Tag: pubmed

J Thromb Haemost. 2021 Jun 1. doi: 10.1111/jth.15415. Online ahead of print.

ABSTRACT

BACKGROUND: Oral anticoagulation (OAC) in atrial fibrillation (AF) reduces the risk of stroke/systemic embolism (SE). The impact of OAC discontinuation is less well documented.

OBJECTIVE: Investigate outcomes of patients prospectively enrolled in GARFIELD-AF who discontinued OAC.

METHODS: OAC discontinuation was defined as cessation of treatment for ≥7 consecutive days. Adjusted outcome risks were assessed in 23,882 patients with 511 days of median follow-up after discontinuation.

RESULTS AND CONCLUSIONS: Patients who discontinued (n=3,114, 13.0%) had a higher risk (Hazard ratio [95% CI]) of all-cause death (1.62 [1.25-2.09]), stroke/systemic embolism (SE) (2.21 [1.42-3.44]) and myocardial infarction (MI) (1.85 [1.09-3.13]) than patients who did not, whether OAC was restarted or not. This higher risk of outcomes after discontinuation was similar for patients treated with vitamin K antagonists (VKA) and direct oral anticoagulants (DOACs) (p for interactions range=0.145-0.778). Bleeding history (1.43 [1.14-1.80]), paroxysmal vs. persistent AF (1.15 [1.02-1.29]), emergency room care setting vs. office (1.37 [1.18-1.59]), major, clinically relevant non-major, and minor bleeding (10.02 [7.19-13.98], 2.70 [2.24-3.25] and 1.90 [1.61-2.23]), stroke/SE (4.09 [2.55-6.56]), MI (2.74 [1.69-4.43]), and left atrial appendage procedures (4.99 [1.82-13.70]) were predictors of discontinuation. Age (0.84 [0.81-0.88], per 10-year increase), history of stroke/TIA (0.81 [0.71-0.93]), diabetes (0.88 [0.80-0.97]), weeks from AF onset to treatment (0.96 [0.93-0.99] per week), and permanent vs. persistent AF (0.73 [0.63-0.86]) were predictors of lower discontinuation rates. Discontinuation for ≥7 consecutive days was associated with significantly higher all-cause mortality, stroke/SE and MI risk. Caution should be exerted when considering any OAC discontinuation beyond 7 days.

PMID:34060704 | DOI:10.1111/jth.15415

NPJ Breast Cancer. 2021 May 31;7(1):68. doi: 10.1038/s41523-021-00272-2.

ABSTRACT

Percent mammographic density (PMD) is a strong breast cancer risk factor, however, other mammographic features, such as V, the standard deviation (SD) of pixel intensity, may be associated with risk. We assessed whether PMD, automated PMD (APD), and V, yielded independent associations with breast cancer risk. We included 1900 breast cancer cases and 3921 matched controls from the Nurses’ Health Study (NHS) and the NHSII. Using digitized film mammograms, we estimated PMD using a computer-assisted thresholding technique. APD and V were determined using an automated computer algorithm. We used logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs). Median time from mammogram to diagnosis was 4.1 years (interquartile range: 1.6-6.8 years). PMD (OR _{per SD}:1.52, 95% CI: 1.42, 1.63), APD (OR _{per SD}:1.32, 95% CI: 1.24, 1.41), and V (OR _{per SD}:1.32, 95% CI: 1.24, 1.40) were positively associated with breast cancer risk. Associations for APD were attenuated but remained statistically significant after mutual adjustment for PMD or V. Women in the highest quartile of both APD and V (OR _{vs Q1/Q1}: 2.49, 95% CI: 2.02, 3.06), or PMD and V (OR _{vs Q1/Q1}: 3.57, 95% CI: 2.79, 4.58) had increased breast cancer risk. An automated method of PMD assessment is feasible and yields similar, but somewhat weaker, estimates to a manual measure. PMD, APD and V are each independently, positively associated with breast cancer risk. Women with dense breasts and greater texture variation are at the highest relative risk of breast cancer.

PMID:34059687 | DOI:10.1038/s41523-021-00272-2

BMJ Open. 2021 May 31;11(6):e047040. doi: 10.1136/bmjopen-2020-047040.

ABSTRACT

OBJECTIVES: We compared intrapartum interventions and outcomes for mothers, neonates and children up to 16 years, for induction of labour (IOL) versus spontaneous labour onset in uncomplicated term pregnancies with live births.

DESIGN: We used population linked data from New South Wales, Australia (2001-2016) for healthy women giving birth at 37+0 to 41+6 weeks. Descriptive statistics and logistic regression were performed for intrapartum interventions, postnatal maternal and neonatal outcomes, and long-term child outcomes adjusted for maternal age, country of birth, socioeconomic status, parity and gestational age.

RESULTS: Of 474 652 included births, 69 397 (15%) had an IOL for non-medical reasons. Primiparous women with IOL versus spontaneous onset differed significantly for: spontaneous vaginal birth (42.7% vs 62.3%), instrumental birth (28.0% vs 23.9%%), intrapartum caesarean section (29.3% vs 13.8%), epidural (71.0% vs 41.3%), episiotomy (41.2% vs 30.5%) and postpartum haemorrhage (2.4% vs 1.5%). There was a similar trend in outcomes for multiparous women, except for caesarean section which was lower (5.3% vs 6.2%). For both groups, third and fourth degree perineal tears were lower overall in the IOL group: primiparous women (4.2% vs 4.9%), multiparous women (0.7% vs 1.2%), though overall vaginal repair was higher (89.3% vs 84.3%). Following induction, incidences of neonatal birth trauma, resuscitation and respiratory disorders were higher, as were admissions to hospital for infections (ear, nose, throat, respiratory and sepsis) up to 16 years. There was no difference in hospitalisation for asthma or eczema, or for neonatal death (0.06% vs 0.08%), or in total deaths up to 16 years.

CONCLUSION: IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed. The size of effect varied by parity and gestational age, making these important considerations when informing women about the risks and benefits of IOL.

PMID:34059509 | DOI:10.1136/bmjopen-2020-047040

BMJ Open. 2021 May 31;11(5):e047627. doi: 10.1136/bmjopen-2020-047627.

ABSTRACT

INTRODUCTION: Hangeshashinto has been employed for oral mucositis prevention in patients receiving cancer treatment, but the evidence has not been sufficiently robust to guide clinical decision-making. This study will therefore be undertaken to assess the effectiveness of Hangeshashinto for preventing oral mucositis in patients with cancer who are receiving treatment.

METHODS AND ANALYSIS: The databases will include PubMed, Embase, the Cochrane Library, Chinese databases and Japanese databases. The literature will be searched from the databases’ inception until May 2021. Other sources, such as potential grey literature, reference lists from included studies and relevant systematic reviews and conference papers, will also be searched. The primary outcome is the incidence of mucositis of any severity, and the secondary outcomes are interruptions to cancer treatment, oral pain and nutritional status. The risk of bias of eligible studies will be assessed using the Cochrane Collaboration’s ‘risk of bias’ tool. Both the Q test and I² statistic will be performed to assess statistical heterogeneity. If I² >50%, sensitivity and subgroup analysis will be conducted. The quality of evidence will be rated according to the Grading of Recommendations, Assessment, Development and Evaluation approach. Egger’s test will be used to assess reporting bias.

ETHICS AND DISSEMINATION: This systematic review will evaluate only published data; therefore, ethical approval is not required.

PROSPERO REGISTRATION NUMBER: CRD42020216145.

PMID:34059515 | DOI:10.1136/bmjopen-2020-047627

J Musculoskelet Neuronal Interact. 2021 Jun 1;21(2):196-205.

ABSTRACT

OBJECTIVES: Plateauing of world records in sports has been suggested to reflect the limits of human physiology. Possible explanations include reduced doping or declining popularity that may even lead to a decrease in human performance. Such a decrease, however, has not yet been observed. We hypothesized that rather than a performance plateau, performance has recently declined.

METHODS: Fifteen athletic disciplines of the Austrian annual rankings were analyzed by regression statistics and the average best performance of the last 20 years compared to earlier periods.

RESULTS: The best performances occurred between 1980-1999 and were on average 2.56% (men) and 1.67% (women) better than between 2000-2019. This attenuation was significant in men in 200 m, 800 m, 1500 m, 10 km, long jump, javelin throw (p<0.05), high jump, pole vault, discus throw, shot put and hammer throw (p<0.001); and in women in 400 m, long jump, discus throw (p<0.05) and high jump (p<0.001). The greatest performance declines were observed in the men’s shot put (9.11%) and hammer throw (11.44%).

CONCLUSIONS: The Austrian track and field annual best results show a performance decline following a peak, instead of a plateau. Future studies should address the causes and whether this also applies to other sports and countries.

PMID:34059565

Res Social Adm Pharm. 2021 May 13:S1551-7411(21)00172-8. doi: 10.1016/j.sapharm.2021.05.006. Online ahead of print.

ABSTRACT

BACKGROUND: Pharmacy stands increasingly on the frontline of patient care, yet current studies of clinical decision-making by pharmacists only capture deliberative processes that can be stated explicitly. Decision-making incorporates both deliberative and intuitive processes. Clinical Judgement Analysis (CJA) is a method novel to pharmacy that uncovers intuitive decision-making and may provide a more comprehensive understanding of the decision-making processes of pharmacists.

OBJECTIVES: This paper describes how CJA potentially uncovers the intuitive clinical decision-making processes of pharmacists. Using an illustrative decision-making example, the application of CJA will be described, including: METHOD: An illustrative study was used, applying an established method for CJA. The decision to initiate anticoagulation, alongside appropriate risk judgements, was chosen as the context. Expert anticoagulation pharmacists were interviewed to define and then refine variables (cues) involved in this decision. Decision tasks with sixty scenarios were developed to explore the effect of these cues on pharmacists’ decision-making processes and distributed to participants for completion. Descriptive statistical and regression analyses were conducted for each participant.

RESULTS: The method produced individual judgement models for each participant, for example, demonstrating that when judging stroke risk each participant’s judgements could be accurately predicted using only 3 or 4 out of the possible 11 cues given. The method also demonstrated that participants appeared to consider multiple cues when making risk judgements but used an algorithmic approach based on one or two cues when making the clinical decision.

CONCLUSION: CJA generates insights into the clinical decision-making processes of pharmacists not uncovered by the current literature. This provides a springboard for more in-depth explorations; explorations that are vital to the understanding and ongoing development of the role of pharmacists.

PMID:34059473 | DOI:10.1016/j.sapharm.2021.05.006

BMJ Glob Health. 2021 May;6(5):e005387. doi: 10.1136/bmjgh-2021-005387.

ABSTRACT

INTRODUCTION: The measurement of progress towards many Sustainable Development Goals (SDG) and other health goals requires accurate and timely all-cause and cause of death (COD) data. However, existing guidance to countries to calculate these indicators is inadequate for populations with incomplete death registration and poor-quality COD data. We introduce a replicable method to estimate national and subnational cause-specific mortality rates (and hence many such indicators) where death registration is incomplete by integrating data from Medical Certificates of Cause of Death (MCCOD) for hospital deaths with routine verbal autopsy (VA) for community deaths.

METHODS: The integration method calculates population-level cause-specific mortality fractions (CSMFs) from the CSMFs of MCCODs and VAs weighted by estimated deaths in hospitals and the community. Estimated deaths are calculated by applying the empirical completeness method to incomplete death registration/reporting. The resultant cause-specific mortality rates are used to estimate SDG Indicator 23: mortality between ages 30 and 70 years from cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. We demonstrate the method using nationally representative data in Myanmar, comprising over 42 000 VAs and 7600 MCCODs.

RESULTS: In Myanmar in 2019, 89% of deaths were estimated to occur in the community. VAs comprised an estimated 70% of community deaths. Both the proportion of deaths in the community and CSMFs for the four causes increased with older age. We estimated that the probability of dying from any of the four causes between 30 and 70 years was 0.265 for men and 0.216 for women. This indicator is 50% higher if based on CSMFs from the integration of data sources than on MCCOD data from hospitals.

CONCLUSION: This integration method facilitates country authorities to use their data to monitor progress with national and subnational health goals, rather than rely on estimates made by external organisations. The method is particularly relevant given the increasing application of routine VA in country Civil Registration and Vital Statistics systems.

PMID:34059494 | DOI:10.1136/bmjgh-2021-005387

Intensive Crit Care Nurs. 2021 May 29:103078. doi: 10.1016/j.iccn.2021.103078. Online ahead of print.

NO ABSTRACT

PMID:34059416 | DOI:10.1016/j.iccn.2021.103078

Intensive Crit Care Nurs. 2021 May 28:103076. doi: 10.1016/j.iccn.2021.103076. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to develop the Nursing Practice Scale for End-of-life Family conferences in critical care and to clarify the current status of nursing practice regarding family conferences.

RESEARCH METHODOLOGY/DESIGN: We conducted a cross-sectional, self-administered questionnaire survey with 955 critical care unit nurses in 97 hospitals. Content validity, factor validity and criterion-related validity, known-group validity, internal consistency and test-retest reliability were evaluated. Data were then analysed statistically.

SETTING: Adult intensive care units or high dependency units in Japan.

RESULTS: Three factors with 39 items were extracted through item analysis and confirmatory factor analysis as hypothesised (Factor 1: Preparation, Factor 2: Discussion and Factor 3: Follow-up), and the mean score per item for each factor was 3.57, 3.73 and 3.75, respectively. Nurses who had any certification or had worked in critical care unit for >5 years had a significantly greater score than the others. The Cronbach’s α were 0.86-0.96 and the intraclass correlation coefficients were 0.79-0.87.

CONCLUSION: The Nursing Practice Scale for End-of-life Family conferences in critical care is a valid and reliable scale. This study could effectively facilitate communication among patients, their families and healthcare providers.

PMID:34059417 | DOI:10.1016/j.iccn.2021.103076

J Adolesc Health. 2021 May 28:S1054-139X(21)00218-4. doi: 10.1016/j.jadohealth.2021.04.021. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to describe the feasibility, cost-effectiveness, and generalizability of a strategy for recruiting adolescents into research studies through social media.

METHODS: We designed and tested six Instagram advertisements (ads) with a combination of Instagram campaign objectives (Traffic vs. Reach) and types of placement (Story vs. Feed). The goal was to obtain remote assent and screen for a larger remote behavioral intervention study. The eligibility criteria for screening were being aged 13-17 years, residing in the United States, and English-speaking. The eligibility for the larger study was past year cybervictimization and smartphone ownership. A target sample was 80 participants, randomly assigned to a control or intervention group and followed up for 16 weeks. Recruitment rates and cost-per-enrolled participant with different advertising strategies, demographics, and retention were examined using descriptive statistics.

RESULTS: The six ads were run over 907.5 hours, generating 1,069,747 impressions, 2,051 click-throughs, and 663 completed screening surveys. Of 493 eligible participants, 24.4% assented to participate, 69.4% completed enrollment, and 4.8% dropped/withdrew after randomization. Average advertising costs were $52/participant; the lowest-cost strategy (Traffic campaign + Feed ad placement) was $19/enrolled participant. The study sample was largely white (81.3%), non-Hispanic (87.5%), and female (77.5%) with an average age of 15.33 years. Nearly half of the participants were identified as lesbian, gay, or bisexual. More than 96% of participants were retained at the 16-week follow-up.

CONCLUSIONS: Instagram can be a feasible and cost-effective way to recruit adolescents for a remote study. This method may be ideal for recruiting hard-to-reach audiences.

PMID:34059428 | DOI:10.1016/j.jadohealth.2021.04.021