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Rate and Predictors of Disease Progression in Patients with Conservatively Managed Intermittent Claudication: A Systematic Review.
Get PDFBACKGROUND: Intermittent claudication (IC) is a common pathology, affecting 4.5% of the United Kingdom population, and is associated with significant health burden if disease progresses to chronic limb-threatening ischemia (CLTI). The natural history of conservatively managed IC remains poorly described, and this study aimed to examine the rate and predictors of progression from IC to CLTI. METHODS: Systematic review (PROSPERO ID: CRD42023401259) in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines of available literature using Scopus, World of Science, Medline, Embase, and CINAHL databases. Adult patients with IC managed conservatively were included. Progression rate was defined as percentage of IC patients developing CLTI at follow-up. Predictors identified from univariate and multivariate analyses were included. A quantitative synthesis was planned if studies depicted homogeneity. RESULTS: Search terms yielded 6,404 unique reports. Nine studies (7 retrospective and 2 prospective cohorts) on a total of 4,115 patients were included in the primary synthesis. Women constituted 22.7% on average (0-30.1%) of patients included within studies. All included studies were nonrandomized cohort designs with expected limitations in terms of determining causal effect. The risk of bias was assessed as "moderate" in 5, and "serious" in 4 of the 9 included studies. 1.1-36.7% of claudicants from studies included developed CLTI by end of follow-up (mean 5.4 ± 2.72 years). A pooled progression rate of 15.26% at maximal (10 years) follow-up did not reach significance (P = 0.67) in meta-analysis and is likely unreliable, demonstrating 99% heterogeneity (P < 0.01). Predictors of progression were advanced age, diabetes, hemodialysis, smoking, serum low-density lipoprotein, HbA1c, and baseline severity of ischemia (Ankle-brachial index, Toe-brachial index and claudication distance) in univariate analysis. Diabetes, smoking and hemodialysis were predictors of progression in multivariate analysis. Only three studies investigating biomarkers of peripheral arterial disease (PAD) progression were found. CONCLUSIONS: Diabetes, renal failure, and smoking are significant predictors of PAD progression. Poor quality evidence and data heterogeneity preclude conclusive estimates of progression rates. Women are underrepresented among studies. Future structured, prospective prognostic studies addressing the progression of conservatively managed IC are needed to inform personalized management strategies
Plasmodium knowlesi Infection Is Associated With Elevated Circulating Biomarkers of Brain Injury and Endothelial Activation.
Get PDFBACKGROUND: Malaria remains a major public health concern with substantial morbidity and mortality worldwide. In Malaysia, the emergence of Plasmodium knowlesi has led to a surge in zoonotic malaria cases and deaths in recent years. Signs of cerebral involvement have been observed in a noncomatose, fatal case of knowlesi infection, but the potential impact of this malaria species on the brain remains unexplored. To address this gap, we investigated circulating levels of brain injury, inflammation, and vascular biomarkers in a cohort of knowlesi-infected patients and controls. METHODS: Archived plasma samples from 19 Malaysian patients with symptomatic knowlesi infection and 19 healthy, age-matched controls were analyzed. Fifty-two biomarkers of brain injury, inflammation, and vascular activation were measured. Wilcoxon tests were used to examine group differences, and biomarker profiles were explored through hierarchical clustering heatmap analysis. RESULTS: Bonferroni-corrected analyses revealed significantly elevated brain injury biomarker levels in knowlesi-infected patients, including S100B (P < .0001), Tau (P = .0007), UCH-L1 (P < .0001), αSyn (P < .0001), Park7 (P = .0006), NRGN (P = .0022), and TDP-43 (P = .005). Compared to controls, levels were lower in the infected group for BDNF (P < .0001), CaBD (P < .0001), CNTN1 (P < .0001), NCAM-1 (P < .0001), GFAP (P = .0013), and KLK6 (P = .0126). Hierarchical clustering revealed distinct group profiles for brain injury and vascular activation biomarkers. CONCLUSIONS: Our findings highlight for the first time a potential impact of P knowlesi infection on the brain, with specific changes in cerebral injury and endothelial activation biomarker profiles. Further studies are warranted to investigate the pathophysiology and clinical significance of these altered markers, through neuroimaging and long-term neurocognitive assessments
Adherence to oral thromboprophylaxis in atrial fibrillation: An overview for clinicians
Get PDFIn most patients with atrial fibrillation, effective stroke prevention necessitates long-term (often lifelong) oral anticoagulant therapy (OAC). However, the effectiveness of OAC therapy in a clinical setting (i.e., outside the controlled environment of randomized clinical trials) is strongly influenced by patients’ adherence and persistence with prescribed therapy.
However, suboptimal adherence to OAC remains a substantial problem in routine practice - available evidence suggests that patients do not take their OAC one out of every four days, and approximately one in three to four patients is poorly adherent to OAC. In addition, around 15% of high-risk OAC-eligible patients with AF refuse to take OAC for a variety of patient-specific reasons.
Poor adherence to OAC therapy is associated with adverse clinical outcomes (such as stroke or systemic embolism, hospitalization, mortality, bleeding [particularly with Vitamin K antagonist therapy]) and increased economic costs.
In this overview, we summarize important aspects of the adherence to medication concept, including the definition and measurement of adherence, the determinants and prevalence of OAC non-adherence, the clinical importance of achieving and maintaining good adherence, strategies to improve adherence to OAC, and alternative treatment options for effective thromboprophylaxis in patients with AF who are non-adherent to OAC therapy
Prevalence and Clinical Significance of Electrocardiographic Complete Right Bundle Branch Block in Young Individuals.
Get PDFBACKGROUND AND AIMS: There is limited information on the clinical significance of complete right bundle branch block (CRBBB) in young individuals. The aim of this study was to determine the prevalence and significance of CRBBB in a large cohort of young individuals aged 14-35 years old. METHODS: From 2008 to 2018, 104,369 consecutive individuals underwent a cardiovascular assessment with a health questionnaire, electrocardiogram, clinical consultation, and selective echocardiography. Follow-up was obtained via direct telephone consultations. Mean follow-up was 7.3 ± 2.7 years. RESULTS: CRBBB was identified in 154 (0.1%) individuals and was more prevalent in males compared with females (0.20% vs. 0.06%; p<0.05) and in athletes compared with non-athletes (0.25% vs. 0.14%; p<0.05). CRBBB-related cardiac conditions were identified in 7 (5%) individuals (4 with atrial septal defect, 1 with Brugada syndrome, 1 with progressive cardiac conduction disease and 1 with atrial fibrillation). Pathology was more frequently identified in individuals with non-isolated CRBBB compared with individuals with isolated CRBBB (14% vs 1%; p < 0.05) and in individuals with a QRS duration of ≥130 milliseconds (ms) compared with individuals with a QRS of <130ms (10% vs 1%; p<0.05). CONCLUSION: The prevalence of CRBBB in young individuals was 0.1% and was more prevalent in males and athletes. CRBBB-related conditions were identified in 5% of individuals and were more common in individuals with non-isolated CRBBB and more pronounced intraventricular conduction delay (QRS duration of ≥130ms). Secondary evaluation should be considered for young individuals with CRBBB with symptoms, concerning family history, additional electrocardiographic anomalies or significant QRS prolongation (≥130ms)
A global core outcome set for orthopaedic interventions in children with spinal dysraphism
Get PDFAims
Orthopaedic interventions in spinal dysraphism (SD) are frequently required to address a wide spectrum of musculoskeletal deformities. The outcomes used to assess treatment, however, are heterogeneous and most fail to incorporate patient/family perceptions. The aim of this study was to identify the minimum set of outcomes to be collected in clinical practice and research settings following orthopaedic intervention in ambulatory and non-ambulatory children with SD.
Methods
The study was based on Core Outcome Measures in Effectiveness trials (COMET) initiative. A list of individual clinical outcomes (ICOs) and outcome measurement tools (OMTs) were obtained from a systematic literature review (SR) and from patients and families through an interview and questionnaire. Core outcomes were rated for importance in a two-round Delphi process that included international orthopaedic surgeons, physiotherapists, orthotists, patients, and families. Outcomes that did not reach consensus during the Delphi process were resolved with a final consensus meeting.
Results
In total, 88 statements, including ICOs and OMTs, were scored during the Delphi process for ambulatory and non-ambulatory children. A total of 35 items were resolved in the final consensus meeting. The final core outcome set (COS) is goal-based and includes 28 outcome parameters to be collected a minimum of one year after any orthopaedic intervention and at subsequent set points during childhood. The COS incorporates clinical examination, mobility and functional assessment, patient-reported outcome measures, and investigations with the Goal Attainment Score recommended for goal setting.
Conclusion
A minimum set of outcomes to evaluate the orthopaedic treatment of SD was created thereby enabling consistency in reporting among centres and studies.
Cite this article: Bone Jt Open 2025;6(11):1371–1381
Digital Information Sharing Before Consultations in General Practice: Protocol for a Scoping Review
Get PDFBackground
Digital tools that enable patients to submit information before consultations, such as Accurx and eConsult, are increasingly used in general practice. These systems aim to streamline workflows, improve documentation, and optimize consultation efficiency. However, evidence about their implementation, impact on health inequalities, and health care outcomes remains limited and fragmented.
Objective
This study aims to map and synthesize the evidence on digital tools used for preconsultation information sharing in family or general practice.
Methods
This scoping review will follow the Joanna Briggs Institute framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Searches were conducted on May 12, 2025, in MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), and the Cochrane Library. Gray literature will be identified via Google Scholar and the National Health Service or government websites. Eligible studies will describe or evaluate digital tools used to collect information from patients before general practice consultations. Two independent reviewers will conduct screening and data extraction. Data will be analyzed using narrative synthesis.
Results
Database searches identified 6991 records, with 4536 (64.88%) remaining after deduplication. Screening began in June 2025. Full-text screening was completed in November 2025, with data extraction and synthesis planned for completion by February 2026. Results will be submitted for publication in early 2026.
Conclusions
This review will summarize evidence concerning the use of digital tools for preconsultation information sharing in general practice. Findings will inform implementation, research priorities, and service improvement in digitally supported care.
International Registered Report Identifier (IRRID)
DERR1-10.2196/8264
Immunogenicity and safety of meningococcal vaccines, MenACWY-CRM and 4CMenB, in groups at increased risk for meningococcal disease
Get PDFINTRODUCTION: Individuals with immunocompromising conditions (e.g. asplenia, complement deficiency, HIV infection) or with high exposure to Neisseria meningitidis (e.g. laboratory workers, those in outbreak settings) have an increased risk of meningococcal disease. Immunization with meningococcal serogroups ACWY (MenACWY) and serogroup B (MenB) vaccines is recommended for high-risk groups in many countries, although definitions of high-risk vary. There are not yet clinical data for the pentavalent meningococcal serogroups ABCWY (MenABCWY) vaccines in high-risk populations. AREAS COVERED: This review examines studies conducted in high-risk groups with the component vaccines of GSK's MenABCWY vaccine, the 4-component MenB vaccine (4CMenB) and quadrivalent MenACWY CRM197-glycoconjugate vaccine (MenACWY-CRM). These component vaccines have been licensed for more than 10 years and are recommended in groups categorized as high risk. EXPERT OPINION: The component vaccines of GSK's MenABCWY vaccine, 4CMenB and MenACWY-CRM, have demonstrated immunogenicity and safety in high-risk groups, including with concomitant or sequential vaccine administration. As expected, immunogenicity was reduced in patients with complement deficiencies, particularly those receiving eculizumab. Further data are required on meningococcal vaccination in high-risk groups for the future refinement of national and regional recommendations and to support proactive approaches to improve vaccine uptake in high-risk groups
Practice Variation in the Evaluation and Management of Asymptomatic Wolff-Parkinson-White Pattern Among Competitive Athletes
Get PDFCity-wide space-time patterns of environmental noise pollution in Kigali, Rwanda
Get PDFBackground: As cities in Sub-Saharan Africa (SSA) become more crowded, noise pollution is also emerging as an important environmental concern, after air pollution. Yet, unlike air pollution, which is enjoying relatively more public attention, there is limited measurement data and policy efforts on environmental noise pollution. &#xD;Objective: We followed a recent city-wide measurement approach used in Accra (Ghana) and characterized environmental noise patterns in Kigali, a contrasting city with very different topography and regulatory system than Accra to inform urban policy. &#xD;Methods: We established 10 ‘fixed’ (yearlong) and 120 ‘rotating’ (weeklong) monitoring sites to capture both the temporal and spatial patterns in Kigali’s sound environment. The measurement occurred between November 2022 and December 2023, and samples were collected at 1-minute interval, resulting in 5,155,014 (3,580 site-days) and 1,190,620 (827 site-days) site-minutes of valid data from the fixed and rotating sites, respectively. The 130 monitoring sites covered a variety of geographic and land-use factors across diverse neighborhoods and sources. We computed several noise metrics, including 1-hour (LAeq1hr), daily (LAeq24hr), day-time (Lday), and night-time (Lnight). &#xD;Results: Daily noise (LAeq24hr) levels across the city ranged between 38-85 dBA. Commercial, business, and industrial (CBI) and high-density residential (HD) communities experienced the highest noise levels, with some sites constantly above 70 dBA at day and 65 dBA at night. About 63% of our observed day-time values (up to ~72% in some areas) exceeded the Rwandan daytime standard (55 dBA) for residential areas, whereas 69% of the observed night-time values (up to 80% in some areas) exceeded the corresponding nighttime standard (45 dBA). In Nyarugenge, the most urbanized district, as much as 75% of our site-days data exceeded day-time standard. However, diurnal patterns throughout the city were similar, rising from ~5am, peaking at about 8am and plateauing until 6pm before falling to their lowest at midnight. Overall, noise levels in the city did not vary much by day of the week, weekdays vs weekend, or dry vs wet seasons.&#xD;Conclusion: Environmental noise in Kigali often exceeded both Rwandan standards and international guidelines, with residents in the city center district, CBI, and HD areas at risk of higher exposure and hence higher risk of adverse effects. Detailed assessment of the sources, at-risk population, and associated health effects may inform Rwandan’s environmental policy efforts and city initiatives in the face of the ongoing urban growth and densification
Experiences of providing self-management support: A qualitative study of pre-registration physiotherapy students at one university
Get PDFBackground
The importance of health care professionals in supporting self-management of individuals with long-term conditions has increased significantly over the last decade. While research has explored health care professionals’ experiences of supporting self-management, there is a paucity of literature exploring student experiences.
Objective
The aim of this study was to explore pre-registration physiotherapy students’ experiences, of using self-management support principles in practice.
Methods
A qualitative methodology was adopted, in which final year pre-registration physiotherapy students, were invited to participate in focus groups to explore their experiences of using self-management principles with patients in practice. Interviews were transcribed verbatim and analysed using thematic analysis.
Results
Four main themes were identified: i) self-management support as something to apply or do, ii) environmental and patient factors influencing application in practice, iii) limited development of self-management support self-efficacy, and iv) learning experiences of self-management support disjointed. Despite self-management support teaching, students had varied theoretical comprehension of the concepts and overall lacked confidence in the practical application.
Conclusions
The findings suggest more consistent and practical approaches would support learning and facilitate the development of students’ self-efficacy for using self-management support principles. For instance, curricula should encompass opportunities to explore simulated scenarios to develop effective collaborative communication with individuals and avoid didactic and directive approaches to providing self-management support. Further research is planned to investigate students’ experiences of a newly validated curriculum where self-management support teaching is integrated and embedded. Research to compare communication curriculum and effectiveness between universities is also warranted
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