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47 ud af 47 tidsskrifter valgt, søgeord (guidelines) valgt, emner højest 180 dage gamle, sorteret efter nyeste først.
177 emner vises.
Atchchuthan Kanagasabai, Callum Evans, Hayley E. Jones, Alastair D. Hay, Sarah Dawson, Jelena Savović, Martha M.C. Elwenspoek
Clinical Microbiology and Infection, 3.01.2024
Tilføjet 3.01.2024
Centor and McIsaac scores are clinical prediction rules for diagnosing group A Streptococcus (GAS) infection in patients with pharyngitis. Their recommended thresholds vary between guidelines.
Læs mere Tjek på PubMedBrennan, L., Stres, D. P., Egboko, F., Patel, P., Broad, E., Brewster, L., Lunn, J., Isba, R.
BMJ Open, 3.01.2024
Tilføjet 3.01.2024
ObjectivesHealth inequalities are systematic differences in health between people, which are avoidable and unfair. Globally, more political strategies are required to address health inequalities, which have increased since the global SARS-CoV-2/COVID-19 pandemic, with a disproportionate impact on children. This scoping review aimed to identify and collate information on how hospitals around the world that deliver care to children have addressed health inequalities. DesignScoping review focused solely on grey literature. Eligibility criteria for selecting studiesFollowing Joanna Briggs Institute guidelines, a four-step approach to identifying literature was adopted. Data sourcesOverton, OpenGrey, OpenMD, Trip Database, DuckDuckGo, Google, targeted websites and children’s hospital websites were searched on March 2023 for items published since 2010. Data extraction and synthesisRetrieved items were screened against clear inclusion and exclusion criteria before data were extracted by two independent reviewers using a data extraction tool. Studies were tabulated by a hospital. A meta-analysis was not conducted due to the varied nature of studies and approaches. ResultsOur study identified 26 approaches to reduction of health inequalities, from 17 children’s hospitals. Approaches were categorised based on their size and scope. Seven approaches were defined as macro, including hospital-wide inequality strategies. Ten approaches were classed as meso, including the establishment of new departments and research centres. Micro approaches (n=9) included one-off projects or interventions offered to specific groups/services. Almost half of the reported approaches did not discuss the evaluation of impact. ConclusionsChildren’s hospitals provide a suitable location to conduct public health interventions. This scoping review provides examples of approaches on three scales delivered at hospitals across high-income countries. Hospitals with the most comprehensive and extensive range of approaches employ dedicated staff within the hospital and community. This review indicates the value of recruitment of both public health-trained staff and culturally similar staff to deliver community-based interventions.
Læs mere Tjek på PubMedBMC Infectious Diseases, 2.01.2024
Tilføjet 2.01.2024
Abstract Background Personalized clinical management of spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE) is challenging due to limited evidence of microbiologic findings and their clinical impact during the clinical course of the disease. We aimed to characterize clinico-microbiological and imaging phenotypes of SD and ISEE to provide useful insights that could improve outcomes and potentially modify guidelines. Methods We performed chart review and collected data on the following parameters: bacterial antibiogram-resistogram, type of primary spinal infection, location of spinal infection, source of infection, method of detection, clinical complications (sepsis, septic embolism, and endocarditis), length of hospital and intensive care unit (ICU) stay, relapse rate, and disease-related mortality in patients with proven pyogenic SD and ISEE treated surgically in a university hospital in Germany between 2002 and 2022. Results We included data from 187 patients (125 SD, 66.8% and 62 ISEE, 33.2%). Gram-positive bacteria (GPB) were overall more frequently detected than gram-negative bacteria (GNB) (GPB: 162, 86.6% vs. GNB: 25, 13.4%, p
Læs mere Tjek på PubMedDaba, C., Atamo, A., Gebretsadik Weldehanna, D., Oli, A., Debela, S. A., Luke, A. O., Gebrehiwot, M.
BMJ Open, 30.12.2023
Tilføjet 30.12.2023
ObjectiveNon-compliance with COVID-19 infection prevention and control (IPC) is one of the global public health problems particularly among those frontline healthcare workers. However, there are no detailed investigations on COVID-19 IPC compliance among healthcare workers in conflict-affected settings. The objective of this research was to assess compliance with COVID-19 IPC measures and determine the factors associated with it among healthcare providers in Ethiopian governmental hospitals affected by conflict. DesignA cross-sectional study was carried out within institutional settings. Study setting and periodThe study was conducted in three public hospitals located in northeastern Ethiopia during the period of March to April 2022. ParticipantsSimple random sampling technique was used to select 325 healthcare workers after proportional allocation was made to each public hospital. Primary outcome measuresThe primary outcome was non-compliance with COVID-19 IPC. A multivariable logistic regression analysis was employed to identify factors associated with the lack of adherence to the COVID-19 IPC protocol. ResultsNearly half (150, 46.2%) of the healthcare workers had non-compliance with COVID-19 IPC protocol. Absence of hand washing soap (adjusted OR (AOR)=2.99; 95% CI 2.46 to 5.76), workload (AOR=2.25; 95% CI 1.33 to 3.84), disruption in the supply of piped water (AOR=1.82; 95% CI 1.11 to 2.99), did not undergo training in COVID-19 IPC (AOR=2.85; 95% CI 1.85 to 4.84), absence of COVID-19 IPC guidelines (AOR=2.14; 95% CI 1.11 to 4.13) and chewing khat (AOR=2.3; 95% CI 1.32 to 3.72) were determinant factors for non-compliance. ConclusionsThe magnitude of non-compliance with COVID-19 IPC was high. Hospital managers and federal ministry of health should provide regular training on COVID-19 IPC, continuous piped water and personal protective facilities for healthcare workers. Ultimately, improving the security situation in the area would help improve COVID-19 IPC compliance among healthcare workers in these and other similar conflict-affected settings.
Læs mere Tjek på PubMedZhen Zhao, Owen Lou, Yiyang Wang, Raymond Yin, Carrie Gong, Florence Deng, Ethan C. Wu, Jing Yi Xie, Jerry Wu, Avery Ma, Yongzhi Guo, Wei Ting Xiong
PLoS One Infectious Diseases, 30.12.2023
Tilføjet 30.12.2023
by Zhen Zhao, Owen Lou, Yiyang Wang, Raymond Yin, Carrie Gong, Florence Deng, Ethan C. Wu, Jing Yi Xie, Jerry Wu, Avery Ma, Yongzhi Guo, Wei Ting Xiong While systemic corticosteroids quicken patient recovery during acute exacerbations of COPD, they also have many adverse effects. The optimal duration of corticosteroid administration remains uncertain. We performed a systematic review and meta-analysis to compare patient outcomes between short- (≤7 days) and long- (>7 days) corticosteroid regimens in adults with acute exacerbations of COPD. MEDLINE, EMBASE, CENTRAL, and hand searches were used to identify eligible studies. Risk of bias was assessed using the Cochrane RoB 2.0 tool and ROBINS-I. Data were summarized as ORs (odds ratios) or MDs (mean differences) whenever possible and qualitatively described otherwise. A total of 11532 participants from eight RCTs and three retrospective cohort studies were included, with 1296 from seven RCTs and two cohort studies eligible for meta-analyses. Heterogeneity was present in the methodology and settings of the studies. The OR (using short duration as the treatment arm) for mortality was 0.76 (95% CI = 0.40–1.44, n = 1055). The MD for hospital length-of-stay was -0.91 days (95% CI = -1.81–-0.02 days, n = 421). The OR for re-exacerbations was 1.31 (95% CI = 0.90–1.90, n = 552). The OR for hyperglycemia was 0.90 (95% CI = 0.60–1.33, n = 423). The OR for infection incidence was 0.96 (95% CI = 0.59–1.156, n = 389). The MD for one-second forced expiratory volume change was -18.40 mL (95% CI = -111.80–75.01 mL, n = 161). The RCTs generally had low or unclear risks of bias, while the cohort studies had serious or moderate risks of bias. Our meta-analyses were affected by imprecision due to insufficient data. Some heterogeneity was present in the results, suggesting population, setting, and treatment details are potential prognostic factors. Our evidence suggests that short-duration treatments are not worse than long-duration treatments in moderate/severe exacerbations and may lead to considerably better outcomes in milder exacerbations. This supports the current GOLD guidelines.Trial registration: Our protocol is registered in PROSPERO: CRD42023374410.
Læs mere Tjek på PubMedLuke Bracegirdle, Matthew Stubbs, Rezaur Rahman, Alexander I. R. Jackson, Helmi C. Burton-Papp, Robert Chambers, Sanjay Gupta, Michael P. W. Grocott, Ahilanandan Dushianthan
PLoS One Infectious Diseases, 29.12.2023
Tilføjet 29.12.2023
by Luke Bracegirdle, Matthew Stubbs, Rezaur Rahman, Alexander I. R. Jackson, Helmi C. Burton-Papp, Robert Chambers, Sanjay Gupta, Michael P. W. Grocott, Ahilanandan Dushianthan Background COVID-19 placed immense strain on healthcare systems, necessitating innovative responses to the surge of critically ill patients, particularly those requiring mechanical ventilation. In this report, we detail the establishment of a dedicated critical care prone positioning team at University Hospital Southampton in response to escalating demand for prone positioning during the initial wave of the pandemic. Methods The formation of a prone positioning team involved meticulous planning and collaboration across disciplines to ensure safe and efficient manoeuvrers. A comprehensive training strategy, aligned with national guidelines, was implemented for approximately 550 staff members from a diverse background. We surveyed team members to gain insight to the lived experience. Results A total of 78 full-time team members were recruited and successfully executed over 1200 manoeuvres over an eight-week period. Our survey suggests the majority felt valued and expressed pride and willingness to participate again should the need arise. Conclusion The rapid establishment and deployment of a dedicated prone positioning team may have contributed to both patient care and staff well-being. We provide insight and lessons that may be of value for future respiratory pandemics. Future work should explore objective clinical outcomes and long-term sustainability of such services.
Læs mere Tjek på PubMedFajardo, E., Lastrucci, C., Bah, N., Mingiedi, C. M., Ba, N. S., Mosha, F., Lule, F. J., Paul, M. A. S., Hughes, L., Barr-DiChiara, M., Jamil, M. S., Sands, A., Baggaley, R., Johnson, C.
BMJ Open, 28.12.2023
Tilføjet 28.12.2023
ObjectivesIn 2019, the WHO released guidelines on HIV testing service (HTS). We aim to assess the adoption of six of these recommendations on HIV testing strategies among African countries. DesignPolicy review. Setting47 countries within the WHO African region. ParticipantsNational HTS policies from the WHO African region as of December 2021. Primary and secondary outcome measures: Uptake of WHO recommendations across national HTS policies including the standard three-test strategy; discontinuation of a tiebreaker test to rule in HIV infection; discontinuation of western blotting (WB) for HIV diagnosis; retesting prior to antiretroviral treatment (ART) initiation and the use of dual HIV/syphilis rapid diagnostic tests (RDTs) in antenatal care. Country policy adoption was assessed on a continuum, based on varying levels of complete adoption. ResultsNational policies were reviewed for 96% (n=45/47) of countries in the WHO African region, 38% (n=18) were published before 2019 and 60% (n=28) adopted WHO guidance. Among countries that had not fully adopted WHO guidance, not yet adopting a three-test strategy was the most common reason for misalignment (45%, 21/47); of which 31% and 22% were in low-prevalence (
Læs mere Tjek på PubMedYirga Legesse Niriayo, Melisew Ayalneh, Gebre Teklemariam Demoz, Nigusse Tesfay, Kidu Gidey
PLoS One Infectious Diseases, 23.12.2023
Tilføjet 23.12.2023
by Yirga Legesse Niriayo, Melisew Ayalneh, Gebre Teklemariam Demoz, Nigusse Tesfay, Kidu Gidey Background Antibiotic use related problems lead to the emergence of resistance, failure of therapy, morbidity, mortality, and unnecessary healthcare expenditure. However, little is known about antimicrobial use related problems in our setting particularly in hospitalized surgical patients. Objective The purpose of this study was to investigate antibiotic use related problems and their determinants among hospitalized surgical patients. Methodology A prospective observational study was conducted from December 2018 to April 2019 at the surgical ward of the Ayder comprehensive specialized hospital, located in Northern Ethiopia. We included patients admitted to the surgical ward who were on antibiotic therapy or were candidates for antibiotic therapy/prophylaxis. The patients were recruited during admission and were followed daily until discharge. Data were collected through patient interviews and expert reviews of medical and medication records. The appropriateness of antibiotic use was evaluated according to the Infectious Disease Society of America, American Society of Health System Pharmacists, and World Health Organization guidelines. Subsequently, antibiotic use related problems were identified and classified based on Cipolle’s method followed by consensus review with experts. Binary logistic regression was performed to identify the determinants of antibiotic use related problems. Statistical significance was set at p
Læs mere Tjek på PubMedNene Kaah Keneh, Sebastien Kenmoe, Arnol Bowo-Ngandji, Jane-Francis Tatah Kihla Akoachere, Hortense Gonsu Kamga, Roland Ndip Ndip, Jean Thierry Ebogo-Belobo, Cyprien Kengne-Ndé, Donatien Serge Mbaga, Nicholas Tendongfor, Lucy Mande Ndip, Seraphine Nkie Esemu
PLoS One Infectious Diseases, 23.12.2023
Tilføjet 23.12.2023
by Nene Kaah Keneh, Sebastien Kenmoe, Arnol Bowo-Ngandji, Jane-Francis Tatah Kihla Akoachere, Hortense Gonsu Kamga, Roland Ndip Ndip, Jean Thierry Ebogo-Belobo, Cyprien Kengne-Ndé, Donatien Serge Mbaga, Nicholas Tendongfor, Lucy Mande Ndip, Seraphine Nkie Esemu Background The emergence of methicillin-resistant Staphylococcus aureus (MRSA) has increased and poses a significant threat to human and animal health in Cameroon and the world at large. MRSA strains have infiltrated various settings, including hospitals, communities, and livestock, contributing to increased morbidity, treatment costs, and mortality. This evidence synthesis aims to understand MRSA prevalence, resistance patterns, and genetic characterization in Cameroon. Methods The methodology was consistent with the PRISMA 2020 guidelines. Studies of any design containing scientific data on MRSA prevalence, genetic diversity, and antimicrobial resistance patterns in Cameroon were eligible for inclusion, with no restrictions on language or publication date. The search involved a comprehensive search strategy in several databases including Medline, Embase, Global Health, Web of Science, African Index Medicus, and African Journal Online. The risk of bias in the included studies was assessed using the Hoy et al tool, and the results were synthesized and presented in narrative synthesis and/or tables and graphs. Results The systematic review analyzed 24 studies, mostly conducted after 2010, in various settings in Cameroon. The studies, characterized by moderate to low bias, revealed a wide prevalence of MRSA ranging from 1.9% to 46.8%, with considerable variation based on demographic and environmental factors. Animal (0.2%), food (3.2% to 15.4%), and environmental samples (0.0% to 34.6%) also showed a varied prevalence of MRSA. The genetic diversity of MRSA was heterogeneous, with different virulence gene profiles and clonal lineages identified in various populations and sample types. Antimicrobial resistance rates showed great variability in the different regions of Cameroon, with notable antibiotic resistance recorded for the beta-lactam, fluoroquinolone, glycopeptide, lincosamide, and macrolide families. Conclusion This study highlights the significant variability in MRSA prevalence, genetic diversity, and antimicrobial resistance patterns in Cameroon, and emphasizes the pressing need for comprehensive antimicrobial stewardship strategies in the country.
Læs mere Tjek på PubMedMohamed Abdulla Ghuloom Abdulla Bucheeri, Marion Elligsen, Philip W. Lam, Nick Daneman, Derek MacFadden
PLoS One Infectious Diseases, 21.12.2023
Tilføjet 21.12.2023
by Mohamed Abdulla Ghuloom Abdulla Bucheeri, Marion Elligsen, Philip W. Lam, Nick Daneman, Derek MacFadden Background Empiric antibiotic treatment selection should provide adequate coverage for potential pathogens while minimizing unnecessary broad-spectrum antibiotic use. We sought to pilot a sepsis treatment algorithm to individualize antibiotic recommendations, and thereby improve early antibiotic de-escalation while maintaining adequacy of coverage (Early-IDEAS). Methods In this observational study, the Early-IDEAS decision support algorithm was derived from previous Gram- negative and Gram-positive prediction rules and models along with local guidelines, and then applied to prospectively identified consecutive adults within 24 hours of suspected sepsis. The primary outcome was the proportion of patients for whom de-escalation of the primary antibiotic regimen was recommended by the algorithm. Secondary outcomes included: (1) proportion of patients for whom escalation was recommended; (2) number of recommended de-escalation steps along a pre-specified antibiotic cascade; and (3) adequacy of therapy in patients with culture-confirmed infection. Results We screened 578 patients, of whom 107 eligible patients were included. The Early-IDEAS treatment recommendation was informed by Gram-negative models in 76 (71%) patients, Gram-positive rules in 64 (59.8%), and local guidelines in 27 (25.2%). Antibiotic de-escalation was recommended in almost half of all patients (n = 52, 48.6%), with a median of 2 steps down the a priori antibiotic treatment cascade. No treatment change was recommended in 45 patients (42.1%), and escalation was recommended in 10 (9.3%). Among the 17 patients with positive blood cultures, both the clinician prescribed regimen and the algorithm recommendation provided adequate coverage for the isolated pathogen in 12 patients (70.6%), (p = 1). Among the 25 patients with positive relevant, non-blood cultures, both the clinician prescribed regimen and the algorithm recommendation provided adequate coverage in 20 (80%), (p = 1). Conclusion An individualized decision support algorithm in early sepsis could lead to substantial antibiotic de-escalation without compromising adequate antibiotic coverage.
Læs mere Tjek på PubMedRobina Aerts, Varun Mehra, Andreas H Groll, Rodrigo Martino, Katrien Lagrou, Christine Robin, Katia Perruccio, Nicole Blijlevens, Marcio Nucci, Monica Slavin, Stéphane Bretagne, Catherine Cordonnier, European Conference on Infections in Leukaemia group
Lancet Infectious Diseases, 20.12.2023
Tilføjet 20.12.2023
Patients with haematological malignancies might develop life-threatening toxoplasmosis, especially after allogeneic haematopoietic stem-cell transplantation (HSCT). Reactivation of latent cysts is the primary mechanism of toxoplasmosis following HSCT; hence, patients at high risk are those who were seropositive before transplantation. The lack of trimethoprim–sulfamethoxazole prophylaxis and various immune status parameters of the patient are other associated risk factors. The mortality of toxoplasma disease—eg, with organ involvement—can be particularly high in this setting.
Læs mere Tjek på PubMedWang, J., Tong, S., Niu, Y., Lu, B.
BMJ Open, 20.12.2023
Tilføjet 20.12.2023
ObjectivesTo explore the attitudes towards exercise, factors influencing exercise and exercise-related needs of patients with moderately to severely active inflammatory bowel disease. DesignA qualitative phenomenological research. SettingThe study was conducted at a comprehensive tertiary hospital in Suzhou, China, which is a secondary care facility. ParticipantsThe study included 17 participants who met specific inclusion criteria: aged between 16 and 70 years, diagnosed with inflammatory bowel disease and in a state of moderate to severe disease activity. Participants were required to be capable of clear self-expression and provide voluntary consent. Exclusion criteria included the presence of cancer or severe physical illness, cognitive impairment or mental illness. InterventionsSemistructured interviews were used to collect data. ResultsThe exercise experiences of participants with moderate to severe inflammatory bowel disease yielded three themes: attitudes towards exercise, factors influencing exercise and exercise-related needs. ConclusionThe majority of participants had negative attitudes towards exercise during periods of moderate to severe activity, largely influenced by disease activity, symptom management, inadequate knowledge of exercise and uncertainty about the value of exercise. Of particular note, professional guidance was generally recognised as stimulating a willingness to exercise positively, and participants demonstrated a strong need for professional guidance. Therefore, it is recommended that clear exercise guidelines for inflammatory bowel disease be constructed to ensure that patients receive safe and effective guidance to develop a healthy lifestyle in order to maximise the benefits of exercise.
Læs mere Tjek på PubMedMaan, Irfaan; Kohli, Manik; Gilson, Richard
Current Opinion in Infectious Diseases, 19.12.2023
Tilføjet 19.12.2023
Purpose of review The 2022 global outbreak of mpox disproportionally affected people with HIV (PWH). We review the data on the presentation, treatment, and prevention of mpox in PWH. Recent findings Most PWH with mpox had a mild and self-limiting illness, no different to people without HIV. A higher rate of rectal symptoms has been reported among PWH and those with advanced HIV disease were at higher risk of severe disease, hospitalization, and death. Treatment with antivirals was widely used in hospitalized patients without any randomized control trial data to support its use and without any data specifically in PWH. Use of smallpox vaccines to prevent mpox is safe in PWH regardless of CD4+ cell count. There is limited data on efficacy in those with lower CD4+ cell count and on long-term protective efficacy. Summary PWH should be offered vaccination against mpox in line with national guidelines. PWH should be individually risk-assessed for severe mpox, based on their CD4+ cell count and co-morbidities and ideally recruited into treatment trials to build an evidence base on efficacy. HIV and other sexually transmitted infection testing should be offered to all people diagnosed with mpox.
Læs mere Tjek på PubMedBamford, Alasdair; Foster, Caroline; Lyall, Hermione
Current Opinion in Infectious Diseases, 19.12.2023
Tilføjet 19.12.2023
Purpose of review HIV screening in pregnancy, universal suppressive antiretroviral therapy (ART) and breastfeeding avoidance can almost completely prevent vertical transmission of HIV. Breastfeeding is associated with an additional risk of transmission, although this risk is extremely low with suppressive maternal ART. This minimal risk must be balanced with the benefits of breastfeeding for women living with HIV (WLHIV) and their infants. Guidance in high-income countries has evolved, moving towards supported breast feeding for women on suppressive ART. Recent findings Breastmilk transmission accounts for an increasing proportion of new infant infections globally. The majority of transmission data comes from studies including women not on suppressive ART. Breastmilk transmissions in the context of undetectable viral load have rarely occurred, although risk factors remain unclear. Outcome data on supported breastfeeding are accumulating, providing evidence for guidelines and informing infant feeding decisions. Long-acting ART for maternal preexposure prophylaxis or treatment, and infant postnatal prophylaxis are promising future options. Summary Breastfeeding on suppressive ART has a very low risk of vertical transmission and can have multiple benefits for WLHIV and their infants. However, caution is advised with relaxation of breastfeeding guidance so as not to jeopardise the global goal of elimination of vertical transmission by 2030.
Læs mere Tjek på PubMedChow, Eric P.F.; Fairley, Christopher K.; Kong, Fabian Y.S.
Current Opinion in Infectious Diseases, 19.12.2023
Tilføjet 19.12.2023
Purpose of review The rise in antimicrobial resistance in several STI pathogens such as Neisseria gonorrhoeae has become a public health threat as only one first-line treatment remains. Reducing screening interval for gonorrhoea and chlamydia in high-prevalence populations has been proposed to address antimicrobial stewardship, but this remains controversial. This review aimed to revisit the epidemiology of infections at the oropharynx and review the current screening recommendations and treatment guidelines in different populations. Recent findings Emerging evidence suggests that the oropharynx is the primary anatomical site for gonorrhoea transmission but maybe not for chlamydia transmission. Most international guidelines recommend 3-monthly oropharyngeal gonorrhoea and chlamydia screening for high-prevalence populations (e.g. men who have sex with men) but not low-prevalence populations (e.g. heterosexuals) given the clinical and public health benefits of screening in low-prevalence populations are still unclear. Doxycycline remains the first-line treatment for oropharyngeal chlamydia in most guidelines. However, some countries have moved from dual therapy (ceftriaxone and azithromycin) to monotherapy (ceftriaxone) for oropharyngeal gonorrhoea treatment to address antimicrobial stewardship. Summary The transmission of gonorrhoea and chlamydia is still not fully understood. Further work will be required to evaluate the benefits and harms of reducing screening in high-prevalence populations.
Læs mere Tjek på PubMedLi, Chunyan; Zhao, Peipei; Tan, Rayner K.J.; Wu, Dan
Current Opinion in Infectious Diseases, 19.12.2023
Tilføjet 19.12.2023
Purpose of review Community engagement is key to the success of sustainable public health interventions. This review highlights recent published studies that describe the use of community-engaged methods in sexually transmitted infection (STI) prevention research. Recent findings We organized the findings using a socio-ecological model. At the individual level, communities were engaged through participation in formative research, short-term consultations and community advisory board participation, as well as co-creation activities. At the interpersonal level, studies reviewed described peer-led interventions that leverage the influence and guidance of peers, patient-led interventions in the form of patient navigation and notification, as well as those that mobilize social networks and the power of social relationships to promote health. At the organizational and community level, multisectoral, multifacility collaborations between community, government, and academic stakeholders were highlighted. At the policy and population level, communities were engaged through community dialogues to disseminate research findings, as well as in developing strategic frameworks and clinical guidelines. Digital tools have also been leveraged for effective community engagement. Summary Communities have an effective role to play in STI prevention and can be engaged at multiple levels. Future efforts may consider the use of community engagement tools highlighted in this review, including digital technologies that have the potential to reach more diverse end-users.
Læs mere Tjek på PubMedJournal of the American Medical Association, 19.12.2023
Tilføjet 19.12.2023
Imagine if a new multicenter, randomized trial of a pharmaceutical drug found that for every 3 patients treated on presentation to the hospital with a common severe illness, one intubation and an intensive care unit (ICU) admission were prevented. This would be an instant blockbuster drug. Insurers would scramble to reimburse it, and guidelines and quality metrics would be established to facilitate implementation. In the setting of worsening hospital and ICU strain globally, health systems would work rapidly to implement pathways for using this new therapy. For reference, the RECOVERY trial testing the use of dexamethasone in hospitalized patients with COVID-19, cited more than 2500 times since publication 3 years ago, reduced the need for intubation for 1 in every 50 patients.
Læs mere Tjek på PubMedClinical Infectious Diseases, 19.12.2023
Tilføjet 19.12.2023
Abstract Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19) and for identifying asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The number of available SARS-CoV-2 nucleic acid detection tests continues to increase as does the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) developed an evidence-based diagnostic guideline to assist clinicians, clinical laboratorians, patients, and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss nuances of test result interpretation in a variety of practice settings, and highlight important unmet research needs related to COVID-19 diagnostic testing. IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel agreed on 12 diagnostic recommendations. Access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention, and the public health response to COVID-19 infection. Information on the clinical performance of available tests continues to grow, but the quality of evidence of the current literature to support this updated molecular diagnostic guideline remains moderate to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is suggested for asymptomatic individuals with known or suspected contact with a COVID-19 case when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions. Evidence in support of rapid testing and testing of upper respiratory specimens other than nasopharyngeal swabs, which offer logistical advantages, is sufficient to warrant conditional recommendations in favor of these approaches.
Læs mere Tjek på PubMedManlapaz, D., Vergara, J. A., Alpuerto, K. M. B., De Los Santos, I. K. S., Enriquez, M. U., Manicio, Z. Z., Mendres, J. E. F., Tolosa, C. G. S., Vilela, Z. G. D., Zabat, Z. E. G. A.
BMJ Open, 15.12.2023
Tilføjet 15.12.2023
BackgroundThe COVID-19 pandemic has taken a toll on both physical activity and fitness as several pursuits and activities have been restricted. Coupled with this, increased food intake and sedentary lifestyles have produced poor physical health outcomes. Online physical education classes have been more difficult to conduct given the limitations of the setup. As such, exergaming has been identified as a possible educational tool that could improve students’ motivation, participation and fitness levels and reduce negative behaviours in class while contributing to the current curriculum. ObjectivesThe study explores the perspectives of both the physical education academic staff and senior high school students from the University of Santo Tomas on the implementation of exergaming to determine the feasibility of exergaming as an educational tool in the Philippines’ physical education curriculum. MethodologyA descriptive qualitative design will be used and participants will be selected through criterion sampling. The authors will conduct a process of question development and pilot FGDs beforehand to ensure smooth proceedings. Once done, they will undergo FGDs conducted through Google Meet. Data will be coded and analysed via thematic analysis using manual coding and NVivo V.12 software to summarise central themes and perceptions. Ethics and disseminationThis study will abide by the Nuremberg Code, Declaration of Helsinki, Belmont Report, Data Privacy Act of 2012 and National Ethical Guidelines (for health-related research) of 2017. The study has received approval from the University of Santo Tomas (UST)-College of Rehabilitation Sciences (CRS) Ethics Review Committee. All participant data will be labelled according to random two-digit computer generated codes to preserve anonymity and stored in password-protected laptops and Google Drive folders to preserve confidentiality. Results will be made available to individual UST physical education academic staff and senior high school students prior to publication in peer-reviewed journal.
Læs mere Tjek på PubMedInfection, 15.12.2023
Tilføjet 15.12.2023
Abstract In a 21-year-old female, AIDS following infection with HIV-2 was diagnosed alongside an HIV-associated high-grade B cell lymphoma. Treatment of HIV-2 with dolutegravir, emtricitabine, and tenofovir resulted in viral suppression and slow recovery of CD4 cell counts. Treatment of lymphoma caused significant adverse effects but led to complete remission. The patient denied sexual activity and intravenous drug abuse. The patient had been born to an HIV-2-positive mother but appropriate perinatal testing based on national guidelines had remained negative. This case recapitulates the natural course of HIV-2 infection.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.12.2023
Tilføjet 14.12.2023
Abstract Background The Viral hepatitis elimination by 2030 is uncertain in resource-limited settings (RLS), due to high burdens and poor diagnostic coverage. This sounds more challenging for hepatitis C virus (HCV) given that antibody (HCVAb) sero-positivity still lacks wide access to HCV RNA molecular testing. This warrants context-specific strategies for appropriate management of liver impairment in RLS. We herein determine the association between anti-HCV positivity and liver impairment in an African RLS. Methods A facility-based observational study was conducted from July-August 2021 among individuals attending the “St Monique” Health Center at Ottou, a rural community of Yaounde,Cameroon. Following a consecutive sampling, consenting individuals were tested for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and HIV antibodies (HIVAb) as per the national guidelines. After excluding positive cases for HBsAg and/or HIVAb, liver function tests (ALT/AST) were performed on eligible participants (HBsAg and HIVAb negative) and outcomes were compared according to HCVAb status; with p 50 years compared to younger ones [38.46%(15/39) versus 12.36% (33/267) respectively, OR(95%CI) = 4.43(2.11-9.29), p 50 versus younger ones [69.23% (27/39) versus 24.72%(66/267) respectively, p
Læs mere Tjek på PubMedYek, Christina; Wang, Jing; Fintzi, Jonathan; Mancera, Alex G.; Keller, Michael B.; Warner, Sarah; Kadri, Sameer S.
Critical Care Explorations, 14.12.2023
Tilføjet 14.12.2023
IMPORTANCE: Many U.S. State crisis standards of care (CSC) guidelines incorporated Sequential Organ Failure Assessment (SOFA), a sepsis-related severity score, in pandemic triage algorithms. However, SOFA performed poorly in COVID-19. Although disease-specific scores may perform better, their prognostic utility over time and in overcrowded care settings remains unclear. OBJECTIVES: We evaluated prognostication by the modified 4C (m4C) score, a COVID-19–specific prognosticator that demonstrated good predictive capacity early in the pandemic, as a potential tool to standardize triage across time and hospital-surge environments. DESIGN: Retrospective observational cohort study. SETTING: Two hundred eighty-one U.S. hospitals in an administrative healthcare dataset. PARTICIPANTS: A total of 298,379 hospitalized adults with COVID-19 were identified from March 1, 2020, to January 31, 2022. m4C scores were calculated from admission diagnosis codes, vital signs, and laboratory values. MAIN OUTCOMES AND MEASURES: Hospital-surge index, a severity-weighted measure of COVID-19 caseload, was calculated for each hospital-month. Discrimination of in-hospital mortality by m4C and surge index-adjusted models was measured by area under the receiver operating characteristic curves (AUC). Calibration was assessed by training models on early pandemic waves and measuring fit (deviation from bisector) in subsequent waves. RESULTS: From March 2020 to January 2022, 298,379 adults with COVID-19 were admitted across 281 U.S. hospitals. m4C adequately discriminated mortality in wave 1 (AUC 0.779 [95% CI, 0.769–0.789]); discrimination was lower in subsequent waves (wave 2: 0.772 [95% CI, 0.765–0.779]; wave 3: 0.746 [95% CI, 0.743–0.750]; delta: 0.707 [95% CI, 0.702–0.712]; omicron: 0.729 [95% CI, 0.721–0.738]). m4C demonstrated reduced calibration in contemporaneous waves that persisted despite periodic recalibration. Performance characteristics were similar with and without adjustment for surge. CONCLUSIONS AND RELEVANCE: Mortality prediction by the m4C score remained robust to surge strain, making it attractive for when triage is most needed. However, score performance has deteriorated in recent waves. CSC guidelines relying on defined prognosticators, especially for dynamic disease processes like COVID-19, warrant frequent reappraisal to ensure appropriate resource allocation.
Læs mere Tjek på PubMedAmber Sacre, Clare Bambra, Josephine M. Wildman, Katie Thomson, Natalie Bennett, Sarah Sowden, Adam Todd
PLoS One Infectious Diseases, 14.12.2023
Tilføjet 14.12.2023
by Amber Sacre, Clare Bambra, Josephine M. Wildman, Katie Thomson, Natalie Bennett, Sarah Sowden, Adam Todd This global umbrella review aimed to synthesise evidence of socioeconomic inequalities in the uptake of routine vaccinations and identify the mechanisms that may contribute to the association. To our knowledge, no attempt has been made to synthesise the global body of systematic reviews across a variety of vaccines, geographical locations, and measures of SES. The inclusion criteria were as follows: studies assessing vaccination uptake according to education, income, occupation/employment, and/or area-level deprivation; any country or universally recommended routine vaccination (according to the WHO); qualitative or quantitative reviews, published 2011-present. The searches were performed in eight databases. The screening process followed PRISMA-E guidelines, each stage was performed by one reviewer, and a 10% sample checked by a second for consistency. Included reviews underwent data extraction, quality appraisal (AMSTAR-2), and narrative synthesis according to country-context. After deduplication, 9,163 reports underwent title and abstract screening, leaving 119 full texts to be assessed for eligibility. Overall, 26 studies were included in the umbrella review. Evidence for lower uptake amongst disadvantaged SES individuals was found in all 26 reviews. However, 17 reviews showed mixed results, as inverse associations were also identified (lower uptake for advantaged SES, and/or higher uptake for disadvantaged SES). Those that explored high-income countries had a greater prevalence of mixed findings than those focusing on low/middle-income countries. The two most frequently cited mechanisms were vaccination knowledge, and confidence in vaccination or vaccination providers. These mechanisms were often understood by review authors as varying by level of education. We find socioeconomic differences in routine vaccination uptake, but the association did not always follow a gradient. Whilst education may be associated with uptake globally, our study indicates that its role varies by country-context. A limitation is the overlap of some primary studies across the included systematic reviews.
Læs mere Tjek på PubMedBMC Infectious Diseases, 14.12.2023
Tilføjet 14.12.2023
Abstract Background The Viral hepatitis elimination by 2030 is uncertain in resource-limited settings (RLS), due to high burdens and poor diagnostic coverage. This sounds more challenging for hepatitis C virus (HCV) given that antibody (HCVAb) sero-positivity still lacks wide access to HCV RNA molecular testing. This warrants context-specific strategies for appropriate management of liver impairment in RLS. We herein determine the association between anti-HCV positivity and liver impairment in an African RLS. Methods A facility-based observational study was conducted from July-August 2021 among individuals attending the “St Monique” Health Center at Ottou, a rural community of Yaounde,Cameroon. Following a consecutive sampling, consenting individuals were tested for anti-HCV antibodies, hepatitis B surface antigen (HBsAg) and HIV antibodies (HIVAb) as per the national guidelines. After excluding positive cases for HBsAg and/or HIVAb, liver function tests (ALT/AST) were performed on eligible participants (HBsAg and HIVAb negative) and outcomes were compared according to HCVAb status; with p 50 years compared to younger ones [38.46%(15/39) versus 12.36% (33/267) respectively, OR(95%CI) = 4.43(2.11-9.29), p 50 versus younger ones [69.23% (27/39) versus 24.72%(66/267) respectively, p
Læs mere Tjek på PubMedInfection, 13.12.2023
Tilføjet 13.12.2023
Abstract In a 21-year-old female, AIDS following infection with HIV-2 was diagnosed alongside an HIV-associated high-grade B cell lymphoma. Treatment of HIV-2 with dolutegravir, emtricitabine, and tenofovir resulted in viral suppression and slow recovery of CD4 cell counts. Treatment of lymphoma caused significant adverse effects but led to complete remission. The patient denied sexual activity and intravenous drug abuse. The patient had been born to an HIV-2-positive mother but appropriate perinatal testing based on national guidelines had remained negative. This case recapitulates the natural course of HIV-2 infection.
Læs mere Tjek på PubMedOrmiston, C. K., Chiangong, J., Livinski, A., Tompkins, D., Williams, F.
BMJ Open, 13.12.2023
Tilføjet 13.12.2023
IntroductionThe COVID-19 pandemic has had drastic effects on worldwide mental health and laid bare health disparities and inequities among marginalised groups and racial/ethnic minoritised communities in the USA. This is especially the case among Hispanic/Latino/a immigrants who face numerous structural and socioeconomic barriers to well-being. The increased mental health burden on Hispanic/Latino/a immigrants may have far reaching effects if left unaddressed. Thus, by understanding further Hispanic/Latino/a immigrant mental health during the pandemic, communities and health providers may be able to better address this growing issue. This scoping review aims to assess and outline the current literature on the pandemic’s effects on Hispanic/Latino/a immigrant mental health in the USA, identify research gaps and areas of urgent concern, and inform future research and public health interventions and guidelines. Methods and analysisA scoping review following the Joanna Briggs Institute methodology will be conducted. The PsycINFO, PubMed, Scopus and Web of Science: Core Collection databases and five grey literature sources will be searched for articles published in English from 1 January 2020 to 31 December 2022. Two independent reviewers will screen the search results at title and abstract and then full text using Covidence with conflicts resolved by a third reviewer. Data collection will also be performed in duplicate using Microsoft Excel with discrepancies resolved by a third reviewer and consensus discussion. Ethics and disseminationEthics approval is not required for this scoping review. Results will be published in a peer-reviewed journal as well as presented at local and national conferences and meetings relevant to our field. Furthermore, to make our findings accessible to non-scientific audiences, we will use various mediums, such as graphical abstracts, policy briefs and fact sheets to share the results in both English and Spanish on different platforms.
Læs mere Tjek på PubMedXiong, S., Klesges, L., Doering, M., Pratt, R. J.
BMJ Open, 12.12.2023
Tilføjet 12.12.2023
BackgroundImplementation science (IS) frameworks, models and theories (FMTs) have gained popularity in guiding the implementation and evaluation of evidence-based interventions (EBIs) for cancer screening. However, there are significant research gaps in understanding their applications in cancer health disparities contexts. This paper outlines a scoping review protocol designed to explore the utilisation of IS FMTs in cancer screening EBIs to inform intervention designs and adaptations. Methods and analysisThis scoping review protocol adheres to Arksey and O’Malley’s five-step methodological framework for conducting scoping studies. Search strategies were conducted in five bibliographic databases: Ovid MEDLINE, PubMed, Scopus, Web of Science and EMBASE. The search was run on 22 June 2023 with an English language filter and a date limit of 2001-current. Two reviewers will independently screen studies for inclusion and exclusion criteria. A third reviewer will be consulted, where appropriate at any of the review stages, to achieve consensus or resolve conflicts. Data will be collected, managed and analysed using Covidence. A narrative synthesis, based on Popay et al’s methodology, will guide reporting and summarisation of results. The review will adhere to the PRISMA Extension for Scoping Reviews guidelines. Ethics and disseminationThis scoping review is a novel approach for examining a growing corpus of research literature on IS FMT applications used in cancer screening EBIs. As a secondary analysis, this scoping review does not require approval from an institutional review board. We anticipate the review will produce insightful information (eg, challenges, key areas for future directions) on the applications of IS TMFs in designing, deploying and testing EBIs for populations experiencing cancer screening disparities. We will disseminate the results through journals and conferences targeting IS and cancer prevention researchers and practitioners.
Læs mere Tjek på PubMedBushra Jamil, Divya Nair, Pruthu Thekkur, Neelofar Laeeq, Anum Adil, Mohammed Khogali, Rony Zachariah, Selma Dar Berger, Srinath Satyanarayana, Ajay M. V. Kumar, Aaron Bochner, Amanda McClelland, Razia Fatima, Anthony D. Harries
PLoS One Infectious Diseases, 11.12.2023
Tilføjet 11.12.2023
by Bushra Jamil, Divya Nair, Pruthu Thekkur, Neelofar Laeeq, Anum Adil, Mohammed Khogali, Rony Zachariah, Selma Dar Berger, Srinath Satyanarayana, Ajay M. V. Kumar, Aaron Bochner, Amanda McClelland, Razia Fatima, Anthony D. Harries Introduction Screening household contacts of TB patients and providing TB preventive therapy (TPT) is a key intervention to end the TB epidemic. Global and timely implementation of TPT in household contacts, however, is dismal. We adapted the 7-1-7 timeliness metric designed to evaluate and respond to infectious disease outbreaks or pandemics, and assessed the feasibility, enablers and challenges of implementing this metric for screening and management of household contacts of index patients with bacteriologically-confirmed pulmonary TB in Karachi city, Pakistan. Methods We conducted an explanatory mixed methods study with a quantitative component (cohort design) followed by a qualitative component (descriptive design with focus group discussions). Results From January-June 2023, 92% of 450 index patients had their household contacts line-listed within seven days of initiating anti-TB treatment (“first 7”). In 84% of 1342 household contacts, screening outcomes were ascertained within one day of line-listing (“next 1”). In 35% of 256 household contacts eligible for further evaluation by a medical officer (aged ≤5 years or with chest symptoms), anti-tuberculosis treatment, TPT or a decision for no drugs was made within seven days of symptom screening (“second 7”). The principal reason for not starting anti-tuberculosis treatment or TPT was failure to consult a medical officer: only 129(50%) of 256 contacts consulted a medical officer. Reasons for poor performance in the “second 7” component included travel costs to see a medical officer, loss of daily earnings and fear of a TB diagnosis. Field staff reported that timeliness metrics motivated them to take prompt action in household contact screening and TPT provision and they suggested these be included in national guidelines. Conclusions Field staff found “7-1-7” timeliness metrics to be feasible and useful. Integration of these metrics into national guidelines could improve timeliness of diagnosis, treatment and prevention of TB within households of index patients.
Læs mere Tjek på PubMedMantina, N. M., Nakayima Miiro, F., Smith, J., McClelland, D. J., Magrath, P. A., Madhivanan, P.
BMJ Open, 10.12.2023
Tilføjet 10.12.2023
IntroductionHuman papillomavirus (HPV) is the causative agent of nearly all cervical cancers. Despite the proven safety and efficacy of HPV vaccines in preventing HPV-related cancers, the global vaccine coverage rate is estimated to only be 15%. HPV vaccine coverage rates are more actively tracked and reported for adolescents 17 years and younger but there is still a critical window of opportunity to intervene and promote HPV vaccination among young adults aged 18–26 years who are still eligible to be vaccinated. This protocol for a qualitative evidence synthesis aims to review perspectives of HPV vaccination among young adults (18–26 years) and identify facilitators and barriers that influence HPV vaccination uptake and decision-making. Methods and analysisSeven databases will be searched from 1 January 2006 to the date of final search. For inclusion, studies must report HPV vaccination perspectives of young adults aged 18–26 years and use qualitative study methods or analysis techniques. Studies will be screened in a two-stage process guided by the eligibility criteria. Final included studies will be evaluated for methodological strengths and limitations using the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. After data extraction, framework analysis will be used to analyse the data applying the socioecological model. Finally, the Grading of Recommendations Assessment, Development and Evaluation - Confidence in the Evidence from Reviews of Qualitative research will be applied to evaluate the confidence in synthesised qualitative findings. The methodology of this review follows the Cochrane Handbook guidelines on qualitative evidence syntheses. Ethics and disseminationFormal ethical approval is not required for this study. Findings will be disseminated through peer-reviewed publications, conference presentations and professional networks. PROSPERO registration numberCRD42023417052.
Læs mere Tjek på PubMedFischer, H.-T., Müller, K., Wenham, C., Hanefeld, J.
BMJ Open, 10.12.2023
Tilføjet 10.12.2023
IntroductionFour years after the devastating Ebola outbreak, governments in West Africa were quick to implement non-pharmaceutical interventions (NPIs) in response to the rapid spread of SARS-CoV-2. The NPIs implemented included physical distancing, closure of schools and businesses, restrictions on public gatherings and mandating the use of face masks among others. In the absence of widely available vaccinations, NPIs were the only known means to try to slow the spread of COVID-19. While numerous studies have assessed the effectiveness of these NPIs in high-income countries, less is known about the processes that lead to the adoption of policies and the factors that influence their implementation and adherence in low-income and middle-income countries. The objective of this scoping review is to understand the extent and type of evidence in relation to the policy formulation, decision-making and implementation stages of NPIs in West Africa. Methods and analysisA scoping review will be undertaken following the guidance developed by Arskey and O’Malley, the Joanna Briggs Institute (JBI) methodology for scoping reviews and the PRISMA guidelines for Scoping Reviews. Both peer-reviewed and grey literature will be searched using Web of Science, Embase, Scopus, APA PsycInfo, WHO Institutional Repository for Information Sharing, JSTOR and Google Advanced Search, and by searching the websites of the WHO, and the West African Health Organisation. Screening will be conducted by two reviewers based on inclusion and exclusion criteria, and data will be extracted, coded and narratively synthesised. Ethics and disseminationWe started this scoping review in May 2023, and anticipate finishing by April 2024. Ethics approval is not required since we are not collecting primary data. This protocol was registered at Open Science Framework (https://osf.io/gvek2/). We plan to disseminate this research through publications, conference presentations and upcoming West African policy dialogues on pandemic preparedness and response.
Læs mere Tjek på PubMedAku, F. Y., Amuasi, J. H., Debrah, L. B., Opoku, D., Gmanyami, J. M., Hoerauf, A., Debrah, A. Y., Quentin, W.
BMJ Open, 9.12.2023
Tilføjet 9.12.2023
IntroductionCountries in the WHO’s African region have found community-based surveillance useful in ensuring the effectiveness of the Integrated Disease Surveillance and Response strategy. This approach encourages community participation in the surveillance system, in addition to early detection of outbreaks and other health threats. Thus, advancements in mobile health have the potential to improve community-based surveillance in Africa. The purpose of this review is to map evidence on available mhealth tools for community-based infectious disease surveillance in Africa. Methods and analysisThe scoping review will follow a mixed-methods approach in line with the framework of Arksey and O’Malley amended by Levac and colleagues and the Joanna Briggs Institute. To retrieve published literature, PubMed, Scopus, Web of Science, Google Scholar and Google databases will be explored. Websites of organisations involved in surveillance activities across the African region will also be explored. Authors will be interested in published literature between 2000 and 2022 in any language. The primary investigator and a second author will independently review the retrieved titles according to the inclusion criteria, while a third reviewer will resolve conflicts that may arise. The review will map evidence according to the key concepts (mhealth, community-based surveillance and Africa) to inform stakeholders and mhealth designers on best practices to adopt involving mhealth approaches at the community level and mhealth tool designs, respectively. Results following the review will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Review Guidelines. Ethics and disseminationEthical approval is not required for scoping reviews as it does not involve the use of human subjects. This review is the first phase in an overall project on digital health. The findings of the review will be published in a peer-reviewed journal and disseminated at suitable forums and conferences.
Læs mere Tjek på PubMedZayadi, A., Edge, R., Parker, C. E., Macdonald, J. K., Neustifter, B., Chang, J., Zhong, G., Singh, S., Feagan, B. G., Ma, C., Jairath, V.
BMJ Open, 9.12.2023
Tilføjet 9.12.2023
ObjectivesExternal control arms (ECAs) provide useful comparisons in clinical trials when randomised control arms are limited or not feasible. We conducted a systematic review to summarise applications of ECAs in trials of immune-mediated inflammatory diseases (IMIDs). DesignSystematic review with an appraisal of ECA source quality rated across five domains (data collection, study populations, outcome definitions, reliability and comprehensiveness of the dataset, and other potential limitations) as high, low or unclear quality. Data sourcesEmbase, Medline and Cochrane Central Register of Controlled Trial were searched through to 12 September 2023. Eligibility criteriaEligible studies were single-arm or randomised controlled trials (RCTs) of inflammatory bowel disease, pouchitis, rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis, psoriasis and atopic dermatitis in which an ECA was used as the comparator. Data extraction and synthesisTwo authors independently screened the search results in duplicate. The characteristics of included studies, external data source(s), outcomes and statistical methods were recorded, and the quality of the ECA data source was assessed by two independent authors. ResultsForty-three studies met the inclusion criteria (inflammatory bowel disease: 16, pouchitis: 1, rheumatoid arthritis: 12, juvenile idiopathic arthritis: 1, ankylosing spondylitis: 5, psoriasis: 3, multiple indications: 4). The majority of these trials were single-arm (33/43) and enrolled adult patients (34/43). All included studies used a historical control rather than a contemporaneous ECA. In RCTs, ECAs were most often derived from the placebo arm of another RCT (6/10). In single-arm trials, historical case series were the most common ECA source (19/33). Most studies (31/43) did not employ a statistical approach to generate the ECA from historical data. ConclusionsStandardised ECA methodology and reporting conventions are lacking for IMIDs trials. The establishment of ECA reporting guidelines may enhance the rigour and transparency of future research.
Læs mere Tjek på PubMedDyer, A. H., Dolphin, H., OConnor, A., Morrison, L., Sedgwick, G., McFeely, A., Killeen, E., Gallagher, C., Davey, N., Connolly, E., Lyons, S., Young, C., Gaffney, C., Ennis, R., McHale, C., Joseph, J., Knight, G., Kelly, E., OFarrelly, C., Bourke, N. M., Fallon, A., ODowd, S., Kennelly, S. P.
BMJ Open, 9.12.2023
Tilføjet 9.12.2023
IntroductionAlzheimer’s disease and other dementias affect >50 million individuals globally and are characterised by broad clinical and biological heterogeneity. Cohort and biobank studies have played a critical role in advancing the understanding of disease pathophysiology and in identifying novel diagnostic and treatment approaches. However, further discovery and validation cohorts are required to clarify the real-world utility of new biomarkers, facilitate research into the development of novel therapies and advance our understanding of the clinical heterogeneity and pathobiology of neurodegenerative diseases. Methods and analysisThe Tallaght University Hospital Institute for Memory and Cognition Biobank for Research in Ageing and Neurodegeneration (TIMC-BRAiN) will recruit 1000 individuals over 5 years. Participants, who are undergoing diagnostic workup in the TIMC Memory Assessment and Support Service (TIMC-MASS), will opt to donate clinical data and biological samples to a biobank. All participants will complete a detailed clinical, neuropsychological and dementia severity assessment (including Addenbrooke’s Cognitive Assessment, Repeatable Battery for Assessment of Neuropsychological Status, Clinical Dementia Rating Scale). Participants undergoing venepuncture/lumbar puncture as part of the clinical workup will be offered the opportunity to donate additional blood (serum/plasma/whole blood) and cerebrospinal fluid samples for longitudinal storage in the TIMC-BRAiN biobank. Participants are followed at 18-month intervals for repeat clinical and cognitive assessments. Anonymised clinical data and biological samples will be stored securely in a central repository and used to facilitate future studies concerned with advancing the diagnosis and treatment of neurodegenerative diseases. Ethics and disseminationEthical approval has been granted by the St. James’s Hospital/Tallaght University Hospital Joint Research Ethics Committee (Project ID: 2159), which operates in compliance with the European Communities (Clinical Trials on Medicinal Products for Human Use) Regulations 2004 and ICH Good Clinical Practice Guidelines. Findings using TIMC-BRAiN will be published in a timely and open-access fashion.
Læs mere Tjek på PubMedFilip, Iulia
AIDS, 9.12.2023
Tilføjet 9.12.2023
Yu, J.-S., Kim, E.-S., Park, K. S., Lee, Y. J., Park, Y. C., Nam, D., Kim, E.-J., Ha, I.-H.
BMJ Open, 7.12.2023
Tilføjet 7.12.2023
ObjectivesFibromyalgia treatment trends vary globally; however, the trend in South Korea has not been investigated yet. This study aimed to analyse the fibromyalgia treatment trends in South Korea. DesignRetrospective, observational study using serial cross-sectional data. SettingThe National Patient Samples of the Korean Health Insurance Review & Assessment Service from 2011 to 2018 were used. ParticipantsA total of 31 059 patients with fibromyalgia were included in this study. The basic characteristics of the patients were stratified by sex, age and comorbidity. A patient was considered to have a condition if it was recorded as a principal diagnosis at least once in a year. Primary and secondary outcome measuresTrends in the types of medical visits and prescribed treatments were investigated and the values are presented as rates per 100 patients. The types of pharmacological treatment were presented according to the existing clinical guidelines. Additionally, combination prescription trends and associated characteristics were investigated. ResultsOf the patients, 66.2% were female. Visits to internal medicine departments showed the most significant increase (2011: 11.34; 2018: 21.99; p
Læs mere Tjek på PubMedCarolina A.D. Santos, Artemis P. Paula, Gentil G. Fonseca Filho, Manoella M. Alves, Andréia F. Nery, Monise G.A. Pontes, Erianna Y.L. Macedo, Ruy M. Oliveira Jr, Sabrinna M. Freitas, Sarah Lima, Fernanda V.C. Varela, Andrezza L.S. Viana, Aline L.P. Silva, Érika G.C. Silva, Lília D'Souza-Li
International Journal of Infectious Diseases, 5.12.2023
Tilføjet 5.12.2023
SARS-CoV-2 has infected over 620 million people and killed more than 6 million worldwide. [1] Since the beginning of the pandemic, Brazil has reported a disproportionately large number of infections and deaths of pregnant women attributed to COVID-19, [2] arguably caused by the disastrous response to the pandemic in its early months, with national policies contrary to scientific recommendations and against international infectious disease societies guidelines. [3]
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.12.2023
Tilføjet 3.12.2023
Abstract We present a rare case of pathology-proven CMV pneumonitis in a patient with HIV infection after presenting with cough and fever. This presentation was complicated by recurrence of symptoms after treatment in the setting of continued uncontrolled HIV infection. This case raised the importance of further discussion regarding best treatment guidelines for CMV pneumonitis for patients with HIV.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.11.2023
Tilføjet 30.11.2023
Abstract We present a rare case of pathology-proven CMV pneumonitis in a patient with HIV infection after presenting with cough and fever. This presentation was complicated by recurrence of symptoms after treatment in the setting of continued uncontrolled HIV infection. This case raised the importance of further discussion regarding best treatment guidelines for CMV pneumonitis for patients with HIV.
Læs mere Tjek på PubMedJournal of the American Medical Association, 29.11.2023
Tilføjet 29.11.2023
In Reply Dr Bergman highlights a number of important potential barriers to COVID-19 antiviral treatment use in nursing homes, including rapidly evolving guidelines concerning the use of monoclonal antibodies, insufficient supply of recommended monoclonal antibodies, and high staffing needs to administer monoclonal antibodies intravenously. These factors likely contributed to the low antiviral treatment rates observed in our study, when monoclonal antibodies were the only treatment available.
Læs mere Tjek på PubMedClinical Infectious Diseases, 26.11.2023
Tilføjet 26.11.2023
AbstractBackgroundLong-term outcomes of tenofovir-containing antiretroviral therapy (ART) for HBV/HIV coinfection were evaluated in Zambia.MethodsA prospective cohort of adults with HIV and hepatitis B surface antigen (HBsAg)-positivity was enrolled at ART (included tenofovir DF + lamivudine) initiation. On therapy, we ascertained HBV viral load (VL) non-suppression, ALT elevation, serologic end-points, progression of liver fibrosis, based on elastography, and hepatocellular carcinoma (HCC) incidence. We also described a subgroup (low HBV VL and no/minimal fibrosis at baseline) that, under current international guidelines, would not have been treated in the absence of their HIV infection.ResultsAmong 289 participants, at ART start, median age was 34 years, 40·1% were women, median CD4 count was 191 cells/mm3, 44·2% were hepatitis B e antigen-positive, and 28·4% had liver fibrosis/cirrhosis. Over median 5.91 years of ART, 13·6% developed HBV viral non-suppression, which was associated with advanced HIV disease. ALT elevation on ART was linked with HBV VL non-suppression. Regression of fibrosis and cirrhosis were common, progression to cirrhosis was absent, and no cases of HCC were ascertained. HBsAg seroclearance was 9·4% at 2 and 15·4% at 5 years, with higher rates among patients with low baseline HBV replication markers.DiscussionReassuring long-term liver outcomes were ascertained during tenofovir-based ART for HBV/HIV coinfection in Zambia. Higher than expected HBsAg seroclearance during ART underscores the need to include people with HIV in HBV cure research.
Læs mere Tjek på PubMedBMC Infectious Diseases, 25.11.2023
Tilføjet 25.11.2023
Abstract Background The declaration of SARS-CoV-2 as a public health emergency of international concern in January 2020 prompted the need to strengthen infection prevention and control (IPC) capacities within health care facilities (HCF). IPC guidelines, with standard and transmission-based precautions to be put in place to prevent the spread of SARS-CoV-2 at these HCFs were developed. Based on these IPC guidelines, a rapid assessment scorecard tool, with 14 components, to enhance assessment and improvement of IPC measures at HCFs was developed. This study assessed the level of implementation of the IPC measures in HCFs across the African Region during the COVID-19 pandemic. Method An observational study was conducted from April 2020 to November 2022 in 17 countries in the African Region to monitor the progress made in implementing IPC standard and transmission-based precautions in primary-, secondary- and tertiary-level HCFs. A total of 5168 primary, secondary and tertiary HCFs were assessed. The HCFs were assessed and scored each component of the tool. Statistical analyses were done using R (version 4.2.0). Results A total of 11 564 assessments were conducted in 5153 HCFs, giving an average of 2.2 assessments per HCF. The baseline median score for the facility assessments was 60.2%. Tertiary HCFs and those dedicated to COVID-19 patients had the highest IPC scores. Tertiary-level HCFs had a median score of 70%, secondary-level HCFs 62.3% and primary-level HCFs 56.8%. HCFs dedicated to COVID-19 patients had the highest scores, with a median of 68.2%, followed by the mixed facilities that attended to both COVID-19 and non-COVID-19 patients, with 64.84%. On the components, there was a strong correlation between high IPC assessment scores and the presence of IPC focal points in HCFs, the availability of IPC guidelines in HCFs and HCFs that had all their health workers trained in basic IPC. Conclusion In conclusion, a functional IPC programme with a dedicated focal person is a prerequisite for implementing improved IPC measures at the HCF level. In the absence of an epidemic, the general IPC standards in HCFs are low, as evidenced by the low scores in the non-COVID-19 treatment centres.
Læs mere Tjek på PubMedBMC Infectious Diseases, 25.11.2023
Tilføjet 25.11.2023
Abstract Background The declaration of SARS-CoV-2 as a public health emergency of international concern in January 2020 prompted the need to strengthen infection prevention and control (IPC) capacities within health care facilities (HCF). IPC guidelines, with standard and transmission-based precautions to be put in place to prevent the spread of SARS-CoV-2 at these HCFs were developed. Based on these IPC guidelines, a rapid assessment scorecard tool, with 14 components, to enhance assessment and improvement of IPC measures at HCFs was developed. This study assessed the level of implementation of the IPC measures in HCFs across the African Region during the COVID-19 pandemic. Method An observational study was conducted from April 2020 to November 2022 in 17 countries in the African Region to monitor the progress made in implementing IPC standard and transmission-based precautions in primary-, secondary- and tertiary-level HCFs. A total of 5168 primary, secondary and tertiary HCFs were assessed. The HCFs were assessed and scored each component of the tool. Statistical analyses were done using R (version 4.2.0). Results A total of 11 564 assessments were conducted in 5153 HCFs, giving an average of 2.2 assessments per HCF. The baseline median score for the facility assessments was 60.2%. Tertiary HCFs and those dedicated to COVID-19 patients had the highest IPC scores. Tertiary-level HCFs had a median score of 70%, secondary-level HCFs 62.3% and primary-level HCFs 56.8%. HCFs dedicated to COVID-19 patients had the highest scores, with a median of 68.2%, followed by the mixed facilities that attended to both COVID-19 and non-COVID-19 patients, with 64.84%. On the components, there was a strong correlation between high IPC assessment scores and the presence of IPC focal points in HCFs, the availability of IPC guidelines in HCFs and HCFs that had all their health workers trained in basic IPC. Conclusion In conclusion, a functional IPC programme with a dedicated focal person is a prerequisite for implementing improved IPC measures at the HCF level. In the absence of an epidemic, the general IPC standards in HCFs are low, as evidenced by the low scores in the non-COVID-19 treatment centres.
Læs mere Tjek på PubMedAjaya Basnet, Basanta Tamang, Mahendra Raj Shrestha, Lok Bahadur Shrestha, Junu Richhinbung Rai, Rajendra Maharjan, Sushila Dahal, Pradip Shrestha, Shiba Kumar Rai
PLoS One Infectious Diseases, 22.11.2023
Tilføjet 22.11.2023
by Ajaya Basnet, Basanta Tamang, Mahendra Raj Shrestha, Lok Bahadur Shrestha, Junu Richhinbung Rai, Rajendra Maharjan, Sushila Dahal, Pradip Shrestha, Shiba Kumar Rai Introduction The lack of standardized methods for detecting biofilms continues to pose a challenge to microbiological diagnostics since biofilm-mediated infections induce persistent and recurrent infections in humans that often defy treatment with common antibiotics. This study aimed to evaluate diagnostic parameters of four in vitro phenotypic biofilm detection assays in relation to antimicrobial resistance in aerobic clinical bacterial isolates. Methods In this cross-sectional study, bacterial strains from clinical samples were isolated and identified following the standard microbiological guidelines. The antibiotic resistance profile was assessed through the Kirby-Bauer disc diffusion method. Biofilm formation was detected by gold standard tissue culture plate method (TCPM), tube method (TM), Congo red agar (CRA), and modified Congo red agar (MCRA). Statistical analyses were performed using SPSS version 17.0, with a significant association considered at p
Læs mere Tjek på PubMedLaura Capitán-Moyano, Nerea Cañellas-Iniesta, María Arias-Fernández, Miquel Bennasar-Veny, Aina M. Yáñez, Enrique Castro-Sánchez
PLoS One Infectious Diseases, 22.11.2023
Tilføjet 22.11.2023
by Laura Capitán-Moyano, Nerea Cañellas-Iniesta, María Arias-Fernández, Miquel Bennasar-Veny, Aina M. Yáñez, Enrique Castro-Sánchez Food insecurity in recent years has increased worldwide due to many planetary events such as the COVID-19 pandemic, geopolitical conflicts, the climate crisis, and globalization of markets. Adolescents are a particularly vulnerable group to food insecurity, as they enter adulthood with less parental supervision and greater personal autonomy, but less legislative or institutional protection. The experience of food insecurity in adolescents is influenced by several environmental factors at different levels (interpersonal, organizational, community, and societal), although they are not usually addressed in the design of interventions, prioritizing the individual behavioural factors. We present a scoping review protocol for assessing and identifying the environmental factors that could influence adolescents’ food insecurity. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) to prepare the protocol. The search strategy will be performed in the following databases: Pubmed/Medline, EMBASE, Biblioteca Virtual de Salud, EBSCOHost, Scopus, Web of Science, and Cochrane Library Plus. The reference list of the included studies will also be hand-searched. Grey literature will be search through the electronic database Grey Literature Report, and local, provincial, national, and international organisations’ websites. Assessment of eligibility after screening of titles, abstract and full text, and the resolution of discrepancies will be performed by three independent reviewers. This scoping review will contribute to refine the “logic model of the problem” which constitutes the first step in the intervention mapping protocol. The “logic model of the problem” from the intervention mapping protocol will serve to classify and analyse the environmental factors. The findings from this review will be presented to relevant stakeholders that have a role in shaping the environmental factors.
Læs mere Tjek på PubMedAbdel Shaheed, C., Ivers, R., Vizza, L., McLachlan, A., Kelly, P. J., Blyth, F., Stanaway, F., Clare, P. J., Thompson, R., Lung, T., Degenhardt, L., Reid, S., Martin, B., Wright, M., Osman, R., French, S., McCaffery, K., Campbell, G., Jenkins, H., Mathieson, S., Boogs, M., McMaugh, J., Bennett, C., Maher, C.
BMJ Open, 21.11.2023
Tilføjet 21.11.2023
IntroductionLow back pain (LBP) is commonly treated with opioid analgesics despite evidence that these medicines provide minimal or no benefit for LBP and have an established profile of harms. International guidelines discourage or urge caution with the use of opioids for back pain; however, doctors and patients lack practical strategies to help them implement the guidelines. This trial will evaluate a multifaceted intervention to support general practitioners (GPs) and their patients with LBP implement the recommendations in the latest opioid prescribing guidelines. Methods and analysisThis is a cluster randomised controlled trial that will evaluate the effect of educational outreach visits to GPs promoting opioid stewardship alongside non-pharmacological interventions including heat wrap and patient education about the possible harms and benefits of opioids, on GP prescribing of opioids medicines dispensed. At least 40 general practices will be randomised in a 1:1 ratio to either the intervention or control (no outreach visits; GP provides usual care). A total of 410 patient–participants (205 in each arm) who have been prescribed an opioid for LBP will be enrolled via participating general practices. Follow-up of patient–participants will occur over a 1-year period. The primary outcome will be the cumulative dose of opioid dispensed that was prescribed by study GPs over 1 year from the enrolment visit (in morphine milligram equivalent dose). Secondary outcomes include prescription of opioid medicines, benzodiazepines, gabapentinoids, non-steroidal anti-inflammatory drugs by study GPs or any GP, health services utilisation and patient-reported outcomes such as pain, quality of life and adverse events. Analysis will be by intention to treat, with a health economics analysis also planned. Ethics and disseminationThe trial received ethics approval from The University of Sydney Human Research Ethics Committee (2022/511). The results will be disseminated via publications in journals, media and conference presentations. Trial registration numberACTRN12622001505796.
Læs mere Tjek på PubMedNisha Jha, Bibechan Thapa, Samyam Bickram Pathak, Sajala Kafle, Anish Mudvari, Pathiyil Ravi Shankar
PLoS One Infectious Diseases, 21.11.2023
Tilføjet 21.11.2023
by Nisha Jha, Bibechan Thapa, Samyam Bickram Pathak, Sajala Kafle, Anish Mudvari, Pathiyil Ravi Shankar Introduction The access, watch, and reserve (AWaRe) classification of antibiotics was developed in 2019 by the WHO Expert Committee on the Selection and Use of Essential Medicines as a tool to support antibiotic stewardship efforts at local, national, and global levels. The objectives of this study were to assess the availability of antibiotics as per WHO AWaRe classification at community pharmacies located around a tertiary care hospital in Lalitpur and to compare these antibiotics with the national essential medicine list of Nepal. Method The cross-sectional study was conducted at community pharmacies located within a two-kilometer radius of a teaching hospital from August to November 2022. A total of 82 community pharmacies registered with the Nepal Chemist and Druggists Association and the Department of Drug Administration were studied. Data was collected using a standard proforma containing the names of the antibiotics classified as per the WHO’s AWaRe classification. Results Access group of antibiotics, Ampicillin, (82;100%), Amoxycillin, (82;100%), Flucloxacillin, (82;100%), and Metronidazole, (82;100%) were available in all community pharmacies. Results from the watch group showed that Azithromycin, (80; 97.6%) was available in all pharmacies followed by Cefixime, (80; 97.6%), Ciprofloxacin, (73; 89%), Levofloxacin, (74; 90.2%)and Ofloxacin, (74; 90.2%). Linezolid, (24; 29.3%) was the most common antibiotics available from the reserve group of antibiotics. Colistin was the second commonly available antibiotic. The most available antibiotic from the not recommended group were Ampicillin/Cloxacillin (82; 100%), followed by Piperacillin/Sulbactam, (39; 47.6%). There were differences in the classification of antibiotics between the WHO AWaRe list and the Essential Medicines list of Nepal in terms of numbers of antibiotics listed. Conclusion Antibiotics from the not recommended and reserve groups were commonly available in community pharmacies. The implementation of antibiotic guidelines should be emphasized along with strict monitoring of the sale of antibiotics without a prescription in community pharmacy settings.
Læs mere Tjek på PubMedSaoussen Miladi, Yasmine Makhlouf, Hiba Boussaa, Leith Zakraoui, Kawther Ben Abdelghani, Alia Fazaa, Ahmed Laatar
PLoS One Infectious Diseases, 17.11.2023
Tilføjet 17.11.2023
by Saoussen Miladi, Yasmine Makhlouf, Hiba Boussaa, Leith Zakraoui, Kawther Ben Abdelghani, Alia Fazaa, Ahmed Laatar Introduction Obesity is a growing and debilitating epidemic worldwide that is associated with an increased inflammation. It is often linked to rheumatic diseases and may impact negatively their natural history. The use of bariatric and metabolic surgery (BMS) has increased thanks to its positive effect on major comorbidities like diabetes type 2. This systematic review provides the most up-to-date published literature regarding the effect of BMS on outcomes in rheumatoid arthritis. Methods This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed, Embase and Cochrane, published until June 16th 2023, and tackling the effect of BMS on disease outcomes in patients with RA were included. Results Three studies met the inclusion criteria. They were published between 2015 and 2022. The total number of RA patients was 33193 and 6700 of them underwent BMS. Compared to non-surgical patients, weight loss after BMS was associated with lower disease activity outcomes at 12 months (p
Læs mere Tjek på PubMedDeane, A. M., Alhazzani, W., Guyatt, G., Finfer, S., Marshall, J. C., Myburgh, J., Zytaruk, N., Hardie, M., Saunders, L., Knowles, S., Lauzier, F., Chapman, M. J., English, S., Muscedere, J., Arabi, Y., Ostermann, M., Venkatesh, B., Young, P., Thabane, L., Billot, L., Heels-Ansdell, D., Al-Fares, A. A., Hammond, N. E., Hall, R., Rajbhandari, D., Poole, A., Johnson, D., Iqbal, M., Reis, G., Xie, F., Cook, D. J., for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group
BMJ Open, 15.11.2023
Tilføjet 15.11.2023
IntroductionThe Re-Evaluating the Inhibition of Stress Erosions (REVISE) Trial aims to determine the impact of the proton pump inhibitor pantoprazole compared with placebo on clinically important upper gastrointestinal (GI) bleeding in the intensive care unit (ICU), 90-day mortality and other endpoints in critically ill adults. The objective of this report is to describe the rationale, methodology, ethics and management of REVISE. Methods and analysisREVISE is an international, randomised, concealed, stratified, blinded parallel-group individual patient trial being conducted in ICUs in Canada, Australia, Saudi Arabia, UK, US, Kuwait, Pakistan and Brazil. Patients≥18 years old expected to remain invasively mechanically ventilated beyond the calendar day after enrolment are being randomised to either 40 mg pantoprazole intravenously or an identical placebo daily while mechanically ventilated in the ICU. The primary efficacy outcome is clinically important upper GI bleeding within 90 days of randomisation. The primary safety outcome is 90-day all-cause mortality. Secondary outcomes include rates of ventilator-associated pneumonia, Clostridioides difficile infection, new renal replacement therapy, ICU and hospital mortality, and patient-important GI bleeding. Tertiary outcomes are total red blood cells transfused, peak serum creatinine level in the ICU, and duration of mechanical ventilation, ICU and hospital stay. The sample size is 4800 patients; one interim analysis was conducted after 2400 patients had complete 90-day follow-up; the Data Monitoring Committee recommended continuing the trial. Ethics and disseminationAll participating centres receive research ethics approval before initiation by hospital, region or country, including, but not limited to – Australia: Northern Sydney Local Health District Human Research Ethics Committee and Mater Misericordiae Ltd Human Research Ethics Committee; Brazil: Comissão Nacional de Ética em Pesquisa; Canada: Hamilton Integrated Research Ethics Board; Kuwait: Ministry of Health Standing Committee for Coordination of Health and Medical Research; Pakistan: Maroof Institutional Review Board; Saudi Arabia: Ministry of National Guard Health Affairs Institutional Review Board: United Kingdom: Hampshire B Research Ethics Committee; United States: Institutional Review Board of the Nebraska Medical Centre. The results of this trial will inform clinical practice and guidelines worldwide. Trial registration number NCT03374800.
Læs mere Tjek på PubMedJournal of the American Medical Association, 15.11.2023
Tilføjet 15.11.2023
In Reply In response to our recent article, Drs Roberts and Kotton suggest that relative valganciclovir overdosing may have contributed to the neutropenia rate in this study group. This concern underscores the challenge of optimal valganciclovir dosing with fluctuating kidney function in the posttransplant setting and the balance of efficacy (adequate dosing) vs myelosuppression (overdosing) in kidney transplant recipients. In our trial, letermovir was compared with the current standard of care, valganciclovir, 900 mg/d, adjusted for creatinine clearance by the Cockcroft-Gault formula. We took specific measures to maintain concordance with the dosing per prescribing information (informed by pharmacokinetic exposure data from the manufacturer) and consensus guidelines. Participants with the greatest risk of relative overdosing (creatinine clearance ≤10 mL/min or dialysis at randomization) were excluded. Creatinine clearance assessment occurred at every study visit and investigators received alerts to make dose adjustments. Although some centers have implemented alternative dosing strategies to avoid toxicity (lower than FDA-approved doses), these strategies have been associated with an increased risk of breakthrough infection and resistance due to underdosing.
Læs mere Tjek på PubMedXu, W., Fang, M., Wang, Z., Wang, J., Tao, C., Ma, L., Li, L., Hu, X.
BMJ Open, 14.11.2023
Tilføjet 14.11.2023
IntroductionElectrocautery is used widely in surgical procedures, but making skin incision has routinely been performed with scalpel rather than electrocautery, for fear that electrocautery may cause poor incision healing, excessive scarring and increased wound complication rates. More and more studies on general surgery support the use of electrocautery for skin incision, but research comparing the two modalities for scalp incision in neurosurgery remains inadequate. This trial aims to evaluate the safety and efficacy of needle-tip monopolar for scalp incision in supratentorial neurosurgery compared with steel scalpel. Methods and analysisIn this prospective, randomised, double-blind trial, 120 eligible patients who are planned to undergo supratentorial neurosurgery will be enrolled. Patients will be randomly assigned to two groups. In controlled group scalp incision will be made with a scalpel from the epidermis to the galea aponeurotica, while in intervention group scalp will be first incised with a steel scalpel from the epidermis to the dermis, and then the subcutaneous tissue and galea aponeurotica will be incised with needle-tip monopolar on cutting mode. The primary outcomes are scar score (at 90 days). The secondary outcomes include incision pain (at 1 day, on discharge, at 90 days) and alopecia around the incision (at 90 days), incision blood loss and incision-related operation time (during operation), incision infection and incision healing (on discharge, at 2 weeks, 90 days). Ethics and disseminationThis trial will be performed according to the principles of Declaration of Helsinki and good clinical practice guidelines. This study has been validated by the ethics committee of West China Hospital. Informed consent will be obtained from each included patient and/or their designated representative. Final results from this trial will be promulgated through publications. Trial registration numberChiCTR2200063243.
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