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Pimentel MAF, Johnson A, Darbyshire JL, Tarassenko L, Clifton DA, Walden A, Rechner I, Watkinson PJ, Young JD. Development of an enhanced scoring system to predict ICU readmission or in-hospital death within 24 hours using routine patient data from two NHS Foundation Trusts. BMJ Open 2024; 14:e074604. [PMID: 38609314 PMCID: PMC11029184 DOI: 10.1136/bmjopen-2023-074604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 03/05/2024] [Indexed: 04/14/2024] Open
Abstract
RATIONALE Intensive care units (ICUs) admit the most severely ill patients. Once these patients are discharged from the ICU to a step-down ward, they continue to have their vital signs monitored by nursing staff, with Early Warning Score (EWS) systems being used to identify those at risk of deterioration. OBJECTIVES We report the development and validation of an enhanced continuous scoring system for predicting adverse events, which combines vital signs measured routinely on acute care wards (as used by most EWS systems) with a risk score of a future adverse event calculated on discharge from the ICU. DESIGN A modified Delphi process identified candidate variables commonly available in electronic records as the basis for a 'static' score of the patient's condition immediately after discharge from the ICU. L1-regularised logistic regression was used to estimate the in-hospital risk of future adverse event. We then constructed a model of physiological normality using vital sign data from the day of hospital discharge. This is combined with the static score and used continuously to quantify and update the patient's risk of deterioration throughout their hospital stay. SETTING Data from two National Health Service Foundation Trusts (UK) were used to develop and (externally) validate the model. PARTICIPANTS A total of 12 394 vital sign measurements were acquired from 273 patients after ICU discharge for the development set, and 4831 from 136 patients in the validation cohort. RESULTS Outcome validation of our model yielded an area under the receiver operating characteristic curve of 0.724 for predicting ICU readmission or in-hospital death within 24 hours. It showed an improved performance with respect to other competitive risk scoring systems, including the National EWS (0.653). CONCLUSIONS We showed that a scoring system incorporating data from a patient's stay in the ICU has better performance than commonly used EWS systems based on vital signs alone. TRIAL REGISTRATION NUMBER ISRCTN32008295.
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Affiliation(s)
| | - Alistair Johnson
- Institute of Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | | | - David A Clifton
- Department of Engineering Science, University of Oxford, Oxford, UK
| | | | - Ian Rechner
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - J Duncan Young
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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O'Sullivan O, Ladlow P, Haswell C, Southern F, Barker-Davies R. Cardiopulmonary exercise testing of an individual with a unilateral transfemoral amputation. BMJ Mil Health 2024:e002628. [PMID: 38316461 DOI: 10.1136/military-2023-002628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - C Haswell
- Complex Trauma, DMRC Stanford Hall, Loughborough, UK
| | - F Southern
- Prosthetics Department, DMRC Stanford Hall, Loughborough, UK
| | - R Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
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Houston AD, Brunger H, White T, Ellis H, Dharm-Datta S, Brockman K, Ladlow P. Introducing heart rate variability technology into the UK defence mild traumatic brain injury service. BMJ Mil Health 2024; 170:78-79. [PMID: 35584851 DOI: 10.1136/bmjmilitary-2022-002113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Andrew David Houston
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - H Brunger
- Neurorehabilitation Unit, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - T White
- Neurorehabilitation Unit, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - H Ellis
- Neurorehabilitation Unit, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - S Dharm-Datta
- Neurorehabilitation Unit, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - K Brockman
- Neurorehabilitation Unit, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
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Edwards CM, Adamo KB. History of childbirth as a potential risk factor for musculoskeletal injury in military personnel. BMJ Mil Health 2023:e002620. [PMID: 38053284 DOI: 10.1136/military-2023-002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Affiliation(s)
| | - K B Adamo
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Zhao X, Zuo L. Multicentre, observational, retrospective cohort of hyperkalaemia burden at haemodialysis facility-level in China: the Visualize-HD study protocol. BMJ Open 2023; 13:e066394. [PMID: 37734899 PMCID: PMC10514616 DOI: 10.1136/bmjopen-2022-066394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/13/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES Hyperkalaemia is a potentially life-threatening disorder in patients undergoing haemodialysis (HD). Excess mortality and hospitalisation have been associated with hyperkalaemia (HK) after the long (2-day) interdialytic interval (LIDI) in patients on thrice a week HD compared with the short (1-day) interdialytic interval. Moreover, not much research has been conducted in China on the descriptive epidemiology and management of HK among different HD centres. The aim of this study is to address this evidence gap by investigating the risk factors associated with HK clinical burden at the HD facility level, current HD centres management patterns, serum potassium management patterns, as well as the risk factors associated with crude mortality in China. DESIGN Multicentre, observational, retrospective cohort study. SETTING This study plans to enrol 300 HD centres across China. Haemodialysis centres having ≥100 patients on maintenance HD within 3 years before study initiation, with participation willingness, routine blood collection post-LIDI and death records will be included. PARTICIPANTS Patients aged ≥18 years and on chronic HD for ≥3 months will be considered eligible. Summary data about serum potassium, characteristics of patients, facility practice patterns will be collected at HD facility level and death records will be at the patient level. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome will be to examine the association between suspected risk factors and HK prevalence at HD facility level. Suspected risk factors include dialysis prescriptions and serum potassium testing frequency, characteristics of patients and related medication usage. The secondary outcome will be to determine the HK prevalence, serum potassium management pattern and risk factors associated with crude mortality. The primary and secondary outcomes will be analysed using regression models. Exploratory outcomes will further investigate the risk factors associated with serum potassium ≥6.0 and ≥6.5 mmol/L. CONCLUSION The study is expected to provide insights to improve dialysis practice patterns and understand the clinical burden of HK. ETHICS AND DISSEMINATION This study protocol was reviewed and approved by the Institutional Review Boards and Ethics Committee of Peking University People's Hospital (Approval number: 2020PHB324-01). The results will be disseminated through national and international presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05020717.
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Affiliation(s)
- Xinju Zhao
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
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Edginton S, Kruger N, Stelfox HT, Brochard L, Zuege DJ, Gaudet J, Solverson KJ, Robertson HL, Fiest KM, Niven DJ, Bagshaw SM, Parhar KKS. Methods for determination of optimal positive end-expiratory pressure: a protocol for a scoping review. BMJ Open 2023; 13:e071871. [PMID: 37527894 PMCID: PMC10401233 DOI: 10.1136/bmjopen-2023-071871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Titrated application of positive end-expiratory pressure (PEEP) is an important part of any mechanical ventilation strategy. However, the method by which the optimal PEEP is determined and titrated varies widely. Methods for determining optimal PEEP have been assessed using a variety of different study designs and patient populations. We will conduct a scoping review to systematically identify all methods for determining optimal PEEP, and to identify the patient populations, outcomes measured and study designs used for each method. The goal will be to identify gaps in the optimal PEEP literature and identify areas where there may be an opportunity to further systematically synthesise and meta-analyse existing literature. METHODS AND ANALYSIS Using scoping review methodology, we will generate a comprehensive search strategy based on inclusion and exclusion criteria generated using the population, concept, context framework. Five different databases will be searched (MEDLINE, EMBASE, CENTRAL, Web of Science and Scopus). Three investigators will independently screen titles and abstracts, and two investigators will independently complete full-text review and data extraction. Included citations will be categorised in terms of PEEP method, study design, patient population and outcomes measured. The methods for PEEP titration will be described in detail, including strengths and limitations. ETHICS AND DISSEMINATION Given this is a synthesis of existing literature, ethics approval is not required. The results will be disseminated to stakeholders via presentation at local, regional and national levels, as well as publication in a high-impact critical care journal. There is also the potential to impact local clinical care protocols and inform broader clinical practice guidelines undertaken by societies.
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Affiliation(s)
- Stefan Edginton
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Natalia Kruger
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Henry Tom Stelfox
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Laurent Brochard
- Interdepartmental Division of Critical Care, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Department of Critical Care, Keenan Research Centre and Li Ka Shing Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Danny J Zuege
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Jonathan Gaudet
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kevin J Solverson
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Helen Lee Robertson
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel J Niven
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sean M Bagshaw
- Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Ken Kuljit S Parhar
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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Moeinzadeh F, Babahajiani M, Seirafian S, Mansourian M, Mortazavi M, Shahidi S, Vahdat S, Saleki M. Assessing physical inactivity as a risk factor for chronic kidney diseases in Iranian population. BMJ Open 2023; 13:e070360. [PMID: 37286321 DOI: 10.1136/bmjopen-2022-070360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Physical inactivity is a major adjustable lifestyle risk factor in renal patients; nevertheless, research on the association of physical activity (PA) with chronic kidney disease (CKD) is unclear. DESIGN Cross-sectional. SETTING We evaluated the secondary care related to the nephrology specialists. PARTICIPANTS We evaluated PA in 3374 Iranian patients with CKD aged ≥18 years. Exclusion criteria were current or prior kidney transplantation, dementia, institutionalisation, expected to start renal replacement therapy or leave the area within study duration, participation in a clinical trial or inability to undergo the informed consent process. PRIMARY AND SECONDARY OUTCOME The renal function parameters were measured and compared with PA, assessed by the Baecke questionnaire. Estimated glomerular filtration rate, haematuria and/or albuminuria were used to estimate decreased kidney function and the incidence of CKD. To estimate the relationship between PA and CKD, we used the multinomial adjusted regression models. RESULTS In the first model, findings indicate that the patients with the lowest PA score had significantly higher odds of CKD (OR 1.44, 95% CI 1.16 to 1.78; p=0.01), adjustment for age and sex attenuated this relationship (OR 1.25, 95% CI 1.56 to 1.78, p=0.04). Furthermore, adjusting for low-density lipoprotein, high-density lipoprotein, triglyceride, fasting blood glucose, body mass index, waist circumference, waist/hip ratio, coexisting diseases and smoking made this relationship insignificant (OR 1.23, 95% CI 0.97 to 1.55; p=0.076). After adjusting for potential confounders, we found that patients with lower PA have higher odds of CKD stage 2 (OR 1.62, 95% CI 1.13 to 2.32; p=0.008), no association with other CKD stages. CONCLUSION These data suggest that physical inactivity contributes to the risk of early CKD, so encouraging patients with CKD to maintain higher PA levels could be used as a simple and useful tool to decrease the risk of disease progression and its related burden.
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Affiliation(s)
- Firouzeh Moeinzadeh
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
| | - Media Babahajiani
- Student Research Committee, Vice Chancellor for Research and Technology, Kurdistan University of Medical Sciences, Sanandaj, Iran (the Islamic Republic of)
| | - Shiva Seirafian
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
| | - Marjan Mansourian
- Epidemiology and Biostatics Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
| | - Mojgan Mortazavi
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
| | - Shahrzad Shahidi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
| | - Sahar Vahdat
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
| | - Mohammad Saleki
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
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Maher JL, Whitmarsh C, Smith P, Taylor H, Fard A, Bilzon J. Feasibility study of high-intensity interval training to reduce cardiometabolic disease risks in individuals with acute spinal cord injury. BMJ Open 2023; 13:e068507. [PMID: 36737096 PMCID: PMC9900054 DOI: 10.1136/bmjopen-2022-068507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Individuals ageing with spinal cord injury (SCI) experience an accelerated trajectory of diseases and disorders, such as cardiovascular disease and diabetes, that resemble those experienced with ageing alone. Currently, an evidence-based approach toward managing this problem does not exist and therefore the purpose of this study is to determine the feasibility of conducting a high-intensity exercise intervention in individuals with acute (<6 months postinjury) SCI to improve cardiometabolic health. METHODS AND ANALYSIS We will conduct a single-centre, two parallel-arm, randomised feasibility study of a high-intensity interval training (HIIT) intervention in individuals with acute SCI. We will enrol 40 individuals (20 intervention, 20 control) with acute SCI attending inpatient rehabilitation at Salisbury District Hospital. Participants will be randomly allocated to the intervention group (HIIT) or control group for 18 weeks. Both groups will participate in standard care throughout the duration of the study. The HIIT group only will also perform supervised HIIT exercise on an arm cycle ergometer three times per week. Over the course of the intervention, most participants will be discharged from the hospital, and at this time, an arm cycle ergometer will be installed in their home and the intervention will transition into outpatient care. We will assess cardiorespiratory fitness, glycaemic control, lipid profile and body habitus as well as qualitative assessments of acceptability at weeks 0, 9 and 18 with the primary outcome being the feasibility of a full Randomised Controlled Trial (RCT). ETHICS AND DISSEMINATION This study will inform a longer-term, definitive, multicentre RCT to establish the impact of this exercise intervention in maintaining the cardiometabolic health of patients during the acute phase following SCI. Results will be disseminated in different formats including peer-reviewed journal articles, conference presentations and internet media, to a wide audience including clinicians, researchers and individuals with SCI. TRIAL REGISTRATION NUMBER ISRCTN57514022.
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Affiliation(s)
| | - Catherine Whitmarsh
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Paula Smith
- Department of Psychology, University of Bath, Bath, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Aram Fard
- Duke of Cornwall Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
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Pei W, He T, Yang P, Lv X, Jiao B, Meng F, Yan Y, Cui L, He G, Zhou X, Wen G, Ruan J, Lu L. Acupuncture combined with cognitive-behavioural therapy for insomnia (CBT-I) in patients with insomnia: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e063442. [PMID: 36585134 PMCID: PMC9809230 DOI: 10.1136/bmjopen-2022-063442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Insomnia affects physical and mental health due to the lack of continuous and complete sleep architecture. Polysomnograms (PSGs) are used to record electrical information to perform sleep architecture using deep learning. Although acupuncture combined with cognitive-behavioural therapy for insomnia (CBT-I) could not only improve sleep quality, solve anxiety, depression but also ameliorate poor sleep habits and detrimental cognition. Therefore, this study will focus on the effects of electroacupuncture combined with CBT-I on sleep architecture with deep learning. METHODS AND ANALYSIS This randomised controlled trial will evaluate the efficacy and effectiveness of electroacupuncture combined with CBT-I in patients with insomnia. Participants will be randomised to receive either electroacupuncture combined with CBT-I or sham acupuncture combined with CBT-I and followed up for 4 weeks. The primary outcome is sleep quality, which is evaluated by the Pittsburgh Sleep Quality Index. The secondary outcome measures include a measurement of depression severity, anxiety, maladaptive cognitions associated with sleep and adverse events. Sleep architecture will be assessed using deep learning on PSGs. ETHICS AND DISSEMINATION This trial has been approved by the institutional review boards and ethics committees of the First Affiliated Hospital of Sun Yat-sun University (2021763). The results will be disseminated through peer-reviewed journals. The results of this trial will be disseminated through peer-reviewed publications and conference abstracts or posters. TRIAL REGISTRATION NUMBER CTR2100052502.
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Affiliation(s)
- Wenya Pei
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Te He
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Pei Yang
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Xiaozhou Lv
- Department of Traditional Chinese Medicine, Zhongshan School of Medicine, Sun Yat-senUniversity, Guangzhou, China
| | - Boyu Jiao
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fanqi Meng
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yingshuo Yan
- Department of Respiratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liqian Cui
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzho, China
| | - Guanheng He
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Zhou
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guihua Wen
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Jingwen Ruan
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liming Lu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Oh RC, Bury DC, McClure CJ. Exertional rhabdomyolysis: an analysis of 321 hospitalised US military service members and its relationship with heat illness. BMJ Mil Health 2022:e002028. [PMID: 36442890 DOI: 10.1136/military-2021-002028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Exertional rhabdomyolysis is a syndrome of muscle breakdown following exercise. This study describes laboratory and demographic trends of service members hospitalised for exertional rhabdomyolysis and examines the relationships with heat illness. METHODS We queried the US Armed Forces Health Surveillance Center's Defence Medical Epidemiology Database for hospitalised cases of rhabdomyolysis associated with physical exertion from January 2010 July 2013. Descriptive statistics reported means and medians of initial, peak and minimal levels of creatine kinase (CK). Correlations explored the relationship between CK, creatinine, length of hospital stay (LOS) and demographic data. RESULTS We analysed 321 hospitalised cases of exertional rhabdomyolysis. 193 (60.1%) cases were associated with heat; 104 (32.4%) were not associated with heat; and 24 (7.5%) were classified as medical-associated exertional rhabdomyolysis. Initial, maximum and minimal CK levels were significantly lower in heat cases: CK=6528 U/L vs 19 247 U/L, p=0.001; 13 146 U/L vs 22 201 U/L, p=0.03; and 3618 U/L vs 10 321 U/L, p=0.023) respectively, compared with cases of rhabdomyolysis with exertion alone. Median LOS was 2 days (range=0-25). In the rhabdomyolysis with exertion alone group and the rhabdomyolysis with heat group, LOS was moderately correlated with maximal CK (Spearman's ρ=0.52, p<0.001, and Spearman ρ=0.38, p<0.001, respectively). There was no significant difference in median LOS between the rhabdomyolysis with exertion alone and rhabdomyolysis associated with heat groups (2 vs 2, p value=0.96). CONCLUSION Most hospitalisations for exertional rhabdomyolysis were associated with heat illness and presented with lower CK levels than cases without associated heat illness. These data add evidence that rhabdomyolysis with heat illness is a different entity than rhabdomyolysis with exertion alone. Differentiating exertional rhabdomyolysis with and without heat should inform future research on rhabdomyolysis prognosis and clinical management.
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Affiliation(s)
- Robert C Oh
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Family Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - D C Bury
- Department of Pathology and Clinical Science Education, Mercer University School of Medicine, Columbus, Georgia, USA
| | - C J McClure
- Desmond T. Doss Health Clinic, 25th Infantry Division, Schofield Barracks, Hawaii, USA
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Chatterjee T, Bhattacharyya D, Yadav A, Pal M. Quantification of physiological and mental workloads of faster and slower finishers of a long-distance military training activity. BMJ Mil Health 2022:e002154. [PMID: 36283744 DOI: 10.1136/military-2022-002154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Long-distance runs with equipment are practised in military training establishments to develop physical stamina and prepare for battles. A study was planned to quantify and compare the physiological and mental workloads of the early and late finishers of a military endurance run through the jungle terrain of north-eastern India in hot and humid conditions. METHODS Twenty-five soldiers of the Indian Army completed a 15 km run through a rural and jungle track with 6.5 kg of equipment. Twelve participants who finished the race before 130 min were categorised as 'early finishers', and 13 were categorised as 'late finishers' who finished the race after 130 min. Physiological parameters, viz., heart rate (HR), breathing rate (BR), estimated core temperature (ECT), peak acceleration (PAC), and physiological intensity (PHYI) and mechanical intensity (MECHI) were recorded using BioHarness V.3 (Zephyr Technologies, USA) and NASA Task Load Index scores were obtained to assess mental workload. Mann-Whitney U test was applied to assess the level of significance at a p value of <0.05. RESULTS HR, ECT and PAC were significantly higher (167.9 and 156.0 beats/min, 39.0℃ and 38.4℃, and 1.1 and 1.0 g, respectively) for the first group compared with the second group. The second group expressed higher BR and subjective responses ('total scores' were 76.5 and 82.5, respectively) than the first. The PHYI was significantly higher (from 7.2 to 6.3) for the first group, whereas the MECHI was similar in both groups. CONCLUSION The successful completion by the first group can be attributed to their motivation to continue heavy work in an adverse environment, and their ability to negotiate with natural obstacles was reflected through controlled subjective responses. Adoption of a possible safe and stable approach to the same task might have led the second group to take a longer duration, exert higher mental effort and demand lower physiological cost.
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Affiliation(s)
- Tirthankar Chatterjee
- Ergonomics, DRDO Defence Institute of Physiology and Allied Sciences, New Delhi, Delhi, India
| | - D Bhattacharyya
- Ergonomics, DRDO Defence Institute of Physiology and Allied Sciences, New Delhi, Delhi, India
| | - A Yadav
- Ergonomics, DRDO Defence Institute of Physiology and Allied Sciences, New Delhi, Delhi, India
| | - M Pal
- Ergonomics, DRDO Defence Institute of Physiology and Allied Sciences, New Delhi, Delhi, India
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Chu H, Jang BH, Kim G, Bae S, Lee H, Nam S, Ahn J. Comparative effectiveness of bisphosphonate treatments for the prevention of re-fracture in glucocorticoid-induced osteoporosis: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e062537. [PMID: 36167395 PMCID: PMC9516213 DOI: 10.1136/bmjopen-2022-062537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Long-term usage of glucocorticoids results in a loss of bone mass and a higher risk of fracture, and the most common cause of secondary osteoporosis is glucocorticoid-induced osteoporosis (GIOP). For preventing GIOP, bisphosphonate (BP) is widely used. However, analysis on BP's effect on the prevention of re-fracture is insufficient. The purpose of the present study is to evaluate the comparative treatment effect and prevention of re-fracture according to the type of BP in GIOP as the basis for a reliable clinical strategy for patients. METHODS AND ANALYSIS We will search electronic databases of the PubMed, Cochrane Library and EMBASE using a comprehensive search strategy in December 2021 with no language restriction. Randomised controlled trials (RCTs), quasi-RCTs, controlled trials and cohort studies evaluating the effectiveness of BP to the patients with GIOP will be included in this study. The primary outcome will be the incidence of hip, vertebral and other fractures. The secondary outcome will include percentage changes on the bone mineral density and incidence of re-fracture. Assessing risk of bias for included studies is done using the Cochrane Risk of Bias tool and Risk Of Bias In Non-randomized Studies-of Intervention tool. If quantitative synthesis is possible, a meta-analysis will be performed. A subgroup analysis will be conducted to compare re-fracture rate on the patients with GIOP who experience previous fractures. This study's result will provide evidence for the effectiveness of BP in the prevention of re-fracture on patients with GIOP. ETHICS AND DISSEMINATION The results will be disseminated through publishing in a peer-reviewed journal or public presentations. Ethical approval is not required as this is a systematic review of publicly available data. PROSPERO REGISTRATION NUMBER CRD42022343787.
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Affiliation(s)
- Hongmin Chu
- Daecheong Public Health Subcenter, Ongjin Public Health Center, Incheon, Korea (the Republic of)
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, Kyung Hee University College of Korean Medicine, Dongdaemun-gu, Seoul, Korea (the Republic of)
| | - GaYoon Kim
- Department of Health Convergence, Ewha Womans University, Seoul, Korea (the Republic of)
| | - Seowoo Bae
- National Cancer Control Institute, National Cancer Center, Goyang, Korea (the Republic of)
| | - Hyeju Lee
- Department of Health Convergence, Ewha Womans University, Seoul, Korea (the Republic of)
| | - Seonghee Nam
- Department of Health Convergence, Ewha Womans University, Seoul, Korea (the Republic of)
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea (the Republic of)
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Zhao Y, Teh JJ, Kung V, Mallappa S. Bowel ischaemia in COVID-19 infection: a scoping review protocol. BMJ Open 2022; 12:e060566. [PMID: 36153022 PMCID: PMC9511006 DOI: 10.1136/bmjopen-2021-060566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION COVID-19 disease was declared as a pandemic by WHO since March 2020 and can have a myriad of clinical presentations affecting various organ systems. Patients with COVID-19 are known to have an increased risk of thromboembolism, including cardiovascular, pulmonary and cerebral ischaemic events. However, an increasing number of case studies have reported that COVID-19 infection is also associated with gastrointestinal ischaemia. This scoping review aims to collate the current evidence of COVID-19-related gastrointestinal ischaemia and raise awareness among healthcare professionals of this lesser known, but serious, non-pulmonary complication of COVID-19 infection. METHODS The proposed scoping review will be conducted as per the Arksey and O'Malley methodological framework (2005) the Joanna Briggs Institute methodology for scoping reviews. A systematic search will be undertaken on different databases including EMBASE, PubMed and MEDLINE. Two independent reviewers will screen titles, abstracts and full-text articles according to the inclusion criteria and extract relevant data from the included articles. Results will be presented in a tabular form with a narrative discussion. ETHICS AND DISSEMINATION Ethical approval will not be required for this scoping review. This scoping review will provide an extensive overview of the association between COVID-19 infection and bowel ischaemia. Further ethical and methodological challenges will also be discussed in our findings to define a new research agenda. Findings will be disseminated through peer-reviewed publications and presentations at both national and international conferences.
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Affiliation(s)
- Yi Zhao
- Imperial College London, London, UK
| | - Jhia Jiat Teh
- Imperial College London, London, UK
- General and Colorectal Surgery, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Victor Kung
- Department of Colorectal Surgery, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Sreelakshmi Mallappa
- General and Colorectal Surgery, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
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Ware LJ, Maposa I, Kolkenbeck-Ruh A, Norris SA, Soepnel L, Crouch S, Kagura J, Naidoo S, Smith W, Davies J. Are cardiovascular health measures heritable across three generations of families in Soweto, South Africa? A cross-sectional analysis using the random family method. BMJ Open 2022; 12:e059910. [PMID: 36153021 PMCID: PMC9511591 DOI: 10.1136/bmjopen-2021-059910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Cardiovascular disease is increasing in many low and middle-income countries, including those in Africa. To inform strategies for the prevention of cardiovascular disease in South Africa, we sought to determine the broad heritability of phenotypic markers of cardiovascular risk across three generations. DESIGN A cross-sectional study conducted in a longitudinal family cohort. SETTING Research unit within a tertiary hospital in a historically disadvantaged, large urban township of South Africa. PARTICIPANTS 195 individuals from 65 biological families with all three generations including third-generation children aged 4-10 years were recruited from the longest running intergenerational cohort study in Africa, the Birth to Twenty Plus cohort. All adults (grandparents and parents) were female while children were male or female. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was heritability of blood pressure (BP; brachial and central pressures). Secondary outcomes were heritability of arterial stiffness (pulse wave velocity), carotid intima media thickness (cIMT) and left ventricular mass indexed to body surface area (LVMI). RESULTS While no significant intergenerational relationships of BP or arterial stiffness were found, there were significant relationships in LVMI across all three generations (p<0.04), and in cIMT between grandparents and parents (p=0.0166). Heritability, the proportion of phenotypic trait variation attributable to genetics, was estimated from three common statistical methods and ranged from 23% to 44% for cIMT and from 21% to 39% for LVMI. CONCLUSIONS Structural indicators of vascular health, which are strong markers of future clinical cardiovascular outcomes, transmit between generations within African families. Identification of these markers in parents may be useful to trigger assessments of preventable risk factors for cardiovascular disease in offspring.
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Affiliation(s)
- Lisa J Ware
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Andrea Kolkenbeck-Ruh
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Larske Soepnel
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Simone Crouch
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juliana Kagura
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Sanushka Naidoo
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Justine Davies
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
- Wallenberg Research Centre at Stellenbosch University, Stellenbosch Institute for Advanced Study, Stellenbosch, South Africa
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Francoeur C, Hornby L, Silva A, Scales NB, Weiss M, Dhanani S. Paediatric death after withdrawal of life-sustaining therapies: a scoping review protocol. BMJ Open 2022; 12:e064918. [PMID: 36123110 PMCID: PMC9486282 DOI: 10.1136/bmjopen-2022-064918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The physiology of dying after withdrawal of life-sustaining measures (WLSM) is not well described in children. This lack of knowledge makes predicting the duration of the dying process difficult. For families, not knowing this process's duration interferes with planning of rituals related to dying, travel for distant relatives and emotional strain during the wait for death. Time-to-death also impacts end-of-life care and determines whether a child will be eligible for donation after circulatory determination of death. This scoping review will summarise the current literature about what is known about the dying process in children after WLSM in paediatric intensive care units (PICUs). METHODS AND ANALYSIS This review will use Joanna Briggs Institute methodology for scoping reviews. Databases searched will include Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials via EBM Reviews Ovid, Ovid PsycINFO, CINAHL and Web of Science. Literature reporting on the physiology of dying process after WLSM, or tools that predict time of death in children after WLSM among children aged 0-18 years in PICUs worldwide will be considered. Literature describing the impact of prediction or timing of death after WLSM on families, healthcare workers and the organ donation process will also be included. Quantitative and qualitative studies will be evaluated. Two independent reviewers will screen references by title and abstract, and then by full text, and complete data extraction and analysis. ETHICS AND DISSEMINATION The review uses published data and does not require ethics review. Review results will be published in a peer-reviewed scientific journal.
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Affiliation(s)
- Conall Francoeur
- Department of Pediatrics, Centre de recherche du CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
| | - Laura Hornby
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Amina Silva
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Matthew Weiss
- Department of Pediatrics, Centre de recherche du CHU de Quebec-Universite Laval, Quebec, Quebec, Canada
- Transplant Québec, Quebec, Québec, Canada
- Canadian Donation and Transplantation Research Program, Ottawa, Ontario, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplantation Research Program, Ottawa, Ontario, Canada
- Critical Care, CHEO, Ottawa, Ontario, Canada
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Grylka-Baeschlin S, Gross MM, Mueller AN, Pehlke-Milde J. Development and validation of a tool for advising primiparous women during early labour: study protocol for the GebStart Study. BMJ Open 2022; 12:e062869. [PMID: 35760537 PMCID: PMC9237887 DOI: 10.1136/bmjopen-2022-062869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pregnant women experience early labour with different physical and emotional symptoms. Early admission to hospital has been found to be associated with increased intervention and caesarean section rates. However, primiparous women often contact the hospital before labour progresses because they encounter difficulties coping with symptoms of onset of labour on their own. An evidence-based instrument for assessing the individual needs to advise primiparous women during early labour is currently missing. The study aims to develop and validate a tool to inform the joint decision for or against hospital admission. METHODS AND ANALYSIS A scale development and validation study will be conducted including following steps: (1) Generation of a pool with 99 items based on a scoping review and focus group discussions with primiparous women, (2) Assessment of content and face validity by an expert panel and item reduction to 32 items, (3) Multicentre data collection in six study sites in Switzerland, with application of the preliminary tool and the validation items with a target sample size of approximately n=400 women and (4), item reduction using exploratory factor analysis, factor loading and item-to-item correlation. Internal consistency of the tool will be assessed using Cronbach's alpha and convergent validity computing correlations of items of the tool with the German versions of the Childbirth Self-Efficacy Inventory and the Cambridge-Worry Scale. Analyses will be performed using Stata V.17. ETHICS AND DISSEMINATION Ethical approval was obtained by the Ethics Committees Zurich and Northwestern and Central Switzerland (BASEC-Nr. 2021-00687). Results will be disseminated at the final study conference, at national and international congresses and by peer reviewed and not peer-reviewed articles in scientific and professional journals. Approved and anonymised data will be shared. The dissemination of the findings will have a contributable impact on clinical practice, scientific discussions and future research. TRIAL REGISTRATION NUMBER DRKS00025572, SNCTP000004555.
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Affiliation(s)
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Antonia N Mueller
- Research Institute of Midwifery, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Jessica Pehlke-Milde
- Research Institute of Midwifery, Zurich University of Applied Sciences, Winterthur, Switzerland
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17
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Jones PR, Voisin S, Nolan BJ, Landen S, Jacques M, Newell B, Zwickl S, Cook T, Wong A, Ginger A, Palmer A, Garnham A, Alvarez-Romero J, Mohandas N, Seale K, Cheung A, Eynon N. Uncovering the effects of gender affirming hormone therapy on skeletal muscle and epigenetics: protocol for a prospective matched cohort study in transgender individuals (the GAME study). BMJ Open 2022; 12:e060869. [PMID: 35545400 PMCID: PMC9096568 DOI: 10.1136/bmjopen-2022-060869] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Gender affirming hormone therapy (GAHT) is increasingly used by transgender individuals and leads to shifts in sex hormone levels. Skeletal muscle is highly responsive to hormone activity, with limited data on the effects of GAHT on different human tissues. Here, we present the protocol for the GAME study (the effects of Gender Affirming hormone therapy on skeletal Muscle training and Epigenetics), which aims to uncover the effects of GAHT on skeletal muscle 'omic' profiles (methylomics, transcriptomics, proteomics, metabolomics) and markers of skeletal muscle health and fitness. METHODS AND ANALYSIS This study is a prospective age-matched cohort study in transgender adults commencing GAHT (n=80) and age-matched individuals not commencing GAHT (n=80), conducted at Austin Health and Victoria University in Victoria, Australia. Assessments will take place prior to beginning GAHT and 6 and 12 months into therapies in adults commencing GAHT. Age-matched individuals will be assessed at the same time points. Assessments will be divided over three examination days, involving (1) aerobic fitness tests, (2) muscle strength assessments and (3) collection of blood and muscle samples, as well as body composition measurements. Standardised diets, fitness watches and questionnaires will be used to control for key confounders in analyses. Primary outcomes are changes in aerobic fitness and muscle strength, as well as changes in skeletal muscle DNA methylation and gene expression profiles. Secondary outcomes include changes in skeletal muscle characteristics, proteomics, body composition and blood markers. Linear mixed models will be used to assess changes in outcomes, while accounting for repeated measures within participants and adjusting for known confounders. ETHICS AND DISSEMINATION The Austin Health Human Research Ethics Committee (HREC) and Victoria University HREC granted approval for this study (HREC/77146/Austin-2021). Findings from this project will be published in open-access, peer-reviewed journals and presented to scientific and public audiences. TRIAL REGISTRATION NUMBER ACTRN12621001415897; Pre-results.
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Affiliation(s)
- Patrice R Jones
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Sarah Voisin
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Brendan J Nolan
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Shanie Landen
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Macsue Jacques
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Beau Newell
- Pride in Sport, ACON Health, Surry Hills, New South Wales, Australia
| | - Sav Zwickl
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Teddy Cook
- Pride in Sport, ACON Health, Surry Hills, New South Wales, Australia
| | - Alex Wong
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Ariel Ginger
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Andrew Palmer
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Andrew Garnham
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | | | - Namitha Mohandas
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Kirsten Seale
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Ada Cheung
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
- Department of Endocrinology (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia
| | - Nir Eynon
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
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18
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Quinten VM, van Meurs M, ter Maaten JC, Ligtenberg JJM. Trends in vital signs and routine biomarkers in patients with sepsis during resuscitation in the emergency department: a prospective observational pilot study. BMJ Open 2016; 6:e009718. [PMID: 27225646 PMCID: PMC4885278 DOI: 10.1136/bmjopen-2015-009718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Sepsis lacks a reliable and readily available measure of disease activity. Thereby, it remains unclear how to monitor response to treatment. Research on numerous (new) biomarkers associated with sepsis provided disappointing results and little is known about changes in vital signs during sepsis resuscitation. We hypothesised that trends in vital signs together with routine biomarker levels during resuscitation might provide information about the response to treatment at a very early stage of sepsis in the emergency department (ED). We therefore explore trends in vital signs and routine biomarker levels during sepsis resuscitation in the ED. DESIGN Prospective observational pilot study. SETTING ED of a tertiary care teaching hospital. PARTICIPANTS 99 Adult non-trauma patients with suspected infection and 2 or more systemic inflammatory response syndrome criteria admitted to the ED. PRIMARY AND SECONDARY OUTCOME MEASURES Vital signs and biomarker levels at admittance (T0) and after 3 h in the ED (T1). RESULTS In total, data of 99 patients were analysed. Of these patients, 63 presented with sepsis, 30 with severe sepsis and 6 with septic shock. All vital signs decreased, except for peripheral oxygen saturation which increased. Almost all routine biomarker levels decreased during resuscitation, except for C reactive protein, bands, potassium, troponin T and direct bilirubin which remained stable. Sodium, chloride and N-terminal prohormone of brain natriuretic peptide increased slightly. CONCLUSIONS Vital signs and biomarker levels showed descending trends during resuscitation, except for parameters directly affected by treatment modalities. Despite these trends, most patients improved clinically. Trends in vital signs and routine biomarkers might be helpful in predicting clinical course and response to treatment in patients with sepsis during early resuscitation.
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Affiliation(s)
- Vincent M Quinten
- Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Matijs van Meurs
- Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pathology and Medical Biology, Medical Biology Section, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan C ter Maaten
- Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Jack J M Ligtenberg
- Department of Emergency Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Affiliation(s)
- Zafir Islam
- Wessex Cardiac Centre, University Hospital Southampton, Southampton, Hampshire, UK
| | - Frazer Warricker
- Wessex Cardiac Centre, University Hospital Southampton, Southampton, Hampshire, UK
| | - Benoy N Shah
- Wessex Cardiac Centre, University Hospital Southampton, Southampton, Hampshire, UK
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20
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Dutheil F, Chambres P, Hufnagel C, Auxiette C, Chausse P, Ghozi R, Paugam G, Boudet G, Khalfa N, Naughton G, Chamoux A, Mermillod M, Bertrand PR. 'Do Well B.': Design Of WELL Being monitoring systems. A study protocol for the application in autism. BMJ Open 2015; 5:e007716. [PMID: 25710916 PMCID: PMC4336464 DOI: 10.1136/bmjopen-2015-007716] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Individuals with autism spectrum disorder (ASD) have difficulties in communication and social interaction resulting from atypical perceptual and cognitive information processing, leading to an accumulation of anxiety. Extreme overloading experienced internally may not be externally visible. Identifying stressful situations at an early stage may avoid socially problematic behaviour from occurring, such as self-injurious behaviour. Activation of the autonomous nervous system (ANS) is involved in the response to anxiety, which can be measured through heart rate variability and skin conductance with the use of portable devices, non-intrusively and pain-free. Thus, developing innovative analysis of signal perception and reaction is necessary, mainly for non-communicative individuals with autism. METHODS AND ANALYSIS The protocol will take place in real life (home and social environments). We aim to associate modifications of the ANS with external events that will be recorded in a synchronous manner through a specific design (spy glasses with video/audio recording). Four phases will be carried out on ASD participants and aged-matched controls: (1) 24-hour baseline pre-experiment (physical activity, sleep), (2) 2 h in a real life situation, (3) 30 min in a quiet environment, interrupted by a few seconds of stressful sound, (4) an interview to record feelings about events triggering anxiety. ASD and control participants will be together for phases 2 and 3, revealing different physiological responses to the same situations, and thus identifying potentially problematic events. The novelty will be to apply time-series analyses (which led to several Nobel Prizes in quantitative finance) on ANS series (heart rate, heart rate variability, skin conductance) and wrist motion. ETHICS AND DISSEMINATION Ethical approval has been obtained from Ethics Committee of Clermont-Ferrand (South-East I), France (2014-A00611-46). Trial findings will be disseminated via open-access peer-reviewed publications, conferences, clinical networks, public lectures and our websites. TRIAL REGISTRATION NUMBER ClinicalTrials identifier NCT02275455.
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Affiliation(s)
- Frédéric Dutheil
- Department of Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Melbourne, Victoria, Australia
- Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions, Clermont University, Blaise Pascal University, Aubière, France
- Human Nutrition Unit (UNH), Research Centre in Human Nutrition (CRNH), INRA, Clermont-Ferrand, France
| | - Patrick Chambres
- Clermont Université, Université Blaise Pascal, Laboratoire de Psychologie Sociale et Cognitive, Clermont-Ferrand, France
- CNRS, UMR 6024, LaPSCo, Clermont-Ferrand, France
| | - Cédric Hufnagel
- Clermont Université, Université Blaise Pascal, Laboratoire de Psychologie Sociale et Cognitive, Clermont-Ferrand, France
- CNRS, UMR 6024, LaPSCo, Clermont-Ferrand, France
| | - Catherine Auxiette
- Clermont Université, Université Blaise Pascal, Laboratoire de Psychologie Sociale et Cognitive, Clermont-Ferrand, France
- CNRS, UMR 6024, LaPSCo, Clermont-Ferrand, France
| | - Pierre Chausse
- Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions, Clermont University, Blaise Pascal University, Aubière, France
- Clermont Université, Université Blaise Pascal, Laboratoire de Psychologie Sociale et Cognitive, Clermont-Ferrand, France
- CNRS, UMR 6024, LaPSCo, Clermont-Ferrand, France
| | - Raja Ghozi
- Signals and Systems Research Unit, National Engineering School of Tunis, El Manar University, Tunis, Tunisia
| | - Guillaume Paugam
- Clermont Université, Université Blaise Pascal, Laboratoire de Mathématiques, Clermont-Ferrand, France
- CNRS, UMR 6620, LM, Clermont-Ferrand, France
| | - Gil Boudet
- Department of Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
| | - Nadia Khalfa
- Signals and Systems Research Unit, National Engineering School of Tunis, El Manar University, Tunis, Tunisia
| | - Geraldine Naughton
- School of Exercise Science, Australian Catholic University, Melbourne, Victoria, Australia
| | - Alain Chamoux
- Department of Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
| | - Martial Mermillod
- Univ Grenoble Alpes, LPNC, Grenoble, France
- CNRS, UMR 5105, LPNC, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Pierre Raphael Bertrand
- Clermont Université, Université Blaise Pascal, Laboratoire de Mathématiques, Clermont-Ferrand, France
- CNRS, UMR 6620, LM, Clermont-Ferrand, France
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Davies W. The influence of hypothermia on the management of traumatic cardiac arrest. J ROY ARMY MED CORPS 2015; 162:71-3. [PMID: 25687256 DOI: 10.1136/jramc-2014-000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/25/2015] [Indexed: 11/04/2022]
Abstract
Post-traumatic hypothermia often occurs as a direct consequence of haemorrhage and shock. Environmental exposure in austere environments may also contribute to its pathogenesis. In those casualties that present in cardiac arrest following injury, coexisting hypothermia may be the primary cause of the arrest, or a marker of the severity of shock. A case of a 25-year-old combat casualty is presented, illustrating some of the technical challenges faced by clinicians while resuscitating hypothermic trauma patients in cardiac arrest.
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Stensvold D, Viken H, Rognmo Ø, Skogvoll E, Steinshamn S, Vatten LJ, Coombes JS, Anderssen SA, Magnussen J, Ingebrigtsen JE, Fiatarone Singh MA, Langhammer A, Støylen A, Helbostad JL, Wisløff U. A randomised controlled study of the long-term effects of exercise training on mortality in elderly people: study protocol for the Generation 100 study. BMJ Open 2015; 5:e007519. [PMID: 25678546 PMCID: PMC4330327 DOI: 10.1136/bmjopen-2014-007519] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Epidemiological studies suggest that exercise has a tremendous preventative effect on morbidity and premature death, but these findings need to be confirmed by randomised trials. Generation 100 is a randomised, controlled study where the primary aim is to evaluate the effects of 5 years of exercise training on mortality in an elderly population. METHODS AND ANALYSIS All men and women born in the years 1936-1942 (n=6966), who were residents of Trondheim, Norway, were invited to participate. Between August 2012 and June 2013, a total of 1567 individuals (790 women) were included and randomised to either 5 years of two weekly sessions of high-intensity training (10 min warm-up followed by 4×4 min intervals at ∼90% of peak heart rate) or, moderate-intensity training (50 min of continuous work at ∼70% of peak heart rate), or to a control group that followed physical activity advice according to national recommendations. Clinical examinations, physical tests and questionnaires will be administered to all participants at baseline, and after 1, 3 and 5 years. Participants will also be followed up by linking to health registries until year 2035. ETHICS AND DISSEMINATION The study has been conducted according to the SPIRIT statement. All participants signed a written consent form, and the study has been approved by the Regional Committee for Medical Research Ethics, Norway. Projects such as this are warranted in the literature, and we expect that data from this study will result in numerous papers published in world-leading clinical journals; we will also present the results at international and national conferences. TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT01666340.
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Affiliation(s)
- Dorthe Stensvold
- KG Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hallgeir Viken
- KG Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øivind Rognmo
- KG Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eirik Skogvoll
- St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigurd Steinshamn
- KG Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital,Trondheim, Norway
| | - Lars J Vatten
- KG Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jeff S Coombes
- School of Human Movement Studies, University of Queensland, Queensland, Australia
| | - Sigmund A Anderssen
- Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Jon Magnussen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jan Erik Ingebrigtsen
- Institute for Science in Sport, Norwegian University of Science and Technology, Trondheim, Norway
| | - Maria A Fiatarone Singh
- Exercise Health and Performance Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia
- Hebrew Senior Life, Boston, Massachusetts, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Arnulf Langhammer
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asbjørn Støylen
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Cardiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jorunn L Helbostad
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic for Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ulrik Wisløff
- KG Jebsen Center of Exercise in Medicine at Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Kang YT, Liao YS, Hsieh CL. Different effects of transcutaneous electric nerve stimulation and electroacupuncture at ST36-ST37 on the cerebral cortex. Acupunct Med 2015; 33:36-41. [PMID: 25432425 PMCID: PMC4345985 DOI: 10.1136/acupmed-2014-010650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/10/2014] [Accepted: 11/14/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The effects of transcutaneous electric nerve stimulation (TENS) and electroacupuncture (EA) on the cerebral cortex are largely unclear. The purpose of the present study was to investigate the effect of TENS and EA on the cerebral cortex by examining their effect on the median nerve-somatosensory evoked potentials (MN-SEPs). METHODS Twenty volunteers were studied. The cortical and cervical spinal potentials were recorded by median nerve stimulation at the left wrist. Sham TENS, 2 Hz TENS and 2 Hz EA were applied to both ST36 and ST37. MN-SEPs were recorded during sham TENS, 2 Hz TENS and 2 Hz EA, with at least 1 week interval for each subject. One-way analysis of variance was used to determine the differences in latency and amplitude of the MN-SEPs observed in the stimulation and post-stimulation periods compared with baseline. Scheffe's post hoc correction was employed to identify pairwise differences. RESULTS No differences in mean latency were found between the stimulation procedures during the stimulation and post-stimulation periods. 2 Hz EA but not sham TENS or 2 Hz TENS caused higher mean amplitudes in N20 and N30 during the stimulation and post-stimulation periods. CONCLUSIONS EA, but not TENS, induces changes in certain components of the signal.
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Affiliation(s)
- Yu-Tien Kang
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Traditional Chinese Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Sheng Liao
- Department of Neurology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Ching-Liang Hsieh
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung, Taiwan
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24
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Barker T, Spencer P, Kirkman E, Lambert A, Midwinter M. An evaluation of the normal range of StO₂measurements at rest and following a mixed exercise protocol. J ROY ARMY MED CORPS 2014; 161:327-31. [PMID: 25168755 DOI: 10.1136/jramc-2014-000312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 07/29/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Assessment of local tissue oxygenation (StO₂) using near infrared spectroscopy is an emerging technique in medical practice with applications in trauma/sepsis management, diagnosis of acute compartment syndrome and assessment of tissue viability. Despite this, there have been little published data on the range of StO₂values in normal subjects. METHODS StO₂measurements were recorded in 105 infantry soldiers using an INVOS System Monitor (Somanetics) from both deltoids, the anterior compartment of the leg and the frontal lobe of the brain. Measurements were taken at rest and following completion of a mixed exercise protocol, consisting of overarm pull-ups, sit-ups and a 3-mile run. RESULTS StO₂values at rest were found to have a wide normal range with a skew left distribution. Mean StO₂was similar between the deltoids (left deltoid 80%, right deltoid 79%), but significantly different between other anatomical sites (leg 68%, brain 73%). However, all sites demonstrated a similar lower range cut-off at approximately 40%. Following exercise, there was a significant increase in StO₂values at all sites (left deltoid by 3.1 ± 2.0%, right deltoid by 2.6 ± 2.3%, leg by 8.0 ± 2.3% and brain by 8.6 ± 1.9%), which persisted for at least 10 min. CONCLUSIONS There were statistically significant differences in mean StO₂values recorded at different anatomical sites, although the reference ranges were wide and substantially overlapped. StO₂increased at all sites after exercise with the effect persisting for at least 10 min. The interaction between exercise and pathological phenomena remains unknown and is an area for further study.
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Affiliation(s)
- Tom Barker
- Academic Department of Military Surgery and Trauma, The Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - P Spencer
- Defence Science & Technology Laboratory, Salisbury, UK
| | - E Kirkman
- Defence Science & Technology Laboratory, Salisbury, UK
| | - A Lambert
- Department of Surgery, Ministry of Defence Hospital Unit Derriford, Plymouth, UK
| | - M Midwinter
- Academic Department of Military Surgery and Trauma, The Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
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Meng Q, Liu X, Shan Q, Yu P, Mao Z, Zhang F, Li J, Zhao T. Acupuncture for treatment of secondary osteoporosis in patients with spinal cord injury: a controlled study. Acupunct Med 2014; 32:381-6. [PMID: 24926075 DOI: 10.1136/acupmed-2013-010463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We explored the effect of adjunctive acupuncture on secondary osteoporosis in patients with spinal cord injury (SCI). METHODS Patients with subacute SCI were recruited and divided into two groups by patient choice: group 1 patients received standard combination therapy and group 2 patients received combination therapy plus acupuncture for 3 months. The concentrations of IgG, IgM and tumour necrosis factor α (TNFα) in serum and the bone mineral density were measured before and after treatment. RESULT The decrease in the concentration of TNFα and IgM in patients in group 2 compared with those in group 1 was statistically significant. The IgG level showed no significant change in either group. Bone mineral density increased more after adjunctive acupuncture, but the difference was not significant. CONCLUSIONS Further research is needed to determine whether acupuncture as an adjunct to combination therapy can reduce osteoporosis in patients with subacute SCI. TRIAL REGISTRATION NUMBER P153-2008-36.
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Affiliation(s)
- Qingxi Meng
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Xin Liu
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Qunqun Shan
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Peng Yu
- The First Veteran Institute of Jinan Military Region, Jinan, Shandong, China
| | - Zhaohu Mao
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Fan Zhang
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Jian Li
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Tingbao Zhao
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
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Ma HP, Ou JC, Yeh CT, Wu D, Tsai SH, Chiu WT, Hu CJ. Recovery from sleep disturbance precedes that of depression and anxiety following mild traumatic brain injury: a 6-week follow-up study. BMJ Open 2014; 4:e004205. [PMID: 24459040 PMCID: PMC3902386 DOI: 10.1136/bmjopen-2013-004205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The detailed course of mental disorders at the acute and subacute stages of mild traumatic brain injury (mTBI), especially with regard to recovery from sleep disturbances, has not been well characterised. The aim of this study was to determine the course of depression, anxiety and sleep disturbance, following an mTBI. SETTING We recruited patients with mTBI from three university hospitals in Taipei and healthy participants as control group for this study. PARTICIPANTS 100 patients with mTBI (35 men) who were older than 20 years, with a Glasgow Coma Scale score of 13-15 and loss of consciousness for <30 min, completed the baseline and 6-week follow-up assessments. 137 controls (47 men) without TBI were recruited in the study. None of the participants had a history of cerebrovascular disease, mental retardation, previous TBI, epilepsy or severe systemic medical illness. PRIMARY OUTCOME MEASURES The Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI) were assessed for the patients with mTBI at baseline and 6 weeks after mTBI and for the controls. RESULTS The ESS scores were not significantly different between the mTBI at baseline or at 6 weeks after mTBI and controls. Although the BAI, BDI and PSQI scores of the mTBI group were significantly different than those of the control group at baseline, all had improved significantly 6 weeks later. However, only the PSQI score improved to a level that was not significantly different from that of the control group. CONCLUSIONS Daytime sleepiness is not affected by mTBI. However, mTBI causes depression and anxiety and diminished sleep quality. Although all these conditions improve significantly within 6 weeks post-mTBI, only sleep quality improves to a pre-mTBI level. Thus, recovery from mTBI-induced sleep disturbance occurs more rapidly than that of mTBI-induced depression and anxiety.
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Affiliation(s)
- Hon-Ping Ma
- Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Emergency Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ju-Chi Ou
- Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chun-Ting Yeh
- Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Emergency Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Dean Wu
- Department of Neurology and Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shin-Han Tsai
- Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Emergency Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Wen-Ta Chiu
- Ministry of Health and Welfare, Taipei, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology and Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, National Defense Medical Center, Taipei, Taiwan
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Møller T, Lillelund C, Andersen C, Ejlertsen B, Nørgaard L, Christensen KB, Vadstrup E, Diderichsen F, Hendriksen C, Bloomquist K, Adamsen L. At cancer diagnosis: a 'window of opportunity' for behavioural change towards physical activity. A randomised feasibility study in patients with colon and breast cancer. BMJ Open 2013; 3:e003556. [PMID: 24189081 PMCID: PMC3822303 DOI: 10.1136/bmjopen-2013-003556] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Challenges exist in identifying, recruiting and motivating sedentary patients with cancer to initiate physical activity towards recommended levels. We hypothesise that the onset period of adjuvant chemotherapy can be 'the open window of opportunity' to identify and motivate sedentary patients with breast and colon cancers, at risk for developing coronary heart disease, to initiate and sustain lifestyle changes. AIMS To investigate the feasibility of oncologists/nurses screening for physical inactivity, in order to identify and recruit an at-risk population of sedentary patients with breast or colon cancer at the onset of adjuvant chemotherapy. Furthermore, the study will examine the adherence to one of two multimodal exercise interventions lasting 12 weeks; (1) hospital-based, high intensity, group exercise intervention (2) home-based, low intensity, individual, pedometer intervention. Both arms will be compared with a control group. METHODS AND ANALYSES All newly referred patients will be screened for sedentary behaviour, using national recommendations. Testing at baseline, 6, 12 and 39 weeks will include; (1) physiological testing (VO2-peak, one repetition maximum muscle strength and lung function (2) fasting full body dual-energy X-ray absorptiometry scan (3) fasting blood glucose, insulin, lipids and cholesterols, (4) psychometric questionnaires (general well-being, quality of life, anxiety and depression, motivational readiness). The randomised controlled trial feasibility design is selected in order to examine barriers for recruitment, programme adherence, safety aspects and potential efficacy to the interventions during adjuvant chemotherapy. ETHICS AND DISSEMINATION The Scientific Committee of the Capital Region (case No. H-1-2011-131) and the Danish Data Protection Agency (j. No. 2011-41-6349) approved the study. Data will be entered and locked into a database hosted by the Copenhagen Trial Unit, Rigshosptialet. Data will be available for analyses to project members and the trial statistician after the 45 included patients have completed the 12-week test. Results will be published in peer-reviewed scientific journals. TRIAL REGISTRATION Current Controlled Trials ISRCTN24901641.
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Affiliation(s)
- Tom Møller
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Lillelund
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Andersen
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lone Nørgaard
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Karl Bang Christensen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Eva Vadstrup
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Finn Diderichsen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hendriksen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Kira Bloomquist
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Lis Adamsen
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
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Abstract
BACKGROUND Acupuncture treatment frequently evokes both pain and fear, causing patients to be hesitant about undergoing the procedure. This study investigated individual differences in autonomic response to acupuncture stimulation and its relationship to fear of the procedure. METHODS Twenty-seven participants filled out the acupuncture fear scale (AFS) questionnaire and underwent acupuncture stimulation at the LI4 acupuncture point. Autonomic responses were measured by recording the skin conductance response (SCR) throughout acupuncture stimulation. Pearson correlation analysis was performed between the self-reported AFS scores and changes in SCR. RESULTS After acupuncture stimulation, SCR significantly increased and there were greater individual differences in enhanced sympathetic activations to acupuncture stimulation. Changes in SCR correlated with scores for the painful sensation domain of the AFS. CONCLUSIONS Our results indicate that fear of acupuncture-induced pain is associated with physiological arousal when people receive acupuncture stimulation. Fear of pain is the dominant factor in acupuncture-related fear and it should be considered in practice and in research.
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Affiliation(s)
- In-Seon Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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