Test-Retest Reliability and Physiological Responses Associated with the Steep Ramp Anaerobic Test in Patients with COPD

The Steep Ramp Anaerobic Test (SRAT) was developed as a clinical test of anaerobic leg muscle function for use in determining anaerobic power and in prescribing high-intensity interval exercise in patients with chronic heart failure and Chronic Obstructive Pulmonary Disease (COPD); however, neither the test-retest reliability nor the physiological qualities of this test have been reported. We therefore, assessed test-retest reliability of the SRAT and the physiological characteristics associated with the test in patients with COPD. 11 COPD patients (mean FEV1 43% predicted) performed a cardiopulmonary exercise test (CPET) on Day 1, and an SRAT and a 30-second Wingate anaerobic test (WAT) on each of Days 2 and 3. The SRAT showed a high degree of test-retest reliability (ICC = 0.99; CV = 3.8%, and bias 4.5 W, error −15.3–24.4 W). Power output on the SRAT was 157 W compared to 66 W on the CPET and 231 W on the WAT. Despite the differences in workload, patients exhibited similar metabolic and ventilatory responses between the three tests. Measures of ventilatory constraint correlated more strongly with the CPET than the WAT; however, physiological variables correlated more strongly with the WAT. The SRAT is a highly reliable test that better reflects physiological performance on a WAT power test despite a similar level of ventilatory constraint compared to CPET

Murri Way! Aborigines and Torres Strait Islanders reconstruct social welfare practice

This book explores Aboriginal and Torres Strait Islander perceptions of their helping styles with their own people and the type of help they provide in the social welfare context. Through semi-structured depth interviews, the use of video as stimulus material and collaborative analysis with Aboriginal and Torres Islander participants, the book identifies the helping process within their own cultural communities and in particular the cultural aspects of their helping approach. In the course of this project active collaboration has occurred between indigenous and non-indigenous people in methodological and ethical processes that reflected as much as possible a political position of indigenous control of the project in relation to problem definition, choice of research methods, data analysis and use of findings. The intent of 'Murri Way' was to provide a 'springboard' for the development of Indigenous Best Practice Models. Readers attention is drawn to the recognition of the contribution of participant's wisdom and knowledge, page iv-vi; the Aboriginal and Torres Strait Islander Terms of Reference, p.95; and details of the inception and aspiration of the project in Chapter 2

Academic success and individual differences

Individual differences in students such as motivation, self-regulation and feedback orientation all have an impact on completing academic tasks. Additionally, motivation to study has been shown to impact course engagement. The aim of this research is to explore whether these individual differences can directly predict academic successes at university

Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival : A cohort study

Background: Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.Methods: Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.Results: Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.Conclusions: The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC. © 2013 Worm et al.; licensee BioMed Central Ltd

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Antibiotic Solutions for Surgical Irrigation

&#x0D; During surgery, wounds can be washed out, or irrigated, using antibiotic, antiseptic, or saline solutions to prevent infections; the evidence in this report found over 20 different antibiotic solutions used across trials.&#x0D; Most studies showed that antibiotic irrigation solutions were better or no different compared to using antiseptic, saline, or no irrigation; however, a small number of studies indicated otherwise. One study reported in a systematic review showed fewer infections and complications for antiseptic compared to a triple antibiotic solution, while another study included in the same systematic review found a higher percentage of implant loss when a triple antibiotic solution was compared to antiseptic; data were poorly reported in these studies.&#x0D; Bacitracin-specific evidence was found in 2 studies; 1 study reported in 1 systematic review showed a higher percentage of infection when bacitracin irrigation was compared to cefazolin and saline irrigation; however, this was not statistically significant. Another study showed no differences in infections requiring surgical intervention or in hospitalization when bacitracin irrigation was compared to no irrigation.&#x0D; One guideline recommends that wound irrigation and intracavity lavage should not be conducted during surgery, and that applying antibiotics before wound closure should only be done as part of a research trial.&#x0D; Due to the mixed findings across studies, high-quality research is needed to clarify the role of antibiotic irrigation during surgery. Because guideline recommendations about wound irrigation, specifically, are based on research published before 2008, updated guidelines to include research from more current studies are needed to reflect current practice.&#x0D; </jats:p

Removable Rigid Dressings for the Post-Operative Management of Leg Amputations

Two systematic reviews and 1 randomized controlled trial provided evidence on the clinical effectiveness and safety of removable rigid dressings compared to soft dressings. Overall, there was limited evidence suggesting that removable rigid dressings had beneficial or neutral effects compared to soft dressings, and both types of dressings were associated with few adverse events. Limitations that may reduce the certainty of the evidence include small sample sizes, lack of randomization in non-randomized studies, lack of blinding, and selective reporting. Three evidence-based guidelines based on low-quality evidence were identified that provided recommendations related to removable rigid dressings. The Australian, Dutch, and US guidelines recommend the rigid dressings for transtibial amputations, although Australian and Dutch guidelines specified removable rigid dressings. The Dutch guideline recommends against the use of rigid dressings for transfemoral amputations. No evidence was identified on the cost-effectiveness of removable rigid dressings compared to alternative dressings. </jats:p

Systemic Thrombolysis by Alteplase for Acute Ischemic Stroke

&#x0D; Evidence was summarized to determine the effect of alteplase in adult stroke patients.&#x0D; There is substantial uncertainty concerning the evidence due to the risk of bias in the available studies and imprecision in how the magnitude of the treatment effects were estimated.&#x0D; The identified research suggests that alteplase administered within 3 hours of a stroke might result in:&#x0D; &#x0D; fewer deaths after 18 months and little-to-no difference in death after 7 days, 3 months, 6 months, or 3 years&#x0D; increased brain bleeds after 7 days but no difference after 36 hours or after 3 months&#x0D; improvements in functioning and independence after 7 days and after 6 months; at 3 months, some studies showed no difference in independence and another study showed higher functioning.&#x0D; &#x0D; &#x0D; The identified research suggests that alteplase administered between 3 hours and 4.5 hours after a stroke might result in:&#x0D; &#x0D; little-to-no difference in deaths after 3 months; at 7 days, some evidence showed little-to-no difference in death while other evidence suggested more deaths&#x0D; little-to-no differences in brain bleeds after 36 hours; at 7 days, some evidence showed no effect on brain bleeds, while other evidence showed more brain bleeds&#x0D; no differences in functioning and independence after 6 months; at 3 months, some evidence showed no effect on functioning, while other evidence reported improved functioning.&#x0D; &#x0D; &#x0D; </jats:p

Heart Function Clinics for Patients With Heart Failure

&#x0D; Low- to moderate-quality clinical evidence suggested that heart failure clinics were associated with significant reductions in all-cause mortality, reductions in heart failure‒related hospitalization, better guideline-directed medical therapy management, and higher adherence to heart failure medications compared to usual care. The findings for all-cause hospitalization were mixed.&#x0D; One low-quality economic study in Denmark found that heart failure clinics were associated with higher costs but no significant difference in mortality rates compared with the usual care. Another moderate cost-effectiveness analysis study in Canada revealed that heart failure clinic interventions were cost-effective compared to standard care, with an incremental cost-effectiveness ratio below the willingness-to-pay threshold.&#x0D; </jats:p