Catalytic Framework: Intersectional Analysis for Community Engagement

The Community Engagement Centre (CEC) has been active across a range of diverse urban and rural populations throughout Pakistan and works closely with marginalised communities. The collective nature of Pakistani culture and its social inequities has required the CEC to recognize the intersections that shape contexts and situations, to promote local ownership, empower communities to identify and utilize existing resources for sustainable change, and improve health outcomes. Through an immersive community engagement (CE) strategy, CEC utilises participatory tools to collect stories from communities to understand their lived experiences, barriers and enablers to access, and the dynamics of power that influence these. To understand this complex relationship, a Catalytic Framework that examined the intersections within communities’ narratives was developed. Preliminary review of community narratives collected as part of programmatic operations yielded four significant elements: (1) unique, individual circumstances, (2) aspects of identity, (3) types of discrimination (if present), and (4) larger structures that reinforce exclusion (or enforce inclusion). A unique feature identified within the process of CE was the role of ‘catalysts’ – one or many people who may have transformative potential at any of these levels due to their influence, active facilitation, or agency. This novel framework enables an understanding of the threads of experience and identifying the elements and structures that impact lives of Pakistan’s diverse population. It works by recognizing the visible intersections of class, identity, gender, and power, as well as questioning what remains unarticulated, and thus promotes meaningful community engagement across different cultures and fields

Catalytic Framework: Intersectional Analysis for Community Engagement

The Community Engagement Centre (CEC) has been active across a range of diverse urban and rural populations throughout Pakistan and works closely with marginalised communities. The collective nature of Pakistani culture and its social inequities has required the CEC to recognize the intersections that shape contexts and situations, to promote local ownership, empower communities to identify and utilize existing resources for sustainable change, and improve health outcomes. Through an immersive community engagement (CE) strategy, CEC utilises participatory tools to collect stories from communities to understand their lived experiences, barriers and enablers to access, and the dynamics of power that influence these. To understand this complex relationship, a Catalytic Framework that examined the intersections within communities’ narratives was developed. Preliminary review of community narratives collected as part of programmatic operations yielded four significant elements: (1) unique, individual circumstances, (2) aspects of identity, (3) types of discrimination (if present), and (4) larger structures that reinforce exclusion (or enforce inclusion). A unique feature identified within the process of CE was the role of ‘catalysts’ – one or many people who may have transformative potential at any of these levels due to their influence, active facilitation, or agency. This novel framework enables an understanding of the threads of experience and identifying the elements and structures that impact lives of Pakistan’s diverse population. It works by recognizing the visible intersections of class, identity, gender, and power, as well as questioning what remains unarticulated, and thus promotes meaningful community engagement across different cultures and fields

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Jeelo Dobara (Live Life Again): a cross-sectional survey to understand the use of social media and community experience and perceptions around COVID-19 vaccine uptake in three low vaccine uptake districts in Karachi, Pakistan

Objective To gather preliminary insights through formative research on social media usage, and experiences, attitudes and perceptions around COVID-19 and COVID-19 vaccination in three high-risk, underserved districts in Karachi, Pakistan.Design Cross-sectional mixed-method design.Participants 392 adults (361 surveys and 30 in-depth interviews (IDI)) from districts South, East and Korangi in Karachi, Pakistan.Main outcome measures Social media usage and knowledge, perception and behaviour towards COVID-19 infection and vaccination.Results Using social media was associated with an increased probability of getting vaccinated by 1.61 units. Most of the respondents (65%) reported using social media, mainly to watch videos and/or keep in touch with family/friends. 84.76% knew of COVID-19 while 88.37% knew about the COVID-19 vaccination, with 71.19% reported vaccine receipt; reasons to vaccinate included belief that vaccines protect from the virus, and vaccination being mandatory for work. However, only 56.7% of respondents believed they were at risk of disease. Of the 54 unvaccinated individuals, 27.78% did not vaccinate as they did not believe in COVID-19. Despite this, 78.38% of respondents scored high on vaccine confidence. In IDIs, most respondents knew about COVID-19 vaccines: ‘This vaccine will create immunity in your body. Therefore, I think we should get vaccinated’, and over half knew how COVID-19 spreads. Most considered COVID-19 a serious public health problem and thought it important that people get vaccinated. However, there was a low-risk perception of self as only a little over half felt that they were at risk of contracting COVID-19.Conclusion With our conflicting results regarding COVID-19 vaccine confidence, that is, high vaccine coverage but low perception of risk to self, it is likely that vaccine coverage is more a result of mandates and coercion than true vaccine confidence. Our findings imply that interactive social media could be valuable in fostering provaccine sentiment

A global systematic review and meta-analysis on the emerging evidence on risk factors, clinical characteristics, and prognosis of multisystem inflammatory syndrome in adults (MIS-A)

Background: The multisystem inflammatory syndrome in adults (MIS-A) has emerged, similar to those in children associated with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) [multisystem inflammatory syndrome in children (MIS-C)]. This review aimed to analyze the risk factors, clinical course, and prognosis of MIS-A. Methods: A comprehensive literature search was conducted using several databases for cases reporting MIS-A from 1 December 2019 till 9 September 2021. The case definitions used to identify potential cases were those recommended by the World Health Organization, Center for Disease Control, and individual country/physician classification. The meta-analysis was performed using Comprehensive Meta-Analysis (CMA) 2.2.027 and Review Manager (RevMan) 5.4.1, employing 95% confidence intervals (CI). Results: Seventy studies were assessed for full-text eligibility, out of which 37 were included. The mean age of the study population was 32.52±10.29 years. The most common symptoms were fever (89.8%, 95% CI: 77.7-95.7%) and diarrhea (49%, 95% CI: 35.4-62.7%). Ventricular tachycardia (57.1%, 95% CI: 43.1-70.1%) was the most common electro-cardiac abnormality. The most common inflammatory marker was elevated C-reactive protein (89.8%, 95% CI: 77.7-95.7%). Abnormal echocardiogram was the most common imaging test result (commonly, ventricular dysfunction and arrhythmias), while steroids were the most administered treatment. Severe cases had a higher need for vasopressor and inotropic support and antibiotic therapy compared to the non-severe cases. One death was reported due to cardiovascular failure. Conclusion: Our collated findings will help clinicians identify the typical presenting symptoms and optimal management of MIS-A. Further research is required to understand the long-term prognosis and the correlation between coronavirus disease 2019 (COVID-19) and MIS-A to understand its pathogenesis and clinical spectru

Meta-Analysis Comparing Fractional Flow Reserve and Angiography-Guided Complete Revascularization of Nonculprit Artery for ST-Elevation Myocardial Infarction

This study aimed to compare complete revascularization (CR) guided by angiography with a fractional flow reserve (FFR)-guided strategy in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD). CR is preferred to culprit-only revascularization for patients with STEMI and MVD. However, whether FFR-guided CR is superior to angiography-guided CR is unclear in patients presenting with STEMI who have MVD. Randomized controlled trials comparing CR with an FFR- or angiography-guided strategy to culprit-only revascularization in patients with STEMI and MVD were systematically identified. A random-effects network meta-analysis was performed comparing clinical outcomes in the 3 arms. A total of 13 studies with a total of 8,927 patients were included in our analysis. Compared with culprit-only revascularization, angiography-guided CR was associated with a significantly decreased risk of myocardial infarction (MI) (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.37 to 0.82), all-cause death (HR 0.69, 95% CI 0.49 to 0.97), and cardiovascular death (HR 0.54, 95% CI 0.34 to 0.85) but FFR-guided CR was not (MI: HR 0.77, 95% CI 0.53 to 1.12; cardiovascular death: HR 0.89, 95% CI 0.64 to 1.24; all-cause death: HR 0.93, 95% CI 0.72 to 1.18). The network meta-analysis comparison of angiography- versus FFR-guided CR showed an HR of 0.75 (95% CI 0.50 to 1.11) for all-cause death and an HR of 0.71 (95% CI 0.54 to 1.17) for MI. In conclusion, for patients with MVD presenting with STEMI, angiography-guided CR may provide additional benefits compared with FFR-guided CR