualitative semi-structured interviews, analysed using reflexive thematic analysis.

Setting

Five general practice surgeries across England.

Participants

Participants with lived experience (people with ADHD and their supporters (n=11)) and PCPs (n=9) (eg, general practitioners and practice managers), recruited via clinical academic networks and previous work packages of this study.

Results

We generated three major themes in relation to ADHD, using reflexive thematic analysis: understanding health, barriers to health and addressing health. Within these, participants reflected on mental and physical health challenges, as well as wider social difficulties and variability in support offered/accessed.

Conclusions

This study highlights that health problems in ADHD are complex and rooted both in individual factors (eg, mental health) and social factors (eg, support). This study also highlights the differences in expectations and fulfilment of healthcare.
Deprescribing benzodiazepine receptor agonists in older adults: a mixed-methods study to adapt the Canadian D-PRESCRIBE intervention to the Belgian community setting
Authors: Pétein Catherine , Dujardin Nathalie , de Montigny Manon , Dewez Evelyne , Spinewine Anne , Henrard Séverine
Published: August 2024

Objective

Guidelines recommend deprescribing benzodiazepine receptor agonists (BZRA) in older adults, yet implementation in clinical practice remains limited. Adapting effective, evidence-based interventions to a new context is a resource-saving strategy. In Canada, the D-PRESCRIBE intervention comprised a patient educational brochure and a pharmaceutical opinion inviting physicians to revise BZRA prescribing and consider safer alternatives. Due to its effectiveness on BZRA deprescribing among Canadian older adults, we aimed to adapt the D-PRESCRIBE intervention to the Belgian community setting.

Design

Recommendations from the ADAPT guidance, that provides a systematic approach for adapting interventions to new contexts, were followed. We conducted a mixed-methods study that comprised (1) group discussions and cognitive interviews to assess the acceptability and need for adaptation of the intervention’s components and (2) a survey on the adapted pharmaceutical opinion. A research committee involving stakeholders’ representatives decided on the adaptations, respecting the core functions of both tools. Changes in intervention components were reported following the Model for Adaptation Design and Impact framework.

Setting

Belgian French-speaking community setting.

Participants

Six older adults (≥65 years), six general practitioners (GPs) and seven pharmacists participated in the group discussions or interviews. 46 GPs and 91 pharmacists responded to the survey.

Results

Participants welcomed the brochure positively. Still, some changes in the vocabulary, wording, photos and icons were made for several purposes including making the patient feel concerned about the brochure and softening the use of fear. The pharmaceutical opinion aroused mixed perceptions. Its name, layout and content were adapted to enhance its acceptability and fit with our healthcare system, practices and national guidelines. The survey highlighted several enablers and barriers to its use from the perspectives of GP and pharmacist.

Conclusions

The Canadian D-PRESCRIBE intervention was adapted to the Belgian setting following a thorough and transparent process. Its feasibility will be tested in a future pilot study (NCT:05929417).
Patients’ preferences, experiences and expectations with wait time until surgery in gynaecological oncology: a mixed-methods study in two gynaecological oncological centres in the Netherlands
Authors: van den Berg Kim , Knegt Anne , Fons Guus , Lok Christianne A R , Aarts Johanna W M
Published: August 2024

Objectives

Patient-centredness of care during wait time before surgery can be improved. In this study we aimed to assess (1) patients’ experiences with and preferences regarding wait time before surgery; (2) the impact of wait time on quality of life (QoL) and (3) which factors influence patients’ wait time experience.

Design, setting, participants

We performed an exploratory sequential mixed-methods study among women with gynaecological cancer in two tertiary hospitals. We conducted semistructured interviews and identified aspects of QoL and factors that influenced wait time acceptability through thematic analysis. We developed a questionnaire from this thematic analysis which was completed by 97 women. Descriptive statistics and univariate and multivariate regression analyses were performed.

Results

Average ideal wait time was 3.5 weeks (±1.7 weeks), minimum and maximum acceptable wait times were 2.2 and 5.6 weeks. Many patients scored above the threshold of the Hospital Anxiety and Depression Scale for anxiety (48%) or depression (34%), had sleeping problems (56%) or experienced pain (54%). A number of factors were more common in patients who indicated that their wait time had been too long: low education level (OR 7.4, 95% CI 0.5 to 5.0, p=0.007), time to surgery >4 weeks (OR 7.0, 95% CI 0.8 to 4.4, p=0.002) and experienced sleep disturbance (OR 3.27, 95% CI 0.0 to 3.1, p=0.05). If patients expectation of wait time was >4 weeks (OR 0.20, 95% CI −4.0 to −0.5 p=0008) or if patients experienced pain (OR 0.26, 95% CI −3.6 to −0.3, p=0.03), they less frequently indicated that wait time had been too long.

Conclusion

To improve patient-centredness of care, healthcare providers should aim to reduce wait time to 3–4 weeks and ensure that patients are well informed about the length of wait time and are aware of high levels of anxiety, depression and pain during this time. Future studies should evaluate what interventions can improve QoL during wait time.
Recombinant fragment of human surfactant protein D to prevent neonatal chronic lung disease (RESPONSE): a protocol for a phase I safety trial in a tertiary neonatal unit
Authors: Bhatt Reena , Madsen Jens , Castillo-Hernandez Tania , Chant Kathy , Dehbi Hakim-Moulay , Marlow Neil , Clark Howard
Published: August 2024

Introduction

Chronic respiratory morbidity from bronchopulmonary dysplasia (BPD) remains the most common complication of preterm birth and has consequences for later respiratory, cardiovascular and neurodevelopmental outcomes. The early phases of respiratory illness are characterised by rapid consumption of endogenous surfactant and slow replenishment. Exogenous surfactant is routinely administered to infants born before 28 weeks of gestation as prophylaxis. Endogenous surfactant includes four proteins, known as surfactant proteins (SPs) A, B, C and D. Current bovine-derived and porcine-derived surfactant preparations only contain SPs B and C. SP-D has a key role in lung immune homeostasis as part of the innate immune system. Laboratory studies using recombinant SP-D have demonstrated reduced inflammation, which may be a pathway to reducing the associated morbidity from BPD. RESPONSE uses a recombinant fragment of human SP D (rfhSP-D), in a phase I safety and dose-escalation trial as the first stage in determining its effect in humans.

Methods and analysis

This is a single-centre, dose-escalation, phase I safety study aiming to recruit 24 infants born before 30 weeks gestation with respiratory distress syndrome. In addition to routine surfactant replacement therapy, participants will receive three doses of rfhSP-D via endotracheal route at either 1 mg/kg, 2 mg/kg or 4 mg/kg. The study uses a Bayesian continual reassessment method to make dose escalation decisions. Dose-limiting events (DLE) in this trial will be graded according to the published Neonatal Adverse Event Severity Score. The primary outcome of this study is to evaluate the safety profile of rfhSP-D across each dose level based on the profile of DLE to establish the recommended phase 2 dose (RP2D) of rfhSP-D.

Ethics and dissemination

The RESPONSE study has received ethical approval from London-Brent NHS Research Health Authority ethics committee. Results from the study will be published in peer-reviewed journals and presented at national and international conferences.

Trial registration numbers

ISRCTN17083028,NCT05898633.

Protocol version

RESPONSE Protocol V.4.0 24th July 2024.
Economic evaluations of pancreatic cancer screening: a systematic review protocol
Authors: Wittram Robert , König Hans-Helmut , Brettschneider Christian
Published: August 2024

Introduction

The early detection of pancreatic cancer is an important step in reducing mortality by offering patients curative treatment. Screening strategies in risk populations and by means of different detection methods have been economically evaluated. However, a synthesis of screening studies to inform resource allocation towards early detection within the disease area has not been done. Therefore, studies evaluating the cost-effectiveness and costs of screening for pancreatic cancer should be systematically reviewed.

Methods and analysis

A systematic review of economic evaluations reporting the cost-effectiveness or costs of pancreatic cancer screening will be conducted. The electronic databases Medline, Web of Science and EconLit will be searched without geographical or time restrictions. Two independent reviewers will select eligible studies based on predefined criteria. The study quality will be assessed using the Consolidated Health Economic Evaluation Reporting Standards statement and the Bias in Economic Evaluation checklist. One reviewer will extract relevant data and a second reviewer will cross-check compliance with the extraction sheet. Key items will include characteristics of screened individuals, the screening strategies used, and costs, health effects and cost-effectiveness as study outputs. Differences of opinion between the reviewers will be solved by consulting a third reviewer.

Ethics and dissemination

Ethics approval is not required for this study since no original data will be collected. The results will be disseminated through presentations at conferences and publication in a peer-reviewed journal. The results of the systematic review will inform future economic evaluations of pancreatic screening, which provide guidance for decision-making in healthcare resource prioritisation.

PROSPERO registration number

CRD42023475348.
Study protocol of a sequential, multiple assignment, randomised trial using an adaptive intervention to reduce loneliness among Chinese older adults in Hong Kong
Authors: Tang Vivien Foong Yee , Jiang Da , Kwok Jojo Yan Yan , Qian Min , Yeung Dannii Yuen-lan , Chow Esther Oi Wah , Choi Namkee G , Chou Kee Lee
Published: August 2024

Background

Loneliness is a prevalent and alarming issue among older adults that requires effective interventions. While randomised controlled trials have been commonly undertaken to explore reduction in loneliness, there is a growing recognition that a comprehensive treatment strategy involving multiple interventions may yield better outcomes. Therefore, this study aims to develop and identify a two-stage adaptive intervention that combines telephone-delivered behavioural activation (Tele-BA) and mindfulness techniques (Tele-MF) to reduce loneliness in older adults in Hong Kong.

Methods

A Sequential, Multiple Assignment, Randomised Trial (SMART) design will be adopted. 244 lonely older adults will be recruited from the community and randomly assigned to either one of the 4-week two-stage, embedded adaptive interventions involving different sequences and dosages of Tele-BA and Tele-MF (eg, 4 weeks of Tele-BA followed by booster sessions for responders or 4 weeks of Tele-BA followed by 4 weeks of Tele-BA with motivational component or 4 weeks of Tele-MF for non-responders) based on a set of decision rules. The primary outcome will be loneliness measured by the Revised University of California Los Angeles (UCLA) Loneliness Scale. Secondary outcomes, such as De Jong Gierveld Loneliness Scale, perceived stress, sleep quality and depressive and anxiety symptoms, will be assessed. Adhering to the intention-to-treat principles, the data will be analysed using linear mixed models. The findings may have implications for the development of psychosocial adaptive interventions involving BA and MF to reduce loneliness and improve well-being among older adults in Hong Kong using the SMART design.

Ethics and dissemination

Ethical approval was obtained by the Human Research Ethics Committee at The Education University of Hong Kong (reference: 2022-2023-0117). The findings from this study will be presented in academic conferences and submitted for publication.

Trial registration number

ChiCTR2300077472.
Factors influencing the reliability of measurements in eyes with full-thickness macular holes: are we measuring incorrectly?
Authors: Moussa George , Jalil Assad , Lippera Myrta , Alnafisee Nouf , Ivanova Tsveta
Published: August 2024

Purpose

The calliper function is used for manual measurements of full thickness macular holes (FTMHs). We aimed to investigate whether a reproducible difference could be detected beyond interobserver variability between two commonly used manufacturers in their manual calliper facility in spectral domain optical coherence tomography (OCT) for metrics related to FTMH.

Methods

This is a non-interventional, retrospective, observational study. Two independent observers examined 8 eyes (16 OCT) scans and 128 measurements (minimal linear diameter (MLD), basal diameter and hole height on both sides) of FTMHs, taken on Heidelberg Spectralis and Topcon Triton (OCT machines). The interobserver agreement and OCT machine agreement of measurements were analysed by Bland-Altman plots and intraclass correlation coefficient (ICC) analysis. Spectralis and Triton had 125 µm and 50 µm horizontal b-scan spacing, respectively.

Results

Overall, we report high absolute agreement in interobserver (ICC 0.991 (95% CI 0.985 to 0.995, p<0.001)) and OCT machine (ICC 0.993 (95% CI 0.987 to 0.996, p<0.001)) variability. Lower horizontal resolution in Triton compared with Spectralis leads to interobserver variability, in smaller horizontal measurements. Lower horizontal scanning density in Spectralis lead to relatively large interobserver variation if different reference scans were chosen, and consistently smaller MLD measurements than Triton. Vertical measurements without 1:1 scaling lead to inaccurate exaggerated oblique vertical measurements. Calliper function appears otherwise identically calibrated.

Conclusions

We report excellent interobserver and OCT machine agreement in measurements. However, the paper shows several factors that could influence the reliability of measurements acquired in eyes with FTMHs, such as the dimension of the hole as well as different image resolution, density scanning protocols or vertical scaling of the OCT machines viewing platform.
Improvement of temperature surveillance of neonates in low-resource settings by a simple low-cost device: a descriptive study
Authors: Garvs Janneke , Genzel-Boroviczény Orsolya , Phiri Ajib , Schultz Andreas
Published: August 2024

Introduction

Neonatal hypothermia in low-resource settings is prevalent and closely associated with high morbidity and mortality. We examined if an easy-to-read temperature detector device improves health outcomes.

Methods

In a descriptive study, 1009 admissions to a neonatal ward in a tertiary care hospital in Lilongwe, Malawi, were analysed and divided into a baseline and a trial group. The data of 531 newborns with standard care (SC) before the trial were compared with 478 newborns during the implementation of the device (device care=DC). Staff and caregivers were trained on using the device and how to react in case of hypothermia. Data were collected from patient files, device documentation sheets, interviews and focus group discussions. Hypothermia was defined as a body temperature <36.5°C.

Results

During the trial, body temperatures throughout the hospital stay were significantly more often obtained (p<0.0001). The median temperature measurements per newborn per day were 1.3 times with SC and 1.6 times with DC, and mild hypothermia was more frequently detected. Moderate hypothermia was avoided in the lightest weight group possibly contributing to significantly shorter hospital stays of surviving newborns (p=0.007). Many caregivers had difficulties using and interpreting the device correctly, and 47% of the reported colours did not match the registered temperatures. Contrary to the above, a questionnaire and focus group discussions with caregivers and health workers showed a high acceptance and the overall opinion that the device was beneficial.

Conclusion

With more frequent temperature checks, infants with lower birth weight possibly benefited from implementing an easy-to-read continuous temperature indicator, but hypothermia rates remained high. Our data and experiences reveal structural, communicational and consistency/interpretation deficits. Although specifically designed for low-resource settings, the implementation of the device needs a well-working and structured environment, especially regarding staff and caregiver communication.
Swedish elite athletes’ experiences of psychotherapy for mental health concerns provided by licensed psychologists and psychotherapists: a qualitative study
Authors: Lundqvist Carolina , Wig Jonas , Schary David P
Published: August 2024

This study explores elite athletes’ experiences of psychotherapy administered by Swedish licensed psychologists or psychotherapists with and without specialisation in elite sports, addressing the research question: What do elite athletes experience as important for psychotherapy effectiveness when seeking treatment from a licensed clinical psychologist or psychotherapist? Five elite athletes (self-assigned women=4, self-assigned men=1; age range: 20–34 years) from three sports (fencing: n=2, handball: n=2, triathlon: n=1) volunteered to participate in interviews. All athletes had worked with more than one licensed psychologists/psychotherapist, either through a regional healthcare or an elite sports specialised clinic while being national or international elite sports level athletes. Data were inductively analysed by the use of reflexive thematic analysis. Trust and professionalism to the psychologist/psychotherapist were generated as an overarching theme. Themes created during data analysis included the psychologist/psychotherapist’s (a) understanding of elite sports and of both the person and the athlete, (b) psychotherapeutic behaviours or skills (ie, holistic problem assessment, communication, empathy, validation, confidentiality, therapeutic alliance, goal-oriented content and ability to tailor psychotherapy to the athlete) and (c) conditions for psychotherapy (time, accessibility and appropriate support). Participants expressed difficulties in differentiating between qualified and unqualified mental health support providers. Mental health services originating within the sport context were perceived to improve accessibility and the possibility of regular sessions. Mental health services provided outside the immediate sporting context, with the psychologist/psychotherapist not being overly involved in sports, was however perceived to enable a more objective and holistic assessment of both non-sport and sport-related concerns impacting on athlete mental health. We conclude that sports organisations must facilitate athletes’ access to psychological treatment, and additionally ensure that practitioners working with psychotherapy have professional expertise and are appropriately qualified. Sports organisations should also systematically evaluate mental health services to ensure quality and that they are up to date with best practices.
What influences ambulance clinician decisions to pre-alert emergency departments: a qualitative exploration of pre-alert practice in UK ambulance services and emergency departments
Authors: O'Hara Rachel , Sampson Fiona C , Long Jaqui , Coster Joanne , Pilbery Richard
Published: August 2024

Background

Ambulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving emergency department (ED) or other clinical area to prepare. Pre-alerts are key to ensuring immediate access to appropriate care, but unnecessary pre-alerts can divert resources from other patients and fuel ‘pre-alert fatigue’ among ED staff. This research aims to provide a better understanding of pre-alert decision-making practice.

Methods

Semi-structured interviews were conducted with 34 ambulance clinicians from three ambulance services and 40 ED staff from six receiving EDs. Observation (162 hours) of responses to pre-alerts (n=143, call-to-handover) was also conducted in the six EDs. Interview transcripts and observation notes were imported into NVIVO and analysed using thematic analysis.

Findings

Pre-alert decisions involve rapid assessment of clinical risk based on physiological observations, clinical judgement and perceived risk of deterioration, with reference to pre-alert guidance. Clinical experience (pattern recognition and intuition) and confidence helped ambulance clinicians to understand which patients required immediate ED care on arrival or were at highest risk of deterioration. Ambulance clinicians primarily learnt to pre-alert ‘on the job’ and via informal feedback mechanisms, including the ED response to previous pre-alerts. Availability and access to clinical decision support was variable, and clinicians balanced the use of guidance and protocols with concerns about retention of clinical judgement and autonomy. Differences in pre-alert criteria between ambulance services and EDs created difficulties in deciding whether to pre-alert and was particularly challenging for less experienced clinicians.

Conclusion

We identified potentially avoidable variation in decision-making, which has implications for patient care and emergency care resources, and can create tension between the services. Consistency in practice may be improved by greater standardisation of guidance and protocols, training and access to performance feedback and cross-service collaboration to minimise potential sources of tension.
Can levels of neuron-specific enolase be used in the diagnostic workup of possible cauda equina syndrome?
Authors: Nicholson Emily , Jaconelli Tom , Crane Steven
Published: August 2024

A shortcut review of the literature was carried out to examine whether the measurement of neuron-specific enolase (NSE) can be used as a marker to exclude spinal cord, cauda equina or other significant spinal nerve root compression. 132 papers were found of which 4 included data on patients relevant to the clinical question, these are discussed in the paper. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. The clinical bottom line is that to date there is no evidence to suggest that measurement of NSE would be beneficial in clinical practice to rule out compression.
Clinical outcomes of potential coeliac disease: a systematic review and meta-analysis
Authors: Shiha Mohamed G , Schiepatti Annalisa , Maimaris Stiliano , Nandi NIcoletta , Penny Hugo A , Sanders David S
Published: August 2024

Objective

Potential coeliac disease (PCD) is characterised by positive serological and genetic markers of coeliac disease with architecturally preserved duodenal mucosa. The clinical outcomes and rates of progression to overt coeliac disease in patients with PCD remain uncertain. In this systematic review and meta-analysis, we aimed to evaluate the clinical outcomes of patients with PCD.

Design

We searched Medline, Embase, Scopus and Cochrane Library from 1991 through May 2024 to identify studies evaluating the clinical outcomes of patients with PCD. The progression rates to villous atrophy, seroconversion and response to a gluten-free diet (GFD) were analysed. A random-effect meta-analysis was performed, and the results were reported as pooled proportions with 95% CIs.

Results

Seventeen studies comprising 1010 patients with PCD were included in the final analyses. The pooled prevalence of PCD among patients with suspected coeliac disease was 16% (95% CI 10% to 22%). The duration of follow-up in most of the studies was at least 1 year, with follow-up periods within individual studies ranging from 5 months to 13 years. During follow-up, 33% (95% CI 18% to 48%; I2=96.4%) of patients with PCD on a gluten-containing diet developed villous atrophy, and 33% (95% CI 17% to 48%; I2=93.0%) had normalisation of serology. Among those who adhered to a GFD, 88% (95% CI 79% to 97%; I2=93.2%) reported symptomatic improvement.

Conclusion

Almost a third of patients with PCD develop villous atrophy over time, whereas a similar proportion experience normalisation of serology despite a gluten-containing diet. Most symptomatic patients benefit from a GFD. These findings highlight the importance of structured follow-up and individualised management for patients with PCD.
Molecular confirmation that fibrocartilaginous dysplasia is a variant of fibrous dysplasia
Authors: Zhou Juan , Su Xuling , Hu Dingjun , Zhang Li , Chen Chunyan , Sun Keyang , Zhang Huizhen , Liu Zhiyan
Published: August 2024

Aims

Fibrocartilaginous dysplasia (FCD) is a subvariant of fibrous dysplasia (FD). This study aims to retrospectively elucidate the clinicopathological and separate genetic features of the cartilaginous and fibro-osseous components of FCD.

Methods

In total, 24 patients (14 men and 10 women) with FCD were included in our cohort. The diagnosis was confirmed morphologically and immunohistochemically, and genetic features were determined via Sanger sequencing.

Results

Five patients were polyostotic, and 19 were monostotic, predominantly concerning the femur. Radiography revealed a well-demarcated ground glass appearance with ring-like or scattered calcification. Histologically, the lesions were characterised by proliferative fibroblasts, immature woven bone and highly differentiated hyaline cartilage. The fibro-osseous components exhibited positive immunoreaction with SATB2 and a low Ki-67 proliferation index. The fibro-osseous and cartilaginous components shared mutations at codon 201 in exon 8 of the guanine nucleotide-binding protein/a-subunit (GNAS)gene, specifically CGT>CAT (p.R201H) in four patients and the wild-type isocitrate dehydrogenase (IDH)1/IDH2gene. Telomerase reverse transcriptase (TERT)promoter mutations (C288T and C229G) occurred in both fibro-osseous and cartilaginous components in two patients.

Conclusions

FCD encompasses areas of conventional FD with additional cartilage. Importantly, the presence or absence of mutations in theGNASgene and/or theTERTpromoter is common between the fibro-osseous and cartilaginous components of the disease. These results further confirmed FCD as a variant of FD.
Effect of Universal Credit on young children’s mental health: quasi-experimental evidence from Understanding Society
Authors: Song Huihui , Zhang Anwen , Barr Benjamin , Wickham Sophie
Published: August 2024

Background

Child mental health has become an increasingly important issue in the UK, especially in the context of significant welfare reforms. Universal Credit (UC) has introduced substantial changes to the UK’s social security system, significantly impacting low-income families. Our aim was to assess the effects of UC’s introduction on children’s mental health for families eligible for UC versus a comparable non-eligible sample.

Methods

Using Understanding Society data from 5806 observations of 4582 children (aged 5 or 8 years) in Great Britain between 2012 and 2018, we created two groups: children whose parents were eligible for UC (intervention group) and children whose parents were ineligible for UC (comparison group). Child mental health was assessed using a parent-reported Strengths and Difficulties Questionnaire. The OR and percentage point change in the prevalence of children experiencing mental health difficulties between the intervention group and the comparison group following the introduction of UC were analysed. We also investigated whether the utilisation of childcare services and changes in household income were mechanisms by which UC impacted children’s mental health.

Results

Logistic regression results demonstrated that the prevalence of mental health problems among eligible children whose parents were unemployed increased by an OR of 2.18 (95% CI 1.14 to 4.18), equivalent to an 8-percentage point increase (95% CI 1 to 14 percentage points) following the introduction of UC, relative to the comparison group. Exploring potential mechanisms, we found neither reduced household income nor increased use of childcare services, which served as a proxy for reduced time spent with parents, significantly influenced children’s mental health.

Conclusions

UC has led to an increase in mental health problems among recipient children, particularly for children in larger families and those aged 8. Policymakers should carefully evaluate the potential health consequences for specific demographics when introducing new welfare policies.
Circulating extracellular vesicles in Systemic Lupus Erythematosus: physicochemical properties and phenotype
Authors: Losada Paula X , Serrato Lina , Daza Ana María , Vanegas-García Adriana , Muñoz Carlos H , Rodriguez Daniel , Diaz Juan Camilo , Pineda Ricardo , Rojas Lopez Mauricio , Vásquez Gloria
Published: August 2024

Objective

This study aimed to identify the physicochemical and phenotypic characteristics of circulating Extracellular Vesicles (EVs) in the plasma of patients with SLE, with or without Lupus Nephritis (LN), and their potential utility as disease biomarkers.

Methods

Plasma-circulating EVs were concentrated using differential centrifugation from adult female patients (n=38) who met the ‘American College of Rheumatology/European Alliance of Associations for Rheumatology 2019’ criteria for SLE diagnosis with (LN) or without LN (nLN), confirmed by renal biopsy. Controls (n=18) were healthy volunteers matched by gender and similar age. The structure, size and Energy Dispersion Spectrum (EDS) of EVs were observed by electron microscopy. The surface charge and size distribution were evaluated using dynamic light scattering. The counts and phenotype of EVs from patients (SLE-EVs) and controls (Ctrl-EVs) were obtained using flow cytometry. Non-parametric statistical tests and exploratory analysis of multiple variables were performed. The discriminatory power of some variables as potential biomarkers of the disease was also evaluated.

Results

Circulating EVs were heterogeneous in morphology and size, but SLE-EVs reached larger diameters than Ctrl-EVs (p<0.0001). Small SLE-EVs and large SLE-EVs were increased compared with Ctrl-EV (p<0.0001 and p<0.05, respectively). Likewise, patients with SLE (LN or nLN) had higher concentrations of large EVs compared with controls (p<0.001 and p<0.0001, respectively). SLE-EVs showed a different EDS (p<0.001) and were less electronegative (p<0.0001) than Ctrl-EVs. EV-CD45+, EV-CD14+ and EV-IgM+ were more frequent in patients with SLE compared with controls (p<0.001, p<0.05 and p<0.001, respectively). The concentrations of large EVs and EV-IgM+ allowed better discrimination of patients from controls.

Conclusions

Plasma-circulating EVs from patients with SLE with and without nephritis are increased in peripheral blood and have different physicochemical properties than controls. Characteristics of EVs such as larger size and the presence of IgM on the surface could help discriminate patients from controls.
Criteria for continuous neuraxial analgesia associated with reduced mortality in patients undergoing thoracotomy
Authors: Semmelmann Axel , Baar Wolfgang , Moneke Isabelle , Loop Torsten
Published: August 2024

Introduction

Both thoracic epidural analgesia and thoracic paravertebral analgesia are effective techniques to control pain and minimize the stress response following thoracic surgery. We hypothesized that continuous neuraxial techniques may be associated with a decrease in the incidence of postoperative mortality after thoracotomy. Additionally, we aimed to identify subgroup populations that may benefit more from neuraxial anesthesia.

Method

1620 patients who underwent open thoracotomy were included in this retrospective study from the German Thoracic Registry database at four university hospitals. All-cause inpatient mortality was determined for patients who had and did not have neuraxial anesthesia. Logistic regression was used to adjust for and explore various covariates.

Results

Continuous neuraxial analgesia was associated with a lower overall mortality in the postoperative period (2.9%, 23/796 vs 5.3%, 44/824, p=0.02) only after the univariate analysis but not the multivariable analysis (OR 0.49, 95 % CI 0.237 to 1.12, p=0.15). In patients with epidural or paravertebral catheters, mortality was significantly lower in the following subgroups: age >75 (5/113 vs 18/77, OR 0.1, 95% CI 0.02 to 0.67, p=0.02), American Society of Anesthesiologists Performance Score >III (11//97 vs 33/155, OR 0.32, 95% CI 0.11 to 0.89, p=0.03), chronic kidney disease (5/83 vs 16/77, OR 0.16, 95% CI 0.03 to 0.82, p=0.03), and postoperative sepsis (9/21 vs 17/25, OR 0.13, 95% CI 0.07 to 0.44, p<0.01).

Conclusions

Neuraxial analgesic techniques are associated with reductions in postoperative mortality after open thoracic surgery in selected patients.
Pulmonary fibrosis may begin in infancy: from childhood to adult interstitial lung disease
Authors: Griese Matthias , Kurland Geoffrey , Cidon Michal , Deterding Robin R , Epaud Ralph , Nathan Nadia , Schwerk Nicolaus , Warburton David , Weinman Jason P , Young Lisa R , Deutsch Gail H
Published: August 2024

Background

Childhood interstitial lung disease (chILD) encompasses a group of rare heterogeneous respiratory conditions associated with significant morbidity and mortality. Reports suggest that many patients diagnosed with chILD continue to have potentially progressive or fibrosing disease into adulthood. Over the last decade, the spectrum of conditions within chILD has widened substantially, with the discovery of novel entities through advanced genetic testing. However, most evidence is often limited to small case series, with reports disseminated across an array of subspecialty, clinical and molecular journals. In particular, the frequency, management and outcome of paediatric pulmonary fibrosis is not well characterised, unlike in adults, where clear diagnosis and treatment guidelines are available.

Methods and results

This review assesses the current understanding of pulmonary fibrosis in chILD. Based on registry data, we have provisionally estimated the occurrence of fibrosis in various manifestations of chILD, with 47 different potentially fibrotic chILD entities identified. Published evidence for fibrosis in the spectrum of chILD entities is assessed, and current and future issues in management of pulmonary fibrosis in childhood, continuing into adulthood, are considered.

Conclusions

There is a need for improved knowledge of chILD among pulmonologists to optimise the transition of care from paediatric to adult facilities. Updated evidence-based guidelines are needed that incorporate recommendations for the diagnosis and management of immune-mediated disorders, as well as chILD in older children approaching adulthood.
Topology of black hole thermodynamics via Rényi statistics
Authors: Tong Chen-Wei , Wang Bin-Hao , Sun Jia-Rui
Published: August 2024

In this paper, we investigate the topological numbers of the four-dimensional Schwarzschild black hole, d-dimensional Reissner–Nordström (RN) black hole, d-dimensional singly rotating Kerr black hole and five-dimensional Gauss–Bonnet black hole via the Rényi statistics. We find that the topological number calculated via the Rényi statistics is different from that obtained from the Gibbs–Boltzmann (GB) statistics. However, what is interesting is that the topological classifications of different black holes are consistent in both the Rényi and GB statistics: the four-dimensional RN black hole, four-dimensional and five-dimensional singly rotating Kerr black holes, five-dimensional charged and uncharged Gauss–Bonnet black holes belong to the same kind of topological class, and the four-dimensional Schwarzschild black hole and $$d(>5)$$

d
(
>
5
)

-dimensional singly rotating Kerr black holes belong to another kind of topological class. In addition, our results suggest that the topological numbers calculated via the Rényi statistics in asymptotically flat spacetime background are equal to those calculated from the standard GB statistics in asymptotically AdS spacetime background, which provides more evidence for the connection between the nonextensivity of the Rényi parameter $$\lambda $$
λ
and the cosmological constant $$\Lambda $$
Λ
.