Pre-treatment assessment of chemotherapy for cancer patients: a multi-site evidence implementation project of 74 hospitals in China.

BACKGROUND: Chemotherapy, whilst treating tumours, can also lead to numerous adverse reactions such as nausea and vomiting, fatigue and kidney toxicity, threatening the physical and mental health of patients. Simultaneously, misuse of chemotherapeutic drugs can seriously endanger patients' lives. Therefore, to maintain the safety of chemotherapy for cancer patients and to reduce the incidence of adverse reactions to chemotherapy, many guidelines state that a comprehensive assessment of the cancer patient should be conducted and documented before chemotherapy. This recommended procedure, however, has yet to be extensively embraced in Chinese hospitals. As such, this study aimed to standardise the content of pre-chemotherapy assessment for cancer patients in hospitals and to improve nurses' adherence to pre-chemotherapy assessment of cancer patients by conducting a national multi-site evidence implementation in China, hence protecting the safety of cancer patients undergoing chemotherapy and reducing the incidence of adverse reactions to chemotherapy in patients. METHODS: The national multi-site evidence implementation project was launched by a JBI Centre of Excellence in China and conducted using the JBI approach to evidence implementation. A pre- and post-audit approach was used to evaluate the effectiveness of the project. This project had seven phases: training, planning, baseline audit, evidence implementation, two rounds of follow-up audits (3 and 9 months after evidence implementation, respectively) and sustainability assessment. A live online broadcast allowed all participating hospitals to come together to provide a summary and feedback on the implementation of the project. RESULTS: Seventy-four hospitals from 32 cities in China participated in the project, four withdrew during the project's implementation, and 70 hospitals completed the project. The pre-and post-audit showed a significant improvement in the compliance rate of nurses performing pre-chemotherapy assessments for cancer patients. Patient satisfaction and chemotherapy safety were also improved through the project's implementation, and the participating nurses' enthusiasm and belief in implementing evidence into practice was increased. CONCLUSION: The study demonstrated the feasibility of academic centres working with hospitals to promote the dissemination of evidence in clinical practice to accelerate knowledge translation. Further research is needed on the effectiveness of cross-regional and cross-organisational collaborations to facilitate evidence dissemination.

The measurement of fatigue in clinicians within hospital settings: A systematic review of measurement properties.

Medical staff fatigue leads to accidents and mistakes and puts patient safety at risk. A measure of fatigue in the workplace may help to quantify, predict, and manage fatigue. This review aimed to evaluate instruments used to measure fatigue in medical staff within hospitals. A systematic review following the JBI methodology was undertaken. A search for articles was conducted in 2021. Included articles (all validation studies) were assessed for methodological quality using the COSMIN checklist. Measurement property data was evaluated for Quality of Evidence using GRADE methodology. Ten studies representing five instruments were reviewed: Occupational Fatigue Exertion and Recovery scale (now superseded); Occupational Fatigue Exertion and Recovery scale (15-item); Multidimensional Fatigue Inventory; Need for Recovery Scale; and the Swedish Occupational Fatigue Inventory. Four instruments show promise for measuring fatigue in hospital medical staff, however, there is limited certainty in the measure property estimates. The Quality of Evidence for measurement properties for all instruments is insufficient. Further validation studies following the COSMIN standards are needed before recommendations for use can be made.

Development of prehospital care quality indicators for the Australian setting: a modified RAND/UCLA appropriateness method.

BACKGROUND: Globally, the measurement of quality is an important process that supports the provision of high-quality and safe healthcare services. The requirement for valid quality measurement to gauge improvements and monitor performance is echoed in the Australian prehospital care setting. The aim of this study was to use an evidence-informed expert consensus process to identify valid quality indicators (QIs) for Australian prehospital care provided by ambulance services. METHODS: A modified RAND/UCLA appropriateness method was conducted with a panel of Australian prehospital care experts from February to May 2019. The proposed QIs stemmed from a scoping review and were systematically prepared within a clinical and non-clinical classification system, and a structure/process/outcome and access/safety/effectiveness taxonomy. Rapid reviews were performed for each QI to produce evidence summaries for consideration by the panellists. QIs were deemed valid if the median score by the panel was 7-9 without disagreement. RESULTS: Of 117 QIs, the expert panel rated 84 (72%) as valid. This included 26 organisational/system QIs across 7 subdomains and 58 clinical QIs within 10 subdomains.Most QIs were process indicators (n=62; 74%) while QIs describing structural elements and desired outcomes were less common (n=13; 15% and n=9; 11%, respectively). Non-exclusively, 18 (21%) QIs addressed access to healthcare, 21 (25%) described safety aspects and 64 (76%) specified elements contributing to effective services and care. QIs on general time intervals, such as response time, were not considered valid by the panel. CONCLUSION: This study demonstrates that with consideration of best available evidence a substantial proportion of QIs scoped and synthesised from the international literature are valid for use in the Australian prehospital care context.

Characteristic heterotopic ossification of the proximal humerus after total shoulder arthroplasty.

OBJECTIVE: A bony spur in a characteristic location involving the proximal humerus is identified on post-operative radiographs in some patients with history of total shoulder arthroplasty. The spur is theorized to represent heterotopic ossification near the attachment site of the pectoralis major tendon on the proximal humerus which is partially detached and then reattached during total shoulder arthroplasty. In this study, we determine the morphology, incidence, demographic associations, and clinical impact of this finding. MATERIALS AND METHODS: This is a single-center, retrospective study of 500 patients who underwent total shoulder arthroplasty (250 standard and 250 reverse technique) between 2012 and 2017. Pre- and post-operative shoulder radiographs were reviewed to identify and measure the characteristic spur; inter-observer agreement was evaluated between the two reviewers. Incidence, demographic associations, and clinical significance were then determined. RESULTS: The study group included 268 men and 234 women with a mean age of 70 (42-89) years, and clinical follow-up of 25 (1-84) months. Characteristic heterotopic ossification was seen in 88 patients (17.6%) and was first noted radiographically at a mean (interquartile range) of 12.1 (11.5-12.8) months after surgery. Male sex (adjusted odds ratio (95% confidence interval), 3.00 (0.68-5.34), p < 0.001) was independently associated with heterotopic ossification. No significant relationships between heterotopic ossification and adverse clinical outcomes were observed. CONCLUSION: Characteristic heterotopic ossification of the proximal humerus in patients status post total shoulder arthroplasty is a common imaging finding that is not associated with adverse clinical outcomes.

Mapping Clinical Barriers and Evidence-Based Implementation Strategies in Low-to-Middle Income Countries (LMICs).

BACKGROUND: Low-to-middle income countries (LMICs) experience a high burden of disease from both non-communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice. AIM: To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies. METHODS: A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6-month, multi-phase, intensive evidence-based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy. RESULTS: A total of 60 implementation projects reporting 58 evidence-based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process-related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence-based practice; most strategies were categorized as educational meetings for healthcare workers. LINKING EVIDENCE TO ACTION: Context-specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low-cost resources. Education for healthcare workers in LMICs is an effective awareness-raising, workplace culture, and practice-transforming strategy for evidence implementation.

An International Educational Training Course for Conducting Systematic Reviews in Health Care: The Joanna Briggs Institute's Comprehensive Systematic Review Training Program.

BACKGROUND: The cornerstone of evidence-based health care is the systematic review of international evidence. Systematic reviews follow a rigorous, standardized approach in their conduct and reporting, and as such, education and training are essential prior to commencement. AIMS: This study reports on the evolution of the Joanna Briggs Institute Comprehensive Systematic Review Training Program (JBICSRTP) as an exemplar approach for teaching systematic review methods. RESULTS: The Joanna Briggs Institute (JBI) is an international research and development center at the University of Adelaide, South Australia. Its mission is to promote and facilitate evidence-based best practice globally, largely through the provision of education and training. JBI was one of the first to consider all forms of evidence in systematic reviews, and as such, implementation of standardized training was essential. Since 1999, JBI has offered a systematic review training program. The JBICSRTP is now delivered face to face over 5 days, with an optional online component; the content aligns to that proposed in the Sicily statement. Over the last 3 years, JBI and its Collaboration have trained over 3,300 people from over 30 countries. A "train-the-trainer" (TtT) style program was established to cope with demand, and to date, hundreds of trainers have been licensed across the globe to deliver the JBICSRTP. LINKING EVIDENCE TO ACTION: Providing standardized training materials, ensuring open and ongoing communication, and adopting a TtT style program while still allowing for local adaptability are strategies that have led to the establishment of a highly skilled global training network and ensured the success and longevity of the JBICSRTP.

Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project.

OBJECTIVE: To assess falls prevention practices in Australian hospitals and implement interventions to promote best practice. DESIGN: A multi-site audit using eight evidence-based audit criteria. Following a baseline audit, barriers to compliance were identified and targeted. Two follow-up audit cycles assessed the sustainability of practice change. SETTING: Nine acute care hospitals around Australia, including a mix of public and private. One medical ward and one surgical ward from each hospital were involved. PARTICIPANTS: A clinical leader from each hospital, trained in evidence implementation, conducted the audits and implementation strategies in their setting. INTERVENTIONS: Multi-component falls prevention interventions were utilized, designed to target specific barriers to compliance identified at each hospital. Common interventions involved staff and patient education. MAIN OUTCOME MEASURE: Percentage compliance with falls prevention audit criteria and change in compliance between baseline and follow-up audits. Fall rate data were also analysed. RESULTS: Mean overall compliance at baseline across all hospitals was 50.4% (range 30.8-76.6%). At the first follow-up, this had increased to 74.5% (range 59.4-87.4%), which was sustained at the second follow-up (74.1%, range 48.6-84.4%). There were no statistically significant differences between compliance rates in medical versus surgical wards or in private versus public hospitals. Despite sustained practice improvement, reported fall rates remained unchanged. The focus on staff education possibly led to improved reporting of falls, which may explain the apparent lack of effect on fall rates. CONCLUSIONS: Clinical audit and feedback is an effective strategy to promote quality improvement in falls prevention practices in acute hospital settings.

Evidence implementation: Development of an online methodology from the knowledge-to-action model of knowledge translation.

This paper describes an online facilitation for operationalizing the knowledge-to-action (KTA) model. The KTA model incorporates implementation planning that is optimally suited to the information needs of clinicians. The can-implement(©) is an evidence implementation process informed by the KTA model. An online counterpart, the can-implement.pro(©) , was developed to enable greater dissemination and utilization of the can-implement(©) process. The driver for this work was health professionals' need for facilitation that is iterative, informed by context and localized to the specific needs of users. The literature supporting this paper includes evaluation studies and theoretical concepts relevant to KTA model, evidence implementation and facilitation. Nursing and other health disciplines require a skill set and resources to successfully navigate the complexity of organizational requirements, inter-professional leadership and day-to-day practical management to implement evidence into clinical practice. The can-implement.pro(©) provides an accessible, inclusive system for evidence implementation projects. There is empirical support for evidence implementation informed by the KTA model, which in this phase of work has been developed for online uptake. Nurses and other clinicians seeking to implement evidence could benefit from the directed actions, planning advice and information embedded in the phases and steps of can-implement.pro(©) .

Perceptual thresholds for the effects of room modes as a function of modal decay.

Room modes cause audible artifacts in listening environments. Modal control approaches have emerged in scientific literature over the years and, often, their performance is measured by criteria that may be perceptually unfounded. Previous research has shown modal decay as a key perceptual factor in detecting modal effects. In this work, perceptual thresholds for the effects of modes as a function of modal decay have been measured in the region between 32 and 250 Hz. A test methodology has been developed to include modal interaction and temporal masking from musical events, which are important aspects in recreating an ecologically valid test regime. This method has been deployed in addition to artificial test stimuli traditionally used in psychometric studies, which provide unmasked, absolute thresholds. For artificial stimuli, thresholds decrease monotonically from 0.9 s at 32 Hz to 0.17 s at 200 Hz, with a knee at 63 Hz. For music stimuli, thresholds decrease monotonically from 0.51 s at 63 Hz to 0.12 s at 250 Hz. Perceptual thresholds are shown to be dependent on frequency and to a much lesser extent on level. The results presented here define absolute and practical thresholds, which are useful as perceptually relevant optimization targets for modal control methods.

Vitamin D deficiency in patients with intellectual disabilities: prevalence, risk factors and management strategies.

BACKGROUND: People with intellectual disabilities have a high risk of osteoporosis and fractures, which could partly be as a result of vitamin D deficiency. AIMS: To compare the serum vitamin D (25(OH)D) levels of 155 patients with intellectual disabilities under psychiatric care and 192 controls, investigate potential risk factors for vitamin D deficiency in people with intellectual disabilities and assess available treatments. METHOD: Cross-sectional observational study followed by treatment evaluation. Results Almost twice as many patients with intellectual disabilities had vitamin D deficiency (25(OH)D <50 nmol/l) compared with controls (77.3% v. 39.6%, P<0.0001). In the intellectual disabilities group, winter season (P<0.0001), dark skin pigmentation (P<0.0001), impaired mobility (P = 0.002) and obesity (P = 0.001) were independently associated with lower serum 25(OH)D. In most patients, 800 IU colecalciferol daily normalised 25(OH)D levels. CONCLUSIONS: Vitamin D deficiency is highly prevalent in people with intellectual disabilities, partly because of insufficient exposure to sunlight. Screening and treatment strategies, aiming to reduce these patients' high fracture risk, should be introduced. Similar strategies may be required in other psychiatric populations at risk for fractures and with a tendency to spend excessive time indoors.

Diabetics are less likely to develop thoracic aortic dissection: a 10-year single-center analysis.

BACKGROUND: Diabetes mellitus (DM) is an acknowledged risk factor for atherosclerosis, and diabetics are more likely to have hypertension. Atherosclerosis and hypertension are risk factors for aortic dissection. However, recent studies have shown that DM is associated with changes in aortic wall collagen. In this retrospective study we assess the relationship between DM and thoracic aortic dissection (TAD). METHODS: Patients with a diagnosis of thoracic aortic dissection during the last 10 years were identified from our hospital records. The prevalence of DM in Stanford type A and B TAD was compared with that of two age- and gender-matched control groups. For every diabetic dissection case, 10 controls were selected from the hospital data. RESULTS: Two hundred nineteen patients (median age 61 years, male:female ratio 145:74) were identified with TAD, comprising 131 type A dissections and 88 type B dissections. Only 3 of 131 (2.3%) type A aortic dissections were diabetics, whereas, in control group 1, 241 of 1310 (18.4%) were diabetics and, in control group 2, 116 of 1310 (8.9%) were diabetics [odds ratios: 0.1 (0.03-0.32) and 0.24 (0.07-0.76), respectively] (P = 0.0001 and 0.007, respectively). Similarly, only 2 of 88 (2.3%) type B aortic dissections were diabetics, whereas 228 of 880 (26.0%) and 102 of 880 (11.6%) were diabetics in groups 1 and 2 [odds ratios: 0.07 (0.02-0.27) and 0.18 (0.04-0.73), respectively] (P = 0.0001 and 0.0035, respectively). All these odds ratios were statistically significant (P < 0.01). CONCLUSIONS: Patients with thoracic aortic dissection are less likely to be diabetic. Although we identified association only, not causality, it is possible that DM, or its treatment, has a protective effect against aortic dissection.

The mitochondrial genome of the deep-sea pyramid urchin Echinocrepis rostrata (Echinoidea: Holasteroida: Pourtalesiidae).

We present the mitochondrial genome of the deep-sea, epibenthic, irregular echinoid Echinocrepis rostrata, representing the first sequenced mitogenome of the order Holasteroida. The length of the complete E. rostrata mitochondrial genome is 15,716 base pairs, and its GC content is 34.87%. It contains 13 protein-coding genes, two rRNA genes, and 22 tRNA genes, whose order is identical to that of all other available echinoid mitogenomes. Phylogenetic analysis of available mitochondrial genomes, based on all coding loci, places E. rostrata as the sister group to spatangoids (heart urchins).

Data Note: The Digital Ludeme Project Database.

This document outlines the types of data collected for the Digital Ludeme Project, an ERC-funded research project that aims to improve our understanding of the development of games throughout human history through computational analysis of the available (partial) historical data of games. This document outlines how this data is collected, formatted and stored, and how it can be accessed. It is the aim of the Digital Ludeme Project to provide a data resource of unprecedented depth and scope for the benefit of historical games researchers worldwide. Special attention is paid to the FAIR Guiding Principles for scientific data management and stewardship.

Bilateral popliteal artery aneurysms in a young man with Loeys-Dietz syndrome.

Loeys-Dietz syndrome is a recently described genetic connective tissue disorder. The syndrome is associated with multiple nonvascular phenotypic anomalies but also aggressive arteriopathy, which has so far principally been shown to cause aortic root dilatation with subsequent dissection and rupture. We report the first ever case of a young man diagnosed with Loeys-Dietz syndrome with asymptomatic large bilateral popliteal artery aneurysms. We have successfully resected these aneurysms and revascularized with synthetic graft.

An Assessment of Officer-Involved Shooting Data Transparency in the United States.

Although researchers and the public intuitively know that the lack of available data on the topic of officer-involved shootings (OIS) is a problem, the scope of the problem has not been identified. A lack of transparency regarding OIS data contributes to the legitimacy crisis facing policing in the United States. Valid and reliable OIS data would create the ability to craft and assess informed public policy. In addition, police organizations' roles could then be evaluated allowing for accountability and additional training based on OIS incidents. Employing content analysis of websites for police agencies, their municipal/county governments, and sheriffs' offices servicing populations of 100,000 or more according to the 2010 U.S. Census, the availability of OIS data is identified and classified. It was found that 155 (of 277) police agencies and 96 (of 548) sheriffs' offices made some form of data available related to OIS incidents across five categories (annual reports, OIS summary reports, individualized shooting reports, press releases, and spreadsheet reports). The current assessment is the first in the literature to systematically evaluate the transparency of law enforcement organizations servicing large jurisdictions regarding OIS incidents. Those reports and data available are described and placed within the context of the recommended national database proposed by Klinger and colleagues to begin to assess the extent of OIS data transparency issues facing policing. In addition, agencies providing data were compared utilizing one-way analysis of variance on a number of structural variables drawn from the 2008 Census of State and Local Law Enforcement Agencies to evaluate any patterns demonstrated by those organizations providing data. Findings suggest great variation in the type, classification, and quality of data presented by law enforcement organizations, which limits its utility for the purposes of research as well as policy creation and evaluation.

JBI series paper 2: tailored evidence synthesis approaches are required to answer diverse questions: a pragmatic evidence synthesis toolkit from JBI.

Evidence synthesis is critical in evidence-based healthcare and is a core program of JBI. JBI evidence synthesis is characterised by a pluralistic view of what constitutes evidence and is underpinned by a pragmatic ethos to facilitate the use of evidence to inform practice and policy. This second paper in this series provides a descriptive overview of the JBI evidence synthesis toolkit with reference to resources for 11 different types of reviews. Unique methodologies such as qualitative syntheses, mixed methods reviews, and scoping reviews are highlighted. Key features include standardised and collaborative processes for development of methodologies and a broad range of tailored resources to facilitate the conduct of a JBI evidence synthesis, including appraisal and data extraction tools, software to support the conduct of a systematic review and an intensive systematic review training program. JBI is one of the leading international protagonists for evidence synthesis, providing those who want to answer health-related questions with a toolkit of resources to synthesize the evidence.

Safety of antipsychotics in people with intellectual disability.

BACKGROUND: Despite frequent use, little is known about the metabolic and endocrine side-effects of antipsychotics in individuals with intellectual disability. AIMS: To compare indices of obesity, glucose, lipids and prolactin between antipsychotic-treated and antipsychotic-naive individuals with intellectual disability and also between participants with intellectual disability and controls from the general population. METHOD: Observational study comparing 138 antipsychotic-treated and 64 antipsychotic-naive participants with intellectual disability in one National Health Service trust with general population controls. RESULTS: Antipsychotic treatment comprised: risperidone 48%,olanzapine 18%, thioxanthenes 10%, other 24%; monotherapy 95% of participants; mean treatment duration 8 years;median daily chlorpromazine equivalent dose 108 mg(range 16­667). Metabolic indices were the same or more favourable in the intellectual disability group than the general population control group but overweight/obesity and type 2 diabetes were more prevalent in the women in the intellectual disability group than the control group. Metabolic indices were similar, statistically or clinically, between the antipsychotic-treated and the antipsychotic-naive groups but there was a non-significant trend towards a higher rate of type 2 diabetes in the antipsychotic group. A total of 100%and 70% of participants on amisulpride/sulpiride and risperidone respectively had hyperprolactinaemia, with secondary hypogonadism in 77% and 4% of affected women and men. CONCLUSIONS: Antipsychotics, on average, did not increase metabolic risk,although the existence of a susceptible subgroup at risk of diabetes cannot be excluded. Some antipsychotics induced hyperprolactinaemic hypogonadism, requiring active management. However, our findings suggest that antipsychotics at the low doses routinely prescribed for people with intellectual disability are generally safe in relation to metabolic adverse effects, even if efficacy remains poorly defined.

Angiosarcoma mimicking a recurrent carotid artery aneurysm.

BACKGROUND: Carotid aneurysm is a rare condition and mostly caused by atherosclerosis, trauma, or fibrodysplasia. Angiosarcoma is an unusual cause for large vessels' aneurysms and a rare malignant neoplasm that may occur in any region of the body, yet seldom originates in the large blood vessels. We report a rare case of an angiosarcoma in the wall of a recurrent carotid aneurysm. METHOD: We undertook a literature review, and only a few cases of vascular aneurysms are reported to be involving or be caused by angiosarcoma. The main aneurysms affected are those of aortic and popliteal arteries. We report the case of a 61-year-old man with an angiosarcoma of the carotid artery. Biopsy of the arterial wall confirmed angiosarcoma. CONCLUSION: From our study, we conclude that an unresolving or recurring aneurysm with equivocal radiological investigations should raise the suspicion of malignancy.

Measurement of fatigue in clinicians within hospital settings: a systematic review protocol of measurement properties.

OBJECTIVE: The objective of this review is to evaluate measurement properties of instruments used to measure fatigue in clinicians within hospital settings. INTRODUCTION: Research has shown that clinician fatigue leads to accidents and mistakes, and puts patient safety at risk. The problem of managing fatigue in clinicians may need a more complex approach than only restricting work hours. It may be helpful to include a measure of fatigue in the workplace so that fatigue may be quantified, predicted, and correlated to performance. INCLUSION CRITERIA: Articles will include clinicians working in hospitals, and will evaluate and present measurement properties of the instruments used to measure fatigue. The studies of interest include validation studies, quantitative research, and instrument development reports. METHODS: Databases to be searched include PubMed, Scopus, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, EThOS (Electronic Thesis Online Service), ProQuest Dissertations and Theses: Global, and will be limited to publications in English. There will be no date limits. Articles will be screened and those meeting the inclusion criteria will be retained and assessed for methodological quality by two independent appraisers. Data will be presented using a narrative synthesis and tables presenting the measurement properties of each instrument and ancillary data. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020186226.

Interval estimation for concentration in the ELISA setting.

Enzyme-linked immunosorbent assays (ELISAs) are often used to quantify the concentration of biological substances. In a typical analysis only a point estimate of the concentration will be presented as interval estimation continues to present challenges for non-linear dose-response models. In this setting, interval estimates calculated using a Wald approach can suffer from poor coverage and have limits that fall outside parameter boundaries. Here we compare profile likelihood interval estimation procedures to Wald type intervals for the interval estimation of a concentration in the ELISA setting. Through a comprehensive simulation study, it is shown that profile likelihood methods result in interval estimates with superior coverage and that are more robust to differences in assay design when compared to Wald based approaches.