bluuebunny/crossref_metadata_2025 huggingface dataset:
Pectoralis major injuries in the military: a surveillance approach to reduce an underestimated problem
Authors: Hauschild Veronique D , Grier TL , Schuh-Renner A , Forrest L J , Hirleman C E , Pinyan E , Jones B H
Published: February 2021

Introduction

Multiple studies report increasing cases of surgically treated pectoralis major (PM) muscle and tendon ruptures in military populations. Studies associate this with a growing popularity of weight-training and bench press exercises. Mild-to-moderate non-surgical PM traumas and overuse injuries have not been included in these studies despite evidence that these types of outpatient injuries account for the majority of the military’s injury medical burden.

Methods

To assess rates of all PM injuries (ruptures, tears, strains, overuse), regardless of form of treatment, a PM injury surveillance definition was derived from International Classification of Disease (ICD) diagnostic codes used in routine US Army injury surveillance. A detailed clinical examination of 2016 Active Duty Army medical records was used to identify ICD codes commonly associated with PM injuries. Cost data were calculated and the definition applied to medical data from 2016 through 2018to assess trends.

Results

The estimated incidence of PM cases among soldiers was over 95% greater than if only considering severe surgical cases. Over 96% of army annual PM injury costs (direct medical and indirect from lost labour) were for outpatient services. PM injury incidence rates were not statistically different from 2016 to 2018.

Conclusions

The PM injury surveillance definition provides a consistent means to monitor trends over time and evaluate the effectiveness of prevention efforts. PM injuries have a larger military impact than previously recognised and prioritised prevention strategies are needed to reduce them. Future interventions could focus on the bench press given its observed association with PM injuries.
Civilian perception of the role of the military in Nigeria’s 2014 Ebola outbreak and health-related responses in the North East region
Authors: Kwaja Chris M A , Olivieri D J , Boland S , Henwood P C , Card B , Polatty D P , Levine A C
Published: February 2021

Introduction

Civilian–military relations play an important yet under-researched role in low-income and middle-income country epidemic response. One crucial component of civilian–military relations is defining the role of the military. This paper evaluates the role of Nigerian military during the 2014–2016 West African Ebola epidemic.

Methods

Focus groups and key informant interviews were conducted throughout three states in North East region of Nigeria: Borno, Yobe and Adamawa. Participants were identified through mapping of stakeholder involvement in Nigerian epidemic response. English-translated transcripts of each key informant interview and focus group discussion were then coded and key themes were elucidated and analysed.

Results

Major themes elucidated include developing inclusive coordination plans between civilian and military entities, facilitating human rights reporting mechanisms and distributing military resources more equitably across geographical catchment areas. The Nigerian Military served numerous functions: 37% (22/59) of respondents indicated ‘security/peace’ as the military’s primary function, while 42% (25/59) cited health services. Variations across geographic settings were also noted: 35% (7/20) of participants in Borno stated the military primarily provided transportation, while 73% (11/15) in Adamawa and 29% (7/24) in Yobe listed health services.

Conclusions

Robust civilian–military relations require an appropriately defined role of the military and clear civilian–military communication. Important considerations to contextualise civilian–military relations include military cultural–linguistic understanding, human rights promotion, and community-based needs assessments; such foci can facilitate the military’s understanding of community norms and civilian cooperation with military aims. In turn, more robust civilian–military relations can promote overall epidemic response and reduce the global burden of disease.
Do premorbid characteristics of home care clients predict delayed discharges in acute care hospitals: a retrospective cohort study in Ontario and British Columbia, Canada
Authors: Arthur Stella A , Hirdes John P , Heckman George , Morinville Anne , Costa Andrew P , Hébert Paul C
Published: February 2021

Background

Improved identification of patients with complex needs early during hospitalisation may help target individuals at risk of delayed discharge with interventions to prevent iatrogenic complications, reduce length of stay and increase the likelihood of a successful discharge home.

Methods

In this retrospective cohort study, we linked home care assessment records based on the Resident Assessment Instrument for Home Care (RAI-HC) of 210 931 hospitalised patients with their Discharge Abstract Database records. We then undertook multivariable logistic regression analyses to identify preadmission predictive factors for delayed discharge from hospital.

Results

Characteristics that predicted delayed discharge included advanced age (OR: 2.72, 95% CI 2.55 to 2.90), social vulnerability (OR: 1.27, 95% CI 1.08 to 1.49), Parkinsonism (OR: 1.34, 95% CI 1.28 to 1.41) Alzheimer’s disease and related dementias (OR: 1.27, 95% CI 1.23 to 1.31), need for long-term care facility services (OR: 2.08, 95% CI 1.96 to 2.21), difficulty in performing activities of daily living and instrumental activities of daily living, falls (OR: 1.16, 95% CI 1.12 to 1.19) and problematic behaviours such as wandering (OR: 1.29, 95% CI 1.22 to 1.38).

Conclusion

Predicting delayed discharge prior to or on admission is possible. Characteristics associated with delayed discharge and inability to return home are easily identified using existing interRAI home care assessments, which can then facilitate the targeting of pre-emptive interventions immediately on hospital admission.
Protocol for a systematic review of living labs in healthcare
Authors: Archibald Mandy , Wiebe Sandra , Rieger Kendra , Linton Janice , Woodgate Roberta
Published: February 2021

Introduction

Healthcare is increasingly challenged to meet the demands of user involvement and knowledge mobilisation required by the 21st-century patient-centred and knowledge-based economies. Innovations are needed to reduce problematic barriers to knowledge exchange and improve collaborative problem solving. Living labs, as open knowledge systems, have the potential to address these gaps but are underexplored in healthcare.

Methods and analysis

We will conduct the first systematic review of living labs across healthcare contexts. We will comprehensively search the following online databases from inception to 31 December 2020: Scopus, the Cochrane Library (Wiley), Medline (OVID), Embase (OVID), Web of Science, PsycINFO (OVID) and EBSCOhost databases including Academic Search Complete, Business Source Premier, Canadian Reference Centre, CINAHL, MasterFILE Premier, SPORTDiscus, Library & Information Science Source, Library, Information Science & Technology Abstracts, AgeLine, EconLit, Art Full Text, Women’s Studies International and Social Work Abstracts. We will search for grey literature using Google advanced techniques and books/book chapters through scholarly and bibliographical databases. We will use a dual-reviewer, two-step selection process with pre-established inclusion criteria and limit to English language publications. Empirical studies of any design examining living lab development, implementation or evaluation in health or healthcare will be included. We will use the Mixed Methods Appraisal Tool (MMAT) for methodological quality appraisal and Covidence software for review management, and we will extract data on pre-established variables such as lab context and technological platforms. We will create evidence tables and analyse across variables such as focal aim and achievement of living lab principles, such as the use of cocreation and multimethod approaches. We will tabulate data for descriptive reporting and narrative synthesis to identify current applications, approaches and promising areas for living lab development across health contexts.

Ethics and dissemination

Ethical approval was not required for this review. This review will inform research into living labs in health environments, including guidance for a living lab in paediatric rehabilitation. Academic publications shared through collaborative networks and social media channels will provide substantive knowledge to the growing tech-health development sector and to researchers, practitioners and organisations seeking enhanced patient/stakeholder engagement and innovations in knowledge translation and evidence-based practice.

PROSPERO registration number

CRD42020175275
Isolated and combined effects of high-intensity interval training and time-restricted eating on glycaemic control in reproductive-aged women with overweight or obesity: study protocol for a four-armed randomised controlled trial
Authors: Moholdt Trine , Silva Catalina P , Lydersen Stian , Hawley John A
Published: February 2021

Introduction

Overweight and obesity in reproductive-aged women is a global problem due to the increased risk of subfertility, pregnancy complications and cardiometabolic diseases. High-intensity interval training and time-restricted eating are two primary lifestyle interventions that, independently, have positive effects on a range of health outcomes. Whether these two strategies have synergistic effects is currently unknown. Our primary aim is to determine the isolated and combined effect of high-intensity interval training and time-restricted eating on glycaemic control in reproductive-aged women with overweight/obesity.

Methods and analysis

The study is a randomised controlled trial with four parallel groups. Women (N=120) aged 18–45 years with body mass index ≥27 kg/m2will be randomly allocated (1:1:1:1) to either: (1) high-intensity interval training, (2) time-restricted eating, (3) a combination of high-intensity interval training and of time-restricted eating, or (4) a control group. The duration of each intervention will be 7 weeks. The primary outcome measure will be glycaemic control, determined by the total area under the plasma glucose curve over 2 hours after a 75-gram oral glucose tolerance test. Secondary outcome measurements will include markers of cardiovascular and metabolic health (peak oxygen uptake, blood pressure, blood lipids, body composition, insulin sensitivity), sleep quality, physical activity, diet and adherence rates to the intervention.

Ethics and dissemination

The Regional Committee Medical Research Ethics, Norway has approved the trial protocol. This study will provide important new knowledge to both the scientific community and the general population about the isolated and combined effects of two novel diet–exercise strategies on cardiovascular and metabolic health among women with overweight/obesity.

Trial registration number

NCT04019860.
Assessing public support for extending smoke-free policies beyond enclosed public places and workplaces: protocol for a systematic review and meta-analysis
Authors: Boderie Nienke W , Mölenberg Famke JM , Sheikh Aziz , Bramer Wichor M , Burdorf Alex , van Lenthe Frank J , Been Jasper V
Published: February 2021

Introduction

Smoke-free enclosed public environments are effective in reducing exposure to secondhand smoke and yield major public health benefits. Building on this, many countries are now implementing smoke-free policies regulating smoking beyond enclosed public places and workplaces. In order to successfully implement such ‘novel smoke-free policies’, public support is essential. We aim to provide the first comprehensive systematic review and meta-analysis assessing levels and determinants of public support for novel smoke-free policies.

Methods and analysis

The primary objective of this review is to summarise the level of public support for novel smoke-free policies. Eight online databases (Embase.com, Medline ALL Ovid, Web of Science Core Collection, WHO Library Database, Latin American and Caribbean Health Sciences Literature, Scientific Online Library Online, PsychINFO and Google Scholar) will be searched from 1 January 2004 by two independent researchers with no language restrictions. The initial search was performed on 15 April 2020 and will be updated prior to finalisation of the report. Studies are eligible if assessing support for novel smoke-free policies in the general population (age ≥16 years) and have a sample size of n≥400. Studies funded by the tobacco industry or evaluating support among groups with vested interest are excluded. The primary outcome is proportion of public support for smoke-free policies, subdivided according to the spaces covered: (1) indoor private spaces (eg, cars) (2) indoor semiprivate spaces (eg, multi-unit housing) (3) outdoor (semi)private spaces (eg, courtyards) (4) non-hospitality outdoor public spaces (eg, parks, hospital grounds, playgrounds) and (5) hospitality outdoor public spaces (eg, restaurant terraces). The secondary objective is to identify determinants associated with public support on three levels: (1) within-study determinants (eg, smoking status) (2) between-study determinants (eg, survey year) and (3) context-specific determinants (eg, social norms). Risk of bias will be assessed using the Mixed Methods Appraisal Tool and a sensitivity analysis will be performed excluding studies at high risk of bias.

Ethics and dissemination

No formal ethical approval is required. Findings will be disseminated to academics, policymakers and the general public.
Factors associated with inpatient length of stay among hospitalised patients with chronic obstructive pulmonary disease, China, 2016–2017: a retrospective study
Authors: Dong Fen , Huang Ke , Ren Xiaoxia , Qumu Shiwei , Niu Hongtao , Wang Yanyan , Li Yong , Lu Minya , Lin Xinshan , Yang Ting , Jiao Jianjun , Wang Chen
Published: February 2021

Objectives

To identify factors associated with length of stay (LOS) in chronic obstructive pulmonary disease (COPD) hospitalised patients, which may help shorten LOS and reduce economic burden accrued over hospital stay.

Design

A retrospective cohort study.

Setting

This study was performed in a tertiary hospital in China.

Participants

Patients with COPD who were aged ≥40 years and newly admitted between 2016 and 2017.

Primary and secondary outcome measures

LOS at initial admission was the primary outcome and health expenditures were the secondary outcome. To identify factors associated with LOS, we collected information at index hospitalisation and constructed a conceptual model using directed acyclic graph. Potential factors were classified into five groups: demographic information, disease severity, comorbidities, hospital admission and environmental factors. Negative binomial regression model was fitted for each block of factors and a parsimonious analysis was performed.

Results

In total, we analysed 565 patients with COPD. The mean age was 69±11 years old and 69.4% were men. The median LOS was 10 (interquartile range 8–14) days. LOS was significantly longer in patients with venous thromboembolism (VTE) (16 vs 10 days, p=0.0002) or with osteoporosis (15 vs 10 days, p=0.0228). VTE ((rate ratio) RR 1.38, 95% CI 1.07 to 1.76), hypoxic–hypercarbic encephalopathy (RR 1.53, 95% CI 1.06 to 2.20), respiratory infection (RR 1.12, 95% CI 1.01 to 1.24), osteoporosis (RR 1.45, 95% CI 1.07 to 1.96) and emergence admission (RR 1.08, 95% CI 1.01 to 1.16) were associated with longer LOS. In parsimonious analysis, all these factors remained significant except emergency admission, highlighting the important role of concomitant morbidities in patients’ hospital stay. Total hospitalisation cost and patients’ out-of-pocket cost increased monotonically with LOS (both ptrend <0.0001).

Conclusion

Patients’ concomitant morbidities predicted excessive LOS in patients with COPD. Healthcare cost increased over the LOS. Quality improvement initiatives may need to identify patients at high risk for lengthy stay and implement early interventions to reduce COPD economic burden.
Study protocol for a single-centre non-inferior randomised controlled trial on a novel three-dimensional matrix positioning-based cognitive fusion-targeted biopsy and software-based fusion-targeted biopsy for the detection rate of clinically significant prostate cancer in men without a prior biopsy
Authors: He Biming , Li Rongbing , Li Dongyang , Huang Liqun , Wen Xiaofei , Yang Guosheng , Wang Haifeng
Published: February 2021

Introduction

The classical pathway for diagnosing prostate cancer is systematic 12-core biopsy under the guidance of transrectal ultrasound, which tends to underdiagnose the clinically significant tumour and overdiagnose the insignificant disease. Another pathway named targeted biopsy is using multiparametric MRI to localise the tumour precisely and then obtain the samples from the suspicious lesions. Targeted biopsy, which is mainly divided into cognitive fusion method and software-based fusion method, is getting prevalent for its good performance in detecting significant cancer. However, the preferred targeted biopsy technique in detecting clinically significant prostate cancer between cognitive fusion and software-based fusion is still beyond consensus.

Methods and analysis

This trial is a prospective, single-centre, randomised controlled and non-inferiority study in which all men suspicious to have clinically significant prostate cancer are included. This study aims to determine whether a novel three-dimensional matrix positioning cognitive fusion-targeted biopsy is non-inferior to software-based fusion-targeted biopsy in the detection rate of clinically significant cancer in men without a prior biopsy. The main inclusion criteria are men with elevated serum prostate-specific antigen above 4–20 ng/mL or with an abnormal digital rectal examination and have never had a biopsy before. A sample size of 602 participants allowing for a 10% loss will be recruited. All patients will undergo a multiparametric MRI examination, and those who fail to be found with a suspicious lesion, with the anticipation of half of the total number, will be dropped. The remaining participants will be randomly allocated to cognitive fusion-targeted biopsy (n=137) and software-based fusion-targeted biopsy (n=137). The primary outcome is the detection rate of clinically significant prostate cancer for cognitive fusion-targeted biopsy and software-based fusion-targeted biopsy in men without a prior biopsy. The clinically significant prostate cancer will be defined as the International Society of Urological Pathology grade group 2 or higher.

Ethics and dissemination

Ethical approval was obtained from the ethics committee of Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. The results of the study will be disseminated and published in international peer-reviewed journals.

Trial registration number

ClinicalTrials.gov Registry (NCT04271527).
Are adverse childhood experiences associated with late-life cognitive performance across racial/ethnic groups: results from the Kaiser Healthy Aging and Diverse Life Experiences study baseline
Authors: Gold Audra L , Meza Erika , Ackley Sarah F , Mungas Dan M , Whitmer Rachel A , Mayeda Elizabeth Rose , Miles Sunita , Eng Chloe W , Gilsanz Paola , Glymour M Maria
Published: February 2021

Objectives

Evidence on adverse childhood experiences (ACEs) and late-life cognitive outcomes is inconsistent, with little research among diverse racial/ethnic groups. We investigated whether ACE exposures were associated with worse late-life cognition for all racial/ethnic groups and at different ages of exposure.

Design

Covariate-adjusted mixed-effects linear regression models estimated associations of: (1) total number of ACEs experienced, (2) earliest age when ACE occurred and (3) type of ACE with overall cognition.

Setting

Kaiser Permanente Northern California members aged 65 years and older, living in Northern California.

Participants

Kaiser Healthy Aging and Diverse Life Experiences study baseline participants, aged 65 years and older (n=1661; including 403 Asian-American, 338 Latino, 427 Black and 493 white participants).

Results

Most respondents (69%) reported one or more ACE, most frequently family illness (36%), domestic violence (23%) and parental divorce (22%). ACE count was not adversely associated with cognition overall (β=0.01; 95% CI −0.01 to 0.03), in any racial/ethnic group or for any age category of exposure. Pooling across all race/ethnicities, parent’s remarriage (β=−0.11; 95% CI −0.20 to −0.03), mother’s death (β=−0.18; 95% CI −0.30 to −0.07) and father’s death (β=−0.11; 95% CI −0.20 to −0.01) were associated with worse cognition.

Conclusion

Adverse childhood exposures overall were not associated with worse cognition in older adults in a diverse sample, although three ACEs were associated with worse cognitive outcomes.
‘It's all about patient safety’: an ethnographic study of how pharmacy staff construct medicines safety in the context of polypharmacy
Authors: Fudge Nina , Swinglehurst Deborah
Published: February 2021

Objective

As polypharmacy increases, so does the complexity of prescribing, dispensing and consuming medicines. Medication safety is typically framed as the avoidance of harm, achievable through adherence to policies, guidelines and operational standards. Automation, robotics and technologies are positioned as key players in the elimination of medication error in the face of escalating demand, despite limited research illuminating how these innovations are taken up, used and adapted in practice. We explore how ‘safety’ is constructed and accomplished in community pharmacies in the context of polypharmacy.

Design and setting

In-depth ethnographic case study across four community pharmacies in England (December 2017–July 2019). Data collection entailed 140 hours participant observation and 19 in-depth interviews. Practice theory informed the analysis.

Participants

33 pharmacy staff (counter staff, technicians, dispensers, pharmacists).

Results

In their working practices related to polypharmacy, staff used the term ‘safety’ in explanations of why and how they were doing things in particular ways. We present three interlinked analytic themes within an overarching narrative of care: caring for the technology; caring for each other; and caring for the patient. Our study revealed a paradox: polypharmacy was visible, pervasive and productive of numerous routines, but rarely discussed as a safety concern per se. Safety meant ensuring medicines were dispensed as prescribed, and correcting errors pertaining to individual drugs through the clinical check. Pharmacy staff did not actively challenge polypharmacy, even when the volume of medicines dispensed might indicate ‘high risk' polypharmacy, locating the responsibility for polypharmacy with prescribing clinicians.

Conclusion

‘Safety’ in the performance of practices relating to polypharmacy was not a fixed, defined notion, but an ongoing, collaborative accomplishment, emerging within an organisational narrative of ‘care’. Despite meticulous attention to ‘safety’, carefully guarded professional boundaries meant that addressing polypharmacy per se in the context of community pharmacy was beyond reach.
Experiences of telehealth e-mentoring within postgraduate musculoskeletal physical therapy education in the UK and Canada: a protocol for parallel mixed-methods studies and cross-cultural comparison
Authors: Heneghan Nicola R , Nazareth Madeleine , Johnson Wendy J , Tyros Isaak , Sadi Jackie , Gillis Heather , Rushton Alison B
Published: February 2021

Introduction

Mentored clinical practice is central to demonstrating achievement of International Educational Standards in advanced musculoskeletal physical therapy. While traditionally delivered face-to-face, telehealth e-mentoring is a novel alternative to offering this unique pedagogy to facilitate mentee critical reflection, deeper learning and enhanced knowledge translation to optimise patient care. With COVID-19 resulting in widespread adoption of telehealth and access to mentors often limited by geography or cost, the potential value of telehealth e-mentoring needs investigating. To investigate the experiences and outcomes of multiple stakeholders (student mentees, mentors and patients) engaged in musculoskeletal physical therapy telehealth e-mentoring across two universities (UK and Canada).

Methods and analysis

Using case study design, we will use sequential mixed methods involving qualitative and quantitative components based on existing evidence. To examine the influence of telehealth e-mentoring on health outcomes in patients with musculoskeletal complaints, we will use patient-reported outcomes for satisfaction, patient empowerment and change in musculoskeletal health. We will conduct semistructured interviews to explore the development of critical thinking, clinical reasoning, communication skills and confidence of students engaged in telehealth e-mentoring. To explore the mentor acceptability and appropriateness of telehealth e-mentoring, we will conduct a focus group in each site. Finally, we will include a focus group of participants from each site to allow a cross-cultural comparison of findings to inform international stakeholders. Quantitative data will be analysed using descriptive statistics (median and IQR) to describe changes in outcome data and qualitative data will be analysed following the Framework Method.

Ethics and dissemination

This study has ethical approval from both institutions: the University of Birmingham (ERN_20-0695) and Western University (2020-116233-47832). Findings will be published in a peer-reviewed journal and disseminated to key stakeholders in musculoskeletal physical therapy education and practice.
Feasibility and acceptability of a multi-domain intervention to increase Mediterranean diet adherence and physical activity in older UK adults at risk of dementia: protocol for the MedEx-UK randomised controlled trial
Authors: Shannon Oliver M , Lee Vivian , Bundy Rafe , Gillings Rachel , Jennings Amy , Stephan Blossom , Hornberger Michael , Balanos George , Paddick Stella Maria , Hanson Sarah , Hardeman Wendy , Holmes Rebecca , Garner Nikki , Aldred Sarah , Siervo Mario , Mathers John C , Minihane Anne Marie
Published: February 2021

Introduction

Dementia prevalence continues to increase, and effective interventions are needed to prevent, delay or slow its progression. Higher adherence to the Mediterranean diet (MedDiet) and increased physical activity (PA) have been proposed as strategies to facilitate healthy brain ageing and reduce dementia risk. However, to date, there have been no dementia prevention trials in the UK focussed on combined dietary and PA interventions. This study aims to: (1) assess feasibility and acceptability of a theory-underpinned digital and group-based intervention for dementia risk reduction in an ‘at risk’ UK cohort; (2) evaluate behaviour change responses to the intervention; and, (3) provide information on cognitive, neurological, vascular and physiological outcomes to inform the design of a follow-on, full-scale efficacy trial.

Methods

One hundred and eight participants aged 55 to 74 years with a QRISK2 score of ≥10% will be recruited to take part in this 24-week multi-site study. Participants will be randomised into three parallel arms: (1) Control; (2) MedDiet; and, (3) MedDiet+PA. The study will evaluate a personalised website, group session and food delivery intervention to increase MedDiet adherence and PA in older adults at risk of dementia. Diet and PA will be monitored prior to, during and following the intervention. Feasibility, acceptability and hypothesised mediators will be assessed in addition to measures of cognitive function, brain structure/perfusion (MRI), vascular function and metabolic markers (blood, urine and faecal) prior to, and following, the intervention.

Discussion

This trial will provide insights into the feasibility, acceptability and mechanism of effect of a multi-domain intervention focussed on the MedDiet alone and PA for dementia risk reduction in an ‘at risk’ UK cohort.

Ethics and dissemination

The study has received NHS REC and HRA approval (18/NI/0191). Findings will be disseminated via conference presentations, public lectures, and peer-reviewed publications.

Trial registration details

ClinicalTrials.govNCT03673722.
Diverse perspectives on hospitalisation events among people with dementia: protocol for a multisite qualitative study
Authors: Gilmore-Bykovskyi Andrea , Cotton Quinton , Morgan Jennifer , Block Laura
Published: February 2021

Introduction

People living with dementia (PLWD) are more likely to experience hospitalisation events (hospitalisation, rehospitalisation) than those without dementia. Many hospitalisation events, particularly rehospitalisation within 30 days of discharge, are thought to be avoidable. Yet our understanding of dementia-specific risk and protective factors surrounding avoidable hospitalisation is limited to specific intersetting transitions and predominantly clinician perspectives. Broader insights are needed to design accessible and effective solutions for reducing avoidable hospitalisations. We have designed the Stakeholders Understanding of Prevention Protection and Opportunities to Reduce HospiTalizations (SUPPORT) Study to address these gaps. The objectives of the SUPPORT Study are to elicit and examine family caregiver, community and hospital providers’ perspectives on avoidable hospitalisation events among PLWD, and to identify opportunities for effective prevention.

Methods and analysis

We will conduct a multisite, descriptive qualitative study to interview around 100 family caregivers, community and hospital providers. We will identify and sample from regions and communities with higher socio-contextual disadvantage and hospital utilisation, and will aim to recruit individuals representing diverse racial/ethnic backgrounds. Interviews will follow a descriptive qualitative design in conjunction with constant comparison techniques to sample divergent situations and events. We will employ a range of analytical approaches to address specific research questions including thematic (inductive and deductive), comparative and dimensional analysis. Interviews will be conducted individually or in focus groups and follow a semistructured interview guide.

Ethics and dissemination

The study is approved by the University of Wisconsin-Madison Institutional Review Board. Informed consent procedures will incorporate steps to evaluate capacity to provide informed consent in the event that participants express concerns with thinking or memory or demonstrate challenges recalling study details during the consent process to ensure capacity to consent to participation. A series of publicly available reports, seminars and symposia will be undertaken in collaboration with collaborating organisation partners.
Validating the RISE UP score for predicting prognosis in patients with COVID-19 in the emergency department: a retrospective study
Authors: van Dam Paul MEL , Zelis Noortje , Stassen Patricia , van Twist Daan J L , De Leeuw Peter W , van Kuijk Sander , Buijs Jacqueline
Published: February 2021

Objective

To mitigate the burden of COVID-19 on the healthcare system, information on the prognosis of the disease is needed. The recently developed Risk Stratification in the Emergency Department in Acutely ill Older Patients (RISE UP) score has very good discriminatory value for short-term mortality in older patients in the emergency department (ED). It consists of six readily available items. We hypothesised that the RISE UP score could have discriminatory value for 30-day mortality in ED patients with COVID-19.

Design

Retrospective analysis.

Setting

Two EDs of the Zuyderland Medical Centre, secondary care hospital in the Netherlands.

Participants

The study sample consisted of 642 adult ED patients diagnosed with COVID-19 between 3 March and until 25 May 2020. Inclusion criteria were (1) admission to the hospital with symptoms suggestive of COVID-19 and (2) positive result of the PCR or (very) high suspicion of COVID-19 according to the chest CT scan.

Outcome

Primary outcome was 30-day mortality, secondary outcome was a composite of 30-day mortality and admission to intensive care unit (ICU).

Results

Within 30 days after presentation, 167 patients (26.0%) died and 102 patients (15.9%) were admitted to ICU. The RISE UP score showed good discriminatory value for 30-day mortality (area under the receiver operating characteristic curve (AUC) 0.77, 95% CI 0.73 to 0.81) and for the composite outcome (AUC 0.72, 95% CI 0.68 to 0.76). Patients with RISE UP scores below 10% (n=121) had favourable outcome (zero deaths and six ICU admissions), while those with scores above 30% (n=221) were at high risk of adverse outcome (46.6% mortality and 19.0% ICU admissions).

Conclusion

The RISE UP score is an accurate prognostic model for adverse outcome in ED patients with COVID-19. It can be used to identify patients at risk of short-term adverse outcome and may help guide decision-making and allocating healthcare resources.
Effect of Tai Chi on muscle strength, physical endurance, postural balance and flexibility: a systematic review and meta-analysis
Authors: Wehner Christian , Blank Cornelia , Arvandi Marjan , Wehner Carina , Schobersberger Wolfgang
Published: February 2021

Objective

To investigate the impact of Tai Chi training on muscle strength, physical endurance, postural balance and flexibility, as measured by tests commonly used in health-related fitness or competitive sports contexts.

Design

Systematic review and meta-analysis.

Data sources

The following databases were searched up to 31 July 2020: CINAHL, Cochrane Library, MEDLINE via PubMed and SPORTDiscus.

Eligibility criteria for studies

Inclusion: (1) Randomised controlled trials published in German or English; (2) Tai Chi used as an intervention to improve physical performance; (3) Test methods commonly used in health-related fitness or competitive sports and (4) Participants aged ≥16 years (irrespective of health status). Exclusion: (1) Studies not focusing on Tai Chi or including Tai Chi mixed with other interventions and (2) Modified or less than eight Tai Chi movements.

Results

Out of 3817 records, 31 studies were included in the review, 21 of them in the meta-analysis. Significant improvements in handgrip strength (2.34 kg, 95% CI 1.53 to 3.14), walking distance during 6 min (43.37 m, 95% CI 29.12 to 57.63), standing time in single-leg-stance with open eyes (6.41 s, 95% CI 4.58 to 8.24) and thoracolumbar spine flexibility (2.33 cm, 95% CI 0.11 to 4.55) were observed.

Conclusion

Tai Chi training seems to moderately improve physical fitness when evaluated by tests used in health-related fitness or competitive sports. Moreover, thoracolumbar spine flexibility seems to be a factor in the improvement of postural balance. Further research is needed, including younger healthy participants performing a widely used, standardised form (eg, Peking-style routine) with high-intensity movements (eg, use of lower stances).
SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study
Authors: Pandanaboyana Sanjay , Moir John , Leeds John S , Oppong Kofi , Kanwar Aditya , Marzouk Ahmed , Belgaumkar Ajay , Gupta Ajay , Siriwardena Ajith K , Haque Ali Raza , Awan Altaf , Balakrishnan Anita , Rawashdeh Arab , Ivanov Bogdan , Parmar Chetan , M Halloran Christopher , Caruana Clifford , Borg Cynthia-Michelle , Gomez Dhanny , Damaskos Dimitrios , Karavias Dimitrios , Finch Guy , Ebied Husam , K Pine James , R A Skipworth James , Milburn James , Latif Javed , Ratnam Apollos Jeyakumar , El Kafsi Jihène , Windsor John A , Roberts Keith , Wang Kelvin , Ravi Krish , V Coats Maria , Hollyman Marianne , Phillips Mary , Okocha Michael , SJ Wilson Michael , A Ameer Nadeem , Kumar Nagappan , Shah Nehal , Lapolla Pierfrancesco , Magee Connor , Al-Sarireh Bilal , Lunevicius Raimundas , Benhmida Rami , Singhal Rishi , Balachandra Srinivasan , Demirli Atıcı Semra , Jaunoo Shameen , Dwerryhouse Simon , Boyce Tamsin , Charalampakis Vasileios , Kanakala Venkat , Abbas Zaigham , Nayar Manu
Published: February 2021

Objective

There is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.

Design

A prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.

Results

1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.

Conclusion

Patients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.
Mechanism of Mir-218-5P in Autophagy, Apoptosis and Oxidative Stress in Rheumatoid Arthritis Synovial Fibroblasts is Mediated by Klf9 and Jak/Stat3 Pathways
Authors: Chen Ming , Li Minghui , Zhang Na , Sun Wenwen , Wang Hui , Wei Wei
Published: February 2021

This study was aimed to investigate the effects of miR-218-5p on the proliferation, apoptosis, autophagy, and oxidative stress of rheumatoid arthritis synovial fibroblasts (RASFs), and the related mechanisms. Quantitative reverse transcription-PCR showed that the expression of miR-218-5p in rheumatoid arthritis synovial tissue was significantly higher than that in healthy synovial tissue. Compared with healthy synovial fibroblasts, miR-218-5p expression was obviously upregulated in RASFs, while KLF9 protein expression was markedly downregulated. Mechanistically, miR-218-5p could directly bind to the 3′ untranslated region of KLF9 to inhibit the expression of KLF9. Additionally, transfection of miR-218-5p small interfering RNA (siRNA) inhibited the proliferation but promoted apoptosis and autophagy of RASFs. Simultaneously, miR-218-5p silencing reduced reactive oxygen species and malondialdehyde levels and increased superoxide dismutase and glutathione peroxidase activity to improve oxidative stress in RASFs. More importantly, the introduction of KLF9 siRNA reversed the effects of miR-218-5p siRNA transfection on RASF proliferation, apoptosis, autophagy, and oxidative stress. What is more, silencing miR-218-5p inhibited the activation of JAK2/STAT3 signaling pathway by targeting KLF9. Collectively, knockdown of miR-218-5p could regulate the proliferation, apoptosis, autophagy and oxidative stress of RASFs by increasing the expression of KLF9 and inhibiting the activation of the JAK2/STAT3 signaling pathway, which may provide a potential target for the mechanism research of RA.
Territory-wide cohort study of Brugada syndrome in Hong Kong: predictors of long-term outcomes using random survival forests and non-negative matrix factorisation
Authors: Lee Sharen , Zhou Jiandong , Li Ka Hou Christien , Leung Keith Sai Kit , Lakhani Ishan , Liu Tong , Wong Ian Chi Kei , Mok Ngai Shing , Mak Chloe , Jeevaratnam Kamalan , Zhang Qingpeng , Tse Gary
Published: February 2021

Objectives

Brugada syndrome (BrS) is an ion channelopathy that predisposes affected patients to spontaneous ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death. The aim of this study is to examine the predictive factors of spontaneous VT/VF.

Methods

This was a territory-wide retrospective cohort study of patients diagnosed with BrS between 1997 and 2019. The primary outcome was spontaneous VT/VF. Cox regression was used to identify significant risk predictors. Non-linear interactions between variables (latent patterns) were extracted using non-negative matrix factorisation (NMF) and used as inputs into the random survival forest (RSF) model.

Results

This study included 516 consecutive BrS patients (mean age of initial presentation=50±16 years, male=92%) with a median follow-up of 86 (IQR: 45–118) months. The cohort was divided into subgroups based on initial disease manifestation: asymptomatic (n=314), syncope (n=159) or VT/VF (n=41). Annualised event rates per person-year were 1.70%, 0.05% and 0.01% for the VT/VF, syncope and asymptomatic subgroups, respectively. Multivariate Cox regression analysis revealed initial presentation of VT/VF (HR=24.0, 95% CI=1.21 to 479, p=0.037) and SD of P-wave duration (HR=1.07, 95% CI=1.00 to 1.13, p=0.044) were significant predictors. The NMF-RSF showed the best predictive performance compared with RSF and Cox regression models (precision: 0.87 vs 0.83 vs. 0.76, recall: 0.89 vs. 0.85 vs 0.73, F1-score: 0.88 vs 0.84 vs 0.74).

Conclusions

Clinical history, electrocardiographic markers and investigation results provide important information for risk stratification. Machine learning techniques using NMF and RSF significantly improves overall risk stratification performance.
Estimating the extent of myocardial damage in patients with STEMI using the DETERMINE score
Authors: Tiller Christina , Holzknecht Magdalena , Reindl Martin , Lechner Ivan , Kalles Verena , Troger Felix , Schwaiger Johannes , Mayr Agnes , Klug Gert , Brenner Christoph , Bauer Axel , Metzler Bernhard , Reinstadler Sebastian Johannes
Published: February 2021

Background

Recently, a simple ECG score (DETERMINE score) has been proposed for estimating myocardial scar in patients with ischaemic cardiomyopathy. We sought to evaluate the usefulness of the DETERMINE score for the assessment of myocardial infarct size (IS) as well as microvascular obstruction (MVO), in the setting of ST-elevation myocardial infarction (STEMI).

Methods

This observational study enrolled 423 patients with STEMI (median age 56, 17% women), revascularised by primary percutaneous coronary intervention (PCI). For evaluation of the DETERMINE and Selvester scoring system (an established but complex ECG score for IS estimation), ECG was conducted before discharge (median: 4 (IQR 2–6) days). Cardiac magnetic resonance (CMR) was conducted within a week after infarction for determination of IS and MVO.

Results

Median DETERMINE score of the overall cohort was 8 points (IQR 5–11). A higher DETERMINE score was significantly associated with a larger IS (21% vs 11% of left ventricular myocardial mass (LVMM), p<0.001) as well as larger MVO (1.2% vs 0.0% of LVMM, p<0.001). In linear and binary multivariable logistic regression analysis, the DETERMINE score remained independently associated with IS (OR 1.09, 95% CI 1.02 to 1.17, p=0.014) and MVO (OR 1.12, 95% CI 1.04 to 1.21, p=0.003), after adjustment for Selvester score and clinical indicators of IS (high-sensitivity cardiac troponin T, high-sensitivity C reactive protein, N-terminal pro-B-type natriuretic peptide, TIMI flow pre-interventional and post-interventional PCI, anterior infarct localisation).

Conclusions

In patients undergoing PCI for STEMI, the DETERMINE score provides an easy and inexpensive tool for appropriate estimation of infarct severity as determined by CMR.
Validity and reliability of the EULAR instrument RAID.7 as a tool to assess individual domains of impact of disease in rheumatoid arthritis: a cross-sectional study of 671 patients
Authors: Duarte Catia , Santos Eduardo José Ferreira , Ferreira Ricardo J O , Kvien Tore K , Dougados Maxime , de Wit Maarten , da Silva Jose Antonio Pereira , Gossec Laure
Published: February 2021

Objective

The rheumatoid arthritis impact of disease (RAID) questionnaire comprises seven patient-important domains of disease impact (pain, function, fatigue, sleep disturbance, emotional well-being, physical well-being, coping). RAID was validated as a pooled-weighted score. Its seven individual items separately could provide a valuable tool in clinical practice to guide interventions targeting the patient’s experience of the disease. The aim was to separately assess the psychometric properties of each of the seven numeric rating scale (NRS) of the RAID (RAID.7).

Material and methods

Post hoc analyses of data from the cross-sectional RAID study and from the Rainbow study, an open-label 12-week trial of etanercept in patients with RA. Construct validity of each NRS was assessed cross-sectionally in the RAID data set by Spearman’s correlation with the respective external instrument of reference. Using the rainbow data set, we assessed reliability through intraclass correlation coefficient between the screening and the baseline visits and responsiveness (sensitivity to change) by standardised response mean between baseline and 12 weeks.

Results

A total of 671 patients with RA with features of established disease were analysed, 563 and 108 from RAID and Rainbow, respectively. The NRS correlated moderately to strongly with the respective external instrument of reference (r=0.62–0.81). Reliability ranged from 0.64 (0.51–0.74) (pain) to 0.83 (0.76–0.88) (sleep disturbance) and responsiveness from 0.93 (0.73–1.13) (sleep disturbance) to 1.34 (1.01–1.64) (pain).

Conclusion

The separate use of the individual NRS of RAID (RAID.7) is valid, feasible, reliable and sensitive to change, representing an opportunity to improve the assessment and treatment of disease impact with minimal questionnaire burden.

Trial registration number

NCT00768053.