bluuebunny/crossref_metadata_2025 huggingface dataset:
Extreme hypercalcaemia caused by immobilisation due to acute spinal cord injury
Authors: Tettero Jesse Marc , van Eeghen Elmer , Kooter Albertus Jozef
Published: June 2021

Hypercalcaemia due to immobilisation is an uncommon diagnosis and requires extensive evaluation to rule out common causes of hypercalcaemia such as primary hyperparathyroidism and malignancy.

We report an unusual case of profound hypercalcaemia due to immobilisation in a young man due to acute spinal cord ischaemia, leading to paraplegia. Other causes of hypercalcaemia were ruled out and elevated bone turnover markers supported our hypothesis. Conventional treatment with intravenous fluids, bisphosphonates and diuretics was insufficient. Subcutaneous calcitonin lowered the plasma calcium acutely and was continued for 8 weeks. Subsequent normocalcaemia was sustained for 2 years.
Unusual cause of dysphagia and dysphonia
Authors: Singh Anup , Khatri Gaurav , Handa Kumud Kumar
Published: June 2021

Forestier’s disease is an idiopathic noninflammatory condition associated with enthesopathy leading to hyperostosis of the vertebrae and peripheral skeletal system. The disease tends to affect elderly individuals and remains asymptomatic in most of the cases. Uncommonly, the patient may present with upper aerodigestive symptomatology, usually dysphagia. In elderly individuals, the disease may closely mimic upper aerodigestive tract malignancy, which should be actively excluded. In our patient, the hypopharyngeal soft tissue distortions created by the bony hypertrophy shifted the clinicoradiological suspicion towards malignant pathology. The current case presents the diagnostic dilemma associated with the disease and the need to keep the possibility of severe cervical bony hypertrophy as a cause of upper aerodigestive symptoms in mind.
Ethics-driven policy framework for implementation of movement restrictions in pandemics
Authors: Zadey Siddhesh , Dharmadhikari Surabhi , Mukuntharaj Pradeeksha
Published: June 2021

In the ongoing COVID-19 pandemic, countries across the globe undertook several stringent movement restrictions to prevent the virus spread. In April 2020, around 3.9 billion people in 90 countries were contained in their homes. Discourse on the ethical questions raised by such restrictions while historically rich is absent when it comes to pragmatic policy considerations by the decision-makers. Drawing from the existing literature, we present a unified ethical principles–pragmatic considerations–policy indicators framework flexibly applicable across different countries and contexts to assess the ethical soundness of movement-restricting policies. Our framework consolidates 11 unique but related ethical principles (harm, justifiability, proportionality, least restrictive means, utility efficiency, reciprocity, transparency, relevance, equity, accountability, and cost and feasibility). We mapped each ethical principle to answerable questions or pragmatic considerations to subsequently generate 34 policy indicators. These policy indicators can help policymakers and health practitioners to decide the ethically substantiated initiation of movement restrictions, monitor progress and systematically evaluate the imposed restrictions. As an example, we applied the framework to evaluate the first two phases of the largest lockdown (March–May 2020) implemented nationwide in India for its adherence to ethical principles. The policy indicators revealed ethical lapses in proportionality, utility efficiency and accountability for India’s lockdown that should be focused on in subsequent restrictions. The framework possesses value towards ensuring that movement-restrictive public health interventions across different parts of the world in the ongoing pandemic and possible future outbreaks are ethically sound.
Evolution of the deployed medical director role in an era of contingency operations: reflections from a United Nations operation
Authors: Nordmann Giles , Ralph J , Smith J E
Published: June 2021

This paper examines the development and evolution of the deployed medical director (DMD) role and argues for the re-establishment of a formal selection process and training pathway. Recent deployments into new areas of operations, deployment of smaller medical treatment facilities (MTFs), the reduced numbers of deployments for clinicians, working with various multinational partners and both military and civilian organisations all pose specific problems for DMDs. The initial and then continued deployment of a secondary care role 2 MTF as part of the United Nations Mission in South Sudan illustrated some of these challenges. Although a novel operation, the broad categories of these new challenges were similar to the historical challenges facing the first DMDs in Afghanistan. Corporate memory loss may be unavoidable to some degree due to rapid turnover in appointments, particularly in single service and joint headquarters. However, individual memory and experience remains extant within the military medical deployable workforce. After the cessation of UK military deployed hospital care involvement in Afghanistan, the UK DMD formal training pathway ended. This paper argues for the re-establishment of a more formal DMD selection process and training pathway to ensure that organisational learning is optimised.
Peer-led HIV care and the UNAIDS 90-90-90 treatment targets in Tigrai, Ethiopia: a cluster randomised trial and economic evaluation ofteach-test-link-tracemodel (TTLT) trial protocol
Authors: Gesesew Hailay , Ward Paul , Karnon Jonathan , Woodman Richard , Mwanri Lillian
Published: June 2021

Introduction

This study will evaluate the acceptability and effectiveness of a new intervention programme calledteach-test-link-trace(TTLT) model in Tigrai, Ethiopia, where peer educators counsel about HIV (teach), perform house-to-house HIV testing (test) through pinprick HIV testing (H2H) or OraQuick HIV self-testing (HIVST), link HIV-positive patients to HIV care (link) and trace lost patients house-to-house (trace).

Methods and analysis

The four-arm cluster randomised trial will be conducted in five phases:Phase 1will assess the acceptability of the TTLT model using a cross-sectional survey among adults aged 18 years irrespective of HIV status in 6909 households from 40 villages (kebeles).Phase 2will assess effectiveness of the TTLT model through comparing intervention and control groups among HIV negative or unknown HIV status. The intervention groups will receive one of the three home-based interventions provided by peer educators: (1) demonstrate and distribute OraQuick HIV self-testing kits (HIVST), (2) perform pinprick HIV testing (H2H) and (3) offer a choice to either receive HIVST or H2H. The control group will receive the standard care in which nurses counsel and refer eligible household members to nearby health facilities to access existing HIV testing services. The primary outcomes of the interventions are proportion of individuals who know of their HIV status (first 90), link to HIV care and treatment (second 90) and meet virological suppression (third 90). We will perform process evaluation through qualitative interviews inphase 3, economic evaluation for cost-effectiveness analysis inphase 4and a sustainability exit strategy using nominal group technique inphase 5. We will apply descriptive and inferential statistics for quantitative studies, and thematic framework analysis for qualitative studies.

Ethics and dissemination

Ethics approval was obtained from the Southern Adelaide Clinical Health Research Ethics Committee (SAC HREC), South Australia, and findings will be disseminated through publications, conference presentations, media release and policy briefs.

Trial registration number

ACTRN12620000570987p.
Soft-shell headgear, concussion and injury prevention in youth team collision sports: a systematic review
Authors: Makovec Knight Jennifer , Nguyen Jack V. K. , Mitra Biswadev , Willmott Catherine
Published: June 2021

Objectives

To assess the association between soft-shell headgear (HG) use and sports-related concussion (SRC). Secondary objectives were to assess the association between HG and superficial head injury and investigate potential increase in injury risk among HG users.

Design

A systematic search in Ovid MEDLINE, Cochrane Library, Scopus, PsycINFO and SPORTDiscus was conducted in April 2020. Inclusion criteria were youth <18, English language, in vivo studies published after 1980 that evaluated SRC and other injury incidence in HG users compared with non-users.

Outcome measures

Incidence rates of SRC, superficial head injury or other injuries.

Results

Eight studies were eligible. The majority (n=5) reported no difference in the rate of SRC among HG users versus non-users. One rugby study identified significantly lower risk of SRC for non-HG users (risk ratio (RR) 0.63; 95% CI 0.41 to 0.98) compared with HG users, whereas a cross-sectional survey of soccer players indicated higher risk of SRC for non-HG users (RR 2.65; 95% CI 1.23 to 3.12) compared with HG users. Three of the four studies investigating superficial head injury found no significant differences with HG use, though the soccer survey reported reduced risk among HG users (RR 1.86; 95% CI 0.09 to 0.11). Increased incidence of injuries to all body regions for rugby HG users was reported in two studies with adjusted RRs of 1.16 (95% CI 1.04 to 1.29) and 1.23 (95% CI 1.00 to 1.50).

Conclusions

HG use was not associated with reduced rates of SRC or superficial head injury in youth soccer and rugby. The possibility of increased injury risk to all body regions for rugby HG users was raised. The need for research specific to youth and female athletes was highlighted.

PROSPERO registration number

CRD42018115310.
Community social support and onset of dementia in older Japanese individuals: a multilevel analysis using the JAGES cohort data
Authors: Miyaguni Yasuhiro , Tabuchi Takahiro , Aida Jun , Saito Masashige , Tsuji Taishi , Sasaki Yuri , Kondo Katsunori
Published: June 2021

Objective

Recently, there has been an increase in the number of people with dementia. However, no study has examined the association between community-level social support and the onset of incident dementia using multilevel survival analysis.

Design

A prospective cohort study.

Participants and setting

We analysed data pertaining to 15 313 (7381 men and 7932 women) community-dwelling adults aged 65 years or older who had not accessed long-term care insurance and were living in Aichi Prefecture (seven municipalities) in Japan.

Primary and secondary outcome measures

The association between community-level social support and onset of incident dementia was examined using the Japan Gerontological Evaluation Study, a prospective cohort study introduced in Japan in 2003. Incident dementia was assessed using Long-term Care Insurance records spanning 3436 days from the baseline survey.

Results

During the 10-year follow-up, the onset of incident dementia occurred in 1776 adults. Among older people, a 1% increase in community-level social support (in the form of receiving emotional support) was associated with an approximately 4% reduction in the risk of developing dementia, regardless of socio-demographic variables and health conditions (HR=0.96; 95% CI=0.94 to 0.99).

Conclusions

Receiving community-level social support in the form of emotional support is associated with a lower risk of developing incident dementia.
Trends of injury mortality during the COVID-19 period in Guangdong, China: a population-based retrospective analysis
Authors: Zheng Xue-Yan , Tang Si-Li , Ma Shu-Li , Guan Wei-Jie , Xu Xiaojun , Xu Haofeng , Xu Ying-Shan , Xu Yan-Jun , Lin Li-Feng
Published: June 2021

Objective

We aimed to ascertain the trends of injury mortality during the COVID-19 period in southern China.

Methods

We conducted a population-based retrospective analysis to compare the mortality changes of all-cause injury and transport injuries, poisoning, falls, fire/heat/hot substances, drowning, self-harm and interpersonal violence, which were further stratified by sex and age. Comparisons were made between the COVID-19 period (between January 2020 and June 2020) and control period (between January 2019 and June 2019) in Guangdong province. We used the negative binomial models to explore the associations of deaths during the COVID-19 period, according to the different sex and age strata.

Results

The all-cause injury mortality in Guangdong province decreased significantly from 28.65 per 100 000 population during the control period to 23.24 per 100 000 population during COVID-19 pandemic period. Similar results were found in specific injury categories. Mortality of self-harm increased by 139.26% in the 10–14 year group during the COVID-19 period as compared with the control period. Although mortality changes in some groups were not statistically significant, some increases were noteworthy during the COVID-19 period (ie, self-harm, transport injury and falls) in the 70–79 year group. The corresponding increase in mortality rate was 16.83%, 3.32% and 4.92%, respectively.

Conclusion

The mortality of all-cause injury, transport injury and drowning during the COVID-19 pandemic was consistently decreased. However, the increase in mortality associated with falls, fire/heat/hot substance injury and self-harm in specific age populations warrant the targeted control and prevention measures for the population at risk.
Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study
Authors: Peter Noel , Bandyopadhyay Soham , Lakhoo Kokila
Published: June 2021

Introduction

Childhood cancers are a leading cause of non-communicable disease deaths for children around the world. The COVID-19 pandemic may have impacted on global children’s cancer services, which can have consequences for childhood cancer outcomes. The Global Health Research Group on Children’s Non-Communicable Diseases is currently undertaking the first international cohort study to determine the variation in paediatric cancer management during the COVID-19 pandemic, and the short-term to medium-term impacts on childhood cancer outcomes.

Methods and analysis

This is a multicentre, international cohort study that will use routinely collected hospital data in a deidentified and anonymised form. Patients will be recruited consecutively into the study, with a 12-month follow-up period. Patients will be included if they are below the age of 18 years and undergoing anticancer treatment for the following cancers: acute lymphoblastic leukaemia, Burkitt lymphoma, Hodgkin lymphoma, Wilms tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas and neuroblastomas. Patients must be newly presented or must be undergoing active anticancer treatment from 12 March 2020 to 12 December 2020. The primary objective of the study was to determine all-cause mortality rates of 30 days, 90 days and 12 months. This study will examine the factors that influenced these outcomes. χ2analysis will be used to compare mortality between low-income and middle-income countries and high-income countries. Multilevel, multivariable logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.

Ethics and dissemination

At the host centre, this study was deemed to be exempt from ethical committee approval due to the use of anonymised registry data. At other centres, participating collaborators have gained local approvals in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for publication in a peer-reviewed journal.
Individualised physical activity programme in patients over 65 years with haematological malignancies (OCAPI): protocol for a single-arm feasibility trial
Authors: Fournier Baptiste , Nicolas-Virelizier Emmanuelle , Russo Chiara , Pérol Olivia , Millet Guillaume Y , Maire Aurélia , Delrieu Lidia , Michallet Anne-Sophie , Assaad Souad , Belhabri Amine , Gilis Lila , Guillermin Yann , Lebras Laure , Rey Philippe , Santana Clémence , Pretet-Flamand Emilie , Terret Catherine , Michallet Mauricette , Fervers Béatrice
Published: June 2021

Introduction

Older adults with cancer suffer from the combined effects of ageing, cancer disease and treatment side effects. The main treatment for patients with haematological malignancies is chemotherapy, associated with significant toxicities. Chemotherapy can alter patients’ physical function and quality of life which are often already diminished in older patients due to ageing and comorbidities. It therefore seems essential to develop and to evaluate interventions capable of preventing physical and psychosocial decline and its consequences. Promoting physical activity is a promising approach to improve physical function and quality of life in older adults with cancer, but there are limited data on the feasibility of such interventions among older patients with haematological malignancies, concomitant to chemotherapy.

Methods and analysis

OCAPI (OnCogeriatric and Individualized Physical Activity) is a single-arm, interdisciplinary, prospective, interventional, feasibility study. It is intended to include 40 patients (20 patients with acute myeloid leukaemia and 20 patients with non-Hodgkin’s lymphoma) over 65 years in an individualised 6-month physical activity programme. The programme consists of individually supervised exercise sessions with an increasing volume of physical activity either at home and/or in a laminar airflow room (depending on the disease and treatment regimen) followed by unsupervised sessions and phone follow-ups. Patients will receive an activity tracker during the 6 months of the programme. Evaluations will take place at inclusion and at 3, 6 and 12 months to assess the feasibility of the programme and to explore potential changes in physical, psychosocial and clinical outcomes. The results will generate preliminary data to implement a larger randomised controlled trial.

Ethics and dissemination

The study protocol was approved by the French ethics committee (Comité de protection des personnes Est I, N°ID-RCB 2019-A01231-56, 12 July 2019). All participants will have to sign and date an informed consent form. The findings will be disseminated in peer-reviewed journals and academic conferences.

Trial registration number

NCT04052126.
Admission glucose level and short-term mortality in older patients with acute myocardial infarction: results from the KORA Myocardial Infarction Registry
Authors: Mamadjanov Temur , Volaklis Konstantinos , Heier Margit , Freuer Dennis , Amann Ute , Peters Annette , Kuch B , Thilo Christian , Linseisen Jakob , Meisinger Christa
Published: June 2021

Study objectives

To investigate the association between admission blood glucose levels and 28-day mortality as well as in-hospital complications in older patients with incident acute myocardial infarction (AMI) undergoing modern treatment.

Methods

From a German population-based regional MI registry, 5530 patients (2016 women), aged 65–84 years, hospitalised with an incident AMI between 1 January 2009 and 31 December 2016 were included in the study. Multivariable logistic regression models were used to assess the associations between admission blood glucose and 28-day mortality as well as in-hospital complications after AMI. Analyses stratified according to age, diabetes and type of infarction (ST-elevation MI (STEMI)/non-STEMI) were conducted.

Results

The adjusted ORs for the association between admission blood glucose and 28-day mortality in young-old (65–74 years) and old (75–84 years) patients with AMI were 1.40 (95% CI: 1.21 to 1.62) and 1.21 (95% CI: 0.98 to 1.50) per 1 SD increase in admission blood glucose, respectively. Furthermore, higher admission blood glucose was related to case fatality irrespective of the diabetes status and type of infarction only in the under-75 group. For the patients aged 75–84 years, it was only true for those without diabetes and STEMI. Admission blood glucose was also associated with major cardiac complications in both age groups.

Conclusion

Admission blood glucose was significantly associated with 28-day case fatality in patients with AMI aged 65–74 years but not 75–84 years; furthermore, in both age groups there was an increased risk of major complications. It seems that admission glucose may play a rather minor role in terms of case fatality in higher aged patients with AMI.
Effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis protocol
Authors: Alharbi Rayan Jafnan , Lewis Virginia , Shrestha Sumina , Miller Charne
Published: June 2021

Introduction

The introduction of trauma systems that began in the 1970s resulted in improved trauma care and a decreased rate of morbidity and mortality of trauma patients. Worldwide, little is known about the effectiveness of trauma care system at different stages of development, from establishing a trauma centre, to implementing a trauma system and as trauma systems mature. The objective of this study is to extract and analyse data from research that evaluates mortality rates according to different stages of trauma system development globally.

Methods and analysis

The proposed review will comply with the checklist of the ‘Preferred reporting items for systematic review and meta-analysis’. In this review, only peer-reviewed articles written in English, human-related studies and published between January 2000 and December 2020 will be included. Articles will be retrieved from MEDLINE, EMBASE and CINAHL. Additional articles will be identified from other sources such as references of included articles and author lists. Two independent authors will assess the eligibility of studies as well as critically appraise and assess the methodological quality of all included studies using the Cochrane Risk of Bias for Non-randomised Studies of Interventions tool. Two independent authors will extract the data to minimise errors and bias during the process of data extraction using an extraction tool developed by the authors. For analysis calculation, effect sizes will be expressed as risk ratios or ORs for dichotomous data or weighted (or standardised) mean differences and 95% CIs for continuous data in this systematic review.

Ethics and dissemination

This systematic review will use secondary data only, therefore, research ethics approval is not required. The results from this study will be submitted to a peer-review journal for publication and we will present our findings at national and international conferences.

PROSPERO registration number

CRD42019142842.
Implementation of the ERAS (Enhanced Recovery After Surgery) protocol for colorectal cancer surgery in the Piemonte Region with an Audit and Feedback approach: study protocol for a stepped wedge cluster randomised trial: a study of the EASY-NET project
Authors: Pagano Eva , Pellegrino Luca , Rinaldi Federica , Palazzo Valentina , Donati Danilo , Meineri Maurizio , Palmisano Sarah , Rolfo Monica , Bachini Ilaria , Bertetto Oscar , Borghi Felice , Ciccone Giovannino
Published: June 2021

Introduction

The ERAS protocol (Enhanced Recovery After Surgery) is a multimodal pathway aimed to reduce surgical stress and to allow a rapid postoperative recovery. Application of the ERAS protocol to colorectal cancer surgery has been limited to a minority of hospitals in Italy. To promote the systematic adoption of ERAS in the entire regional hospital network in Piemonte an Audit and Feedback approach (A&F) has been adopted together with a cluster randomised trial to estimate the true impact of the protocol on a large, unselected population.

Methods

A multicentre stepped wedge cluster randomised trial is designed for comparison between standard perioperative management and the management according to the ERAS protocol. The primary outcome is the length of hospital stay (LOS). Secondary outcomes are: incidence of postoperative complications, time to patients’ recovery, control of pain and patients’ satisfaction. With an A&F approach the adherence to the ERAS items is monitored through a dedicated area in the study web site. The study includes 28 surgical centres, stratified by activity volume and randomly divided into four groups. Each group is randomly assigned to a different activation period of the ERAS protocol. There are four activation periods, one every 3 months. However, the planned calendar and the total duration of the study have been extended by 6 months due to the COVID-19 pandemic.

The expected sample size of about 2200 patients has a high statistical power (98%) to detect a reduction of LOS of 1 day and to estimate clinically meaningful changes in the other endpoints.

Ethics and dissemination

The study protocol has been approved by the Ethical Committee of the coordinating centre and by all participating centres. Study results will be timely circulated within the hospital network and published in peer-reviewed journals.

Trial registration number

NCT04037787.
Does living at moderate altitudes in Austria affect mortality rates of various causes? An ecological study
Authors: Burtscher Johannes , Millet Gregoire P , Burtscher Martin
Published: June 2021

Objectives

The effects of altitude residence on ageing, longevity and mortality are poorly understood. While adaptations to chronic exposure to altitude may exert beneficial effects on cardiovascular risk factors and some types of cancer, an elevated risk to die from chronic respiratory diseases has been reported. Moreover, high-altitude residence may be correlated with increased depression and suicide rates. The present study tested the hypothesis that living at moderate altitudes (up to 2000 m) is associated with reduced mortality from all causes.

Setting and participants

We used a dataset comprising all deaths (n=467 834) across 10 years of a country (Austria) characterised by varying levels of altitudes up to 2000 m.

Main outcome measures

Total number of deaths, age-standardised mortality rates (ASMRs) per 100 000 population, cause-specific ASMRs.

Results

ASMRs for residents living in higher (>1000 m) versus lower (<251 m) altitude regions (with agriculture employment below 3%) were 485.8 versus 597.0 (rate ratio and 95% CI 0.81 (0.72 to 0.92); p<0.001) for men and 284.6 versus 365.5 (0.78; 0.66 to 0.91); p=0.002) for women. Higher levels of agriculture employment did not influence mortality rates. Diseases of the circulatory system and cancers were main contributors to lower mortality rates at higher altitude. Residence at higher altitude did not negatively affect mortality rates from any other diseases. We highlight gender effects and—beside environmental factors—also discuss socioeconomic factors that may be responsible for conflicting results with data from other populations.

Conclusions

Living at moderate altitude (1000–2000 m) elicits beneficial effects on all-cause mortality for both sexes, primarily due to lower ASMRs from circulatory diseases and cancer. The presented analysis on cause-specific ASMRs over a 10-year period among the entire population of an alpine country will contribute to a better understanding on the effects of altitude-related mortality.
Community prescribing for cancer patients at the end of life: a national study
Authors: Emanuel Gabrielle , Verne Julia , Forbes Karen , Hounsome Luke , Henson Katherine E
Published: June 2021

Background

Good end-of-life care is essential to ensure dignity and comfort in death. To our knowledge, there has not been a national population-based study in England of community prescribing of all drugs used in end-of-life care for patients with cancer.

Methods

57 632 people who died from malignant cancer in their own home or in a care home in 2017 in England were included in this study. National routinely collected data were used to examine community prescriptions dispensed for drugs for symptom control and anticipatory prescribing by key sociodemographic factors in the last 4 months of life.

Results

94% of people who died received drugs to control their symptoms and 65% received anticipatory prescribing. Prescribing increased for the symptom control drug group (53% to 75%) and the anticipatory prescribing group (4% to 52%) over the 4-month period to death.

Conclusions

Most individuals who died of cancer in their own home or a care home were dispensed drugs commonly used to control symptoms at the end of life, as recommended by best-practice guidance. Lower prescribing activity was found for those who died in a care home, highlighting a potential need for improved end-of-life service planning.
Limitations in health professionals’ knowledge of end-of-life law: a cross-sectional survey
Authors: White Ben P , Willmott Lindy , Feeney Rachel , Neller Penny , Then Shin-Ning , Bryant Jamie , Waller Amy , Yates Patsy
Published: June 2021

Background

Insufficient knowledge about end-of-life law can impede the provision of safe and high-quality end-of-life care. Accurate legal knowledge across health professions is critical in palliative and end-of-life settings given the reliance on multidisciplinary care. Most research has focused on doctors, finding significant knowledge gaps. The limited evidence about other health professions also suggests legal knowledge deficits.

Objective

To determine and compare levels of knowledge about end-of-life law across a broad sample of Australian health professionals and medical students, and to identify predictors of legal knowledge.

Methods

An online pre-training survey was completed by participants enrolled in a national training programme on end-of-life law. The optional survey collected demographic data and measured baseline legal knowledge and attitudes towards end-of-life law.

Results

Response rate was 67% (1653/2456). The final sample for analysis (n=1564, 95% of respondents), included doctors, medical students, nurses and a range of allied health professionals. Doctors and nurses had slightly higher levels of legal knowledge than did medical students and allied health professionals; all had critical knowledge gaps. Demographic and professional characteristics predicted knowledge levels, with experience of end-of-life law in practice, confidence applying law and recent continuing professional development being positively associated with legal knowledge.

Conclusions

This study provides new evidence about legal knowledge across a broad range of health professions. While knowledge levels varied somewhat across professions, knowledge gaps were observed in all professional groups. Education and training initiatives to enhance knowledge of end-of-life law should be tailored to meet the specific needs of each profession.
Prevalences of comorbid anxiety disorder and daily smartphone-based self-reported anxiety in patients with newly diagnosed bipolar disorder
Authors: Stanislaus Sharleny , Coello Klara , Kjærstad Hanne Lie , Sletved Kimie Stefanie Ormstrup , Seeberg Ida , Frost Mads , Bardram Jakob Eyvind , Jensen Rasmus Nejst , Vinberg Maj , Faurholt-Jepsen Maria , Kessing Lars Vedel
Published: June 2021

Background

Around 40% of patients with bipolar disorder (BD) additionally have anxiety disorder. The prevalence of anxiety in patients with newly diagnosed BD and their first-degree relatives (UR) has not been investigated.

Objective

To investigate (1) the prevalence of a comorbid anxiety diagnosis in patients with newly diagnosed BD and their UR, (2) sociodemographic and clinical differences between patients with and without a comorbid anxiety diagnosis and (3) the association between smartphone-based patient-reported anxiety and observer-based ratings of anxiety and functioning, respectively.

Methods

We recruited 372 patients with BD and 116 of their UR. Daily smartphone-based data were provided from 125 patients. SCAN was used to assess comorbid anxiety diagnoses.

Findings

In patients with BD, the prevalence of a comorbid anxiety disorder was 11.3% (N=42) and 10.3% and 5.9% in partial and full remission, respectively. In UR, the prevalence was 6.9%. Patients with a comorbid anxiety disorder had longer illness duration (p=0.016) and higher number of affective episodes (p=0.011). Smartphone-based patient-reported anxiety symptoms were associated with ratings of anxiety and impaired functioning (p<0.001).

Limitations

The SCAN interviews to diagnose comorbid anxiety disorder were carried out regardless of the participants’ mood state.

Clinical implications

The lower prevalence of anxiety in newly diagnosed BD than in later stages of BD indicates that anxiety increases with progression of BD. Comorbid anxiety seems associated with poorer clinical outcomes and functioning and smartphones are clinically useful for monitoring anxiety symptoms.

Trial registration number

ClinicalTrials.gov Registry (NCT02888262).
Retention of doctors in emergency medicine: a scoping review of the academic literature
Authors: Darbyshire Daniel , Brewster Liz , Isba Rachel , Body Richard , Basit Usama , Goodwin Dawn
Published: June 2021

Introduction

Workforce issues prevail across healthcare; in emergency medicine (EM), previous work improved retention, but the staffing problem changed rather than improved. More experienced doctors provide higher quality and more cost-effective care, and turnover of these physicians is expensive. Research focusing on staff retention is an urgent priority.

Methods

This study is a scoping review of the academic literature relating to the retention of doctors in EM and describes current evidence about sustainable careers (focusing on factors influencing retention), as well as interventions to improve retention. The established and rigorous JBI scoping review methodology was followed. The data sources searched were MEDLINE, Embase, Cochrane, HMIC and PsycINFO, with papers published up to April 2020 included. Broad eligibility criteria were used to identify papers about retention or related terms, including turnover, sustainability, exodus, intention to quit and attrition, whose population included emergency physicians within the setting of the ED. Papers which solely measured the rate of one of these concepts were excluded.

Results

Eighteen papers met the inclusion criteria. Multiple factors were identified as linked with retention, including perceptions about teamwork, excessive workloads, working conditions, errors, teaching and education, portfolio careers, physical and emotional strain, stress, burnout, debt, income, work–life balance and antisocial working patterns. Definitions of key terms were used inconsistently. No factors clearly dominated; studies of correlation between factors were common. There were minimal research reporting interventions.

Conclusion

Many factors have been linked to retention of doctors in EM, but the research lacks an appreciation of the complexity inherent in career decision-making. A broad approach, addressing multiple factors rather than focusing on single factors, may prove more informative.
Comparison of a new predictive model with other critical scores for predicting in-hospital mortality among children with pneumonia-related bacteremia
Authors: Lin Jilei , Zhang Yin , Song Anchao , Yang Nan , Ying Linyan , Dai Jihong
Published: June 2021

Prediction of mortality in children with pneumonia-related bacteremia is necessary for providing timely care and treatment. This study aims to develop and validate a nomogram and compare it with Pediatric Risk of Mortality III (PRISM III), Brighton Pediatric Early Warning Score (Brighton PEWS) and Pediatric Critical Illness Score (PCIS), which are widely used in predicting in-hospital mortality in children with pneumonia-related bacteremia. This retrospective study collected clinical data of hospitalized children with pneumonia-related bacteremia in Chongqing, China (January 2013–May 2019). The nomogram was built using multivariate logistic regression analysis. The nomogram was compared with PRISM III, PEWS and PCIS in accuracy and clinical benefits in predicting in-hospital mortality in children with pneumonia-related bacteremia. A total of 242 children were included. The nomogram including time to first positivity of blood cultures (TTFP), serum albumin (ALB) and lactate dehydrogenase (LDH) was established. The area under the receiver operating characteristic curve of the nomogram was 0.84 (95% CI 0.77 to 0.91) in the training set and 0.82 (95% CI 0.71 to 0.93) in the validating set. Good consistency was observed between the predictions and the actual observations, and the decision curve analysis showed that the nomogram was clinically useful. The results showed that the nomogram significantly performed better than the three critical scores. In conclusion, a nomogram-illustrated model incorporating TTFP, ALB and LDH for predicting in-hospital mortality in children with pneumonia-related bacteremia at the early stage was established and validated. It performed better than PRISM III, PEWS and PCIS.
Genetic enhancement, TED talks and the sense of wonder
Authors: Filip Loredana
Published: June 2021

TED talks are an emergent and hybrid genre (Ludewig) and have become a highly successful disseminator and populariser of scientific knowledge (Sugimoto et al). The popular appeal of TED may also stem from the promise to deliver life-changing insights in a short amount of time. Besides, TED talks may rely on a science fictional ‘sense of wonder’ (Sawyer) in their representations of new technologies. CRISPR-Cas9 is a genome-editing technology that has captured the imagination of scientists.Science’s 2015 Breakthrough of the Year, CRISPR became the focus of ethical debates because of its potential to engineer the human. Rather than its therapeutic use, it is the potential for enhancement that gains traction in media. For these reasons, scientists have called for “a global pause in any clinical applications of the CRISPR technology in human embryos” (Doudna). TED talks actively shape the discourse on genetics at a global level. Embedded in the American culture of self-help and self-improvement, TED talks produce genetic stories that may favour an optimistic representation of genetic engineering. This paper aims to pursue the following questions: how do TED’s formal elements affect the representation of the genome? And how do they influence contemporary constructions of identity? By focusing on two playlists—‘How does DNA work?’ and ‘Get into your genes’ – this paper investigates the emergence of at least three formal features that inform these stories. These three recurring elements—conceptual breakthroughs, a sense of awe, and prophetic statements—also animate a sense of wonder and rely on the notion of ‘vision’ to define the human. In the end, TED talks aim to anticipate or even shape the future. This article argues that we need to pay close attention to how they set out to shape our ‘genetic future’.
Laminoplasty versus laminectomy with fusion for treatment of multilevel cervical compressive myelopathy: an updated meta-analysis
Authors: Wang Jing , Wo Jin , Wen Jun , Zhang Liu , Xu Weiwei , Wang Xiangyu
Published: June 2021

Background

Multilevel cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) are debilitating degenerative diseases. If conservative treatment is ineffective, surgical options for multilevel CSM and OPLL include laminoplasty (LP) and laminectomy with fusion (LF). In this updated meta-analysis, we aimed to compare the clinical outcomes and complications of both approaches.

Methods

We searched PubMed, the Cochrane Library and Embase datasets from their inception to 31 March 2020, to identify all eligible studies comparing LP versus LF for multilevel CSM and OPLL. Data were extracted according to predefined endpoints. We summarised data by the random-effects or fixed-effect models, as necessary.

Results

Of 533 eligible studies, 16 were identified, which included 638 patients who underwent LP and 671 patients who underwent LF. No significant differences were observed between preoperative and postoperative scores of the Japanese Orthopaedic Association (p=1.0 and 0.20, respectively); Visual Analogue Scale (p=0.24 and 0.89, respectively); sagittal vertical axis ((p=0.16 and 0.87, respectively); Nurick Scale (p=0.59 and 0.17, respectively); and range of motion (p=0.67 and 0.63, respectively). However, total complications were higher for LF compared with LP (p=0.006). A significantly higher incidence of C5 palsy was observed in the LF group (p=0.004). The postoperative Neck Disability Index (NDI) was also higher in the LF group (p<0.001).

Conclusions

Although LP and LF shared similar clinical improvement, LP had fewer complications, a lower incidence of C5 palsy, and better NDI scores and recovery outcomes than LF. Randomised studies are warranted to validate these findings.
Medical eponyms: redeeming or not the long-standing tradition
Authors: Castillo Aleman Yandy Marx
Published: June 2021

Background

Healthcare workers often use terms such as Apgar, Babinski or Glasgow in their routine duties. These terms are used worldwide; they are universal and recognised in various languages. Medical eponyms are immutable by the nature; they save valuable time by streamlining communication among health professionals. However, some of these terms lack accuracy and lead to confusion.

Objective and methods

This perspective article aims to analyse the current status of the divergent trends about redeeming (or not) the long-standing tradition of using medical eponyms. Multiple positions regarding the use of these terms have been expressed in the medical literature, and these are summarised in the manuscript. Although, this compilation is based primarily on the author’s medical background and experience.

Results

There is an interesting debate in the scientific community about the suitability of certain eponyms. Defenders and detractors argue a broad spectrum of points, but there is still no international consensus. The use of classical, ethical and well-recognised medical eponyms will remain a cornerstone in daily clinical settings, textbooks and medical journals. However, their use can be inconsistent or confused in specific conditions, and they can be influenced by local geography and culture.

Conclusions

There is a need to refrain from using unethical and controversial eponyms throughout the whole of science. Further academic and scientific efforts should be addressed to provide a structural systematisation, semantic classification and etymological categorisation on the use of medical eponyms.
Exercise-nutrient interactions for improved postprandial glycemic control and insulin sensitivity
Authors: Gillen Jenna B. , Estafanos Stephanie , Govette Alexa
Published: June 2021

Type 2 diabetes (T2D) is a rapidly growing yet largely preventable chronic disease. Exaggerated increases in blood glucose concentration following meals is a primary contributor to many long-term complications of the disease that decrease quality of life and reduce lifespan. Adverse health consequences also manifest years prior to the development of T2D due to underlying insulin resistance and exaggerated postprandial concentrations of the glucose-lowering hormone insulin. Postprandial hyperglycemic and hyperinsulinemic excursions can be improved by exercise, which contributes to the well-established benefits of physical activity for the prevention and treatment of T2D. The aim of this review is to describe the postprandial dysmetabolism that occurs in individuals at risk for and with T2D, and highlight how acute and chronic exercise can lower postprandial glucose and insulin excursions. In addition to describing the effects of traditional moderate-intensity continuous exercise on glycemic control, we highlight other forms of activity including low-intensity walking, high-intensity interval exercise, and resistance training. In an effort to improve knowledge translation and implementation of exercise for maximal glycemic benefits, we also describe how timing of exercise around meals and post-exercise nutrition can modify acute and chronic effects of exercise on glycemic control and insulin sensitivity.

Novelty: Exaggerated postprandial blood glucose and insulin excursions are associated with disease risk. Both a single session and repeated sessions of exercise improve postprandial glycemic control in individuals with and without T2D. The glycemic benefits of exercise can be enhanced by considering the timing and macronutrient composition of meals around exercise.
Laboratory activities to support online chemistry courses: a literature review
Authors: Kennepohl Dietmar
Published: June 2021

The laboratory is an essential element in the teaching and learning of chemistry, but it is challenging to provide this when delivering courses and programs online or at a distance. Studies have repeatedly shown that alternate laboratory modes can lead to equivalent student performance when compared with in-person experiences. In this literature review, we will examine five modes of laboratory delivery (i.e., face-to-face, virtual, remote control, home-study kits and, to a lesser extent, self-guided field trips) that may be considered in providing quality practical laboratory activities to support online studies. Each mode brings its own particular strengths and weaknesses and can be used individually or in combination. The selection and integration of those modes, which is driven by learning outcomes and other factors, will be examined as part of the design process. Finally, future laboratory design will certainly include new technologies, but potentially also elements like open educational resources, learning analytics, universal design, and citizen science.
Anonymization of Daily Activity Data by Using ℓ-diversity Privacy Model
Authors: Parameshwarappa Pooja , Chen Zhiyuan , Koru Güneş
Published: June 2021

In the age of IoT, collection of activity data has become ubiquitous. Publishing activity data can be quite useful for various purposes such as estimating the level of assistance required by older adults and facilitating early diagnosis and treatment of certain diseases. However, publishing activity data comes with privacy risks: Each dimension, i.e., the activity of a person at any given point in time can be used to identify a person as well as to reveal sensitive information about the person such as not being at home at that time. Unfortunately, conventional anonymization methods have shortcomings when it comes to anonymizing activity data. Activity datasets considered for publication are often flat with many dimensions but typically not many rows, which makes the existing anonymization techniques either inapplicable due to very few rows, or else either inefficient or ineffective in preserving utility. This article proposes novel multi-level clustering-based approaches using a non-metric weighted distance measure that enforce ℓ-diversity model. Experimental results show that the proposed methods preserve data utility and are orders more efficient than the existing methods.
Axonal Growth Abnormalities Underlying Ocular Cranial Nerve Disorders
Authors: Whitman Mary C.
Published: June 2021

Abnormalities in cranial motor nerve development cause paralytic strabismus syndromes, collectively referred to as congenital cranial dysinnervation disorders, in which patients cannot fully move their eyes. These disorders can arise through one of two mechanisms: ( a) defective motor neuron specification, usually by loss of a transcription factor necessary for brainstem patterning, or ( b) axon growth and guidance abnormalities of the oculomotor, trochlear, and abducens nerves. This review focuses on our current understanding of axon guidance mechanisms in the cranial motor nerves and how disease-causing mutations disrupt axon targeting. Abnormalities of axon growth and guidance are often limited to a single nerve or subdivision, even when the causative gene is ubiquitously expressed. Additionally, when one nerve is absent, its normal target muscles attract other motor neurons. Study of these disorders highlights the complexities of axon guidance and how each population of neurons uses a unique but overlapping set of axon guidance pathways.