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In recent years, the prevalence and mortality of heart failure (HF) and other associated cardiovascular diseases have doubled in sub-Saharan Africa (SSA). Studies in high-income countries indicate that HF with concurrent atrial fibrillation (AF) is linked to increased mortality. Our objective was to determine the incidence and clinical outcomes of AF among patients with HF in SSA.
A prospective cohort study using data collected between October 2018 and May 2020.
Outpatient clinic at a tertiary hospital in Mwanza, Tanzania.
303 adult participants (aged ≥18 years) with HF as defined by the European Society of Cardiology guidelines (2016) and 100 adults with HF as defined by clinical criteria alone were enrolled into the study. Patients with comorbid medical condition that had prognosis of <3 months (ie, advance solid tumours, advance haematological malignancies) were excluded.
Participants were screened for AF, and their medical history, physical examinations and sociodemographic information were oor adverse outcomes in patients with HF.
110 bpm, HR 1.879, 95% CI 1.508 to 2.340, p less then 0.001) as an easily measurable, high-impact physical examination finding for adverse outcomes in patients with HF.
Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication.
A systematic review.
CENTRAL, MEDLINE, EMBASE, CINAHL and Index to Chiropractic Literature databases were searched and updated up to 22 July 2020.
We only included randomised controlled trials published in English where at least one arm provided data on non-operative treatment and included participants diagnosed with neurogenic claudication with imaging confirmed LSS.
Two independent reviewers extracted data and assessed risk of bias using the Cochrane Risk of Bias Tool 1. Grading of Recommendations Assessment, Development and Evaluation was used for evidence synthesis.
Of 15 200 citations screened, 156 were assessed and 23 new trials were identified. There is moderate-quality evidence from three trials that Manual therapy and exercise provides superior aprovided insufficient quality evidence to make conclusions on their effectiveness.
CRD42020191860.
CRD42020191860.
To evaluate the measurement properties of outcome measures currently used in the assessment of degenerative cervical myelopathy (DCM) for clinical research.
Systematic review DATA SOURCES MEDLINE and EMBASE were searched through 4 August 2020.
Primary clinical research published in English and whose primary purpose was to evaluate the measurement properties or clinically important differences of instruments used in DCM.
Psychometric properties and clinically important differences were both extracted from each study, assessed for risk of bias and presented in accordance with the Consensus-based Standards for the selection of health Measurement Instruments criteria.
Twenty-nine outcome instruments were identified from 52 studies published between 1999 and 2020. They measured neuromuscular function (16 instruments), life impact (five instruments), pain (five instruments) and radiological scoring (five instruments). No instrument had evaluations for all 10 measurement properties and <50% had assessmeates studies evaluating outcome measures used to assess patients with DCM. Overall, there is a need for a set of agreed tools to measure outcomes in DCM. These findings will be used to inform the development of a core measurement set as part of AO Spine RECODE-DCM.
It remains unclear whether vitamin D status is related to cancer risk. We examined this relationship using laboratory, administrative and survey data.
Retrospective cohort study.
All care settings within Calgary, Alberta, Canada and surrounding rural communities.
Patients tested for serum 25-hydroxyvitamin D from 2009 to 2013 without a past cancer diagnosis but with an ECG and body mass index ±3 months from testing were included. Age, sex, mean hours of daylight during month of testing were linked to census dissemination area-level indicators of socioeconomic status measured in 2011.
Hospital discharge diagnoses for any cancer, major cancer (colorectal, breast, lung, prostate, skin) and other cancers >3 months from testing from 2009 to 2016. Cox proportional hazard models were used to examine associations with incident cancer after adjusting for potential confounders. Interactions were tested using multiplicative terms.
Among 72 171 patients, there were 3439 cancer diagnoses over a median of 5. and may be modified by community variation in vitamin D supplementation.
To identify validated dermatology-specific and disease-specific psychosocial needs assessment tools for caregivers of paediatric patients with dermatological conditions. A secondary objective was to assess the adequacy of their measurement properties.
Systematic review.
EMBASE, PsycINFO, MEDLINE (in Ovid SP), Cochrane, Cumulative Index to Nursing and Allied Health EBSCO, U Search and Web of Science were searched (2000-5 October 2021). Grey literature, bibliographies, online databases of QoL tools and several trial registers were searched (2000-5 Oct 2021).
Eligible studies involved adult caregivers caring for a child (no age limit) with any form of any skin condition. Predetermined exclusion criteria, as per protocol, were applied to the search results.
Title, abstract, full-text screening and data abstraction (standardised forms) were done independently in duplicate. Both's predefined methodological criteria assessed risk of bias. Narrative synthesis was used to present the findings.
187 full-tex42019159956).
PROSPERO (CRD42019159956).
Endotracheal tube (ETT) insertion depth estimation is important for optimal placement of ETT tip and balanced ventilation of the lungs. Various methods are available to determine the ETT insertion depth. The Neonatal Resuscitation Programme recommends the gestational age and nasal-tragus length (NTL) methods for estimating ETT insertion depth during cardiopulmonary resuscitation. However, the prospective data comparing these two methods is lacking.
This is an open-label multi-centre randomised controlled trial, where gestational age and NTL methods will be used to determine the initial ETT insertion depth in term and preterm infants that are less than 28 days old, requiring oral intubation in the delivery room or neonatal intensive care unit (NICU).
The trial is aimed to recruit 454 infants over 3 years across tertiary level NICUs.
The primary outcome includes an optimally positioned ETT, defined as an ETT tip between the upper border of the first thoracic vertebra and the lower border of the second thoracic vertebra. The outcome is assessed by a paediatric radiologist, who will be masked to the group assignment. Secondary outcomes are malpositioned ETT tips, pneumothorax, ETT repositioning, chronic lung disease, invasive ventilation days, and death.
Data will be analysed using the intention-to-treat principle. The primary and categorical secondary outcomes will be compared using the χ
test. Adjusted risk ratios of outcomes will be calculated along with 95% CIs through multivariable logistic regression analysis, including covariates deemed biologically to influence the outcomes.
The study has been approved by the PNU Research Ethics Board (20-0148) and the respective ethical review boards of the participating centres. The results will be disseminated through conference meetings, social media platforms, and publications in scientific journals.
NCT04393337.
NCT04393337.
There have been long-standing debates about the potential health consequences of hate crimes over and above other types of crimes. Besides the direct consequences for victims, less is known about whether hate crimes have spillover effects onto the health of local residents.
We drew data on cardiovascular disease risk factors from middle-aged Americans in the National Longitudinal Survey of Youths 1979 and on hate crimes from the FBI's Uniform Crime Reports. selleck kinase inhibitor Employing multivariable logistic regression, we estimated the associations between changes in state/county-level all and group-specific hate crime rates from 2000 to 2006 and incident individual-level diabetes, hypertension, obesity and depressive symptoms from 2008 to 2016. All models controlled for individual-level sociodemographic factors and financial strain, county-level and state-level changes in the total crime rate, the percentage of non-Hispanic Black and Hispanic/Latino residents, and median household income, as well as state-level changes iny.
To describe general practitioners' (GPs) involvement in end-of-life care, continuity and outcomes of care, and reported management challenges in the Australian context.
Sixty-three GPs across three Australian states participated in a follow-up survey to report on care provided for decedents in the last year life using a clinic-based data collection process. The study was conducted between September 2018 and August 2019.
Approximately one-third of GPs had received formal palliative care training. Practitioners considered themselves as either the primary care coordinator (53.2% of reported patients) or part of the management team (40.4% of reported patients) in the final year of care. In the last week of life, patients frequently experienced reduced appetite (80.6%), fatigue (77.9%) and psychological problems (44.9%), with GPs reporting that the alleviation of these symptoms were less than optimal. Practitioners were highly involved in end-of-life care (eg, home visits, consultations via telephone and family meetings), and perceived higher levels of satisfaction with communication with palliative care services than other external services. For one-third of patients, GPs reported that the last year of care could potentially have been improved.
There are continuing needs for integration of palliative care training into medical education and reforms of healthcare systems to further support GPs' involvement in end-of-life care. Further, more extensive collection of clinical data is needed to evaluate and support primary care management of end-of-life patients in general practice.
There are continuing needs for integration of palliative care training into medical education and reforms of healthcare systems to further support GPs' involvement in end-of-life care. Further, more extensive collection of clinical data is needed to evaluate and support primary care management of end-of-life patients in general practice.
Most studies on febrile children have focused on infants and young children with serious bacterial infection (SBI). Although population studies have described an increased risk of sepsis in adolescents, little is known about febrile adolescents attending the emergency department (ED). We aimed to describe patient characteristics and management of febrile adolescents attending the ED.
The MOFICHE/PERFORM study (Management and Outcome of Febrile Children in Europe/Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union), a prospective multicentre study, took place at 12 European EDs. Descriptive and multivariable regression analyses were performed, comparing febrile adolescents (12-18 years) with younger children in terms of patient characteristics, markers of disease severity (vital signs, clinical alarming signs), management (diagnostic tests, therapy, admission) and diagnosis (focus, viral/bacterial infection).
37 420 encounters were included, of which 2577 (6.
