Conectar
by Elizabeth Baguley, Madelyn Knaub, Jessica VanDyke, Gideon Hirschfield, Mark G. Swain, Gail Wright, Deirdre McCaughey, Abdel Aziz Shaheen
Pandemic restrictions impacted healthcare, particularly during the first year. We evaluated the impact of the pandemic on quality of life and clinical care among patients with primary biliary cholangitis (PBC). This mixed-methods study administered quality of life surveys (Fear of COVID-19 Scale [FCV-19S], EuroQol 5-dimension 3-level [EQ-5D-3L], 29-item Patient-Reported Outcomes Measurement Instrument Survey [PROMIS-29]) and a PBC Care Delivery questionnaire to 348 Canadian PBC patients, followed by two focus groups with patients (n = 14) and stakeholders (n = 3). Quality of life scores were compared among sub-groups (i.e., care delays and pandemic appointment type) and with various reference populations. Most participants were female (94.0%) and Caucasian (88.2%), with a median age of 63.0 years (IQR: 55.9–71.2). During the pandemic, 75.8% had the majority (≥ 50%) of their hepatologist appointments virtually, but only 22.4% preferred to continue with virtual care post-pandemic. Participants with care delays had worse scores on the FCV-19S (p = 0.014), EQ-5D-3L (p = 0.009), and PROMIS-29 (i.e., fatigue, anxiety, sleep disturbance, ability to participate in social roles and activities, p pThis study aimed to identify intraoperative and perioperative factors influencing 30-day mortality after cardiac surgery and to develop a risk score (POP-score) for its prediction.
Retrospective cohort study with multivariable regression analysis.
A tertiary care cardiac surgery centre in Austria; data from consecutive patients undergoing cardiac surgery between 2010 and 2020 were analysed.
A total of 8072 patients were included. The cohort was randomly divided into a derivation cohort (75%) and a validation cohort (25%).
The primary outcome measure was 30-day mortality. We analysed associations between intraoperative and perioperative variables and 30-day mortality, assessed via multivariable regression analysis.
Several factors were significantly associated with 30-day mortality, including intraoperative RBC transfusion (OR 3.407 (95% CI 2.124–5.464)), postoperative high-sensitive cardiac troponin T cut-off levels (OR 2.856 (95% CI 1.958 to 4.165)), need for dialysis/haemofiltration (OR 2.958 (95% CI 2.013 to 4.348)) and temporary extracorporeal membrane oxygenation support (OR 5.218 (95% CI 3.329 to 8.179)) (p
The validated POP-score provides an improved tool for predicting 30-day mortality after cardiac surgery by incorporating intraoperative and perioperative factors alongside the EuroSCORE II. Although model performance was evaluated using 7-day peak troponin data, the score can be calculated within the first 72 hours postoperatively in most patients, supporting its clinical applicability for early decision-making, resource allocation and patient counselling. Further research is warranted to assess its clinical utility in diverse populations.
Parkinson’s disease is the second most prevalent neurodegenerative disease worldwide, with up to 70% of patients exhibiting freezing of gait (FOG). FOG is defined as transient episodes when one is unable to effectively engage in the stepping process (despite the intention to walk), which decreases or completely ceases forward movement. Although several FOG triggers have been identified, eliciting FOG remains challenging in research, hindering progress in research and therapy. Virtual reality (VR) offers a promising approach to evoke FOG during overground walking by combining environmental and neuropsychological triggers. This project aims to validate an existing open-source VR-FOG toolbox that integrates multiple triggers.
A within-subject repeated measures crossover study design with a 1-hour washout period will be used for this project to validate the VR-FOG toolbox. This will consist of three blocks (baseline non-VR, VR non-FOG and VR-FOG). All participants will first complete a baseline walking trial without VR, then be randomised to either the VR non-FOG environment—a virtual replica of the laboratory—or the VR-FOG environment containing multiple virtual FOG triggers. After a 1-hour washout period, they will complete the remaining VR condition. A crossover design will minimise ordering effects of VR conditions on FOG frequency and duration. Twenty participants with Parkinson’s disease with FOG will be tested at St. Pölten University of Applied Sciences (Austria) and 20 at the University of Exeter (UK) and will be recruited from local communities. Multisite testing will verify that the VR-FOG environment triggers FOG regardless of testing location.
Ethical approval was obtained from the Lower Austrian Ethics Commission and the University of Exeter review boards. All data will be anonymised, used solely for this project and securely stored in General Data Protection Regulation-compliant repositories. Study results will be presented at scientific conferences and published in peer-reviewed journals.
To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries.
Systematic review.
Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023.
Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions.
The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions.
Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented.
Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals.
These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives.
This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
No patient or public contribution.
Trial Registration: CRD42023413817
To evaluate the implementation of the Transitional Care Model (TCM), an evidence-based, advanced practice registered nurse-led multi-component intervention, as part of a randomised controlled trial during the first year of the COVID-19 pandemic.
Parallel convergent mixed-methods approach.
Data for this study were collected between June 2020 and February 2021. Data from 78 patients who received the intervention and 68 recorded meetings with system leaders and clinical teams were analysed using descriptive statistics, directed content analysis, and joint display.
Fidelity to delivery of elements of the TCM components was variable, with the Hospital-to-Home visit elements having the widest range (14.3%–100%) and Maintaining Relationships elements having the highest range (97.3%–98.6%). There were 27 identified challenges and 15 strategies for implementing the TCM with fidelity during the pandemic.
The COVID-19 pandemic impacted all aspects of the delivery of the TCM across all sites. This historical event highlighted the need for services and support for patients and caregivers transitioning from the hospital to home.
Evidence-based solutions are needed to enhance healthcare delivery and patient outcomes. Findings will guide nurses in implementing proven transitional care interventions.
Findings will inform the implementation and scaling of transitional care and other evidence-based interventions across diverse healthcare settings.
GRAMMS reporting guidelines.
No patient or public contribution.
ClinicalTrials.gov identifier: NCT04212962. https://www.clinicaltrials.gov/study/NCT04212962?titles=NCT04212962&rank=1
Leishmaniasis poses a significant public health problem in Kenya, where effective case management and treatment rely on accurate diagnosis. This review aims to summarise the research landscape on leishmaniasis diagnostics in Kenya and identify gaps.
This scoping review expands a previously published scoping review on leishmaniasis in Kenya to further analyse studies focusing on diagnostics. The field of diagnostics was chosen because of recent pushes for novel tools and because of the role timely diagnosis plays in disease elimination. A comprehensive search of PubMed, Embase via Embase.com, Web of Science Core Collection, the Cochrane Library, ClinicalTrials.gov, WHO ICTRP and the Pan African Clinical Trials Registry was conducted, covering studies up to 5 January 2024.
After dual, blind screening with conflict resolution by a third reviewer, 41 studies were included in the review. These studies examined a range of diagnostic tools; however most were assessed in one or few studies, and none evaluated real-time PCR. Additional gaps in the research landscape include a lack of diagnostics for cutaneous leishmaniasis and post-kala-azar dermal leishmaniasis in Kenya, outdated literature surrounding the Direct Agglutination Test and randomised trials for any diagnostic tool.
Future research should focus on solidifying the validity and reliability of diagnostic tools in the Kenyan context and updating previous work.
Vector control is imperative for eliminating leishmaniasis as a public health problem in Kenya. As elimination efforts expand in East Africa, it is crucial to understand the current research landscape. To address that need and identify gaps, a scoping review was conducted to characterise the landscape of leishmaniasis vector research in Kenya.
Building on a previously published scoping review by this team, we updated database searches in PubMed, Embase via Embase.com, Web of Science Core Collection, the Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) and the Pan African Clinical Trials Registry to incorporate literature up to 4 January 2024 and focused on vector-related papers. Studies classified as ‘prevention’ in the original scoping review were included due to overlapping definitions.
A total of 95 studies were included in the analysis. Although a wide range of sandfly species have been documented, most of the research is outdated, having taken place 20–40 years ago. Existing studies are mostly epidemiological with little focus on basic and clinical research. There are also no studies on post-kala-azar dermal leishmaniasis despite its potential contribution to the disease transmission cycle. The geographical scope of the research is largely limited to traditional transmission foci with little attention to new disease hotspots such as North Eastern Kenya.
These research gaps need to be addressed to better inform the country’s leishmaniasis prevention and vector control strategy.
Frontotemporal lobar degeneration (FTLD) is the second most common early-onset dementia. Several studies demonstrated that neuroinflammation and iron accumulation occur in FTLD. However, the timing and relevance of these processes and whether these two are merely cause or consequence remains unclear. Elucidating the role is crucial to assess the rationale for using anti-inflammatory therapies in FTLD. Additionally, the process of glymphatic brain clearance has gained attention as a potential contributor in the disease pathophysiology.
In this multimodal biomarker study, we use a combination of ultra-high field (7T) MR, blood and cerebrospinal fluid (CSF) biomarkers to investigate the role of neuroinflammation, iron accumulation and brain clearance in FTLD, and to identify biomarkers to differentiate FTLD-TDP from FTLD-tau. We aim to include 25 patients with probable FTLD-tau, 25 with probable FTLD-TDP and 50 healthy individuals with 50% risk to develop FTLD. We will use several MRI techniques, including magnetic resonance spectroscopy, diffusion weighted spectroscopy and quantitative susceptibility mapping. In addition, we will assess the prevalence of perivascular spaces (PVS) and the mobility of CSF to address glymphatic brain clearance. We will compare quantitative MR markers between patients with FTLD-tau and FTLD-TDP, presymptomatic mutation carriers and healthy controls, and correlate these measures with clinical data and biomarkers in blood and CSF.
We obtained ethical approval from the Medical Ethics Committee Leiden Den Haag Delft (NL78272.058.21). The results will be disseminated through presentations at national and international conferences, open-access peer-reviewed publications, ClinicalTrials.gov and to the public through social media posts and annual newsletters.
Objetivo: evaluar la calidad de vida de los cuidadores de niños con necesidades especiales de salud. Método: estudio cuantitativo, en una Unidad de Pediatría, con 16 madres de niños con necesidades especiales de salud. La recolección de datos se produjo mediante la aplicación del instrumento WHOQOL-bref. Para el análisis de los datos se utilizó la estadística descriptiva e inferencial. Resultados: la calidad de vida de los familiares cuidadores es influenciada por los aspectos físicos; psicológica; del medio ambiente y de las relaciones sociales. Conclusiones: la percepción general de la calidad de vida de estos cuidadores no puede considerarse satisfactoria, ya que los valores asociados a todos los ámbitos son relativamente bajos.
FreshRSS 