Thomasenfeldman9031

Postoperative delirium is common among older cardiac surgery patients. Proteasome inhibitor Often difficult to predict and address prophylactically, delirium complicates the postoperative course by increasing morbidity and mortality as well as prolonging both hospital and intensive care unit (ICU) lengths of stay. Based on our pilot trial, we intend to study the effect of scheduled 6-hourly acetaminophen administration for 48 hours post-cardiac surgery with cardiopulmonary bypass (CPB) on the incidence of in-hospital delirium and long-term neurocognitive outcomes. Additionally, effect on duration and severity of delirium, rescue analgesic consumption, acute and chronic pain scores and lengths of hospital and ICU stay will also be explored.

This multicentre, randomised, placebo-controlled, quadruple-blinded trial will include 900 older (>60 years) cardiac surgical patients requiring CPB. Patients meeting the inclusion criteria and not meeting any exclusion criteria will be enrolled at seven centres across the USA with Beth Israel Deaconess Medical Center (BIDMC), Boston, as the central coordinating centre. Additional sites may be included to broaden or speed accrual. The primary outcome measure is the incidence of in-hospital delirium till day 30. Secondary outcomes include the duration and severity of in-hospital delirium, hospital and ICU lengths of stay, postoperative pain scores, postoperative rescue analgesic consumption, postoperative cognitive function and chronic sternal pain. Creation of a biorepository and the use of intraoperative-blinded electroencephalogram (EEG) and cerebral oximetry data will support exploratory endpoints to determine mechanistic predictors of postoperative delirium.

This trial is approved and centrally facilitated by the Institutional Review Board at BIDMC. An independent Data Safety and Monitoring Board is responsible for maintaining safety oversight. Protocol # 2019 P00075, V.1.4 (dated 20 October 2020).

NCT04093219.

NCT04093219.

To identify patterns of age disparities in cancer survival, using colon and lung cancer as exemplars.

Systematic review of the literature.

We searched Embase, MEDLINE, Scopus and Web of Science through 18 December 2020.

We retained all original articles published in English including patients with colon or lung cancer. Eligible studies were required to be population-based, report survival across several age groups (of which at least one was over the age of 65) and at least one other characteristic (eg, sex, treatment).

Two independent reviewers extracted data and assessed the quality of included studies against selected evaluation domains from the QUIPS tool, and items concerning statistical reporting. We evaluated age disparities using the absolute difference in survival or mortality rates between the middle-aged group and the oldest age group, or by describing survival curves.

Out of 3047 references, we retained 59 studies (20 for colon, 34 for lung and 5 for both sites). Regardless of the cancer site, the included studies were highly heterogeneous and often of poor quality. The magnitude of age disparities in survival varied greatly by sex, ethnicity, socioeconomic status, stage at diagnosis, cancer site, and morphology, the number of nodes examined and treatment strategy. Although results were inconsistent for most characteristics, we consistently observed greater age disparities for women with lung cancer compared with men. Also, age disparities increased with more advanced stages for colon cancer and decreased with more advanced stages for lung cancer.

Although age is one of the most important prognostic factors in cancer survival, age disparities in colon and lung cancer survival have so far been understudied in population-based research. Further studies are needed to better understand age disparities in colon and lung cancer survival.

CRD42020151402.

CRD42020151402.

Very little is known about possible clinical sequelae that may persist after resolution of acute COVID-19. A recent longitudinal cohort from Italy including 143 patients followed up after hospitalisation with COVID-19 reported that 87% had at least one ongoing symptom at 60-day follow-up. Early indications suggest that patients with COVID-19 may need even more psychological support than typical intensive care unit patients. The assessment of risk factors for longer term consequences requires a longitudinal study linked to data on pre-existing conditions and care received during the acute phase of illness. The primary aim of this study is to characterise physical and psychosocial sequelae in patients post-COVID-19 hospital discharge.

This is an international open-access prospective, observational multisite study. This protocol is linked with the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) and the WHO's Clinical Characterisation Protocol, which includes patients with su(www.isaric.org). PROTOCOL REGISTRATION NUMBER osf.io/c5rw3/ PROTOCOL VERSION 3 August 2020 EUROQOL ID 37035.

The use of artificial intelligence (AI) to support the diagnosis of acute ischaemic stroke (AIS) could improve patient outcomes and facilitate accurate tissue and vessel assessment. However, the evidence in published AI studies is inadequate and difficult to interpret which reduces the accountability of the diagnostic results in clinical settings. This study protocol describes a rigorous systematic review of the accuracy of AI in the diagnosis of AIS and detection of large-vessel occlusions (LVOs).

We will perform a systematic review and meta-analysis of the performance of AI models for diagnosing AIS and detecting LVOs. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols guidelines. Literature searches will be conducted in eight databases. For data screening and extraction, two reviewers will use a modified Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. We will assess the included studies using the Quses.

CRD42020179652.

CRD42020179652.

Following well-established practices in demography, this article discusses several measures based on the number of COVID-19 deaths to facilitate comparisons over time and across populations.

National populations in 186 United Nations countries and territories and populations in first-level subnational administrative entities in Brazil, China, Italy, Mexico, Peru, Spain and the USA.

None (death statistics only).

An unstandardised occurrence/exposure rate comparable to the Crude Death Rate; an indirectly age-and-sex standardised rate that can be derived even when the breakdown of COVID-19 deaths by age and sex required for direct standardisation is unavailable; the reduction in life expectancy at birth corresponding to the 2020 number of COVID-19 deaths.

To date, the highest unstandardised rate has been in New York, at its peak exceeding the state 2017 crude death rate. Populations compare differently after standardisation while parts of Italy, Spain and the USA have the highest unstandardised rates, is a valid alternative to adjust international comparisons for differences in population distribution by sex and age-groups. A number of populations have experienced reductions in 2020 life expectancies that are substantial by recent historical standards.

To analyse the physical activity carried out by the adolescents in the study, its relationship to being overweight (overweight+obese) and to analyse the structure of the social network of friendship established in adolescents doing group sports, using different parameters indicative of centrality.

It was carried out in an educational environment, in 11 classrooms belonging to 5 Schools in Ponferrada (Spain).

235 adolescents were included in the study (49.4% female), who were classified as normal weight or overweight.

Physical Activity Questionnaire for Adolescents (PAQ-A) was used to study the level of physical activity. A social network analysis was carried out to analyse structural variables of centrality in different degrees of contact.

30.2% of the participants in our study were overweight. Relative to female participants in this study, males obtained significantly higher scores in the PAQ-A (OR 2.11; 95% CI 1.04 to 4.25; p value 0.036) and were more likely to participate in group sport (OR 4.59n the social network depending on the intensity of contact they have with their peers.

To explore parent and staff views on the acceptability of a randomised controlled trial investigating temperature thresholds for antipyretic intervention in critically ill children with fever and infection (the FEVER trial) during a multi-phase pilot study.

Mixed methods study with data collected at three time points (1) before, (2) during and (3) after a pilot trial.

English, Paediatric Intensive Care Units (PICUs).

(1) Pre-pilot trial focus groups with pilot site staff (n=56) and interviews with parents (n=25) whose child had been admitted to PICU in the last 3 years with a fever and suspected infection, (2) Questionnaires with parents of randomised children following pilot trial recruitment (n=48 from 47 families) and (3) post-pilot trial interviews with parents (n=19), focus groups (n=50) and a survey (n=48) with site staff. Analysis drew on Sekhon

's theoretical framework of acceptability.

There was initial support for the trial, yet some held concerns regarding the proposed temperature thresholds and not using paracetamol for pain or discomfort. Pre-trial findings informed protocol changes and training, which influenced views on trial acceptability. Staff trained by the FEVER team found the trial more acceptable than those trained by colleagues. Parents and staff found the trial acceptable. Some concerns about pain or discomfort during weaning from ventilation remained.

Pre-trial findings and pilot trial experience influenced acceptability, providing insight into how challenges may be overcome. We present an adapted theoretical framework of acceptability to inform future trial feasibility studies.

ISRCTN16022198 and NCT03028818.

ISRCTN16022198 and NCT03028818.

Irritability is defined as a tendency towards anger in response to frustration. Clinically, impairing irritability is a significant public health problem. There is a need for mechanism-based psychotherapies targeting severe irritability as it manifests in the context of disruptive mood dysregulation disorder (DMDD). This study protocol describes a randomised multiple baseline design testing the preliminary efficacy of a new treatment, exposure-based cognitive-behavioral therapy for severe irritability in youth, which also integrates components of parent management training. We will investigate associations of this intervention with primary clinical measures, as well as ecological momentary assessment measures.

Forty youth will be enrolled. Participants, aged 8-17 years, must present at least one of two core symptoms of DMDD abnormal mood or increased reactivity to negative emotional stimuli, with severe impairment in one domain (home, school, peers) and moderate in another, or moderate impairment in at les to assess target engagement.

The research project and all related materials were submitted and approved by the appropriate Institutional Review Board (IRB) of the National Institute of Mental Health (NIMH).

NCT02531893 and NCT00025935.

NCT02531893 and NCT00025935.