Is ethnicity a risk factor for mortality in major trauma? A single-centred cohort study

INTRODUCTION

Many studies have found varying health outcomes in patients from different minority ethnic groups. There has been limited research into the outcomes in major trauma dependent on ethnicity. The aim was to analyse whether ethnicity was an independent risk factor for 30-day mortality in patients presenting to a major trauma centre when adjusting for confounders.

METHODS

This was a retrospective review of all patients presenting to a single major trauma centre from 2010 to 2020. Data were collected on patient demographics and variables including mechanism and injury severity score. Logistic regression was used to determine significant predictors of mortality.

RESULTS

There were 10,668 data sets with ethnicity data; of these 9,098 were of White ethnicity, 1,143 were Asian and 427 were classified as Black. The 30-day mortality rate was 7.76% for White ethnicities, 6.91% for Asian ethnicity and 5.15% for people of Black ethnicity. On multivariate logistic regression, ethnicity (p = 0.076) was not associated with 30-day mortality. Age, Injury Severity Score (ISS), Probability of Survival (PS) score, shock and Glasgow Coma Scale (GCS; p < 0.001) were associated with 30-day mortality. White ethnicity had an odds ratio (OR) of mortality of 1.16 (95% confidence interval [CI] 0.658-2.040) (p = 0.609) compared with Black ethnicity and an OR of 0.74 (95% CI 0.546-1.001) (p = 0.050) compared with Asian patients. Black patients had an OR of mortality of 0.65 (95% CI 0.351-1.193) (p = 0.164) compared with the Asian population.

CONCLUSION

Ethnicity is not a significant risk factor for 30-day mortality in trauma patients.

A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

RATIONALE

Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities.

METHODS

We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed.

RESULTS

We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool.

CONCLUSIONS

By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.

Disinfection by methylthionine chloride and chitosan in combination with Photo radiation therapy on caries affected dentin nano hardness, adhesive integrity, and bond failure

OBJECTIVE

The aim of the study was to assess the disinfection efficacy, bond integrity, and nano hardness of caries-affected dentin (CAD) surface bonded to resin cement when disinfected with chlorhexidine (CHX), Methylene blue activated by Photodynamic therapy (MB-PDT), chitosan, silver diamine fluoride (SDF), chitosan activated by PDT, and SDF-diode laser against S. mutans.

MATERIALS AND METHODS

A total of 60 human mandibular molars were extracted non-traumatically and gathered using ICDAS criteria. The dentin surface was prepared, leaving CAD to receive a disinfection procedure. After inoculation with S. mutans, the CAD samples were divided into six groups and disinfected with various disinfectants (n = 10) CHX, MB-PDT, chitosan, chitosan-PDT, SDF, and SDF+ diode laser. Survival rates of S. mutans were analyzed following the restoration of samples with resin cement via the etch and rinse method to assess SBS. Also, nano hardness was analyzed. Statistical analysis was performed by using the ANOVA and the Tukey multiple test (p<0.05). The Kruskal-Wallis test was used to evaluate the change in survival rate.

RESULTS

Related to the survival rates, the SDF+ diode laser displayed the highest reduction in S. mutans levels and chitosan presented the lowest level of disinfection. The intergroup comparison revealed that CHX and chitosan-PDT displayed comparable outcomes of S. mutans survival rate to that of SDF+ diode laser (p>0.05). Likewise, MB-PDT and SDF displayed a comparable survival rate of S. mutans to Chitosan disinfection (p>0.05). Considering SBS and nano hardness, the highest SBS and NH were exhibited by the SDF+ diode laser, and the lowest SBS and NH values were exhibited by MB-PDT. The intragroup comparison revealed that CAD specimens disinfected with Chitosan-PDT showed comparable SBS and NH values to the SDF+ diode laser (p>0.05). CHX, chitosan, and SDF exhibited bond values and NH comparable to MB-PDT (p<0.05).

CONCLUSIONS

Synergistic use of Silver diamine fluoride with diode laser and chitosan activated by PDT can be used as an alternative to CHX for controlling S. mutans growth, promoting enhanced bond efficacy and nano hardness for bonding resin cement to the caries-affected dentin.

A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

RATIONALE

Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities.

METHODS

We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed.

RESULTS

We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool.

CONCLUSIONS

By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.

Clinical Practice Guidelines (CPGs) for stroke rehabilitation from Low- and Middle-Income Countries (LMICs): Protocol for systematic review

INTRODUCTION

Stroke rehabilitation guidelines promoteclinical decision making, enhance quality of healthcare delivery, minimize healthcare costs, and identify gaps in current knowledge to guide future research. However, there are no published reviews that have exclusively evaluated the quality of existing Clinical Practice Guidelines (CPGs) for stroke rehabilitation from Low- and Middle-Income Countries (LMICs) or provided any insights into the cultural variation, adaptations, or gaps in implementation specific to LMICs.

OBJECTIVES

To identify CPGs developed by LMICs for stroke rehabilitation and evaluate their quality using AGREE-II and AGREE-REX tool.

METHODS

The review protocol is prepared in accordance with the PRISMA-P guidelines and the review was registered in PROSPERO (CRD42022382486). The search was run in Medline, EMBASE, CINHAL, PEDro for guidelines published between 2000 till July 2022. Additionally, SUMSearch, Google, and other guideline portals and gray literature were searched. The included studies were then subjected to data extraction for the following details: Study ID, title of the CPG, country of origin, characteristics of CPG (Scope-national/regional, level of care, multidisciplinary/uni-disciplinary), and information on stroke rehabilitation relevant recommendations. The quality of the included CPGs will be subsequently evaluated using AGREE-II and AGREE-REX tool.

RESULTS & CONCLUSION

This systematic review aims to explore the gaps in existing CPGs specific to LMICs and will aid in development/adaptation/contextualization of CPGs for implementation in LMICs.

COMPARISON BETWEEN PRE- AND POST-OPERATIVELY BOTOX INJECTION IN SECONDARY WOUNDS HEALING

Tension impacts wound healing and scarring. Tissue stress reduces blood flow and promotes fibroblastic response in wound treatment. Botox injections reduce tension. A total of 18 male albino rats weighing 250-350 grams each got 1 IU of Botox and saline injected into a subcutaneous muscle in the center of each 1.5 CM two circles with 4.5 CM a gap between them. Group A seven days pre-operatively; group B, after wound incidence. The study compared Botox-treated wounds to those treated immediately after surgery. Group A animals were surgery-ready after 7 days, removed full-thickness skin. Group B got Botox and saline in separate cages following full-thickness skin excision. Each group had three equal subgroups. Each group had immunohistochemistry tests on days 3, 7, and 14. and histological test on day 14 only, Skin biopsies following euthanasia showed significant variations between A and B groups. On day three, the group A showed increase significantly MMP-9 expression than B group. On day 7, the group A displayed a significant increase CD31 expression, suggesting significant new blood vessel development than group B. On day 14, both groups showed strong MMP-9 and CD31 expression, demonstrated greater endothelial cell, and keratinocyte proliferation resulted in very well re-epithelialization. Botox injection before surgery improved wound healing and reduced fibrosis and scarring.

Corrigendum to "Cartesian Control of Sit-to-Stand Motion Using Head Position Feedback"

[This corrects the article DOI: 10.1155/2020/1979342.].

Green synthesized silver nanoparticles using the plant-based reducing agent Matricaria chamomilla induce cell death in colorectal cancer cells

OBJECTIVE

There is a need to treat cancer cells with safe and natural nanoparticles to avoid the side effects of chemotherapeutic agents. Chamomile is considered a safe, natural plant with anticancer activity. We synthesize simple, inexpensive, and eco-friendly silver nanoparticles (SNs) using Chamomile (CHM) to tune their anticancer properties.

MATERIALS AND METHODS

SN-CHM was synthesized by reducing 1 mM silver nitrate aqueous solution in 100 mL with the aqueous ethanolic flower extract of CHM (18 mg/mL, w/v). The reaction proceeded overnight at 600 rpm and 28°C. SN-CHM was characterized for their % yield, average diameter, charge, morphology, and silver release. Moreover, SN-CHM was investigated for its antioxidant and anticancer activities at 200 µg/mL and 5 mg/ mL, respectively.

RESULTS

A 59.12% yield and a uniform SN-CHM size of 115 ± 3.1 nm with a ζ-potential of -27.67 ± (-3.92) mv were observed. The UV-visible absorption showed shifts from 379.5 to 383.5 nm for CHM and SN-CHM, respectively. Moreover, Ag+ was ultimately released from SN-CHM after 5 h. Fourier Transform Infrared Spectroscopy (FT-IR) showed characteristic absorption peaks of CHM and produced SN-CHM. Furthermore, SN-CHM showed moderate antioxidant activity. SN-CHM inhibited the % viability of SW620 and HT-29 cell lines at 20 μM. SN-CHM may also greatly upregulate the apoptotic gene BAX while considerably downregulating the anti-apoptotic genes BCL2 and BCL-Xl.

CONCLUSIONS

CHM can be a safe soft drink, especially when conjugated with Ag ions as anticancer NPs. SN-CHM is considered potent anticancer activity against SW620, and HT-29 cell lines.

THE IMPACT OF ALOE VERA GEL ON REMINERALIZATION OF THE TOOTH AND ITS EFFECT AGAINST ENTEROCOCCUS FAECALIS: AN IN VITRO STUDY

The Aloe vera plant is a cactus-like plant in the Liliacea family that has been known and utilized for its medical benefits. It has been attempted to be used as a remineralizing agent and shows an antibacterial effect. Aim of the study - assessment of the remineralizing effect of solution of saturated Aloe vera gel compared to distal water by microhardness Vickers test and Densometric X-Ray Analysis and effect of Aloe vera gel against Enterococcus faecalis. 10 extracted permanent molars were used in this in vitro study. each tooth enrolls in Teflon tape and only the enamel of the occlusal surface was exposed to a demineralizing solution (acid etch) for 45 seconds in-vitro and randomly assigned to two groups: Group 1 was treated with distal water; group 2 was treated with Aloe vera gel. All groups except the control baseline group were treated with their respective remineralizing solution for 10 days. Vicker's Microhardness Number (VHN) and Densometric X-Ray Analysis were carried out at baseline, post-demineralization and later post 10 days of remineralization. The antibacterial effect of Aloe vera gel was assessed by the disc diffusion method. The filter paper was immersed in 20µl of different concentrations of Aloe vera gel extract as fresh Aloe vera (100 %) and (50 % and 25 %) diluted with de-ionized water after that the disc was distributed in a plate containing the E. faecalis. Antibiotics disc of Augmentin (Amoxicillin and Clavulanic acid 30ug) were also poured in the same plate and incubated at 37°C for 24 hours and the zone of inhibition of antibiotic was measured for comparison with a zone of inhibition of filter paper saturated with Aloe vera gel. Densitometric X-Ray Analysis and Microhardness Number (VHN) evaluation showed improvement in the enamel density and the surface hardness after remineralization. The mean value in the group treated with Aloe vera solution was higher than the recorded mean value for the group treated with distal water. There was a significant difference between Aloe vera solution and distal water. Significant (p-value≤0.05) after 10 days. The antibacterial effect showed that E. faecalis was resistant to Aloe vera gel in different concentrations compared with Augmentin (Amoxicillin and Clavulanic acid 30ug). Aloe vera gel could be used for caries prevention in terms of safety and efficiency. While E. faecalis show resistance activity against Aloe vera gel.

Measurement, determinants, barriers, and interventions for exercise adherence: A scoping review

BACKGROUND

Adherence to exercise interventions is the cornerstone of a successful rehabilitation program. However, there is limited evidence on multifaceted components of exercise adherence. Therefore, we aimed to summarize the existing literature on measurement, determinants, barriers, theoretical frameworks, and evidence-based interventions that support exercise adherence.

METHODS

We conducted a scoping review based on the PRISMA extension for scoping reviews guidelines and searched the literature in PubMed, Cochrane Databases of Systematic Reviews, ScienceDirect, and Web of Science. Two reviewers independently screened articles. The included articles were subjected to data extraction and qualitative synthesis.

RESULTS

A total of 72 articles were included for this review. Data synthesis showed that there are no gold standard methods of measuring exercise adherence; however, questionnaires and daily logs are commonly used tools. The determinants of adherence are personal, disease-related, therapy-related, provider-related, and health system-related. The common barriers to adherence are the absence of a caregiver, low health literacy, poor communication by healthcare providers, cost, and lack of access to health facilities. Few evidence-based interventions used for supporting adherence are behavioral strategies, improving self-efficacy, motivational therapy, and mHealth or multimedia.

CONCLUSION

Non-adherence to exercises is a challenge for healthcare providers. There are no standard guidelines for the evaluation and management of non-adherence to exercises. Future studies should aim at developing objective measures of exercise adherence and investigate the long-term effects of adherence strategies in different disease populations. It is an under-researched area and requires multipronged strategies to improve adherence levels among patients.

The bidirectional relationship between growth and appetite regulation in the first year of life

 

Childhood obesity is a public health crisis. Even though appetite traits in infancy were associated with childhood adiposity, whether early weight gain can influence later appetite has not been researched. Our aim was to prospectively examine the bidirectional association between growth and appetite traits during the first year of life. We followed up 450 healthy term infants for 12 months (m). Appetite traits at 4 weeks (wk), 6m and 12m were assessed using the Baby and Child Eating Behaviour Questionnaires. Infant feeding, anthropometric, socioeconomic and demographic data were also collected. Infant weight-for-age z-scores (WFAZ) were calculated using the WHO 2006 growth reference. Growth was assessed as conditional WFAZ change (cWFAZc) by saving the residuals from linear regression models of WFAZ at each successive time point versus WFAZ at the earlier time point. Multivariable linear regression was used to analyse bidirectional associations between cWFAZc (0-4wk, 4wk-6m, 6-12m) and appetite traits Enjoyment of Food (EF), Food Responsiveness (FR), Satiety Responsiveness (SR) and Slowness in Eating (SE) at 4wk, 6m and 12m. All models were adjusted for relevant confounders. At 4wk, SR score was associated with lower (β:-0.16; 95% CI:-0.28,-0.03), and FR score with higher (β:0.10; 95% CI:0.01,0.19) cWFAZc from 4wk to 12m. SR score at 6m was inversely associated with cWFAZc from 6-12m (β:-0.09; 95% CI:-0.16,-0.01). Conversely, higher cWFAZc between 4wk-6m was associated with higher EF (β:0.10; 95% CI:0.01,0.19) and FR (β:0.16; 95% CI:0.04,0.29) scores at 12m. cWFAZc between 6m-12m was inversely associated with SR at 12m (β:-0.18; 95% CI:-0.35,-0.01). Our results suggest that the growth acceleration hypothesis, where faster growth in infancy leads to later obesity, may be mediated by an up-regulation of appetite traits at 12m. This highlights the public health importance of avoiding growth acceleration in infancy as a way to curb the childhood obesity epidemic.

Key messages

• Weight gain in early infancy impacts appetite regulation in the first year of life and up-regulation of appetite traits at 12 months predisposes to childhood obesity.

• Avoiding growth acceleration in infancy can decrease the risk for childhood obesity.

Correlation of Serum Uric Acid with Cognition, Severity, and Stage of Disease in Patients with Idiopathic Parkinson’s Disease and Vascular Parkinsonism: A Cross-Sectional Study

Background:

Uric acid (UA) being a potent antioxidant may reduce the oxidative stress and progression of Parkinson’s disease. However, the role of UA is not yet established in people with Idiopathic Parkinson’s disease (IPD) and Vascular Parkinsonism (VP).

Objectives:

We aimed i) to compare the serum UA levels in IPD, VP, and healthy adults and ii) to find a relation between UA levels with disease severity, disease stage, and cognitive function in people with IPD and VP.

Methods:

A cross-sectional study was conducted among people with IPD (n=70), VP (n=70), and healthy adults (n=70). Demographics details, body mass index, duration of illness, levodopa usage, comorbidities, MDS-UPDRS scores, modified H&Y scale, MMSE, and serum UA levels were collected from participants. Pearson’s correlation coefficient was used to find the correlation between UA levels, MDS-UPDRS, H & Y, and MMSE scores.

Results:

The age of the participants ranged from 59 to 80 years. Results showed that serum UA level in healthy control (5.41±0.99; p=0.001) and VP groups (5.27 ± 0.99; p=0.001) were significantly higher compared to IPD group (4.34 ±1.03). We found a significant negative correlation between UA and MDS-UPDRS (r=-0.68, p<0.01) and H & Y scores (r = -0.61, p<0.01) and a significant positive correlation of UA with MMSE (r=0.55, p<0.01) in the IPD group. UA levels in the VP group were not correlated with any of the outcome measures.

Conclusion:

In people with IPD, serum UA level was negatively correlated with severity and progression of the disease but positively correlated with cognitive ability.

The quality of reporting in cardiac MRI artificial intelligence segmentation studies - a systematic review

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by an NIHR AI Award, AI_AWARD01706. This research was also funded in part, by the Wellcome Trust [Grant number 205188/Z/16/Z ].

Background

There has been a rapid increase in the number of Artificial Intelligence (AI) studies of cardiac MRI (CMR) segmentation. AI has huge potential to improve image analysis assessments. However, advancement and clinical translation in this field depend on researchers presenting their work in a transparent and reproducible manner.

Purpose

This systematic review aimed to evaluate the quality of reporting in AI studies involving CMR segmentation.

Methods

MEDLINE and EMBASE databases were searched for AI CMR segmentation studies on 18/11/2021. The flow of study inclusion is shown in Figure 1. Any AI method to segment any cardiac structure on CMR was eligible for inclusion. Each study was assessed for compliance with the Checklist for Artificial Intelligence in Medical Imaging (CLAIM).

Results

70 studies were included in the qualitative analysis. Studies were published between 2015 to 2021, with the majority (71%) published in 2020 and 2021. Most studies were performed in Europe (33%), China (27%) and the USA (26%). Short-axis sections were segmented in 70% of studies and most commonly included both ventricles (51%) or the left ventricle alone (30%). 20 different architecture implementations were represented. Figure 2 summarises the most relevant CLAIM domains to AI segmentation. The training sample eligibility criteria, demographics and clinical characteristics were not reported in 47% and 81% of studies, respectively. Ground truth annotations, source of the annotations and annotation tool were absent in 31%, 36% and 51% of studies respectively. Preprocessing steps and software libraries and packages used in training were not included in 27% and 24%. Details on the training approach including the number of models trained and method of selecting the final model were missing in 20% and 17% of the studies. Methods of validation or testing on external data, inter- and intra- rater variability and failure analysis were unreported in 57%, 63% and 74%, respectively.

Conclusion

This systematic review highlights important gaps in the AI literature of CMR studies. We identified key items missing in the dataset description, model development, validation and testing that limit the transparency, reproducibility and hence validity of published AI studies. This review may support closer adherence to established frameworks for reporting standards.

Development of people with disabilities (PWD)-friendly module for bakery production

People with disabilities (PWDs) are often excluded from the surrounding community due to their physical or mental health deficiencies. This special group needs special care to enable them to have equal opportunities in all aspects. This project aims to develop PWDfriendly modules specially designed to train and build PWD skills on basic bakeries products including pizza bread, red bean bun, sausage bread and “paung” bread (plain bun). Considering their disabilities in reading for most of the PWD, the modules are more focused on visual presentations rather than instructions. To access the functioning of the modules, direct practical experience was conducted in a series of workshops in community-based rehabilitation (CBR). The effectiveness of the modules was evaluated in terms of their feasibility and acceptability including colour scheme, language used, skills and knowledge enhancement, user friendly and attractiveness level. Most of the respondents either strongly agreed or agreed on the components of feasibility and acceptability of the PWD-friendly modules. The modules were said to user friendly, helpful and recommended to be used by others. Not only these modules could improve the PWD skills on bakeries products for commercialization but also increased their motivation and self-confidence to get involved with the community.

Simultaneous malignant hyperthermia reactions in two siblings during living donor liver transplantation

We report a case of simultaneous malignant hyperthermia reactions occurring in two siblings during living donor liver transplantation. This report highlights the conflicting goals in the clinical management of liver transplantation and malignant hyperthermia, including the use of total intravenous anaesthesia and dantrolene in the face of the potential for drug-induced hepatotoxicity in the remnant liver or transplanted liver graft, as well as cautious fluid management needed for liver transplantation balanced against the liberal fluid therapy required to prevent acute kidney injury associated with malignant hyperthermia. The logistical challenges of managing this emergency in two closely related patients are discussed, including rapid preparation of two vapour-free anaesthesia machines, the need for availability of additional dantrolene and the requirement for additional personnel. Prompt recognition, immediate removal of the triggering agents and conversion to total intravenous anaesthesia helped to curtail the malignant hyperthermic reactions in our patients, both of whom made a full recovery.

Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus

OBJECTIVE

To develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies.

METHOD

We conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK.

RESULTS

In round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains-(1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4.

CONCLUSION

We developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders' experiences and the cost-effectiveness of implementing these strategies.

Adaptive sports for promoting physical activity in community-dwelling adults with stroke: A feasibility study

BACKGROUND

Despite proven health benefits of regular participation in physical activities (PA), adults with stroke fail to achieve recommended levels of PA. Sports being an enjoyable activity is more likely to encourage participation. Therefore, the objectives of the present study are i) to develop and test the feasibility of adaptive sports for promoting PA and Quality of Life (QoL) in community-dwelling adults with stroke, and ii) to explore the participants perception and experiences of playing adaptive sports.

METHODS

Two focus groups were conducted among the eight experts and a person with stroke to develop adaptive sports. To test the feasibility of these adaptive sports, in a multi methods study eighteen community dwelling adults with stroke were recruited. Participants played adaptive sports twice a week for two months in a community center. Participants pre and post intervention PA levels and QoL were measured. Participants were also interviewed at the end of the program to explore their experiences of participation in adaptive sports.

RESULTS

At the end of the program retention rate of the participants was 83.33% and there was a significant improvement in PA levels, while the improvement in QoL was not statistically significant. Participants expressed positive experience with the program. There were no adverse events during or after the participation. Health benefits, fitness, and fun were reported as facilitators, while lack of access to the sporting facility and lack of caregiver support were reported as barriers to participation.

CONCLUSION

Adaptive sports appear to be safe, feasible, and well accepted by the adults with stroke.

Prevalence of COPD among population above 30 years in India: A systematic review and meta-analysis

Background

By 2030, Sustainable Development Goal 3.4 aims to reduce the premature mortality caused by non-communicable diseases through prevention and treatment. Chronic obstructive pulmonary disease is the second leading cause of mortality and disability-adjusted life years in India. This review was conducted to estimate the prevalence of COPD using systematic review and meta-analysis technique.

Method

Search was conducted using six databases for studies on COPD among population above 30 years in India between years 2000 to 2020. Cross-sectional and cohort studies reporting prevalence of COPD and associated risk factors were included in the present review. Screening and data extraction was done by two authors independently. Studies were appraised for quality using the modified New Castle Ottawa scale and reporting quality was assessed using STROBE guidelines.

Result

Our search returned 8973 records, from which 23 records fulfilled the eligibility criteria. Overall, the prevalence of COPD among population aged 30 years and above in India was 7%. Risk factors like active and passive smoking, biomass fuel exposure, environmental tobacco smoke, occupational exposure to dust, indoor and outdoor pollution, and increasing age were reported to have a significant association with COPD among Indian population.

Conclusion

Our findings suggest the need for a multicentric national-level research study to understand COPD burden and its contributing risk factors. The findings also suggest the need for COPD sensitive health literacy program focused on early screening and primary prevention of risk factors for COPD, which may help early initiation of self-management practices, that are crucial for better quality of life.

Adherence to home exercises and rehabilitation (ADHERE) after stroke in low-to-middle-income countries: A randomized controlled trial

Background: Adherence to prescribed exercises is essential for home-based programs to be effective, but evidence for strategies to enhance exercise adherence in people with stroke is lacking.Objectives: To determine the effect of adherence strategies on the proportion of people with stroke who adhere to prescribed home-based exercises and their level of adherence at 6 and 12 weeks of intervention. Our secondary objective was to determine the effect of the combined intervention on mobility and quality of life post-stroke.Methods: We conducted an RCT among people with stroke (Exp = 27, Con = 25) living in semi-urban India. Both groups received standard hospital care and a home exercise program. The experimental group also received adherence strategies delivered over five sessions. Adherence was measured using the Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) , mobility using Mobility Disability Scale, and quality of life using the Stroke Impact Scale.Results: The experimental group had better exercise adherence compared to the control group both at six (mean difference [MD] 45, 95% CI 40, 64, p < .001) and 12 weeks (MD 51, 95% CI 39, 63, p < .001). The experimental group also had better mobility at 12 weeks (median (IQR), experimental 42 (57), median (IQR), control 95 (50), p = .002). There was no difference in the quality of life scores between groups at six or 12 weeks.Conclusion: The adherence strategies were effective in improving exercise adherence and mobility post-stroke but did not improve quality of life.Trial registration: CTRI/2018/08/015212.

471 LET’S TALK DEMENTIA

Introduction

By 2021 over one million people will be living with dementia (1) costing the government an estimated £30bn a year (2). However, cognitive decline is often misdiagnosed or missed completely in hospital admissions, resulting in delays in detection and treatment for patients. Quick and simple screening tools such as the Abbreviated Mental Test Score (AMTS) could help provide early detection and faster treatment times for such patients. Data from Queen Elizabeth Hospital Kings Lynn showed that only 56.8% of patients over the age of 75 were being assessed for cognitive function on admission, while the national targets are set at 90%.

Methods

A multi-cycle, trust wide, quality improvement project was used to improve screening outcomes for dementia in QEHKL. A baseline measure of screening was taken by QEHKL coding department. Five PDSA (Plan Do Study Act) cycles were undertaken, implementing interventions to aid screening at each stage. Examples include improved medical clerking booklets, trust wide education and allocated ward ‘Dementia Champions’. Performance was assessed by auditors, through patient notes and discharge letters.

Results

Over a 4-month period, 432 patient notes were inspected on six medical wards. Results after interventions showed a significant rise in Dementia Screening from 58.7% to 89.8%. AMTS completion was 70.7% in September 2020 on medical wards which improved to 85.7% in November 2020. Results were collected during the COVID-19 pandemic however, COVID wards were excluded.

Conclusion

The QI project has highlighted that education and accessible tools can improve cognitive screening numbers. An important note is, due to increased pressures during the COVID pandemic it is plausible that screening rates were adversely affected. Despite this, our figures still show positive improvement. The next cycle of our project includes surgical wards and we expect by the time of presentation to have this data to show.

Burden of COPD among population above 30 years in India: protocol for a systematic review and proposed meta-analysis

BACKGROUND

The Sustainable Development Goals and the National Health Policy of India aim to reduce premature mortality from noncommunicable diseases (NCD) by one-third in the next decade and by 25% by 2025, respectively. Among NCDs globally, chronic obstructive pulmonary disease (COPD) is a major contributor to death and disability. This underscores the need to understand the burden of COPD at the national level by synthesizing evidence and collating the state-wise COPD data to estimate the prevalence of COPD and to highlight the associated risk factors to inform policymakers.

METHOD

The systematic literature search will be carried out in PubMed, Cochrane, Scopus, Web of Science, CINAHL, and ProQuest databases with restrictions for studies published between 2000 and 2020 and available in English. Cross-sectional or cohort studies conducted in and among the Indian population aged 30 years and above will be included. Case reports, randomized trials, meta-analysis, commentaries, and qualitative studies will be excluded from the review. Quality assessment of the included studies will be performed using New Castle Ottawa scale and adherence to reporting standards will be checked using STROBE checklist for Observational Cohort and Cross-Sectional Studies.

DISCUSSION

Prevalence of COPD in the population aged 30 years and above, diagnosed through spirometry and nonspirometry, will be compared and reported and a meta-analysis will be performed to obtain pooled prevalence rates of COPD and the risk factors associated with COPD.

Toward a uniform pathway in managing incidental lung nodules on computerised tomography [CT] coronary angiography; for a cost effective and safe outcome

Background

National Institute for Health and Care Excellence guidelines (NICE CG95) recommends computed tomography coronary angiography [CTCA] as the first line investigation for all patients with suspected typical or atypical angina irrespective of pre-test probability due to its excellent performance and cost effectiveness. However previous cost effectiveness analyses have not factored in the burden of lung nodules [LN] or extracardiac incidentalomas, which are commonly identified on CTCA.

Purpose

As we increasingly detect LN on CTCA scans, it is prudent that a uniform pathway is followed for surveillance of LN. The British Thoracic Society (BTS) has enabled evidence-based development of an algorithm for the management of LN which defines a cut off LN size of ≥5mm requiring further follow up. We aimed to assess the compliance of LN follow up in our patients according to radiology recommendation on CTCA reports and also to assess how well these recommendations adhere to BTS guidelines.

Method

117 patients who underwent CTCA as the initial diagnostic investigation were retrospectively identified from the rapid access chest pain clinic database. Data was collected during a 1 year period between January - December 2017. Data was analysed to determine whether appropriate surveillance pathway was followed for repeat imaging. According to BTS guidelines, nodules ≥5mm should have a systematic work up for surveillance and hence we have stratified our data based on the nodule size. In case of multiple nodules, the largest nodule size was considered.

Results

Out of 117 patients, 77% patients were female with average age 57.8±9.0 years. 40% patients were found to have incidental LN with an average size of 4.63±1.92mm; 44% had a history of cigarette smoking.

Among patient with nodules, 22 (19%) had CT thorax to assess interval change and interestingly 16 (73%) had persisting LN; whereas in 4 (18%), the LN resolved and only 2 (9%) showed increase in LN size. Repeat CT chest was advised for these 2 patients; 1 was advised to undergo biopsy which eventually ruled out malignancy. 6 patients (5%) from group 1 were recommended for repeat CT despite having LN size &lt;5mm.

In the remaining 25 patients (21%) with LN, 15 (60%) did not have further surveillance imaging even though this was recommended by the reporting radiologist. Of these only 3 (12%) had LN ≥5mm which qualified for surveillance CT.

Conclusion

CTCA frequently detects incidentalomas especially LN which cannot be overlooked and require further imaging irrespective of the primary presentation. Our findings also suggest a discrepancy on surveillance CT recommendation against the current BTS guidelines, with potential significant impact on the overall cost effectiveness of CTCA. A systematic approach to LN surveillance could be best achieved with a multidisciplinary team approach (e.g. referral pathway to nodule MDT) and adherence to a standard guideline.

Lung nodule surveillance following CTCA

Funding Acknowledgement

Type of funding source: None

Midwifery leadership, advocacy and action to improve maternal health in PNG

Background

The SDG target for maternal mortality is less than 70 per 100,000 live births; in Papua New Guinea, it is estimated to be 145. PNG will require significant resources and strong leadership to meet the 2030 target. The PNG Midwifery Leadership Buddy Program (Buddy Program), funded and coordinated by Rotary, offers an innovative model to improve maternal health, which may be transferable to other low-middle-income countries.

Objectives

The Buddy Program aims to build midwifery leadership resulting in improved outcomes in PNG. As partners, midwives from PNG and Australia undertake leadership training in Port Moresby and enter a reciprocal peer support relationship. Over 12 months, they support each other in their professional roles and progress a quality improvement project.

Results

Three cohorts of midwives (18 from each country), have participated in the leadership training and the first group has completed 12 months of peer support. Participants have reported increased confidence for leadership, action and advocacy. There has been some communication challenges and variation in expectations, predominately due to cultural differences. The Buddy Program has resulted in a number of tangible projects including the introduction of family planning education at a local school and University, introduction of respectful care in pregnancy charter and increased surveillance and treatment of pregnant women with anaemia. Interestingly, a number of participants have continued to support each other beyond the initial 12-month commitment.

Conclusions

Supportive partnerships that grow midwifery leadership hold significant potential to increase the quality of maternity care and reduce preventable maternal deaths in low-middle-income countries.

Key messages

Midwifery leadership plays a vital role in addressing the SDG targets for maternal health. The Buddy Program offers an innovative model to progress the agenda for universal access to quality maternity care.

Cartesian Control of Sit-to-Stand Motion Using Head Position Feedback

Sit-to-stand (STS) motion is an indicator of an individual's physical independence and well-being. Determination of various variables that contribute to the execution and control of STS motion is an active area of research. In this study, we evaluate the clinical hypothesis that besides numerous other factors, the central nervous system (CNS) controls STS motion by tracking a prelearned head position trajectory. Motivated by the evidence for a task-oriented encoding of motion by the CNS, we adopt a robotic approach for the synthesis of STS motion and propose this scheme as a solution to this hypothesis. We propose an analytical biomechanical human CNS modeling framework where the head position trajectory defines the high-level task control variable. The motion control is divided into low-level task generation and motor execution phases. We model CNS as STS controller and its Estimator subsystem plans joint trajectories to perform the low-level task. The motor execution is done through the Cartesian controller subsystem that generates torque commands to the joints. We do extensive motion and force capture experiments on human subjects to validate our analytical modeling scheme. We first scale our biomechanical model to match the anthropometry of the subjects. We do dynamic motion reconstruction through the control of simulated custom human CNS models to follow the captured head position trajectories in real time. We perform kinematic and kinetic analyses and comparison of experimental and simulated motions. For head position trajectories, root mean square (RMS) errors are 0.0118 m in horizontal and 0.0315 m in vertical directions. Errors in angle estimates are 0.55 rad, 0.93 rad, 0.59 rad, and 0.0442 rad for ankle, knee, hip, and head orientation, respectively. RMS error of ground reaction force (GRF) is 50.26 N, and the correlation between ground reaction torque and the support moment is 0.72. Low errors in our results validate (1) the reliability of motion/force capture methods and anthropometric technique for customization of human models and (2) high-level task control framework and human CNS modeling as a solution to the hypothesis. Accurate modeling and detailed understanding of human motion can have significant scope in the fields of rehabilitation, humanoid robotics, and virtual characters' motion planning based on high-level task control schemes.

Measurement of adherence to home-based exercises among community-dwelling stroke survivors in India

OBJECTIVES

To develop an adherence questionnaire specific to stroke and measure the level of adherence to home-based exercises among community-dwelling stroke survivors.

METHODS

We developed and validated the "Stroke-Specific Measure of Adherence to Home-based Exercises" (SS-MAHE). We measured the exercise adherence among 92 community-dwelling stroke survivors in a cross-sectional study.

RESULTS

The SS-MAHE has two sections covering (a) the dosage of prescribed exercises and (b) dosage of actual exercises done by the participants. It was found to be reliable with ICC score of 0.81 (95% CI, 0.44, 0.94, p = .001.) Adherence was measured by comparing prescribed exercises to the actual exercises performed at home. We rated participants as "adherent" if they were following more than 70% of the prescribed exercise dosage. In our sample of 92 stroke survivors, only 28% of participants were adherent to prescribed home-based exercises.

CONCLUSION

SS-MAHE is a practical and reliable tool to measure adherence to home-based exercises after a stroke. Exercise adherence among stroke survivors is less than ideal. There is a need for strategies to specifically target exercise adherence in stroke survivors.

Blocking FcRn in humans reduces circulating IgG levels and inhibits IgG immune complex-mediated immune responses

The neonatal crystallizable fragment receptor (FcRn) functions as an intracellular protection receptor for immunoglobulin G (IgG). Recently, several clinical studies have reported the lowering of circulating monomeric IgG levels through FcRn blockade for the potential treatment of autoimmune diseases. Many autoimmune diseases, however, are derived from the effects of IgG immune complexes (ICs). We generated, characterized, and assessed the effects of SYNT001, a FcRn-blocking monoclonal antibody, in mice, nonhuman primates (NHPs), and humans. SYNT001 decreased all IgG subtypes and IgG ICs in the circulation of humans, as we show in a first-in-human phase 1, single ascending dose study. In addition, IgG IC induction of inflammatory pathways was dependent on FcRn and inhibited by SYNT001. These studies expand the role of FcRn in humans by showing that it controls not only IgG protection from catabolism but also inflammatory pathways associated with IgG ICs involved in a variety of autoimmune diseases.

P1876Atrial fibrillation related symptoms and cardiovascular outcomes

Background

Comprehensive information on the impact of atrial fibrillation (AF)-related symptoms and quality of life (QoL) on adverse outcomes is sparse.

Purpose

We aimed to investigate whether AF-related symptoms and/or QoL are associated with cardiovascular outcomes in a large cohort of AF patients.

Methods

A total of 3902 participants with documented AF from two nationwide prospective cohort studies in Switzerland were included. Information on AF-related symptoms was assessed yearly by standardized questionnaires, QoL was quantified using a visual analog scale (0–100, with higher scores indicating better QoL). The primary endpoint was a composite of stroke and systemic embolism. The secondary endpoint was a composite of cardiovascular death, hospitalization for heart failure and myocardial infarction. We assessed associations using multivariable, time-updated Cox proportional-hazards models including age, sex, study cohort, history of heart failure, hypertension, diabetes, prior stroke, prior myocardial infarction, vascular disease and prior catheter ablation for AF as covariates.

Results

Mean age was 72 years, and 72% were male. The median QoL score was 75 points, and 2572 (66%) participants had AF-related symptoms. Symptomatic individuals were younger (71 vs 75 years) and had more often paroxysmal AF (29 vs 23%) (p for both <0.001). The most frequent symptoms were palpitations (42%), dyspnea (25%) and fatigue (18%). In multivariable, time-updated models, the hazard ratio (HR) was 1.24 (95% confidence intervals (CI) 0.72; 2.11, p=0.43) for the primary endpoint and HR 0.83 (95% CI 0.65; 1.06, p=0.14) for the secondary endpoint in symptomatic vs non-symptomatic individuals. There was a significant, inverse association for a 5-point increase in the QoL score with both the primary (HR 0.94 (95% CI 0.88; 0.99), p=0.04) and secondary (HR 0.91 (95% CI 0.88; 0.93), p<0.0001) endpoints.

Conclusions

AF-related symptoms are not associated with adverse cardiovascular events in AF patients. In contrast, QoL is inversely associated with to adverse cardiovascular outcomes.