Live long and PROSPERO: A comment on Chiu and coworkers

The a priori registration of systematic reviews provides a way to describe the methods for a meta-analysis before Review Paper selection commences. Chiu and coworkers report a systematic review of blood pressure variability, deviating from the protocol registered on PROSPERO (CRD42020190429)

The real world mental health needs of heart failure patients are not reflected by the depression randomized controlled trial evidence

Introduction: International depression screening guidelines in heart failure (HF) are partly based on depression treatment efficacy from randomized controlled trials (RCTs). Our aim was to test the external validity of depression RCT criteria in a sample of real-world HF patients. Methods: HF patients admitted to 3 hospitals in South Australia were referred to a HF psychologist if not already receiving current psychiatric management by psychologist or psychiatrist elsewhere. Screening and referral protocol consisted of the following; (a). Patient Health Questionnaire $10; (b). Generalized Anxiety Disorder Questionnaire$7); (c). positive response to 1 item panic attack screener; (d). evidence of suicidality. Patients were evaluated against the most common RCT exclusion criteria personality disorder, high suicide risk, cognitive impairment, psychosis, alcohol or substance abuse or dependency, bi-polar depression. Results: Total 81 HF patients were referred from 404 HF admissions, and 73 were assessed (age 60.6613.4, 47.9% female). Nearly half (47%) met at least 1 RCT exclusion criterion, most commonly personality disorder (28.5%), alcohol/substance abuse (17.8%) and high suicide risk (11.0%). RCT ineligibility criteria was more frequent among patients with major depression (76.5% vs. 46.2%, p,.01) and dysthymia (26.5% vs. 7.7%, p = .03) but not significantly associated with anxiety disorders. RCT ineligible patients reported greater severity of depression (M = 16.665.0 vs. M = 12.967.2, p = .02) and were higher consumers of HF psychotherapy services (M = 11.564.7 vs. M = 8.564.8, p = .01). Conclusion: In this real-world sample comparable in size to recent RCT intervention arms, patients with depression disorders presented with complex psychiatric needs including comorbid personality disorders, alcohol/substance use and suicide risk. These findings suggest external validity of depression screening and RCTs could serve as a basis for level A guideline recommendations in cardiovascular diseases

Classifying excessive exercise: Examining the relationship between compulsive exercise with obsessive‐compulsive disorder symptoms and disordered eating symptoms

Objective: There remains a lack of consensus around nosology for compulsive exercise (CE). Although widely observed in eating disorders (ED), CE shares theoretical overlap with obsessive‐compulsive disorder (OCD), where exercise compulsions occur in response to obsessions. Yet, there is limited and mixed evidence of a relationship between CE with OCD. This study aims to explore the appropriate diagnostic classification of CE through examination of CE in relation to OCD, obsessional thinking, and ED symptoms. Method: Two hundred and eighty one adults with mental health symptoms, dieting, and exercise behaviour completed measures of OCD, CE, and disordered eating symptoms. Regression and Receiver Operating Characteristic analyses examined relationships between dimensions of CE with OCD and ED symptoms, and the predictive ability of CE assessment for detecting threshold OCD and ED symptoms. Results: CE assessment was poor at predicting threshold OCD symptoms, probable Anorexia Nervosa, and Binge Eating Disorder and moderate at detecting probable disordered eating and Bulimia Nervosa. Associations between CE and OCD symptoms were not significant after adjustment for ED symptoms. Obsessional thinking was associated only with lack of exercise enjoyment. Conclusions: Results indicate that excessive exercise might represent a distinct disorder, with some shared traits across CE, OCD and ED symptoms. Findings question the utility of adaptation of OCD diagnostic criteria for CE. Assessment and treatment implications are considered

Development and validation of a priori risk model for extensive white matter lesions in people age 65 years or older: The Dijon MRI study

Objectives The objective was to develop and validate a risk model for the likelihood of extensive white matter lesions (extWML) to inform clinicians on whether to proceed with or forgo diagnostic MRI. Design Population-based cohort study and multivariable prediction model. Setting Two representative samples from France. Participants Persons aged 60-80 years without dementia or stroke. Derivation sample n=1714; validation sample n=789. Primary and secondary outcome measures Volume of extWML (log cm3) was obtained from T2-weighted images in a 1.5 T scanner. 20 candidate risk factors for extWML were evaluated with the C-statistic. Secondary outcomes in validation included incident stroke over 12 years follow-up. Results The multivariable prediction model included six clinical risk factors (C-statistic=0.61). A cut-off of 7 points on the multivariable prediction model yielded the optimum balance in sensitivity 63.7% and specificity 54.0% and the negative predictive value was high (81.8%), but the positive predictive value was low (31.5%). In further validation, incident stroke risk was associated with continuous scores on the multivariable prediction model (HR 1.02; 95% CI 1.01 to 1.04, P=0.02) and dichotomised scores from the multivariable prediction model (HR 1.28; 95% CI 1.02 to 1.60, P=0.03). Conclusions A simple clinical risk equation for WML constituted by six variables can inform decisions whether to proceed with or forgo brain MRI. The high-negative predictive value demonstrates potential to reduce unnecessary MRI in the population aged 60-80 years

Commentary: An Extension of the Australian Postgraduate Psychology Education Simulation Working Group Guidelines: Simulated Learning Activities Within Professional Psychology Placements

A Commentary on The use of simulated patients in medical education: AMEE Guide No 42 by Cleland, J. A., Abe, K., and Rethans, J. J. (2009). Med. Teach. 31, 477–486. doi: 10.1080/01421590903002821 Simulation based education by Cleland, J. A. (2017). Psychologist 30, 36–40. Building Academic Staff Capacity for Using eSimulations in Professional Education for Experience Transfer by Cybulski, J., Holt, D., Segrave, S., O'Brien, D., Munro, J., Corbitt, B., et al. (2010). Sydney, NSW: Australian Learning and Teaching Council. Student and staff views of psychology OSCEs by Sheen, J., McGillivray, J., Gurtman, C. and Boyd, L. (2015). Aust. Psychol. 50, 51–59. doi: 10.1111/ap.12086 The Australian Postgraduate Psychology Education Simulation Working Group (APPESWG) recently published guidelines titled "A new reality: The role of simulated learning activities in postgraduate psychology training programs" (Paparo et al., 2021). The document was developed in the context of COVID 19-related disruption to practica within professional psychology training. As a consequence, many training providers adopted simulated training activities as a way to support course progression during the pandemic. Paparo and colleagues' stated aims were to provide comprehensive guidance for the use of simulation as a competency-based training tool and in the interests of public and student safety, both during and after COVID 19. The guidelines included nine criteria for best practice in simulated learning activities in training, for example, that activities should be competency-based, should mirror real-life practice situations and should provide opportunities for active participation and trainee reflection (see Paparo et al. for detail). The document provided helpful guidance on the use of simulated learning activities (SLA) as part of course content within an Australian professional psychology training context, however the guidelines did not cover simulated placement experiences. Considerations especially around supervision and the development of professional and ethical practice within a simulated learning environment need to be made to effectively apply the APPESWG Guidelines within a placement context. Here, we extend these guidelines for provision of simulated professional psychology placements based on our successful development and implementation of large-scale simulated placements at an Australian University (2020-current). Previously, all professional psychology placements in Australia were limited to in-vivo options, however the latest version of the Accreditation Standards for Psychology Programs (Australian Psychology Accreditation Council, 2019) now make provision for simulated learning within required placement experiences at Level 3, Professional Competencies. This extension of the Paparo et al. (2021) article provides guidelines specifically for the use of simulation with professional psychology placements, with a focus on the Australian context

Impact of Model Choice When Studying the Relationship Between Blood Pressure Variability and Risk of Stroke Recurrence

Long-term blood pressure variability (BPV), an increasingly recognized vascular risk factor, is challenging to analyze. The objective was to assess the impact of BPV modeling on its estimated effect on the risk of stroke. We used data from a secondary stroke prevention trial, PROGRESS (Perindopril Protection Against Stroke Study), which included 6105 subjects. The median number of blood pressure (BP) measurements was 12 per patient and 727 patients experienced a first stroke recurrence over a mean follow-up of 4.3 years. Hazard ratios (HRs) of BPV were estimated from 6 proportional hazards models using different BPV modeling for comparison purposes. The 3 commonly used methods first derived SD of BP measures observed over a given period of follow-up and then used it as a fixed covariate in a Cox model. The 3 more advanced modeling accounted for changes in BP or BPV over time in a single-stage analysis. While the 3 commonly used methods produced contradictory results (for a 5 mmHg increase in BPV, HR=0.75 [95% CI, 0.68–0.82], HR=0.99 [0.91–1.08], HR=1.19 [1.10–1.30]), the 3 more advanced modeling resulted in a similar moderate positive association (HR=1.08 [95% CI, 0.99–1.17]), whether adjusted for BP at randomization or mean BP over the follow-up. The method used to assess BPV strongly affects its estimated effect on the risk of stroke, and should be chosen with caution. Further methodological developments are needed to account for the dynamics of both BP and BPV over time, to clarify the specific role of BPV

Risk factors for dementia in the context of cardiovascular disease: A protocol of an overview of reviews

Background Dementia is a major public health priority. Although there is abundant evidence of an associ-ation between dementia and poor cardiovascular health, findings have been inconsistent and uncertain in identifying which factors increase dementia risk in those with cardiovascular disease. Indeed, multiple variables including sociodemographic, economic, health, lifestyle and education may indicate who is at higher vs. lower dementia risk and could be used in prediction modelling. Therefore, the aim of this review is to synthesise evidence on the key risk factors for dementia in those with a history of cardiovascular disease. Methods This is an overview of reviews protocol, registered on PROSPERO (CRD42021265363). Four electronic databases including MEDLINE, EMBASE, PsycINFO, and the Cochrane Database of Systematic Reviews will be searched. Studies will be included if they are systematic reviews and/or meta-analyses that have investigated the risk of incident dementia (all-cause and subtypes including Alzheimer's disease and vascular dementia) in people with a history of coronary heart disease, heart failure, atrial fibrillation, hypertension, hyperli-pidaemia, and vascular stiffness. Study selection will be completed by two independent researchers according to the eligibility criteria, and conflicts resolved by a third reviewer. References will be exported into Covidence for title and abstract sifting, full-text review, and data extraction. Methodological quality will be assessed using the AMSTAR-2 criteria and confidence of evidence will be assessed using the GRADE classification. This overview of reviews will follow PRISMA guidelines. If there is sufficient homogeneity in the data, the results will be pooled, and a meta-analysis conducted to determine the strength ofassociation between each risk factor and incident all-cause dementia and its subtypes for each cardiovascular diagnoses separately.Discussion We will create a comprehensive summary of the key risk factors linking cardiovascular dis-eases to risk of incident dementia. This knowledge is essential for informing risk predictive model development as well as the development of risk reduction and prevention strategies

Impact of Model Choice When Studying the Relationship Between Blood Pressure Variability and Risk of Stroke Recurrence

Long-term blood pressure variability (BPV), an increasingly recognized vascular risk factor, is challenging to analyze. The objective was to assess the impact of BPV modeling on its estimated effect on the risk of stroke. We used data from a secondary stroke prevention trial, PROGRESS (Perindopril Protection Against Stroke Study), which included 6105 subjects. The median number of blood pressure (BP) measurements was 12 per patient and 727 patients experienced a first stroke recurrence over a mean follow-up of 4.3 years. Hazard ratios (HRs) of BPV were estimated from 6 proportional hazards models using different BPV modeling for comparison purposes. The 3 commonly used methods first derived SD of BP measures observed over a given period of follow-up and then used it as a fixed covariate in a Cox model. The 3 more advanced modeling accounted for changes in BP or BPV over time in a single-stage analysis. While the 3 commonly used methods produced contradictory results (for a 5 mmHg increase in BPV, HR=0.75 [95% CI, 0.68-0.82], HR=0.99 [0.91-1.08], HR=1.19 [1.10-1.30]), the 3 more advanced modeling resulted in a similar moderate positive association (HR=1.08 [95% CI, 0.99-1.17]), whether adjusted for BP at randomization or mean BP over the follow-up. The method used to assess BPV strongly affects its estimated effect on the risk of stroke, and should be chosen with caution. Further methodological developments are needed to account for the dynamics of both BP and BPV over time, to clarify the specific role of BPV

Changes of left ventricular mechanics after trans-catheter aortic valve implantation and surgical aortic valve replacement for severe aortic stenosis: A tissue-tracking cardiac magnetic resonance study

Background: Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). The aim of the present study was to assess their changes early and late after trans-catheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) using cardiac magnetic resonance (CMR) tissue-tracking imaging. Methods: In 59 patients with severe AS undergoing either TAVI (n = 35) or surgical AVR (n = 24), CMR with late gadolinium enhancement (LGE) imaging was performed before and early post-procedure to evaluate LV function and mass, and presence/extent of LGE. A third CMR scan was performed in 29 patients after a mean follow-up of 15 ± 4 months. Tissue-tracking analysis was applied to cine CMR images, to assess LV global longitudinal (GLS), circumferential (GCS) and radial (GRS) strains.
 Results: The TAVI and surgical AVR groups were similar with respect to baseline (p = 0.14) and early post-procedure (p = 0.16) LV ejection fraction. However, baseline LV GLS was significantly impaired in TAVI patients compared to surgical AVR patients (p = 0.025). Early post-procedure, TAVI resulted in a significant improvement of LV GLS (p = 0.003), while a significant worsening of LV GLS was observed early after surgical AVR (p = 0.012). At longer term follow-up, both TAVI and surgical AVR groups experienced a significant reduction of LV mass and a significant improvement of LV myocardial mechanics in all the three directions. Conclusions: Treatment-specific differences in the changes of LV myocardial mechanics early after afterload release by TAVI and surgical AVR are present. Later, both interventions are associated with an improvement of LV myocardial deformation, alongside a regression of LV hypertrophy

Association Between Blood Pressure Variability and Cerebral Small-Vessel Disease: A Systematic Review and Meta-Analysis

Background-—Research links blood pressure variability (BPV) with stroke; however, the association with cerebral small-vessel disease (CSVD) remains unclear. As BPV and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding cerebrovascular morphological characteristics. Methods and Results-—A systematic review was performed from inception until March 3, 2019. Eligibility criteria included population, adults without stroke (2=85%) independent of mean systolic pressure. Likewise, higher diastolic BPV was associated with higher odds for CSVD (OR, 1.30; 95% CI, 1.14–1.48; I2=53%) independent of mean diastolic pressure. There was no evidence of a pairwise interaction between systolic/diastolic and BPV/mean ORs (P=0.47), nor a difference between BPV versus mean pressure ORs (P=0.58). Fifty-four standardized mean differences were pooled and provided similar results for pairwise interaction (P=0.38) and difference between standardized mean differences (P=0.70). Conclusions-—On the basis of the available studies, BPV was associated with CSVD independent of mean blood pressure. However, more high-quality longitudinal data are required to elucidate whether BPV contributes unique variance to CSVD morphological characteristics