Responses to "Bio-optimized Curcuma longa extract is efficient on knee osteoarthritis pain: a double-blind multicenter randomized placebo controlled three-arm study": authors' reply

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Triage for out-of-hours primary care calls: a reliability study of a new French-language algorithm, the SALOMON rule

Introduction: Triage systems for out-of-hours primary care physician (PCP) calls have been implemented empirically but no triage algorithm has been validated to date. A triage algorithm named SALOMON (Système Algorithmique Liégeois d’Orientation pour la Médecine Omnipraticienne Nocturne) was developed to guide triage nurses. This study assessed the performance of the algorithm using simulated PCP calls. Methods: Ten nurses were involved in 130 simulated PCP call scenarios, allowing the determination of SALOMON’s inter-rater agreement by comparing the actual choices of a specific triage flowchart and the level of care selected as compared with reference assignments. Intra-rater agreement was estimated by comparing triage after training (T1) and 3 to 6 months after SALOMON use in clinical practice (T2). Results: Overall selection of flowcharts was accurate for 94 .1% of scenarios at T1 and 98.7% at T2. Level of triage was adequate for 93.4% of scenarios at T1 and 98.5% at T2. Both flowchart and triage level accuracy improved significantly from T1 to T2 (p < 0.0001). SALOMON algorithm use is associated with a 0.97/0.99 sensitivity and 0.97/0.99 specificity, at T1/T2 respectively. Conclusions: Results revealed that using the SALOMON algorithm is valid for out-of-hours PCP calls triage by nurses. The criterion validity of this algorithm should be further evaluated through its implementation in a real life setting

Civilian deaths from weapons used in the Syrian conflict

Article introduction: What started as a peaceful uprising in Syria in March 2011 escalated quickly to an armed conflict. By 2012 conflict had become the leading cause of death of Syrians. Health systems have been reshaped, now being separated into areas controlled by the government, the opposition, or self proclaimed Islamic State factions—we group the last two as non-state armed groups (NSAG; fig 1). These areas differ vastly in terms of service delivery capacity, number of trained staff, and accessto essential medicines. Indirect conflict related deaths have arisen from poor sanitation and severe disruption to Syria’s healthcare system. In December 2014, 20% of Syria’s public hospitals were completely non-functional, and another 35% provided only partial services. Direct conflict related deaths are those that are caused by weapons and other violent methods used in warfare. In this article we assess the direct conflict related deaths (hereafter termed violent deaths) of women and children among civilians killed in the Syrian conflict, because they are identified as vulnerable populations in public health and under specific laws of war such as the Geneva Conventions

COVID-19 and quality of care in Belgian general practices compared to 36 other European countries : results from the international cross-sectional PRICOV-19 study

Background: COVID-19 confronted general practices with unprecedented challenges to provide high-quality care. This paper aims to: (1) assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) study differences between the three Belgian regions; and (3) benchmark the performance of Belgian practices against the performance in other European countries. Methods: Data were collected in 2020–2021 using a self-administered survey in 479 Belgian practices. Thirty-four survey questions were selected as outcome variables. The adjusted logistic regression models included four practice characteristics as covariates: practice type, being a teaching practice, multidisciplinarity, and payment system. Benchmarking against the performance in 36 other participating European countries was done for each outcome variable. Results: 77.6% of Belgian practices reported incidents related to timely care. Limitations to the practice building or infrastructure threatened high-quality care in 55.6% of the practices. 57.2% always used a cleaning protocol, 38.5% provided sufficient time to disinfect between consultations, or a separate doctor bag for infection-related home visits (27.9%). Most (54.8%) Belgian practices actively reached out to vulnerable patients. Many significant differences between the Belgian regions disappeared when adjusting for practice characteristics. Belgium ranked relatively high on the European level for most outcome variables on safety and effectiveness. Regarding person-centeredness, equity, and efficiency, a scattered pattern was found. Regarding timely care, Belgium ranked in the lowest quarter of European countries. Conclusion: Future studies using different design methods are crucial to gain in-depth insights into the underlying mechanisms of ensuring high-quality care

Characteristics of primary care practices associated with patient education during COVID-19 : results of the PRICOV-19 cross-sectional study in 38 countries

Background During the COVID-19 pandemic, prevention was at the heart of the management of the health crisis with an important component related to citizen health education and therapeutic education for both the covid infected patient and the patient at risk. Primary care practices (PCPs) played a crucial role in these educational activities. Questions / Objectives This paper aims to explore which PCP configurations enabled responsiveness to the patient education component during the COVID-19 pandemic. Methods A "Patient Education - PE" score was created based on responses to six self-reported questionnaire items, such as staff involvement in providing information to patients by telephone. These were compiled by PRICOV, a multi-country cross-sectional study in Europe and Israel. A linear mixed model (LMM) analysis was performed with continuous PE score and PCP characteristics with 3638 respondents. Results The mean PE score was 2.55 (SD. 0.68) with a maximum of 4 and varies suite widely between countries. Among all PCP characteristics, the following factors significantly (p < 0.05) increasing the PE score are main payment system (with a capitation payment system or another system compared to the fee for service), perception of the same or above average PCP with patients with chronic conditions and perception of adequate government support. Conclusion The results highlight some levers that will overcome some barriers and enable the development of the educational approach appropriate to primary care; the model presented is still incomplete and requires further investigation to identify additional configuration elements favorable to educational activities

Civil war and death in Yemen: Analysis of SMART survey and ACLED data, 2012–2019

Conflict in Yemen has displaced millions and destroyed health infrastructure, resulting in the world’s largest humanitarian disaster. The objective of this paper is to examine mortality in Yemen to determine whether it has increased significantly since the conflict began in 2015 compared to the preceding period. We analysed 91 household surveys using the Standardized Monitoring and Assessment of Relief and Transitions methodology, covering 2,864 clusters undertaken from 2012–2019, and deaths from Armed Conflict Location & Event Data Project database covering the conflict period 2015–2019. We used a Poisson-Gamma model to estimate pre-conflict (μp, baseline value) and conflict period (μc) mean death rates using household survey data from 2012–2019. To analyse changes in the distribution of deaths and estimate nationwide excess deaths, we applied pre- and post-conflict death rates to total population numbers. Further, we tested for association between excess death and security levels by governorate. The national estimated crude death rate/10,000 in the conflict period was 0.20 (95% CI: 0.17, 0.24), which is meaningfully higher than the estimated baseline rate of 0.19 (95% CI: 0.17, 0.22). Applying the conflict period rate to the Yemeni population, we estimated 168,212 excess deaths that occurred between 2015 and 2019. There was an 17.8% increase in overall deaths above the baseline during the conflict period. A large share (67.2%) of the excess deaths were due to combat-related violence. At the governorate level, posterior crude death rate varied across the country, ranging from 0.03 to 0.63 per 10,000 per day. Hajjah, Ibb, and Al Jawf governorates presented the highest total excess deaths. Insecurity level was not statistically associated with excess deaths. The health situation in Yemen was poor before the crisis in 2015. During the conflict, intentional violence from air and ground strikes were responsible for more deaths than indirect or non-violent causes. The provision of humanitarian aid by foreign agencies may have helped contain increases in indirect deaths from the conflict

Joint data analysis in nutritional epidemiology: identification of observational studies and minimal requirements

Background: Joint data analysis from multiple nutrition studies may improve the ability to answer complex questions regarding the role of nutritional status and diet in health and disease. Objective: The objective was to identify nutritional observational studies from partners participating in the European Nutritional Phenotype Assessment and Data Sharing Initiative (ENPADASI) Consortium, as well asminimal requirements for joint data analysis. Methods: A predefined template containing information on study design, exposure measurements (dietary intake, alcohol and tobacco consumption, physical activity, sedentary behavior, anthropometric measures, and sociodemographic and health status), main health-related outcomes, and laboratory measurements (traditional and omics biomarkers) was developed and circulated to those European research groups participating in the ENPADASI under the strategic research area of "diet-related chronic diseases." Information about raw data disposition and metadata sharing was requested. A set of minimal requirements was abstracted from the gathered information. Results: Studies (12 cohort, 12 cross-sectional, and 2 case-control) were identified. Two studies recruited children only and the rest recruited adults. All studies included dietary intake data. Twenty studies collected blood samples. Data on traditional biomarkers were available for 20 studies, of which 17 measured lipoproteins, glucose, and insulin and 13 measured inflammatory biomarkers. Metabolomics, proteomics, and genomics or transcriptomics data were available in 5, 3, and 12 studies, respectively. Although the study authors were willing to share metadata, most refused, were hesitant, or had legal or ethical issues related to sharing raw data. Forty-one descriptors of minimal requirements for the study data were identified to facilitate data integration. Conclusions: Combining study data sets will enable sufficiently powered, refined investigations to increase the knowledge and understanding of the relation between food, nutrition, and human health. Furthermore, t he minimal requirements for study data may encourage more efficient secondary usage of existing data and provide sufficient information for researchers to draft future multicenter research proposals in nutrition

Convalescent plasma for Covid-19-induced ARDS in mechanically ventilated patients

Abstract: BackgroundPassive immunization with plasma collected from convalescent patients has been regularly used to treat coronavirus disease 2019 (Covid-19). Minimal data are available regarding the use of convalescent plasma in patients with Covid-19-induced acute respiratory distress syndrome (ARDS).MethodsIn this open-label trial, we randomly assigned adult patients with Covid-19-induced ARDS who had been receiving invasive mechanical ventilation for less than 5 days in a 1:1 ratio to receive either convalescent plasma with a neutralizing antibody titer of at least 1:320 or standard care alone. Randomization was stratified according to the time from tracheal intubation to inclusion. The primary outcome was death by day 28.ResultsA total of 475 patients underwent randomization from September 2020 through March 2022. Overall, 237 patients were assigned to receive convalescent plasma and 238 to receive standard care. Owing to a shortage of convalescent plasma, a neutralizing antibody titer of 1:160 was administered to 17.7% of the patients in the convalescent-plasma group. Glucocorticoids were administered to 466 patients (98.1%). At day 28, mortality was 35.4% in the convalescent-plasma group and 45.0% in the standard-care group (P=0.03). In a prespecified analysis, this effect was observed mainly in patients who underwent randomization 48 hours or less after the initiation of invasive mechanical ventilation. Serious adverse events did not differ substantially between the two groups.ConclusionsThe administration of plasma collected from convalescent donors with a neutralizing antibody titer of at least 1:160 to patients with Covid-19-induced ARDS within 5 days after the initiation of invasive mechanical ventilation significantly reduced mortality at day 28. This effect was mainly observed in patients who underwent randomization 48 hours or less after ventilation initiation. (Funded by the Belgian Health Care Knowledge Center; ClinicalTrials.gov number, NCT04558476.) In this open-label, randomized trial in patients newly receiving mechanical ventilatory support for Covid-19-associated ARDS, those who received convalescent plasma had lower 28-day mortality than those who received standard care