bluuebunny/crossref_metadata_2025 huggingface dataset:
Neisseria gonorrhoeaeinfective endocarditis
Authors: Fenech Marylou , Xerri Thelma , Grech Paula , Portelli Anette
Published: May 2022

We present a case of endocarditis secondary to disseminatedNeisseria gonorrhoeaeinfection affecting the native tricuspid valve. After a thorough workup, our patient was treated conservatively with appropriate intravenous antibiotic therapy for 6 weeks. A follow-up echocardiogram showed resolution of the vegetation without any residual valvular involvement. Literature review reveals 99 cases of infective endocarditis which occurred secondary toN. gonorrhoeaeinfection, of which, only 4 cases (6%) affected the tricuspid valve. Through this case report, we highlight the importance of thorough history taking including a sexual and social history, as well as careful recognition of the clinical signs, which helped us reach this uncommon diagnosis while always maintaining a high clinical suspicion of rare causes of endocarditis.
Graves’ thyrotoxicosis soon after hemithyroidectomy for low-risk papillary thyroid carcinoma
Authors: Housin Ahmad , Tamilia Michael
Published: May 2022

Hyperthyroidism is a medical problem that is commonly encountered by emergency physicians, internists and endocrinologists. The development of hyperthyroidism in the postoperative setting of hemithyroidectomy is quite rare. Reported causes include destructive thyroiditis and inappropriate thyroid hormone replacement. Here we report a case of Graves’ disease causing thyrotoxicosis soon after surgery in a woman who underwent hemithyroidectomy for low-risk papillary thyroid carcinoma.
Measurement of intraocular temperature in glaucoma: week-day and seasonal fluctuations
Authors: Mansouri Kaweh , Gillmann Kevin , Rao Harsha Laxmana , Szurman Peter , Weinreb Robert N
Published: May 2022

Purpose

To evaluate long-term intraocular temperature (IOT) variations in eyes with primary open-angle glaucoma (POAG) using an intraocular telemetric sensor.

Methods

This prospective, open-label, multicentre observational study analysed the IOT variations in 22 eyes of 22 patients with POAG. All enrolled patients underwent implantation of an intraocular pressure (IOP) sensor during cataract surgery. The telemetric system uses a built-in temperature sensor to control measured IOP for temperature. Each time a patient measures their IOP, both the IOP and IOT are recorded in the reader device. Patients were instructed to self-measure their IOP as often as desired, but at least four times daily. Recorded readings were retrieved and analysed using mixed effect models and pairwise comparisons using Bonferroni correction to assess the statistical significance of average IOT variations between each individual weekday and calendar month.

Results

The mean age of patients was 67.8±6.8 years and 36.4% were women. A total of 132 745 readings over 21 102 measurement-days were obtained. On average, IOT was significantly higher on Sundays (34.57°C; 95% CI 34.37 to 34.78) than on any other day of the week (p<0.001). Mean IOT on other weekdays ranged from 34.48°C to 34.51°C. Over the year, IOT followed a clear seasonal pattern, reaching its maximum in July (34.8°C; 95% CI 34.56 to 34.97) and its minimum in January (34.4°C; 95% CI 34.15 to 34.56; p<0.001).

Conclusions

This study demonstrates the feasibility of continual and long-term measurement of IOT using intraocular sensors. The results show significant short-term and long-term fluctuations of IOT. Research is warranted to understand the impact of IOT variations on IOP, ocular perfusion and glaucoma progression.
Clinically relevant factors associated with a binary outcome of diabetic macular ischaemia: an OCTA study
Authors: Yang Da Wei , Tang Zi Qi , Tang Fang Yao , Szeto Simon KH , Chan Jason , Yip Fanny , Wong Cherie YK , Ran An Ran , Lai Timothy YY , Cheung Carol Y.
Published: May 2022

Aims

We investigated the demographic, ocular, diabetes-related and systemic factors associated with a binary outcome of diabetic macular ischaemia (DMI) as assessed by optical coherence tomography angiography (OCTA) evaluation of non-perfusion at the level of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in a cohort of patients with diabetes mellitus (DM).

Materials and methods

617 patients with DM were recruited from July 2015 to December 2020 at the Chinese University of Hong Kong Eye Centre. Image quality assessment (gradable or ungradable for assessing DMI) and DMI evaluation (presence or absence of DMI) were assessed at the level of the SCP and DCP by OCTA.

Results

1107 eyes from 593 subjects were included in the final analysis. 560 (50.59%) eyes had DMI at the level of SCP, and 647 (58.45%) eyes had DMI at the level of DCP. Among eyes without diabetic retinopathy (DR), DMI was observed in 19.40% and 24.13% of eyes at SCP and DCP, respectively. In the multivariable logistic regression models, older age, poorer visual acuity, thinner ganglion cell–inner plexiform layer thickness, worsened DR severity, higher haemoglobin A1c level, lower estimated glomerular filtration rate and higher low-density lipoprotein cholesterol level were associated with SCP-DMI. In addition to the aforementioned factors, presence of diabetic macular oedema and shorter axial length were associated with DCP-DMI.

Conclusion

We reported a series of associated factors of SCP-DMI and DCP-DMI. The binary outcome of DMI might promote a simplified OCTA-based DMI evaluation before subsequent quantitative analysis for assessing DMI extent and fulfil the urge for an updating diabetic retinal disease staging to be implemented with OCTA.
Incidence, causes and risk factors of vision loss in rural Southern China: 6-year follow-up of the Yangxi Eye Study
Authors: Zhao Xinyu , Lin Jianqiang , Yu Shanshan , Xie Liqiong , Jin Ling , Xiong Kun , Tsui Ching-Kit , Xu Yue , Wu Benjuan , Liu Bin , Wang Wei , Congdon Nathan , Huang Wenyong , He Mingguang , Liang Xiaoling
Published: May 2022

Purpose

To report the 6-year incidence, causes and risk factors for vision loss (visual impairment (VI) and blindness), among elderly adults in rural southern China.

Methods

Population-based, cohort study. Initiated in 2014, the study recruited participants aged 50 and older using random cluster sampling from Yangxi County. All eligible participants were invited to attend interviews and comprehensive eye examinations at the 6-year follow-up between November 2020 and March 2021. The WHO categories of vision loss were used to define incident cases of VI (3/60≤VA <6/12), moderate-to-severe VI (MSVI) (3/60≤VA<6/18) and blindness (VA <3/60) in the better-seeing eye.

Results

Among the 5825 baseline participants, 3187 (64.4%) of 4946 surviving subjects participated in the 6-year follow-up. Based on presenting and best-corrected VA, respectively, the crude incidence rate of blindness was 0.8% (95% CI 0.5% to 1.1%) vs 0.3% (95% CI 0.1% to 0.5%), for MSVI 6.7% (95% CI 5.7% to 7.6%) vs 4.6% (95% CI 3.8% to 5.4%) and for any VI 16.1% (95% CI 14.5% to 17.6%) vs 12.9% (95% CI 11.6% to 14.1%). Cataract (48.3%) and refractive errors (44.4%) were the most common causes of vision loss. Factors significantly associated with greater incident vision loss were older age, female sex, less education, living alone and longer axial length (all p<0.05).

Conclusions

Substantial work is still required to reduce avoidable vision loss in rural China. Screening outreach and efforts to improve awareness which target the poorer and less educated are urgently needed to reduce the growing unmet need for eye care due to ageing.
Predictors of myopic macular degeneration in a 12-year longitudinal study of Singapore adults with myopia
Authors: Foo Li Lian , Xu Lingqian , Sabanayagam Charumathi , Htoon Hla M , Ang Marcus , Zhang Jingwen , Ohno-Matsui Kyoko , Cheng Ching Yu , Hoang Quan V , Tan Chuen-Seng , Saw Seang-Mei , Wong Chee Wai
Published: May 2022

Purpose

To investigate the predictive factors for myopic macular degeneration (MMD) and progression in adults with myopia.

Methods

We examined 828 Malay and Indian adults (1579 myopic eyes) with myopia (spherical equivalent (SE) ≤–0.5 dioptres) at baseline who participated in both baseline and 12-year follow-up visits of the Singapore Malay Eye Study and the Singapore Indian Eye Study. Eye examinations, including subjective refraction and axial length (AL) measurements, were performed. MMD was graded from fundus photographs following the Meta-Analysis for Pathologic Myopia classification. The predictive factors for MMD development and progression were assessed in adults without and with MMD at baseline, respectively as risk ratios (RR) using multivariable modified Poisson regression models. The receiver operating characteristic curve was used to visualise the performance of the predictive models for the development of MMD, with performance quantified by the area under the curve (AUC).

Results

The 12-year cumulative MMD incidence was 10.3% (95% CI 8.9% to 12.0%) among 1504 myopic eyes without MMD at baseline. Tessellated fundus was a major predictor of MMD (RR=2.50, p<0.001), among other factors including age, worse SE and longer AL (all p<0.001). The AUC for prediction of MMD development was found to be 0.78 (95% CI 0.76 to 0.80) for tessellated fundus and increased significantly to an AUC of 0.86 (95% CI 0.84 to 0.88) with the combination of tessellated fundus with age, race, gender and SE (p<0.001). Older age (p=0.02), worse SE (p<0.001) and longer AL (p<0.001) were found to be predictors of MMD progression.

Conclusions

In adults with myopia without MMD, tessellated fundus, age, SE and AL had good predictive value for incident MMD. In adults with MMD, 1 in 10 eyes experienced progression over the same period. Older age, more severe myopia and longer AL were independent risk factors for progression.
Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis
Authors: Brooke-Wavell Katherine , Skelton Dawn A , Barker Karen L , Clark Emma M , De Biase Sarah , Arnold Susanne , Paskins Zoe , Robinson Katie R , Lewis Rachel M , Tobias Jonathan H , Ward Kate A , Whitney Julie , Leyland Sarah
Published: May 2022

Exercise and physical activity can improve bone strength and the risk of falls, which may offer benefits in the prevention and management of osteoporosis. However, uncertainty about the types of exercise that are safe and effective instigates lack of confidence in people with osteoporosis and health professionals. Existing guidelines leave some questions unresolved. This consensus statement aimed to determine the physical activity and exercise needed to optimise bone strength, reduce fall and fracture risk, improve posture and manage vertebral fracture symptoms, while minimising potential risks in people with osteoporosis. The scope of this statement was developed following stakeholder consultation. Meta-analyses were reviewed and where evidence was lacking, individual studies or expert opinion were used to develop recommendations. A multidisciplinary expert group reviewed evidence to make recommendations, by consensus when evidence was not available. Key recommendations are that people with osteoporosis should undertake (1) resistance and impact exercise to maximise bone strength; (2) activities to improve strength and balance to reduce falls; (3) spinal extension exercise to improve posture and potentially reduce risk of falls and vertebral fractures. For safety, we recommend avoiding postures involving a high degree of spinal flexion during exercise or daily life. People with vertebral fracture or multiple low trauma fractures should usually exercise only up to an impact equivalent to brisk walking. Those at risk of falls should start with targeted strength and balance training. Vertebral fracture symptoms may benefit from exercise to reduce pain, improve mobility and quality of life, ideally with specialist advice to encourage return to normal activities. Everyone with osteoporosis may benefit from guidance on adapting postures and movements. There is little evidence that physical activity is associated with significant harm, and the benefits, in general, outweigh the risks.
Impact of ski geometry data and standing height ratio on the ACL injury risk and its use for prevention in recreational skiers
Authors: Ruedl Gerhard , Posch Markus , Tecklenburg Katja , Schranz Alois , Greier Klaus , Faulhaber Martin , Scher Irving , Burtscher Martin
Published: May 2022

Objectives

To evaluate the impact of ski geometry data and standing height ratio on anterior cruciate ligament (ACL) injury risk of male and female recreational skiers.

Methods

A retrospective questionnaire-based, case–control study of ACL-injured and uninjured recreational skiers was conducted during six consecutive winter seasons. Ski geometry data (ski length, side-cut radius, widths of the tip, waist and tail) were recorded from each participant’s skis. Standing heights at the front and rear components of the ski binding were measured with a digital sliding calliper, and the standing height ratio between the front and rear was calculated.

Results

A total of 1817 recreational skiers participated in this study, of whom 392 (21.6%) sustained an ACL injury. Multiple logistic regression analysis indicates a higher age, a lower skill level and riskier behaviour as independent individual risk factors associated with an ACL injury. An increase in ski length, tip width of the ski, standing height at the rear ski binding component, and in standing height ratio were found to be independent equipment-related risk factors for an ACL injury.

Conclusion

Reduced ski length, narrower ski tip width, lower rear standing height and a lower standing height ratio (ie, rear component of the ski binding is more elevated compared with the front component) were associated with a reduced likelihood for ACL injury. When buying or renting skis, these parameters could be considered to reduce the likelihood of ACL injury in recreational skiers.
EarLy Surveillance for Autoimmune diabetes: protocol for a qualitative study of general population and stakeholder perspectives on screening for type 1 diabetes in the UK (ELSA 1)
Authors: Quinn Lauren Marie , Shukla David , Greenfield Sheila Margaret , Barrett Tim , Garstang Joanna , Boardman Felicity , Litchfield Ian , Dayan Colin , Gardner Christine , Connop Clair , Lepley Amanda , Narendran Parth
Published: May 2022

Objective

Type 1 diabetes (T1D) is the most common form of diabetes in children, accounting for 96% of cases, with 29 000 children affected in the UK. Studies have recently identified immunotherapies that safely delay the development of T1D for at least 3 years, and further therapies are in development. General population screening programs in other countries can now accurately identify children with presymptomatic T1D who can be entered into prevention studies. The UK does not have such a system in place. We aim to explore whether parents and children in the UK would want to be part of such a program of testing for T1D in the general population, how they would want to be informed and participate in such a program, and how any barriers to recruitment and participation can be addressed. Additionally, the views of stakeholders who would be involved in the testing program will be collected and analyzed.

Research design and methods

We will interview parents/guardians and children aged 3–13 years about their views on screening for T1D. We will recruit purposefully to ensure representation across ethnicities and socioeconomic groups. Interviews will be transcribed, analyzed and used to inform iterative co-design work with additional families to address any issues raised. Similar qualitative work will be undertaken with professional stakeholders who would be involved in implementing any future screening program. Where possible, all aspects of this study will be performed remotely by phone or online to minimize infection risk.

Conclusions

This qualitative study will provide the first insights into acceptability of testing and monitoring for T1D in the general population from the perspective of families and stakeholders in the UK. Co-design work will help establish the barriers and identify strategies to mitigate and overcome these issues, as an important step towards consideration of national testing for T1D.
Challenges to evidence-informed decision-making in the context of pandemics: qualitative study of COVID-19 policy advisor perspectives
Authors: Vickery Jamie , Atkinson Paul , Lin Leesa , Rubin Olivier , Upshur Ross , Yeoh Eng-Kiong , Boyer Chris , Errett Nicole A
Published: May 2022

Introduction

The exceptional production of research evidence during the COVID-19 pandemic required deployment of scientists to act in advisory roles to aid policy-makers in making evidence-informed decisions. The unprecedented breadth, scale and duration of the pandemic provides an opportunity to understand how science advisors experience and mitigate challenges associated with insufficient, evolving and/or conflicting evidence to inform public health decision-making.

Objectives

To explore critically the challenges for advising evidence-informed decision-making (EIDM) in pandemic contexts, particularly around non-pharmaceutical control measures, from the perspective of experts advising policy-makers during COVID-19 globally.

Methods

We conducted in-depth qualitative interviews with 27 scientific experts and advisors who are/were engaged in COVID-19 EIDM representing four WHO regions and 11 countries (Australia, Canada, Colombia, Denmark, Ghana, Hong Kong, Nigeria, Sweden, Uganda, UK, USA) from December 2020 to May 2021. Participants informed decision-making at various and multiple levels of governance, including local/city (n=3), state/provincial (n=8), federal or national (n=20), regional or international (n=3) and university-level advising (n=3). Following each interview, we conducted member checks with participants and thematically analysed interview data using NVivo for Mac software.

Results

Findings from this study indicate multiple overarching challenges to pandemic EIDM specific to interpretation and translation of evidence, including the speed and influx of new, evolving, and conflicting evidence; concerns about scientific integrity and misinterpretation of evidence; the limited capacity to assess and produce evidence, and adapting evidence from other contexts; multiple forms of evidence and perspectives needed for EIDM; the need to make decisions quickly and under conditions of uncertainty; and a lack of transparency in how decisions are made and applied.

Conclusions

Findings suggest the urgent need for global EIDM guidance that countries can adapt for in-country decisions as well as coordinated global response to future pandemics.
Prereferral rectal artesunate and referral completion among children with suspected severe malaria in the Democratic Republic of the Congo, Nigeria and Uganda
Authors: Brunner Nina C , Omoluabi Elizabeth , Awor Phyllis , Okitawutshu Jean , Tshefu Kitoto Antoinette , Signorell Aita , Akano Babatunde , Ayodeji Kazeem , Okon Charles , Yusuf Ocheche , Athieno Proscovia , Kimera Joseph , Tumukunde Gloria , Angiro Irene , Kalenga Jean-Claude , Delvento Giulia , Lee Tristan T , Lambiris Mark J , Ross Amanda , Cereghetti Nadja , Visser Theodoor , Napier Harriet G , Buj Valentina , Burri Christian , Lengeler Christian , Hetzel Manuel W
Published: May 2022

Introduction

Children who receive prereferral rectal artesunate (RAS) require urgent referral to a health facility where appropriate treatment for severe malaria can be provided. However, the rapid improvement of a child’s condition after RAS administration may influence a caregiver’s decision to follow this recommendation. Currently, the evidence on the effect of RAS on referral completion is limited.

Methods

An observational study accompanied the roll-out of RAS in three malaria endemic settings in the Democratic Republic of the Congo (DRC), Nigeria and Uganda. Community health workers and primary health centres enrolled children under 5 years with suspected severe malaria before and after the roll-out of RAS. All children were followed up 28 days after enrolment to assess their treatment-seeking pathways.

Results

Referral completion was 67% (1408/2104) in DRC, 48% (287/600) in Nigeria and 58% (2170/3745) in Uganda. In DRC and Uganda, RAS users were less likely to complete referral than RAS non-users in the pre-roll-out phase (adjusted OR (aOR)=0.48, 95% CI 0.30 to 0.77 and aOR=0.72, 95% CI 0.58 to 0.88, respectively). Among children seeking care from a primary health centre in Nigeria, RAS users were less likely to complete referral compared with RAS non-users in the post-roll-out phase (aOR=0.18, 95% CI 0.05 to 0.71). In Uganda, among children who completed referral, RAS users were significantly more likely to complete referral on time than RAS non-users enrolled in the pre-roll-out phase (aOR=1.81, 95% CI 1.17 to 2.79).

Conclusions

The findings of this study raise legitimate concerns that the roll-out of RAS may lead to lower referral completion in children who were administered prereferral RAS. To ensure that community-based programmes are effectively implemented, barriers to referral completion need to be addressed at all levels. Alternative effective treatment options should be provided to children unable to complete referral.

Trial registrstion number

NCT03568344; ClinicalTrials.gov.
‘Imperfect but useful’: pandemic response in the Global South can benefit from greater use of mathematical modelling
Authors: Mandal Sandip , Parchani Kanchan , Arinaminpathy Nimalan , Sarkar Swarup , Bhargava Balram , Panda Samiran
Published: May 2022

Mathematical modelling has been a helpful resource for planning public health responses to COVID-19. However, there is a need to improve the accessibility of models built within country contexts in the Global South. Immediately following the overwhelming ‘second wave’ of COVID-19 in India, we developed a user-friendly, web-based modelling simulator in partnership with the public health experts and health administrators for subnational planning. The purpose was to help policy-makers and programme officials at the state and district levels, to construct model-based scenarios for a possible third wave. Here, we describe our experiences of developing and deploying the simulator and propose the following recommendations for future such initiatives: early preparation will be the key for pandemic management planning, including establishment of networks with potential simulator users. Ideally, this preparedness should be conducted during ‘peace time’, and coordinated by agencies such as WHO. Second, flexible modelling frameworks will be needed, to respond rapidly to future emergencies as the precise nature of any pandemic is impossible to predict. Modelling resources will, therefore, need to be rapidly adaptable to respond as soon as a novel pathogen emerges. Third, limitations of modelling must be communicated clearly and consistently to end users. Finally, systematic mechanisms are required for monitoring the use of models in decision making, which will help in providing modelling support to those local authorities who may benefit most from it. Overall, these lessons from India can be relevant for other countries in the South-Asian-Region, to incorporate modelling resources into their pandemic preparedness planning.
Supporting community-based mental health initiatives: insights from a multi-country programme and recommendations for funders
Authors: Larrieta June , Miguel Esponda Georgina , Gandhi Yashi , Simpson Nikita , Biriotti Maurice , Kydd Anna , Eaton Julian , Ryan Grace Kathryn
Published: May 2022

Community-based mental health initiatives are uniquely positioned to understand the mental health needs of their local population and provide relevant, culturally appropriate and sustainable responses. However, at the grassroots level, mental health initiatives in low- and middle-income countries face key challenges, such as inadequate funding, barriers to demonstrating impact and difficulty engaging with stakeholders. The Ember Mental Health programme establishes 12-month partnerships with community-based mental health initiatives in low- and middle-income countries to support them to address these challenges, grow and achieve sustainability. This paper outlines a longitudinal qualitative study conducted to evaluate the 2020-2021 Ember Mental Health programme. Data were collected from March 2020 to March 2021 through semistructured interviews conducted with 11 initiatives at various time points throughout their Ember Mental Health partnership. A framework approach was used to analyse all data in its original language. Findings indicated that initiatives particularly benefited from provision of side-by-side mentorship; opportunities for skills strengthening and strategic thinking; occasions to network with other like-minded initiatives and/or experts in global mental health; and support on team empowerment and well-being. Based on these findings, we put forward various recommendations for funders and other stakeholders working to support community-based mental health initiatives in low- and middle-income countries. Through establishing collaborative partnerships that challenge more top-down, traditional funder–grantee relationships, it is possible to support the rich ecosystem of initiatives working to address the mental health needs of communities.
Comparative efficacy and safety of statins for osteoporosis: a study protocol for a systematic review and network meta-analysis
Authors: Xiong Mengxin , Xue Yaojun , Zhu Wei , Deng Ali , Tan Zhangkui , Zhou Guangwen , Xiang Nan
Published: May 2022

Introduction

Osteoporosis (OP) is a prevalent skeletal disease with high mortality and morbidity, followed by acute and chronic back pain, severe spinal deformity and dysfunction. First-line drugs for OP work through antiresorptive or anabolic mechanisms. Although with good efficacy, these drugs still have certain limitations in clinical application due to delivery routes, medication cycles and cost issues. Nowadays, statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) appear to be potentially promising drugs for OP. Despite the controversy, previous studies have shown the efficacy of statins in treating OP. Other studies have further indicated that the therapeutic effect of OP in statin-treated patients is dose dependent. However, scientists have not yet reached a consensus on the use of statins for the treatment or which statin to choose first. This study aims to review the literature, ascertaining the relative efficacy and safety of statins for patients with OP using a Bayesian network meta-analysis.

Methods and analysis

We will systematically search the following databases: MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, Chinese BioMedical Literature Database and preprint servers to include randomised controlled trials that compare different statins for treating OP. Primary outcomes are the incidence of overall fractures and bone mineral density changes. Secondary outcomes contain adverse effects and bone turnover markers. All items of this review will comply with the Cochrane Handbook, and the quality of evidence will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. A traditional pairwise meta-analysis and the Bayesian network meta-analysis will be performed to compare the efficacy of different statins.

Ethics and dissemination

Ethical approval is not required since this is a protocol study for meta-analyses. Results will be submitted to a peer-reviewed journal.

PROSPERO registration number

CRD42021242619.

Search dates

From database inception to February 2022.
Acupuncture for chronic sciatica: protocol for a multicenter randomised controlled trial
Authors: Yu Fang-Ting , Liu Cun-Zhi , Ni Guang-Xia , Cai Guo-Wei , Liu Zhi-Shun , Zhou Xiao-Qing , Ma Chao-Yang , Meng Xiu-Li , Tu Jian-Feng , Li He-Wen , Yang Jing-Wen , Yan Shi-Yan , Fu Hai-Yang , Xu Wen-Tao , Li Jing , Xiang Hong-Chun , Sun Tian-Heng , Zhang Beng , Li Mei-Hua , Wan Wen-Jun , He Cheng , Ji Xiao-Lan , Zhu Wei , Shi Guang-Xia , Wang Li-Qiong
Published: May 2022

Background

Chronic Sciatica is a disabling condition causing considerable medical, social and financial implications. Currently, there is no recognised long-term effective treatment to alleviate sciatica. Acupuncture has been widely used for treating chronic pains with persistent analgesic effects. We aim to evaluate the efficacy and safety of acupuncture for chronic sciatica with follow-up in 52 weeks.

Methods and analysis

This is a multicenter randomised sham-controlled trial. A total of 216 patients with chronic sciatica will be enrolled and randomly assigned to the acupuncture or sham acupuncture group. There will be 10 treatment sessions applied in 4 weeks with frequency decreased over time. Patients will complete follow-ups during 52 weeks. The primary outcomes are changes in leg pain intensity and disability from baseline to week 4. Secondary outcomes include back pain intensity, frequency and bothersomeness, quality of life, and global perceived effect. Adverse events will be recorded in detail.

Ethics and dissemination

Ethical approval of this trial was granted from the ethics committee of Beijing University of Chinese Medicine and all study centres (No. 2020BZYLL0803). Written informed consent will be obtained from enrolled patients. Trial results will be disseminated in peer-reviewed publications.

Trial registration number

ChiCTR2100044585 (Chinese Clinical Trial Registry, http://www.chictr.org.cn, registered on 24 March 2021); preresults.
Relationships between SUVmax of lung adenocarcinoma and different T stages, histological grades and pathological subtypes: a retrospective cohort study in China
Authors: Sun Xiaoyan , Chen Tianxiang , Xie Chun , Liu Liu , Lei Bei , Wang Lihua , Ruan Maomei , Yan Hui , Zhang Qi , Chang Cheng , Xie Wenhui
Published: May 2022

Objectives

Cancer cell has aberrant metabolism. The purpose of this study aimed to investigate relationships between maximum standard uptake value (SUVmax）of 18fluoro-2-deoxy-d-glucose and T stages, histological grades and pathological subtypes of lung adenocarcinoma.

Design

Retrospective cohort study, employing the Kruskal-Wallis, Bonferroni-Dunn and Mann-Whitney tests to compare SUVmax of different T stages, histological grades and pathological subtypes of lung adenocarcinoma.

Setting

The outpatients who had aberrant positron emission tomography/CT (PET/CT) images in chest were enrolled this study from August 2016 to November 2018 in Shanghai, China.

Participant

Initial 11 270 patients with suspected lung cancer who underwent PET/CT examinations were surveyed. A total of 1454 patients who were diagnosed as lung adenocarcinoma by pathologist were included in this project.

Primary outcome measures

SUVmax value at different tumour-node-metastasis stages of lung adenocarcinoma before surgery.

Results

The mean SUVmax of patients with lung adenocarcinoma was significantly elevated with the increase in T stages. There were significant evident differences in SUVmax among T1a–T1c (p<0.05). However, after the staging of patients was more than T1 stage, SUVmax of T2a, T2b, T2 visceral pleural invasion, T3 and T4 had not dramatic changes. SUVmax value of lung adenocarcinoma in the same T stage group was the highest in patients with the high grade of malignancy and solid-predominant invasive adenocarcinoma.

Conclusions

SUVmax value was significantly associated with T stages, grades of malignancy and pathological subtypes of lung adenocarcinoma.
Assessing the potentiality of algorithms and artificial intelligence adoption to disrupt patient primary care with a safer and faster medication management: a systematic review protocol
Authors: Oliva Antonio , Altamura Gerardo , Nurchis Mario Cesare , Zedda Massimo , Sessa Giorgio , Cazzato Francesca , Aulino Giovanni , Sapienza Martina , Riccardi Maria Teresa , Della Morte Gabriele , Caputo Matteo , Grassi Simone , Damiani Gianfranco
Published: May 2022

Introduction

In primary care, almost 75% of outpatient visits by family doctors and general practitioners involve continuation or initiation of drug therapy. Due to the enormous amount of drugs used by outpatients in unmonitored situations, the potential risk of adverse events due to an error in the use or prescription of drugs is much higher than in a hospital setting. Artificial intelligence (AI) application can help healthcare professionals to take charge of patient safety by improving error detection, patient stratification and drug management. The aim is to investigate the impact of AI algorithms on drug management in primary care settings and to compare AI or algorithms with standard clinical practice to define the medication fields where a technological support could lead to better results.

Methods and analysis

A systematic review and meta-analysis of literature will be conducted querying PubMed, Cochrane and ISI Web of Science from the inception to December 2021. The primary outcome will be the reduction of medication errors obtained by AI application. The search strategy and the study selection will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the population, intervention, comparator and outcome framework. Quality of included studies will be appraised adopting the quality assessment tool for observational cohort and cross-sectional studies for non-randomised controlled trials as well as the quality assessment of controlled intervention studies of National Institute of Health for randomised controlled trials.

Ethics and dissemination

Formal ethical approval is not required since no human beings are involved. The results will be disseminated widely through peer-reviewed publications.
Cross-sectional survey of education on LGBT content in medical schools in Japan
Authors: Yoshida Eriko , Matsushima Masato , Okazaki Fumiko
Published: May 2022

Objectives

We aimed to clarify current teaching on lesbian, gay, bisexual, transgender (LGBT) content in Japanese medical schools and compare it with data from the USA and Canada reported in 2011 and Australia and New Zealand reported in 2017.

Design

Cross-sectional study.

Setting

Eighty-two medical schools in Japan.

Participants

The deans and/or relevant faculty members of the medical schools in Japan.

Primary outcome measure

Hours dedicated to teaching LGBT content in each medical school.

Results

In total, 60 schools (73.2%) returned a questionnaire. One was excluded because of missing values, leaving 59 responses (72.0%) for analysis. In total, LGBT content was included in preclinical training in 31 of 59 schools and in clinical training in 8 of 53 schools. The proportion of schools that taught no LGBT content in Japan was significantly higher than that in the USA and Canada, both in preclinical and clinical training (p<0.01). The median time dedicated to LGBT content was 1 hour (25th–75th percentile 0–2 hours) during preclinical training and 0 hour during clinical training (25th–75th percentile 0–0 hour). Only 13 schools (22%) taught students to ask about same-sex relations when obtaining a sexual history. Biomedical topics were more likely to be taught than social topics. In total, 45 of 57 schools (79%) evaluated their coverage of LGBT content as poor or very poor, and 23 schools (39%) had some students who had come out as LGBT. Schools with faculty members interested in education on LGBT content were more likely to cover it.

Conclusion

Education on LGBT content in Japanese medical schools is less established than in the USA and Canada.
Study protocol for a single-centre randomised controlled trial to investigate the effect of lung recruitment in paediatric patients after cardiac surgery
Authors: Gu Miaomiao , Deng Ni , Xia Wenxi , Deng Lijing , Liang Guopeng
Published: May 2022

Introduction

A number of published studies have revealed that lung recruitment can improve oxygenation, shorten the duration of mechanical ventilation (MV) and decrease mortality in adults with acute hypoxaemic respiratory failure, especially patients with acute respiratory distress syndrome. However, few articles have assessed lung recruitment in paediatric patients, especially after cardiac surgery. This clinical trial aimed to determine whether lung recruitment can reduce the duration of MV in paediatric patients with hypoxaemic respiratory failure after cardiac surgery.

Method and analysis

In this trial, we will randomly assign 234 paediatric patients (aged 28 days to 14 years) within 72 hours after cardiac surgery with an arterial oxygen tension (PaO2) to fraction of inspired oxygen (FiO2) ratio (PaO2/FiO2) of <300 to either a lung recruitment group or a conventional group. The primary endpoint will be the duration of MV. The secondary endpoints will be ventilator-free days, PaO2/FiO2, respiratory system compliance, duration of non-invasive ventilation, reintubation rate, length of intensive care unit stay, length of hospital stay, occurrence of serious adverse events (barotrauma, persistent hypotension and arrhythmia), postoperative pulmonary complications.

Ethics and dissemination

The ethics committee of West China Hospital of Sichuan University granted ethics approval for this study (20 August 2019). The results will be published in peer-reviewed journals and presented at conferences.

Trial registration number

ChiCTR1900025990.
A quality improvement project assessing a new mode of lecture delivery to improve postgraduate clinical exposure time in the Department of Internal Medicine, Makerere University, Uganda
Authors: Mulindwa Frank , Andia Irene , McLaughlin Kevin , Kabata Pritch , Baluku Joseph , Kalyesubula Robert , Kagimu Majid , Ocama Ponsiano
Published: May 2022

Background

The Masters in Internal Medicine at the Makerere University College of Health Sciences is based on a semester system with a blend of lectures and clinical work. The programme runs for 3 years with didactic lectures set mostly for mornings and clinical care thereafter. Anecdotal reports from attending physicians in the department highlighted clinical work time interruption by didactic lectures which was thought to limit postgraduate (PG) students’ clinical work time. We set out to evaluate the clinical learning environment and explore avenues to optimise clinical exposure time.

Methods

Baseline data in form of time logs documenting first-year PG activities was collected by intern doctors without the awareness of the PGs. In addition, a PG and attending physician survey on PG ward performance was carried out. These data informed a root cause analysis from which an intervention to change the mode of lecture delivery from daily lecturers across the semester to a set of block lectures was undertaken. Postimplementation time logs and survey data were compared with the pre-intervention data.

Results

Post-intervention, during a period of 50 ward round observations, PGs missed 3/50 (6%) ward rounds as compared with 10/50 (20%) pre-intervention. PGs arrived on wards before attending physicians 18/24 (75%) times post-intervention and on average had 59 min to prepare for ward rounds as compared with 5/26 (19.2%) times and 30 min, respectively, pre-intervention. Both PGs and physicians believed PGs had enough time for patient care post-intervention (17/17 (100%) vs 4/17 (23.5%) and 7/8 (87.5%) vs 2/8 (25%)), respectively.

Conclusion

The baseline data collected confirmed the anecdotal reports and a change to a block week lecture system led to improvements in PGs’ clinical work time and both resident and physician approvals of PG clinical work.
Improving quality of antenatal care services in a high case load tertiary care teaching hospital (Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College) in Kanpur, Uttar Pradesh, India
Authors: Sharma Praveen Kumar , Ghosh Sebanti , Prabhakar Vikrant , Singh Mahtab , Forissier Thomas , Prasad Rajendra , Datta Anjali , Patil Benazir , Pandey Kiran , Gupta Neena , Nigam Seema
Published: May 2022

In India, half of all pregnant women between the ages of 15 and 49 years are anaemic. In Uttar Pradesh (UP), this figure is slightly higher at 51%. Unfortunately, only 5.4% pregnant women received full antenatal care (ANC) (National Family Health Survey 4, 2015–2016). A formative research conducted in UP in 2016 found that only 9% of pregnant women in UP consume the five recommended food groups, as per global recommendations.

Ganesh Shankar Vidyarthi Memorial Medical College Hospital is one of the four high case load tertiary care facilities in Kanpur, UP, with an obstetrics and gynaecology (OBGY) outpatient department (OPD) of 2500–3000 consultations with delivery load of 250–300 deliveries per month and paediatric OPD of approximately 5400–6000 consultations per month. It was identified that pregnant women visiting the OPD for ANC were not receiving maternal nutrition-related services, and anthropometric measurements to assess nutritional status and gestational weight gain were also not done.

The department of OBGY decided to apply the four-step Point of Care Quality Improvement (POCQI) approach using Plan–Do–Study–Act cycle for implementation of the maternal nutrition protocol during ANC.

In April 2019, with the support of A&T, the hospital team applied the POCQI methodology to improve ANC service provision. By the end of 2019, the measurement and recording of anthropometric parameters increased to 84% and 74% for height and weight, respectively, from the baseline of zero. Hb testing increased from 58% to 84% and blood pressure (BP) monitoring from zero to 84%. Maternal nutrition counselling was delivered to 76% of the pregnant women visiting the OPD, which was a significant achievement for a new practice introduced into the system.

The improved practices identified and implemented by the department are being sustained through active engagement of the staff and supportive leadership of the department of OBGY.
Improving tracheostomy delivery for trauma and surgical critical care patients: timely trach initiative
Authors: McShane Erin K , Sun Beatrice J , Maggio Paul M , Spain David A , Forrester Joseph D
Published: May 2022

Background

Tracheostomy is recommended within 7 days of intubation for patients with severe traumatic brain injury (TBI) or requiring prolonged mechanical ventilation. A quality improvement project aimed to decrease time to tracheostomy to ≤7 days after intubation for eligible patients requiring tracheostomy in the surgical intensive care unit (SICU).

Local problem

From January 2017 to June 2018, approximately 85% of tracheostomies were performed >7 days after intubation. The tracheostomy was placed a median of 10 days after intubation (range: 1–57).

Methods

Quality improvement principles were applied at an American College of Surgeons-verified level I trauma centre to introduce and analyse interventions to improve tracheostomy timing. Using the electronic health record, we analysed changes in tracheostomy timing, hospital length of stay (LOS), ventilator-associated pneumonia and peristomal bleeding rates for three subgroups: patients with TBI, trauma patients and all SICU patients.

Interventions

In July 2018, an educational roll-out for SICU residents and staff was launched to inform them of potential benefits of early tracheostomy and potential complications, which they should discuss when counselling patient decision-makers. In July 2019, an early tracheostomy workflow targeting patients with head injury was published in an institutional Trauma Guide app.

Results

Median time from intubation to tracheostomy decreased for all patients from 14 days (range: 4–57) to 8 days (range: 1–32, p≤0.001), and median hospital LOS decreased from 38 days to 24 days (p<0.001, r=0.35). Median time to tracheostomy decreased significantly for trauma patients after publication of the algorithm (10 days (range: 3–21 days) to 6 days (range: 1–15 days), p=0.03). Among patients with TBI, family meetings were held earlier for patients who underwent early versus late tracheostomy (p=0.008).

Conclusions

We recommend regular educational meetings, enhanced by digitally published guidelines and strategic communication as effective ways to improve tracheostomy timing. These interventions standardised practice and may benefit other institutions.
Impact of a policy to improve the management of oral medications when patients are fasting before a procedure: an interrupted time series analysis
Authors: To The-Phung , Braat Sabine , Lim Andrew , Brien Jo-anne , Heland Melodie , Hardidge Andrew , Story David
Published: May 2022

Background

Managing medications inappropriately when patients have oral intake restrictions can cause patient harm. This study evaluated the impact of a medication policy separating fasting from nil by mouth with respect to giving oral medications in patients fasting before a diagnostic or interventional procedure.

Methods

The policy stipulated that ‘fasting’ means oral medications should be given with a sip of water up to 1 hour before a procedure, unless there is a clinical reason to withhold, while ‘nil by mouth’ means nothing to be given orally, including medications.

The policy was implemented in Surgical areas in February 2015 and Medical areas in March 2015 at a tertiary referral hospital in Melbourne, Australia, and included bedside signs, clinical champions and education sessions.

The study was conducted in 2020. Admission and medication records were matched for non-elective procedure patients from January 2014 to May 2016. The monthly proportion of doses omitted inappropriately and overall omissions pre/post-policy implementation were compared using segmented regression.

Results

Pre-implementation, the proportion of doses withheld inappropriately and total omissions in medical areas were 18.1% and 28.0%, respectively. Post-implementation, an absolute reduction of 13.4% (95% CI 9.0% to 17.7%) and 11.1% (95% CI 2.6% to 19.6%), respectively, was seen. Post-implementation linear trend showed a 0.3% (95% CI 0.0% to 0.6%) increase in inappropriate omissions but not overall omissions.

In Surgical areas, pre-implementation proportions for inappropriate and overall omissions were lower than Medical areas’. Post-implementation, there was an absolute decrease in doses withheld inappropriately (8.3%, 95% CI 0.8% to 15.7%, from 11.9% pre-implementation) but not total omissions.

Conclusions

Distinguishing fasting from nil by mouth appeared to provide clarity for some staff: a reduction in inappropriate omissions was seen post-implementation. Although the small increase in post-implementation linear trend for inappropriate omissions in Medical areas suggests sustainability issues, total omissions were sustained. The policy’s concepts require verification beyond our institution.