BMJ. 2024 May 30;385:q1196. doi: 10.1136/bmj.q1196.
NO ABSTRACT
PMID:38816027 | DOI:10.1136/bmj.q1196
Tag: statistics
BMJ Open Ophthalmol. 2024 May 29;9(1):e001469. doi: 10.1136/bmjophth-2023-001469.
ABSTRACT
PURPOSE: Considering the putative role of light in myopia, and variations in socioeconomic, lifestyle, educational and environmental factors across ethnicities, we objectively investigated light exposure patterns in Indian school children.
METHODS: The light exposure profile of 143 school children (9-15 years, 50 myopes) recorded using a validated wearable light tracker for six continuous days was analysed. Additional data for non-school days were available for 87 children (26 myopes). The illuminance exposure levels, time spent outdoors and epoch (number of times participant is exposed to a predefined range of lux level per day) were compared between myopes and non-myopes across different light conditions: ≥1000, ≥3000, ≥5000 and ≥10 000 lux. For school days, light exposure profiles during (1) before school, school and after school hours; and (2) class, break and transition (when a student travels to and from school) time were analysed.
RESULTS: The overall median (IQR) daily illuminance exposure level, time spent outdoors and epochs at outdoors (≥1000 lux) were 807 (507-1079) lux/day, 46 (30-64) min/day and 9 (6-12) times/day, respectively. The daily illuminance exposure on non-school days was significantly higher in non-myopes than myopes (6369 (4508-9112) vs 5623 (2616-6929) lux/day, p=0.04). During transition time (school days), non-myopes had significantly higher illuminance exposure (910 (388-1479) vs 550 (263-1098) lux/day, p=0.04), spent more time outdoors (25 (10-43) vs 14 (4-29) min/day, p=0.01) and had higher outdoor epochs (6 (4-11) vs 5 (2-8) times/day, p=0.01) than myopes.
CONCLUSIONS: A small but significant difference in illuminance exposure, time spent outdoors and epoch was noted between myopes and non-myopes during transition time, which may have implications in myopia control.
PMID:38816010 | DOI:10.1136/bmjophth-2023-001469
BMJ Open Qual. 2024 May 29;13(Suppl 1):e002697. doi: 10.1136/bmjoq-2023-002697.
ABSTRACT
INTRODUCTION: Sick preterm neonates are most vulnerable to developing skin injuries. Despite sound knowledge and application of evidence-based practices for preventing medical adhesive-related skin injury (MARSI), the incidence of MARSI was 30 events per 1000 adhesive application days in our unit.
AIMS AND OBJECTIVES: We aimed to reduce the median MARSI rate from the existing 30 per 1000 MARSI days to <5 per 1000 MARSI over 5 months from June 2023 to October 2023.
MATERIAL & METHODS: With the point-of-care quality improvement (QI) approach, a prospective study was planned to reduce the incidence of MARSI among sick very preterm newborns (<32 weeks gestational age) and eventually improve overall skin condition during hospital stay. Sequential Plan-Do-Study-Act cycles were implemented based on the identified risk factors recognised during recurring team discussions.
RESULTS: We demonstrated a reduction in the MARSI rate from 30 events per 1000 adhesive applications (during baseline assessment) to zero events per 1000 adhesive applications at the end of the study period. It was temporally related to the assessment of skin risk stratification at admission using a validated tool, regular assessment of neonatal skin condition score based on the skin risk stratification, and reinforcement of MARSI prevention bundle by application of barrier spray. Awareness regarding ‘skin injury prevention’ bundles was continually generated among healthcare professionals. The MARSI rate remained <5 events per adhesive application in the sustenance phase over 6 months.
CONCLUSION: Implementing evidence-based skin care practices resulted in a significant reduction in iatrogenic cutaneous injury events in very preterm neonates.
PMID:38816009 | DOI:10.1136/bmjoq-2023-002697
BMJ Open Qual. 2024 May 30;13(2):e002790. doi: 10.1136/bmjoq-2024-002790.
ABSTRACT
Previous work found referrals for end-of-life care are made late in the dying process and assessment processes for care funding, through continuing healthcare fast-track funding often inhibit people being able to die at home. The average time to discharge was 6.3 days and 29% died in hospital, as median survival was only 15 days.We aimed to support discharge to home within 1 day by December 2023 for patients, wishing to die at home, referred to the end-of-life discharge team in a medium-sized district general hospital in Southwest England.In phase 1, we identified 13 people on a patient-by-patient basis, learning from obstacles. Barriers identified included sourcing of equipment, communication between teams and clunky paperwork. Median time to discharge was 2 days (range within 24 hours to 8 days) with 2/13 (15.4%) dying prior to discharge. In phase 2, we extended the pilot, and 104 patients were identified; 94 people were discharged to home, with a median of wait of 1 day (range 0-7) to discharge, and 10 (9.6%) died prior to discharge (median 1 day; range 0-4). Median survival from discharge for the 94 who achieved their wishes to go home to die was 9 days (range 1-205 days). Only 26/94 (27.7%) people survived more than 30 days.Rapid decision-making and structures to support home-based end-of-life care can support more people to die in their preferred place of care, by using a community-based rapid response team instead of, or in parallel with continuing healthcare fast-track funding referral applications. Current pathways and funding models are not fit for purpose in an urgent care scenario when we have only one chance to get it right.
PMID:38816007 | DOI:10.1136/bmjoq-2024-002790
BMJ Open Qual. 2024 May 29;13(2):e002745. doi: 10.1136/bmjoq-2024-002745.
ABSTRACT
INTRODUCTION: Patient safety is a high priority in the Danish health care system, including that hospital patients get the proper nutrition during their stay. A Nutrition Committee at Odense University Hospital is responsible for policy regarding nourishment at the hospital. If patients experience suboptimal treatment, i.e. improper nourishment, in the Danish health care system, they have the right to file a complaint. These complaints enable the improvement potentials based on the patients’ first hand experiences. Therefore, our aim was to examine the nutrition complaint pattern and to get a deeper understanding of the context surrounding nutrition problems, allowing the extraction of learning potentials.
METHODS: We analysed complaints submitted to Odense University Hospital between 2018 and 2022 using the Healthcare Complaint Analysis Tool. The complaints were categorised into categories, levels of severity and overall patient harm. The complaints containing a high-severity nutrition problem were read through and thematised into aspects not defined in the Healthcare Complaint Analysis Tool.
RESULTS: Between 2018 and 2022, 60 complaint cases containing 89 nutrition problems were filed to Odense University Hospital. Most (58.3%) of these were filed by the patients’ relatives. The nutrition problems were mostly of low severity (56.2%), while 23.6% were severe, and 20.2% were very severe. The reading of 18 very severe nutrition complaints revealed a cascade of problems triggered by the nutrition problem in six cases. Moreover, we saw that two high-severity nutrition problems led to catastrophic harm.
DISCUSSION: A low proportion of nutrition problems may express an underestimation regarding nourishment at the hospital. A patient’s threshold may not be exceeded by suboptimal nutrition and therefore does not file a complaint. However, complaints contain important insights contributing to wider learning, given that improvements at the hospital so far are based on clinicians’ reporting, overlooking the patient perspective.
PMID:38816005 | DOI:10.1136/bmjoq-2024-002745
BMJ Open Qual. 2024 May 29;13(2):e002608. doi: 10.1136/bmjoq-2023-002608.
ABSTRACT
IMPORTANCE: Adequate situational awareness in patient care increases patient safety and quality of care. To improve situational awareness, an innovative, low-fidelity simulation method referred to as Room of Improvement, has proven effective in various clinical settings.
OBJECTIVE: To investigate the impact after 3 months of Room of Improvement training on the ability to detect patient safety hazards during an intensive care unit shift handover, based on critical incident reporting system (CIRS) cases reported in the same hospital.
METHODS: In this educational intervention, 130 healthcare professionals observed safety hazards in a Room of Improvement in a 2 (time 1 vs time 2)×2 (alone vs in a team) factorial design. The hazards were divided into immediately critical and non-critical.
RESULTS: The results of 130 participants were included in the analysis. At time 1, no statistically significant differences were found between individuals and teams, either overall or for non-critical errors. At time 2, there was an increase in the detection rate of all implemented errors for teams compared with time 1, but not for individuals. The detection rate for critical errors was higher than for non-critical errors at both time points, with individual and group results at time 2 not significantly different from those at time 1. An increase in the perception of safety culture was found in the pre-post test for the questions whether the handling of errors is open and professional and whether errors are discussed in the team.
DISCUSSION: Our results indicate a sustained learning effect after 12 weeks, with collaboration in teams leading to a significantly better outcome. The training improved the actual error detection rates, and participants reported improved handling and discussion of errors in their daily work. This indicates a subjectively improved safety culture among healthcare workers as a result of the situational awareness training in the Room of Improvement. As this method promotes a culture of safety, it is a promising tool for a well-functioning CIRS that closes the loop.
PMID:38816004 | DOI:10.1136/bmjoq-2023-002608
J Int Assoc Provid AIDS Care. 2024 Jan-Dec;23:23259582241251728. doi: 10.1177/23259582241251728.
ABSTRACT
Recent studies have shown social determinants of health (SDOH) to impact HIV care engagement. This cross-sectional study (Oct 20-Apr 21) assessed the impact of a range of SDOH on HIV care engagement using data from HIV Care Connect, a consortium of three HIV care facility-led programs (Alabama, Florida, Mississippi). The exposures were captured using the PRAPARE (Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences) scale. The outcome was captured using the Index of Engagement in HIV Care scale. Participants (n = 132) were predominantly non-White (87%) and male (52%) with a median age of 41 years. Multivariable logistic regression adjusted for various sociodemographics showed lower HIV care engagement to be associated with being uninsured/publicly insured, having 1-3 unmet needs, socially integrating ≤five times/week, and having stable housing. Factors such as unmet needs, un-/underinsurance, and social integration may be addressed by healthcare and community organizations.
PMID:38816001 | DOI:10.1177/23259582241251728
Hum Reprod. 2024 May 30:deae117. doi: 10.1093/humrep/deae117. Online ahead of print.
ABSTRACT
STUDY QUESTION: Can a genome-wide association study (GWAS) meta-analysis, including a large sample of young premenopausal women from a founder population from Northern Finland, identify novel genetic variants for circulating anti-Müllerian hormone (AMH) levels and provide insights into single-nucleotide polymorphism enrichment in different biological pathways and tissues involved in AMH regulation?
SUMMARY ANSWER: The meta-analysis identified a total of six loci associated with AMH levels at P < 5 × 10-8, three of which were novel in or near CHEK2, BMP4, and EIF4EBP1, as well as highlighted significant enrichment in renal system vasculature morphogenesis, and the pituitary gland as the top associated tissue in tissue enrichment analysis.
WHAT IS KNOWN ALREADY: AMH is expressed by preantral and small antral stage ovarian follicles in women, and variation in age-specific circulating AMH levels has been associated with several health conditions. However, the biological mechanisms underlying the association between health conditions and AMH levels are not yet fully understood. Previous GWAS have identified loci associated with AMH levels in pre-menopausal women, in or near MCM8, AMH, TEX41, and CDCA7.
STUDY DESIGN, SIZE, DURATION: We performed a GWAS meta-analysis for circulating AMH level measurements in 9668 pre-menopausal women.
PARTICIPANTS/MATERIALS, SETTING, METHODS: We performed a GWAS meta-analysis in which we combined 2619 AMH measurements (at age 31 years) from a prospective founder population cohort (Northern Finland Birth Cohort 1966, NFBC1966) with a previous GWAS meta-analysis that included 7049 pre-menopausal women (age range 15-48 years) (N = 9668). NFBC1966 AMH measurements were quantified using an automated assay. We annotated the genetic variants, combined different data layers to prioritize potential candidate genes, described significant pathways and tissues enriched by the GWAS signals, identified plausible regulatory roles using colocalization analysis, and leveraged publicly available summary statistics to assess genetic and phenotypic correlations with multiple traits.
MAIN RESULTS AND THE ROLE OF CHANCE: Three novel genome-wide significant loci were identified. One of these is in complete linkage disequilibrium with c.1100delC in CHEK2, which is found to be 4-fold enriched in the Finnish population compared to other European populations. We propose a plausible regulatory effect of some of the GWAS variants linked to AMH, as they colocalize with GWAS signals associated with gene expression levels of BMP4, TEX41, and EIFBP41. Gene set analysis highlighted significant enrichment in renal system vasculature morphogenesis, and tissue enrichment analysis ranked the pituitary gland as the top association.
LARGE SCALE DATA: The GWAS meta-analysis summary statistics are available for download from the GWAS Catalogue with accession number GCST90428625.
LIMITATIONS, REASONS FOR CAUTION: This study only included women of European ancestry and the lack of sufficiently sized relevant tissue data in gene expression datasets hinders the assessment of potential regulatory effects in reproductive tissues.
WIDER IMPLICATIONS OF THE FINDINGS: Our results highlight the increased power of founder populations and larger sample sizes to boost the discovery of novel trait-associated variants underlying variation in AMH levels, which aided the characterization of GWAS signals enrichment in different biological pathways and plausible genetic regulatory effects linked with AMH level variation for the first time.
STUDY FUNDING/COMPETING INTEREST(S): This work has received funding from the European Union’s Horizon 2020 Research and Innovation Programme under the MATER Marie Sklodowska-Curie Grant Agreement No. 813707 and Oulu University Scholarship Foundation and Paulon Säätiö Foundation. (N.P.-G.), Academy of Finland, Sigrid Jusélius Foundation, Novo Nordisk, University of Oulu, Roche Diagnostics (T.T.P.). This work was supported by the Estonian Research Council Grant 1911 (R.M.). J.R. was supported by the European Union’s Horizon 2020 Research and Innovation Program under Grant Agreements No. 874739 (LongITools), 824989 (EUCAN-Connect), 848158 (EarlyCause), and 733206 (LifeCycle). U.V. was supported by the Estonian Research Council grant PRG (PRG1291). The NFBC1966 received financial support from University of Oulu Grant No. 24000692, Oulu University Hospital Grant No. 24301140, and ERDF European Regional Development Fund Grant No. 539/2010 A31592. T.T.P. has received grants from Roche, Perkin Elmer, and honoraria for scientific presentations from Gedeon Richter, Exeltis, Astellas, Roche, Stragen, Astra Zeneca, Merck, MSD, Ferring, Duodecim, and Ajaton Terveys. For all other authors, there are no competing interests.
PMID:38815977 | DOI:10.1093/humrep/deae117
Int J Sports Physiol Perform. 2024 May 29:1-7. doi: 10.1123/ijspp.2023-0372. Online ahead of print.
ABSTRACT
PURPOSE: Determine the effects of advanced footwear technology (AFT) in track spikes and road-racing shoes on running economy (RE).
METHODS: Four racing shoes (3 AFT and 1 control) and 3 track spikes (2 AFT and 1 control) were tested in 9 male distance runners on 2 visits. Shoes were tested in a random sequence over 5-minute trials on visit 1 (7 trials at 16 km·h-1; 5-min rest between trials) and in the reverse/mirrored order on visit 2. Metabolic data were collected and averaged across visits.
RESULTS: There were significant differences across footwear conditions for oxygen consumption (F = 13.046; P < .001) and energy expenditure (F = 14.710; P < .001). Oxygen consumption (in milliliters per kilogram per minute) in both the first AFT spike (49.1 [1.7]; P < .001; dz = 2.1) and the other AFT spike (49.3 [1.7]; P < .001; dz = 1.7) was significantly lower than the control spike (50.2 [1.6]), which represented a 2.1% (1.0%) and 1.8% (1.0%) improvement in RE, respectively, for the AFT spikes. When comparing the subjects’ most economic shoe by oxygen consumption (49.0 [1.5]) against their most economic spike (49.0 [1.8]), there were no statistical differences (P = .82). Similar statistical conclusions were made when comparing energy expenditure (in watts per kilogram).
CONCLUSIONS: AFT track spikes improved RE ∼2% relative to a traditional spike. Despite their heavier mass, AFT shoes resulted in similar RE as AFT spikes. This could make the AFT shoe an attractive option for longer track races, particularly in National Collegiate Athletic Association and high school athletics, where there are no stack-height rules.
PMID:38815961 | DOI:10.1123/ijspp.2023-0372
Int J Biol Macromol. 2024 May 28:132709. doi: 10.1016/j.ijbiomac.2024.132709. Online ahead of print.
ABSTRACT
Bacterial Metabolite through a fermentation process is a growing trend and a promising alternative for use as functional components. Non-hydrothermal water-soluble (WSPs) and hydrothermally treated water-insoluble (WIPs) Maitake polysaccharides were fermented with Lactobacillus acidophilus (LA) and Lactobacillus plantarum (LP). Chemical composition analysis indicated that Maitake polysaccharides contained 58.22 ± 1.35 % total sugar and 31.46 % β-glucan, essential for metabolites production. 6-glucanase was used to degrade the WIPs, and hydrothermally treated WIP fibers exhibited smooth microstructure. Hence, the LA and LP bacteria investigated the potential fermented metabolic activities and differences between WSPs(Sp1)and WIP(Sp3) Maitake polysaccharides using LC-MS, and 887 metabolites were identified. Using Venn, Partial least squares discriminant analysis (PLS-DA), VIP Metabolites, and other multivariate statistical analysis methods, metabolites were expressed differently in all samples. Due to hydrothermal processing, WIP induced the highest growth of LA and LP, with an abundance of isocitrate metabolites. Furthermore, 50 metabolite correlations were identified, leading to the classification of 6 distinct metabolic groups. Thus, the study offers the initial comprehensive analysis of metabolites in Lactobacillus-fermented Maitake polysaccharides, aiding in understanding its metabolic interactions and facilitating progress in food engineering research.
PMID:38815943 | DOI:10.1016/j.ijbiomac.2024.132709