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AnteayerBMJ Open

Coping in the role as next of kin of a person with a brain tumour: a qualitative metasynthesis

Por: Lien · A. W. · Rohde · G.
Objective

Being the next of kin of a person with a brain tumour is a stressful experience. For many, being a next of kin involves fear, insecurity and overwhelming responsibility. The purpose of this study was to identify and synthesise qualitative original studies that explore coping in the role as next of kin of a person with a brain tumour.

Methods

A qualitative metasynthesis guided by Sandelowski and Barroso’s guidelines was used. The databases Medline, CHINAL and PsycINFO were searched for studies from January 2000 to 18 January 2022. Inclusion criteria were qualitative original studies that aimed to explore coping experience by the next of kin of a person with brain tumour. The next of kin had to be 18 years of age or older.

Results

Of a total of 1476 screened records data from 20 studies, including 342 participants (207 females, 81 males and 54 unclassified) were analysed into metasummaries and a metasynthesis. The metasynthesis revealed that the next of kin coping experiences were characterised by two main themes: (1) coping factors within the next of kin and as a support system, such as their personal characteristics, perceiving the role as meaningful, having a support system, and hope and religion; (2) coping strategies—control and proactivity, including regaining control, being proactive and acceptance.

Conclusion

Next of kin of patients with brain tumours used coping factors and coping strategies gathered within themselves and in their surroundings to handle the situation and their role. It is important that healthcare professionals suggest and facilitate these coping factors and strategies because this may reduce stress and make the role of next of kin more manageable.

Patients self-reported medical care for low back pain: a nationwide population-based study

Por: Gomes · L. A. · Cruz · E. B. · Henriques · A. R. · Branco · J. C. · Canhao · H. · Rodrigues · A. M.
Objectives

To estimate the prevalence of medical care-seeking among adults with low back pain (LBP) and to characterise and compare use of diagnostic procedures and medical management between primary and secondary care.

Design

Cross-sectional study.

Setting

Data from the EpiReumaPt, a nationwide population-based study conducted in Portugal including a representative sample of non-institutionalised adults (n=10 661) stratified by administrative territorial units was analysed.

Participants

Individuals who self-reported history of LBP within the previous 12 months (n=6434) and sought medical care for this problem in the same period (n=2618).

Outcome measures

Patients’ self-reported diagnostic workup and management procedures performed by medical care for LBP collected through a structured questionnaire. Medical care procedures were stratified by level of care.

Results

The prevalence of medical care-seeking for LBP was 38.0% (95% CI 35.9% to 40.1%). Primary care in isolation (45.3%) was the most sought level of care. Emergency departments (25.9%) and orthopaedics (19.4%) were the most sought secondary medical specialties. Several pathoanatomical diagnoses were used, supported by laboratory or imaging tests (91.1%). Disc herniation (20.4%) and osteoarthritis (19.7%) were the most frequent diagnoses, and X-ray (63.7%) was the most frequent diagnostic procedure self-reported by individuals. Most (75.1%) reported being treated for LBP: 80.4% with oral medication and 49.9% with injectables. The mean duration of pharmacological treatment was 104.24 (SD, 266.80) days. The use of pathoanatomical diagnoses, laboratory or imaging tests, and pharmacological treatments were generally more frequent for secondary care (p

Conclusions

Medical care for LBP is frequent and associated with high levels of pathoanatomical diagnoses, imaging and laboratory tests and pharmacological therapy in both primary and secondary care settings. Funding and delivery actions should be prioritised to assure appropriate care for LBP.

Towards definitions of critical illness and critical care using concept analysis

Por: Kayambankadzanja · R. K. · Schell · C. O. · Gerdin Wärnberg · M. · Tamras · T. · Mollazadegan · H. · Holmberg · M. · Alvesson · H. M. · Baker · T.
Objective

As ‘critical illness’ and ‘critical care’ lack consensus definitions, this study aimed to explore how the concepts’ are used, describe their defining attributes, and propose potential definitions.

Design and methods

We used the Walker and Avant approach to concept analysis. The uses and definitions of the concepts were identified through a scoping review of the literature and an online survey of 114 global clinical experts. We used the Arksey and O’Malley framework for scoping reviews and searched in PubMed and Web of Science with a strategy including terms around critical illness/care and definitions/etymologies limited to publications in English between 1 January 2008 and 1 January 2020. The experts were selected through purposive sampling and snowballing, with 36.8% in Africa, 25.4% in Europe, 22.8% in North America, 10.5% in Asia, 2.6% in South America and 1.8% in Australia. They worked with anaesthesia or intensive care 59.1%, emergency care 15.8%, medicine 9.5%, paediatrics 5.5%, surgery 4.7%, obstetrics and gynaecology 1.6% and other specialties 3.9%. Through content analysis of the data, we extracted codes, categories and themes to determine the concepts’ defining attributes and we proposed potential definitions. To assist understanding, we developed model, related and contrary cases concerning the concepts, we identified antecedents and consequences to the concepts, and defined empirical referents.

Results

Nine and 13 articles were included in the scoping reviews of critical illness and critical care, respectively. A total of 48 codes, 14 categories and 4 themes were identified in the uses and definitions of critical illness and 60 codes, 13 categories and 5 themes for critical care. The defining attributes of critical illness were a high risk of imminent death; vital organ dysfunction; requirement for care to avoid death; and potential reversibility. The defining attributes of critical care were the identification, monitoring and treatment of critical illness; vital organ support; initial and sustained care; any care of critical illness; and specialised human and physical resources. The defining attributes led to our proposed definitions of critical illness as, ‘a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility’, and of critical care as, ‘the identification, monitoring and treatment of patients with critical illness through the initial and sustained support of vital organ functions.’

Conclusion

The concepts critical illness and critical care lack consensus definitions and have varied uses. Through concept analysis of uses and definitions in the literature and among experts, we have identified the defining attributes of the concepts and proposed definitions that could aid clinical practice, research and policy-making.

Developing a risk stratification tool for predicting opioid-related respiratory depression after non-cardiac surgery: a retrospective study

Por: Roy · S. · Bruehl · S. · Feng · X. · Shotwell · M. S. · Van De Ven · T. · Shaw · A. D. · Kertai · M. D.
Objectives

Accurately assessing the probability of significant respiratory depression following opioid administration can potentially enhance perioperative risk assessment and pain management. We developed and validated a risk prediction tool to estimate the probability of significant respiratory depression (indexed by naloxone administration) in patients undergoing noncardiac surgery.

Design

Retrospective cohort study.

Setting

Single academic centre.

Participants

We studied n=63 084 patients (mean age 47.1±18.2 years; 50% men) who underwent emergency or elective non-cardiac surgery between 1 January 2007 and 30 October 2017.

Interventions

A derivation subsample reflecting two-thirds of available patients (n=42 082) was randomly selected for model development, and associations were identified between predictor variables and naloxone administration occurring within 5 days following surgery. The resulting probability model for predicting naloxone administration was then cross-validated in a separate validation cohort reflecting the remaining one-third of patients (n=21 002).

Results

The rate of naloxone administration was identical in the derivation (n=2720 (6.5%)) and validation (n=1360 (6.5%)) cohorts. The risk prediction model identified female sex (OR: 3.01; 95% CI: 2.73 to 3.32), high-risk surgical procedures (OR: 4.16; 95% CI: 3.78 to 4.58), history of drug abuse (OR: 1.81; 95% CI: 1.52 to 2.16) and any opioids being administered on a scheduled rather than as-needed basis (OR: 8.31; 95% CI: 7.26 to 9.51) as risk factors for naloxone administration. Advanced age (OR: 0.971; 95% CI: 0.968 to 0.973), opioids administered via patient-controlled analgesia pump (OR: 0.55; 95% CI: 0.49 to 0.62) and any scheduled non-opioids (OR: 0.63; 95% CI: 0.58 to 0.69) were associated with decreased risk of naloxone administration. An overall risk prediction model incorporating the common clinically available variables above displayed excellent discriminative ability in both the derivation and validation cohorts (c-index=0.820 and 0.814, respectively).

Conclusion

Our cross-validated clinical predictive model accurately estimates the risk of serious opioid-related respiratory depression requiring naloxone administration in postoperative patients.

Efficiency of ER:YAG laser therapy in combination with behaviour management technique in reducing anxiety among paediatric dental patients - a study protocol for a randomised clinical trial

Por: Belcheva · A. · Shindova · M.
Introduction

When providing dental care to children with a high level of dental anxiety, the range of approaches is divided into two sections: use of behaviour management techniques (BMTs) and application of alternative methods for caries removal. In an attempt to reduce dental anxiety, they can be mixed and matched in accordance with the dentists’ choice. Owing to its promoted advantages, erbium-doped yttrium aluminium garnet (Er:YAG) laser turns into an ideal alternative technique for hard dental tissue therapy in anxious paediatric patients. The aim of the study is to assess the efficacy of a modified version of the BMT ‘Latent inhibition’ in combination with Er:YAG laser for achieving a reduction of dental anxiety in paediatric dental patients.

Methods and analysis

This is a protocol for a randomised controlled clinical trial. The participants will be children aged 6–9 years, requiring conservative treatment of occlusal carious lesion on a second primary molar. Patients will be randomly assigned to the experimental or control group via a computer-generated sequence. In both groups, ‘Latent inhibition’ will be used as an anxiety-management technique. In the experimental group, caries treatment will be performed with Er:YAG laser, whereas that in the control group it will be performed with conventional rotary instruments. Outcome measures will be dental anxiety felt before and after the treatment, reported by the patient on a modified version of the Faces Scale by LeBaron et al., and the dynamics of heart rate, registered during the treatment session, which will be measured with a mobile pulse oximeter. Data will be analysed by independent sample t-test and paired t-test (p0.05).

Ethics and dissemination

The study protocol has been approved by the Committee for Scientific Research Ethics, Medical University–Plovdiv, Bulgaria (reference number P-2839, protocol of approval number 3/30.04.2015) and registered on a publicly accessible database. This research received institutional funding from the Medical University–Plovdiv, Bulgaria. The results will be presented through peer-reviewed publications and conference presentations.

Trial registration number

NCT04924452.

Accounts of preventative coping: an interview study of stroke survivors on general practice registers

Por: Scott Reid · P. · Neville · E. · Cater · F. · Mullis · R. · Mant · J. · Duschinsky · R.
Objectives

Preventative coping is an underexplored aspect of coping behaviour. Specifically, coping is a key concern in stroke survivor accounts, but this has yet to be investigated with reference to secondary prevention.

Design

Secondary analysis of a qualitative data set comprising semistructured interviews of 22 stroke survivors recruited from five general practices in the East of England. The topic guide included exploration of advice and support given by their doctor on medication and lifestyle. The interviews were coded using thematic analysis.

Results

The accounts emphasised individual responsibility. Two key themes were identified, which foregrounded the role of self-concept for coping: (a) striving to be ‘good’, (b) appeal to ideas of ‘personality’. In the former, preventative behaviour was depicted in moralistic terms, with the doctor as an adjudicator. In the latter, participants attributed their coping behaviour to their personality, which might help or hinder these efforts.

Conclusions

We highlight that coping was characterised by survivors as something enacted by the individual self, and consider how constructions of self may impact preventative coping efforts.

Quantitative analysis of International Health Regulations Annual Reports to identify global disparities in the preparedness for radiation emergencies

Por: Sharma · U. C. · Attwood · K. · Pokharel · S.
Objectives

Radiation emergencies are rare but can have minor confined effects to catastrophic consequences across the large geographical territories. Geographical disparities in the preparedness for radiation emergencies can negatively impact public-safety and delay protective actions. We examined such disparities using the global and regional radiation preparedness data from the revised annual International Health Regulations (IHR) data sets.

Settings

We used IHR State Party Annual Reporting (SPAR) tool and its associated health indicators developed to mitigate public health risk from radiation emergencies. Using the most recent (2019) SPAR database developed for radiation emergencies, along with 12 other cross-sector indicators, we examined the disparities among WHO state and region-wide capacity scores for operational preparedness.

Results

Based on the analysis of the 2019 annual reporting data sets from 171 countries, radiation emergency was one of the top three global challenges with an average global preparedness capacity of 55%. Radiation emergency preparedness capacity scores showed highest dispersion score among all 13 capacities suggesting higher disparities for preparedness across the globe. Only 38% of the countries had advanced functional capacity with ≥80% operational readiness, with 28% countries having low to very low operational readiness. No geographical regions had ≥80% operational readiness for radiation emergencies, with 4/6 geographical regions showing limited capacity or effectiveness. Global data from 171 countries showed that the capacity to respond to radiation emergencies correlated with the capacity for chemical events with a correlation coefficient () of 0.70 (CI 0.61 to 0.77).

Conclusion

We found major global disparities for the operational preparedness against radiation emergencies. Collaborative approaches involving the public health officials and policymakers at the regional and state levels are needed to develop additional guidance to adapt emergency preparedness plans for radiation incidents.

Prevalence and predictors of mother and newborn skin-to-skin contact at birth in Papua New Guinea

Por: Aboagye · R. G. · Okyere · J. · Dowou · R. K. · Adzigbli · L. A. · Tackie · V. · Ahinkorah · B. O. · Seidu · A.-A.
Objective

This study examined the prevalence and predictors of maternal and newborn skin-to-skin contact at birth in Papua New Guinea.

Design

Data for the study was extracted from the 2016–18 Papua New Guinea Demographic and Health Survey. We included 6,044 women with birth history before the survey in the analysis. Percentages were used to summarise the prevalence of maternal and newborn skin-to-skin contact. A multivariable multilevel binary logistic regression was adopted to examine the predictors of maternal and newborn skin-to-skin contact. The results were presented using adjusted ORs (aORs), with their respective 95% confidence intervals (CIs). Statistical significance was set at p

Setting

The study was conducted in Papua New Guinea.

Participant

Mothers with children under 5 years.

Outcome measures

Mother and newborn skin-to-skin contact.

Results

The prevalence of mother and newborn skin-to-skin contact was 45.2% (95% CI=42.4 to 48.0). The odds of mother and newborn skin-to-skin contact was higher among women with primary education (aOR=1.38; 95% CI=1.03 to 1.83), women with four or more antenatal care attendance (aOR=1.27; 95% CI=1.01 to 1.61), those who delivered at the health facility (aOR=1.27; 95% CI=1.01 to 1.61), and women from communities with high socioeconomic status (aOR=1.45; 95% CI=1.11 to 1.90).

Conclusion

The study has demonstrated that the prevalence of mother and newborn skin-to-skin contact in Papua New Guinea is low. Factors shown to be associated with mother and newborn skin-to-skin contact were maternal level of education, antenatal care attendance, health facility delivery, and community socioeconomic status. A concerted effort should be placed in improving maternal health service utilisation such as antenatal care attendance and skilled birth delivery, which subsequently lead to the practice of skin-to-skin contact. Also, women should be empowered through education as it has positive impact on their socioeconomic status and health service utilisation.

What can lead to late diagnosis of HIV in an illegal gold mining environment? A qualitative study at the French Guianas border with Brazil

Por: Floersheim · C. · Musso · S. · Eubanks · A. · Douine · M. · Spire · B. · Sagaon-Teyssier · L. · Parriault · M. C. · Girard · G. · Mosnier · E.
Objective

The present study aimed to understand what factors can lead to late HIV diagnosis of illegal gold miners at French Guiana’s border with Brazil.

Design

An exploratory qualitative study with in-depth interviews and observations was conducted between November 2019 and February 2020.

Setting

The study was conducted in the main medical healthcare service and two non-governmental organisation premises in the Oyapock border region, which is a supply area for illegal gold mining sites.

Participants

Fifteen people living with HIV diagnosed with CD4 count 6/L were interviewed. Seven women and eight men participated; they were between 31 and 79 years old, and the median time since HIV diagnosis was 6 years. Eight had links to illegal gold mining.

Findings

Three key themes for late HIV diagnosis emerged: (1) the presence of economic and political structural factors which constitute risks for this illegal activity, specifically the repression of gold mining sites by French Armed Forces and the distance from healthcare facilities; (2) representations of the body and health, related to the living conditions of this population; prioritisation of health emergencies and long-term self-medication; and (3) gender roles shaping masculinity and heterosexuality contributing to a perception of not being at risk of HIV and delaying testing.

Conclusion

This study highlights structural, group-based and individual factors that reduce access to HIV testing and healthcare in general for a population of migrant workers in an illegal gold mining area. Faced with harsh living conditions and state repression, these workers develop a vision of health which prioritises the functionality of the body. Associated with gender roles which are partly shaped both by the mining activity and its geographical location, this vision can lead to late HIV diagnosis.

Rural-urban differentials in the influences of individual and geospatial preparedness on institutional childbirth: a cross-sectional study in Bangladesh

Por: Rahman · M. M. · Ara · T. · Aninda · M. H. H. M. K. · Nurul · A. · Haider · M. M.
Objective

This study aims to explore the rural–urban differentials in the influences of individual and geospatial preparedness on institutional childbirth in Bangladesh. A related aim of this paper is to derive estimates to measure geospatial preparedness for institutional births, through statistical modelling, when no data are available for measuring this areal indicator.

Design, settings and participants

The paper used data from a large-scale nationally representative Bangladesh Multiple Indicator Cluster Survey 2019. The analytical sample included 9203 currently married women of reproductive age who had a live birth in the 2 years preceding the survey.

Methods

Mixed effect logistic regression models were employed to explore the rural–urban differentials in influences of individual and geospatial preparedness on institutional childbirth. The district-level random effect estimation was done to measure geospatial preparedness. The conditional autoregressive model was used to examine the association of geospatial preparedness with areal variation in institutional births.

Results

In rural settings, women who gave birth to a female newborn were 18% less likely to have facility births compared with women who gave birth to a male newborn. Also, women from households in the highest wealth quintile were twice as likely to have facility births compared with those from households in the poorest wealth quintile. In contrast, in urban areas, facility births did not vary by sex of the fetus or by households’ socioeconomic status. The geospatial preparedness explained 8% and 9% of the variability in institutional births in rural and urban areas, respectively. Geospatial mapping revealed low preparedness in the hill tracts. Findings identified geospatial preparedness as a potential source of areal variation in facility births.

Conclusion

Findings suggest improving district-level preparedness and developing differential programme strategies for urban and rural areas to increase the national prevalence and more equitable use of institutional childbirth in Bangladesh.

Multicountry study protocol of COCOON: COntinuing Care in COVID-19 Outbreak global survey of New, expectant, and bereaved parent experiences

Por: Loughnan · S. A. · Gautam · R. · Silverio · S. A. · Boyle · F. M. · Cassidy · J. · Ellwood · D. · Homer · C. · Horey · D. · Leisher · S. H. · de Montigny · F. · Murphy · M. · O'Donoghue · K. · Quigley · P. · Ravaldi · C. · Sandall · J. · Storey · C. · Vannacci · A. · Wilson · A. N. · Flena
Introduction

Globally, the COVID-19 pandemic has significantly disrupted the provision of healthcare and efficiency of healthcare systems and is likely to have profound implications for pregnant and postpartum women and their families including those who experience the tragedy of stillbirth or neonatal death. This study aims to understand the psychosocial impact of COVID-19 and the experiences of parents who have accessed maternity, neonatal and bereavement care services during this time.

Methods and analysis

An international, cross-sectional, online and/or telephone-based/face-to-face survey is being administered across 15 countries and available in 11 languages. New, expectant and bereaved parents during the COVID-19 pandemic will be recruited. Validated psychometric scales will be used to measure psychosocial well-being. Data will be analysed descriptively and by assessing multivariable associations of the outcomes with explanatory factors. In seven of these countries, bereaved parents will be recruited to a nested, qualitative interview study. The data will be analysed using a grounded theory analysis (for each country) and thematic framework analysis (for intercountry comparison) to gain further insights into their experiences.

Ethics and dissemination

Ethics approval for the multicountry online survey, COCOON, has been granted by the Mater Misericordiae Human Research Ethics Committee in Australia (reference number: AM/MML/63526). Ethics approval for the nested qualitative interview study, PUDDLES, has been granted by the King’s College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (reference number: HR-19/20-19455) in the UK. Local ethics committee approvals were granted in participating countries where required. Results of the study will be published in international peer-reviewed journals and through parent support organisations. Findings will contribute to our understanding of delivering maternity care services, particularly bereavement care, in high-income, lower middle-income and low-income countries during this or future health crises.

Sleep quality and associated factors among pregnant women attending antenatal care unit at Gondar, Ethiopia: a cross-sectional study

Por: Takelle · G. M. · Muluneh · N. Y. · Biresaw · M. S.
Objective

This study aimed to determine the prevalence and associated factors of poor sleep quality among pregnant women in Ethiopia.

Method

Institutional based cross-sectional study.

Setting

University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.

Participants

A total of 415 pregnant women were recruited by using a systematic random sampling technique from 28 April 2020 to 12 June 2020.

Measurement

The desired data were collected through face-to-face interview technique by using validated questionnaires such as the Pittsburgh Sleep Quality Index, Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Oslo-3 and Abuse Assessment Screen. The data were analysed by using SPSS V.20. Logistic regression analysis was used to identify associated factors with poor sleep quality. Variables having a p value of less than 0.2 in the bivariate analysis were entered to the multivariable logistic regression. A p value of less than 0.05 was considered statistically significant, at 95% CI.

Result

In this study, 175 (42.2%) pregnant women had poor sleep quality. According to multivariable logistic regression, being first and third trimesters of gestational age (adjusted OR (aOR) 2.31, 95% CI 1.16 to 4.61 and aOR 3.45, 95% CI 2.05 to 5.79, respectively), consumption of caffeinated substances (aOR 2.96, 95% CI 1.68 to 5.52), having depression (aOR 2.12, 95% CI 1.19 to 3.76), having high perceived stress (aOR 5.39, 95% CI 1.96 to 14.79) and experience of intimate partner violence (aOR 5.57, 95% CI 2.19 to 14.68) were positive significant associated factors with poor sleep quality.

Conclusion and recommendation

The prevalence of poor sleep quality among pregnant women was relatively high. First and third trimesters, consumption of caffeinated substances, antenatal depression, high perceived stress and intimate partner violence were factors significantly associated with poor sleep quality. This result suggests that all pregnant women should be screened and treated for poor sleep quality during the first and third trimesters.

Quality of reporting of randomised controlled trials of artificial intelligence in healthcare: a systematic review

Por: Shahzad · R. · Ayub · B. · Siddiqui · M. A. R.
Objectives

The aim of this study was to evaluate the quality of reporting of randomised controlled trials (RCTs) of artificial intelligence (AI) in healthcare against Consolidated Standards of Reporting Trials—AI (CONSORT-AI) guidelines.

Design

Systematic review.

Data sources

We searched PubMed and EMBASE databases for studies reported from January 2015 to December 2021.

Eligibility criteria

We included RCTs reported in English that used AI as the intervention. Protocols, conference abstracts, studies on robotics and studies related to medical education were excluded.

Data extraction

The included studies were graded using the CONSORT-AI checklist, comprising 43 items, by two independent graders. The results were tabulated and descriptive statistics were reported.

Results

We screened 1501 potential abstracts, of which 112 full-text articles were reviewed for eligibility. A total of 42 studies were included. The number of participants ranged from 22 to 2352. Only two items of the CONSORT-AI items were fully reported in all studies. Five items were not applicable in more than 85% of the studies. Nineteen per cent (8/42) of the studies did not report more than 50% (21/43) of the CONSORT-AI checklist items.

Conclusions

The quality of reporting of RCTs in AI is suboptimal. As reporting is variable in existing RCTs, caution should be exercised in interpreting the findings of some studies.

What are common barriers and helpful solutions to colorectal cancer screening? A cross-sectional survey to develop intervention content for a planning support tool

Por: Kotzur · M. · Macdonald · S. · O'Carroll · R. E. · O'Connor · R. C. · Irvine · A. · Steele · R. J. C. · Robb · K. A.
Objective

Colorectal screening using faecal immunochemical tests (FITs) can save lives if the people invited participate. In Scotland, most people intend to complete a FIT but this is not reflected in uptake rates. Planning interventions can bridge this intention-behaviour gap. To develop a tool supporting people willing to do colorectal screening with planning to complete a FIT, this study aimed to identify frequently experienced barriers and solutions to these barriers.

Design

This is a cross-sectional study.

Setting

Participants were recruited through the Scottish Bowel Screening Programme to complete a mailed questionnaire.

Participants

The study included 2387 participants who had completed a FIT (mean age 65 years, 40% female) and 359 participants who had not completed a FIT but were inclined to do so (mean age 63 years, 39% female).

Outcome measures

The questionnaire assessed frequency of endorsement of colorectal screening barriers and solutions.

Results

Participants who had not completed a FIT endorsed significantly more barriers than those who had completed a FIT, when demographic, health and behavioural covariates were held constant (F(1,2053)=13.40, p2=0.01). Participants who completed a FIT endorsed significantly more solutions than those who did not (U=301 585.50, z=–3.21, p

Conclusion

This survey identified six barriers and seven solutions as key content to include in the development of a planning tool for colorectal screening using the FIT. Participatory research is required to codesign an engaging and accessible planning tool.

Development and validation of a dynamic 48-hour in-hospital mortality risk stratification for COVID-19 in a UK teaching hospital: a retrospective cohort study

Por: Wiegand · M. · Cowan · S. L. · Waddington · C. S. · Halsall · D. J. · Keevil · V. L. · Tom · B. D. M. · Taylor · V. · Gkrania-Klotsas · E. · Preller · J. · Goudie · R. J. B.
Objectives

To develop a disease stratification model for COVID-19 that updates according to changes in a patient’s condition while in hospital to facilitate patient management and resource allocation.

Design

In this retrospective cohort study, we adopted a landmarking approach to dynamic prediction of all-cause in-hospital mortality over the next 48 hours. We accounted for informative predictor missingness and selected predictors using penalised regression.

Setting

All data used in this study were obtained from a single UK teaching hospital.

Participants

We developed the model using 473 consecutive patients with COVID-19 presenting to a UK hospital between 1 March 2020 and 12 September 2020; and temporally validated using data on 1119 patients presenting between 13 September 2020 and 17 March 2021.

Primary and secondary outcome measures

The primary outcome is all-cause in-hospital mortality within 48 hours of the prediction time. We accounted for the competing risks of discharge from hospital alive and transfer to a tertiary intensive care unit for extracorporeal membrane oxygenation.

Results

Our final model includes age, Clinical Frailty Scale score, heart rate, respiratory rate, oxygen saturation/fractional inspired oxygen ratio, white cell count, presence of acidosis (pH

Conclusions

Our model incorporates both static risk factors (eg, age) and evolving clinical and laboratory data, to provide a dynamic risk prediction model that adapts to both sudden and gradual changes in an individual patient’s clinical condition. On successful external validation, the model has the potential to be a powerful clinical risk assessment tool.

Trial registration

The study is registered as ‘researchregistry5464’ on the Research Registry (www.researchregistry.com).

Impact of COVID-19 on college students at one of the most diverse campuses in the USA: a factor analysis of survey data

Por: Liu · B. · Huynh · E. · Li · C. · Wu · Q.
Objective

This survey study is designed to understand the impact of the COVID-19 pandemic on stress among specific subpopulations of college students.

Design, settings and participants

An online questionnaire was sent to the students from University of Nevada, Las Vegas, between October 2020 and December to assess the psychological impact of COVID-19. A total of 2091 respondents signed the consent form online and their responses were collected.

Main outcome measures

Measures of psychological stress, as prescribed by the Perceived Stress Scale (PSS-10). An explanatory factor analysis was carried out on the PSS-10 results. We subsequently analysed each factor using stepwise linear regression that focused on various sociodemographic groups.

Results

A two-factor model was obtained using the explanatory factor analysis. After comparing with the past studies that investigated the factor structure of the PSS-10 scale, we identified these two factors as ‘anxiety’ and ‘irritability’. The subsequent stepwise linear regression analysis suggested that gender and age (p

Conclusions

To our knowledge, this is the first study that assessed the perceived stress of university students in the USA during the COVID-19 pandemic. Through exploratory factor analysis, we showed that the PSS-10 scale could be summarised as a two-factor structure. A stepwise regression approach was used, and we found both of the factors are significantly associated with the gender of the participants. However, we found no significant association between both factors and ethnicity. Our findings will help identify students with a higher risk for stress and mental health issues in pandemics and future crises.

Automated digital counselling with social network support as a novel intervention for patients with heart failure: protocol for randomised controlled trial

Por: Peiris · R. G. · Ross · H. · Chan · C. T. · Poon · S. · Auguste · B. L. · Rac · V. E. · Farkouh · M. · McDonald · M. · Kaczorowski · J. · Code · J. · Duero Posada · J. · Ong · S. · Kobulnik · J. · Tomlinson · G. · Huszti · E. · Arcand · J. · Thomas · S. G. · Akbari · A. · Maunder · R. · Grov
Introduction

Heart failure (HF) symptoms improve through self-care, for which adherence remains low among patients despite the provision of education for these behaviours by clinical teams. Open Access Digital Community Promoting Self-Care, Peer Support and Health Literacy (ODYSSEE–vCHAT) combines automated digital counselling with social network support to improve mortality and morbidity, engagement with self–care materials, and health-related quality of life.

Methods and analysis

Use of ODYSSEE-vCHAT via Internet-connected personal computer by 162 HF patients will be compared with a control condition over 22 months. The primary outcome is a composite index score of all-cause mortality, all-cause emergency department visits, and HF-related hospitalisation at trial completion. Secondary outcomes include individual components of the composite index, engagement with self-care materials, and patient-reported measures of physical and psychosocial well-being, disease management, health literacy, and substance use. Patients are recruited from tertiary care hospitals in Toronto, Canada and randomised on a 1:1 ratio to both arms of the trial. Online assessments occur at baseline (t=0), months 4, 8 and 12, and trial completion. Ordinal logistic regression analyses and generalised linear models will evaluate primary and secondary outcomes.

Ethics and dissemination

The trial has been approved by the research ethics boards at the University Health Network (20-5960), Sunnybrook Hospital (5117), and Mount Sinai Hospital (21-022-E). Informed consent of eligible patients occurs in person or online. Findings will be shared with key stakeholders and the public. Results will allow for the preparation of a Canada-wide phase III trial to evaluate the efficacy of ODYSSEE-vCHAT in improving clinical outcomes and raising the standard of outpatient care.

Trial registration number

NCT04966104

Two mental models of integrated care for advanced liver disease: qualitative study of multidisciplinary health professionals

Por: Arney · J. · Gray · C. · Walling · A. M. · Clark · J. A. · Smith · D. · Melcher · J. · Asch · S. · Kanwal · F. · Naik · A. D.
Objectives

The purpose of this paper is to present two divergent mental models of integrated advanced liver disease (AdvLD) care among 26 providers who treat patients with AdvLD.

Setting

3 geographically dispersed United States Veterans Health Administration health systems.

Participants

26 professionals (20 women and 6 men) participated, including 9 (34.6%) gastroenterology, hepatology, and transplant physicians, 2 (7.7%) physician assistants, 7 (27%) nurses and nurse practitioners, 3 (11.5%) social workers and psychologists, 4 (15.4%) palliative care providers and 1 (3.8%) pharmacist.

Main outcome measures

We conducted qualitative in-depth interviews of providers caring for patients with AdvLD. We used framework analysis to identify two divergent mental models of integrated AdvLD care. These models vary in timing of initiating various constituents of care, philosophy of integration, and supports and resources needed to achieve each model.

Results

Clinicians described integrated care as an approach that incorporates elements of curative care, symptom and supportive care, advance care planning and end-of-life services from a multidisciplinary team. Analysis revealed two mental models that varied in how and when these constituents are delivered. One mental model involves sequential transitions between constituents of care, and the second mental model involves synchronous application of the various constituents. Participants described elements of teamwork and coordination supports necessary to achieve integrated AdvLD care. Many discussed the importance of having a multidisciplinary team integrating supportive care, symptom management and palliative care with liver disease care.

Conclusions

Health professionals agree on the constituents of integrated AdvLD care but describe two competing mental models of how these constituents are integrated. Health systems can promote integrated care by assembling multidisciplinary teams, and providing teamwork and coordination supports, and training that facilitates patient-centred AdvLD care.

Impact of cancer on income, wealth and economic outcomes of adult cancer survivors: a scoping review

Por: Bentley · C. · Teckle · P. · McQuarrie · L. · Peacock · S. · El Adam · S.
Objective

To summarise peer-reviewed evidence on the effect of a cancer diagnosis on the different sources of income of individuals diagnosed with cancer during adulthood (age ≥18 years).

Design

A scoping review following the Joanna Briggs Institute’s methodological framework for conducting scoping reviews and reporting results following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews checklist.

Data sources

Ovid MEDLINE, PsycINFO, CINAHL, EMBASE, Econ-Lit and Evidence-based Medicine Reviews, and reference lists of evidence syntheses. Published literature of any study type in English was searched from January 2000 to December 2020.

Eligibility and criteria

Study participants were individuals diagnosed with cancer during adulthood (age ≥18 years). Studies from any country and/or healthcare system were included. Primary outcomes were employment income (eg, individual or household); investment income (eg, stocks/bonds, properties, savings); government transfer payments (eg, disability income/pension); debt and bankruptcy.

Data extraction and synthesis

Findings are summarised descriptively and in tabular form.

Results

From 6297 citations retrieved, 63 studies (67 articles) met our inclusion criteria. Most (51%) were published in 2016–2020; 65% were published in the USA or Scandinavia. Survivors incurred debt (24 studies), depleted savings (13 studies) and liquidated stocks/bonds (7 studies) in response to a cancer diagnosis. 41 studies reported changes to employment income; of these, 12 case–control studies reported varying results: 5 reported survivors earned less than controls, 4 reported no significant differences, 2 reported mixed results and 1 reported income increased. Initial declines in income tended to lessen over time.

Conclusions

Cancer’s impact on survivors’ income is complex and time-varying. Longitudinal studies are needed to document the trend of initial declines in income, with declines lessening over time, and its variations. Study designs using standardised income measures and capturing treatment type and follow-up time will improve our understanding of cancer’s impact on survivors’ income.

Intravenous ferric derisomaltose in iron-deficient patients undergoing transcatheter aortic valve implantation due to severe aortic stenosis: study protocol of the randomised controlled IIISAS trial

Por: Bardan · S. · Kvaslerud · A. B. · Andresen · K. · Klove · S. F. · Edvardsen · T. · Gullestad · L. · Broch · K.
Introduction

Iron deficiency is a prevalent comorbidity in patients with severe aortic stenosis and may be associated with procedural and clinical outcomes after transcatheter aortic valve implantation (TAVI). In the Intravenous Iron Supplement for Iron Deficiency in Patients with Severe Aortic Stenosis (IIISAS) trial, we aim to examine whether a single administration of ferric derisomaltose can improve physical capacity after TAVI.

Methods and analysis

This randomised, double-blind, placebo-controlled trial aims to enrol 150 patients with iron deficiency who are scheduled for TAVI due to severe aortic stenosis. The study drug and matching placebo are administered approximately 3 months prior to TAVI, and the patients are followed for 3 months after TAVI. Inclusion criteria are iron deficiency, defined as serum ferritin

Ethics and dissemination

Ethical approval was obtained from the Regional Committee for Medical and Health Research of South-Eastern Norway and The Norwegian Medicines Agency. Enrolment has begun, and results are expected in 2022. The results of the IIISAS trial will be disseminated by presentations at international and national conferences and by publications in peer-reviewed journals.

Trial registration number

NCT04206228

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