Conectar
by Thomas C. Scheier, Richard Whitlock, Mark Loeb, Philip James Devereaux, Andre Lamy, Michael McGillion, MacKenzie Quantz, Ingrid Copland, Shun-Fu Lee, Dominik Mertz
Sternal surgical site infections after cardiac surgery can lead to significant morbidity, mortality, and cost. The effects of negative pressure wound management and adding vancomycin as perioperative antimicrobial prophylaxis are unknown. The PICS-PREVENA pilot/vanguard trial, a 2x2 factorial, open label, cluster-randomized crossover trial with 4 periods, was conducted at two major cardiac surgery hospitals in Ontario, Canada. Sites were randomized to one of eight sequences of the four study arms (Cefazolin or Cefazolin + Vancomycin (not analyzed) and standard wound dressing or a negative pressure 3M Prevena incision management system (Prevena). Only diabetic or obese patients were eligible for the latter comparison. This trial investigated feasability including adherence to protocol of each intervention (goal: > 90% each) and loss to follow-up (goal:by Chamberline E. Ozigbu, Zhenlong Li, Bankole Olatosi, James W. Hardin, Nicole L. Hair
While prior studies have identified sociodemographic correlates of zero-dose status within populations in sub-Saharan Africa (SSA), few have applied spatial regression techniques to explore geographic variability in these relationships. We aimed to address this gap using data from Demographic and Health Surveys conducted in SSA between 2010 and 2020. Our sample comprised children aged 12–59 months in 33 countries and 329 survey regions. Data were aggregated to the first-level administrative unit prior to analysis. First, using ordinary least squares regression, we documented global relationships between theoretically important sociodemographic characteristics and zero-dose prevalence. Next, we identified patterns, i.e., geographic clustering, of zero-dose prevalence. Finally, using multiscale geographically weighted regression, we described spatial variability in relationships between sociodemographic characteristics and zero-dose prevalence. We detected 27 regions with higher than expected concentrations of zero-dose children. All but one of these hot spots were observed in 7 Western and Central African countries; only 1 was located in an Eastern African country. Regions with higher proportions of mothers with no antenatal care visits were consistently found to have higher rates of zero-dose children. In contrast, relationships between zero-dose prevalence and indicators of religious affiliation, delivery site, maternal age, maternal education, and maternal employment were found to vary locally in terms of their strength and/or direction. Study findings underscore spatial disparities in zero-dose prevalence within SSA and, further, highlight the importance of geographically informed strategies to effectively address immunization gaps. Implementing targeted interventions based on regional sociodemographic dynamics is crucial for achieving comprehensive vaccination coverage in SSA.Cerebral palsy (CP) is the most common motor disability in children, with higher prevalence in low-income and middle-income countries (LMICs) compared with high-income countries (HICs). Children with CP (CwCP) often face significant challenges in achieving toileting independence due to motor, sensory and cognitive impairments. Parents play a pivotal role in managing these challenges, often encountering significant emotional, physical and social burdens. Despite the importance of toileting for autonomy and dignity, limited evidence exists on tailored toilet training programmes for CwCP, especially in LMICs. Understanding parental perspectives is essential to addressing these gaps and informing family-centred interventions.
This scoping review aims to explore parents’ perspectives on toileting management for CwCP, focusing on strategies, challenges and unmet needs, to inform future research and the development of supportive interventions. This scoping review will be conducted in accordance with the guidelines of the Joanna Briggs Institute and summarised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews framework. The English language full-text articles, published between January 2014 and December 2024, addressing the parental perspectives, challenges and strategies related to the task of toileting in CwCP below 18 years of age will be included. Systematic searches will be conducted through PubMed, EMBASE, CINAHL, Scopus, Web of Science and grey literature. The data will be extracted and analysed thematically using Microsoft Excel.
The present protocol has been registered in the Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/73YQZ). Ethical approval is not required, as this review uses secondary data from published studies and does not involve direct participant recruitment. The findings will synthesise themes related to parents’ strategies, challenges and expectations in toileting management for CwCP. They will help address existing literature gaps and inform the development of practical, evidence-informed toileting education programmes for parents.
by Xin Xu, Ghada Homsi, Sherry T. Liu, Jennifer M. Gaber, Naa A. Inyang, Brian L. Rostron, Caryn F. Nagler, James Nonnemaker
BackgroundIn 2022, 3.7% of U.S. adults currently smoked cigars. This study assesses cigar-smoking-attributable fractions in U.S. healthcare expenditures and associated annual healthcare expenditures overall and by payer, including publicly funded healthcare programs.
MethodsData were obtained from the 2000, 2005, 2010, and 2015–2017 National Health Interview Survey linked with corresponding panels from the Medical Expenditure Panel Survey data through 2018. The final sample (n = 53,733) was restricted to adults aged 25 + . Estimates from four-part models and data from the Personal Health Care component of the 2001–2018 National Health Expenditures Accounts were combined to estimate fractions of and annual healthcare expenditures attributable to cigar smoking. All models controlled for sociodemographic characteristics and health-related behaviors.
ResultsDuring 2001–2018, an estimated 1.8% (95% CI = 0.9%–3.4%) or $29.7 billion annually of U.S. healthcare expenditures could be attributed to cigar smoking. Most of this was funded by other third-party health insurance programs, a mix of private and public payers (e.g., Department of Veterans Affairs).
ConclusionsCigar smoking creates a preventable financial burden on the U.S. healthcare system. Health consequences associated with cigar smoking may remain after successful quitting. The findings underscore the importance of preventing initiation of cigar smoking and providing evidence-based cessation methods to reduce the health and economic burden of cigar smoking.
by Stefan Saverimuttu, Kate McInnes, Kristin Warren, Lian Yeap, Stuart Hunter, Brett Gartrell, An Pas, James Chatterton, Bethany Jackson
The ability to efficiently derive insights from wildlife necropsy data is essential for advancing conservation and One Health objectives, yet close reading remains the mainstay of knowledge retrieval from ubiquitous free-text clinical data. This time-consuming process poses a barrier to the efficient utilisation of such valuable resources. This study evaluates part of a bespoke text-mining application, DEE (Describe, Explore, Examine), designed for extracting insights from free-text necropsy reports housed in Aotearoa New Zealand’s Wildbase Pathology Register. A pilot test involving nine veterinary professionals assessed DEE’s ability to quantify the occurrence of four clinicopathologic findings (external oiling, trauma, diphtheritic stomatitis, and starvation) across two species datasets by comparison to manual review. Performance metrics—recall, precision, and F1-score—were calculated and analysed alongside tester-driven misclassification patterns. Findings reveal that while DEE (and the principals underlying its function) offers time-efficient data retrieval, its performance is influenced by search term selection and the breadth of vocabulary which may describe a clinicopathologic finding. Those findings characterized by limited terminological variance, such as external oiling, yielded the highest performance scores and the most consistency across application testers. Mean F1-scores across all tested findings and application testers was 0.63–0.93. Results highlight the utility and limitations of term-based text-mining approaches and suggests that enhancements to automatically capture this terminological variance may be necessary for broader implementation. This pilot study highlights the potential of relatively simple, rule-based text-mining approaches to derive insights natural language wildlife data in the support of One Health goals.To explore Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices.
A cross-sectional survey design.
An online survey was sent to Australian and New Zealand nursing and midwifery educators across the 45 Schools of Nursing and Midwifery between July and September 2023. The online survey consisted of 29 open- and closed-ended questions about nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices.
There was a total of 127 responses to the first open-ended question. A total of 97 nursing and midwifery educators then completed the remaining questions. While educators had mostly positive views about integrating planetary health into their teaching, they lacked the knowledge and/or confidence to do so effectively.
Australian and New Zealand nursing and midwifery educators acknowledge that planetary health should be included in nursing and midwifery curricula, but most reported a deficit in knowledge and/or confidence to integrate these complex concepts into their teaching. When considering planetary health, most educators focussed on climate change, which demonstrates their limited understanding of the concept of planetary health.
All nurses and midwives need to understand how the health of the planet and human civilization are interconnected and be prepared to address complex global health challenges now and in the future. Across the world, key healthcare organizations have called upon nursing and midwifery educators to prepare the healthcare workforce to practice in a more sustainable way, including supporting decarbonization of healthcare. However, our study has demonstrated that nursing and midwifery educators do not feel ready to respond due to a lack of required knowledge and/or confidence.
We used the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).
No patient or public contribution.
by Kazuya Takahashi, Michalina Lubiatowska, Huma Shehwana, James K. Ruffle, John A. Williams, Animesh Acharjee, Shuji Terai, Georgios V. Gkoutos, Humayoon Satti, Qasim Aziz
BackgroundThe exact mechanisms underlying paediatric abdominal pain (AP) remain unclear due to patient heterogeneity. This preliminary study aimed to identify AP phenotypes and develop predictive models to explore associated factors, with the goal of guiding future research.
MethodsIn 13,790 children from a large birth cohort, data on paediatric and maternal demographics and comorbidities were extracted from general practitioner records. Machine learning (ML) clustering was used to identify distinct AP phenotypes, and an ML-based predictive model was developed using demographics and clinical features.
Results1,274 children experienced AP (9.2%) (average age: 8.4 ± 1.1 years, male/female: 615/659), who clustered into three distinct phenotypes: Phenotype 1 with an allergic predisposition (n = 137), Phenotype 2 with maternal comorbidities (n = 676), and Phenotype 3 with minimal other comorbidities (n = 340). As the number of allergic diseases or maternal comorbidities increased, so did the frequency of AP, with 17.6% of children with ≥ 3 allergic diseases and 25.6% of children with ≥ 3 maternal comorbidities. The predictive model demonstrated moderate performance in predicting paediatric AP (AUC 0.67), showing that a child’s ethnicity, paediatric allergic diseases, and maternal comorbidities were key predictive factors. When stratified by ML-predicted probability, observed AP rates were 18.9% in the 60% group.
ConclusionsThis study identified distinct AP phenotypes and key risk factors using ML. Furthermore, the predictive ML model enabled risk stratification for paediatric AP. These analyses provide valuable insights to guide future investigations into the mechanisms of AP and may facilitate research aimed at identifying targeted interventions to improve patient outcomes.
This study aimed to gain clinician consensus on which signs/symptoms reported to be indicative of biofilm in chronic wounds are likely to be so. An international, two-round eDelphi process including wound care clinicians ran from December 2023 to February 2024. Participants rated 26 items on a 9-point Likert scale. Consensus to include: ≥ 70% of respondents rate an item 7–9, ≤ 15% rate it 1–3. Consensus to exclude: ≥ 70% of respondents rate an item 1–3, ≤ 15% rate it 7–9. Eleven items (visual indicators [a shiny, slimy, persistent layer, easily removed, returns quickly without frequent intervention]; failure to respond to antimicrobials; infection > 30 days duration; poor quality granulation tissue; stalled wound despite optimal management; persistent/prolonged inflammation; wound > 6 weeks duration; soft tissue deterioration despite antimicrobials/debridement; signs of local infection; tunnelling/undermining; presence of slough) achieved consensus to include status. To our knowledge, consensus work on this topic has not previously been performed on such a wide scale. When examined alongside similar work, clinical opinion on the matter lacks coherence. We hope that these findings will help direct us toward greater cohesiveness. The work supports a need for research to quantify the predictive abilities of signs and symptoms reported to be indicative of biofilm in chronic wounds.
Chronic limb ischemia (CLI) is a significant health issue, particularly among patients with diabetes who are at elevated risk of diabetic foot ulcers (DFU) due to peripheral neuropathy and ischemia. In Singapore, approximately one in six adults is affected by diabetes, with a lifetime risk of developing DFU ranging from 15% to 25%. This paper examines the indications, surgical techniques and postoperative protocols for transverse tibial transport (TTT), an innovative limb salvage procedure implemented in a general hospital in Singapore and presents our early experience with this technique. All six patients in our study successfully achieved limb salvage with complete wound healing, with a median healing time of 4 months. Four patients required additional wound debridement and skin coverage to facilitate healing. Importantly, none of the patients experienced pin site infections during the procedure or throughout the postoperative healing phase. Our study demonstrates favourable outcomes and underscores the clinical utility of TTT in augmenting the multimodal treatment of recalcitrant DFUs.
Delirium, a common, serious and often preventable complication in older hospitalised adults, contributes to significant health and social care costs. Carers are uniquely positioned to identify early signs and support delirium prevention. The Prevention & Early Delirium Identification Carer Toolkit (PREDICT), a novel model of care designed to educate carers about delirium management and prevention strategies, enables them to actively participate in the care and recovery of their person. Developed through a comprehensive literature review, a co-designed eDelphi and pilot study, PREDICT demonstrated acceptability and feasibility.
To evaluate the effectiveness, implementation and cost-benefit of a PREDICT in hospital settings.
A stepped-wedge cluster randomised controlled trial (SW-cRCT), consisting of a cohort study, healthcare service evaluation, and process evaluation. The study will assess carer and staff knowledge of delirium, carer care giving stress, health service outcomes (e.g., incidence, length of stay, readmissions) and cost-benefit.
PREDICT is a scalable, person-centred approach that supports both patients and carers, with the potential to embed best-practice delirium management into routine healthcare.
This study was developed in consultation with older adults, carers and healthcare staff. Two consumer representatives joined the project steering committee and contributed to shaping the research question, refining the study protocol and selecting outcome measures relevant to families and healthcare staff. Carers were involved in reviewing participant information sheets and the PREDICT website, providing feedback to ensure clarity and accessibility. Results will be shared with participants and the wider community through plain-language summaries and public presentations.
Australian and New Zealand Clinical trial: ACTRN12625000705482 registered on the 3rd of July 2025
The comparative efficacy of brief behavioral therapy for insomnia (BBTI) remains unclear.
This systematic review and network meta-analysis examined the effectiveness of different BBTI approaches and compared BBTI with other nonpharmacological interventions, such as cognitive behavioral therapy for insomnia (CBT-I).
Three databases were searched from inception to December 27, 2024. Primary outcomes were insomnia severity and sleep quality. Secondary outcomes included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and daytime sleepiness. A frequentist network meta-analysis with random-effects modeling was conducted. Heterogeneity was assessed using the I 2 statistic.
Eighteen randomized controlled trials involving 1104 participants (mean age: 52.6 years) were included. Compared with usual care, BBTI significantly reduced insomnia severity (mean difference [MD] = −4.79; 95% confidence interval [CI = −6.05, −3.53]; I 2 = 0%) and improved sleep quality (MD = −3.45; 95% CI [−4.97, −1.94]; I 2 = 0%). BBTI also shortened sleep onset latency (MD = −19.81 min; 95% CI = −30.64, −8.98; I 2 = 17%) and wake after sleep onset (MD = −15.51 min; 95% CI [−22.75, −8.27]; I 2 = 47%) and increased sleep efficiency (MD = 10.78%; 95% CI [7.67%, 13.89%]; I 2 = 8%). No significant differences were found in total sleep time or daytime sleepiness. Face-to-face BBTI and CBT-I demonstrated similar outcomes. Face-to-face BBTI ranked as the most effective approach based on the surface under the cumulative ranking curve.
Face-to-face BBTI is an optimal nonpharmacological option for improving sleep quality and efficiency and reducing insomnia severity, sleep onset latency, and wake after sleep onset.
PROSPERO number: CRD42021242589
To explore the design, development, and implementation of a peer-led community café to support people in mental health crisis from the perspectives of key stakeholders in Ireland.
Qualitative descriptive study.
Twelve individuals representing the Community Café Operations Team and Senior Healthcare Management took part in a stakeholder convening or individual interview between February and July 2023 in Ireland. Data was analysed using Burnard's thematic content analysis framework, and findings were mapped onto the RE-AIM framework. This process was supported by the involvement of a person with lived experience who had previously utilised the Community Café as a customer.
Key findings identified in relation to the design, development and implementation of the Community Café included: person centredness, co-production, alternative service provision (out-of-hours), staff supports, challenges affecting sustainability, and governance issues.
Close collaboration among healthcare services, practitioners, service users and community partners is essential in developing mental health services, prioritising co-production and person-centred service delivery. Key components include out-of-hours service provision, staff support, sustainability, and governance. By addressing these areas, healthcare systems can better meet the needs of service users on their recovery journey.
The findings generate new knowledge to inform the development of community and crisis cafes, improve service user outcomes, and support recovery. The results provide valuable insights into key stakeholder perspectives guiding the design, development, and implementation of peer-led community cafes, highlighting best practices to shape future initiatives.
The study provides valuable insights for policy makers, service developers, and care recipients by highlighting lessons learned from designing, developing, and implementing a peer-led Community Café. It showcases best practice in co-producing a peer-led service to address both service user and service needs.
We used the COREQ guidelines for reporting qualitative studies.
The study design was co-created with the Community Café Operations team, who contributed to the methods, interview schedule, and interpretation of findings. One team member (D.B.) worked in the Community Café, and a customer with lived experience of mental health difficulties helped contextualise and interpret the results.
This integrative review aims to identify what nurses currently offer through digital technology and their success in managing chronic pain.
An integrative review guided by Whittemore and Knafl was conducted.
Five databases—CINAHL, Medline, PsycINFO, PubMed, and Scopus—were utilised to gather relevant studies from January 2018 to November 2024.
Selected studies were assessed using the Mixed Methods Appraisal Tool and the Joanna Briggs Appraisal Tool. Braun and Clarke's thematic analysis was applied to identify pertinent themes.
Digital nursing technologies such as telehealth and web-based interventions effectively deliver interventions to assess and manage chronic pain; these technologies can reduce healthcare resource utilisation and increase accessibility. This review highlights that nurses commonly deliver exercise, cognitive-behavioural therapy, acceptance and commitment therapy and self-management techniques through digital technology.
This review indicates that web-based interventions and telemedicine are the primary digital technologies employed by nurses for chronic pain management providing psychosocial interventions, with evidence supporting their effectiveness. Digital and web-based technology is essential to bridge healthcare access gaps as nurses can provide this successfully with minimal nursing support and cost to the patient.
Evidence supports nurses in providing psychosocial interventions for the management of chronic pain, particularly web-based psychosocial interventions. Nurses need to adopt digital technology to improve access to care and patient outcomes and to maintain professional development in an increasingly digital world.
No patient or public contribution was used for this study.
The management of diabetic foot ulcers in patients with peripheral artery disease remains challenging. Human placenta-derived cells (PDA-002), a mesenchymal stromal cell-like population obtained from full-term placental tissue, possess angiogenic and tissue regenerative properties. Participants were stratified based on peripheral artery disease status. A total of 159 individuals were randomly assigned to receive intramuscular PDA-002 at one of three doses (3 × 106, 10 × 106 and 30 × 106 cells) or a placebo. This Phase 2 multi-center, randomised, double-blind, placebo-controlled trial evaluated adults with chronic diabetic foot ulcers with and without peripheral artery disease. The primary efficacy endpoint was the proportion of participants achieving complete wound closure of the index ulcer within 3 months, with sustained closure maintained for an additional 4 weeks. PDA-002 was well-tolerated, with no treatment-related serious adverse events. Intramuscular PDA-002 treatment achieved the highest efficacy at the 3 × 106 cell dose within the peripheral artery disease subgroup (38.5% vs. 22.6% for placebo), meeting a stringent 4-week durability endpoint that surpassed the U.S. Food and Drug Administration's recommended 2-week sustainability criterion. PDA-002 shows promise as a breakthrough treatment for diabetic foot ulcers and peripheral artery disease, demonstrating efficacy with two intramuscular doses and no re-treatment.
Trial Registration: ClinicalTrials.gov identifier: NCT # 02264288
School feeding programmes (SFPs) are widely implemented to address child poverty, food insecurity and malnutrition, yet evidence on their influence on children’s health outcomes is limited. With ongoing debate around universal versus targeted provision, this scoping review aims to map global literature on SFPs, identify which health and well-being outcomes are reported, and explore how these outcomes vary by programme type (targeted vs universal).
Scoping review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was pre-registered on the Open Science Framework.
Four electronic databases—Medline, PubMed, Web of Science and Google Scholar—were searched in December 2023 and July 2025. Reference lists of included papers were also screened.
Included studies examined the impact of SFPs on physical, emotional, psychological and social health outcomes in children aged 5–16. Only English-language studies published between 2009 and 2025 were included.
Data were extracted using a structured template and reviewed by multiple authors. Due to the heterogeneity in study designs and reported outcomes, a narrative synthesis approach was used to group findings thematically, following established guidance for narrative synthesis in systematic reviews.
A total of 44 papers were included in the final review, spanning 13 countries and published between 2009 and 2025. SFPs were associated with healthier weight status, improved dietary intake, better social engagement and reductions in stigma. Targeted programmes addressed food insecurity but were more often linked to stigma and poorer mental health outcomes.
Universal SFP were effective at improving children’s health outcomes such as healthy weight, improved behaviour and social support. Overall, both targeted and universal SFP positively impact children’s health outcomes and address health disparities.
by Catarina Simões, Diana S. Vasconcelos, Raquel Xavier, Xavier Santos, Catarina Rato, D. James Harris
Fire has long been recognized as an important ecological and evolutionary force in plant communities, but its influence on vertebrate community ecology, particularly regarding predator-prey interactions, remains understudied. This study reveals the impact of wildfires on the diet of Podarcis lusitanicus, a lizard species inhabiting a fire-prone region in the Iberian Peninsula. In order to explore diet variability associated with different local burn histories, we evaluated P. lusitanicus diet across three types of sites in Northern Portugal: those had not burned since 2016, those burned in 2016, and those more recently burned in 2022. Podarcis lusitanicus is a generalist arthropod predator with dietary flexibility. Given the turnover of arthropod species after fire, it is expected to find variations in diet caused by different fire histories, especially between unburned and recently burned sites. From DNA metabarcoding of faecal samples, our study revealed that while prey richness remained unaffected by wildfire regime, significant shifts occurred in diet composition between more recently burned and unburned areas. Specifically, we found that differences in diet composition between these two fire regimes were due to the presence of Tapinoma ants and jumping spiders (Salticus scenicus). These prey were present in the diets of lizards occupying unburned areas, while these were absent in areas burned in 2022. Interestingly, diets in unburned areas and areas burned in 2016 showed no significant differences, highlighting the lizards’ ecological flexibility and the habitat’s resilience over time. The ant species T. topitotum was found in dominance in both burned areas, suggesting that this species may be fire tolerant. In addition, families such as Cicadellidae and Noctuidae were found to be more associated with more recently burned areas. The use of DNA metabarcoding in this study was essential to provide a more detailed and accurate view of predator-prey interactions in ecosystems susceptible to fire, and therefore a better understanding of changes in prey consumption in this fire-adapted ecosystem.The aim of this study was to develop a conceptual understanding of the role of caring for older adults with combined vision and hearing impairment (DSI).
Dual sensory impairment (DSI) impacts both listening and speechreading communication, function and social participation, meaning that older adults often require support and care to ‘age in place’ successfully. Family carers play a key role in supporting older adults with DSI to maintain social and physical health.
This qualitative study uses Charmaz's constructivist grounded theory (GT) methodology. Data were collected between 2017 and 2019 and analysed using constructivist GT methods. Lengthy interviews with eight family carers of older adults living with DSI explored personal histories of DSI, relationships with families, social networks and health care professionals.
This study demonstrates that caring in this context is predominantly social and ‘invisible’. To reduce the social effort of their family member with DSI and to maintain their own self-identity, family carers adopted a ‘conscious caring’ approach. This is conceptualised as an approach to caring that supports family carers to access resources embedded in their social networks by bridging the gap between the dyad and their broader, more diverse social networks.
This study identifies that a reduction in both close and broader social networks limits personal, social and psychosocial resources and impacts the capacity of the dyad to renegotiate their roles, create and maintain their individual and shared social networks and successfully transition to living with DSI.
There is a gap in the literature regarding the impact of sensory impairments on complex communication, health and social care needs of older adults and the role that family carers play. Registered nurses require complex communication skills to support older persons with DSI during health and social care interactions. A better understanding of DSI itself, as well as understanding the key role family carers play in integrating care for their family member, is crucial to delivering person-centred care.
This study addresses a growing social gerontological issue and identifies the role that family carers play in integrating health and social care for their family member with DSI. Better professional recognition of DSI and increased visibility of the challenges of living with DSI could help address barriers to effective communication between service providers, formal care support staff and those with DSI. Integrating family carers into care teams is critical to improving health and social care experiences for both caregiver and care receiver.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore multiprofessional views about system-wide factors influencing (impeding or facilitating) the delivery of stroke mechanical thrombectomy (MT) services and/or improvements to this pathway in England.
A pragmatic exploratory qualitative study using online focus groups and semi-structured interviews with National Health Service (NHS) professionals and those working in a stroke strategic/policy lead role. We thematically analysed the data using the Framework Approach to understand participants’ views on the challenges to improving current and future MT implementation.
NHS trusts and other key stroke strategic/policy organisations covering 10 geographical regions in England and a national perspective.
A total of 29 professionals, working in an NHS clinical and managerial position and/or a stroke strategic national/regional clinical/policy lead role, participated in five focus groups and six individual semi-structured interviews between April and June 2024.
We identified five themes relating to MT implementation progress and challenges (1) workforce, (2) clinical care pathways, (3) service/system, (4) cross-cutting theme: communications and (5) cross-cutting theme: culture. Our analysis emphasised the increasing complexity and inter-related factors shaping the emergency stroke pathway for MT provision and a need to acknowledge key people-related, organisational and sociocultural factors during service planning.
Despite the challenges and complexity, professionals were optimistic that further progress would be made with MT delivery in England. However, ongoing improvement strategies are required, which also acknowledge wider cultural factors and system-wide relationships and are not just focused on care pathways and resources.
This study aimed to analyse the number of myocardial infarction (MI) admissions during the COVID-19 lockdown periods of 2020 and 2021 (March 15th to June 15th) and compare them with corresponding pre-pandemic period in 2019. The study also evaluated changes in critical treatment intervals: onset to door (O2D), door to balloon (D2B) and door to needle (D2N) and assessed 30-day clinical outcomes. This study examined MI care trends in India during the COVID-19 lockdown period, irrespective of patients’ COVID-19 infection status.
Multicentre retrospective cohort study
Twenty-three public and private hospitals across multiple Indian states, all with 24/7 interventional cardiology facilities.
All adults (>18 years) admitted with acute myocardial infarction between March 15 and June 15 in 2019 (pre-pandemic), 2020 (first lockdown) and 2021 (second lockdown). A total of 3614 cases were analysed after excluding duplicates and incomplete data.
Number of MI admissions, median O2D, D2B and D2N times.
30-day outcomes including death, reinfarction and revascularisation.
MI admissions dropped from 4470 in year 2019 to 2131 (2020) and 1483 (2021). The median O2D increased from 200 min (IQR 115–428) pre-COVID-19 to 390 min (IQR 165–796) in 2020 and 304 min (IQR 135–780) in 2021. The median D2B time reduced from 225 min (IQR 120–420) in 2019 to 100 min (IQR 53–510) in 2020 and 130 min (IQR 60–704) in 2021. Similarly, D2N time decreased from 240 min (IQR 120–840) to 35 min (IQR 25–69) and 45 min (IQR 24–75), respectively. The 30-day outcome of death, reinfarction and revascularisation was 4.25% in 2020 and 5.1% in 2021, comparable to 5.8% reported in the Acute Coronary Syndrome Quality Improvement in Kerala study.
Despite the expansion of catheterisation facilities across India, the country continues to fall short of achieving international benchmarks for optimal MI care.
by Esther Ba-Iredire, James Atampiiga Avoka, Luke Abanga, Abigail Awaitey Darkie, Emmanuel Junior Attombo, Eric Agboli
IntroductionThe alarming rate of drug-resistant tuberculosis (DR-TB) globally is a threat to treatment success among positive tuberculosis (TB) cases. Studies aimed at determining the prevalence, trend of DR-TB and socio-demographic and clinical risk factors contributing to DR-TB in the four regions of Ghana are currently unknown. This study sought to determine the prevalence and trend of DR-TB, identify socio-demographic and clinical risk factors that influence DR-TB, and analyse the relationship between underweight and adverse drug reactions and treatment outcomes among DR-TB patients in four regions of Ghana.
MethodIt was a retrospective review conducted over 5 years, from January 2018 to the end of December 2022. The data were retrieved from the DR-TB registers and folders at the Directly Observed Treatment (DOT) centres in the four regions. Analysis of the data was conducted using STATA version 17.
ResultsThe prevalence of DR-TB in Ashanti was 10.1%, Eastern 5.3%, 27.8% in Central, and 2.7% in the Upper West region for the year 2022. The overall prevalence rate of DR-TB for the period 2018–2022 was 13.8%. The socio-demographic and clinical risk factors that influence DR-TB in the four regions are: age, marital status (aOR 3.58, P-value Conclusion
The study shows that the prevalence of DR-TB in Ghana is low, probably not because the cases have reduced but due to inadequate GeneXpert machines to detect the cases. Age, marital status, education, alcohol intake, previously treated TB cases, adverse drug reactions, underweight, and treatment outcome are factors influencing the development of DR-TB. Therefore, interventions aimed at improving the nutritional status of DR-TB cases and minimising adverse drug reactions will improve treatment outcomes.
FreshRSS 