A think-aloud study on the feasibility of using the ICECAP-SCM in patients with end stage organ failure and the impact of functional decline on capability wellbeing at the end of life.

An ageing population and the rising costs associated with end of life care have led to increased scrutiny of the economic decision-making processes at the end of life. Critics argue that the normative framework that underpins the economic evaluation of health care interventions may be inappropriate for evaluating end of life care interventions. A broader evaluative space, that goes beyond health to capture the wider benefits of end of life interventions may provide a more appropriate basis for evaluating end of life care. One option for operationalising this broader evaluative space is the use of the ICECAP-SCM which is a self-complete tool for evaluating health and wellbeing at the end of life. There is, however, little evidence about its use in patients near the end of life. This thesis reports a PhD study that aimed to determine the feasibility of using the ICECAP-SCM alongside the more traditionally used EQ-5D-5L, and the ICECAP-A in patients with end stage organ failure. The thesis also aims to explore the impact of functional decline on health and broader aspects of wellbeing. This is the first study to investigate how the three tools measure quality of life in end stage organ failure, and explore the impact of decline on wellbeing using the three measures. A systematic review of the literature showed that there is insufficient evidence on the feasibility of using measures suitable for economic decision making in evaluating end of life care interventions. Qualitative methods such as cognitive interviews were useful in providing a better understanding of the way measures were understood and completed by respondents, and issues that can affect their use. The feasibility of using the ICECAP-SCM is explored through think-aloud interviews. Sixty patients with end stage heart failure, end stage renal failure and end stage COPD participated in the research. Interview transcripts were examined for errors in comprehension, retrieval, judgement and response. The constant comparative method was used to analyse qualitative data providing an in-depth insight into measure completion. Qualitative thematic analysis further explored the impact of functional decline on health and capability wellbeing. Error rates were low across all three measures and differences in error rates between the measures were small. The measures were acceptable, clear and easy to complete. The impact of terminal illness on health and capability wellbeing, and the extent to which participants were able to cope and adapt to the effects of their condition varied across the groups. The ICECCAP-SCM is feasible to use with patients with end stage organ failure receiving care in different settings. Future research should consider exploring the feasibility of using the ICECAP-SCM in patients on other dying trajectories such as the frailty trajectory where patients are likely to receive care in nursing homes. The findings provide an opportunity to researchers and policy makers interested in the use of a measure suitable for economic decision making which captures the wider benefits of end of life interventions and services

Use of single pill anti-hypertensive combination medications in Cardiology Clinic of a Tertiary Health Institution in Nigeria

Background: Majority of patients with hypertension require 2 or more medications to provide adequate blood pressure (BP) control. In addition, contemporary guidelines on the management of hypertension favor the use of single-pill combinations (SPCs) as they simplify the treatment regimen and decrease the daily pill burden for patients, both of which are associated with improved adherence. In spite of this, there is a lack of data in sub-Saharan Africa on the frequency of use of SPC anti-hypertensive medications. Method: We prospectively collected detailed clinical data from 373 patients with primary diagnosis of hypertension attending the cardiology clinic of University of Abuja Teaching Hospital between 2016 and 2017. Results: Three hundred and seventy three patients with mean age of 50.6 ± 12.3 years and mean body mass index of 31.2 ± 6.5kg/m2 on anti-hypertensive treatment were evaluated. Baseline mean systolic and diastolic BPs were 161.1 ± 3.1mmHg and 95.4 ± 15.6mmHg respectively, while the mean pulse pressure was 56.6 ± 18.1mmHg. 212 (56.8%) where on SPCs, with 32.5% on angiotensin receptor blockers (ARBs) plus hydrochlorothiazide (HCTZ), 18.9% on angiotensin converting enzyme inhibitors (ACEIs) plus HCTZ, 9.9% on amlodipine (AML) plus ARB, 3.3% on AML plus ACEI, 3.8% on thiazide-like diuretic plus atenolol, 29.2% on HCTZ plus amiloride, and 2.4% on triple combination of AML+ARB+HCTZ. Conclusion: Our study has shown that over 50% of our patients were on SPC anti-hypertensive medications, with the most prescribed single pill combination being angiotensin receptor blocker plus thiazide diuretic

Anti-inflammatory and antioxidant activities of ethylacetate fraction of Sida linifolia L. (Malvaceae)

Sida linifolia L., a known weed found in West Africa and other parts of the world, is being used in African traditional medicine for many purposes, including the relief of uncomfortable teething, and the prevention of malaria. This study aimed to fractionate the crude extract of S. linifolia and determine the anti-inflammatory, and antioxidant properties of the most potent fraction. In the examination of anti-inflammatory compounds, in vitro tests for platelet aggregation, albumin denaturation, protease, and phospholipase A2 were utilized. To assess the in vivo anti-inflammatory effects, rat paw edema was induced with carrageenan and egg albumin. The total antioxidant capacity (TAC), 1,1-diphenyl-2-picrylhydrazyl (DPPH), ferric reducing power (FRAP), and nitric oxide (NO) assays were used in the in vitro antioxidant assessment. The result of the phytochemical screening revealed that there were varying concentrations of terpenoids, saponins, steroids, alkaloids, flavonoids, tannins, and other phenols. The ethylacetate leaf fraction of S. linifolia EALFSL displayed robust, concentration-dependent anti-inflammatory effects by significantly inhibiting hypotonicity-and heat-induced hemolysis, platelet aggregation, protein denaturation, protease activity, and phospholipase A2 activity, which were comparable to those of the reference drugs (aspirin/prednisolone). In vivo studies also revealed that EALFSL was able, at different doses, to inhibit the progress of carrageenan-induced rat paw edema and egg albumin models. Though it was less active than the butylated hydroxytoluene BHT (0.30 mg/ml), ascorbic acid (0.32-0.50 mg/ml), and gallic acid (0.47 mg/ml), the EALFSL fraction's IC50 values ranged from 0.93 to 1.20 mg/ml. The results demonstrated that EALFSL has significant concentration-dependent antioxidant activity. These suggest that the ethylacetate leaf fraction of S. linifolia possesses anti-inflammatory and antioxidant effects

Exploring the relationship between falls, fall‐related psychological concerns, and personality traits in adults : a scoping review protocol

Background and Aims: Personality traits, such as neuroticism and extraversion, are emerging as important predictors of falls. Despite their significance, existing fall prevention programs often overlook these traits, creating a notable research gap. This study aims to conduct a comprehensive scoping review to explore the existing literature on the relationships among personality traits, falls, and fall-related psychological concerns (FrPCs). Methods: This scoping review will adhere to the framework established by Arksey and O'Malley, incorporating extensions recommended by the Joanna Briggs Institute and using the PRISMA-ScR checklist. A thorough search strategy will be employed, aligning with the population, concept, and context (PCC) selection criteria. Electronic databases, including MEDLINE, APA PsycINFO, Web of Science, CINAHL, and SPORTDiscus, will be searched from their inception to the present. Additionally, a manual search of the reference lists of identified and relevant full-text articles will be conducted. Two independent reviewers will screen titles and abstracts, perform full-text reviews, and extract data from pertinent articles. Discussion: Personality traits are increasingly recognized as influential predictors of falls and related psychological concerns. This review aims to make a substantial contribution to the existing literature by being the first to comprehensively explore and provide a descriptive synthesis of the relationship between personality traits and falls, as well as FrPCs in adults. It is hoped that the outcomes of this review will enhance our comprehension of the role of personality traits in falls, potentially informing future research and strategies for this critical area of study. Scoping Review Registration: This scoping review protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/KR74X)

Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study):multicentre randomised controlled trial

OBJECTIVE: To evaluate whether a structured online supervised group physical and mental health rehabilitation programme can improve health related quality of life compared with usual care in adults with post-covid-19 condition (long covid).DESIGN: Pragmatic, multicentre, parallel group, superiority randomised controlled trial.SETTING: England and Wales, with home based interventions delivered remotely online from a single trial hub.PARTICIPANTS: 585 adults (26-86 years) discharged from NHS hospitals at least three months previously after covid-19 and with ongoing physical and/or mental health sequelae (post-covid-19 condition), randomised (1:1.03) to receive the Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) intervention (n=298) or usual care (n=287).INTERVENTIONS: Best practice usual care was a single online session of advice and support with a trained practitioner. The REGAIN intervention was delivered online over eight weeks and consisted of weekly home based, live, supervised, group exercise and psychological support sessions.MAIN OUTCOME MEASURES: The primary outcome was health related quality of life using the patient reported outcomes measurement information system (PROMIS) preference (PROPr) score at three months. Secondary outcomes, measured at three, six, and 12 months, included PROMIS subscores (depression, fatigue, sleep disturbance, pain interference, physical function, social roles/activities, and cognitive function), severity of post-traumatic stress disorder, general health, and adverse events.RESULTS: Between January 2021 and July 2022, 39 697 people were invited to take part in the study and 725 were contacted and eligible. 585 participants were randomised. Mean age was 56 (standard deviation (SD) 12) years, 52% were female participants, mean health related quality of life PROMIS-PROPr score was 0.20 (SD 0.17), and mean time from hospital discharge was 323 (SD 144) days. Compared with usual care, the REGAIN intervention led to improvements in health related quality of life (adjusted mean difference in PROPr score 0.03 (95% confidence interval 0.01 to 0.05), P=0.02) at three months, driven predominantly by greater improvements in the PROMIS subscores for depression (1.39 (0.06 to 2.71), P=0.04), fatigue (2.50 (1.19 to 3.81), P&lt;0.001), and pain interference (1.80 (0.50 to 3.11), P=0.01). Effects were sustained at 12 months (0.03 (0.01 to 0.06), P=0.02). Of 21 serious adverse events, only one was possibly related to the REGAIN intervention. In the intervention group, 141 (47%) participants fully adhered to the programme, 117 (39%) partially adhered, and 40 (13%) did not receive the intervention.CONCLUSIONS: In adults with post-covid-19 condition, an online, home based, supervised, group physical and mental health rehabilitation programme was clinically effective at improving health related quality of life at three and 12 months compared with usual care.TRIAL REGISTRATION: ISRCTN registry ISRCTN11466448.</p

Acute Rehabilitation following traumatic anterior shoulder dISlocAtioN (ARTISAN) : protocol for a multicentre randomised controlled trial

Introduction: First-time traumatic anterior shoulder dislocation (TASD) is predominantly managed non-operatively. People sustaining TASD have ongoing pain, disability and future risk of redislocation. There are no published randomised controlled trials (RCTs) comparing different non-operative rehabilitation strategies to ascertain the optimum clinically effective approach after TASD. Methods and analysis: In this multicentre adaptive RCT, with internal pilot, adults with a radiologically confirmed first time TASD treated non-surgically will be screened at a minimum of 30 sites. People with neurovascular complications, bilateral dislocations or are unable to attend physiotherapy will be excluded. Randomisation will be on a 1:1 treatment allocation, stratified by age, hand dominance and site. Participants will receive a single session of advice; or a single session of advice plus offer of further physiotherapy (maximum 4 months). The primary analysis will be the difference in Oxford Shoulder Instability Score at 6 months. A sample size of a minimum of 478 participants will allow us to show a four point difference with 90% power. An embedded qualitative study will explore the participants’ experiences of the trial interventions. Ethics, registration and dissemination: Funded by NIHR HTA (16/167/56), 1 June 2018; National Research Ethic Committee approved (18/WA/0236), 26 July 2018. First site opened 5 November 2018 and final results will be updated on trial registries and submitted to a peer-reviewed journal and will inform rehabilitation strategies after a TASD. Study Within A Trial (SWAT) funded by MRC (MR/R013748/1), 1 May 2019; registered on the MRC-HTMR All-Ireland Hub (reference number SWAT 121). Trial registration number: ISRCTN63184243. (Trial stage: Pre-results

UK robotic arthroplasty clinical and cost effectiveness randomised controlled trial for hips (RACER-Hip) : a study protocol

Introduction: The number of robotic-assisted hip replacement procedures has expanded globally with the intended aim of improving outcomes. Intraoperative robotic-arm systems add additional costs to total hip replacement (THR) surgery but may improve surgical precision and could contribute to diminished pain and improved function. Additionally, these systems may reduce the need for expensive revision surgery. Surgery with conventional instruments may be just as successful, quick and affordable. There is timely demand for a robust evaluation of this technology. Methods and analysis: The Robotic Arthroplasty Clinical and cost Effectiveness Randomised controlled trial for Hips (RACER-Hip) is a multicentre (minimum of six UK sites), participant–assessor blinded, randomised controlled trial. 378 participants with hip osteoarthritis requiring THR will be randomised (1:1) to receive robotic-assisted THR, or THR using conventional surgical instruments. The primary outcome is the Forgotten Joint Score at 12 months post-randomisation; a patient-reported outcome measure assessing participants’ awareness of their joint when undertaking daily activities. Secondary outcomes will be collected post-operatively (pain, blood loss and opioid usage) and at 3, 6, 12, 24 months, then 5 and 10 years postrandomisation (including function, pain, health-related quality of life, reoperations and satisfaction). Allocation concealment will be accomplished using a computer-based randomisation procedure on the day of surgery. Blinding methods include the use of sham incisions for marker clusters and blinded operation notes. The primary analysis will adhere to the intention-to-treat principle. Results will adhere to Consolidated Standards of Reporting Trials statements. Ethics and dissemination: The trial was approved by an ethics committee (Solihull Research Ethics Committee, 30 June 2021, IRAS: 295831). Participants will provide informed consent before agreeing to participate. Results will be disseminated using peer-reviewed journal publications, presentations at international conferences and through the use of social media. We will develop plans to disseminate to patients and public with our patient partners

Route of drug administration in out-of-hospital cardiac arrest: A protocol for a randomised controlled trial (PARAMEDIC-3)

© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).AIMS: The PARAMEDIC-3 trial evaluates the clinical and cost-effectiveness of an intraosseous first strategy, compared with an intravenous first strategy, for drug administration in adults who have sustained an out-of-hospital cardiac arrest. METHODS: PARAMEDIC-3 is a pragmatic, allocation concealed, open-label, multi-centre, superiority randomised controlled trial. It will recruit 15,000 patients across English and Welsh ambulance services. Adults who have sustained an out-of-hospital cardiac arrest are individually randomised to an intraosseous access first strategy or intravenous access first strategy in a 1:1 ratio through an opaque, sealed envelope system. The randomised allocation determines the route used for the first two attempts at vascular access. Participants are initially enrolled under a deferred consent model.The primary clinical-effectiveness outcome is survival at 30-days. Secondary outcomes include return of spontaneous circulation, neurological functional outcome, and health-related quality of life. Participants are followed-up to six-months following cardiac arrest. The primary health economic outcome is incremental cost per quality-adjusted life year gained. CONCLUSION: The PARAMEDIC-3 trial will provide key information on the clinical and cost-effectiveness of drug route in out-of-hospital cardiac arrest.Trial registration: ISRCTN14223494, registered 16/08/2021, prospectively registered.Peer reviewe

Synthesis, Characterization, Antimicrobial Studies and Corrosion Inhibition Potential of 1,8-dimethyl-1,3,6,8,10,13-hexaazacyclotetradecane: Experimental and Quantum Chemical Studies

The macrocylic ligand, 1,8-dimethyl-1,3,6,8,10,13-hexaazacyclotetradecane (MHACD) was synthesized by the demetallation of its freshly synthesized Ni(II) complex (NiMHACD). Successful synthesis of NiMHACD and the free ligand (MHACD) was confirmed by various characterization techniques, including Fourier transform infra-red (FT-IR), proton nuclear magnetic resonance (1H-NMR), carbon-13 nuclear magnetic resonance (13C-NMR), ultraviolet-visible (UV-vis), and energy dispersive x-ray (EDX) spectroscopic techniques. The anti-bacteria activities of MHACD were investigated against Staphylococcus aureus and Enterococcus species and the results showed that MHACD possesses a spectrum of activity against the two bacteria. The electrochemical cyclic voltammetry study on MHACD revealed that it is a redox active compound with promising catalytic properties in electrochemical applications. The inhibition potential of MHACD for mild steel corrosion in 1 M HCl was investigated using potentiodynamic polarization method. The results showed that MHACD inhibits steel corrosion as a mixed-type inhibitor, and the inhibition efficiency increases with increasing concentration of MHACD. The adsorption of MHACD obeys the Langmuir adsorption isotherm; it is spontaneous and involves competitive physisorption and chemisorption mechanisms. Quantum chemical calculations revealed that the energy of the highest occupied molecular orbital (HOMO) of MHACD is high enough to favor forward donation of charges to the metal during adsorption and corrosion inhibition. Natural bond orbital (NBO) analysis revealed the presence of various orbitals in the MHACD that are capable of donating or accepting electrons under favorable conditions