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Incidence of diabetes mellitus following hospitalisation with influenza: a population-based cohort study in England

Por: Middleton · S. · McKeever · T. M. · Grudzinska · F. S. · Huang · Y. · Bolton · C. E.
Objectives

To establish the incidence of developing diabetes mellitus (DM) post hospitalisation with influenza.

Design

Retrospective cohort study.

Setting

Electronic healthcare records from Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics in England.

Participants

13 710 adults with a first episode of hospitalised influenza as the primary cause for admission between 1 July 2004 and 1 March 2021 based on ICD-10 codes without pre-existing DM were included. A randomly selected group (a) from CPRD records matched for age, sex and General Practitioner (GP) practice and (b) an unmatched group of hospitalised sepsis patients were used as comparator groups.

Outcome measures

Patients were followed from 1 day after discharge till either DM diagnosis, death or end of GP record. HRs for incidence of DM were calculated using adjusted Cox regression models.

Results

Incidence of DM was 12.5 per 1000 person years. Adjusted HRs (aHR) for developing DM after hospitalised influenza compared with matched controls was 1.54 (95% CI 1.39 to 1.70, p

Conclusion

Patients’ post hospitalisation with influenza had a greater incidence of DM when compared with both matched controls and patients following hospitalisation with sepsis.

Clinician factors influencing decision-making in emergency general surgery (EGS): a scoping review protocol

Por: Groundwater · E. · Bisset · C. N. · Bradley · R. · John-Charles · R. · Maeda · Y. · McKee · T. · Moug · S. J.
Introduction

Emergency general surgery (EGS) decisions often occur under time pressure and with reduced patient involvement in comparison to the elective setting. Variation in decision-making in the field of EGS is partly attributable to patient and contextual factors, but clinician factors also likely shape decisions.

This scoping review aims to clarify which clinician factors have been investigated in relation to decision-making in adult EGS, which have been identified as influential, and the methods used to measure them.

Methods and analysis

Any studies reporting on individual clinician factors and decision-making in EGS will be eligible. Studies must be only in adult populations (patients aged 18 and over). This review will consider quantitative, qualitative and mixed-methods study designs.

This scoping review will be conducted in accordance with the methodology developed by the Joanna Briggs Institute and reported in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. This protocol was prospectively registered with the Open Science Framework: https://osf.io/xcqp4. We will search MEDLINE, EMBASE, CINAHL, CDSR and CENTRAL. The search strategy will be adapted for each database, and no time or language restrictions will be applied.

Two independent reviewers will screen studies for eligibility and extract data using a purpose-designed data extraction form, with disagreements resolved by a third reviewer. Extracted data will be synthesised using a narrative approach to map key concepts, describe study characteristics and identify gaps in the literature.

Ethics and dissemination

Ethical approval is not required as this review will use publicly available data. Findings will be disseminated through peer-reviewed publication and conference presentations.

The Nottingham recovery from COVID-19 research platform (NoRCoRP): Functional, clinical and patient-reported outcomes in adults referred to a post-COVID respiratory service

by Malik Hamrouni, Ayushman Gupta, Sophie Middleton, Sabrina Prosper, Theresa Harvey-Dunstan, Joanne Porte, Tricia M. McKeever, Ian P. Hall, Charlotte E. Bolton

Aims

To characterise symptoms, function and patient-reported outcome measures (PROMs), and identify associated factors in adults with persisting respiratory symptoms post-COVID.

Methods

Cross-sectional analysis of 210 non-hospitalised adults referred to a post-COVID respiratory clinic (December 2020-July 2024) who consented to research. Assessments included demographics, symptoms, lung function, chest CT, and several PROMs: MRC dyspnoea score, Nijmegen Questionnaire score (NQ), Hospital Anxiety and Depression Scale, Chalder Fatigue Scale, Short Physical Performance Battery (SPPB) and Fried Frailty Index. Multivariate logistic regression examined key exposure-outcome associations.

Results

Among participants (mean age 49.4 years; 68% female; median 13.3 months since COVID-19 diagnosis), 95% reported shortness of breath, 54% had clinically significant breathlessness (MRC ≥ 3), 68% had an NQ score (>23) consistent with dysregulated breathing, 32% had a low SPPB score ( Conclusion

In non-hospitalised patients with persistent respiratory symptoms post-COVID, dysregulated breathing, deconditioning and psychological distress were key factors linked with symptom burden. These findings suggest a multidisciplinary approach should be considered to optimise recovery.

Immune Profiling in Early Cognitive Disorders (IMPRINT) study protocol: a longitudinal cohort study exploring biomarkers of inflammation in early dementia with Lewy bodies and Alzheimers disease, as part of the Dementias Platform UK

Por: Crook · H. · Swann · P. · Fye · H. · Kigar · S. · Savulich · G. · Mckeever · A. · Herrero · E. · Turner · L. · Aimola · L. · Grey · G. D. · Blackburn · D. · Matthews · P. M. · Su · L. · Chouliaras · L. · Rowe · J. B. · Malhotra · P. · OBrien · J. T.
Introduction

Growing evidence points towards the integral role of both central and peripheral inflammation across all neurodegenerative diseases, including dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD). The immune alterations observed in these diseases may occur long before the onset of clinical and cognitive symptoms; however, the exact timing and role of inflammation in the pathogenesis of neurodegenerative disease remains unclear. Findings to date are conflicting, with most work focused on AD rather than other dementias and most studies from single sites and cross-sectional. Through longitudinally examining detailed phenotypes of the peripheral immune system using mass cytometry, the Immune Profiling in Early Cognitive Disorders study aims to uncover specific immune signatures in early AD and DLB, how these signatures change over time and how they relate to disease progression and cognitive changes.

Methods and analysis

Blood, cerebrospinal fluid, saliva and urine samples will be collected from a cohort of participants with either prodromal (mild cognitive impairment) or early dementia due to Lewy bodies or AD (MCI-LB and DLB; and MCI-AD and AD), alongside healthy controls. Through immunophenotyping with mass cytometry, detailed immune fingerprints will be identified for these groups. We will assess which key combinations of immune cell clusters are predictive of disease phenotype, cognitive decline and progression to dementia. Samples will also be evaluated with novel techniques to measure markers of degenerative pathology and inflammation.

Ethics and dissemination

This study was approved by the Preston North West Research Ethics committee (21/NW/0314) and is registered with the ISRCTN registry (ISRCTN62392656). The study is ongoing (since June 2022). Baseline visits are being undertaken, and follow-up visits have started for some participants. Full data analyses will be completed and submitted for publication upon conclusion of the study.

The clinical application of shared decision-making in emergency surgery: a scoping review protocol

Por: Bisset · C. N. · Keane · C. · McKee · T. · John-Charles · R. · Wells · C. I. · Moug · S. J.
Introduction

Shared decision-making (SDM) between clinicians and patients is considered ‘best practice’. There is limited evidence regarding SDM in surgery, particularly in the emergency setting. Emergency SDM may be particularly challenging due to: time pressures, the patient’s underlying condition and the nature of the patient-surgeon interaction. However, emergency surgery arguably has a greater need for SDM due to the likelihood of disparate outcomes from intervention, which is dependent on the various treatment options available. This is necessary for patients to make informed decisions regarding their treatment of surgical pathology. The primary objective of this scoping review is to understand the extent and type of evidence in relation to SDM in emergency surgery to determine methods for improving SDM.

Methods

Any studies reporting SDM in emergency surgery on adult patients (age >18 years) will be included. EMBASE, Medline, Cochrane, CINAHL and Scopus databases will be searched for articles with no language or date limits. Studies will be screened by two independent reviewers, with consensus met prior to data extraction. Data extracted to include study design, details of study population, tools used to measure SDM, prevalence of SDM and barriers and enablers for SDM.

A systematic narrative synthesis will be performed following JBI (Joanna Briggs Institute) guidance. These will summarise findings of included studies. The findings may inform future research into facilitating implementation of SDM in emergency surgery.

Ethics and dissemination

This study does not require ethical approval. Final findings will be submitted for peer-reviewed publication and presentation at surgical conferences.

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