Conectar
This study aimed to identify intraoperative and perioperative factors influencing 30-day mortality after cardiac surgery and to develop a risk score (POP-score) for its prediction.
Retrospective cohort study with multivariable regression analysis.
A tertiary care cardiac surgery centre in Austria; data from consecutive patients undergoing cardiac surgery between 2010 and 2020 were analysed.
A total of 8072 patients were included. The cohort was randomly divided into a derivation cohort (75%) and a validation cohort (25%).
The primary outcome measure was 30-day mortality. We analysed associations between intraoperative and perioperative variables and 30-day mortality, assessed via multivariable regression analysis.
Several factors were significantly associated with 30-day mortality, including intraoperative RBC transfusion (OR 3.407 (95% CI 2.124–5.464)), postoperative high-sensitive cardiac troponin T cut-off levels (OR 2.856 (95% CI 1.958 to 4.165)), need for dialysis/haemofiltration (OR 2.958 (95% CI 2.013 to 4.348)) and temporary extracorporeal membrane oxygenation support (OR 5.218 (95% CI 3.329 to 8.179)) (p
The validated POP-score provides an improved tool for predicting 30-day mortality after cardiac surgery by incorporating intraoperative and perioperative factors alongside the EuroSCORE II. Although model performance was evaluated using 7-day peak troponin data, the score can be calculated within the first 72 hours postoperatively in most patients, supporting its clinical applicability for early decision-making, resource allocation and patient counselling. Further research is warranted to assess its clinical utility in diverse populations.
Although some research supports the maintenance of positive outcomes from cardiac rehabilitation Phase II (CR II) up to 12 months, the barriers to maintaining physical activity and risk factor management during CR maintenance (CR III) are well known.
To investigate participants' ability to sustain clinical, quality-of-life (QOL), and behavioral outcomes and share their experiences 6 months after CR II completion.
Longitudinal explanatory sequential pre-CR/post-CR study in a community hospital within a large health system. A convenience sample of 155 participants completed a reassessment of health outcomes. Participants also completed an online survey about barriers and facilitators during and after CR II. Analysis methods included MANOVA and summative content analysis.
The sample was mostly male, white, non-Hispanic, and college educated, with a mean age of 67.9 years. CR II participants sustained most behavioral outcomes, but not all clinical outcomes. Outcomes that improved/maintained were physical activity, tobacco status, diet, and QOL. Outcomes that worsened/returned to pre-CR II were weight, blood pressure, and depression. Participants described their motivation for staying healthy, top concerns, goals, barriers, and strengths/resources. Common responses included exercise, weight, diet, quality of life, family, and friends.
Our findings suggest the need for the implementation of innovative strategies during CR II that may extend past discharge into CR III. These include the introduction of digital technology and eHealth to provide value-added service to patients and a solid foundation for future maintenance and a structured, behavioral weight loss intervention. Establishing these tools, in addition to developing a support system will help patients to initiate maintenance care before program completion.
by Azusa Kubota, Kentaro Kojima, Shinnosuke Koketsu, Takayuki Kannon, Takehiro Sato, Kazuyoshi Hosomichi, Yoshiaki Shinohara, Atsushi Tajima
Brain asymmetry is a fundamental feature of neural organization. However, the molecular basis of hippocampal lateralization in response to environmental stimuli remains poorly understood. Here, we examined the transcriptomic profiles of the left and right hippocampal CA1 regions in rats reared under isolated or enriched housing conditions to elucidate hemisphere-specific responses and shared molecular adaptations. RNA-sequencing analysis revealed lateralized differences in the number and identity of differentially expressed genes, accompanied by distinct biological themes, as indicated by overrepresentation and gene set enrichment analysis. The left CA1 region was prominently engaged in pathways related to synaptic organization and mitochondrial function, whereas the right CA1 region exhibited enrichment in transcriptional regulation and RNA metabolic processes. Despite these asymmetries, co-expression and protein–protein interaction network analyses revealed shared molecular architectures. Immediate early genes formed consistent central hubs across both hemispheres, and a common Mecp2–Grin2b–Cdkl5–Tet3 protein interaction cluster was identified as a potential integrative regulatory module. Additional enrichment analysis of differentially expressed genes shared between hemispheres further highlighted conserved responses, particularly in synaptic plasticity and cell–cell communication. Together, these findings demonstrate that the left and right CA1 regions employ distinct yet partially convergent transcriptional programs to adapt to environmental stimuli. This coordinated molecular asymmetry provides novel insights into hippocampal lateralization and its role in experience-dependent brain plasticity.
by Claire A. MacGeorge, Matthew Henry, Hannah A. Ford, Lacy Malloch, Emily Fratesi, Shannon Cabaniss, Jaime Baldner, Melody Greer, Kristin Gaffney, Milan Bimali, Preetha Abraham, Linda Y. Fu, P. Songthip Ounpraseuth, Christine B. Turley
BackgroundAttention-deficit/hyperactivity Disorder (ADHD) is the most common neurobehavioral condition of childhood and can be controlled with stimulant medication. Evidence-based guidelines endorse use of standardized ADHD symptom reports to facilitate medication titration to therapeutic dosage. Children living in under-resourced areas experience barriers to receiving this recommended evidence-based care. The Remote ADHD Monitoring Program (RAMP) uses a text-based platform to relay symptom reports from caregivers and teachers to healthcare providers. This pilot study is a feasibility study examining intervention uptake. It compares the submission of structured symptom reports in those children enrolled in RAMP compared to usual care as well as utilization of the RAMP platform by providers.
MethodsThis paper describes the protocol to evaluate the feasibility of deploying RAMP in practices serving rural or underserved children. We will recruit 36 dyads from 4 practices in 2 separate states. Each dyad will include a caregiver and their child aged 5–11 years with a diagnosis of ADHD who is starting or reinitiating stimulants. Dyads will be randomized 1:1 to receive the RAMP intervention or usual care with attention controls. Our primary outcome is number of symptom reports (paper assessments in control arm and RAMP reports in intervention arm) per participant that are completed by caregivers and teachers and returned to providers. Our secondary outcome is proportion of submitted RAMP reports that are reviewed by providers.
DiscussionAs telehealth use increases, it is critical that we improve access to high quality care for children with chronic conditions. Leveraging technology may be a meaningful approach to improve efficiency in optimizing medication management. This pilot study tests a text-based platform designed to improve communication between the caregivers and teachers of children with ADHD and health care providers. If successful, a future trial will examine the effectiveness of the RAMP intervention on improvement in symptoms.
Trial registrationClinicalTrials.gov NCT06743425.
To map the extent of the use of the term ‘planetary health’ in peer-reviewed nursing literature.
Scoping Review.
CINAHL, ProQuest Nursing & Allied Health Premium, MEDLINE, APA PsycINFO, ProQuest Dissertations & Theses and Web of Science were searched in January and February 2024 for English and French-language publications. A follow-up search was conducted on 10 June 2024 to determine if additional literature was published.
A scoping review was conducted using the Arksey and O'Malley methodology for scoping reviews. To be included the article had to explicitly use the term ‘planetary health’ and ‘nursing’ or ‘nurses’.
Sixty-eight articles met the criteria for the scoping review and were included in this review, with the majority published between 2017 and 2024. Predominant literature included discussion papers, commentaries and editorials. A lack of original research is apparent. Most of the publications were calls to action for nurses to advance planetary health in nursing education, practice, research and advocacy work.
Literature confirms that planetary health is a recent and an important topic in nursing, and nurses have a well-documented role to play in planetary health, given the numerous calls to action in nursing leadership, education, practice and research. There is a need to publish the essential work nurses are doing in planetary health in various nursing domains.
This scoping review revealed a clear and urgent call to action for nurses to address planetary health. Given this finding, nurses have a responsibility to advocate for a planetary health approach in the profession and take action to contribute to planetary health through education, research, practice and advocacy.
Not applicable, as no patients or public were involved.
This study aimed to examine the psychosocial impact and identify risk factors for poor psychosocial outcomes in healthcare professionals during the Coronavirus disease 2019 (COVID-19) pandemic in Cyprus.
Healthcare professionals are in the forefront of the COVID-19 pandemic facing an unprecedented global health crisis, which can have consequences on their psychosocial health. There is a need to identify risk factors for poor psychosocial outcomes to inform the design of tailored psychological interventions.
Cross-sectional online study.
A total of 1071 healthcare professionals completed self-report questionnaires. Measures included sociodemographic information, COVID-19-related characteristics, quality of life (Brief World Health Organization Quality of Life; WHOQOL-Bref), anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire-8; PHQ-8), occupational burnout (Copenhagen Burnout Inventory; CBI), and coping (Brief Coping Orientation to Problems Experienced; Brief COPE). This article follows the STROBE reporting guidelines.
The prevalence of moderate to severe anxiety and clinically significant depression was 27.6% and 26.8%, respectively. Significant risk factors for poor psychological outcomes included being female, being a nurse or doctor (vs non-medical professional), working in frontline units (inpatient, intensive care), perceptions of inadequate workplace preparation to deal with the pandemic, and using avoidance coping. Depression and occupational burnout were significant risk factors for poor quality of life.
The findings suggest several individual, psychosocial, and organisational risk factors for the adverse psychological outcomes observed in healthcare professionals during the COVID-19 pandemic.
This study highlights the urgent need for screening for anxiety and depression and psychological interventions to combat an imminent mental health crisis in healthcare professionals during the COVID-19 pandemic. Pandemic response protocols and public health initiatives aiming to improve and prevent mental health problems in healthcare professionals during the current and future health crises, need to account for the various factors at play.
This study aims to determine the incidence and impact of ocular injuries among the different combat sports disciplines of boxing, mixed martial arts (MMA), kickboxing and Muay Thai in Texas, USA.
A case–control study was conducted to analyse retrospective postmatch physical reports from combat sports matches that took place in the state of Texas from January 2019 to January 2022. Ocular injuries and other match characteristics such as sport type and match outcome were identified by postmatch physical reports. Postmatch physical reports were collected from the Texas Department of Licensing and Regulation database. Statistical analysis was used to stratify injuries and compare the impact of injuries on match outcome.
Combat sports fighters in Texas, USA.
3070 participants were included in the study. Participants were fighters who participated in combat sports matches in Texas, USA, between January 2019 and January 2022.
The original plan was to measure the incidence of ocular injuries across different combat sports including boxing, MMA, kickboxing and Muay Thai. However, due to a limited sample size of kickboxing and Muay Thai matches, the ocular injury incidence was only measured for boxing and MMA. The association between ocular injury and match outcome was assessed using 2 statistical analysis.
The respective incidence rates of ocular injuries in boxing and MMA were 9.7 and 12.2 injuries per 100 matches. The association between ocular injury and match outcome (win, lose or draw) was statistically significant in boxing but not statistically significant in MMA matches.
Our findings revealed that ocular injuries are significantly associated to losing a boxing match (p=0.011), but not associated to match outcome in MMA (p=0.232). Additionally, MMA matches report a larger variety of ocular injuries compared with boxing matches.
The aim of this systematic review was to assess and synthesize the global evidence on existing general dementia training and education for the social care workforce.
Mixed-methods systematic review.
Systematic searches on five databases (PubMed, APA PsychINFO, CINAHL Plus, Scopus, Web of Science) were conducted for articles published between 2010 and July 2024.
Each abstract and full text was screened by two research team members, with conflicts of inclusion dissolved by a third team member. Data were extracted and studies narratively synthesized by the group into comparisons of content, delivery mode, workforce and outcomes/impact.
Twenty-seven studies from 13 mainly high-income countries were included in this review. Most studies provided training to care home staff, with studies using remote, in-person and blended training delivery modes. While the focus was on generic dementia education, various interventions have been evidenced in the social care workforce, to different effects. Most changes in outcomes were reported for staff knowledge and confidence, while evidence on impacts on people with dementia is limited and mixed.
There are various types of in-person and remote dementia training available for the social care workforce, with overall positive impacts on knowledge and change in care delivery. Evidenced interventions need to be implemented across countries and have the potential to improve dementia knowledge, particularly in lower- and middle-income countries where evidence and the social care workforce are limited.
Findings provide clear recommendations on the value and benefit of diverse dementia training on the social care workforce, care delivery and limited but emerging evidence on service user outcomes. Nurses are key parts of the staff working in social care settings, including care homes and would thus benefit from the identified dementia training.
Two former unpaid carers and three voluntary sector staff helped interpret the findings and reviewed drafts of the manuscript. They are co-authors.
Wound care remains a high-priority area for improvement in the Canadian health care system. Older adults aged 65 and older are disproportionately affected by chronic and non-healing wounds and often experience multiple co-morbid conditions, challenges which can be further complicated by living in rural and northern areas. A workshop-based multi-methods study was conducted to describe rural and northern perspectives on opportunities and feasibility to implement innovative wound care technologies. Each workshop included pre- and post- workshop surveys, a live demonstration of Swift Skin and Wound, a Q&A session, and facilitated discussion exploring the technology's feasibility, usability, and accessibility in northern and rural care contexts. Participants who volunteered for the study included care staff and healthcare executives (N = 11), described their perspectives on implementing AI-driven digital wound care management solutions with a focus on integration into health care settings. Three themes were identified including: confidence and optimism in improving wound care management, recognition of the superiority of AI-driven digital wound care solutions over current practices, and the importance of adaptable change processes for successful adoption. While generalizability may be limited, findings suggest that adopting AI-driven wound care tools could improve wound assessment accuracy and streamline care for aging populations in rural and northern areas.
Hospitalisation is one of the most stressful life events for older adults, particularly for those who are pre-frail or frail. Multi-component community-based interventions have the potential to address the complex needs of older adults post-acute care admission. While some available interventions have been developed with end-user engagement, fully involving older people who are pre-frail or frail in the design of interventions has been less common. Multi-component community-based interventions that address the needs of older adults and their care partners with potential implementation barriers informed by healthcare providers, community partners and health system decision makers are needed. This protocol paper describes the planned process of co-designing for older patients discharged into the community, a Post-Acute Care Intervention for Frailty using Information and Communication technology.
The development of a complex multi-component frailty intervention which meets older people’s needs involves several concurrent tasks and methodologies, each informed by co-design and conducted with consideration to eventual implementation. These tasks include: (1) establishing a Research Advisory Board, (2) assessing the feasibility and validity of using hospital administrative data to identify frail or pre-frail older adults and their needs, (3) conducting a needs assessment of patients returning to the community, (4) mapping community assets to identify existing programmes and services to help tailor the intervention, (5) co-designing a multicomponent frailty intervention, (6) selecting study outcome measures and (7) selecting and tailoring a digital health patient portal to support intervention delivery, data capture and communication.
Each task requiring ethics approval will be submitted to the Hamilton Integrated Research Ethics Board at McMaster University. Results will be disseminated through peer-reviewed journal articles, conferences and networks of relevant knowledge users who have the capacity to promote dissemination of the results. A toolkit will be developed to help researchers and healthcare providers replicate the methodology for other populations.
Presenteeism, defined as reduced work efficiency due to health issues despite attending work, accounts for a substantial proportion of labour productivity loss. Although pain significantly impacts presenteeism, the relationship between pain and presenteeism remains poorly understood due to the multifaceted nature of pain, encompassing psychosocial factors and daily functioning. This study aimed to identify which of these factors are significantly associated with presenteeism among employees.
Cross-sectional study using self-administered questionnaires and generalised additive model analysis.
Multiple workplaces (including a university and hospitals) in Japan.
Employed individuals (n=212, age range: 20–65 years; 59 males and 153 females) participated. They were recruited through workplace bulletin boards, email announcements and direct invitations. Participants with and without chronic pain were included.
Participants completed self-report measures, including the Health and Work Performance Questionnaire (HPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Pain Catastrophising Scale (PCS), Beck Depression Inventory-second edition (BDI-II), State-Trait Anxiety Inventory (STAI) and WHO Disability Assessment Schedule 2.0 (WHODAS 2.0).
The results indicated that absolute HPQ was significantly associated with BDI-II scores (F=4.51, p=0.035). On the other hand, relative HPQ was influenced by SF-MPQ (F=3.76, p=0.005), PCS (F=4.16, p=0.014), STAI (F=5.62, p=0.019) and limited daily activities (F=13.25, p=0.00035).
These findings suggest that presenteeism is multifactorial, with pain, psychosocial factors and daily functioning playing critical roles. Moreover, the impact of depression on presenteeism differs from that of pain and anxiety. Therefore, tailored intervention approaches may be required for each factor, ultimately improving workplace productivity.
This study was preregistered at UMIN-CTR (UMIN000054797).
Poor chest health is the leading cause of early mortality in children with cerebral palsy (CP). It is also the most common reason to seek healthcare, accruing significant costs and reducing quality-of-life for children and families. Clinical trials examining chest health interventions in CP are characterised by inconsistent outcome measures, limiting the capacity for evidence synthesis to inform clinical application. The study aims to develop a core outcome set (COS) and related measurement instruments to assess, monitor and evaluate chest health in children with CP, both in research and routine clinical practice. The COS will reflect the views of children, young people, parent/carers, clinicians and researchers, emphasising under-represented groups in research and those at risk of poorer chest health.
A 3-phase methodology will be conducted in line with the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. (1) Candidate outcomes will be identified through a qualitative evidence synthesis and interviews with key stakeholders. Findings will be mapped to COMET-taxonomy, generating a list of candidate outcomes. (2) An international e-Delphi survey will invite stakeholders to rate the importance of each outcome, followed by a consensus meeting to ratify the COS. (3) A structured review, guided by health measurement taxonomy, will evaluate relevant instruments, with a final meeting to agree on recommended measures for each COS domain.
Ethical approval was provided by the University of Plymouth Research Ethics Committee for the qualitative interview study (ID5116), e-Delphi study and consensus meeting (ID5636). Study findings will be published open access in a peer-reviewed journal and presented at relevant national and international conferences.
COMET registration: 2590 (https://www.comet-initiative.org/Studies/Details/2590)
CRD42024562735.
Aboriginal people in the Kimberley are concerned that scientific research, government Inquiries and Royal Commissions are not adequately informing policy and service design. In this protocol paper, we outline our proposed scoping review to identify and provide a broad overview of scientific literature regarding the health, well-being, mental health, disability, education and social outcomes of children and adolescents living in the Kimberley region of Western Australia and the recommendations that came from them.
This scoping review is guided by Arksey and O’Malley’s (2005) methodological framework. We will conduct a comprehensive search across multiple databases using several search engines. Inclusion criteria were established to inform the selection of papers to be included in the review. After de-duplication, all titles and abstracts will be reviewed, followed by full-text screening. A second reviewer will independently screen 20% of the titles, abstracts and full texts. Two reviewers will discuss discrepancies, and a third reviewer will resolve any disagreements that may arise. We will use a data extraction template in Covidence to systematically extract relevant data.
This scoping review does not require ethics approval, as we are investigating the breadth of existing literature regarding the outcomes of children and adolescents in the Kimberley, Western Australia. The scoping review results will be published in peer-reviewed journal(s) and shared with relevant policymakers to help inform future policies and service improvements and designs in the region.
Food intolerances are prevalent in Europe and can cause considerable physical discomfort, dietary restrictions and psychosocial challenges. Among the prominent causes of food intolerance are defects in the digestion and/or transport of short-chain fermentable carbohydrates, fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). A common diagnostic tool for food intolerance is the hydrogen breath test, which monitors the production of H2 gas from the fermentation of ingested FODMAPs by colonic microbiota. However, this method is limited due to its relatively poor correlation with gastrointestinal (GI) symptoms experienced by patients. Diagnosis is complicated as food intolerance is often associated with functional GI disorders, while FODMAPs may exert their effects individually or in combination. Further research on the pathophysiology and the impact of intervention strategies for these conditions is required to improve the diagnosis of food intolerance.
The Lactobreath pilot study is a randomised, two-arm, double-blinded controlled study. 120 healthy, free-living adults will undergo 6-hour postprandial tests with lactose or glucose (control) to investigate the molecular composition of human exhaled breath (exhalome) as a potential source of biomarkers associated with clinical and metabolic traits of lactose malabsorption (Lactobreath profiles). This serves as a proof-of-concept for the future application of this technology in diagnosing food intolerance. We will use a sensitive, non-invasive, real-time measurement technique based on secondary electrospray ionisation coupled with high-resolution mass spectrometry to analyse the chemical profile of the postprandial exhalome after lactose ingestion. Symptoms of lactose intolerance will be assessed using a standardised questionnaire and mechanistically linked to specific key metabolites of the discriminating breath profile. In parallel, a solid-state sensor will measure postprandial hydrogen gas in breath samples, while GI gases (CH4, H2, O2) and intestinal transit time will be monitored using a novel ingestible gas sensor (Atmo Gas capsule). Metabolites in urine, including lactose-derived metabolites, will be investigated using gas chromatography coupled with mass spectrometry. Postprandial bowel sounds will be recorded by wearable sensors (DigeHealth AG). Baseline assessments will be completed before the dietary challenge to capture usual dietary intake (repeated 24-hour recall), faecal microbiota (shallow shotgun sequencing) and to evaluate genetic polymorphisms using saliva samples (PCR analysis of selected penetrant single-nucleotide polymorphisms).
The Lactobreath study has been approved by the Ethics Committee of the Canton of Zurich, Switzerland (#2023-01639). The project results will be published in open-access journals, presented at national and international conferences and communicated to the public and other relevant stakeholders via the communication channels of all investigators and partners. All results derived from the study will be accessible, in line with the Swiss National Science Foundation open access policy.
This study aimed to co-design a model of brilliant care for older people that provides clear, actionable principles to guide how brilliant care for older people can be realised.
As the demand for and international importance of care for older people grows, so too does the negative discourse about care for older people. This ongoing focus on deficiencies can have implications for patients, carers, clinicians, health services, and policymakers, overshadowing opportunities for innovation and positive change.
Experience-based co-design informed this study, grounded in the lived experiences of key stakeholders.
Three scaffolded co-design workshops were facilitated, involving lived experience experts, managers, professionals, clinicians, and an academic (n= 13). The data collected during these workshops were analysed using a qualitative descriptive method and documented according to COREQ guidelines to optimise rigour and transparency.
The participants co-designed a model of brilliant care for older people, comprising principles to promote connection and innovation. To promote connection, the model includes protecting staff member time to deliver meaningful care and demonstrating that everyone matters. To promote innovation, it encourages role flexibility, curiosity, small improvements, and the recognition of brilliant practices.
This article presents a co-designed model of brilliant care for older people, incorporating principles of connection and innovation that can be enacted through simple, resource-efficient practices.
For those who manage and deliver care for older people, the model encompasses simple, accessible, and cost-effective principles to: positively deviate from norms within the sector, offering care to older people; and to deliver brilliant care for older people. Furthermore, given that the model was co-designed with lived experience experts, managers, professionals, and clinicians, its principles are imbued with their experiential insights, which served to bring particular priorities to the fore.
The co-designers, who included lived experience experts, were invited to participate in workshops to co-design a model of brilliant care for older people, during which they discussed and critiqued the findings constructed from the data and co-designed the model.
Cardiovascular (CV) disease is the leading cause of morbidity and mortality globally. Low-density lipoprotein cholesterol (LDL-C) is an important modifiable risk factor of major adverse cardiovascular events. Patients without prior myocardial infarction (MI) or stroke but with established risk factors and elevated LDL-C may benefit from intensive lipid-lowering therapy (LLT); however, the size and potential healthcare burden of this population globally are not known. The benefits of evolocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, in these patients, are currently being studied in the phase 3 Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarction or Stroke (VESALIUS-CV) trial. To characterise the high-risk pre–CV-event (VESALIUS-CV–like) individuals in the real world, an observational study is being conducted across multiple countries.
This retrospective cohort study will use a common protocol and an analytical common data model approach to characterise VESALIUS-CV–like individuals in the real world across different geographical regions and healthcare settings. The study period will be from 2010 to 2022, subject to data availability in study sites. Patients aged 50 years and older at high risk of CV disease but without prior MI or stroke will be included in this study. VESALIUS-CV–like individuals are defined through a combination of the following: (1) one diagnosis of coronary artery disease, cerebrovascular disease, peripheral artery disease or diabetes with microvascular complications or chronic insulin use; (2) an elevated LDL-C measurement and (3) other high-risk factors. The objectives of this study are to estimate the prevalence of VESALIUS-CV–like individuals, describe their characteristics and care pathways and estimate their incidence rates of CV events and healthcare costs. The prevalence of VESALIUS-CV–like individuals will be expressed as annual prevalence; patient characteristics at index date will be presented using summary statistics; care pathways will be summarised as LLT prescription across time; and the incidence of defined CV events will be expressed as events per person-years as well as at certain time periods. Healthcare costs will be presented as CV-related costs in different time periods.
Approvals of the study protocol were obtained from relevant local ethics and regulatory frameworks for each participating database. The results of the study will be submitted to peer-reviewed scientific publications and presented at scientific conferences.
To evaluate whether remdesivir is associated with cardiac adverse events (CAEs), addressing concerns raised by basic experiments, clinical case reports and observational studies.
Systematic review and meta-analysis.
MEDLINE and Embase, searched from January 2020 to December 2023.
Randomised controlled trials (RCTs) comparing remdesivir with placebo or standard care in patients with COVID-19, with a primary focus on cardiac safety.
We included RCTs that evaluated the safety of remdesivir in patients with COVID-19 . Eligible studies were those that compared remdesivir with placebo or standard care in adult patientsCOVID-19 . Inclusion criteria emphasised safety outcomes, particularly CAEs, as primary endpoints.
Two reviewers independently extracted data. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Harms guidelines. Risk of bias (RoB) was assessed using the Cochrane Collaboration tool. A random-effects model was used for data synthesis. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to assess the certainty of evidence. The primary outcome was the incidence of any CAEs, defined as a composite of all reported cardiac-related harms. Secondary outcomes included specific CAEs such as arrhythmias, heart failure and myocardial disorders.
We identified 1698 studies, of which seven RCTs met the inclusion criteria, comprising a total of 4566 participants. The RoB was assessed across multiple domains, with four RCTs showing low risk and three showing moderate risk in specific areas. Pooled analysis revealed no significant association between remdesivir use and CAEs (RR=0.84, 95% CI: 0.68 to 1.04, p=0.118). Subgroup analyses showed consistent findings across different patient demographics and comorbidities. GRADE assessment indicated moderate certainty for overall CAEs, low certainty for arrhythmias and heart failure (due to imprecision and study-level bias), and very low certainty for myocardial disorders (due to small sample size and indirectness).
Contrary to preliminary concerns and case reports, our meta-analysis found no evidence of a statistically significant association between remdesivir and CAEs among patients with COVID-19 . These findings provide reassurance to clinicians regarding the safety profile of remdesivir in this patient population, supporting its use as an antiviral therapy in the treatment of COVID-19. Further research is warranted to validate these findings and to clarify whether remdesivir may have a neutral or potentially protective effect on cardiac outcomes.
CRD42022383647.
To determine patient and nursing factors associated with peripheral intravenous access success among hospitalised adults on medical-surgical units.
A prospective, cross-sectional, correlational design was guided by STROBE.
Within a quaternary care hospital with multiple medical-surgical units, nurses who attempted intravenous access completed case report forms and medical records were reviewed to record 38 factors associated with intravenous access success. After identifying factors associated with first attempt and overall intravenous access success in univariate analyses, prediction models were fit and calibration (based on plots) and discrimination (using the C-statistic) were evaluated using bootstrap sampling.
Of 394 adults, 244 (61.9%) had first attempt and 323 (82.0%) had overall intravenous access success. Ultrasound was used in 227 (57.6%) intravenous access attempts and use was associated with less vein visibility and palpability and higher nurse perception of difficult intravenous access. In multivariable modelling, four factors were associated with first attempt intravenous access success: using a wrist vein, higher nurse expertise in intravenous access, nurse use of an ultrasound in patients with high-risk vein characteristics, and higher nurse confidence in first attempt success; model goodness of fit was good. Seven factors were associated with overall intravenous access success: shorter patient hospital length of stay, no history of diabetes, higher patient anxiety level, nurse use of an ultrasound in patients with high-risk vein characteristics, higher nurse expertise in intravenous access, higher nurse confidence in first attempt success, and nurse prediction of difficult intravenous access was low; model goodness of fit was strong.
Patients' vein characteristics and nurses' confidence in first attempt intravenous access success were predominant characteristics of intravenous access success.
Factors of importance in achieving intravenous access can be easily assessed prior to first attempt and may enhance first attempt and overall success.
Authors adhered to relevant EQUATOR guidelines and used the following reporting method: STROBE (The Strengthening the Reporting of Observational Studies).
To examine immigrant and minority parents' experiences of having a newborn infant in the neonatal intensive care unit and explore healthcare professionals' experiences in delivering care to immigrant and minority families.
A meta-ethnographic review informed by eMERGe guidelines.
We conducted a systematic literature review. Studies were included if they explored immigrant or minority parent experiences in neonatal intensive care units and health professional experiences delivering care to immigrant and minority families in neonatal intensive care. Reporting followed ENTREQ guidelines.
Database searches included CINAHL, MEDLINE, PubMed, PsycINFO, Scopus and Google Scholar. Boolean search strategies were used to identify qualitative studies. No limitations on commencement date; the end date was 23rd August 2022. PRISMA guidelines used for screening and article quality assessed using Joanna Briggs Institute criteria for qualitative studies.
Initial search yielded 2468 articles, and nine articles met criteria for inclusion. Three overarching themes were identified: (1) Overwhelming Emotions, (subthemes: Overwhelming Inadequacy; Cultural Expressions of Guilt; Not Belonging), (2) Circles of Support, (subthemes: Individual Level-Spirituality; External Level-Connecting with Family; Structured Peer-to-Peer Support), (3) Negotiating Relationships with Healthcare Professionals (subthemes: Connecting; Disconnected; Linguistic Barriers). Interactions between healthcare professionals and immigrant and minority parents were the strongest recurring theme.
There can be a mismatch between immigrant and minority families' needs and the service support provided, indicating improvements in neonatal intensive care are needed. Despite challenges, parents bring cultural and family strengths that support them through this time, and many neonatal intensive care staff provide culturally respectful care.
Professionals should be encouraged to identify and work with family strengths to ensure parents feel supported in the neonatal intensive care unit. Findings can inform policy and practice development to strengthen health professionals capabilities to support immigrant and minority families in neonatal units.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists were used to report the screening process.
To identify the reasons and/or risk factors for hospital admission and/or emergency department attendance for older (≥60 years) residents of long-term care facilities.
Older adults' use of acute services is associated with significant financial and social costs. A global understanding of the reasons for the use of acute services may allow for early identification and intervention, avoid clinical deterioration, reduce the demand for health services and improve quality of life.
Systematic review registered in PROSPERO (CRD42022326964) and reported following PRISMA guidelines.
The search strategy was developed in consultation with an academic librarian. The strategy used MeSH terms and relevant keywords. Articles published since 2017 in English were eligible for inclusion. CINAHL, MEDLINE, Scopus and Web of Science Core Collection were searched (11/08/22). Title, abstract, and full texts were screened against the inclusion/exclusion criteria; data extraction was performed two blinded reviewers. Quality of evidence was assessed using the NewCastle Ottawa Scale (NOS).
Thirty-nine articles were eligible and included in this review; included research was assessed as high-quality with a low risk of bias. Hospital admission was reported as most likely to occur during the first year of residence in long-term care. Respiratory and cardiovascular diagnoses were frequently associated with acute services use. Frailty, hypotensive medications, falls and inadequate nutrition were associated with unplanned service use.
Modifiable risks have been identified that may act as a trigger for assessment and be amenable to early intervention. Coordinated intervention may have significant individual, social and economic benefits.
This review has identified several modifiable reasons for acute service use by older adults. Early and coordinated intervention may reduce the risk of hospital admission and/or emergency department.
This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.
No patient or public contribution.
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