Cohort profile: characterisation, determinants, mechanisms and consequences of the long-term effects of COVID-19 – providing the evidence base for health care services (CONVALESCENCE) in the UK

Purpose
The pathogenesis of the long-lasting symptoms which can follow an infection with the SARS-CoV-2 virus (‘long covid’) is not fully understood. The ‘COroNaVirus post-Acute Long-term EffectS: Constructing an evidENCE base’ (CONVALESCENCE) study was established as part of the Longitudinal Health and Wellbeing COVID-19 UK National Core Study. We performed a deep phenotyping case-control study nested within two cohorts (the Avon Longitudinal Study of Parents and Children and TwinsUK) as part of CONVALESCENCE.

Participants
From September 2021 to May 2023, 349 participants attended the CONVALESCENCE deep phenotyping clinic at University College London. Four categories of participants were recruited: cases of long covid (long covid(+)/SARS-CoV-2(+)), alongside three control groups: those with neither long covid symptoms nor evidence of prior COVID-19 (long covid(-)/SARS-CoV-2(-); control group 1), those who self-reported COVID-19 and had evidence of SARS-CoV-2 infection, but did not report long covid (long covid(-)/SARS-CoV-2(+); control group 2) and those who self-reported persistent symptoms attributable to COVID-19 but no evidence of SARS-CoV-2 infection (long covid(+)/SARS-CoV-2(-); control group 3). Remote wearable measurements were performed up until February 2024.

Findings to date
This cohort profile describes the baseline characteristics of the CONVALESCENCE cohort. Of the 349 participants, 141 (53±15 years old; 21 (15%) men) were cases, 89 (55±16 years old; 11 (12%) men) were in control group 1, 75 (49±15 years old; 25 (33%) men) were in control group 2 and 44 (55±16 years old; 9 (21%) men) were in control group 3.

Future plans
The study aims to use a multiorgan score calculated as the cumulative total for each of nine domains (ie, lung, vascular, heart, kidney, brain, autonomic function, muscle strength, exercise capacity and physical performance). The availability of data preceding acute COVID-19 infection in cohorts may help identify the consequences of infection independent of pre-existing subclinical disease and also provide evidence of determinants that influence the development of long covid.

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Duration of antibiotherapy for patients with diabetic foot osteomyelitis without amputation: a protocol for a systematic review and network meta-analysis

Introduction
Diabetic foot osteomyelitis (DFO) poses a serious threat to the quality of life and survival of patients, and systemic antibiotic therapy is effective and plays a pivotal role in the management of patients with DFO without amputation. However, the optimal duration of systemic antibiotic therapy is not clear. We aim to perform a network meta-analysis (NMA) to assess the efficacy and safety of different durations of antibiotic therapy for patients with DFO without amputation.

Methods and analysis
We will search multiple databases, including the China National Knowledge Infrastructure, VIP database, Wanfang Data, ScienceDirect, EBSCO, EMBASE, Web of Science, Cochrane Library, and PubMed. The outcome indicators are remission rate, time needed for complete wound healing, major amputation rates and the rate of antibiotic-related adverse events. Risk of bias will be evaluated using the Cochrane risk-of-bias tool. NMA will be performed using STATA/MP V.15.0. The surface under the cumulative ranking area will be calculated to rank each treatment.

Ethics and dissemination
This study is a systematic review protocol collecting data from published literature and does not require approval from an institutional review board. Results from this systematic review will be published in a peer-reviewed journal.

PROSPERO registration number
CRD42023486089.

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Development of a taxonomy mapping dental services integration: a scoping review protocol

Introduction
The integration of dental services within the broader healthcare landscape is crucial for achieving integrated healthcare delivery. However, we lack a clear representation of the full spectrum of possible dental service integration, which is necessary for policymakers, healthcare system organisers, researchers, professionals and patients themselves to optimise organisations. Our present research aims to establish the foundation for a taxonomy of dental services that is fully integrated into the health domain, while minimising historical, cultural or epistemological biases.

Methods and analysis
This protocol outlines a scoping review that will adhere to the framework of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. It has also been registered on the Open Science Framework. The research team, including a patient representative, advocate and transdisciplinary researcher, who has been involved from the inception, describes a two-phase dynamic screening process. An initial search will be conducted in the PubMed database using a Boolean search strategy based on theoretical frameworks that view health through a biopsychosocial continuum. New taxa will be progressively identified, and in the second phase, we will develop a new search strategy based on the results obtained and will explore deeper into certain categories or subcategories of taxa. Iterative strategies may also involve using new databases and even grey literature. This process will be repeated until taxon saturation is achieved and will be updated prior to submission to capture the latest literature, ultimately resulting in a comprehensive taxonomy, at the scale of individual healthcare pathways (micro- and meso-levels of organisation).

Ethics and dissemination
This scoping review will analyse published secondary data and does not require ethical review. The findings will be disseminated through publication in scientific journals, presentation at conferences and sharing through professional networks.

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[Articles] Incident cytopenia and risk of subsequent myeloid neoplasm in age-related clonal hematopoiesis: a multi-biobank case-control study

Longitudinal analysis across three large cohorts found that it is rare for patients with CHIP to develop MN without first developing cytopenia. The risk for MN among patients with CHIP resides almost entirely among those with cytopenia. These findings suggest that cytopenia is a critical step in progression from CHIP to MN, underscoring its utility as an endpoint in cancer prevention trials for CHIP patients.

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Protocol for a global menopause priority setting partnership

Introduction
All those born with functioning ovaries will eventually experience menopause, and many will be symptomatic. However, significant gaps in the evidence base for menopause care remain. This National Institute for Health and Care Research James Lind Alliance Menopause Priority Setting Partnership (MAPS) will engage with clinicians and those with lived experience globally to determine the leading priorities for future menopause research.

Methods and analysis
MAPS will follow the established James Lind Alliance methodology which has already resulted in over 100 ‘top 10’ research priorities across health domains. It will be led by a steering group comprised of clinicians and lived experience members. Leveraging the networks of steering group members and partner organisations, the priority setting partnership will identify evidence uncertainties using an online survey. Evidence checking will be undertaken to determine which questions have already been answered. Prioritisation will be done in two stages, initially by online survey and then at a face-to-face workshop.

Ethics and dissemination
Ethical approval was not required. The final top 10 priorities for menopause, as ranked by stakeholders at the final consensus workshop, will be disseminated in the relevant peer-reviewed journals. A final report will be available on the MAPS and James Lind Alliance websites. The leading priorities will inform the future global research agenda for menopause.

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How do programme directors perceive trainee attrition? A qualitative focus group study in three Dutch teaching hospitals

Objective
To gain insight into programme directors’ (PDs’) perceptions of trainee attrition from postgraduate medical education (PGME), focusing on interactions between stakeholders within the learning environment and roles of PDs in the process leading to attrition.

Design, setting and participants
We performed a focus group study with 27 PDs from three Dutch teaching hospitals and analysed transcripts using template analysis.

Results
PDs identified attrition as a multilevel problem, in which personal, workplace and system-bound factors play a role. PDs mentioned balancing professional and personal responsibilities, in particular parenthood and high ambitions, as important trainee-related factors. PDs adopt different, at times conflicting, roles when guiding trainees, for example, assessor and mentor, and they struggle to balance these roles. They displayed various emotions when discussing attrition, varying from disappointment to frustration and anger, yet could also frame attrition positively as new opportunity. PDs used numerous resources to support trainees in difficulty, in a reactive rather than in a pro-active manner. A generation difference between faculty and trainees regarding work-life balance was mentioned as impeding mutual understanding. On the system level, PDs observed how implicit beliefs and negative interactions between actors in the learning environment impede trainees’ well-being.

Conclusions
PDs perceived trainee attrition as a multi-level problem that highlighted conflicting roles for the PD and evoked a wide range of emotions. The authors propose the following interventions: (1) address conflicting roles of PDs by reallocating specific tasks to other independent ‘third parties’, for example, professional coaching; (2) implement pro-active support for trainees unrelated to assessment; (3) create awareness of implicit assumptions of stakeholders and promote social belonging; (4) foster a supportive learning climate with clinical leaders as role models.

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