287 research outputs found
Utilization of mechanical power and associations with clinical outcomes in brain injured patients : a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial
No full textFunding Information: The authors received no direct funding for this work. SW is supported by institutional research grants and the National Institutes of Health. MS receives support from NIMH K01MH115789. ST is supported by the Eliot Phillipson Clinician Scientist Training Program and Clinician Investigator Program at the University of Toronto. RDS is supported on NIA R33AG071744. Publisher Copyright: © 2023, The Author(s).Peer reviewe
Publisher Correction: Global estimates on the number of people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020
No full textFully disaggregated data is not available publicly due to data sharing agreements with some principal investigators yet requests for summary data can be made to the corresponding author.” Furthermore, the information in the “Funding” section was incomplete. The following information was added: “This study was funded by Brien Holden Vision Institute, Fondation Thea, Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation (LCIF), Sightsavers International, and University of Heidelberg.” The “Competing interests” section has been corrected from “The authors declare no competing interests” to the following detailed information: GBD 2019 Blindness and Vision Impairment Collaborators Declarations N S Bayileyegn reports participation on a Data Safety Monitoring Board or Advisory Board with Jimma University, and leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Jimma University as a discipline committee member; outside the submitted work. S Bhaskar reports grants or contracts from the Japan Society for the Promotion of Science (JSPS), JSPS International Fellowship, Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT), the Australian Academy of Science, Grant-in-Aid for Scientific Research (KAKENHI); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Rotary District 9675 as the District Chair of Diversity, Equity, and Inclusion; the Global Health & Migration Hub Community and the Global Health Hub Germany (Berlin, Germany) as the Chair and Manager; PLOS One, BMC Neurology, Frontiers In Neurology, Frontiers in Stroke, Frontiers in Public Health and BMC Medical Research Methodology as an Editorial Board Member; and with the College of Reviewers, Canadian Institutes of Health Research (CIHR), and the Government of Canada as a Member; outside the submitted work. X Dai reports support for the present manuscript from the Institute for Health Metrics and Evaluation and the University of Washington. M Cenderadewi reports grants or contracts from James Cook University (International Research Training Program Scholarship for doctoral study), and support for attending meetings and travel from James Cook University; all outside the submitted work. M Foschi reports consulting fees from Roche; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Sanofi, Merck, and Novartis; support for attending meetings and travel from Novartis and Roche; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with MSBase as a scientific leadership board member, and Cochrane Review Group for Multiple Sclerosis and other rate diseases of the CNS as a member; all outside the submitted work. F Ghassemi reports support for the present manuscript from medical writing. B N G Goulart reports stock or stock options with Bristo Myers-Squibb and Pfizer; outside the submitted work. V B Gupta reports grants or contracts from the National Health and Medical Research Council (NHMRC); outside the submitted work. S Hallaj reports support for the present manuscript from the National Institute of Health, Bridge to AI common fund (grant number: OT2 OD032644). I M Ilic reports support for the present manuscript from the Ministry of Education, Science and Technological development, Republic of Serbia (project No 175042, 2011-2023). S Islam reports support for the present manuscript from the National Health and Medical Research Council (NHMRC) Investigator Grant and the Heart Foundation Vanguard Grant. J H Kempen reports support for the present manuscript from Sight for Souls and Mass Eye and Ear Global Surgery Program; and leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Sight for Souls as the President. K Krishan reports other non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, Panjab University (Chandigarh, India); outside the submitted work. O P Kurmi reports grants or contracts from the British Council India paid to Coventry University; outside the submitted work. V C Lansingh reports consulting fees from HelpMeSee, and financial support for attending meetings and travel from HelpMeSee; outside the submitted work. J L Leasher leadership or fiduciary roles in board, society, committee or advocacy groups, unpaid with the National Eye Institute as a member and the National Eye Health Education Program as a planning committee member; outside the submitted work. M Lee reports support for the present manuscript from the Ministry of Education of the Republic of Korea, and the National Research Foundation of Korea (NRF-2021R1I1A4A01057428) and Bio-convergence Technology Education Program through the Korea Institute for Advancement Technology (KIAT) funded by the Ministry of Trade, Industry and Energy (No. P0017805). C McAlinden reports grants or contracts from the Welsh Government on the following study: Feasibility of an alternative pathway for hospital referrals from Diabetic Eye Screening Wales (DESW) for people suspected with sight-threatening diabetic eye disease (diabetic maculopathy). No funds will be received from the author’s institution or personally related to this study. Any work conducted as part of this study is as an unpaid collaborator; consulting fees from Acufocus (Irvine, California, USA), Atia Vision (Campbell, California, USA), Bausch and Lomb (Bridgewater, New Jersey, USA), BVI / PhysIOL (Liège, Belgium), Coopervision (Pleasanton, California, USA), Cutting Edge (Labége, France), Fudan University (Fudan, China), Hoya (Frankfurt, Germany), Knowledge Gate Group (Copenhagen, Denmark), Johnson & Johnson Surgical Vision (Santa Ana, California, USA), Keio University (Tokyo, Japan), Ludwig-Maximilians-University (München, Germany), Medevise Consulting SAS (Strasbourg, France), Novartis (Basel, Switzerland), Ophtec BV (Groningen, The Netherlands), Sun Yat-sen University (Guangzhou, China), SightGlass vision (Menlo Park, California, USA), Science in Vision (Bend, Oregan, USA), SpyGlass (Aliso Viejo, California, USA), Targomed GmbH (Bruchsal, Germany), University of São Paulo (São Paulo, Brazil), and Vold Vision (Arkansas, USA); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Scope (Crawley, UK), Bausch and Lomb (Bridgewater, New Jersey, USA), and Thea pharmaceuticals (Clemont-Ferrand, France); support for attending meetings and/or travel from Royal College of Ophthalmologists (London, UK), Scope (Crawley, UK), Portuguese Society of Ophthalmology (Portugal), British Society of Refractive surgery (BSRS), Thea pharmaceuticals (Clemont-Ferrand, France), Bausch and Lomb (Bridgewater, New Jersey, USA); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the British Society of Refractive Surgery (BSRS) as an unpaid council member, and the Royal College of Ophthalmologists (London, UK) as an unpaid PROM advisor; other financial interests from the Quality of Vision (QoV) Questionnaire tool, the Orthokeratology and Contact Lens Quality of Life Questionnaire (OCL-QoL), and paid peer reviews for Research Square; outside of the submitted work. Finally, the section “Author Contributions” has been added and an Appendix with more detailed information for individual author contributions has been included in the form of electronic supplementary material. The original article has been corrected
Correction to: MASK 2017: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma multimorbidity using real-world-evidence
No full textFollowing publication of the original article [1], the authors reported that one of the collaborators’ names was spelled incorrectly. In this Correction the incorrect and correct author name are shown. In the author list of this Correction article, only the corresponding author and institutional author are presented
Impact of Vutrisiran on Quality of Life and Physical Function in Patients with Hereditary Transthyretin-Mediated Amyloidosis with Polyneuropathy
No full textPublisher Copyright: © 2023, The Author(s).Introduction: Hereditary transthyretin (ATTRv; v for variant) amyloidosis, also known as hATTR amyloidosis, is a progressive and fatal disease associated with rapid deterioration of physical function and patients' quality of life (QOL). Vutrisiran, a subcutaneously administered RNA interference (RNAi) therapeutic that reduces hepatic production of transthyretin, was assessed in patients with ATTRv amyloidosis with polyneuropathy in the pivotal HELIOS-A study. Methods: The phase 3 open-label HELIOS-A study investigated the efficacy and safety of vutrisiran in patients with ATTRv amyloidosis with polyneuropathy, compared with an external placebo group from the APOLLO study of the RNAi therapeutic patisiran. Measures of QOL and physical function were assessed. Results: At month 18, vutrisiran improved Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) total score (least squares mean difference [LSMD] in change from baseline [CFB]: –21.0; p = 1.84 × 10–10) and Norfolk QOL-DN domain scores, compared with external placebo. This benefit relative to external placebo was evident across all baseline polyneuropathy disability (PND) scores and most pronounced in patients with baseline PND scores I–II. Compared with external placebo, vutrisiran also demonstrated benefit in EuroQoL-Visual Analog Scale (EQ-VAS) score (LSMD in CFB: 13.7; nominal p = 2.21 × 10–7), 10-m walk test (LSMD in CFB: 0.239 m/s; p = 1.21 × 10–7), Rasch-built Overall Disability Score (LSMD in CFB: 8.4; p = 3.54 × 10–15), and modified body mass index (mBMI) (LSMD in CFB: 140.7; p = 4.16 × 10–15) at month 18. Overall, Norfolk QOL-DN, EQ-VAS, and mBMI improved from pretreatment baseline with vutrisiran, whereas all measures worsened from baseline in the external placebo group. At month 18, Karnofsky Performance Status was stable/improved from baseline in 58.2/13.1% with vutrisiran versus 34.7/8.1% with external placebo. Conclusion: Vutrisiran treatment provided significant clinical benefits in multiple measures of QOL and physical function in patients with ATTRv amyloidosis with polyneuropathy. Benefits were most pronounced in patients with earlier-stage disease, highlighting the importance of early diagnosis and treatment. Trial Registration Number: ClinicalTrials.gov: NCT03759379.Peer reviewe
Hospital-based caregiver intervention for people following hip fracture surgery (HIP HELPER) : multicentre randomised controlled feasibility trial with embedded qualitative study in England
No full textObjectives: To assess the feasibility of conducting a pragmatic, multi-centre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery.
Design: Two-arm, multi-centre, pragmatic, open, feasibility RCT with embedded qualitative study.
Setting: National Health Service (NHS) providers in five English hospitals.
Participants: Community-dwelling adults, aged 60 years and over, who undergo hip fracture surgery and their informal caregivers.
Intervention: Usual care: usual NHS care.
Experimental: usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme comprised of three, one-hour, one-to-one training sessions for a patient and caregiver, delivered by a nurse, physiotherapist or occupational therapist in the hospital setting pre-discharge. After discharge, patients and caregivers were supported through three telephone coaching sessions. Randomisation and blinding: Central randomisation was computer generated (1:1), stratified by hospital and level of patient cognitive impairment. There was no blinding.
Main outcome measures: Data collected at baseline and four months post-randomisation included: screening logs, intervention logs, fidelity checklists, acceptability data and clinical outcomes. Interviews were conducted with a subset of participants and health professionals.
Results: 102 participants were enrolled (51 patients; 51 caregivers). Thirty-nine percent (515/1311) of patients screened were eligible. Eleven percent (56/515) of eligible patients consented to be randomised. Forty-eight percent (12/25) of the intervention group reached compliance to their allocated intervention. There was no evidence of treatment contamination. Qualitative data demonstrated the trial and HIP HELPER programme was acceptable.
Conclusions: The HIP HELPER programme was acceptable to patient-caregiver dyads and health professionals. The COVID-19 pandemic impacting on site’s ability to deliver the research. Modifications are necessary to the design for a viable definitive RCT.
Trial registration number: ISRCTN13270387 Data availability statement: The data that support the findings of this study are available from the corresponding author (TS) upon reasonable request. This includes access to the full protocol, anonymised participant-level dataset and statistical code.
STRENGTHS AND LIMITATIONS OF THIS STUDY
• Mixed-method approach provided useful feasibility and acceptability data.
• Assessment of diverse measures allowed evaluation of data collection for key outcome domains.
• Participant experiences and acceptability data suggest perceived value in the HIP HELPER programme. • 10% of the cohort were living with cognitive impairment; none were recruited to the qualitative sub-study. • COVID-19 pandemic affected NHS services, which impacted on study delivery
Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
No full textBackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed.FundingBill & Melinda Gates Foundation
Global estimates on the number of people blind or visually impaired by cataract: a meta-analysis from 2000 to 2020
No full textBackground: To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by cataract and their proportion of the total number of vision-impaired individuals. Methods: A systematic review and meta-analysis of published population studies and gray literature from 2000 to 2020 was carried out to estimate global and regional trends. We developed prevalence estimates based on modeled distance visual impairment and blindness due to cataract, producing location-, year-, age-, and sex-specific estimates of moderate to severe vision impairment (MSVI presenting visual acuity <6/18, ≥3/60) and blindness (presenting visual acuity <3/60). Estimates are age-standardized using the GBD standard population. Results: In 2020, among overall (all ages) 43.3 million blind and 295 million with MSVI, 17.0 million (39.6%) people were blind and 83.5 million (28.3%) had MSVI due to cataract blind 60% female, MSVI 59% female. From 1990 to 2020, the count of persons blind (MSVI) due to cataract increased by 29.7%(93.1%) whereas the age-standardized global prevalence of cataract-related blindness improved by −27.5% and MSVI increased by 7.2%. The contribution of cataract to the age-standardized prevalence of blindness exceeded the global figure only in South Asia (62.9%) and Southeast Asia and Oceania (47.9%). Conclusions: The number of people blind and with MSVI due to cataract has risen over the past 30 years, despite a decrease in the age-standardized prevalence of cataract. This indicates that cataract treatment programs have been beneficial, but population growth and aging have outpaced their impact. Growing numbers of cataract blind indicate that more, better-directed, resources are needed to increase global capacity for cataract surgery
Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study
No full textBackground: Gallbladder cancer (GBC) is rare but aggressive. The extent of surgical intervention for different GBC stages is non-uniform, ranging from cholecystectomy alone to extended resections including major hepatectomy, resection of adjacent organs and routine extrahepatic bile duct resection (EBDR). Robust evidence here is lacking, however, and survival benefit poorly defined. This study assesses factors associated with recurrence-free survival (RFS), overall survival (OS) and morbidity and mortality following GBC surgery in high income countries (HIC) and low and middle income countries (LMIC). Methods: The multicentre, retrospective Operative Management of Gallbladder Cancer (OMEGA) cohort study included all patients who underwent GBC resection across 133 centres between 1st January 2010 and 31st December 2020. Regression analyses assessed factors associated with OS, RFS and morbidity. Findings: On multivariable analysis of all 3676 patients, wedge resection and segment IVb/V resection failed to improve RFS (HR 1.04 [0.84–1.29], p = 0.711 and HR 1.18 [0.95–1.46], p = 0.13 respectively) or OS (HR 0.96 [0.79–1.17], p = 0.67 and HR 1.48 [1.16–1.88], p = 0.49 respectively), while major hepatectomy was associated with worse RFS (HR 1.33 [1.02–1.74], p = 0.037) and OS (HR 1.26 [1.03–1.53], p = 0.022). Furthermore, EBDR (OR 2.86 [2.3–3.52], p < 0.0010), resection of additional organs (OR 2.22 [1.62–3.02], p < 0.0010) and major hepatectomy (OR 3.81 [2.55–5.73], p < 0.0010) were all associated with increased morbidity and mortality. Compared to LMIC, patients in HIC were associated with poorer RFS (HR 1.18 [1.02–1.37], p = 0.031) but not OS (HR 1.05 [0.91–1.22], p = 0.48). Adjuvant and neoadjuvant treatments were infrequently used. Interpretation: In this large, multicentre analysis of GBC surgical outcomes, liver resection was not conclusively associated with improved survival, and extended resections were associated with greater morbidity and mortality without oncological benefit. Aggressive upfront resections do not benefit higher stage GBC, and international collaborations are needed to develop evidence-based neoadjuvant and adjuvant treatment strategies to minimise surgical morbidity and prioritise prognostic benefit. Funding:Cambridge Hepatopancreatobiliary Department Research Fund. © 2023 The Author(s
A world-wide study on delirium assessments and presence of protocols
No full textAcknowledgement of collaborative authors: The “WDAD Study Team” comprises of 158 non-author collaborators. They are listed in Appendix 1a in the Supplementary Data. The authors would like to gratefully acknowledge the many participating clinicians for supporting the 2023 WDAD Study Team and survey. They are named in Appendix 1b in the Supplementary Data.Peer reviewe
Screening for Future Cardiovascular Disease Using Age Alone Compared with Multiple Risk Factors and Age
No full textThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
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