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Statins used for secondary prevention in patients with stroke reduce the risk of further ischaemic strokes and cardiovascular events

Por: Hill · J. · Hare · M.

Commentary on: Tramacere, I, Boncoraglio, GB, Banzi, R, et al. Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis. BMC Med 2019;17:67. doi:10.1186/s12916-019-1298-5.

Implications for practice and research

  • The secondary use of statins is effective in reducing the absolute risk of ischaemic stroke and cardiac events in patients who previously have had an ischaemic stroke or transient ischaemic attack (TIA).

  • Further research is required to ascertain which statin is the most effective.

  • Context

    Stroke is one of the major causes of worldwide death and disability, with one in four people predicted to experience a stroke within their lifetime.1 After a stroke or a TIA, there remains a substantial long-term risk of recurrent stroke.2 It is recommended that statins should be used to reduce the risk of recurrent stroke...

    Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study

    Por: Rawal · L. B. · Kharel · C. · Yadav · U. N. · Kanda · K. · Biswas · T. · Vandelanotte · C. · Baral · S. · Abdullah · A. S.
    Background/objective

    The increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal.

    Design

    We used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders’ consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically.

    Setting

    Data were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level.

    Participants

    We conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6).

    Results

    The CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation.

    Conclusion

    Engaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW’s capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal.

    The experience of school‐aged children with hospitalisation

    Abstract

    Aims and objectives

    This study intended to contribute to the improvement of nursing care for both children and their parents and aimed to identify the best and worst experiences of school‐aged children during hospitalisation.

    Background

    Child hospitalisation has traditionally been studied from the parent's perspective, but studies in which the child is the subject are scarce and mainly focus on to the hospitalisation experiences.

    Design

    A cross‐sectional, observational and descriptive exploratory design was used, and STROBE reporting guidelines were followed.

    Methods

    A paper survey was applied by the primary researcher within a 3 months period to 252 children. It presented two open‐ended statements: ‘In my opinion the best thing about the hospital is …’ and ‘In my opinion the worst thing about the hospital is…’. The study was submitted and approved by the national data protection commission and also by the ethics committees of each of the six institutions where the study was undertaken. Informed consent was also obtained from children and parents.

    Results

    Answers were analysed through content analysis. Five categories were identified for each of the open‐ended statements. Children identified ‘people’, ‘physical environment’, ‘activities’, ‘outcomes’ and ‘food’ as best experiences. The worst experiences included: ‘feelings’, ‘activities’, ‘food’, ‘environment’ and ‘outcomes’.

    Conclusions

    The results allowed the identification of the children's most valued aspects of hospitalisation.

    Relevance to Clinical Practice

    The results should be considered by healthcare professionals in order to make the hospitalisation experience more positive from the perspective of the school‐aged children.

    Containment of Antibiotic REsistance--measures to improve antibiotic use in pregnancy, childbirth and young children (CAREChild): a protocol of a prospective, quasiexperimental interventional study in Lao PDR

    Por: Machowska · A. · Sihavong · A. · Eriksen · J. · Vongsouvath · M. · Marrone · G. · Sychareun · V. · Hanson · C. · Keohavong · B. · Brauner · A. · Mayxay · M. · Kounnavong · S. · Lundborg · C. S.
    Introduction

    Antibiotics are essential to treat infections during pregnancy and to reduce both maternal and infant mortality. Overall use, but especially non-indicated use, and misuse of antibiotics are drivers of antibiotic resistance (ABR). High non-indicated use of antibiotics for uncomplicated vaginal deliveries is widespread in many parts of the world. Similarly, irrational use of antibiotics is reported for children. There is scarcity of evidence regarding antibiotic use and ABR in Lao PDR (Laos). The overarching aim of this project is to fill those knowledge gaps and to evaluate a quality improvement intervention. The primary objective is to estimate the proportion of uncomplicated vaginal deliveries where antibiotics are used and to compare its trend before and after the intervention.

    Methods and analysis

    This 3-year, prospective, quasiexperimental study without comparison group includes a formative and interventional phase. Data on antibiotic use during delivery will be collected from medical records. Knowledge, attitudes and reported practices on antibiotic use in pregnancy, during delivery and for children, will be collected from women through questionnaires. Healthcare providers’ knowledge, attitudes and practices of antibiotics administration for pregnant women, during delivery and for children, will be collected via adapted questionnaires. Perceptions regarding antibiotics will be explored through focus group discussions with women and individual interviews with key stakeholders. Faecal samples for culturing of Escherichia coli and Klebsiella spp. and antibiotic susceptibility testing will be taken before, during and 6 months after delivery to determine colonisation of resistant strains. The planned intervention will comprise training workshops, educational materials and social media campaign and will be evaluated using interrupted time series analysis.

    Ethics and dissemination

    The project received ethical approval from the National Ethics Committee for Health Research, Ministry of Health, Laos. The results will be disseminated via scientific publications, conference presentations and communication with stakeholders.

    Trail registration number

    ISRCTN16217522; Pre-results.

    Implementation of a comprehensive surveillance system for recording suicides and attempted suicides in rural India

    Por: Vijayakumar · L. · Pathare · S. · Jain · N. · Nardodkar · R. · Pandit · D. · Krishnamoorthy · S. · Kalha · J. · Shields-Zeeman · L.
    Introduction

    WHO reports that 78 of the 140 low-income and middle-income countries (LMICs) do not have a registration system for suicides and attempted suicides. Absence of data on suicide and attempted suicide in LMICs, which account for 79% of suicides worldwide, is a major impediment in understanding the magnitude of the problem and formulating prevention strategies to reduce suicide and self-harm. A comprehensive surveillance system has the potential to address this data gap. The objective of this study is to describe the development of a comprehensive surveillance system in rural India by adding a community based component and reflect on its added value in obtaining data on suicide and attempted suicide compared with relying only on hospital and police records.

    Method

    The comprehensive system consists of three components. Community surveillance involved collecting information on suicides and attempted suicides from third party key informants such as village heads, teachers, priests, shopkeepers, private physicians, private hospitals and community health workers. The second component consisted of data from public health facilities. The final component consisted of suicide data from police records. Information was collected for a period of 12 months from August 2018 to July 2019 from 116 villages (population 377 276) in Gujarat, India.

    Results

    An average of 710 community informants were interviewed each month (mean: 6.72 informants per village). The community surveillance system identified 67 cases of suicide compared with 30 cases by hospital and police records (Cochran’s Q test 67.9 p

    Discussion

    This is the first report of implementing a large-scale comprehensive surveillance system for suicide and attempted suicide in a LMIC. The combination of community surveillance system and official data from hospital and police records addresses the problem of under-reporting of suicide and suicide attempts in India and other LMIC.

    New graduate nurses’ clinical competence: A mixed methods systematic review 新毕业护士的临床能力:混合方法的系统回顾

    Abstract

    Aim

    To appraise and synthesize evidence of empirical studies reporting assessment of new graduate nurses’ clinical competence in clinical settings.

    Design

    Mixed methods systematic review.

    Data sources

    The search strategy included keywords relevant to: new graduate nurse; clinical competence; and competence assessment. The searched literature databases included CINAHL, MEDLINE, Embase, PsycINFO and Web of Science. The search was limited to full‐text papers in English or French, published between 2010 –September 2019.

    Review Methods

    Inclusion criteria were: 1) empirical studies; 2) detailed method and complete results sections; 3) competence assessment in clinical settings; and 4) new graduate nurses (≤24 months). Two independent reviewers screened eligible papers, extracted data and used the Mixed Methods Appraisal Tool framework for quality appraisal. Divergences were solved through discussion.

    Results

    About 42 papers were included in this review: quantitative (N = 31), qualitative (N = 7) and mixed methods (N = 4). Findings suggest that new graduate nurses exhibit a good or adequate level of competence. Longitudinal studies show a significant increase in competence from 0–6 months, but findings are inconsistent from 6‐12 months.

    Conclusion

    There are a multitude of quantitative tools available to measure clinical competence. This suggests a need for a review of their rigor.

    Impact

    No recent reviews comprehensively synthesized the findings from new graduate nurses’ clinical competence. This review has found that new graduate nurses’ competence has been mostly assessed as good, despite the expectation that they should be more competent. Longitudinal studies did not always show a significant increase in competence. These findings can help nurse educators in providing more support to new graduate nurses throughout the transition period or design improved transition programme. This review also identified quantitative tools and qualitative methods that can be used for competence assessment.

    摘要

    目标

    评价和综合报告新毕业护士在临床环境下临床能力评估的实证研究的证据。

    设计

    混合方法的系统回顾。

    数据来源

    搜索策略包括相关关键词:新毕业护士;临床能力;和能力评估。检索到的文献数据库包括护理学数据库(CINAHL)、联机医学文献分析和检索系统(MEDLINE)、荷兰医学文摘数据库(Embase)、心理学文摘(PsycINFO)和科学网(Web of Science)。搜索范围仅限于2010年至2019年9月期间出版的英文或法文的全文论文。

    评审方法

    入选标准为:1) 实证研究;2)详细的方法和完整的结果部分;3)临床环境中的能力评估;以及4)新毕业护士(工作2年内)。两位独立审稿人筛选出符合条件的论文,提取数据,并使用混合方法评价工具框架进行质量评价。通过讨论解决分歧。

    结果

    本文中共收录42篇论文:定量方法(N=31篇)、定性方法(N=7篇)和混合方法(N=4篇)。研究发现显示,新毕业护士表现出良好或足够的临床能力水平。纵向研究显示,工作0‐6个月的能力有显著提高,但工作6‐12个月内的能力研究发现不相一致。

    结论

    可用于衡量临床能力的定量工具有很多。这表明有必要重新审视这些工具的严谨性。

    影响

    近期的评价并未全面综合新毕业护士临床能力的研究发现。本评价发现,新毕业护士的能力大部分被评估为良好,尽管他们的能力被寄予更高的预期。纵向研究并不总能显示其能力有显著提升。这些发现有助于护理教育工作者在过渡期为新毕业护士提供更多的支持,或设计更完善的过渡方案。本评价还确定了可用于能力评估的定量工具和定性方法。

    Patient‐reported experience measures are essential to improving quality of care for chronic wounds: An international qualitative study

    Abstract

    Traditional quality measures for chronic wounds have focused on objective outcomes that are challenging to risk adjust, lack patient input, and have limited ability to inform quality improvement interventions. Patient‐reported experience measures (PREMs) provide information from the patient perspective regarding health care quality and have potential to improve patient‐centredness, increase care efficiency, and generate actionable data for quality improvement. The purpose of this study was to understand patient experiences and health care processes that impact quality of care among patients with chronic wounds. Sixty patients at least 18 years of age with various wound aetiologies were recruited from Canada, Denmark, The Netherlands, and the United States as part of a larger phase 1 qualitative study to develop a patient‐reported outcome measure for chronic wounds (WOUND‐Q). All patients had a chronic wound for at least 3 months, were fluent in their native speaking language, and able to participate in a one‐on‐one semi‐structured interview. Interviews were digitally recorded and transcribed verbatim. Interpretive description was used to identify recurrent themes relating to patient experience and quality of care. We identified five domains (care coordination, establishing/obtaining care, information delivery, patient‐provider interaction, and treatment delivery) and 21 sub‐domains (access to patient information, interdisciplinary communication, encounter efficiency, provider availability, specialist referral, staff professionalism, travel/convenience, modality, reciprocity, understandability/consistency, accountability, continuity, credentials, rapport, appropriateness, complication management, continuity, environment/setting, equipment and supply needs, expectation, and patient‐centred) as potential opportunities to measure and improve quality of care in the chronic wound population. PREMs for chronic wounds represent an important opportunity to engage patients and longitudinally assess quality across clinical settings and providers. Future research should focus on developing PREMs to complement traditional objective and patient‐reported outcome measures for chronic wounds.

    International mixed methods study protocol to develop a patient-reported outcome measure for all types of chronic wounds (the WOUND-Q)

    Por: Klassen · A. · van Haren · E. L. · Cross · K. · Fan · K. L. · Gibbons · C. · Hoogbergen · M. M. · Longmire · N. M. · Poulsen · L. · Sorensen · J. A. · Squitieri · L. · Tsangaris · E. · van Alphen · T. C. · van Dishoeck · A.-M. · Vasilic · D. · Pusic · A. L.
    Introduction

    Most patient-reported outcome measures (PROM) for chronic wounds are specific to a single wound type (eg, pressure ulcer) or part of the body. A barrier to outcome assessment in wound care and research is the lack of a rigorously designed PROM that can be used across wound types and locations. This mixed method study describes the protocol for an international collaboration to develop and validate a new PROM called the WOUND-Q for adults with chronic wounds.

    Methods and analysis

    In phase I, the qualitative approach of interpretive description is used to elicit concepts important to people with wounds regarding outcome. Participants from Canada, Denmark, the Netherlands, and the USA are aged 18 years and older and have a wound that has lasted 3 months or longer. Interviews are digitally recorded, transcribed and coded. A conceptual framework and preliminary item pool are developed from the qualitative dataset. Draft scales are formed to cover important themes in the conceptual framework. These scales are refined using feedback from people with chronic wounds and wound care experts. After refinement, the scales are translated into Danish and Dutch, following rigorous methods, to prepare for an international field-test study. In phase II, data are collected in Canada, Denmark, the Netherlands, and the USA. An international sample of people with a large variety of chronic wounds complete the WOUND-Q. Rasch Measurement Theory analysis is used to identify the best subset of items to retain for each scale and to examine reliability and validity.

    Ethics and dissemination

    This study is coordinated at Brigham and Women’s Hospital (Boston, USA). Ethics board approval was received at each participating site for both study phases. Findings will be published in peer-reviewed journals and presented at national and international conferences and meetings.

    Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis

    Por: Wijn · S. R. W. · Rovers · M. M. · Rongen · J. J. · Osteras · H. · Risberg · M. A. · Roos · E. M. · Hare · K. B. · van de Graaf · V. A. · Poolman · R. W. · Englund · M. · Hannink · G.
    Introduction

    Arthroscopic partial meniscectomy (APM) after degenerative meniscus tears is one of the most frequently performed surgeries in orthopaedics. Although several randomised controlled trials (RCTs) have been published that showed no clear benefit compared with sham treatment or non-surgical treatment, the incidence of APM remains high. The common perception by most orthopaedic surgeons is that there are subgroups of patients that do need APM to improve, and they argue that each study sample of the existing trials is not representative for the day-to-day patients in the clinic. Therefore, the objective of this individual participant data meta-analysis (IPDMA) is to assess whether there are subgroups of patients with degenerative meniscus lesions who benefit from APM in comparison with non-surgical or sham treatment.

    Methods and analysis

    An existing systematic review will be updated to identify all RCTs worldwide that evaluated APM compared with sham treatment or non-surgical treatment in patients with knee symptoms and degenerative meniscus tears. Time and effort will be spent in contacting principal investigators of the original trials and encourage them to collaborate in this project by sharing their trial data. All individual participant data will be validated for missing data, internal data consistency, randomisation integrity and censoring patterns. After validation, all datasets will be combined and analysed using a one-staged and two-staged approach. The RCTs’ characteristics will be used for the assessment of clinical homogeneity and generalisability of the findings. The most important outcome will be the difference between APM and control groups in knee pain, function and quality of life 2 years after the intervention. Other outcomes of interest will include the difference in adverse events and mental health.

    Ethics and dissemination

    All trial data will be anonymised before it is shared with the authors. The data will be encrypted and stored on a secure server located in the Netherlands. No major ethical concerns remain. This IPDMA will provide the evidence base to update and tailor diagnostic and treatment protocols as well as (international) guidelines for patients for whom orthopaedic surgeons consider APM. The results will be submitted for publication in a peer-reviewed journal.

    PROSPERO registration number

    CRD42017067240.

    Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period 出院后近期由家访护士发现的儿科临床及社会问题

    Abstract

    Aim

    To describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge.

    Design

    Analysis of nursing documentation generated as part of a randomized controlled trial evaluating the effect of a nurse home visit on healthcare re‐use.

    Methods

    We analysed home visit records of 651 children (age <18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial. Registered nurses documented concerns in structured fields and free‐text notes in visit records. Descriptive statistics were used to summarize visit documentation. Free‐text visit notes were reviewed and exemplars illustrative of quantitative findings were selected.

    Results

    Overall, nurses documented at least one concern in 56% (N  = 367) of visits. Most commonly, they documented concerns about medication safety (15% or 91 visits). Specifically, in 11% (N  = 58) of visits nurses were concerned that caregivers lacked a full understanding of medications and in 8% (N  = 49) of visits families did not have prescribed discharge medications. Pain was documented as present in 9% of all visits (N  = 56). Nurses completed referrals to other providers/services in 12% of visits (N  = 78), most frequently to primary care providers. In 13% of visits (N  = 85) nurses documented concerns considered beyond the immediate scope of the visit related to social needs such as housing and transportation.

    Conclusion

    Inpatient and community nurses and physicians should be prepared to reconcile and manage discharge medications, assess families’ medication administration practices and anticipate social needs after paediatric discharge.

    Impact

    Little empirical data are available describing concerns manifesting immediately after paediatric hospital discharge.

    Concerns about medication safety were most frequent followed by concerns related to housing and general safety.

    The results are important for clinicians preparing children and families for discharge and for community clinicians caring for discharged children.

    目的

    描述出院后96小时内出现的儿科出院后问题。

    设计

    分析作为随机对照试验的一部分生成的护理文档,评估护士家访对再利用医疗护理的影响。

    方法

    我们对2015年和2016年在中西部某大型儿童医院住院的651名儿童(十八岁以下)的家庭探访记录进行分析。注册护士在结构化字段中记录问题,并在探访记录中提供自由文本笔记。采用描述性统计方法对探访记录进行总结。对自由文本探访笔记进行评估,并挑选了说明定量研究结果的样本。

    结果

    总体来看,在56%的探访中(N =367),护士记录了至少一个问题。最常见的情况是,他们记录了对药物安全性的担忧(15%或91次探访)。具体来说,在11%的探访中(N =58),护士担忧照护人员缺乏对药物的全面了解,在8%的探访中(N =49),未对访问家庭开出院用药。在所有探访中,9%(N =56)记录有疼痛情况。护士在12%的探访中完成了转诊给其他医疗服务提供者/医疗服务机构(N =78),其中最常见的是转诊给初级医疗服务提供者。在13%的探访(N =85)中,护士记录了在探访即时范围之外考虑的与住房和交通等社会需求有关的问题。

    结论

    住院部及社区护士、医师应做好出院药物的协调和管理工作,评估家庭用药行为,并预测从儿科部出院后的社会需求。

    影响

    很少有经验数据可用于描述儿科医院出院后立即出现的问题。药物安全性相关担忧问题最多,其次是对住房和一般安全性的担忧问题。本项研究结果对临床医生使儿童和家庭做好出院准备以及社区医生照顾出院儿童具有重要意义。

    Knowledge acquisition and retention following Saving Childrens Lives course for healthcare providers in Botswana: a longitudinal cohort study

    Por: Meaney · P. A. · Joyce · C. L. · Setlhare · S. · Smith · H. E. · Mensinger · J. L. · Zhang · B. · Kalenga · K. · Kloeck · D. · Kgosiesele · T. · Jibril · H. · Mazhani · L. · de Caen · A. · Steenhoff · A. P.
    Objectives

    Millions of children die every year from serious childhood illnesses. Most deaths are avertable with access to quality care. Saving Children’s Lives (SCL) includes an abbreviated high-intensity training (SCL-aHIT) for providers who treat serious childhood illnesses. The objective of this study was to examine the impact of SCL-aHIT on knowledge acquisition and retention of providers.

    Setting

    76 participating centres who provide primary and secondary care in Kweneng District, Botswana.

    Participants

    Doctors and nurses expected by the District Health Management Team to provide initial care to seriously ill children, completed SCL-aHIT between January 2014 and December 2016, submitted demographic data, course characteristics and at least one knowledge assessment.

    Methods

    Retrospective, cohort study. Planned and actual primary outcome was adjusted acquisition (change in total knowledge score immediately after training) and retention (change in score at 1, 3 and 6 months), secondary outcomes were pneumonia and dehydration subscores. Descriptive statistics and linear mixed models with random intercept and slope were conducted. Relevant institutional review boards approved this study.

    Results

    211 providers had data for analysis. Cohort was 91% nurses, 61% clinic/health postbased and 45% pretrained in Integrated Management of Childhood Illness (IMCI). A strong effect of SCL-aHIT was seen with knowledge acquisition (+24.56±1.94, p

    Conclusions

    aHIT for care of the seriously ill child significantly increased provider knowledge and loss of knowledge occurred over time. IMCI training did not significantly impact overall knowledge acquisition nor retention, while professional status impacted overall score and lost to follow-up impacted retention.

    Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies

    Por: Ayoub-Charette · S. · Liu · Q. · Khan · T. A. · Au-Yeung · F. · Blanco Mejia · S. · de Souza · R. J. · Wolever · T. M. · Leiter · L. A. · Kendall · C. · Sievenpiper · J. L.
    Objective

    Sugar-sweetened beverages (SSBs) are associated with hyperuricaemia and gout. Whether other important food sources of fructose-containing sugars share this association is unclear.

    Design

    To assess the relation of important food sources of fructose-containing sugars with incident gout and hyperuricaemia, we conducted a systematic review and meta-analysis of prospective cohort studies.

    Methods

    We searched MEDLINE, Embase and the Cochrane Library (through 13 September 2017). We included prospective cohort studies that investigated the relationship between food sources of sugar and incident gout or hyperuricaemia. Two independent reviewers extracted relevant data and assessed the risk of bias. We pooled natural-log transformed risk ratios (RRs) using the generic inverse variance method with random effects model and expressed as RR with 95% confidence intervals (CIs). The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system.

    Results

    We identified three studies (1 54 289 participants, 1761 cases of gout), comparing the highest with the lowest level of exposure for SSBs, fruit juices and fruits. No reports were found reporting incident hyperuricaemia. Fruit juice and SSB intake showed an adverse association (fruit juice: RR=1.77, 95% CI 1.20 to 2.61; SSB: RR=2.08, 95% CI 1.40 to 3.08), when comparing the highest to lowest intake of the most adjusted models. There was no significant association between fruit intake and gout (RR 0.85, 95% CI 0.63 to 1.14). The strongest evidence was for the adverse association with SSB intake (moderate certainty), and the weakest evidence was for the adverse association with fruit juice intake (very low certainty) and lack of association with fruit intake (very low certainty).

    Conclusion

    There is an adverse association of SSB and fruit juice intake with incident gout, which does not appear to extend to fruit intake. Further research is needed to improve our estimates.

    Trial registration number

    NCT02702375; Results.

    Counselling-based psychosocial intervention to improve the mental health of abused pregnant women: a protocol for randomised controlled feasibility trial in a tertiary hospital in eastern Nepal

    Por: Sapkota · D. · Baird · K. · Saito · A. · Rijal · P. · Pokharel · R. · Anderson · D.
    Introduction

    The strong correlation between domestic and family violence (DFV) and mental health has been well documented in studies. Pregnancy is a period when both DFV and mental distress tend to occur and/or accentuate. Although limited, available evidence from developed countries has shown continual support and education as psychological first aid that can reduce DFV and improve mental health. However, there is significantly less number of studies from resource-constrained countries; thus, there continues to be a substantial gap in knowledge and awareness regarding effective interventions for DFV.

    Methods and analysis

    A two-arm randomised trial with a nested qualitative study has been planned to assess feasibility and treatment effect estimates of a counselling-based psychosocial intervention among pregnant women with a history of abuse. A total of 140 pregnant women who meet the inclusion criteria will be recruited into the study. Block randomisation will be used to allocate women equally into two groups. The intervention group will receive a counselling session, an information booklet and continuous support by a researcher, while women in the control group will receive contact information of local support services. Feasibility measures, such as rates of recruitment, consent and retention, will be calculated. Qualitative interviews with participants and healthcare providers will explore the acceptability and usability of the intervention. Outcome measures, such as psychological distress, quality of life, social support and self-efficacy, will be measured at baseline, 4 weeks postintervention and 6 weeks postpartum.

    Ethics and dissemination

    This study has obtained ethical approval from the Griffith University Human Research Ethics Committee, the Nepal Health Research Council and the Institutional Review Board of a tertiary hospital in Dharan, Nepal. The findings will be disseminated via peer-reviewed publications and conference presentations and will be used to inform a future multicentre trial.

    Trial registration number

    12618000307202; Pre-results.

    Evaluating 3D-printed models of coronary anomalies: a survey among clinicians and researchers at a university hospital in the UK

    Por: Lee · M. · Moharem-Elgamal · S. · Beckingham · R. · Hamilton · M. · Manghat · N. · Milano · E. G. · Bucciarelli-Ducci · C. · Caputo · M. · Biglino · G.
    Objective

    To evaluate the feasibility of three-dimensional (3D) printing models of coronary artery anomalies based on cardiac CT data and explore their potential for clinical applications.

    Design

    Cardiac CT datasets of patients with various coronary artery anomalies (n=8) were retrospectively reviewed and processed, reconstructing detailed 3D models to be printed in-house with a desktop 3D printer (Form 2, Formlabs) using white resin.

    Setting

    A University Hospital (division of cardiology) in the UK.

    Participants

    The CT scans, first and then 3D-printed models were presented to groups of clinicians (n=8) and cardiovascular researchers (n=9).

    Intervention

    Participants were asked to assess different features of the 3D models and to rate the models’ overall potential usefulness.

    Outcome measures

    Models were rated according to clarity of anatomical detail, insight into the coronary abnormality, overall perceived usefulness and comparison to CT scans. Assessment of model characteristics used Likert-type questions (5-point scale from ‘strongly disagree’ to ‘strongly agree’) or a 10-point rating (from 0, lowest, to 10, highest). The questionnaire included a feedback form summarising overall usefulness. Participants’ imaging experience (in a number of years) was also recorded.

    Results

    All models were reconstructed and printed successfully, with accurate details showing coronary anatomy (eg, anomalous coronary artery, coronary roofing or coronary aneurysm in a patient with Kawasaki syndrome). All clinicians and researchers provided feedback, with both groups finding the models helpful in displaying coronary artery anatomy and abnormalities, and complementary to viewing 3D CT scans. The clinicians’ group, who had substantially more imaging expertise, provided more enthusiastic ratings in terms of models’ clarity, usefulness and future use on average.

    Conclusions

    3D-printed heart models can be feasibly used to recreate coronary artery anatomy and enhance understanding of coronary abnormalities. Future studies can evaluate their cost-effectiveness, as well as potentially explore other printing techniques and materials.

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