bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience of living with type 1 diabetes in a low-income country: a qualitative study from Liberia
Authors: Adler Alma J , Trujillo Celina , Schwartz Leah , Drown Laura , Pierre Jacquelin , Noble Christopher , Allison Theophilus , Cook Rebecca , Randolph Cyrus , Bukhman Gene
Published: October 2021

Introduction

While epidemiological data for type 1 diabetes (T1D) in low/middle-income countries, and particularly low-income countries (LICs) including Liberia is lacking, prevalence in LICs is thought to be increasing. T1D care in LICs is often impacted by challenges in diagnosis and management. These challenges, including misdiagnosis and access to insulin, can affect T1D outcomes and frequency of severe complications. Despite the severe nature of T1D and growing burden in sub-Saharan Africa, little is currently known about the impact of T1D on patients and caregivers in the region.

Methods

We conducted a qualitative study consisting of interviews with patients with T1D, caregivers, providers, civil society members and a policy-maker in Liberia to better understand the psychosocial and economic impact of living with T1D, knowledge of T1D and self-management, and barriers and facilitators for accessing T1D care.

Results

This study found T1D to have a major psychosocial and economic impact on patients and caregivers, who reported stigma, diabetes distress and food insecurity. Patients, caregivers and providers possessed the knowledge necessary to effectively manage T1D but insufficient community awareness leads to delayed diagnosis, often in an emergency department. Most patients reported receiving free services and materials, though the cost of transportation to clinic visits and recommended foods is a barrier to disease management. Many providers noted the lack of national T1D-specific guidelines and registries. Policy-makers reported a lack of prioritisation of and resources for T1D. These barriers, combined with scarcity and expense of appropriate foods, pose severe barriers for self-management of T1D.

Conclusion

T1D was found to have a significant impact on patients and caregivers, and informants identified several key individual and systems-level barriers to effective T1D care in Liberia. Addressing these concerns is vital for designing sustainable and effective programmes for treating patients living with T1D.
Inclusion of participants from low-income and middle-income countries in core outcome sets development: a systematic review
Authors: Karumbi Jamlick , Gorst Sarah L , Gathara David , Gargon Elizabeth , Young Bridget , Williamson Paula R
Published: October 2021

Objective

Our study aims to describe differences or similarities in the scope, participant characteristics and methods used in core outcome sets (COS) development when only participants from high-income countries (HICs) were involved compared with when participants from low-income and middle-income countries (LMICs) were also involved.

Design

Systematic review.

Data sources

Annual Core Outcome Measures in Effectiveness Trials systematic reviews of COS which are updated based on SCOPUS and MEDLINE, searches. The latest systematic review included studies published up to the end of 2019.

Eligibility criteria for selecting studies

We included studies reporting development of a COS for use in research regardless of age, health condition or setting. Studies reporting the development of a COS for patient-reported outcomes or adverse events or complications were also included.

Data extraction and synthesis

Data were extracted in relation to scope of the COS study, participant categories and the methods used in outcome selection.

Results

Studies describing 370 COS were identified in the database. Of these, 75 (20%) included participants from LMICs. Only four COS were initiated from an LMIC setting. More than half of COS with LMIC participants were developed in the last 5 years. Cancer and rheumatology were the dominant disease domains. Overall, over 259 (70%) of COS explicitly reported including clinical experts; this was higher where LMIC participants were also included 340 (92%). Most LMIC participants were from China, Brazil and South Africa. Mixed methods for consensus building were used across the two settings.

Conclusion

Progress has been made in including LMIC participants in the development of COS, however, there is a need to explore how to enable initiation of COS development from a range of LMIC settings, how to ensure prioritisation of COS that better reflects the burden of disease in these contexts and how to improve public participation from LMICs.
Knowledge, perceptions and practices of pharmacists regarding generic substitution in China: a cross-sectional study
Authors: Qu Jinghan , Zuo Wei , Wang Shaohong , Du Liping , Liu Xin , Gao Yang , Li Jiantao , Pan Hui , Du Xiaoli , Mei Dan , Took Roxane L , Schafermeyer Kenneth W , Lukas Stephanie , Zhang Bo
Published: October 2021

Objective

To evaluate pharmacists’ knowledge, perceptions and practices towards generic substitution in the 11 pilot locations in China.

Design

An online cross-sectional survey using questionnaires was conducted. A convenience sampling technique was implemented to recruit pharmacists.

Setting and participants

The study took place in medical institutions of 11 pilot locations that participated in the pilot national centralised procurement programme in 2019. Two thousand two hundred and ninety-one pharmacists including hospital pharmacists or community pharmacists based on health-systems or clinics participated in the study.

Results

Most of the participants had the good knowledge of requirements for evaluating the quality and efficacy of generic drugs (n=2118; 92.4%), and the definition of generic drugs (n=2078; 90.7%). In terms of perceptions, 67.3% of respondents were of the opinion that generic drugs are equally as effective as the brand-name drugs, and 69.0% of respondents were of the opinion that generic drugs are as safe as brand equivalents. A high percentage of participants supported the policy of generic substitution (n=1634; 71.4%). A significant positive correlation was demonstrated between total knowledge score and total perception score (ρ=0.267; p<0.001). Efficacy, safety and the direction of national policies and hospital regulations were the main factors affecting pharmacists’ willingness to dispense generic drugs.

Conclusions

The study identified gaps in respondents’ knowledge and perceptions of generic substitution. Pharmacists who are more knowledgeable in generic drugs tend to hold a more supportive attitude towards generic substitution. Although it appeared that pharmacists in China have largely accepted generic substitution, they still have concerns regarding the reliability and quality of generic drugs. The current issues need to be addressed for the realisation of the true value of generic drugs as part of the country’s healthcare cost-containment strategy as well as the implementation of generic substitution policy in China.
Creation of an electronic patient-reported outcome measure platform Voxe: a mixed methods study protocol in paediatric solid organ transplantation
Authors: Anthony Samantha J , Pol Sarah J , Lin Jia , Barwick Melanie , Brudno Michael , Manase Dorin , Parekh Rulan Savita , Silva Amanda , Stinson Jennifer
Published: October 2021

Introduction

Patient-reported outcome measures (PROMs) provide an opportunity for meaningful patient engagement and shared decision-making. The objective of this research programme is to improve health outcomes for paediatric solid organ transplant patients by implementing PROMs into clinical care. The current study aims to create Voxe, a paediatric user-centred electronic PROM platform, by engaging patients and healthcare providers throughout the design and development process.

Methods and analysis

The creation of Voxe will occur over two phases that build on previous research. The user interface design phase employs a ‘user-centric’ approach to identify end-users’ needs and iteratively refine the look and layout of Voxe to meet these needs. Transplant recipients, aged 10–17, and healthcare providers will participate in three rounds of testing (24 participants total). Participants will: (1) complete task-based activities (outcomes—effectiveness and efficiency), (2) complete questionnaires (outcome—satisfaction) and (3) participate in a semi-structured interview. The following phase involves software development and Voxe usability testing. Transplant recipients, aged 8–17, and healthcare providers will participate in four rounds of iterative testing (24–40 participants total). The think-aloud technique will be employed, and participants will describe their thoughts and feelings while interacting with a Voxe prototype. Participants will: (1) log into Voxe and complete tasks (outcomes—time on task, successful task completion, frequency of critical and non-critical errors and error-free rate), (2) complete questionnaires (outcome—satisfaction) and (3) participate in a semi-structured interview. Findings will result in the creation and launch of a user-centred electronic PROM platform.

Ethics and dissemination

Research ethics board approval has been provided by The Hospital for Sick Children. This research is critical to answering methodological and operational questions to inform Voxe implementation in paediatric clinical settings and facilitate PROM data collection. Future investigations will include an implementation-effectiveness evaluation.
Potential effects on cardiometabolic risk factors and body composition by short message service (SMS)-guided training after recent minor stroke or transient ischaemic attack: post hoc analyses of the STROKEWALK randomised controlled trial
Authors: Vahlberg Birgit Maria , Lundström Erik , Eriksson Staffan , Holmback Ulf , Cederholm Tommy
Published: October 2021

Objectives

To evaluate effects of mobile phone text-messaging exercise instructions on body composition, cardiometabolic risk markers and self-reported health at 3 months after stroke.

Design

Randomised controlled intervention study with per-protocol analyses.

Setting

University Hospital in Sweden.

Participants

Seventy-nine patients (mean (SD) age 64 (10) years, 37% female) ≥18 years with good motor function (modified Rankin Scale ≤2) and capable to perform 6 min walking test at hospital discharge were randomised to either intervention (n=40) or control group (n=39). Key exclusion criteria: subarachnoid bleeding, uncontrolled hypertension, severe psychiatric problems or cognitive limitations.

Interventions

The intervention group received beyond standard care, daily mobile phone instructional text messages to perform regular outdoor walking and functional leg exercises. The control group received standard care.

Main outcome measures

Fat mass and fat-free mass were estimated by bioelectric impedance analysis. Cardiometabolic risk factors like blood lipids, glycated haemoglobin and blood glucose were analysed at baseline and after 3 months.

Results

Both groups changed favourably in fat-free mass (1.83 kg, 95% CI 0.77 to 2.89; p=0.01, effect size (ES)=0.63 vs 1.22 kg, 95% CI 0.39 to 2.0; p=0.05, ES=0.54) and fat mass (−1.30 kg, 95% CI −2.45 to −0.14; p=0.029, ES=0.41 vs −0.76 kg, 95% CI −1.74 to 0.22; p=0.123, ES=0.28). Also, many cholesterol related biomarkers improved; for example, total cholesterol −0.65 mmol/L, 95% CI −1.10 to −0.2; p=0.06, ES: 0.5 vs −1.1 mmol/L, 95% CI −1.47 to −0.56; p>0.001, ES=0.8. However, there were no between-group differences. At 3 months, 94% and 86%, respectively, reported very good/fairly good health in the text messaging and control groups.

Conclusions

No clear effect of 3 months daily mobile phone delivered training instructions was detected on body composition, cardiovascular biochemical risk factors or self-perceived health. Further research is needed to evaluate secondary prevention efforts in larger populations after recent stroke.

Trial registration number

NCT02902367.
Prevalence of strabismus among preschool children in eastern China and comparison at a 5-year interval: a population-based cross-sectional study
Authors: Wang Yue , Zhao Andi , Zhang Xiaohan , Huang Dan , Zhu Hui , Sun Qigang , Yu JiaJia , Chen Ji , Zhao Xiaoyan , Li Rui , Han Shu , Dong Weiyi , Ma Fanfei , Chen XueJuan , Liu Hu
Published: October 2021

Objective

To update data on strabismus and evaluate the changes in prevalence and patterns among preschoolers in eastern China over a period of 5 years.

Design

Nanjing Eye Study, a longitudinal population-based study.

Setting

Recruitment and testing in kindergartens in Yuhuatai District, Nanjing.

Participants

2300 eligible children.

Main outcome measures

Comprehensive ocular examinations were conducted in 1986 children aged 48–<60 months in Nanjing Eye Study (NES, 2016–2017), including visual acuity, ocular alignment, refractive error and ocular structures evaluation. The prevalence rate and pattern of strabismus were calculated and compared with those from the Nanjing Pediatric Vision Project (NPVP, 2011–2012) in children of the same age, of the same area and using the same diagnostic criteria.

Results

The overall prevalence rate of strabismus in NES was 5.56% (95% CI 4.54% to 6.57%), which was not significantly different from that in NPVP (4.99%, 95% CI 4.13% to 5.84%, p=0.40). The prevalence of subtypes of strabismus underwent significant changes, with significant increase in intermittent exotropia (IXT) in NES (2.78% vs 4.69%, p=0.001) and significant decrease in constant exotropia (1.17% vs 0.15%, p<0.001). Significant change in pattern was observed in IXT, where the proportion of the convergence insufficiency type (2.90% vs 27.17%) increased and exceeded the divergence excess type (20.29% vs 11.96%) to be the second common type (p<0.001).

Conclusion

The prevalence of strabismus appeared stable in children aged 48–<60 months in eastern China at a 5-year interval. The prevalence of IXT increased significantly, and the convergence insufficiency type became more prevalent in patients with IXT. Timely detection and intervention of IXT are important among preschoolers.
Novel biomechanical injury risk score demonstrates correlation with lower limb posterior chain injury in 50 elite-level rugby union athletes
Authors: Hughes Rhys , Cross Matt , Stokes Keith , Tobin Daniel , Power Eoin , McNally Steph , Pamment Jonathan
Published: October 2021

Objectives

Lower limb posterior chain injury (PCI) is common among athletic populations, with multifactorial risk factors including age, previous injury, strength measurements, range of motion and training load. Biomechanics are commonly considered in the prevention and rehabilitation of PCI by performance staff. However, there is no documented testing method to assess for associations between biomechanics and PCI. The aim of this study was to investigate whether there is an association between an easily applicable, novel biomechanical assessment tool and PCI.

Methods

Fifty male elite-level rugby union athletes (age 22.83±5.08) participating in the highest tier of England were tested at the start of the 2019 preseason period and PCIs (N=48) were recorded over the 2019/2020 playing season. Participants’ biomechanics were analysed using two-dimensional video analysis against an injury risk score (IRS) system in the performance of the combined movement—prone hip extension and knee flexion. Participants’ biomechanics in carrying out this movement were scored against the 10-point IRS, where the more compensatory movement recorded sees an increase in an individual’s IRS. Participants’ IRS was then compared against the number of PCIs sustained and Spearman’s correlation coefficient was used for statistical analysis.

Results

There is a significant association between IRS and PCI (R=0.542, p<0.001). Linear regression demonstrated that an increase in 1 in IRS was associated with a 35% increase in PCI incidence (R²=0.346).

Conclusion

A significance between the IRS and PCI provides preliminary support for its use as an injury risk assessment tool.
Did attending P.A.R.T.Y. change youth perceptions? Results from 148 Queensland schools participating in the Prevent Alcohol and Risk-Related Trauma in Youth Program, 2018–2019
Authors: Cameron Cate M , Eley Rob , Judge Chantelle , O'Neill Roisin , Handy Michael
Published: October 2021

Background

Prevent Alcohol and Risk-Related Trauma in Youth (P.A.R.T.Y.) is an immersive 1 day in-hospital injury awareness and prevention programme designed to educate high-school students on the consequences of a variety of risk-taking behaviours. This multisite contemporary analysis examined differences in programme effect and temporal changes on participant knowledge and attitudes.

Methods

Metropolitan and rural schools were invited to attend the programme at one of the 11 hospital sites throughout Queensland, Australia. Pre–post study design with participant questionnaires provided at three time periods: immediately preprogramme and postprogramme, and 4 months later. The questionnaire used scenarios to determine a participant’s opinion on the safety of drugs/alcohol, driving and risk-taking activities, using Likert scales.

Results

A total of 5999 students participated in the programme between 1 January 2018 and 31 December 2019. Responses to all questions related to safety, harm or risk followed a similar pattern. The immediate postcourse responses demonstrated significant increased awareness of risk or change in action, followed by a decay at 4 months to within 10% of preprogramme levels. Public school students, males and students from Central and North Queensland demonstrated lower risk-aversion (p<0.05).

Conclusion

This study demonstrated across more than 100 school sites, the positive change in knowledge and student participant attitudes towards risk-taking behaviours after attending the P.A.R.T.Y. programme. The need to address the significant decay at the 4-month follow-up was identified. Findings offered potential for tailoring of messaging to target key demographic groups/topics where the decay was greatest.
MET overexpression contributes to STAT4-PD-L1 signaling activation associated with tumor-associated, macrophages-mediated immunosuppression in primary glioblastomas
Authors: Wang Qiang-Wei , Sun Li-Hua , Zhang Ying , Wang Zheng , Zhao Zheng , Wang Zhi-Liang , Wang Kuan-Yu , Li Guan-Zhang , Xu Jian-Bao , Ren Chang-Yuan , Ma Wen-Ping , Wang Hong-Jun , Li Shou-Wei , Zhu Yong-Jian , Jiang Tao , Bao Zhao-Shi
Published: October 2021

Background

Dysregulated receptor tyrosine kinases, such as the mesenchymal-epidermal transition factor (MET), have pivotal role in gliomas. MET and its interaction with the tumor microenvironment have been previously implicated in secondary gliomas. However, the contribution of MET gene to tumor cells’ ability to escape immunosurveillance checkpoints in primary gliomas, especially in glioblastoma (GBM), which is a WHO grade 4 glioma with the worst overall survival, is still poorly understood.

Methods

We investigated the relationship between MET expression and glioma microenvironment by using multiomics data and aimed to understand the potential implications of MET in clinical practice through survival analysis. RNA expression data from a total of 1243 primary glioma samples (WHO grades 2–4) were assembled, incorporating The Cancer Genome Atlas, Chinese Glioma Genome Atlas, and GSE16011 data sets.

Results

Pearson’s correlation test from the three data sets indicated that MET showed a robust correlation with programmed death-ligand 1 (PD-L1) and STAT pathways. Western blot analysis revealed that in GBM cell lines (N33 and LN229), PD-L1 and phosphorylated STAT4 were upregulated by MET activation treatment with hepatocyte growth factor and were downregulated on MET suppression by PLB-1001. Tumor tissue microarray analysis indicated a positive correlation between MET and PD-L1 and macrophage-associated markers. Chromatin immunoprecipitation-PCR assay showed enrichment of STAT4 in the PD-L1 DNA. Transwell co-culture and chemotaxis assays revealed that knockdown of MET in GBM cells inhibited macrophage chemotaxis. Moreover, we performed CIBERSORTx and single-cell RNA sequencing data analysis which revealed an elevated number of macrophages in glioma samples with MET overexpression. Kaplan-Meier survival analysis indicated that activation of the MET/STAT4/PD-L1 pathway and upregulation of macrophages were associated with shorter survival time in patients with primary GBM.

Conclusions

These data indicated that the MET-STAT4-PD-L1 axis and tumor-associated macrophages might enforce glioma immune evasion and were associated with poor prognosis in GBM samples, suggesting potential clinical strategies for targeted therapy combined with immunotherapy in patients with primary GBM.
Avelumab for platinum-ineligible/refractory recurrent and/or metastatic squamous cell carcinoma of the head and neck: phase Ib results from the JAVELIN Solid Tumor trial
Authors: Guigay Joël , Lee Keun-Wook , Patel Manish R , Daste Amaury , Wong Deborah J , Goel Sanjay , Gordon Michael S , Gutierrez Martin , Balmanoukian Ani , Le Tourneau Christophe , Mita Alain , Vansteene Damien , Keilholz Ulrich , Schöffski Patrick , Grote Hans Juergen , Zhou Dongli , Bajars Marcis , Penel Nicolas
Published: October 2021

Background

Recurrent and/or metastatic (R/M) disease develops in approximately 65% of patients with squamous cell carcinoma of the head and neck (SCCHN) and is associated with a poor prognosis. Immune checkpoint inhibitors have proven effective in multiple tumor types, including R/M SCCHN. We report the efficacy and safety of avelumab (antiprogrammed death ligand 1 antibody) in an expansion cohort of patients with platinum-refractory/ineligible R/M SCCHN enrolled in the phase I JAVELIN Solid Tumor trial (NCT01772004).

Methods

Eligible patients with R/M SCCHN were aged ≥18 years and had received ≥1 line of platinum-based chemotherapy with disease progression or recurrence within 6 months of the last dose or were ineligible for platinum-based chemotherapy. All patients received avelumab 10 mg/kg every 2 weeks. Tumor assessments were carried out by a blinded independent review committee (IRC) and investigators according to Response Evaluation Criteria in Solid Tumors V.1.1 (RECIST 1.1). Key endpoints included best overall response, duration of response (DOR) and progression-free survival (PFS) assessed by IRC and investigator per RECIST 1.1, overall survival (OS), and safety.

Results

Between April 24, 2015, and November 13, 2015, 153 patients were enrolled. Patients had a median of two prior lines of therapy for metastatic or locally advanced disease (range 0–6); 12 patients (7.8%) were not eligible for platinum-based chemotherapy. At data cut-off (December 31, 2017), the confirmed objective response rate was 9.2% (95% CI 5.1% to 14.9%) assessed by IRC and 13.1% (95% CI 8.2% to 19.5%) assessed by investigator. Median DOR was not reached (95% CI 4.2 to not estimable) based on IRC assessment. Median PFS was 1.4 months (95% CI 1.4 to 2.6) assessed by IRC and 1.8 months (95% CI 1.4 to 2.7) assessed by investigator; median OS was 8.0 months (95% CI 6.5 to 10.2). Any-grade treatment-related adverse events (TRAEs) occurred in 83 patients (54.2%) and were grade ≥3 in 10 patients (6.5%). The most common TRAEs were fatigue (n=19, 12.4%), fever (n=14, 9.2%), pruritus (n=12, 7.8%), and chills (n=11, 7.2%), and there were no treatment-related deaths.

Conclusion

Avelumab showed clinical activity and was associated with a low rate of grade ≥3 TRAEs in heavily pretreated patients with platinum-refractory/ineligible R/M SCCHN.
Clinical profile of fatal familial insomnia: phenotypic variation in 129 polymorphisms and geographical regions
Authors: Zhang Jing , Chu Min , Tian ZiChen , Xie KeXin , Cui Yue , Liu Li , Meng JiaLi , Yan HaiHan , Ji Yang-Mingyue , Jiang Zhuyi , Xia Tian-Xinyu , Wang Dongxin , Wang Xin , Zhao Ye , Ye Hong , Li Junjie , Wang Lin , Wu Liyong
Published: October 2021

Objective

Elucidate the core clinical and genetic characteristics and identify the phenotypic variation between different regions and genotypes of fatal familial insomnia (FFI).

Methods

A worldwide large sample of FFI patients from our case series and literature review diagnosed by genetic testing were collected. The prevalence of clinical symptoms and genetic profile were obtained, and then the phenotypic comparison between Asians versus non-Asians and 129Met/Met versus 129Met/Val were conducted.

Results

In total, 131 cases were identified. The age of onset was 47.51±12.53 (range 17–76) years, 106 patients died and disease duration was 13.20±9.04 (range 2–48) months. Insomnia (87.0%) and rapidly progressive dementia (RPD; 83.2%) occurred with the highest frequency. Hypertension (33.6%) was considered to be an objective indicator of autonomic dysfunction. Genotype frequency at codon 129 was Met/Met (84.7%) and Met/Val (15.3%), and allele frequency was Met (92.4%) and Val (7.6%).129 Met was a risk factor (OR: 3.728, 95% CI: 2.194 to 6.333, p=0.000) for FFI in the non-Asian population. Comparison of Asians and non-Asians revealed clinical symptoms and genetic background to show some differences (p<0.05). In the comparison of 129 polymorphisms, a longer disease duration was found in the 129 MV group, with alleviation of some clinical symptoms (p<0.05). After considering survival probability, significant differences in survival time between genotypes remained (p<0.0001).

Conclusions

Insomnia, RPD and hypertension are representative key clinical presentations of FFI. Phenotypic variations in genotypes and geographic regions were documented. Prion protein gene 129 Met was considered to be a risk factor for FFI in the non-Asian population, and 129 polymorphisms could modify survival duration.
Sensitivity of brain MRI and neurological examination for detection of upper motor neurone degeneration in amyotrophic lateral sclerosis
Authors: Nitert Abram D , Tan Harold HG , Walhout Renée , Knijnenburg Nienke L , van Es Michael A , Veldink Jan H , Hendrikse Jeroen , Westeneng Henk-Jan , van den Berg Leonard H
Published: October 2021

Objectives

To investigate sensitivity of brain MRI and neurological examination for detection of upper motor neuron (UMN) degeneration in patients with amyotrophic lateral sclerosis (ALS).

Methods

We studied 192 patients with ALS and 314 controls longitudinally. All patients visited our centre twice and underwent full neurological examination and brain MRI. At each visit, we assessed UMN degeneration by measuring motor cortex thickness (CT) and pyramidal tract fibre density (FD) corresponding to five body regions (bulbar region and limbs). For each body region, we measured degree of clinical UMN and lower motor neuron (LMN) symptom burden using a validated scoring system.

Results

We found deterioration over time of CT of motor regions (p≤0.0081) and progression of UMN signs of bulbar region and left arm (p≤0.04). FD was discriminative between controls and patients with moderate/severe UMN signs (all regions, p≤0.034), but did not change longitudinally. Higher clinical UMN burden correlated with reduced CT, but not lower FD, for the bulbar region (p=2.2×10−10) and legs (p≤0.025). In the arms, we found that severe LMN signs may reduce the detectability of UMN signs (p≤0.043). With MRI, UMN degeneration was detectable before UMN signs became clinically evident (CT: p=1.1×10−10, FD: p=6.3×10−4). Motor CT, but not FD, deteriorated more than UMN signs during the study period.

Conclusions

Motor CT is a more sensitive measure of UMN degeneration than UMN signs. Motor CT and pyramidal tract FD are discriminative between patients and controls. Brain MRI can monitor UMN degeneration before signs become clinically evident. These findings promote MRI as a potential biomarker for UMN progression in clinical trials in ALS.
Leptospirosis. Do you consider the diagnosis?
Authors: Rudland S. V.
Published: October 2021

Patients with Leptospirosis, usually a water borne zoonotic disease, are likely to present themselves to Royal Naval primary health carers, who deal with a young active population, frequently participating in watersports.

Leptospira, which belong to the order Spirochaetaceae, comprise of two distinct species. Within each species there are a number of serologically different serovars (serotypes), arranged in related serogroups.

L. interrogans var Icterohaemorrhagiae and L. interrogans var Hebdomadis serovar hardjo are the most commonly reported organisms in Great Britain. Traditionally water and sewage workers have been amongst those most frequently infected, but with improved health care awareness this group has been overtaken by farmworkers, and a growing group of people engaged in aquatic sports.

Symptoms of Leptospiral infection vary in severity from a mild flu-like illness to symptoms resulting from severe renal, hepatic or meningeal involvement.

Mild symptoms respond to oral penicillin, erythromycin or tetracyclines, whilst more serious illness requires i.v. penicillin and supportive nursing. Spirochaetes can be detected in culture using darkground microscopy, and sero-conversion detected by IgM specific dot ELISA techniques. Suspected sera should be sent to PHLS Leptospira Reference Unit, County Hospital, Hereford. HR1 2ER. (Tel: 0432 277117).
The Global maritime distress and safety system
Authors: Jones P.
Published: October 2021

The evolution of modern communications, in particular by satellite, has enabled the development of a Global system for the alerting and coordination of search and rescue organisations in the event of maritime disaster. A brief overview of the components of the system is given after a review of the various official bodies involved in its inception.
Experiences with ureteroscopy
Authors: Spalding T. J. W.
Published: October 2021

Thirty-nine patients underwent 44 ureteroscopic procedures between January 1985 and August 1988 for diagnostic and therapeutic purposes. Twenty six procedures were undertaken on 23 patients for extraction of ureteric calculi and were successful on the initial attempt in 14 (61%). Four stones not removed on the first attempt were however disimpacted and subsequently passed spontaneously, and three more were removed at a second ureteroscopy. The overall success rate therefore was 91%. Only two patients required ureterolithotomy.

Ureteroscopic stone extraction is therefore an effective technique with minimal morbidity and allows rapid return of servicemen to high category medical fitness.
Space Motion Sickness
Authors: Pingree B. J. W.
Published: October 2021

Space Motion Sickness (SMS) is the malady which frequently occurs shortly after attainment of sustained exposure to hypogravity. It is characterised by a variety of symptoms, which may proceed to nausea and eventually vomiting. Natural adaptation usually occurs if exposure to hypogravity is maintained. The condition appears to be the manifestation of motion sickness that is specific to hypogravity. It is associated with otolith-canal and otolith-eye conflict. SMS may have operational significance in impairing the performance of spacecraft crews. The condition is likely to be amenable to treatment with anti-motion sickness drugs. It may be possible to reduce any operational effects of SMS by suitable crew selection and training procedures.
The Effect of Clothing on the initial Responses to Cold Water Immersion in man
Authors: Tipton M. J. , Stubbs D. A. , Elliott D. H.
Published: October 2021

The protection provided by three clothing assemblies against the cold shock response was investigated. Nine healthy male volunteers each undertook three two minute head-out immersions into stirred water at 10°C. The subjects wore a different clothing assembly for each immersion, these were:

(a)

Swimming trunks only;

(b)

Conventional clothing (equivalent to RN No 8s);

(c)

Conventional clothing plus windproof/showerproof clothing (RN foul-weather clothing Mk III).

The cardiac, ventilatory and thermal responses of the subjects were examined before and during the immersions.

No significant differences were found between the magnitude of the responses recorded on immersion when conventional clothing or foul-weather clothing were worn. Mean skin temperature was lower (P<0.05) and respiratory frequency and minute ventilation were higher (P<0.05) on immersion in swimming trunks compared to the other two conditions.

It is concluded that when policies for the use of immersion protective clothing are being formulated, consideration should be given to all of the potentially hazardous responses associated with cold water immersion.
Ventilation with isoflurane in the Triservice anaesthetic apparatus: a comparison with halothane and trichlorethylene
Authors: Roberts D. R. D. , Pethybridge R. J.
Published: October 2021

Recovery from anaesthesia using the Triservice anaesthetic apparatus with either isoflurane alone or halothane and trichlorethylene, was assessed by measurement of reaction time. There was no statistically significant improvement in recovery between patients who received low concentrations of isoflurane and those who received halothane and trichlorethylene.

The mean profiles of systolic pressure and heart rate were significantly greater in the isoflurane group (P<0.05) than in the halothane/trichlorethylene group. Cardiovascular stability was maintained into the recovery period. The benefits of low concentrations of isoflurane as sole agent in the Triservice anaesthetic apparatus and their extrapolation to a shocked casualty in a military setting are discussed.
The hazards of operational diving in heavily oil-polluted water
Authors: Peterson K. A. , Portouw S. J.
Published: October 2021

The war in the Gulf and the resultant massive oil spill has prompted an assessment of the health hazards to naval divers operating in oil-fouled environments. A review of current literature and discussions with experts in the field was undertaken to assess these hazards. With the assistance of Kuwait Petroleum, an assay of the content of average Kuwait crude was obtained. The risks of contact with crude oil and its vapours via the skin, inhalation and ingestion have been assessed. Contact dermatitis is the most likely sequel. A chemical pneumonitis from oil inhalation is possible but extremely unlikely. A health risk from ingestion of crude oil is equally unlikely since no toxic effect is thought to occur below a consumption of 5 ml/kg (350 ml for an average diver). Trace metals were found to be at a level of less than 1/10 of the minimal toxic dose for all but vanadium. No increased risk of skin cancer can be found in animal studies of crude oil. Epidemiological studies have recorded no increased risk of bladder or thyroid cancer in petroleum workers, but an increase in lung, nasal cavity, sinus and skin cancer has been shown following chronic exposure to low levels of petroleum vapour. No medical indication was found for modification of existing operational procedures, although, since the toxicity of some components of crude oil is unknown, the use of improved equipment to avoid contact should be studied.
Laryngeal mask airway and tracheal tube insertion by unskilled personnel
Authors: Davies P. R. F. , Tighe S. Q. M. , Greenslade G. L. , Evans G. H.
Published: October 2021

After a short training programme 11 naval medical trainees inserted a laryngeal mask airway (LMA) and a tracheal tube (ETT) in random order in a total of 110 anaesthetized patients. They were allowed 40 seconds for each attempt. Success was defined as the detection of expired carbon dioxide within 40 seconds of Guedel airway removal which subsequently rose to an end-tidal value of at least 4 kPa, together with satisfactory lung expansion and ventilation, without other airway intervention by the anaesthetist. One hundred and four LMA insertions were successful compared with 56 ETTs (p<0.01). All first attempts at LMA insertion were successful, whereas satisfactory ETT placement was progressive. Insertion was also quicker with the LMA (20 seconds) than with the ETT (35 seconds) (p<0.01). Further studies are indicated to assess the value of the LMA in emergencies.
Medical audit: A Well Woman Clinic in the Royal Naval training practice, Gibraltar
Authors: Westwood P. R.
Published: October 2021

In order to assess the effectiveness of patient self-selection, and the value of dedicating surgery time to a specific clinic, attendances at a Well Woman Clinic were compared with attendances for the same reasons at other times. During the nine month audit period the opportunity was also taken to overhaul the Age/Sex Register, and assess the uptake of Cervical Screening at the Garrison Medical Centre. This unit is part of the Royal Naval Training Practice in Gibraltar.
Advanced Trauma Life Support aboard RFA Argus
Authors: Greenslade G. L. , Taylor R. H.
Published: October 2021

The Advanced Trauma Life Support (ATLS) system was adopted for casualty reception and resuscitation. ATLS permitted well-informed triage decisions to be made, coupled with appropriate initial, possibly life-saving, treatment. The training given on board has continued to benefit patients treated by ex-Argus staff in their peacetime roles.
Primary Casualty Reception Ship: the hospital within—Operation Granby
Authors: Dewar E. P.
Published: October 2021

As the build-up of Operation Granby forces developed in the Gulf, casualty estimates indicated the need for a 100-bed hospital facility to care for the possible maritime casualties. RFA Argus, the Air Training Ship, was identified as the potential Primary Casualty Reception Ship (PCRS) and at the end of September 1990 plans were drawn up to convert the forward hangar into a two-storey 100-bed hospital in collective protection (COLPRO).

In the three weeks prior to deployment, the hospital was designed, built, equipped and staffed.

Argus arrived in the Gulf in mid-November as the PCRS with, all in COLPRO, a 10-bed intensive care unit (ICU), a 14-bed high dependency unit (HDU), a 76-bed low dependency unit (LDU) plus four operating tables in two theatres with full support services.

The hospital was staffed by a medical team of 136 personnel and supported by the Air department with four casualty evacuation helicopters, an RN Party and the staff of the RFA.

One hundred and five patients were treated of which 78 were returned to duty. Argus as PCRS spent longer in the northern Persian Gulf than any other ship, UK or US.
Immersion fatalities: Hazardous responses and dangerous discrepancies
Authors: Tipton M. J.
Published: October 2021

In this paper the following question is addressed: ‘Why, given the plethora of standards, specifications and guidelines for immersion protective equipment, are lives still being lost at sea and fatal accident enquiries questioning the quality of such equipment?’

In attempting to answer this question, consideration is given to the extent to which both the possible prevailing environmental conditions, and the physiological responses they evoke, are recognised in the design, selection and evaluation of immersion protective equipment. The hazardous responses associated with immersion in cold water are briefly reviewed and the value and relevance of some of the existing tests of immersion protective clothing are considered.

It is concluded that: i. when standards, policies and tests for the selection and use of immersion protective clothing are being formulated, consideration should be given to all of the hazardous responses associated with immersion; ii. it should be recognised that the performance of immersion protective equipment during an accident may be significantly inferior to that predicted by routine testing for certification.
Repeated pseudo-obstruction, mental subnormality – and serious snags
Authors: Guy R. J. , Barker C. P. G.
Published: October 2021

Chronic intestinal pseudo-obstruction has certain identifiable causes but many cases remain idiopathic. The majority of patients are managed successfully by conservative means with the avoidance of surgery. A case is presented where diagnosis was made difficult by autism and which was complicated by perforation of a gastric ulcer. Management of pseudo-obstruction is discussed and emphasis placed on an awareness of alternative life-threatening pathologies at re-presentation.
Investigating Gulf Veterans’ Health Concerns
Authors: Graham J. T.
Published: October 2021

In order to answer the questions arising from the health concerns of Gulf veterans, the Defence Medical Services have collated relevant health data so that they may be systematically analysed. However, data coverage is limited and there are concerns about its quality. Intramural studies alone will not be robust enough to determine if veterans are experiencing an excess of ill-health so a programme of epidemiological studies will be commissioned in collaboration with the Medical Research Council.
Acute compartment syndrome complicating Colles’ fracture
Authors: Howden P. E.
Published: October 2021

Colles’ fracture is a common injury and has a relatively high associated morbidity. Compartment syndrome is a rare complication, but a high index of suspicion must be maintained in the initial post-injury and post-reduction periods.
Fortune favours the Brave - The Capture of Guadeloupe 1815
Authors: Agnew R. A. L.
Published: October 2021

In August 1815, Sir Philip Durham and Sir James Leith, with the help of the French Royalist Comte de Vaugiraud from Martinique, landed a body of troops on the island of Guadeloupe. After a skirmish, in which the British army lost 16 killed and about 50 wounded, the Comte Linois struck his flag and surrendered the island. Afterwards he was, along with his adjutant-general, conveyed to France under the terms of the articles of the capitulation treaty. The Commander in Chief of the Leeward Islands Squadron at that time, Admiral Sir Philip Durham KCB, and his Secretary, Surgeon John Forbes, played important roles in the recapture of the island.
Role model nursing leaders in COVID-19 crisis
Authors: Mollahadi Mohsen , Mokhtari Nouri Jamileh , Moradian Seyed Tayeb
Published: October 2021

Background

Applying the principles and skills of management, including planning, organising and leadership skills, will greatly help to improve the quality of nursing manager duties. This is even more important during crisis management, such as the COVID-19 crisis. The objective of the present study was to express the experiences of nursing managers in the COVID-19 crisis.

Methods

A qualitative conventional content analysis approach was used to discover the nursing leadership style in the COVID-19 crisis. The present study was conducted in one hospital in Tehran, Iran. 20 Iranian nursing managers in all nursing management positions such as head nurse, matron and supervisor were interviewed. Semi-structured interview was conducted at one hospital in Iran, using reflective and open-ended questions. Interviews were audio recorded and transcribed. The study was carried out in 2020 while data saturation occurred, no new categories or codes have emerged and the study questions were answered. Credibility and conformability were established through member checking. The report of the analysis was returned to the participants in order to get the assurance that the researchers had portrayed their real world in codes and extracted categories.

Results

Four main themes emerged from data analysis including ‘managers as role model’, ‘full responsiveness’, ‘being in constant challenge’ and ‘post disaster growth’.

Conclusion

Nursing management is one of the activities that the manager must be constantly aware of the activities of his subset. This requires a constant presence in the workplace and communication with nursing staff. Also, in times of crisis, the manager, in addition to having scientific ability, must also have sufficient experience. These two factors will lead to crisis management. Also, training staff and managers in crisis management is one of the most important issues in nursing management.
Hospitalisation for systemic lupus erythematosus associates with an increased risk of mortality in Australian patients from 1980 to 2014: a longitudinal, population-level, data linkage, cohort study
Authors: Raymond Warren David , Lester Susan , Preen David Brian , Keen Helen Isobel , Inderjeeth Charles Anoopkumar , Furfaro Michael , Nossent Johannes Cornelis
Published: October 2021

Objective

Mortality rates for patients with SLE have not been reported in Australia. This study determined the association between a hospitalisation for SLE with mortality.

Methods

Population-level cohort study of patients with SLE (n=2112; 25 710 person-years) and general population comparators (controls) (n=21, 120; 280 637 person-years) identified from hospital records contained within the WA Rheumatic Disease Epidemiological Registry from 1980 to 2013. SLE was identified by ICD-9-CM: 695.4, 710.0, ICD-10-AM: L93.0, M32.0. Controls were nearest matched (10:1) for age, sex, Aboriginality and temporality. Using longitudinal linked health data, we assessed the association between a hospitalisation for SLE mortality and mortality with univariate and multivariate Cox proportional hazards and competing risks regression models.

Results

At timezero, patients with SLE were similar in age (43.96 years), with higher representation of females (85.1% vs 83.4%, p=0.038), Aboriginal Australians (7.8% vs 6.0%) and smokers (20.5% vs 13.2%). Before study entry, patients with SLE (mean lookback 9 years) had higher comorbidity accrual (Charlson Comorbidity Index ≥1 item (42.0% vs 20.5%)), especially cardiovascular disease (CVD) (44.7% vs 21.0%) and nephritis (16.4% vs 0.5%), all p<0.001. During follow-up (mean 12.5 years), 548 (26.0%) patients with SLE and 2450 (11.6%) comparators died. A hospitalisation for SLE increased the unadjusted (HR 2.42, 95% CI 2.20 to 2.65) and multivariate-adjusted risk of mortality (aHR 2.03, 95% CI 1.84 to 2.23), which reduced from 1980 to 1999 (aHR 1.42) to 2000–2014 (aHR 1.27). Females (aHR 2.11), Aboriginal Australians (aHR 3.32), socioeconomically disadvantaged (aHR 2.49), and those <40 years old (aHR 7.46) were most vulnerable. At death, patients with SLE had a higher burden of infection (aHR 4.38), CVD (aHR 2.09) and renal disease (aHR 3.43), all p<0.001.

Conclusions

A hospitalisation for SLE associated with an increased risk of mortality over the 1980–2014 period compared with the general population. The risk was especially high in younger (<40 years old), socioeconomically disadvantaged and Aboriginal Australians.