Category: Nevin Manimala

BMJ Open. 2024 Jun 6;14(6):e086428. doi: 10.1136/bmjopen-2024-086428.

ABSTRACT

OBJECTIVES: The main objective of this study was to investigate the characteristics of patients receiving private community physiotherapy (PT) the first year after a hip fracture. Second, to determine whether utilisation of PT could improve health-related quality of life (HRQoL).

METHODS: In an observational cohort study, 30 752 hip fractures from the Norwegian Hip Fracture Register were linked with data from Statistics Norway and the Norwegian Control and Payment of Health Reimbursements Database. Association between covariates and utilisation of PT in the first year after fracture, the association between covariates and EQ-5D index score and the probability of experiencing ‘no problems’ in the five dimensions of the EQ-5D were assessed with multiple logistic regression models.

RESULTS: Median age was 81 years, and 68.4% were females. Most patients with hip fracture (57.7%) were classified as American Society of Anesthesiologists classes 3-5, lived alone (52.4%), and had a low or medium level of education (85.7%). In the first year after injury, 10 838 of 30 752 patients with hip fracture (35.2%) received PT. Lower socioeconomic status (measured by income and level of education), male sex, increasing comorbidity, presence of cognitive impairment and increasing age led to a lower probability of receiving postoperative PT. Among those who used PT, EQ-5D index score was 0.061 points (p<0.001) higher than those who did not. Correspondingly, the probability of having ‘no problems’ in three of the five dimensions of EQ-5D was greater.

CONCLUSIONS: A minority of the patients with hip fracture had access to private PT the first year after injury. This may indicate a shortcoming in the provision of beneficial post-surgery rehabilitative care reducing post-treatment HRQoL. The findings underscore the need for healthcare policies that address disparities in PT access, particularly for elderly patients, those with comorbidities and reduced health, and those with lower socioeconomic status.

PMID:38844395 | DOI:10.1136/bmjopen-2024-086428

BMJ Open. 2024 Jun 6;14(6):e079660. doi: 10.1136/bmjopen-2023-079660.

ABSTRACT

BACKGROUND: Primary dysmenorrhoea occurs in up to 50% of menstruating females. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used therapeutic remedies for dysmenorrhoea in Uganda. However, NSAIDs are associated with a 3-5 fold increase in the risk of gastrointestinal (GI) adverse drug effects.

OBJECTIVES: We aimed to determine the prevalence and associated factors of self-reported NSAID-related GI adverse effects in female students who use NSAIDs in managing dysmenorrhoea-associated pain at Makerere University.

DESIGN: A cross-sectional study.

SETTING: Makerere University’s main campus, situated North of Kampala, Uganda.

PARTICIPANTS: 314 female students pursuing an undergraduate programme at Makerere University and residing in different halls of residence and hostels.

OUTCOMES: Social demographic data, menstrual history and treatment data.

RESULTS: Overall, 314 valid responses were received from female students with a median age of 22 years (IQR: 18-29 years). The median age at menarche was 13 years (IQR: 9-18 years). 41% (n=129/314) of the respondents had used medication for dysmenorrhoea and 32% (n=41/129) of whom reported NSAID-associated GI adverse effects with nausea being the most frequently reported (44%, n=18/41)Factors independently associated with GI adverse effects were: age at menarche (p=0.026), duration of menstruation (p=0.030) and use of ibuprofen (p=0.005). Females taking ibuprofen for dysmenorrhoea were about four times as likely to have NSAID-associated GI adverse effects (adjusted OR 3.87, 95% CI 1.51 to 9.91) than those who did not receive ibuprofen. Logistic regression was used to determine factors associated with self-reported adverse effects of NSAIDs among the female students. A p<0.05 was considered statistically significant.

CONCLUSION: We found a considerably high prevalence of NSAID-related GI adverse effects driven by factors such as age at menarche and ibuprofen use.

PMID:38844394 | DOI:10.1136/bmjopen-2023-079660

BMJ Open. 2024 Jun 6;14(6):e080126. doi: 10.1136/bmjopen-2023-080126.

ABSTRACT

OBJECTIVES: We aimed to develop a new data-driven method to predict the therapeutic indication of redeemed prescriptions in secondary data sources using antiepileptic drugs among individuals aged ≥65 identified in Danish registries.

DESIGN: This was an incident new-user register-based cohort study using Danish registers.

SETTING: The study setting was Denmark and the study period was 2005-2017.

PARTICIPANTS: Participants included antiepileptic drug users in Denmark aged ≥65 with a confirmed diagnosis of epilepsy.

PRIMARY AND SECONDARY OUTCOME MEASURES: Sensitivity served as the performance measure of the algorithm.

RESULTS: The study population comprised 8609 incident new users of antiepileptic drugs. The sensitivity of the algorithm in correctly predicting the therapeutic indication of antiepileptic drugs in the study population was 65.3% (95% CI 64.4 to 66.2).

CONCLUSIONS: The algorithm demonstrated promising properties in terms of overall sensitivity for predicting the therapeutic indication of redeemed antiepileptic drugs by older individuals with epilepsy, correctly identifying the therapeutic indication for 6 out of 10 individuals using antiepileptic drugs for epilepsy.

PMID:38844392 | DOI:10.1136/bmjopen-2023-080126

BMJ Open. 2024 Jun 6;14(6):e080393. doi: 10.1136/bmjopen-2023-080393.

ABSTRACT

BACKGROUND: General practitioners (GPs) were on the front line of the COVID-19 outbreak. Identifying clinical profiles in COVID-19 might improve patient care and enable closer monitoring of at-risk profiles.

OBJECTIVES: To identify COVID-19 profiles in a population of adult primary care patients, and to determine whether the profiles were associated with negative outcomes and persistent symptoms.

DESIGN, SETTING AND PARTICIPANTS: In a prospective multicentre study, 44 GPs from multiprofessional primary care practices in the Paris area of France recruited 340 consecutive adult patients (median age: 47 years) with a confirmed diagnosis of COVID-19 during the first two waves of the epidemic.

METHOD AND OUTCOME: A latent class (LC) analysis with 11 indicators (clinical signs and symptoms) was performed. The resulting profiles were characterised by a 3-month composite outcome (COVID-19-related hospital admission and/or death) and persistent symptoms three and 6 months after inclusion.

RESULTS: We identified six profiles: ‘paucisymptomatic’ (LC1, 9%), ‘anosmia and/or ageusia’ (LC2, 12.9%), ‘influenza-like syndrome with anosmia and ageusia’ (LC3, 15.5%), ‘influenza-like syndrome without anosmia or ageusia’ (LC4, 24.5%), ‘influenza-like syndrome with respiratory impairment’ (LC5) and a ‘complete form’ (LC6, 17.7%). At 3 months, 7.4% of the patients were hospitalised (with higher rates in LC5), and 18% had persistent symptoms (with higher rates in LC5 and LC6). At 6 months, 6.4% of the patients had persistent symptoms, with no differences between LCs.

CONCLUSION: Our findings might help GPs to identify patients at risk of persistent COVID-19 symptoms and hospital admission and then set up procedures for closer monitoring.

PMID:38844390 | DOI:10.1136/bmjopen-2023-080393

BMJ Paediatr Open. 2024 Jun 6;8(1):e002489. doi: 10.1136/bmjpo-2023-002489.

ABSTRACT

OBJECTIVE: To assess the financial non-medical out-of-pocket costs of hospital admissions for children with a febrile illness.

DESIGN: Single-centre survey-based study conducted between March and November 2022.

SETTING: Tertiary level children’s hospital in the North East of England.

PARTICIPANTS: Families of patients with febrile illness attending the paediatric emergency department MAIN OUTCOME MEASURES: Non-medical out-of-pocket costs for the admission were estimated by participants including: transport, food and drinks, child care, miscellaneous costs and loss of earnings.

RESULTS: 83 families completed the survey. 79 families (95.2%) reported non-medical out-of-pocket costs and 19 (22.9%) reported financial hardship following their child’s admission.Total costs per day of admission were median £56.25 (IQR £32.10-157.25). The majority of families reported incurring transport (N=75) and food and drinks (N=71) costs.

CONCLUSIONS: A child’s hospital admission for fever can incur significant financial costs for their family. One in five participating families reported financial hardship following their child’s admission. Self-employed and single parents were disadvantaged by unplanned hospital admissions and at an increased risk of financial hardship. Local hospital policies should be improved to support families in the current financial climate.

PMID:38844385 | DOI:10.1136/bmjpo-2023-002489

BMJ Paediatr Open. 2024 Jun 6;8(1):e002235. doi: 10.1136/bmjpo-2023-002235.

ABSTRACT

BACKGROUND: Neural tube defects are a significant cause of morbidity and mortality that can occur in the early pregnancy periods. Though the burden is high, it gains only limited attention. In Ethiopia, the estimated number of neural tube defect cases was significantly higher. So, identifying factors contributing to it would be significant for planning risk reduction and preventive strategies. Therefore, identifying the possible determinants was aimed at this study.

METHODS: A hospital-based, unmatched case-control study was conducted on 104 cases and 208 controls selected from neonatal intensive care units of teaching hospitals in Gedeo Zone and Sidama Region, southern Ethiopia from December 2021 to November 2022. All neural tube defect cases were included consecutively and controls were selected by using a simple random sampling method. Data were collected using interviewer-administered semistructured questionnaires. Data analysis was done by using SPSS V.25. Binary logistic regression was used, and variables with a p value less than 0.25 in bivariate analysis were entered into the multivariable logistic regression model. An adjusted OR with a 95% CI was estimated, and finally, variables that show a level of p value less than 0.05 in multivariable analysis were declared statistically significant.

RESULT: After controlling confounders, factors such as unplanned pregnancy 2.20 (95% CI 1.20 to 4.041), history of abortions 2.09 (95% CI 1.19 to 3.67), khat chewing 6.67 (95% CI 2.95 to 15.06), antipyretic and analgesic medications 2.87 (95% CI 1.47 to 5.56) and, being a female neonate 2.11 (95% CI 1.21 to 3.67) were significantly associated with a neural tube defect.

CONCLUSION: This study has identified some determinants of neural tube defects. Hence, the behavioural, medical and obstetrical conditions of mothers need serious evaluation in the prepregnancy period. So, improving preconception counselling and prenatal care practices would have a significant role in reducing the risk of neural tube defects.

PMID:38844382 | DOI:10.1136/bmjpo-2023-002235

BMJ Open Gastroenterol. 2024 Jun 6;11(1):e001342. doi: 10.1136/bmjgast-2023-001342.

ABSTRACT

INTRODUCTION: The management of non-alcoholic steatohepatitis (NASH) is an unmet clinical need. Misoprostol, a structural analogue of naturally occurring prostaglandin E1, has been reported to decrease proinflammatory cytokine production and may have a potential role in treating NASH. We aimed to evaluate the efficacy and safety of misoprostol in treating patients with NASH.

METHODS: In this phase 2, double-blind, randomised, placebo-controlled trial, patients with NASH were randomly assigned in a 1:1 ratio to receive 200 µg of misoprostol or placebo thrice daily for 2 months. The primary endpoint was an improvement in liver function tests (LFTs), interleukin-6 (IL-6) and endotoxin levels. The secondary endpoint was improvement in insulin resistance, dyslipidaemia, hepatic fibrosis and hepatic steatosis.

RESULTS: A total of 50 patients underwent randomisation, of whom 44 (88%) were males. The age range was 25-64 years (mean±SE of mean (SEM) 38.1±1.4). 19 (38%) patients had concomitant type 2 diabetes mellitus. 32 (64%) patients were either overweight or obese. At the end of 2 months’ treatment, a reduction in total leucocyte count (TLC) (p=0.005), alanine aminotransferase (ALT) (p<0.001), aspartate aminotransferase (AST) (p=0.002) and controlled attenuation parameter (CAP) (p=0.003) was observed in the misoprostol group, whereas placebo ensued a decline in ALT (p<0.001), AST (p=0.018), gamma-glutamyl transferase (GGT) (p=0.003), CAP (p=0.010) and triglycerides (p=0.048). There was no diminution in insulin resistance, hepatic fibrosis (elastography) and dyslipidaemia in both groups. However, misoprostol resulted in a significant reduction in CAP as compared with the placebo group (p=0.039). Moreover, in the misoprostol group, pretreatment and post-treatment IL-6 and endotoxin levels remained stable, while in the placebo group, an increase in the IL-6 levels was noted (p=0.049). Six (12%) patients had at least one adverse event in the misoprostol group, as did five (10%) in the placebo group. The most common adverse event in the misoprostol group was diarrhoea. No life-threatening events or treatment-related deaths occurred in each group.

CONCLUSION: Improvement in the biochemical profile was seen in both misoprostol and placebo groups without any statistically significant difference. However, there was more improvement in steatosis, as depicted by CAP, in the misoprostol group and worsening of IL-6 levels in the placebo group.

TRIAL REGISTRATION NUMBER: NCT05804305.

PMID:38844374 | DOI:10.1136/bmjgast-2023-001342

BMJ Qual Saf. 2024 Jun 6:bmjqs-2024-017185. doi: 10.1136/bmjqs-2024-017185. Online ahead of print.

ABSTRACT

INTRODUCTION: Many patient safety practices are only partly established in routine clinical care, despite extensive quality improvement efforts. Implementation science can offer insights into how patient safety practices can be successfully adopted.

OBJECTIVE: The objective was to examine the literature on implementation of three internationally used safety practices: medication reconciliation, antibiotic stewardship programmes and rapid response systems. We sought to identify the implementation activities, factors and outcomes reported; the combinations of factors and activities supporting successful implementation; and the implications of the current evidence base for future implementation and research.

METHODS: We searched Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Education Resources Information Center from January 2011 to March 2023. We included original peer-reviewed research studies or quality improvement reports. We used an iterative, inductive approach to thematically categorise data. Descriptive statistics and hierarchical cluster analyses were performed.

RESULTS: From the 159 included studies, eight categories of implementation activities were identified: education; planning and preparation; method-based approach; audit and feedback; motivate and remind; resource allocation; simulation and training; and patient involvement. Most studies reported activities from multiple categories. Implementation factors included: clinical competence and collaboration; resources; readiness and engagement; external influence; organisational involvement; QI competence; and feasibility of innovation. Factors were often suggested post hoc and seldom used to guide the selection of implementation strategies. Implementation outcomes were reported as: fidelity or compliance; proxy indicator for fidelity; sustainability; acceptability; and spread. Most studies reported implementation improvement, hindering discrimination between more or less important factors and activities.

CONCLUSIONS: The multiple activities employed to implement patient safety practices reflect mainly method-based improvement science, and to a lesser degree determinant frameworks from implementation science. There seems to be an unexploited potential for continuous adaptation of implementation activities to address changing contexts. Research-informed guidance on how to make such adaptations could advance implementation in practice.

PMID:38844348 | DOI:10.1136/bmjqs-2024-017185

Emerg Med J. 2024 Jun 6:emermed-2023-213708. doi: 10.1136/emermed-2023-213708. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal Early Warning System (EWS) scores for identifying patients at risk of clinical deterioration among those transported by ambulance services remain uncertain. This retrospective study compared the performance of 21 EWS scores to predict clinical deterioration using vital signs (VS) measured in the prehospital or emergency department (ED) setting.

METHODS: Adult patients transported to a single ED by ambulances and subsequently admitted to the hospital between 1 January 2019 and 18 April 2019 were eligible for inclusion. The primary outcome was 30-day mortality; secondary outcomes included 3-day mortality, admission to intensive care or coronary care units, length of hospital stay and emergency call activations. The discriminative ability of the EWS scores was assessed using the area under the receiver operating characteristic curve (AUROC). Subanalyses compared the performance of EWS scores between surgical and medical patient types.

RESULTS: Of 1414 patients, 995 (70.4%) (53.1% male, mean age 68.7±17.5 years) were included. In the ED setting, 30-day mortality was best predicted by VitalPAC EWS (AUROC 0.71, 95% CI (0.65 to 0.77)) and National Early Warning Score (0.709 (0.65 to 0.77)). All EWS scores calculated in the prehospital setting had AUROC <0.70. Rapid Emergency Medicine Score (0.83 (0.73 to 0.92)) and New Zealand EWS (0.88 (0.81 to 0.95)) best predicted 3-day mortality in the prehospital and ED settings, respectively. EWS scores calculated using either prehospital or ED VS were more effective in predicting 3-day mortality in surgical patients, whereas 30-day mortality was best predicted in medical patients. Among the EWS scores that achieved AUROC ≥0.70, no statistically significant differences were detected in their discriminatory abilities to identify patients at risk of clinical deterioration.

CONCLUSIONS: EWS scores better predict 3-day as opposed to 30-day mortality and are more accurate when estimated using VS measured in the ED. The discriminatory performance of EWS scores in identifying patients at higher risk of clinical deterioration may vary by patient type.

PMID:38844334 | DOI:10.1136/emermed-2023-213708

J Environ Sci (China). 2024 Nov;145:139-151. doi: 10.1016/j.jes.2023.07.020. Epub 2023 Jul 21.

ABSTRACT

Linking meteorology and air pollutants is a key challenge. The study investigated meteorological effects on PM_2.5 concentration using the advanced convergent cross mapping method, utilizing hourly PM_2.5 concentration and six meteorological factors across eight provinces and cities in Vietnam. Results demonstrated that temperature (ρ = 0.30) and radiation (ρ = 0.30) produced the highest effects, followed by humidity (ρ = 0.28) and wind speed (ρ = 0.24), while pressure (ρ = 0.22) and wind direction (ρ = 0.17) produced the weakest effects on PM_2.5 concentration. Comparing the ρ values showed that temperature, wind speed, and wind direction had greater impacts on PM_2.5 concentration during the dry season whereas radiation had a more influence during the wet season; Southern stations experienced larger meteorological effects. Temperature, humidity, pressure, and wind direction had both positive and negative influences on PM_2.5 concentration, while radiation and wind speed mostly had negative influences. During PM_2.5 pollution episodes, there was more contribution of meteorological effects on PM_2.5 concentration indicated by ρ values. At contaminated levels, humidity (ρ = 0.45) was the most dominant factor affecting PM_2.5 concentration, followed by temperature (ρ = 0.41) and radiation (ρ = 0.40). Pollution episodes were pointed out to be more prevalent under higher humidity, higher pressure, lower temperature, lower radiation, and lower wind speed. The ρ calculation also revealed that lower temperature, lower radiation, and higher humidity greatly accelerated each other under pollution episodes, further enhancing PM_2.5 concentration. The findings contributed to the literature on meteorology and air pollution interaction.

PMID:38844315 | DOI:10.1016/j.jes.2023.07.020