bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heyde’s syndrome: a systematic review of case reports
Authors: Saha Bibek , Wien Eric , Fancher Nicholas , Kahili-Heede Melissa , Enriquez Nathaniel , Velasco-Hughes Alena 
Published: May 2022

ObjectiveHeyde’s syndrome (HS), a rare condition characterised by a unique relationship between severe aortic stenosis and angiodysplasia, is often diagnosed late increasing the risk for a prolonged hospital course and mortality in the elderly. The leading hypothesis explaining the aetiology of HS is acquired von Willebrand syndrome (AVWS) but not all studies support this claim. While individual cases of HS have been reported, here we present the first systematic review of case reports and focus on the prevalence of AVWS.DesignA systematic search was conducted through PubMed/MEDLINE, CINAHL-EBSCO, Web of Science and Google Scholar since inception. The resulting articles were screened by two independent reviewers based on inclusion criteria that the article must be a case report/series or a letter to the editor in English describing HS in an adult patient.ResultsSeventy-four articles encompassing 77 cases met the inclusion criteria. The average age was 74.3±9.3 years old with a slight female predominance. The small intestine, especially the jejunum, was the most common location for bleeding origin. Capsule endoscopy and double balloon enteroscopy were superior at identifying bleeding sources than colonoscopy (p=0.0027 and p=0.0095, respectively) and oesophagogastroduodenoscopy (p=0.0006 and p=0.0036, respectively). The mean duration from symptom onset to diagnosis/treatment of HS was 23.8±39 months. Only 27/77 cases provided evidence for AVWS. Surgical and transcutaneous aortic valve replacement (AVR) were superior at preventing rebleeding than non-AVR modalities (p<0.0001).ConclusionFurther research is warranted for a stronger understanding and increased awareness of HS, which may hasten diagnosis and optimal management.
A critical examination of research narratives ‘rumours’ and passive community resistance in medical research
Authors: Nyirenda Deborah , Sariola Salla , Desmond Nicola 
Published: May 2022

Several studies in Africa have reported effects of ‘rumours, misconceptions or misinformation’ on medical research participation and uptake of health interventions. As such, community engagement has sometimes been used for instrumental purposes to enhance acceptability of research or interventions and prevent ‘rumours’. This paper seeks to highlight the value of ongoing engagement with communities to understand research narratives ‘rumours’ reproduced in medical research. We demonstrate that ‘rumours’ are a form of divergent communication or local interpretation of medical research that needs critical attention, and we question the ethics of dismissing such divergent communication.This paper draws on experiences from ethnographical research, which aimed to understand community engagement in medical research projects conducted in Malawi. We observed that even though community meetings were held to improve participation, ‘rumours’ about research influenced decision making. ‘Rumours’ presented local critiques of medical research, legitimate concerns informed by historical experiences and local conceptualisation of health. Structural inequalities, negative outcomes or absence of visible benefits following research participation informed unmet expectations, discontent with research and consequently passive resistance. The sociocultural context where participating research communities often rely on social networks for information nurtured propagation of these divergent perspectives to inform lay discourse around medical research.We conclude that ongoing engagement, critical self-reflection and attempts to decode deeper meaning of ‘rumours’ throughout research implementation is necessary, to show respect and address community concerns expressed through ‘rumours’, enhance informed participation and adoption of future health interventions.
TB morbidity estimates overlook the contribution of post-TB disability: evidence from urban Malawi
Authors: Tomeny Ewan M , Nightingale Rebecca , Chinoko Beatrice , Nikolaidis Georgios F , Madan Jason J , Worrall Eve , Ngwira Lucky Gift , Banda Ndaziona Peter , Lönnroth Knut , Evans Denise , Chakaya Jeremiah , Rylance Jamie , Mortimer Kevin , Squire S. Bertel , Meghji Jamilah 
Published: May 2022

IntroductionDespite growing evidence of the long-term impact of tuberculosis (TB) on quality of life, Global Burden of Disease (GBD) estimates of TB-related disability-adjusted life years (DALYs) do not include post-TB morbidity, and evaluations of TB interventions typically assume treated patients return to pre-TB health. Using primary data, we estimate years of life lost due to disability (YLDs), years of life lost due to premature mortality (YLL) and DALYs associated with post-TB cardiorespiratory morbidity in a low-income country.MethodsAdults aged ≥15 years who had successfully completed treatment for drug-sensitive pulmonary TB in Blantyre, Malawi (February 2016–April 2017) were followed-up for 3 years with 6-monthly and 12-monthly study visits. In this secondary analysis, St George’s Respiratory Questionnaire data were used to match patients to GBD cardiorespiratory health states and corresponding disability weights (DWs) at each visit. YLDs were calculated for the study period and estimated for remaining lifespan using Malawian life table life expectancies. YLL were estimated using study mortality data and aspirational life expectancies, and post-TB DALYs derived. Data were disaggregated by HIV status and gender.ResultsAt treatment completion, 222/403 (55.1%) participants met criteria for a cardiorespiratory DW, decreasing to 15.6% after 3 years, at which point two-thirds of the disability burden was experienced by women. Over 90% of projected lifetime-YLD were concentrated within the most severely affected 20% of survivors. Mean DWs in the 3 years post-treatment were 0.041 (HIV-) and 0.025 (HIV+), and beyond 3 years estimated as 0.025 (HIV-) and 0.010 (HIV+), compared with GBD DWs of 0.408 (HIV+) and 0.333 (HIV-) during active disease. Our results imply that the majority of TB-related morbidity occurspost-treatment.ConclusionTB-related DALYs are greatly underestimated by overlooking post-TB disability. The total disability burden of TB is likely undervalued by both GBD estimates and economic evaluations of interventions, particularly those aimed at early diagnosis and prevention.
Changes in marriage, divorce and births during the COVID-19 pandemic in Japan
Authors: Ghaznavi Cyrus , Kawashima Takayuki , Tanoue Yuta , Yoneoka Daisuke , Makiyama Koji , Sakamoto Haruka , Ueda Peter , Eguchi Akifumi , Nomura Shuhei 
Published: May 2022

IntroductionMarriage, divorce and fertility are declining in Japan. There is concern that the COVID-19 pandemic may have accelerated the decrease in marriages and births while increasing the number of divorces. Changes in partnership behaviours and fertility have significant implications for mental health, well-being and population demographics.MethodsJapanese vital statistical data were collected for December 2011–May 2021. We used the Farrington algorithm on the daily numbers of marriages, divorces and births (per month) in order to determine whether any given month between January 2017 and May 2021 had a significant excess or deficit. Analyses were conducted at the national and regional levels.ResultsDuring the pandemic, significant deficits in the national number of marriages were noted in January 2020, April 2020, May 2020, July 2020, September 2020 and April 2021. Regional marriage patterns reflected national trends. Divorces were noted to be in deficit during April 2020, May 2020 and May 2021 at the country level. Regional analyses mirrored national divorce trends with the exception of Shikoku, which showed no deficits during the pandemic. Significant deficits in the number of total births were noted in December 2020, January 2021 and February 2021. Regionally, birth deficits were concentrated in Chubu, Kansai and Kanto. After the start of the pandemic, no significant excesses in marriages, divorces or births were noted at the national or regional level.ConclusionsMarriages and divorces declined during the pandemic in Japan, especially during state of emergency declarations. There were decreased births between December 2020 and February 2021, approximately 8–10 months after the first state of emergency, suggesting that couples altered their pregnancy intention in response to the pandemic. Metropolitan regions were more affected by the pandemic than their less metropolitan counterparts.
Systematic review of low-income and middle-income country perceptions of visiting surgical teams from high-income countries
Authors: Velin Lotta , Lantz Adam , Ameh Emmanuel A. , Roy Nobhojit , Jumbam Desmond T. , Williams Omolara , Elobu Alex , Seyi-Olajide Justina , Hagander Lars 
Published: May 2022

BackgroundThe shortage of surgeons, anaesthesiologists and obstetricians in low-income and middle-income countries (LMICs) is occasionally bridged by foreign surgical teams from high-income countries on short-term visits. To advise on ethical guidelines for such activities, the aim of this study was to present LMIC stakeholders’ perceptions of visiting surgical teams from high-income countries.MethodWe performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in November 2021, using standardised search terms in PubMed/Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO) and Global Index Medicus, and complementary hand searches in African Journals Online and Google Scholar. Included studies were analysed thematically using a meta-ethnographic approach.ResultsOut of 3867 identified studies, 30 articles from 15 countries were included for analysis. Advantages of visiting surgical teams included alleviating clinical care needs, skills improvement, system-level strengthening, academic and career benefits and broader collaboration opportunities. Disadvantages of visiting surgical teams involved poor quality of care and lack of follow-up, insufficient knowledge transfers, dilemmas of ethics and equity, competition, administrative and financial issues and language barriers.ConclusionSurgical short-term visits from high-income countries are insufficiently described from the perspective of stakeholders in LMICs, yet such perspectives are essential for quality of care, ethics and equity, skills and knowledge transfer and sustainable health system strengthening. More in-depth studies, particularly of LMIC perceptions, are required to inform further development of ethical guidelines for global surgery and support ethical and sustainable strengthening of LMIC surgical systems.
Future developments and new technologies in the field of faecal incontinence: scanning the horizon using late-stage clinical trial registrations
Authors: Thomson Katie H , Dangova Kim , Bliss Donna Z , Wallace Sheila , O'Connor Nicole , Richter Holly E , Pearson Fiona 
Published: May 2022

AimThe aim of this study was to examine how new technologies in late-stage clinical trials might address unmet patient, practitioner or caregiver need for faecal incontinence (FI) over the next 5 years.MethodsHorizon scanning techniques were used to provide insights into the current landscape of emerging health technologies. A search was performed across clinical trial registries using the National Institute for Health Research Innovation Observatory’s ScanMedicine database (scanmedicine.com) to identify new, emerging interventions or health technologies (drugs, medical devices or diagnostics) that were addressing or investigating FI. Trials were then screened for relevance to FI in a non-blinded duplicate manner.Results1163 records were identified through searching ScanMedicine, and 136 trials were included in the final data extraction and mapping process. The most frequently investigated FI intervention topics were complementary therapies (n=17, 12.4%); electrical stimulation (n=13, 9.5%); pelvic floor muscle training/biofeedback/sphincter exercises (n=13, 9.5%) and implanted sacral nerve stimulation (n=12, 8.7%). There was little evidence of new pharmaceutical technologies in development. Existing drugs are, however, being repurposed and trialled for the treatment of FI (eg, linaclotide, colesevelam). Such repurposed drugs often have lower development costs, shorter timelines and report lower failure rates compared with new pharmaceutical products.ConclusionOverall, the innovation space as indicated by late-stage clinical trials related to FI, is relatively stagnant. Patients, carers and healthcare professionals are demanding more effective treatment and containment options; however, these are unlikely to come to market in the immediate future.
Core stabilisation exercises reduce chronic low back pain in Air Force fighter pilots: a randomised controlled trial
Authors: Mendes Priscilla Rique Furtado , Gomes S R A , Costa L D O , Liguori A D A L , Bulhões L C C , Brasileiro J S 
Published: May 2022

BackgroundThere is evidence that core stabilisation, strength and endurance training contribute to reduce low back pain in the general population. However, we are not aware of the effect of these exercises on fighter aviation pilots. Therefore, the present study aims to investigate the effects of an exercise protocol on chronic low back pain in Brazilian Air Force fighter pilots. Changes in neck pain, lumbar disability, range of motion, strength and resistance were also investigated.MethodsFourteen participants with chronic low back pain were randomised into two groups: stabilisation exercise group (SEG—n=7), exercise protocol twice a week for 12 weeks) and the regular exercise group (REG—n=7), which performed their own usual exercise routine. The evaluations were carried out before and after the training period. The primary outcome was the intensity of low back pain and the secondary outcomes were cervical pain, functional disability, range of motion, maximum isometric strength and trunk muscle resistance.ResultsThe SEG had a significant reduction in low back pain compared with the REG (difference of 2.3 points, p=0.04) and a lower rate of cervical pain (difference of 2.5 points, p=0.01) at the end of the protocol. Maintenance of trunk muscle strength was also observed in the SEG over the period, while the REG presented a decrease in flexural strength to the right side (difference between groups: −3.7%, p=0.04). There were no differences in the rates of disability, range of motion or resistance to fatigue between groups.ConclusionsThe stabilisation exercise programme focused on the core muscles was successful in decreasing the fighter pilots’ chronic lumbar pain. Pilots are normally active; however, our results indicate that specific trunk training programmes should be offered considering the work needs of these subjects.Clinical trials‘Exercise protocol for pilots with back pain’ (registered: 09 October 2018)—NCT03713814(https://clinicaltrials.gov/ct2/show/NCT03713814).
Nutritional knowledge in British Army recruits during basic training
Authors: Rawcliffe Alex J , Ogden H B , Rushmere J , Morgan A S L , Jacka K , Struszczak L , Chapman S , Roberts A 
Published: May 2022

BackgroundAppropriate nutritional intake is essential to optimise both general health and performance in military recruits. General nutritional knowledge is a significant and modifiable determinant of dietary behaviour; however, the level of nutritional knowledge in British Army recruits undertaking basic training is poorly understood.MethodsThe Nutritional Knowledge Questionnaire for Athletes was completed by 29 male (age: 22.3±3.8 years) and 26 female (age: 22.0±3.0 years) standard-entry recruits at the end of basic training, and 15 male (age: 20.7±3.2 years) infantry recruits both at the start and end of basic training for the British Army. Between-group and within-group differences in total and subcomponent (ie, carbohydrate, protein, fat, vitamins and minerals, general nutrition, fluid intake, and sporting performance) scores were analysed.ResultsStandard-entry male recruits had more correct answers (52%) than standard-entry female recruits (38%) and male infantry recruits (40%) at the end of training. Infantry recruits had similar levels of nutritional knowledge at the start (39% correct) and end (40% correct) of training. Nutritional knowledge related to protein (range: 53%–75% correct answers) and vitamins and minerals (range: 42%–63% correct answers) were the two highest scoring subcomponents within each group.ConclusionBritish Army recruits, in particular standard-entry female and infantry recruits, have poor nutritional knowledge, which did not improve throughout basic training. Better nutritional intervention, especially surrounding carbohydrate and fluid education, is required during British Army basic training to optimise career-long dietary behaviour.
Autonomic dysfunction after moderate-to-severe traumatic brain injury: symptom spectrum and clinical testing outcomes
Authors: Li Lucia M , Vichayanrat Ekawat , del Giovane Martina , Lai Helen Hoi Lun , Iodice Valeria 
Published: May 2022

BackgroundSurvivors of moderate-to-severe traumatic brain injury (msTBI) frequently experience troublesome unexplained somatic symptoms. Autonomic dysfunction may contribute to these symptoms. However, there is no previous study of clinical subjective and objective autonomic dysfunction in msTBI.MethodsWe present results from two groups of patients with msTBI. The first, a case–control comparative study, comprises prospectively recruited msTBI outpatients, in whom we measured burden of autonomic symptoms using the Composite Autonomic Symptom Score (COMPASS31) questionnaire. The second, a descriptive case series, comprises retrospectively identified msTBI outpatients who had formal clinical autonomic function testing at a national referral autonomics unit.ResultsGroup 1 comprises 39 patients with msTBI (10F:20M, median age 40 years, range 19–76), median time from injury 19 months (range 6–299) and 44 controls (22F:22M, median age 45, range 25–71). Patients had significantly higher mean weighted total COMPASS-31 score than controls (p<0.001), and higher gastrointestinal, orthostatic and secretomotor subscores (corrected p<0.05). Total COMPASS31 score inversely correlated with subjective rating of general health (p<0.001, rs=−0.84). Group 2 comprises 18 patients with msTBI (7F:11M, median age 44 years, range 21–64), median time from injury 57.5 months (range 2–416). Clinical autonomic function testing revealed a broad spectrum of autonomic dysfunction in 13/18 patients.ConclusionsThere is clinically relevant autonomic dysfunction after msTBI, even at the chronic stage. We advocate for routine enquiry about potential autonomic symptoms, and demonstrate the utility of formal autonomic testing in providing diagnoses. Larger prospective studies are warranted, which should explore the causes and clinical correlates of post-TBI autonomic dysfunction.
Accuracy of prehospital clinicians’ perceived prognostication of long-term survival in critically ill patients: a nationwide retrospective cohort study on helicopter emergency service patients
Authors: Heino Anssi , Björkman Johannes , Tommila Miretta , Iirola Timo , Jäntti Helena , Nurmi Jouni 
Published: May 2022

ObjectivesPrehospital critical care physicians regularly attend to patients with poor prognosis and may limit the advanced therapies. The aim of this study was to evaluate the accuracy of poor prognosis given by prehospital critical care clinicians.DesignCohort study.SettingWe performed a retrospective cohort study using the national helicopter emergency medical services (HEMS) quality database.ParticipantsPatients classified by the HEMS clinician to have survived until hospital admission solely because of prehospital interventions but evaluated as having no long-term survival by prehospital clinician, were included.Primary and secondary outcomeThe survival of the study patients was examined at 30 days, 1 year and 3 years.ResultsOf 36 715 patients encountered by the HEMS during the study period, 2053 patients were classified as having no long-term survival and included. At 30 days, 713 (35%, 95% CI 33% to 37%) were still alive and 69 were lost to follow-up. Furthermore, at 1 year 524 (26%) and at 3 years 267 (13%) of the patients were still alive. The deceased patients received more often prehospital rapid sequence intubation and vasoactives, compared with patients alive at 30 days. Patients deceased at 30 days were older and had lower initial Glasgow Coma Scores. Otherwise, no clinically relevant difference was found in the prehospital vital parameters between the survivors and non-survivors.ConclusionsThe prognostication of long-term survival for critically ill patients by a prehospital critical care clinician seems to fulfil only moderately. A prognosis based on clinical judgement must be handled with a great degree of caution and decision on limitation of advanced care should be made cautiously.
Recording and evaluating affect and coping during COVID-19 in healthcare workers and outcomes (REACCH-Out): mental health implications for our junior doctor cohort
Authors: Akbar Sarah , McNally Samantha 
Published: May 2022

The announcement of the COVID-19 pandemic in March 2020 had a huge impact on surgical practice in the UK. Many surgical trainees were redeployed to areas within the hospital to provide additional cover during this time. Providing adequate well-being and support to trainees is imperative during such times of hardship.18 plastic surgery junior doctors were redeployed to either intensive care units, emergency departments or medical wards during the period of intervention. A 2–3 weekly quantitative survey was completed by trainees which aimed to explore rates of anxiety, depression and coping during the first peak of the pandemic. A ‘COVID-19 Care Package’ was provided and regular interactions with the parent team was encouraged via the online platform of Zoom to support surgical junior doctors.The average anxiety score for trainees exceeded that regarded as ‘normal’ as predicted by the Hospital Anxiety and Depression Scale. Core surgical-level trainees were found to show higher scores of anxiety and depression throughout the course of project as compared with their senior specialty registrar counterparts. 43.8% of junior doctors reported greater levels of stress since the announcement of the pandemic. 81% of junior doctors stated they would value regular check-ins with work colleagues during difficult times.Providing a strong support system for trainees is vital to ensure doctors are not overwhelmed during potentially volatile times in their careers. The use of psychological monitoring tools to guide the implementation of appropriate levels of support for individuals could aid in enhanced junior doctor well-being and support. Feedback from surveys during this time of study suggests that surgical trainees agree that contact with their parent team and colleagues has a positive impact on their well-being and trainees value regular ‘check-ins’ with their colleagues on a monthly basis.