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Are we getting better over time? Clinical and patient-reported outcomes for reverse shoulder arthroplasty: a National Joint Registry cohort study

Por: OMalley · O. · Davies · A. · Taghavi Azar Sharabiani · M. · Rangan · A. · Sabharwal · S. · Reilly · P.
Objectives

This study aims to review whether both clinical and Patient Reported Outcome Measures (PROMs) of Reverse Shoulder Arthroplasty have improved over time using the National Joint Registry (NJR).

Design

This study is a population-based cohort study using the NJR and Hospital Episode Statistics for England.

Setting

Publicly funded hospitals and procedures in England from 1 January 2013 to 31 December 2021.

Participants

All patients that received a reverse shoulder arthroplasty (RSA) in the specified time period. Patients were excluded if they had less than 1 year of follow-up.

Main outcome measures

Primary outcome was revision at one year. Secondary outcomes were non-revision re-operation and mortality at one year, length of stay (LOS) and mean change in Oxford Shoulder Score (OSS) from pre-operatively to 6 months post-operatively.

Results

There were 24 411 RSA cases available for analysis. There was no significant improvement in revision rates over time; however, there was a significant reduction in non-revision re-operations (OR 0.93 (0.86–0.99) p=0.03) and mortality (0.96 (0.92–1.00) p=0.04). LOS over time improved with an average reduction of 0.24 days per year, ranging from a mean of 3.94 days in 2013 to 2.44 days in 2021 (p

Conclusion

Over the 9-year period recorded in the NJR, revision rates were low and remained similar. There has, however, been an improvement in other clinical outcomes such as non-revision reoperation and mortality as well as functional outcomes and reduced LOS, which demonstrates progress in the quality of care provided to shoulder replacement patients and is suggestive of advancements in surgical techniques, perioperative management and rehabilitation strategies.

Comparative outcomes of culprit-only versus complete revascularisation in cardiogenic shock complicating acute myocardial infarction: insights from the Gulf-Cardiogenic Shock registry

Por: Daoulah · A. · Seraj · S. · Elmahrouk · A. · Arafat · A. A. · Panduranga · P. · Almahmeed · W. · Arabi · A. · Alobaikan · S. · Al Shehri · M. · Yousif · N. · Aloui · H. · Qutub · M. · Alharbi · W. · Rajan · R. · Kahin · M. · Al Maashani · S. · Hassan · T. · Al Suwaidi · J. · AlQahtani · A.
Objectives

To compare in-hospital and long-term outcomes between culprit-only percutaneous coronary intervention (PCI) and multivessel PCI in patients with acute myocardial infarction complicated by cardiogenic shock and multivessel coronary artery disease.

Design

Retrospective subgroup analysis of the multicentre Gulf-Cardiogenic Shock registry.

Setting

13 tertiary care centres across six Gulf countries (Saudi Arabia, Qatar, Oman, UAE, Kuwait and Bahrain) between January 2020 and December 2022.

Participants

961 patients with angiographically confirmed multivessel coronary artery disease who underwent PCI were included from the Gulf-Cardiogenic Shock registry. Patients were divided into culprit-only PCI group (n=792, 82.4%) and multivessel PCI group (n=169, 17.6%). Patients with single-vessel disease were excluded.

Interventions

Patients underwent either culprit-only PCI (intervention limited to the culprit artery) or multivessel PCI (immediate intervention to both culprit and non-culprit arteries during the same procedure).

Primary and secondary outcome measures

The primary outcome was in-hospital all-cause mortality. Secondary outcomes included reinfarction, cerebrovascular accident, major and minor bleeding events, target lesion revascularisation, target vessel revascularisation, hospital stay duration and freedom from major adverse cardiac and cerebrovascular events (MACCEs) at 6 and 12 months.

Results

Hospital mortality was comparable between multivessel PCI and culprit-only PCI groups (43.2% vs 46.1%; p=0.493). Freedom from MACCE rates at 6 and 12 months were 62% and 46% for multivessel PCI versus 70% and 49% for culprit-only PCI, respectively (log-rank p=0.711). Subgroup analysis revealed that culprit-only PCI was associated with increased hospital mortality in patients older than 70 years (OR 1.55, 95% CI: 1.01 to 2.39). Multivariable analysis of the interaction between revascularisation strategy and the subgroups revealed that culprit vessel revascularisation was associated with increased mortality in patients with left main disease (OR: 1.99 (95% CI: 1.22 to 3.27), p=0.006) and left anterior descending lesions (OR: 1.54 (95% CI: 1.06 to 2.25), p=0.025).

Conclusions

No statistically significant differences in hospital mortality or long-term MACCE-free survival were observed between culprit-only PCI and multivessel PCI strategies in patients with cardiogenic shock complicating acute myocardial infarction. However, patients older than 70 years may benefit from a multivessel PCI approach. These findings support current guideline recommendations favouring culprit-only PCI due to reduced procedural complexity while highlighting the need for individualised treatment strategies based on patient age and clinical factors. Further prospective randomised studies are needed to validate these age-specific findings and identify optimal patient selection criteria for each revascularisation strategy.

Exploring associations between active school environments and childrens physical activity, mental health and educational performance in Greater London primary schools: the Health and Activity of Pupils in the Primary Years (HAPPY) study protocol

Por: Ram · B. · Gullett · N. · Benkhelfa · A. · Cunningham · M. · Taghavi Azar Sharabiani · M. · van Sluijs · E. · Siddiqui · N. · Hillsdon · M. · Summerbell · C. · Pallan · M. · Saxena · S.
Introduction

School environments that encourage children to be physically active can embed lifelong positive health behaviours and contribute towards reducing health inequalities. The Health and Activity of Pupils in the Primary Years (HAPPY) study aims to: (1) explore the extent to which the WHO criteria for creating active school environments are implemented by primary schools and (2) examine associations between active school environments and children’s physical activity, mental health and educational performance.

Methods and analysis

The HAPPY study is a quasi-experimental study comprising: (1) a survey of state-funded Greater London primary schools to identify implementation of the WHO’s six criteria and (2) a cross-sectional study to examine associations between schools’ active environment score (derived from the school survey) and pupils’ physical activity, mental health and educational performance. For our cross-sectional study, we will recruit up to 1000 year-three children (aged 7–8 years). Our primary outcome is accelerometer (GENEActiv) assessed physical activity, our secondary outcomes are parent-reported child mental health (Strengths and Difficulties Questionnaire) and teacher-reported educational performance (age-related expectations). Using multilevel mixed-effects regression models, we will examine associations between the active environment score and physical activity. Physical activity will be included as a measure of acceleration and also different intensities (light, moderate, vigorous). We will repeat this analysis to examine associations between the active environment score and mental health and educational performance. We will adjust for school characteristics and area-level deprivation and include pupil characteristics (eg, sex, ethnic group) as covariates. Clustering at the school level will be included as a random effect.

Ethics and dissemination

Ethical approval has been obtained from Imperial College Research Ethics Committee (ref: 6800895). Findings will be disseminated through a summary report to all participating schools, peer-reviewed publications, presentations at national and international conferences and National Institute for Health and Care Research policy briefings.

Timing of mechanical ventilation and its association with in-hospital outcomes in patients with cardiogenic shock following ST-elevation myocardial infarction: a multicentre observational study

Por: Arabi · A. · Al Suwaidi · J. · Daoulah · A. · AlQahtani · A. A. · Shahid · Z. · Jamjoom · A. · Elmahrouk · A. · AlShehri · M. · Panduranga · P. · Al Rawahi · A. S. M. · Livingston · G. S. · Mousa · A. A.-d. T. · Aloui · H. · Aldossari · M. · Yousif · N. · Noor · H. · Rajan · R. · Al Mahm
Objective

To evaluate the association between the timing of invasive mechanical ventilation (MV) initiation and clinical outcomes in patients with cardiogenic shock (CS) secondary to ST-elevation myocardial infarction (STEMI).

Design

Retrospective analysis of a multicentre registry.

Setting

Data were obtained from the Gulf-Cardiogenic Shock registry, which includes hospitals across six countries in the Middle East.

Participants

1117 patients diagnosed with STEMI and CS. Of these, 672 (60%) required MV and were included in this analysis.

Primary and secondary outcome measures

The primary outcome was in-hospital mortality. Secondary outcomes included comparisons of baseline characteristics, Society of Coronary Angiogram and Intervention (SCAI) shock stage, and clinical parameters among groups based on time to MV.

Results

Participants were categorised by time from shock diagnosis to MV: early (≤15 min), intermediate (30 min) and late (≥60 min). Median times were 15 min (IQR 10–20), 30 min (IQR 25–35) and 60 min (IQR 45–70), respectively. Baseline characteristics were comparable across groups. Increased delay in MV was associated with a higher mortality risk during the first 60 min post-diagnosis, beyond which the risk plateaued. Delayed MV was an independent predictor of in-hospital mortality (OR 2.14, 95% CI 1.36 to 3.38, p

Conclusions

Early initiation of MV in patients with STEMI complicated by CS was associated with lower in-hospital mortality. These findings highlight the importance of timely respiratory support, warranting further investigation in prospective or randomised controlled studies.

Blood pressure variability and mortality in patients admitted with acute stroke in a tertiary care stroke centre (2016-2019): a retrospective cohort study

Por: Tawengi · M. · Hourani · R. F. · Alyaarabi · T. · Elsabagh · A. A. · Al-Dali · Y. · Ghassan Hommos · R. · Baraka · J. · Tawengi · A. M. · Abdallah · B. M. · Hatem · A. · Sardar · S. · Imam · Y. Z. · Akhtar · N. · Zahid · M. · Doi · S. · Danjuma · M. I.-M. · Elzouki · A.
Objectives

The influence of short-term variations in blood pressure (BP) in acute stroke on clinical outcomes remains uncertain. Our study explores the relationship between BP variability (BPV) from stroke admission up to 72 hours and in-hospital and 1-year mortality.

Design

Retrospective observational cohort study.

Setting

Hamad General Hospital (HGH) a tertiary care stroke centre in Qatar.

Participants

2820 participants were initially included. After the exclusion of ineligible subjects, 2554 patients (82.5% male, median age 53±9 years) were included. 893 (34.96%) were from the Middle East and North Africa, 1302 (50.98%) were from South Asia, 258 (10.10%) from Southeast Asia, 9 (0.35%) were from East Asia and 92 (3.60%) were from other regions. Eligible participants were adult patients above 18 years of age who presented with acute ischaemic or haemorrhagic stroke. Excluded individuals were those younger than 18 years, had incomplete data, had transient ischaemic attack (TIA), had severe hypoglycaemia on admission (

Interventions

We measured the BP every 4 hours over 3 days with a total of 18 readings from stroke admission. We then categorised BPV into five (L1–L5) and four (L1–L4) levels for systolic and diastolic BPs, respectively, and evaluated their association with mortality.

Results

There were increased odds of in-hospital mortality with increased systolic and diastolic variability (L2, OR 2.64, 95% CI 1.44 to 4.84; L3, OR 4.20 95% CI 2.14 to 8.24; L4, OR 10.14, 95% CI 4.93 to 20.85; L5, OR 23.18, 95%CI 10.88 to 49.37), (p=0.002 to

Conclusion

In a retrospective cohort of ethnically diverse acute stroke patient population, BPV was significantly associated with both in-hospital and 1-year mortality. Further prospective research is needed to define BPV and establish interventions and management accordingly.

Characteristics and outcomes of diabetic foot ulcers treated with surgical debridement and standardized wound care

Abstract

Diabetic foot ulcers (DFUs) pose a significant clinical challenge, often leading to amputations and hospitalisation. This study aimed to investigate the characteristics and outcomes of DFUs treated with surgical debridement and standardised wound care. This descriptive cross-sectional study focused on diabetic patients with appropriate vascular conditions, as determined by an Ankle Brachial Index >0.9. Based on their infection status, participants were admitted to Poursina Hospital in Rasht, Iran, and subjected to initial supportive measures, antibiotic therapy and surgical debridement. The study incorporated primary treatment with wet bandages, silver spray and fibrinolysin ointment. Statistical analysis employed SPSS 22 software. Most patients were male (54.7%) and under 60 years old (50.7%). Overweight status was prevalent in 69.3% of diabetic ulcer patients, amongst whom 48% underwent wrist debridement. The 64% and 36% of the cases had grade III and grade II Texas index. Moreover, 96% of patients exhibited signs of infection and were classified as Stage Texas B. Reoperation was necessary for 34.7% of patients. The mean hospital stay was 8.5 ± 7.55 days, and the average recovery time was 15.2 ± 15.19 days. Out of 75 patients, 10 were unable to return to limb function due to disability. In this study, around one-third of patients required secondary repair with grafts and flaps. A small number of them were unable to recover because of underlying disability, and the mean recovery time in other cases was 24 days. Future studies should follow up with patients for longer periods to assess long-term therapeutic outcomes and quality of life.

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