To examine whether cost-free (CF) smoking cessation medication was more effective than a prescription for cessation medication in patients after transient ischaemic attack (TIA) or stroke.

Two-site randomised trial.

Stroke prevention clinics (SPCs) in Ontario, Canada.

Smokers with TIA or stroke, willing to quit smoking.

Smoking status was assessed in SPC attendees. Smokers were advised to quit smoking and received recommendations for cessation medication and counselling. Consenting participants were randomly assigned (1:1) to either a CF medication group or a prescription-only (Rx) group. CF participants immediately received a 12-week supply of cessation medication. Rx participants were given a prescription for 12 weeks of cessation medication. Follow-up counselling was provided for 26 weeks.

The primary outcome was 40-week continuous abstinence verified using a carbon monoxide breath test at 52-week follow-up. Secondary outcomes included abstinence at intermediate timepoints, medication adherence and serious adverse events.

Hundred and ninety-four participants were randomised and 131 (67.5%) completed the trial. The 40-week continuous abstinence rate at 52-week follow-up was 15.5% in the CF group versus 14.0% in the Rx group (OR=1.13; 95% CI 0.51 to 2.53). The 14-week continuous abstinence rate at 26-week follow-up was 18.6% in the CF group versus 16.8% in the Rx group (OR=1.20; 95% CI 0.56 to 2.55). Seven-day point-prevalence abstinence at 12 weeks was 38.1% in the CF group versus 26.9% in the Rx group (OR=1.76; 95% CI 0.94 to 3.28). Medication adherence was higher in the CF group versus the Rx group (47.4%±41.2% vs 25.5±36.8%, p

Our findings were inconclusive; we failed to meet our recruitment target and the effect size was smaller than anticipated. CF medication improved medication adherence.

NCT00962988; ClinicalTrials.gov Identifier.

Measures to mitigate the COVID-19 outbreak in the migrant worker dormitories in Singapore included lockdown and isolation of residents for prolonged periods. In this paper, we explore efforts to ease tensions and support mental health under these conditions.

Case study of dormitory residents under lockdown from April to August 2020 comprises a nested mixed-method approach using an online questionnaire (n=175) and semistructured interviews (n=23) of migrant workers sampled from the survey (August to September 2020). Logistic regression models were used to analyse survey data. Semistructured interviews were analysed using applied thematic analysis.

Survey and interview data showed that mental health was largely protected despite initial rising tensions over restrictions during lockdown. Sources of tension negatively affecting low stress responses included job related worries, OR=0.07 (95% CI 0.03 to 0.18, p

Interviewees shared how their adaptive capability played a pivotal protective role alongside social support and solidarity; aided by regular use of messaging applications, which supported mental health, OR=4.81 (95% CI 1.54 to 15.21, p

Tensions are mapped to protective solutions informing guidelines for future outbreak stress management response.

To examine long-term effectiveness of rehabilitation services on physical function, pain severity and post-traumatic stress disorder (PTSD) in earthquake survivors over a 4-year period.

Prospective cohort study with early and late intervention and geographical control group.

Three counties of Sichuan Province, China.

591 survivors of the 2008 Wenchuan earthquake were followed-up over a 4-year period ranging from 2008 to 2012.

In Mianzhu county, a comprehensive hospital-based and community-based rehabilitation programme was implemented in September 2008; in Anxian county, the same programme was implemented 1 year later; in Shifang county, the programme was not implemented and survivors from this county served as a control group.

Physical function was measured using Modified Barthel Index (MBI), pain severity with Visual Analogue Scale and PTSD with the PTSD Checklist-Civilian Version. All outcomes were assessed at three time points (baseline from 2008 to 2009, 2010 and 2012) and analysed with mixed effects regression.

400 patients completed all assessments. In all groups, physical function and pain severity improved over time. MBI improvement per month as compared with control was greater in the late rehabilitation (b=1.69, 95% CI 1.20 to 2.19) than the early rehabilitation group (b=0.96, 95% CI 0.68 to 1.24). This rehabilitation effect was however marginally decreasing over time. Superior improvement as compared with control with regard to pain was only found in the early rehabilitation group (b=–0.05, 95% CI –0.09 to –0.02). PTSD symptoms decreased over time, but the observed differences could not be specifically linked to the rehabilitation intervention.

Physical rehabilitation of earthquake survivors appears to be effective in improving physical function and, if delivered early, pain. Effects on mental health are less clear and need further examination using more consistent and frequent assessments of relevant outcomes and determinants.

Initial reports suggest people experiencing homelessness (PEH) are at high risk for SARS-CoV-2 infection and associated morbidity and mortality. However, there have been few longitudinal evaluations of the spread and impact of COVID-19 among PEH. This study will estimate the prevalence and incidence of COVID-19 infections in a cohort of PEH followed prospectively in Toronto, Canada. It will also examine associations between individual-level and shelter-level characteristics with COVID-19 infection, adverse health outcomes related to infection and vaccination. Finally, the data will be used to develop and parameterise a mathematical model to characterise SARS-CoV-2 transmission dynamics, and the transmission impact of interventions serving PEH.

Ku-gaa-gii pimitizi-win will follow a random sample of PEH from across Toronto (Canada) for 12 months. 736 participants were enrolled between June and September 2021, and will be followed up at 3-month intervals. At each interval, specimens (saliva, capillary blood) will be collected to determine active SARS-CoV-2 infection and serologic evidence of past infection and/or vaccination, and a detailed survey will gather self-reported information, including a detailed housing history. To examine the association between individual-level and shelter-level characteristics on COVID-19-related infection, adverse outcomes, and vaccination, shelter and healthcare administrative data will be linked to participant study data. Healthcare administrative data will also be used to examine long-term (up to 5 years) COVID-19-related outcomes among participants.

Ethical approval was obtained from the Unity Health Toronto and University of Toronto Health Sciences Research Ethics Boards (# 20-272). Ku-gaa-gii pimitizi-win was designed in collaboration with community and service provider partners and people having lived experience of homelessness. Findings will be reported to groups supporting Ku-gaa-gii pimitizi-win, Indigenous and other community partners and service providers, funding bodies, public health agencies and all levels of government to inform policy and public health programs.

Camrelizumab is a selective, humanised, high-affinity IgG₄ kappa monoclonal antibody against programmed cell death 1 that shows effective antitumour activity with acceptable toxicity in multiple tumour types. The CameL trial demonstrated that camrelizumab plus chemotherapy (CC) significantly prolonged the median progression-free survival and median overall survival versus chemotherapy alone (CA) in patients with advanced non-squamous non-small cell lung cancer (NSCLC). Our study was conducted to investigate the cost-effectiveness of the two strategies in chemotherapy-naive patients with advanced non-squamous NSCLC.

A Markov simulation model was generated based on the CameL trial. The two simulated treatments included CC and CA.

Utility was derived from published literature, and costs were calculated based on those at our hospital in Chengdu, China. Incremental cost-effectiveness ratios (ICERs) were calculated to compare the cost-effectiveness of the two treatment arms.

In the overall population, the total costs were $27 223.40 and $13 740.10 for CC and CA treatment, respectively. The CC treatment produced 1.37 quality-adjusted life years (QALYs), and the CA treatment produced 1.17 QALYs. Hence, patients who were in the CC group spent an additional $13 483.30 and generated an increase of 0.20 QALYs, resulting in an ICER of $67 416.50 per QALY.

For chemotherapy-naive patients with advanced non-squamous NSCLC, CC is not considered a cost-effective treatment versus CA in China when considering a willingness-to-pay threshold of $31 500 per QALY.

NCT03134872

Knee osteoarthritis is a leading cause of disability, resulting in pain and reduced quality of life. Exercise is the cornerstone of conservative management but effects are, at best, moderate. Early evidence suggests that repetitive transcranial magnetic stimulation (rTMS) applied over the primary motor cortex (M1) may improve the effect of exercise in knee osteoarthritis. This pilot study aims to (1) determine the feasibility, safety and participant-rated response to an intervention adding M1 rTMS to exercise in knee osteoarthritis; (2) elucidate physiological mechanisms in response to the intervention; (3) provide data to conduct a sample size calculation for a fully powered trial.

This is a pilot randomised, assessor-blind, therapist-blind and participant-blind, sham-controlled trial. Thirty individuals with painful knee osteoarthritis will be recruited and randomly allocated to receive either: (1) active rTMS+exercise or (2) sham rTMS+exercise intervention. Participants will receive 15 min of either active or sham rTMS immediately prior to 30 min of supervised muscle strengthening exercise (2x/week, 6 weeks) and complete unsupervised home exercises. Outcome measures of feasibility, safety, pain, function and physiological mechanisms will be assessed before and/or after the intervention. Feasibility and safety will be analysed using descriptive analysis. Within-group and between-group comparisons of pain and function will be conducted to examine trends of efficacy.

This study has been approved by the University of New South Wales Human Research Ethics Committee (HC210954). All participants will provide written informed consent. The study results will be submitted for peer-reviewed publication.

ACTRN12621001712897p.

To assess costs, health outcomes and cost-effectiveness of interventions that aim to improve quality of diet and level of physical activity in adolescents.

A Markov model was developed to assess four potential benefits of healthy behaviour for adolescents: better mental health (episodes of depression and generalised anxiety disorder), higher earnings and reduced incidence of type 2 diabetes and adverse pregnancy outcomes (in terms of preterm delivery). The model parameters were informed by published literature. The analysis took a societal perspective over a 20-year period. One-way and probabilistic sensitivity analyses for 10 000 simulations were conducted.

A hypothetical cohort of 100 adolescents with a mean age of 13 years.

An exemplar school-based, multicomponent intervention that was developed by the Engaging Adolescents for Changing Behaviour programme, compared with usual schooling.

Incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life-year (QALY) gained.

The exemplar dietary and physical activity intervention was associated with an incremental cost of £123 per adolescent and better health outcomes with a mean QALY gain of 0.0085 compared with usual schooling, resulting in an ICER of £14 367 per QALY. The key model drivers are the intervention effect on levels of physical activity, quality-of-life gain for high levels of physical activity, the duration of the intervention effects and the period over which effects wane.

The results suggested that such an intervention has the potential to offer a cost-effective use of healthcare-resources for adolescents in the UK at a willingness-to-pay threshold of £20 000 per QALY. The model focused on short-term to medium-term benefits of healthy eating and physical activity exploiting the strong evidence base that exists for this age group. Other benefits in later life, such as reduced cardiovascular risk, are more sensitive to assumptions about the persistence of behavioural change and discounting.

ISRCTN74109264.

The term frontotemporal dementia (FTD) refers to a heterogeneous group of neurodegenerative disorders affecting the frontal and temporal lobes. Cognitively, impairment of executive function and social cognition predominates across the FTD spectrum, although other domains can be affected. Traditionally, cognition is tested through standard ‘pen and paper’ tasks in FTD. However, recent attempts have been made across other neurodegenerative disorders such as Alzheimer’s disease to develop computerised batteries that allow more accurate and sensitive detection of cognitive impairment.

This paper describes the development of a novel battery of tests for a tablet computer, particularly focused on FTD. It consists of 12 different tasks which aim to tap into information processing speed, various aspects of executive function, social cognition, semantic knowledge, calculation and visuospatial skills. Future studies will focus on validating the battery in a healthy control cohort, comparing it against a standard ‘pen and paper’ psychometric battery, and finally testing it within an FTD cohort, including those with genetic forms of FTD where we will be able to assess its ability to detect very early cognitive deficits prior to the onset of symptoms.

Normative data will be produced in the initial validation study (approved by the UCL Ethics Committee, project ID 17691/002) and will be made available online.

The aim of the study was to estimate the prevalence and correlates of cardiovascular disease (ischaemic heart disease and/or stroke (IHDS)) in Mongolia.

Cross-sectional study.

National community-based sample of people aged 15–69 years in Mongolia.

6654 people (15–69 years, mean 41.3) who participated in the 2019 Mongolia STEPS survey.

Self-reported prevalence of IHDS and biological and social covariates. Determinants of IHDS were estimated with logistic regression.

The prevalence of IHDS was 14.0%, 15.6% among women and 12.3% among men. Older age (45–69 years), being married or cohabiting, and urban residence were positively associated, and male sex was negatively associated, with IHDS. Additionally, experience of threats, hypertension, current tobacco use, passive smoking, sedentary behaviour and high physical activity were positively associated with IHDS.

Almost one in seven people aged 15–69 years had IHDS in Mongolia. Several factors amenable to public health intervention for IHDS were identified, including experience of threats, hypertension, current tobacco use, passive smoking and sedentary behaviour.

At the very start of medical residency training, entrustment of clinical tasks may be a major challenge, on which current scientific knowledge is scarce. This study therefore aimed to gain insight into the process of supervisors’ decision making underlying the entrustment of clinical tasks at the start of one-on-one supervisor–trainee working relationships.

This study was performed in a general practice (GP) training department in the Netherlands.

For this study, we recruited supervisor–trainee pairs who were just about to start the first year of GP residency training. Of 10 eligible supervisor–trainee pairs, 4 participated.

We used a qualitative, social-constructivist research approach. Data from naturalistic non-participant observations and semistructured interviews with supervisors in four GP practices were triangulated and analysed using a thematic analysis approach.

Supervisors’ early entrustment decisions were based on generic trainee qualities such as self-reflexivity, knowing one’s limitations and asking for help in time, rather than on task-specific performance. At the start of residency training, supervisors’ primary concern was to create a safe working and learning environment in which trainees could and would ask for timely supervision while being entrusted with challenging tasks. Supervisors used idiosyncratic entrustment strategies that were influenced by their propensity to trust, previous experiences with trainees, and their perspective on learning and teaching.

Entrustment decisions require high levels of safety for all stakeholders involved. Especially at the beginning of supervisor–trainee relationships, establishing an educational alliance in which entrustment is the subject of ongoing trainee–supervisor conversations is essential to achieve and maintain and optimal balance between trainee learning and patient safety. Additional research may further our understanding of early entrustment decision making and the role of generic trainee qualities in different settings.

Falling is associated with adverse effects on the health of older people. The majority of research into falls among older people has focused on prevention, with less attention to ‘how to fall safely’. Previous research suggests that motor analogies can be used to promote safe landing by young adults; however, the efficacy of this technique for older people remains unknown. This study aims to determine whether a motor analogy is useful for promoting safe falling in the older adult population.

The study adopts a randomised, controlled, single-blinded study design. People 65 years and older will be randomly allocated to a control condition or a motor analogy condition. They will receive a nudge in a forward, backward or sideways direction (randomised order), which will initiate a fall. The nudge will occur at variable (randomised) time points, so participants will not be aware of when they will fall. Participants in the motor analogy condition will be instructed to ‘land like a feather’, whereas participants in the control condition will be instructed to ‘land safely’. The primary outcome parameters are maximum impact force (normalised by mass) applied to different body segments during impact and fracture risk ratio of wrists and hips. A two-way multivariate analysis of variance will be conducted to examine differences between the motor analogy and control conditions as a function of the different variables.

The University of Waikato Human Research Ethics Committee (Health 2021#45) has granted ethical approval. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences.

Australian New Zealand Clinical Trials Registry ACTRN12621001189819. Registered on 6 September 2021.

Patients with acute congestive heart failure (HF) regularly undergo urinary catheterisation (UC) at hospital admission. We hypothesised that UC has no clinical benefits with regard to weight loss during inpatient diuretic therapy for acute congestive HF and increases the risk of urinary tract infection (UTI).

Retrospective, non-inferiority study.

Geneva University Hospitals’ Department of Medicine, a tertiary centre.

In a cohort of HF patients, those catheterised within 24 hours of diuretic therapy (n=113) were compared with non-catheterised patients (n=346).

The primary endpoint was weight loss 48 hours after starting diuretic therapy. Secondary endpoints were time needed to reach target weight, discontinuation of intravenous diuretics and resolution of respiratory failure. Complications included the time to a first UTI, first hospital readmission and death.

A total of 48-hour weight loss was not statistically different between groups and the adjusted difference was below the non-inferiority boundary of 1 kg (0.43 kg (95% CI: –0.03 to 0.88) in favour of UC, p

In this retrospective study, with no obvious hourly diuresis-based diuretic adjustment strategy, weight loss without UC was not inferior to weight loss after UC within 24 hours of initiating diuretic treatment. UC had no impact on clinical improvement and increased the risk of UTI. This evidence, therefore, argues against the systematic use of UC during a diuretic therapy for HF.

To investigate the impact of COVID-19 on the well-being of surgeons and allied health professionals as well as the support provided by their institutions.

This cross-sectional study involved distributing an online survey through medical organisations, social media platforms and collaborators.

It included all staff based in an operating theatre environment around the world.

1590 complete responses were received from 54 countries between 15 July and 15 December 2020. The average age of participants was 30–40 years old, 64.9% were men and 32.5% of a white ethnic background. 79.5% were surgeons with the remainder being nurses, assistants, anaesthetists, operating department practitioners or classified other.

Participants that had experienced any physical illness, changes in mental health, salary or time with family since the start of the pandemic as well as support available based on published recommendations.

32.0% reported becoming physically ill. This was more likely in those with reduced access to personal protective equipment (OR 4.62; CI 2.82 to 7.56; p

This work has highlighted a need and strategies to improve conditions for the healthcare workforce, ultimately benefiting patient care.

This study aims to determine the prevalence and factors associated with injuries in the adult population of Nepal.

Secondary analysis of the data from the cross-sectional WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) Survey Nepal, 2019. A multistage cluster sample of 5593 adults aged 15–69 years who have been the usual residents of the household for at least 6 months. A binary logistic regression model was employed to identify the determinants of injuries.

Data were derived from the STEPS Survey Nepal, 2019.

The primary outcome was injured person defined as one who had road traffic injuries (RTIs), had other serious unintentional/accidental injury, or had been seriously injured in a violent incident within the past 12 months. The secondary outcome measure was factors associated with injuries.

Over 11% of the 4996 study participants reported any injuries during the past 12 months. About 3.75% of the participants experienced a RTI, 4.71% had experienced unintentional injuries other than RTI, while 5.33% had been injured in violent incidents. Individuals belonging to the middle wealth quintile (crude OR (COR)=2.95, 95% CI 1.27 to 6.84) were associated with increased odds of RTIs. By occupation, homemaker (COR=0.45, 95% CI 0.24 to 0.84) was protective against these injuries. Likewise, currently married individuals (COR=3.74, 95% CI 1.37 to 10.17), ever married individuals (COR=3.49, 95% CI 1.08 to 11.25) and individuals not in employment (COR=2.13, 95% CI 1.16 to 3.91) were associated with an increased likelihood of sustaining an intentional injury. Injuries were higher among rural participants.

This study provides the baseline population-based estimates of the prevalence of injuries in Nepal. It describes the mechanisms and risk factors of these injuries. It is hoped that this evidence will serve as a stimulus for future studies to elucidate comprehensive national information about injuries.

To assess the risk of severe COVID-19 outcomes in patients with autoimmune rheumatic diseases (ARDs) and transplant recipients compared with matched general population comparators.

Population-based matched cohort study using administrative health data sets.

British Columbia, Canada.

All adults with test-positive SARS-CoV-2 infections. SARS-CoV-2-positive patients with ARDs and those with transplantation were matched to SARS-CoV-2-positive general population comparators on age (±5 years), sex, month/year of initial positive SARS-CoV-2 test and health authority.

COVID-19-related hospitalisations, intensive care unit (ICU) admissions, invasive ventilation and COVID-19-specific mortality. We performed multivariable conditional logistic regression models adjusting for socioeconomic status, Charlson Comorbidity Index, hypertension, rural address and number of previous COVID-19 PCR tests.

Among 6279 patients with ARDs and 222 transplant recipients, all SARS-CoV-2 test positive, risk of hospitalisation was significantly increased among patients with ARDs (overall ARDs (adjusted OR (aOR) 1.30; 95% CI 1.19 to 1.43)); highest within ARDs: adult systemic vasculitides (aOR 2.18; 95% CI 1.17 to 4.05) and transplantation (aOR 10.56; 95% CI 6.88 to 16.22). Odds of ICU admission were significantly increased among patients with ARDs (overall ARDs (aOR 1.30; 95% CI 1.11 to 1.51)); highest within ARDs: ankylosing spondylitis (aOR 2.03; 95% CI 1.18 to 3.50) and transplantation (aOR 8.13; 95% CI 4.76 to 13.91). Odds of invasive ventilation were significantly increased among patients with ARDs (overall ARDs (aOR 1.60; 95% CI 1.27 to 2.01)); highest within ARDs: ankylosing spondylitis (aOR 2.63; 95% CI 1.14 to 6.06) and transplantation (aOR 8.64; 95% CI 3.81 to 19.61). Risk of COVID-19-specific mortality was increased among patients with ARDs (overall ARDs (aOR 1.24; 95% CI 1.05 to 1.47)); highest within ARDs: ankylosing spondylitis (aOR 2.15; 95% CI 1.02 to 4.55) and transplantation (aOR 5.48; 95% CI 2.82 to 10.63).

The risk of severe COVID-19 outcomes is increased in certain patient groups with ARDs or transplantation, although the magnitude differs across individual diseases. Strategies to mitigate risk, such as booster vaccination, prompt diagnosis and early intervention with available therapies, should be prioritised in these groups according to risk.

When resources are strained during communicable disease outbreaks, novel palliative care interventions may be required to optimally support people who use substances with life-limiting illnesses. Therefore, we asked the question, ‘what is known about communicable disease outbreaks, palliative care and people who use substances?’, such as palliative care interventions that can improve the quality of life of patients with life-limiting illnesses.

We conducted a scoping review that involved comprehensive searches in six bibliographic databases from inception to April 2021 (Medline ALL (Medline and Epub Ahead of Print and In-Process and Other Non-Indexed Citations), Embase Classic+Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trial, PsycInfo all from the OvidSP platform, Scopus from Elsevier) and grey literature searches. We included English and French records about people ≥18 years old with life-limiting illnesses who use substances during communicable disease outbreaks. We identified, summarised and presented the findings about palliative care interventions in figures, tables and narrative descriptions.

We identified 32 records about palliative care interventions for people who use substances during communicable disease outbreaks. The majority focused on palliative care for people who use substances with AIDS during HIV epidemics (n=27, 84.4%), and approximately half were published in the USA (n=15, 46.9%). Most common substances used were alcohol (n=18, 56.3%), opioids (n=14, 43.8%) and cocaine (n=10, 31.3%). Four groups of palliative care interventions were identified: (1) symptom management (n=20, 62.5%), (2) psychosocial support (n=15, 46.9%), (3) advance care planning (n=8, 25.0%) and (4) healthcare provider training (n=6, 18.8%).

Beyond studies on HIV epidemics, there is limited knowledge about palliative care interventions for people who use substances during communicable disease outbreaks. Research and guidance are needed about how best to provide palliative care to this population with complex needs including in resource-limited countries.

Buchman DZ, Ding P, Lo S, et al. Palliative care for people who use substances during communicable disease epidemics and pandemics. BMJ Open 2021; 11: e053124

Hand signatures offer a more authentic personalisation, which carries over to a sense of trust, although are costly and time-consuming when considering large postal surveys. The objective of this study was to compare response rates when using either hand-signed or electronic-signed letters in a postal survey.

We embedded this randomised controlled trial within a national cross-sectional postal survey of emergency physicians in Canada. The survey aimed to describe current practice patterns with respect to primary headache disorders.

We randomly sampled 500 emergency physicians listed in the Scott’s Canadian Medical Directory, 2019 edition.

Using computer-generated random numbers, physicians were allocated to receiving either hand-signed (n=250) or electronic signed (n=250) letters. The initial mailout contained a US$5 Tim Hortons coffee card with the invitation letter. Four reminders were sent to non-responders every 3 weeks. The same type of signature was used for the initial invitation and subsequent reminders.

The primary outcome was the survey response rate.

Among 500 physicians invited, 32 invitations were undeliverable. Among the remaining 468 physicians, 231 had been allocated to the hand-signed group and 237 to the electronic signed group. The response rate in the hand-signed group was 87 (37.7%) vs 97 (40.9%) in the electronic-signed group (absolute difference in proportions –3.3%, 95% CI –12.1% to 5.6%).

There was no significant difference in physician response rate between hand-signed and e-signed cover letter and reminder letters. Electronic signatures should be used in future postal surveys among physicians to save on time and labour without impacting response rates.

Previous studies on transoesophageal echocardiography in coronary artery bypass grafting mainly focused on whether to change the surgical plan rather than improve the clinical prognosis. Currently, there are sparse studies on the relationship between transoesophageal echocardiography indicators and the prognosis of patients undergoing coronary artery bypass grafting. The primary aim of this study is to explore the association between transoesophageal echocardiography monitoring indicators the respiratory variability of inferior vena cava diameter, tricuspid annular plane systolic excursion and the incidence of acute kidney injury in coronary artery bypass grafting patients.

We designed this prospective multicenter cohort study, which included approximately 150 adult patients (≥18 years) undergoing elective coronary artery bypass surgery. Different hospitals will be assessed to obtain information on the prevalence, risk factors, management strategies and outcomes in coronary artery bypass surgery. The cohort will be followed after the coronary artery bypass surgery period, up to 30 days after enrolment. The incidence of postoperative acute kidney injury and baseline data will be presented by descriptive statistics. We will use Freidman inspection and multivariable logistic regression to assess the association between transoesophageal echocardiography monitoring indicators and the incidence of acute kidney injury in coronary artery bypass grafting patients.

The study has been approved by the ethics committee of Shandong Provincial Qianfoshan Hospital, China (approval number: YXLL-KY-2021(067)). This is an observational study that poses no risk to the patients. All participants will obtain informed consent according to the ethics committee before patient enrolment. Funding sources will have no influence on data handling, analyses or writing of the manuscript. The article is planned for submission in an international peer-reviewed journal.

NCT05139108.

Cardiac troponin is used as a prognostic biomarker after cardiac surgery. However, numerous confounding elements, such as inflammation, liver and renal function biomarkers, have been associated with troponin variations. Furthermore, several thresholds regarding the definition of myocardial infarction have been suggested. We aimed to confirm the accuracy of troponin, analysed as time-dependent variable, to predict mortality independently from other biomarkers; and to assess the incidence and prognosis of a 10 times upper normal value threshold (troponin_10N) used in the current fourth definition of myocardial infarction.

In a prospective cohort of patients who underwent cardiopulmonary bypass cardiac procedures, we assessed the association between serum levels of troponin, creatinine, bilirubin, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), C-reactive protein (CRP), lactate and in-hospital mortality. Several models were tested, including time-dependent Cox regression, survival and latent class analyses. Repetitive measurements were accounted for.

We included 3857 patients. In-hospital mortality was 2.8%. Troponin was independently associated with mortality in all models, after adjusting for other biomarkers. Of note, troponin_10N was reached in 3830/3857 (99.3%) of patients. Similarly, renal function was independently associated with mortality. Conversely, CRP and liver biomarkers were not associated with mortality, once adjusting for other confounders.

We confirmed that troponin increase was independently associated with mortality after cardiac surgery. This association was independent of inflammatory syndrome and renal and liver failure. Troponin_10N was reached in almost all patients, questioning the relevance of this criterion to define postoperative myocardial infarctions after cardiac surgery.

To develop and examine the prevalence of quality and safety indicators to monitor care of older Australians receiving home care packages (HCPs), a government-funded aged care programme to support individuals to live at home independently.

Cross-sectional.

Home care recipients, Australia.

90 650 older individuals (aged ≥65 years old and ≥50 years old for people of Aboriginal or Torres Strait Islander descent) who received a HCP between 1 January 2016 and 31 December 2016 nationally were included.

The Registry of Senior Australians developed 15 quality and safety indicators: antipsychotic use, high sedative load, chronic opioid use, antimicrobial use, premature mortality, home medicines reviews, chronic disease management plan, wait-time for HCP, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium/dementia-related hospitalisations, emergency department (ED) presentations and pressure injuries. Risk adjusted prevalence (%, 95% CI) and geographical area (statistical level 3) variation during 2016 were examined.

In 2016, a total of 102 590 HCP episodes were included for 90 650 individuals, with 66.9% (n=68 598) level 1–2 HCP episodes (ie, for basic care needs) and 33.1% (n=33 992) level 3–4 HCP (ie, higher care needs). The most prevalent indicators included: antibiotic use (52.4%, 95% CI 52.0 to 52.7), chronic disease management plans (38.1%, 95% CI 37.8 to 38.4), high sedative load (29.1%, 95% CI 28.8 to 29.4) and ED presentations (26.4%, 95% CI 25.9 to 26.9). HCP median wait time was 134 days (IQR 41–406). Geographical variation was highest in chronic disease management plans and ED presentations (20.7% of areas outside expected range).

A comprehensive outcome monitoring system to monitor the quality and safety of care and variation for HCP recipients was developed. It provides a pragmatic, efficient and low burden tool to support evidence-based quality and safety improvement initiatives for the aged care sector.