bluuebunny/crossref_metadata_2025 huggingface dataset:
Observational study of the relationship between nurse staffing levels and compliance with mandatory nutritional assessments in hospital
Authors: Recio‐Saucedo A. , Smith G. B. , Redfern O. , Maruotti A. , Griffiths P. ,   Missed Care Study Group
Published: January 2021

Background

In the UK, it is recommended that hospital patients have their nutritional status assessed within 24 h of admission using the Malnutrition Universal Screening Tool (MUST). The present study aimed to examine the association between nurse staffing levels and missed nutritional status assessments.

Methods

A single‐centre, retrospective, observational study was employed using routinely collected MUST assessments from 32 general adult hospital wards over 2 years, matched to ward nurse staffing levels. We used mixed‐effects logistic regression to control for ward characteristics and patient factors.

Results

Of 43 451 instances where staffing levels could be linked to a patient for whom an assessment was due, 21.4% had no MUST score recorded within 24 h of admission. Missed assessments varied between wards (8–100%). There was no overall association between registered nurse staffing levels and missed assessments; although higher admissions per registered nurse were associated with more missed assessments [odds ratio (OR) = 1.09, P = 0.005]. Higher healthcare assistant staffing was associated with lower rates of missed assessments (OR = 0.80, P < 0.001). There was a significant interaction between registered nurses and healthcare assistants staffing levels (OR = 0.97, P = 0.011).

Conclusions

Despite a written hospital policy requiring a nutritional assessment within 24 h of admission, missed assessments were common. The observed results show that compliance with the policy for routine MUST assessments within 24 h of hospital admission is sensitive to staffing levels and workload. This has implications for planning nurse staffing.
Demography of the Intertidal Fucoid Hormosira banksii: Importance of Recruitment to Local Abundance
Authors: Lewis Ryan D. , Johnson Craig R. , Wright Jeffrey T.
Published: January 2021

Canopy‐forming macroalgae form the basis of diverse coastal ecosystems globally. The fucoid Hormosira banksii is often the dominant canopy‐forming macroalga in the temperate intertidal of southern Australia and New Zealand, where it is commonly associated with an understory of coralline turf. Hormosira banksii is susceptible to both natural and anthropogenic disturbance and despite its abundance, few studies have examined the demography of this important species. This study determined the demographic response of H. banksii to different gradients of disturbance to both its canopy and to the understory coralline turf. We established plots in which the density of H. banksii and/or understory coralline turf was manipulated in a pulse perturbation to simulate a disturbance event. The manipulated plots contained eight treatments ranging from 100% removal of H. banksii to 100% removal of the understory coralline turf. We then measured recruitment and followed individual recruits for up to 18 months to determine growth and survivorship. We found that H. banksii recruitment was seasonally variable throughout the experiment and highest over summer, survivorship of recruits was generally high, and the species was slow‐growing and long‐lived. Moreover, the level of disturbance did not seem to affect recruitment, growth, or survivorship and post‐recruitment mortality was independent of H. banksii density. In this system, it appears that H. banksii is a relatively long‐lived perennial species whose demography is density‐independent which appears to allow recovery from disturbance.
Suppression gene drive in continuous space can result in unstable persistence of both drive and wild‐type alleles
Authors: Champer Jackson , Kim Isabel K. , Champer Samuel E. , Clark Andrew G. , Messer Philipp W.
Published: January 2021

Rapid evolutionary processes can produce drastically different outcomes when studied in panmictic population models vs. spatial models. One such process is gene drive, which describes the spread of “selfish” genetic elements through a population. Engineered gene drives are being considered for the suppression of disease vectors or invasive species. While laboratory experiments and modelling in panmictic populations have shown that such drives can rapidly eliminate a population, it remains unclear if these results translate to natural environments where individuals inhabit a continuous landscape. Using spatially explicit simulations, we show that the release of a suppression drive can result in what we term “chasing” dynamics, in which wild‐type individuals recolonize areas where the drive has locally eliminated the population. Despite the drive subsequently reconquering these areas, complete population suppression often fails to occur or is substantially delayed. This increases the likelihood that the drive is lost or that resistance evolves. We analyse how chasing dynamics are influenced by the type of drive, its efficiency, fitness costs, and ecological factors such as the maximal growth rate of the population and levels of dispersal and inbreeding. We find that chasing is more common for lower efficiency drives when dispersal is low and that some drive mechanisms are substantially more prone to chasing behaviour than others. Our results demonstrate that the population dynamics of suppression gene drives are determined by a complex interplay of genetic and ecological factors, highlighting the need for realistic spatial modelling to predict the outcome of drive releases in natural populations.
Dermatophytic melanonychia: A case series of an increasing disease
Authors: Starace Michela , Ambrogio Francesca , Bruni Francesca , Piraccini Bianca Maria , Alessandrini Aurora
Published: January 2021

Background

Melanonychia refers to brown‐black colour pigmentation due to melanin or not‐melanin deposition in the nail plate. Onychoscopy allows to distinguish if the pigmentation is due by melanin or not.

The main causes of non‐melanic pigmentation are subungual haematoma and pigmented onychomycosis. Fungal melanonychia (FM) is rare and may present as diffuse or longitudinal pigmentation. Differential diagnosis includes melanic activation, such as ethnic‐type nail pigmentation or frictional melanonychia, but also versus melanic proliferation, such as nevus or nail melanoma. Fungal melanonychia can be due to a colonisation by fungi with black variant or by melanin activation due to inflammation of fungal invasion.

Objectives

The aim of paper is to increase clinical and dermoscopic knowledge of this increasingly frequent disease.

Methods

In this retrospective observational study, twenty patients with dermatophytic melanonychia were collected, with available clinical and dermoscopic pictures. The diagnosis of dermatophytic melanonychia was made based on clinical manifestation and mycological examination. KOH smear was performed in all cases. For each patient, clinical data included: age, gender, type of melanonychia and involved fingers.

Results

This study aimed to show increased incidence of dermatophytic melanonychia and its correct management. In addition, we reviewed our collected cases and described the clinical and dermoscopic features of dermatophytic melanonychia.

Conclusions

The results of this study showed that physicians should keep in mind the diagnosis of this increasing disease, and that it cannot be performed relying only on clinical grounds. We would like to highlight the importance of tools as KOH examination, culture and dermoscopy.
Inflation volume‐balloon diameter and inflation pressure‐balloon diameter characteristics of commonly used bronchial blocker balloons for single‐lung ventilation in children
Authors: Goetschi Markus , Kemper Michael , Kleine‐Brueggeney Maren , Dave Mital H. , Weiss Markus
Published: January 2021

Background

Balloon‐tipped bronchial blocker catheters are widely used in pediatric thoracic anesthesia to establish single‐lung ventilation. In clinical practice, their balloons demonstrate sudden expansion when inflated with air. In addition, there are concerns related to the high inflation pressures required to expand the balloons.

Methods

This in vitro study assessed inflation volume‐ and inflation pressure‐balloon diameter characteristics of the Fogarty arterial embolectomy catheters and Arndt endobronchial blockers. Balloon diameters were photographically assessed during unrestricted volume‐ and pressure‐guided inflation, using air up to the maximum allowed inflation volume as indicated by the manufacturers. Inflation pressures required to open the blocker balloons and inflation pressures needed to expand them to maximum indicated diameter were measured.

Results

Volume‐guided inflation demonstrated a late acute rise in diameter in Fogarty blocker balloons, whereas in the Arndt endobronchial blocker balloons almost linear inflation volume‐to‐diameter characteristics were observed. Pressure‐guided inflation on the other hand demonstrated low‐volume, high‐pressure characteristics in the Fogarty blocker balloons, with inflation pressures required to expand the balloons to maximum diameters ranging from (mean (SD)) 636 (75) to 947 (152) cmH2O. The inflation pressures required to open the Fogarty blocker balloons were even >1000 cmH2O. Inflation pressures required to expand the 5 F, 7 F, and 9 F Arndt endobronchial blocker balloons to maximum indicated diameter were much lower, namely at 218 (15), 252 (28), and 163 (8) cmH2O.

Conclusion

Based on these study findings, the balloons of Fogarty arterial embolectomy catheters represent high‐pressure devices and do not permit stepwise controlled bronchial blockage. The Arndt endobronchial blockers have some advantages over the Fogarty blocker devices, but also represent high‐pressure equipment and must be used with caution and limited duration. Manufacturers are asked to design pediatric endobronchial blocker catheters with truly high‐volume, low‐pressure balloons in accordance to age‐related pediatric airway dimensions.
Predictors of glucose metabolism and blood pressure among Ethiopian individuals with HIV/AIDS after one‐year of antiretroviral therapy
Authors: Amare Hiwot , Olsen Mette F. , Friis Henrik , Andersen Åse B. , Abdissa Alemseged , Yilma Daniel , Girma Tsinuel , Faurholt‐Jepsen Daniel
Published: January 2021

Objective

Better understanding of glucose metabolism in patients with HIV after initiating antiretroviral therapy (ART) is important to target treatment and follow‐up for diabetes risk and other non‐communicable diseases in resource‐limited settings. The aim of this study was to assess the changes and predictors of glucose metabolism and blood pressure among patients with HIV on ART for 12 months.

Methods

One‐year follow‐up of Ethiopian patients with HIV after initiation of ART was done. Outcomes were changes in fasting plasma glucose (FPG), and 30‐minute (30mPG) and 2‐hour plasma glucose (2hPG) after oral glucose tolerance test, glycated haemoglobin (HbA1c), fasting plasma insulin (p‐insulin), homeostatic model assessment index for insulin resistance (HOMA‐IR) and blood pressure.  

Results

The mean age was 33 years, and the majority were women. During the first 12 months, levels of all plasma glucose parameters decreased, while p‐insulin (10B 3.1; 95% CI2.4, 4.0), HOMA‐IR (10B 3.1; 95% CI2.3, 4.0) and systolic blood pressure (B 4.0; 95% CI2.5, 5.5) increased. Fat‐free mass at baseline predicted higher increments in p‐insulin, HOMA‐IR and blood pressure; whereas, fat mass predicted higher increment in HbA1c.

Conclusions

Among Ethiopian patients with HIV, blood pressure and insulin increased, and all glucose parameters declined during 12‐month of ART. Only longer‐term follow‐up will tell us whether insulin increase is due to insulin resistance or from recovering β‐cells.
Hop Performance After Return to Sport in Anterior Cruciate Ligament-Reconstructed Gaelic Football and Hurling Athletes
Authors: Murphy Damien , Louw Quinette A. , Moloney Colum , Leibbrandt Dominique , Clifford Amanda M.
Published: January 2021

Purpose: Anterior cruciate ligament (ACL) injuries are among the most severe injuries in the Gaelic Athletic Association. Hop tests measure functional performance after ACL reconstruction as they replicate the key requirements for a match situation. However, research examining functional recovery of ACL-reconstructed Gaelic athletes is lacking. The objective of this study is to determine if athletes restore normal hop symmetry after ACL reconstruction and to examine if bilateral deficiencies persist in hop performance following return to sport. Methods: A cross-sectional design was used to evaluate hop performance of 30 ACL-reconstructed Gaelic athletes who had returned to competition and 30 uninjured controls in a battery of hop tests including a single, 6-m, triple, and triple-crossover hop test. Results: In each test, the mean symmetry score of the ACL reconstruction group was above the cutoff for normal performance of 90% adopted by this study (98%, 99%, 97%, and 99% for the single, 6-m, triple, and triple-crossover hop, respectively). No significant differences in absolute hop scores emerged between involved and control limbs, with the exception of the single-hop test where healthy dominant limbs hopped significantly further than ACL-reconstructed dominant limbs (P = .02). No significant deficits were identified on the noninvolved side. Conclusions: The majority of ACL-reconstructed Gaelic athletes demonstrate normal levels of hop symmetry after returning to competition. Suboptimal hop performance can persist on the involved side compared with control limbs. Targeted rehabilitation may be warranted after returning to competition to restore performance to levels of healthy uninjured athletes.
The Effects of Intermittent Pneumatic Compression on the Reduction of Exercise-Induced Muscle Damage in Endurance Athletes: A Critically Appraised Topic
Authors: Stedge Hannah L. , Armstrong Kirk
Published: January 2021

Clinical Scenario: Endurance sports require a great deal of physical training to perform well. Endurance training and racing stress the skeletal muscle, resulting in exercise-induced muscle damage (EIMD). Athletes attempt to aid their recovery in various ways, one of which is through compression. Dynamic compression consists of intermittent pneumatic compression (IPC) devices, such as the NormaTec Recovery System and Recovery Pump. Clinical Question: What are the effects of IPC on the reduction of EIMD in endurance athletes following prolonged exercise? Summary of Key Findings: The current literature was searched to identify the effects of IPC, and 3 studies were selected: 2 randomized controlled trials and 1 randomized cross-over study. Two studies investigated the effect of IPC on delayed onset muscle soreness and plasma creatine kinase in ultramarathoners. The other looked at the impact of IPC on delayed onset muscle soreness in marathoners, ultramarathoners, triathletes, and cyclists. All studies concluded IPC was not an effective means of improving the reduction of EIMD in endurance-trained athletes. Clinical Bottom Line: While IPC may provide short-term relief of delayed onset muscle soreness, this device does not provide continued relief from EIMD. Strength of Recommendation: In accordance with the Strength of Recommendation Taxonomy, the grade of B is recommended based on consistent evidence from 2 high-quality randomized controlled trials and 1 randomized cross-over study.
The nuclear piston activates mechanosensitive ion channels to generate cell migration paths in confining microenvironments
Authors: Lee Hong-pyo , Alisafaei Farid , Adebawale Kolade , Chang Julie , Shenoy Vivek B. , Chaudhuri Ovijit
Published: January 2021

Cells utilize a nuclear piston to mechanically generate migration paths in confining matrices.
Tissue-resident CD4
+
T helper cells assist the development of protective respiratory B and CD8
+
T cell memory responses
Authors: Son Young Min , Cheon In Su , Wu Yue , Li Chaofan , Wang Zheng , Gao Xiaochen , Chen Yao , Takahashi Yoshimasa , Fu Yang-Xin , Dent Alexander L. , Kaplan Mark H. , Taylor Justin J. , Cui Weiguo , Sun Jie
Published: January 2021

Identification of a CD4
+
helper T cell population providing in situ help to B and CD8
+
T cells in the respiratory mucosa.
Killing the buzz: NK cells in the aged brain
Authors: Clark Rachael A.
Published: January 2021

Senescent neuroblasts activate NK cells in the dentate gyrus of the aged brain, leading to neuronal destruction that impairs cognition.
Genome Copy Number Regulates Inclusion Expansion, Septation, and Infectious Developmental Form Conversion in Chlamydia trachomatis
Authors: Brothwell Julie A. , Brockett Mary , Banerjee Arkaprabha , Stein Barry D. , Nelson David E. , Liechti George W.
Published: January 2021

DNA replication is essential for the growth and development of
Chlamydia trachomatis
; however, it is unclear how this process contributes to and is controlled by the pathogen’s biphasic life cycle. While inhibitors of transcription, translation, cell division, and glucose-6-phosphate transport all negatively affect chlamydial intracellular development, the effects of directly inhibiting DNA polymerase have never been examined. We isolated a temperature-sensitive
dnaE
mutant (the

dnaE
ts

mutant) that exhibits an ∼100-fold reduction in genome copy number at the nonpermissive temperature (40°C) but replicates similarly to the parent at the permissive temperature of 37°C. We measured higher ratios of genomic DNA nearer the origin of replication than the terminus in the

dnaE
ts

mutant at 40°C, indicating that this replication deficiency is due to a defect in DNA polymerase processivity. The

dnaE
ts

mutant formed fewer and smaller pathogenic vacuoles (inclusions) at 40°C, and the bacteria appeared enlarged and exhibited defects in cell division. The bacteria also lacked both discernible peptidoglycan and polymerized MreB, the major cell division-organizing protein in
Chlamydia
responsible for nascent peptidoglycan biosynthesis. We also found that the absolute genome copy number, rather than active genome replication, was sufficient for infectious progeny production. Deficiencies in both genome replication and inclusion expansion were reversed when the

dnaE
ts

mutant was shifted from 40°C to 37°C early in infection, and intragenic suppressor mutations in

dnaE
ts

also restored genome replication and inclusion expansion in the

dnaE
ts

mutant at 40°C. Overall, our results show that genome replication in
C. trachomatis
is required for inclusion expansion, septum formation, and the transition between the microbe’s replicative and infectious forms.

IMPORTANCE
Chlamydiae transition between infectious, extracellular elementary bodies (EBs) and noninfectious, intracellular reticulate bodies (RBs). Some checkpoints that govern transitions in chlamydial development have been identified, but the extent to which genome replication plays a role in regulating the pathogen’s infectious cycle has not been characterized. We show that genome replication is dispensable for EB-to-RB conversion but is necessary for RB proliferation, division septum formation, and inclusion expansion. We use new methods to investigate developmental checkpoints and dependencies in
Chlamydia
that facilitate the ordering of events in the microbe’s biphasic life cycle. Our findings suggest that
Chlamydia
utilizes feedback inhibition to regulate core metabolic processes during development, likely an adaptation to intracellular stress and a nutrient-limiting environment.
Supplemental Material: Provenance of the El Salto Formation (early Oligocene to early Miocene), southern part of La Reforma caldera, Baja California Sur, Mexico
Authors: Ocampo-Díaz Yam Zul Ernesto , al. et
Published: January 2021

Seven data tables
Treatment of benzodiazepine withdrawal syndrome in a severe traumatic brain injury patient
Authors: Teah Ming Kai , Chan Guan Keng , Wong Melvin Teck Fui , Yeap Tat Boon
Published: January 2021

Prolonged exposure to benzodiazepines (BDZ) may contribute towards physical dependence, which is manifested by iatrogenic Benzodiazepine Withdrawal Syndrome (BWS), a condition often underdiagnosed. Current evidence recommends precluding BDZ infusion as sedation in the intensive care unit to avoid possible withdrawal and delirium issues. Administration of dexmedetomidine should be considered to facilitate weaning in patients with BWS.
Anaesthetic management of a patient with eosinophilic granulomatosis with polyangiitis for internal fixation of a fractured femur
Authors: Mohamed Hassan , CE Ó Mathúna Euan , Elbardesy Hany , Shorten George
Published: January 2021

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease with an estimated annual incidence of 0.5–6.8 per million. It is characterised by necrotising vasculitis with multiorgan eosinophilic infiltration. Pulmonary manifestations are the most common presentation of EGPA, and cardiac complications are the most common cause of death. Anaesthetic management of EGPA is challenging due to perioperative pulmonary complications, multiorgan involvement and greater risk of cholinesterase enzyme deficiency. We are reporting the anaesthetic management of a 58-year-old woman, diagnosed with EGPA 3 years ago, who underwent urgent intramedullary nail insertion for a femur fracture. The anaesthetic technique comprised femoral nerve block and spinal anaesthesia, thereby avoiding (1) the need for upper airway manipulation, (2) potential adverse effects of anticholinesterase drugs (for reversal of neuromuscular blockade) and (3) histamine release associated with morphine administration perioperatively. Surgery and anaesthesia were uneventful.
The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India
Authors: Ashworth Danielle , Sharma Pankhuri , Silverio Sergio A , Khan Simi , Kathuria Nishtha , Garg Priyanka , Ghule Mohan , Shivkumar V B , Tayade Atul , Mehra Sunil , Shivkumar Poonam V , Tribe Rachel M
Published: January 2021

Introduction

India has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.

Methods

A pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.

Results

Before training, ASHAs’ knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.

Conclusion

This study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.
Treatable but not curable cancer in England: a retrospective cohort study using cancer registry data and linked data sets
Authors: White Rachel , Stanley Fintan , Than Jen , Macnair Archie , Pethick Joanna , Fallica Gregory , Hounsome Luke , Maher Jane
Published: January 2021

Objectives

This study estimates the prevalence of cancers that are categorised as treatable but not curable (TbnC) in England. It provides a quantification of the population and a framework to aid identification of this group to enable the design of tailored support services.

Design

Through consultation with clinical and data experts an algorithmic definition of TbnC was developed. Using cancer registry data sets, with five other linked data sets held by the National Disease Registration Service, the algorithm was applied as part of this retrospective cohort study to estimate the size and characteristics of the TbnC population.

Setting and participants

The health data records of 1.6 million people living with cancer in England in 2015, following a cancer diagnosis between 2001 and 2015, were retrospectively assessed for TbnC status.

Results

An estimated 110 615 people in England were living with TbnC cancer at the end of 2015, following identification of TbnC cancer between 2012 and 2015. In addition, 51 946 people fit the initial search criteria but were found to have been in their last year of life at the end of 2015 and therefore considered separately here as end of life cases. A further 57 117 people in England were initially identified as being at high risk of recurrence or having their life being shortened by cancer but did not fit the TbnC conceptual framework and were excluded, but their results are also reported under ‘group B’.

Conclusions

A population living with TbnC cancer can be identified using data currently collected on a national scale in England. This large population living with TbnC cancer requires personalised treatment and support.
Study protocol for a prospective, double-blinded, observational study investigating the diagnostic accuracy of an app-based diagnostic health care application in an emergency room setting: the eRadaR trial
Authors: Faqar-Uz-Zaman S Fatima , Filmann Natalie , Mahkovic Dora , von Wagner Michael , Detemble Charlotte , Kippke Ulf , Marschall Ursula , Anantharajah Luxia , Baumartz Philipp , Sobotta Paula , Bechstein Wolf O , Schnitzbauer Andreas A
Published: January 2021

Introduction

Occurrence of inaccurate or delayed diagnoses is a significant concern in patient care, particularly in emergency medicine, where decision making is often constrained by high throughput and inaccurate admission diagnoses. Artificial intelligence-based diagnostic decision support system have been developed to enhance clinical performance by suggesting differential diagnoses to a given case, based on an integrated medical knowledge base and machine learning techniques. The purpose of the study is to evaluate the diagnostic accuracy of Ada, an app-based diagnostic tool and the impact on patient outcome.

Methods and analysis

The eRadaR trial is a prospective, double-blinded study with patients presenting to the emergency room (ER) with abdominal pain. At initial contact in the ER, a structured interview will be performed using the Ada-App and both, patients and attending physicians, will be blinded to the proposed diagnosis lists until trial completion. Throughout the study, clinical data relating to diagnostic findings and types of therapy will be obtained and the follow-up until day 90 will comprise occurrence of complications and overall survival of patients. The primary efficacy of the trial is defined by the percentage of correct diagnoses suggested by Ada compared with the final discharge diagnosis. Further, accuracy and timing of diagnosis will be compared with decision making of classical doctor–patient interaction. Secondary objectives are complications, length of hospital stay and overall survival.

Ethics and dissemination

Ethical approval was received by the independent ethics committee (IEC) of the Goethe-University Frankfurt on 9 April 2020 including the patient information material and informed consent form. All protocol amendments must be reported to and adapted by the IEC. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.

Trial registration number

DRKS00019098.
Group practice impacts on patients, physicians and healthcare systems: a scoping review
Authors: Zwiep Terry , Ahn San (Hilalion) , Brehaut Jamie , Balaa Fady , McIsaac Daniel I , Rich Susan , Wallace Tom , Moloo Husein
Published: January 2021

Objective

To identify the advantages and disadvantages that group practices have on patients, physicians and healthcare systems.

Study design

A scoping review was performed based on the methodology proposed by Arksey and O’Malley, and refined by Levac et al. Titles and abstracts were screened by two reviewers. A quantitative analysis was performed to assess the type, year and region of publication, as well as the population studied. A qualitative descriptive analysis was performed to identify common themes.

Study setting

MEDLINE, EMBASE and Cochrane databases were searched from database inception to October 2018 for papers which assessed outcomes relevant to the research question.

Results

Our search strategy returned 2408 papers and 98 were included in the final analysis. Most papers were from the USA, were surveys and assessed physician outcomes. Advantages of group practices for patients included improved satisfaction and quality of care. Studies of physicians reported improved quality of life and income, while disadvantages included increased stress due to poor interpersonal relationships. Studies of healthcare systems reported improved efficiency and better utilisation of resources.

Conclusions

Group practices have many benefits for patients and physicians. However, further work needs to be done assessing patient outcomes and establishing the elements that make a group practice successful.
Physical frailty and health-related quality of life among Chinese rural older adults: a moderated mediation analysis of physical disability and physical activity
Authors: Hao Wenting , Li Jie , Fu Peipei , Zhao Dan , Jing Zhengyue , Wang Yi , Yu Caiting , Yuan Yemin , Zhou Chengchao
Published: January 2021

Objectives

The purpose of this study is to explore the mediating effect of physical disability as well as the role of physical activity (PA) as a moderator in the relationship between physical frailty and health-related quality of life (HRQoL) among rural older adults in China.

Design

Cross-sectional analysis.

Setting

Rural households in Shandong of China (Rushan, Qufu, Laolin).

Participants and methods

A survey was conducted among 3243 rural older adults. The data were collected using questionnaires measuring physical frailty, physical disability, HRQoL and PA. Bootstrap analyses were employed to explore the mediating effect of physical disability and also the moderating role of PA on physical frailty and HRQoL.

Results

After controlling for age and education, physical disability partially mediated the effect of physical frailty on HRQoL (indirect effect=−0.143, 95% CI −0.175 to –0.113), with the mediating effect accounting for 33.71% of the total effect. PA moderated the relationship between physical frailty and physical disability as well as the relationship between physical disability and HRQoL. Specifically, the interaction term between physical frailty and PA significantly predicted physical disability (β=−0.120, t=−7.058, p<0.001), and the interaction term between physical disability and PA also had a significant predictive effect on HRQoL (β=0.115, t=6.104, p<0.001).

Conclusions

PA appears to moderate the indirect effect of physical disability on the association between physical frailty and HRQoL. This study provides support for potential mechanisms in the association between physical frailty and HRQoL. Encouraging rural older adults to increase PA appropriately might improve HRQoL for older adults with physical frailty and physical disability problems.
Factors affecting consultant attitudes to undertaking undergraduate medical student teaching in the UK: a systematic review
Authors: Harris Isobel Marion , McNeilly Heather , Benamer Hani , Ward Derek J , Sitch Alice J , Parry Jayne
Published: January 2021

Objective

This systematic review aimed to explore consultant attitudes towards teaching undergraduate medical students in the UK.

Design

Systematic review.

Methodology

Standard systematic review methodology was followed. MEDLINE, EMBASE and OpenGrey were searched from inception to August 2019 to identify studies exploring senior doctors’ attitudes towards teaching undergraduate medical students. Two reviewers independently carried out key methodological steps including study screening/selection, quality assessment and data extraction. A narrative synthesis was undertaken.

Results

Five studies were included in the review dating 2003–2015. Two studies used questionnaires, and three used focus groups/semistructured interviews. Key findings identified across all studies were consultants generally found teaching undergraduate medical students enjoyable, and consultants identified time constraints as a barrier to teaching. Other findings were consultants feeling there was a lack of recognition for time spent teaching, and a lack of training/guidance regarding teaching students.

Conclusions

This is the first systematic review to explore senior hospital doctors’ attitudes towards teaching undergraduate medical students. Despite these five studies spanning 12 years, the same attitudes and issues regarding teaching are identified by all, suggesting lack of time particularly is a persistent problem regarding consultant-based teaching. An anecdotal impression is that consultants are no longer as enthusiastic about teaching as they once were, but it is evident over the 12 years of these studies that enjoyment levels, and presumably enthusiasm, have not changed significantly.
Population-based study on the prevalence and clinical profile of adults with cerebral palsy in Northern Ireland
Authors: McConnell Karen , Livingstone Emma , Perra Oliver , Kerr C
Published: January 2021

Objectives

This study aimed to report the prevalence and clinical characteristics of adults with cerebral palsy (CP) in a geographically defined region of the UK.

Design and setting

Cross-sectional study using the Northern Ireland Cerebral Palsy Register (NICPR).

Participants

All validated cases known to the NICPR, born 1981–2001 and alive and resident in Northern Ireland at age 19 years were included.

Results

The study included 1218 persons with CP aged 19–39 years, 46 of whom died in adulthood. The prevalence of CP was 2.38 per 1000. The majority of cases had spastic CP (n=1132/1218, 93%) and could walk (n=949/1218, 78%). Those that died in adulthood typically had bilateral spastic CP (n=39/46) and used a wheelchair (n=40/46).

Conclusion

The prevalence of CP in adults is similar to other common neurological conditions such as multiple sclerosis and Parkinson’s disease. The needs of adults with CP vary widely with almost half having two or more associated impairments that may require multiprofessional and multiagency coordination. Results from this study can be used to inform transformation of health and care services for adults with CP.
Reduced foveal cone density in early idiopathic macular telangiectasia
Authors: Song Hongxin , Rossi Ethan A , Williams David R
Published: January 2021

Objective

Idiopathic macular telangiectasia (MacTel) is considered primarily a vascular disease affecting juxtafoveal retinal capillaries. However, recent evidence suggests that neuronal changes may occur early in disease development. We used high-resolution adaptive optics retinal imaging to elucidate the foveal cone photoreceptor changes at a cellular level in patients with MacTel.

Methods and analysis

We used adaptive optics scanning light ophthalmoscopy (AOSLO) to evaluate the foveal cone photoreceptors in the less-affected eye of patients with asymmetric MacTel. AOSLO images of cone photoreceptors were obtained in a 4°×4° area centred on the foveola. Individual cone positions were identified within a 2°×2° area centred on the fovea, using semiautomatic cone marking software with manual correction, permitting calculation of a map of cone density.

Results

In all participants, one eye was affected with MacTel, the fellow eye was clinically normal or near normal, with visual acuity of 20/25 or better and subtle angiographic leakage. The foveal cone mosaics were continuous with tight packing and cones exhibited normal reflectivity. However, cone density was significantly lower for all participants (mean=80 733 cones/mm2) within 0.5° than the cone density previously reported for normal eyes.

Conclusions

Foveal cone density is lower than normal in the clinically less-affected eyes of patients with asymmetric MacTel. This suggests that cone photoreceptor loss may precede classic obvious vascular changes in idiopathic MacTel.
Therapeutic thoracentesis symptoms and activity: a qualitative study
Authors: Twose Chloe , Ferris Rebecca , Wilson Andrew , Rahman Najib , Farquhar Morag , Mishra Eleanor
Published: January 2021

Introduction

Malignant pleural effusions (MPEs) commonly occur in patients with advanced cancer. Drainage of fluid is used to relieve symptoms and improve quality of life.

Objective

To improve our understanding of how therapeutic aspiration affects symptoms and activities in patients with MPE.

Methods

Patients presenting to the Pleural Clinic at Norfolk and Norwich University Hospital with a confirmed or suspected MPE participated in up to three semistructured interviews during their diagnostic/therapeutic pathway. Interviews were analysed using framework analysis by two researchers independently.

Results

Sixteen patients participated. Symptoms reported before drainage included breathlessness, cough, chest pain, fatigue and anorexia. Symptoms affected their activities, including walking, bending over and socialisation. Patients described anxiety about the underlying diagnosis and fear of over-reliance on others. Expectations of drainage outcome varied, with some hoping for a cure and others hoping for any improvement. After drainage, breathlessness, chest pain and cough improved in some patients. They reported feeling and sleeping better, but fatigue and poor appetite remained. Participants were more active after aspiration, but the duration of improvement was a few days only. Despite this, patients still felt the procedure worthwhile.

Conclusion

Overall health and respiratory symptoms improved following drainage, but constitutional symptoms did not improve. This may be because constitutional symptoms are caused by the underlying cancer. This study suggests that clinicians should consider a range of symptoms, rather than just breathlessness, in planning outcomes for clinical trials. These results are important to inform patients about the potential benefits and duration of symptom improvement after therapeutic aspiration.
Early palliative intervention: effects on patient care satisfaction in advanced cancer
Authors: Mah Kenneth , Swami Nadia , O'Connor Brenda , Hannon Breffni , Rodin Gary , Zimmermann Camilla
Published: January 2021

Objective

In a cluster-randomised controlled trial of early palliative care (EPC) in advanced cancer, EPC was robustly associated with increased patient satisfaction with care. The present study evaluated mediational mechanisms underlying this EPC effect, including improved physical and psychological symptoms and quality of life, as well as relationships with healthcare providers and preparation for end of life.

Method

Participants with advanced cancer (n=461) completed measures at baseline and then monthly to 4 months. Mediational analyses, using a robust bootstrapping approach, focused on 3-month and 4-month follow-up data.

Results

At 3 months, EPC decreased psychological symptoms, which resulted in greater satisfaction either directly (βindirect effect=0.05) or through greater quality of life (βindirect effect=0.02). At 4 months, EPC increased satisfaction through improved quality of life (βindirect effect=0.08). Physical symptom management showed no significant mediational effects at either time point. Better relationships with healthcare providers consistently mediated the EPC effect on patient satisfaction at 3 and 4 months, directly (βindirect effect=0.13–0.16) and through reduced psychological symptoms and/or improved quality of life (βindirect effect=0.00–0.02). At 4 months, improved preparation for end-of-life mediated EPC effects on satisfaction by enhancing quality of life (βindirect effect=0.01) or by reducing psychological symptoms and thereby increasing quality of life (βindirect effect=0.02).

Conclusion

EPC increases satisfaction with care in advanced cancer by attending effectively to patients’ emotional distress and quality of life, enhancing collaborative relationships with healthcare providers, and addressing concerns about preparation for end-of-life.

Trial registration number

NCT01248624
Experiences, challenges and lessons learnt in medical staff redeployment during response to COVID-19
Authors: Sykes Anny , Pandit Meghana
Published: January 2021

Background

The response to the COVID-19 pandemic required redeployment of large numbers of staff to avoid acute services being overwhelmed. This unprecedented, previously unplanned redeployment occurred in a rapidly changing environment. This paper describes the process of redeployment at a teaching hospital and assessment of this by the redeployed doctors and redeployment team.

Objective

Identify key lessons from the redeployment process to inform resilience and future planning for further COVID-19 peaks.

Methods

Redeployment team experiences and challenges were documented in real time and formal structured feedback obtained. All redeployed doctors were asked for quantitative and qualitative feedback regarding their experiences in two distinct acute areas with different approaches to staffing.

Results

63 redeployed staff and five members of the redeployment team completed feedback questionnaires. Most redeployed doctors (76%) were satisfied and had adequate support and training. Redeployment was associated with self-reported stress and anxiety in 95% with 59% describing this as moderate or greater. This was reduced by adequate communication, supervision and a sense of belonging to a firm with access to simple information making a significant difference. Awareness of and satisfaction with well-being support services was also high (71%).

The redeployment team identified having a well-mixed team who met daily, an online portal and engagement with leads as the key factors for being successful.

Conclusion

Redeployment in response to COVID-19 was associated with reported stress and anxiety in most redeployed doctors. Communication, local induction and feeling valued and being part of a team helped reduce this.
Incidence and outcomes of intracerebral haemorrhage with mechanical compression hydrocephalus
Authors: Owen Bryce , Akbik Omar , Torbey Michel , Davis Herbert , Carlson Andrew P
Published: January 2021

Introduction

Intracerebral haemorrhage (ICH) within deep structures adjacent to the third ventricle is associated with worse outcomes when compared with lobar ICH due to the critical role of deep nuclei in normal neurological functioning. New evidence suggests another contributing factor to poor outcome is obstruction of cerebrospinal fluid outflow by clot burden causing mechanical compression of the third ventricle. The authors reviewed the incidence and outcomes of mechanical compression ICH in order to identify this high-risk group which may potentially benefit from minimally invasive evacuation.

Methods

Patients with spontaneous, non-traumatic, supratentorial ICH were identified retrospectively over a 30-month period. CT imaging was reviewed to assess location of the ICH, volume of the ICH, presence of hydrocephalus requiring external ventricular drain (EVD) placement, and time to clearing of the third ventricle. Hydrocephalus was then categorised as due to ‘primarily intraventricular haemorrhage (IVH)’, ‘primarily mechanical compression’ or ‘mixed’. Functional outcomes at discharge were assessed using the modified Rankin Score (mRS).

Results

287 patients met inclusion criteria, of which 39 (13.5%) patients developed hydrocephalus that required EVD. EVD patients had significantly higher mRS at discharge (p≤0.001) when compared with the non-EVD group. Lobar location was associated with lower odds of poor outcome compared with thalamic location (OR 0.107–0.560). Mechanical compression hydrocephalus was associated with poor outcome when compared with the primary IVH hydrocephalus subgroup (p=0.037) as well as longer time to clearing of the third ventricle (p=0.006).

Conclusions

Mechanical obstruction requiring EVD occurs in approximately (21/287) 7.3% of all patients with spontaneous supratentorial ICH. It is unknown if the worse morbidity in these subjects is purely related to damage to deep structures surrounding the third ventricle or if secondary damage from hydrocephalus could be mitigated with targeted minimally invasive clot evacuation.
Heterogeneity and incidence of non-response for changes in cardiorespiratory fitness following time-efficient sprint interval exercise training
Authors: Metcalfe Richard S , Vollaard Niels BJ
Published: January 2021

Interindividual variability for training-induced changes in maximal oxygen uptake (VO2max) is well described following continuous aerobic and high-intensity interval training. Whether similar variability is observed following time-efficient sprint interval training with minimal training volume (i.e., reduced-exertion high-intensity interval training; REHIT) is unknown. We conducted a pooled analysis of n=117 (68 men) training participants (mean±SD: age: 30±10 y; VO2max: 34.8±7.5 ml·kg-1·min-1), who completed a VO2max assessment before and 3 days after 6 weeks of REHIT comprising of two 10-20 second ‘all-out’ cycling sprints per session, and n=40 no-intervention control participants (age: 30±13 y; VO2max: 31.5±6.5 ml·kg-1·min-1) who completed repeated VO2max tests over a comparable timeframe. Individual responses estimated using 50% confidence intervals derived from the technical error were interpreted against a smallest worthwhile change (SWC) of 1.75 ml·kg-1·min-1. The standard deviation of individual responses was 2.39 ml·kg-1·min-1 demonstrating clinically meaningful heterogeneity in training-induced changes in VO2max following REHIT that exceed the technical, biological and random within-subjects variability of VO2max assessment. The likely (75% probability) non-response rate was 18% (21/117), and 49% (57/117) of individuals demonstrated increases in VO2max likely higher than the SWC. We conclude that the well-described increase in VO2max following REHIT at the group level is subject to substantial variability in magnitude at an individual level. This has important implications for exercise prescription and can be harnessed to elucidate mechanisms of adaptation.

Novelty:
• There is substantial heterogeneity in VO2max responses following time-efficient sprint interval training
• Proportion of non-response was 18% and ∽50% of individuals show clinically meaningful increases in VO2max