Search Results for: ESC 2022: Linea guida sulla cardio-oncologia

Objectives
To map the scope of available evidence on relationships between multimorbidity patterns and functioning among adults in low- and middle-income countries (LMICs), and describe methods used.

Design
Scoping review guided by a five-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines.

Data sources
PubMed/MEDLINE, Scopus, EBSCOhost (CINAHL) and Cochrane databases were searched from January 1976 to March 2023, plus reference lists of included studies.

Eligibility criteria for selecting studies
Peer-reviewed full-text articles or conference proceedings of any design, published in English or Afrikaans, involving adults ( >18 years) with multimorbidity living in LMICs. Studies had to refer to associations between multimorbid patterns of co-occurrence and functioning. Multimorbidity was defined as the coexistence of ≥2 diseases, including any combination of non-communicable, infectious and mental health conditions.

Data extraction and synthesis
Data were extracted independently by two reviewers using a piloted form. Findings were synthesised according to methodological approaches, multimorbidity-pattern epidemiology, evidence gaps/limitations and recommendations for future research. The International Classification of Functioning, Disability and Health framework was used to classify functional problems.

Results
Nine studies (total sample size: 62 003) were included, mainly from upper-middle-income Asian countries. Key methodological inconsistencies were identified in defining and operationalising multimorbidity, conditions included in determining patterns, statistical methods for pattern determination and functioning outcome measures. Five main multimorbidity pattern domains emerged: Cardio-Metabolic and Coronary Atherosclerotic, Musculoskeletal, Respiratory and Digestive/Visceral, Degenerative, and Mental Health-Related. Mobility limitations, instrumental activities of daily living, self-care and bowel/bladder problems were consistently linked to all pattern domains.

Conclusions
The limited and geographically skewed body of literature, along with methodological inconsistencies, hampers a comprehensive understanding of multimorbidity patterns and associations with functioning in LMICs. Future research should explore context-specific multimorbidity definitions, employ transparent methodologies, use standardised measures and incorporate diverse samples to inform tailored interventions and policies.

Science and medicine are dynamic, evolving areas of study and practice. Scientific journal publications reflect the rapidly shifting knowledge and paradigms set by the scientific community. This community produces and consumes journal content, impacted by multidimensional current and historical contexts. The paradigm-shifting events of 2020 amplified awareness and demand for scientific journals to more fully reflect the intersection of science, medicine, and health equity. From this demand came the inspiration to develop the Diversity, Equity, and Inclusion (DEI) Section in Gastroenterology in January 2022, and, soon after, a parallel DEI section in Clinical Gastroenterology and Hepatology (CGH) in July 2022, within the framework of the American Gastroenterological Association (AGA) Equity Project.

Objectives
Kangaroo mother care (KMC) is high impact for survival of low birth weight neonates, but there are few rigorous evaluations of duration required for impact. We conducted a scoping review of KMC duration measurement methods and assessed their validation.

Design
Scoping review in accordance with Joanna Briggs Institute guidance for conducting scoping review.

Data sources
MEDLINE, Embase, Cochrane Library, PsycINFO, African Index Medicus, Latin American and Caribbean Health Sciences Literature, ClinicalTrials.gov, International Clinical Trials Registry Platform, International Standard Randomised Controlled Trial Number Registry, Medrxiv and OpenGrey were searched through November 2022.

Eligibility criteria for selecting studies
Publications with primary data on KMC duration were included. We excluded short procedural skin-to-skin care studies.

Data extraction and synthesis
Selection and data abstraction were conducted by two independent reviewers. A data charting form based on the variables of interest was used to abstract data.

Results
A total of 213 publications were included, of which 54 (25%) documented a method of measuring KMC duration. Only 20 publications (9%) provided a detailed description of the duration measurement method, and none reported validity. Most studies used caregiver reports (29, 54%) or healthcare worker observations (17, 31%). Other methods included independent observers and electronic monitoring devices.

Conclusion
Only 9% of KMC studies reporting duration documented the measurement method applied, and no studies were found with documented validation of duration measurement methods. Accurate and comparable data on the dose response of KMC will require duration measurement methods to be validated against a gold standard such as an independent observer.

Introduction
Propofol is a fast-acting intravenous anaesthetic widely used for sedation and anaesthesia in gastrointestinal endoscopy, bronchoscopy, and the induction/maintenance of general anaesthesia in outpatients and inpatients; however, propofol has several undesirable effects, including injection pain, which affects the physical and mental health of patients, and cardiopulmonary depression, characterised by hypotension, bradycardia and apnea, which commonly occur in clinical practice. Ciprofol (HSK3486) is a propofol analogue with good clinical safety, high potency and some advantages over propofol, including lower injection pain and haemodynamic depression in patients undergoing gastroscopy and colonoscopy. This study aims to compare the impact of equivalent effective doses of propofol and ciprofol on haemodynamic changes in patients undergoing bronchoscopy under general anaesthesia.

Methods
This prospective, double-blind, randomised, controlled clinical trial will recruit 250 patients aged 18–80 years scheduled for elective bronchoscopy under general anaesthesia. The cohort will be randomised into two groups in a 1:1 ratio: propofol (200 mg/20 mL of saline) and ciprofol (40 mg/20 mL of saline). The primary outcomes are changes in heart rate and blood pressure before and after induction, laryngeal mask airway (LMA) placement and bronchoscopy placement. The secondary outcomes are the incidence of choking and injection pain, the type and dose of vasoactive drugs used during the operation, and the level of postoperative satisfaction among surgeons, anaesthesiologists and patients.

Ethics and dissemination
This trial was approved by the Medical Ethics Committee of Shanghai Fourth People’s Hospital, School of Medicine, Tongji University and registered with the Chinese Clinical Trials Registry (Identifier: ChiCTR2200063048) on 29 August 2022. The findings of this study will be disseminated through various channels. Academic dissemination will include publication in peer-reviewed journals and presentations at national and international conferences.

Trial registration number
ChiCTR2200063048.

Objectives
COVID-19, a public health emergency affecting the world in 2019, not only greatly promoted the development and application of vaccines but also effectively shortened the publishing time of scientific papers. In view of these facts, the current situation, status, problems and development trends of vaccine research and application were explored through bibliometric analysis of highly cited papers in the vaccine field within the time frame of 2014–2024, and the countries, institutions, authors, funding agencies and other relevant information that contributed most to vaccine research and application were summarised.

Design
Bibliometric analysis through data analysis and visual mapping.

Data sources
Scientific articles.

Data extraction and synthesis
‘Vaccine’ and ‘vaccines’ were used in the WoS database to retrieve the publications and to adequately collect the data; Microsoft Excel was used for data analysis; and VOSviewer was used for visual description of data. Overall publication trends, countries, institutions and funding agencies, authors and articles, journals and languages, and research areas and co-occurrence keywords were analysed by bibliometrics.

Results
A total of 3258 highly cited papers were published in the field of vaccines in the past decade, from 735 different journals. With the COVID-19 pandemic in 2019, the number of highly cited papers in the field of vaccine research increased significantly from 2020 to 2024, accounting for 76.12%. The number of highly cited papers for vaccines peaked in 2021 and 2022, followed by a rapid decline. Highly cited papers came from 7133 institutions in 153 countries, and the most influential country in the field of vaccines was the USA, which published 1733 highly cited papers, accounting for 53.19% of the highly cited papers. The top 15 institutions with the largest influence were all from the USA or UK with 2567 published papers in total, accounting for 78.79% of highly cited papers. 4787 funding agencies were recognised in funding 2368 highly cited papers. A total of 30 926 authors in 90 research areas contributed significantly to global vaccine research. The most highly cited paper was ‘Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine’ from the New England Journal of Medicine, which was cited 9435 times in total. Among the 9848 co-occurrence keywords, COVID-19 (including SARS-CoV-2, 2019-COVID and SARS2) was the most frequently co-occurrence keyword. It appeared in 1720 articles, accounting for 52.79%, indicating that COVID-19 was the most popular study in the last decade.

Conclusions
This study visualised the research and application of vaccines in the world from the perspective of papers output, drew the knowledge map and identified the important research hotspots and development trends in the vaccine field in the recent 10 years (2014–2024), which is helpful for Centres for Disease Control and Prevention, clinicians, researchers and health policymakers to better understand the research status and problems in vaccine research and application and predict its future development direction.

Objectives
Health research that significantly impacts global clinical practice and policy is often published in high-impact factor (IF) medical journals. These outlets play a pivotal role in the worldwide dissemination of novel medical knowledge. However, researchers identifying as women and those affiliated with institutions in low- and middle-income countries (LMICs) have been largely under-represented in high-IF journals across multiple fields of medicine. To evaluate disparities in gender and geographical representation among authors who have published in any of five top general medical journals, we conducted scientometric analyses using a large-scale dataset extracted from the New England Journal of Medicine, Journal of the American Medical Association, The BMJ, The Lancet and Nature Medicine.

Methods
Author metadata from all articles published in the selected journals between 2007 and 2022 were collected using the DimensionsAI platform. The Genderize.io Application Programming Interface was then used to infer each author’s likely gender based on their extracted first name. The World Bank country classification was used to map countries associated with researcher affiliations to the LMIC or the high-income country (HIC) category. We characterised the overall gender and country income category representation across the five medical journals. In addition, we computed article-level diversity metrics and contrasted their distributions across the journals.

Results
We studied 151 536 authors across 49 764 articles published in five top medical journals, over a period spanning 15 years. On average, approximately one-third (33.1%) of the authors of a given paper were inferred to be women; this result was consistent across the journals we studied. Further, 86.6% of the teams were exclusively composed of HIC authors; in contrast, only 3.9% were exclusively composed of LMIC authors. The probability of serving as the first or last author was significantly higher if the author was inferred to be a man (18.1% vs 16.8%, p

Objectives
The purpose of our research was to understand intersections between health, spirituality and well-being in the Métis Nation of Alberta (MNA) Region 3.

Design
This Métis-guided, community-based, participatory research builds on our previous patient-oriented community-based study where we co-developed a qualitative structured survey with leaders, Elders and community members to explore health, spirituality and well-being in the MNA Region 3.

Setting
Métis people are affected by historical and contemporary impacts of colonisation. This includes the residential school experience, impacting how Métis people relate to themselves, to others and to their culture. Alberta has the highest Métis population in Canada, and our research is based in the most densely populated region.

Participants
101 surveys were completed between September and November 2021, via Qualtrics. Twenty-five participants who completed surveys participated in community-based participatory research sharing circle data analysis groups in January 2022, via Zoom.

Results
Six overarching themes were developed in our participatory data analysis: (1) searching, (2) interconnectedness, (3) colonisation and systems, (4) traditional practices and teachings, (5) spiritual and religious practices and (6) relationship with Métis identity.

Conclusions
We discovered multiple intersections between health, spirituality and well-being within the MNA Region 3. Our results indicate that the impacts of colonisation for Métis people are poorly understood. More research is needed to understand the ongoing impacts of colonisation, including increased understanding about Métis identity, health, spirituality, religion and well-being. In particular, more research is needed about the effects of intergenerational trauma in the broader MNA, and across Canada.

Objective
The purpose of this study was to analyse the heterogeneity of health information-seeking behaviour (HISB) among patients with type 2 diabetes (T2D) in rural areas based on latent profiles and to explore the relationship between various behaviours and glycaemic control rates and the factors influencing glycaemic control rates.

Methods
Between January and July 2022, a stratified cluster random sampling method was used to sample T2D patients in the rural Guangxi Zhuang Autonomous Region. Participants completed a general information questionnaire and a HISB scale. Latent profile analysis (LPA) identified behaviour categories, and 2 tests examined differences in glycaemic control rates across these categories. Multivariate logistic regression was used to analyse factors influencing glycaemic control. The glycaemic control rate was defined as the proportion of individuals whose HbA1c levels are less than 7.0%, indicating good control, in relation to the total number of individuals assessed.

Results
A total of 2178 valid questionnaires were received in this study, and respondents were divided into three categories according to the LPA of their HISB: negative (18.3%), occlusive (46.8%) and inefficient (34.9%). The glycaemic control rate of patients with T2D in rural areas was 22.6% (494/2178 cases). Multivariate logistic regression analysis revealed that the category of patients’ HISB profile, age, course of disease and educational level were the factors influencing the glycaemic control rate (all p

Objective
To assess the acceptance of multiple micronutrient supplements and current iron and folic acid supplement utilisation among pregnant and lactating women in rural Ethiopia.

Design
Community-based cross-sectional study using a mixed method.

Setting
This study was carried out in five regions (Oromia, Gambela, Sidama, SNNPR (Southern Nations, Nationalities and Peoples Region) and Somali) of Ethiopia, 2022. A multistage random sampling technique was employed. A structured questionnaire was used to collect data from 410 pregnant and lactating women. A purposive sampling technique was used to select participants for the five Focused Group Discussions and fifteen Key Informant Interviews. Both bivariable and multivariable logistic regression analysis was conducted with a p value

Objective
To understand how area deprivation inequalities in COVID-19 mortality changed during the national vaccination programme in England and to identify the extent to which these inequalities might be explained by unequal vaccination uptake.

Design
Ecological study.

Setting
307 Lower Tier Local Authorities in England, March 2020 – December 2022.

Main outcome measure
Inequality in age-standardised mortality rates 28 days after a positive COVID-19 test by area-level deprivation from March 2020 to December 2022. We employ three different measures of this inequality: the disparity index, the concentration and generalised concentration index, and absolute and relative measures of inequality. We use the 2019 edition of the Index of Multiple Deprivation, transformed into quintiles.

Results
Relative inequalities in age-standardised mortality rates 28 days after a positive COVID-19 test reduced substantially (from around 6.9 times higher in most deprived to least deprived to 1.2 times higher) in the 25 months after the national vaccination rollout began. Vaccination uptake between the most and least deprived quintiles widened with each dose. Inequalities in cumulative mortality rates developed quickly, and while they stabilised and reduced, they did not disappear. We estimate that if vaccination rates in the most deprived areas had been the same as those in the least deprived, absolute disparity inequality would have been reduced from 118.9 per 100 000 (95% CI 117.0 to 120.7) to 40.2 (95% CI 3.7 to 76.7) at the end of 2022.

Conclusions
National COVID-19 vaccination strategies offer the potential to significantly reduce inequalities in COVID-19 mortality rates. However, more could be achieved if barriers to vaccination uptake in the most deprived areas are overcome.

Objectives
Prehospital notifications (pre-alerts) enable emergency department (ED) staff to prepare for the arrival of patients requiring a time-critical response. Effective communication of the pre-alert is key to enabling the ED to prepare appropriately, but evidence on communication practices is lacking. We undertook qualitative research to understand how pre-alert communication may be improved to optimise the ED response for pre-alerted patients.

Design, setting and participants
Data collection took place within three UK Ambulance Services and six EDs between August 2022 and April 2023. We undertook semi-structured interviews with 34 ambulance and 40 ED staff and 156 hours non-participation observation of pre-alert practice (143 pre-alerts). Verbatim interview transcripts and observation notes were imported into NVivo and analysed using a thematic approach.

Results
We identified significant variation in how pre-alerts were communicated that influenced how effectively information was transferred. Ambulance and ED staff demonstrated a shared recognition that pre-alerts need to be communicated concisely, but both received minimal training in how to give and receive pre-alerts. Efficient pre-alerting was influenced by clinician experience and seniority. ED and ambulance clinicians following different information-sharing formats sometimes led to interruptions, information loss and tensions, particularly when an early ‘headline’ clinical concern had not been shared. Ambulance clinicians sometimes questioned the appropriateness of their pre-alert when ED clinicians did not explain the rationale for not giving the expected response (that is, being accepted into a high-priority area of the ED). Additional sources of frustration included technological problems and poor communication of estimated time of arrival and caller/responder identities.

Conclusions
Use of a shared format, including a headline ‘cause for concern’, may improve the clarity, usefulness and civility of pre-alerts, particularly when the clinician’s concern is not obvious from observations. Basic training on how to undertake pre-alerts for both ED and ambulance clinicians may improve understanding of the importance of pre-alert communication.

Trial registration number
ISRCTN12652860.

Background
The patient safety climate in community pharmacies was measured nationally in Sweden in 2008. Since that time the Swedish pharmacy market has undergone a re-regulation which probably has affected the patient safety climate in pharmacies.

Objectives
The aim was to evaluate the patient safety climate among pharmacists working in Swedish community pharmacies and compare it with historical data.

Design
The patient safety climate among pharmacists was analysed in two cross-sectional surveys. Historical data from 2008 and data collected in 2022 were compared. The Safety Attitudes Questionnaire (SAQ), containing items on safety culture arranged in six dimensions, was used in both surveys. It uses a 5-point Likert scale to create a quantitative description of the respondents’ perception of patient safety climate.

Setting
Community pharmacies in Sweden.

Participants
These surveys were census studies because all pharmacists working in community pharmacies in Sweden were invited to participate and no sampling occurred.

Results
The number of respondents was 2738 in 2008 and 1931 in 2022. The patient safety climate in Swedish community pharmacies appears to have worsened between 2008 and 2022 according to the pharmacists. All values of the dimensions included in the SAQ have decreased, except for the dimension of Stress Recognition, where an increase indicated a larger awareness among the pharmacists of how stress impacts their work. The overall negative trend in SAQ values seen between 2008 and 2022 was consistent, irrespective of the respondent’s level of education, their role in the pharmacy or the number of years since their education was completed.

Conclusions
The patient safety climate in community pharmacies in Sweden seems to have deteriorated. With an increasingly strained healthcare system, community pharmacists must be reliable defenders of patient safety, and it is essential to ensure that the climate in their workplace supports the important work being carried out.

Objective
This paper examines the outcomes of the public sector capacity strengthening (PSCS) approach and how they contribute to the promotion of maternal, newborn, and child health, and nutrition (MNCH+N), family planning (FP) and malaria prevention-related outcomes.

Design
The qualitative study implemented from July to August of 2022 used the outcome harvesting methodology and key informant interviews to elicit information including most significant change (MSC) stories to evaluate project outcomes over 5 years (2017–2022).

Setting
The study was conducted in Sokoto, Kebbi, Nasarawa, Bauchi and Ebonyi states of Nigeria.

Participants
The study focused on public sector stakeholders who were exposed to the PSCS intervention and were selected from government agencies. Nine study participants were engaged per state, bringing the total number of participants to 45. Data were analysed thematically and elicited MSC stories were analysed for content.

Results
The PSCS approach empowered stakeholders at the individual level to disseminate MNCH+N, FP and malaria prevention messages, monitor health and social and behaviour (SBC) activities and increase the demand for health services. At the organisational level, the approach facilitated coordination of SBC activities, enabled training cascades and promoted adherence to health service guidelines. At the system level, it strengthened ward development committees to address health challenges. Challenges hindering stakeholders’ application of PSCS-acquired skills include inadequate workforce, negative attitudes of health workers, funding constraints, cultural barriers, lack of government ownership and limited accessibility.

Conclusions
This study shows that the PSCS approach is an effective model to scale up capacity for SBC in MNCH+N, FP and malaria prevention programmes. In response to documented supply-side challenges impeding the application of gained knowledge and skill, we recommend inclusive health worker recruitment, sensitisation programmes for health workers, government ownership, improved security, healthcare infrastructure and transportation systems.

Objectives
To explore care home managers’ views and experiences of optimising medicines use for residents with dementia during the COVID-19 pandemic.

Design, setting and participants
A descriptive exploratory qualitative study using semistructured interviews (conducted via telephone or online videoconferencing platform), with care home managers across Northern Ireland, purposively sampled from care homes that provided care for residents with dementia. Care home managers were asked to describe their experiences of accessing primary healthcare services (such as those provided by general practitioners and community pharmacists), how medicines use by residents with dementia was affected by the pandemic, and what they had learnt from their experiences. Data were analysed using inductive thematic analysis.

Results
Fourteen interviews were conducted between January and July 2022. Four themes, ‘isolation’, ‘burden’, ‘disruption’ and ‘connection and communication’, were identified; isolation was a cross-cutting theme that permeated the other themes. Care home managers described feeling isolated from healthcare professionals, healthcare services and residents’ family members. This isolation placed additional burden on care home staff and residents with dementia by increasing staff workload and negatively affecting residents’ well-being. Participants reported that disruption to primary healthcare service provision, particularly services provided by general practices, had significant impact on residents with dementia. Participants described a lack of face-to-face contact with healthcare professionals, and medication reviews often ceased to take place. The connection and communication between key stakeholders were perceived to be important when optimising medicines for residents with dementia.

Conclusions
This study has highlighted the challenges and initial impact of the COVID-19 pandemic on medicines optimisation for care home residents with dementia, which was characterised by isolation. Further research is needed to determine the extent of the long-term impact of the COVID-19 pandemic on this resident population. In future public health crises, better communication is needed between healthcare professionals and care homes.

Objectives
The study aims to explore the workplace learning experiences of medical faculty in critical care specialties at a university hospital, focusing on how they develop their professional identity and construct the meaning of their work.

Design
Qualitative, phenomenological study.

Setting
The current study was conducted at a university hospital in South Korea between November 2022 and October 2023.

Participants
Five faculty members (two males and three females) from critical care specialties (eg, emergency medicine) with over 15 years of experience, each having served as faculty at a university hospital for more than 5 years.

Results
Six key themes emerged: cultivating ‘doctor-ishness’ in the realm of critical care, beacon of inner drive: guiding professional growth, nexus for leveraging expertise and fostering professional growth, the challenging reality of becoming an ‘ideal’ faculty, the shifting tides of the medical profession’s role and weaving workplace learning into a unique rhythm of practice. These themes collectively highlight that faculty members’ workplace learning involves a transition from functional professionals to reflective practitioners.

Conclusions
Workplace learning of faculty members with critical care specialties is understood as an ongoing, context-dependent and individualised process in which emotions play a crucial role in determining the depth and significance of learning and shaping professional identities. This study highlights their capacity for agency and potential, offering a perspective beyond previous research that has primarily focused on their hardships. By shedding light on their workplace learning from an insider’s view and underscoring the need to support professional development in these high-stakes fields, our findings suggest theoretical and practical interventions to foster the mutual growth of faculty and hospital organisations.

Objectives
While Colombians gained broad legal access to abortion in 2022, people still lack knowledge about its availability and face variable quality of care at health facilities. This study sought to understand whether online sellers provide the instructions and medication dosages necessary for effective medication abortions.

Design
The study design involved mystery clients contacting sellers identified across websites and social media platforms (Facebook, Instagram, and TikTok) to purchase abortion pills. Unique sellers were contacted with two profiles (first and second trimester pregnancy gestational ages). Mystery clients documented information received on physical effects, complications and how to take the pills from the sellers in a predesigned survey in SurveyCTO.

Setting
The study was conducted in Colombia from July to September 2023. We documented and described sellers’ conversations with mystery clients and pills received. We identified 161 sellers across platforms, which resulted in 65 unique sellers after deduplication. We attempted to contact each unique seller twice.

Results
Almost all sellers screened for gestational age using last menstrual period. Bleeding (84.6%) and cramping (66.7%) were the physical effects most commonly mentioned to mystery clients, although pain was mentioned to second trimester clients more often than first (40.5% vs 22.0%). Less than 17% of sellers highlighted possible complications that could require medical attention. Almost 90% of purchases were received (88.9%). All contained manufacturer-branded misoprostol and 77.5% were undamaged aluminium blister packages. While 82.6% of first trimester clients were instructed to take an initial misoprostol dosage in line with Colombia’s Ministry of Health guidelines, all second trimester clients were told to take a dosage exceeding the recommended amount. Although most sellers provided appropriate information on administration routes for the pills, sellers also provided contradictory and unnecessary instructions.

Conclusion
Online sellers of abortion pills may persist even as legal abortion becomes more widely available in Colombia. While misoprostol was received from many of these sellers, they did not provide sufficient information about potential complications or accurate dosing instructions to second trimester clients. Accurate medication abortion information specific to Colombia should be made more accessible so that people can more easily navigate the new care landscape.