Multicenter Approach Research Articles

Do migrants better in reintegration? A multicenter follow-up study on re-delinquency, addiction-related behavior and resocialization after German Forensic Addiction Treatment

In Germany, Forensic Addiction Treatment serves the purpose of reintegration into society. Patients with a migration background are over-represented, show slightly higher rates of premature termination and exhibit less successful outcomes. However, outcome research was often limited by conceptual ambiguities and insufficient control for confounding variables. In the present article, we defined reintegration as a comprehensive concept comprising three domains (re-delinquency, addiction-related behavior, resocialization). In a multicenter approach, 466 migrant patients were compared on 35 catamnestic variables to a group of non-migrants matched on the variables sex, main offense, main diagnostic group and age at discharge. For to seek evidence for and against interrelation, we applied both inferential and Bayesian statistics. Both groups show almost the same substance use behaviors and identical re-delinquency rates, with some tendency toward more serious re-offenses among non-migrants. The migrant-group combines more favorable patterns on relevant indicators of resocialization. However, while treatment is proving equally successful in terms of its core purpose of reintegration, it does not succeed in overcoming systemic barriers to accessing the general health care system, as migrants show more reluctant help-seeking behaviors. This, in turn, could increase the risk of long-term re-delinquency due to a lack of adequate post-forensic support. Hence, barriers should be reduced and treatment offers should be adapted to migrants’ needs.

How much do 68Ga-, 177Lu- and 131I-based radiopharmaceuticals contribute to the global radiation exposure of nuclear medicine staff?

BackgroundThe radiation exposure of nuclear medicine personnel, especially concerning extremity doses, has been a significant focus over the past two decades. This study addresses the evolving practice of NM, particularly with the rise of radionuclide therapy and theranostic procedures, which involve a variety of radionuclides such as 68Ga, 177Lu, and 131I. Traditional studies have concentrated on common radioisotopes like 99mTc, 18F, and 90Y, but there is limited data on these radionuclides, which are more and more frequently used. This study, part of the European SINFONIA project, aims to fill this gap by providing new dosimetry data through a multicenter approach. The research monitors extremity doses to hands, eye lens doses, and whole-body doses in nuclear medicine staff handling 68Ga, 177Lu, and 131I. It examines the type of activities performed and the protective measures used. The study extrapolates measured doses to annual doses, comparing them with annual dose limits, and assesses the contribution of these specific procedures to the overall occupational dose of nuclear medicine personnel.ResultsMeasurements were conducted from November 2020 to August 2023 across nine hospitals. The highest whole-body, eye lens and extremity doses were observed for 68Ga. Average maximum extremity doses, normalized per manipulated activity, were found of 6200 µSv/GBq, 30 µSv/GBq and 260 µSV/GBq for 68Ga, 177Lu and 131I, respectively. Average whole-body doses stayed below 60 µSv/GBq for all 3 isotopes and below 200 µSv/GBq for the eye lens dose. The variation in doses also depends on the task performed. For 68Ga there is a risk of reaching the annual dose limit for skin dose during synthesis and dispensing.ConclusionsThis study’s measurement campaigns across various European countries have provided new and extensive occupational dosimetry data for nuclear medicine staff handling 68Ga, 177Lu and 131I radiopharmaceuticals. The results indicate that 68Ga contributes significantly to the global occupational dose, despite its relatively low usage compared to other isotopes. Staff working in radiopharmacy hot labs, labeling and dispensing 177Lu contribute less to the finger dose compared to other isotopes.

Current situation and capacity of cancer diagnosis and treatment in county hospitals in China: a multicenter cross-sectional survey

PurposeCounty-level hospitals in China constitute a vital component of the healthcare system, delivering essential medical services, emergency care, and specialized treatments, particularly in oncology. This study aimed to comprehensively evaluate the current status of cancer diagnosis and treatment in county hospitals and assess their overall capacity.MethodsA nationwide cross-sectional survey by the China Anti-cancer Association (CACA) from February to May 2023 assessed cancer diagnosis and treatment in mainland China's county hospitals. Using a multi-center approach, a fifty-five-question questionnaire was administered to oncology professionals and management staffs, focusing on hospital facilities, oncology specialists, cancer cases, treatment capabilities, and healthcare collaboration. Questionnaire reliability and validity were established in a 2022 national survey. Participants, aged 18 or older, were recruited through purposive sampling, receiving self-administered questionnaires for confidentiality. SAS 9.4 software facilitated statistical analysis.ResultsThe study encompassed 76 county-level medical institutions, with 82.9% of them featuring established oncology departments providing comprehensive cancer care, including early screening, diagnosis, treatment, and long-term follow-up. Notably, a total of 56.6% of the institutions surveyed implemented programs for cancer screening and early diagnosis. A significant proportion of advanced cancer patients received treatment and follow-up at the county level. Persistent disparities in medical insurance policies at the county level were identified as a continuing challenge. Furthermore, 82.9% of hospitals had cultivated collaborative relationships with higher-level institutions to enhance patient care quality and treatment capacity. The study revealed a 56.6% shortage of remote collaboration platforms in these hospitals. The need for a patient-centered approach in county hospitals was underscored.ConclusionWhile county-level hospitals face challenges, such as a shortage of specialized oncologists and advanced resources, they exhibit progress in standardizing cancer care to enhance diagnosis and treatment in rural areas.

Factors Associated With Colorectal Cancer Screening Behaviors Among Urban Populations in China: A Mixed-Methods Study Using the Health Belief Model.

Adherence to guideline-recommended colorectal cancer screening (CRCS) among average-risk urban populations in China remains significantly suboptimal. This mixed-methods study aimed to investigate screening behaviors and associated factors among average-risk urban populations through a multi-center approach. From February to July 2024, 550 participants were recruited via stratified random sampling in Harbin, China. They completed questionnaires related to health beliefs and knowledge. Additionally, semi-structured interviews were conducted to explore CRCS behaviors, with data analyzed using directed content analysis based on the Health Belief Model (HBM). Five hundred twenty two participants (95.0%) completed the survey. Identified factors influencing screening behavior among average-risk urban populations included perceived severity of colorectal cancer (CRC), benefits of colon cancer surveillance, barriers to surveillance, and knowledge. Twenty-six individuals were engaged in qualitative interviews. Twenty-four themes were identified and categorized by frequency. Both quantitative and qualitative data suggest that CRCS behavior among urban average-risk populations is suboptimal, and the identified factors can be mapped onto the HBM. This mixed-methods study demonstrates that key factors influencing screening behavior among urban average-risk populations align with the HBM. These identified factors should be meticulously considered in future systematic interventions to enhance screening behaviors.

The prevalence and associated factors of intraoperative hypotension following thoracic surgery in resources limited area, 2023. multi-centre approach

Background: Hypotension is an independent predictor of long-term patient morbidity and duration of hospital stay. Multiple factors contribute to the development of intraoperative hypotension. Prevention and treatment of these factors may reduce patients’ hypotension and its associated morbidity and mortality. This study aimed to assess the prevalence and associated factors of intraoperative hypotension in patients undergoing elective thoracic surgery. Methods: This institution-based cross-sectional study was conducted among 174 adult patients who underwent elective thoracic surgery. A systematic random sampling technique was used, and quantitative data were collected through interviews and data retrieval from charts via a pretested questionnaire. Both bivariable and multivariable logistic regression analyses were performed to evaluate the associations between independent and dependent variables. The level of statistical significance was defined as a P-value less than 0.05. The data were entered into Info 7.2.1 and analysed via SPSS version 26 software, which was used to calculate descriptive statistics, and bivariate and multivariate logistic regression were performed. Results: In general, information was collected from 174 patients during the study period. The results of the present study revealed that 65 (41%) patients developed intraoperative hypotension (95% CI: 36.43%-48%). Intraoperative blood loss was significantly associated with intraoperative hypotension [AOR=9.58, 95% CI (2.57--35.8)] (P=0.001). Conclusion and recommendation: The findings of this study revealed high rates of intraoperative hypotension episodes, which were 41%, in patients who underwent elective thoracic surgery. Age, ASA class, type of intraoperative blood loss, type of procedure pre-existence comorbidity and duration of surgery were predictors of intraoperative hypotension in patients who underwent elective thoracic surgery. The anaesthetist’s, surgeon and PACU staff’s understanding of these factors is very crucial for close follow-up of this group of patients.

Temporal development of subdural collections in infants with confessed abusive head trauma: a forensic neuroimaging study.

Estimating the age of injury in pediatric abusive head trauma (AHT) is a challenging task but potentially valuable for the identification of perpetrators. The aims of the study are (1) to describe the temporal development of different imaging features of subdural collections (SDCs), and (2) to provide novel age-diagnostic reference data for forensic-radiological expert reports. Using a multi-center approach and a 10-year study period, serial neuroimaging studies of 13 comprehensively investigated AHT cases (8 CT and 26 MRI scans) were analyzed regarding several subdural imaging parameters (SDC appearances, entities, components, and associated findings). Due to confessions by perpetrators, the time points of the trauma were presumed unique and known in all cases facilitating correlation of imaging findings with time. Hyperdense SDCs in CT were found up to 9 d post-injury (p.i.), CSF-like SDCs in CT or MRI as early as from the 3rd hour p.i., and subdural membrane formation as late as from day 283. The heterogeneous variant of the subdural hematohygroma was observed to be the dominant SDC entity between 3 h and 22 d p.i. The tadpole sign was detected in MRI between 3 h and 46 d p.i. Certain subdural imaging findings may be helpful for estimating the age of injury in AHT. Subdural membrane formation is demonstrated to be a late finding and the tadpole sign is an early phenomenon p.i. The data corroborated that the sediment but not the supernatant has the potential for being valuable for age-diagnostic aspects. Question Reliable evidence-based data on the development of SDCs is sparse but required for expert opinions on pediatric AHT. Findings Reference data on the evolution of the imaging appearance of SDCs and associated phenomena in confirmed cases of AHT are provided. Clinical relevance As there is a great need for estimating the age of injury in criminal and civil proceedings, many clinical radiologists are confronted with the diagnostic and forensic aspects of AHT that are addressed in the present study.

Framing the Multi-Centre Qualitative Research Design as a Novel Methodology for Nursing and Healthcare Research: Reflections and A Methodological Discussion.

To discuss the multi-centre qualitative methodology as a unique design, articulate its guiding paradigm/theoretical perspectives, and highlight its methodological and methodical issues. A secondary objective is to generate further scholarly discourse regarding the multi-centre approach within the broader qualitative research tradition. Methodological discussion. Rather than an emphasis on only experiences, the multi-centre approach is presented as a unique design which also focuses on uncovering why a phenomenon or problem exists and perceptions regarding the phenomenon/problem. With its focus on capturing multiple subjective realities, the multi-centre qualitative design is arguably underpinned by pragmatist constructivism which offers a robust framework for researching phenomenon in a way that is both theoretically informed and practically relevant. Methodologically, the multi-centre qualitative research design emphasises a problem-centred enquiry, collaborative approach and rigorous study protocols, systematic site selection, contextual immersion and sensitivity and methodical flexibility. With the rapidly evolving nursing and global health landscape, the multi-centre design lends itself to exploring and capturing perceptions on a larger scale compared to single site studies. Careful planning, availability of adequate resources, rigorous protocols and quality assurance plans are critical to ensuring its success. The multi-centre approach offers the possibility of undertaking the same study across multiple settings/locations which has the potential to improve representation and strengthen transferability. This methodological discussion offers clarity regarding the use of the multi-centre approach and offering strategies for its subsequent uptake in nursing and healthcare research. Not applicable. No patient or public contribution.

A multi-center big-data approach for precise PICC-RVT prognosis and identification of major risk factors in clinical practice

BackgroundThe Peripherally Inserted Central Catheter (PICC) is a widely used technique for delivering intravenous fluids and medications, especially in critical care units. PICC may induce venous thrombosis (PICC-RVT), which is a frequent and serious complication. In clinical practice, Color Doppler Flow Imaging (CDFI) is regarded as the gold standard for diagnosing PICC-RVT. However, CDFI not only requires prominent time and effort from experienced healthcare professionals, but also relies on the formation and development of PICC-RVT, especially at early stages of PICC-RVT, when PICC-RVT is not apparent. A prognosis tool for PICC-RVT is crucial to bridge the gap between its diagnosis and treatment, especially in resource-limited settings, such as remote healthcare facilities. ObjectiveEvaluate over 14,885 models from various machine learning techniques to identify an effective prognostic model (referred to as PRAD - PICC-RVT Assessment via Deep-learning) for quantifying the risks associated with PICC-RVT. MethodsTo tackle the challenges associated with PICC-RVT diagnosis, we gathered a comprehensive dataset of 5,272 patients from 27 healthcare centers across China. From a pool of 14885 models from various machine learning techniques, we systematically screened a data-driven prognostic model to quantify the risks associated with PICC-RVT. This model aims to provide objective evidence, and facilitate timely interventions. ResultsThe proposed model displayed exceptional predictive accuracy, achieving an accuracy of 86.4 % and an AUC of 0.837. Based on the prognosis model, we further incorporated a weight analysis to identify the major contributing factors for PICC-RVT risk during catheterization. Albumin levels, primary diagnosis, hemoglobin levels, platelet levels, and education level are emphasized as important risk factors. ConclusionsOur method excels in predicting early PICC-RVT risks, especially in asymptomatic patients. The findings in this paper offers insights into controllable PICC risk factors that could benefit vast patients and reduce disease burden through stratification and early intervention.

Management Strategies for Obese Diabetes

In recent years, there has been a growing emphasis on the relationship between obesity and diabetes. An analysis of Korean data revealed that more than 75% of diabetic patients were overweight or obese, with two-thirds having abdominal obesity. Traditional treatment goals for diabetes have primarily focused on lowering blood glucose levels to prevent and treat microvascular and macrovascular complications, which is known as the glucocentric approach. However, with the recognition of the shared pathophysiology of insulin resistance in both diabetes and obesity, a weight-centric approach has emerged, particularly beneficial for patients in whom insulin resistance is a primary driver of type 2 diabetes. Of note, the overlap of various physiological aspects in diabetic patients necessitates a multicentric approach for effective type 2 diabetes management. Recent guidelines now recommend weight loss as a primary treatment goal alongside blood glucose control for overweight and obese diabetic patients, highlighting the significance of weight management in diabetes care. Medications such as glucagon-like peptide-1 (GLP-1) receptor agonist or dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist with weight-loss effects are recommended for this patient population. Ongoing research is exploring the potential of various gut hormone-based therapies, offering hope for effective weight management and improved diabetes outcomes in the growing population of obese diabetic individuals.

Spinocerebellar Ataxia in Brazil: A Comprehensive Genotype - Phenotype Analysis.

Spinocerebellar ataxias (SCAs) are a diverse group of hereditary neurodegenerative disorders characterized by progressive degeneration of the cerebellum and other parts of the nervous system. In this study, we examined the genotype‒phenotype correlations in SCAs within the Brazilian population by leveraging a comprehensive dataset of 763 individuals from SARAH Network of Rehabilitation Hospitals. Using a retrospective, cross-sectional, observational, multicentric approach, we analysed medical records and conducted standardized molecular testing to explore epidemiological characteristics, clinical manifestations, and genetic profiles of SCAs in Brazil. Our findings revealed the predominance of SCA3, followed by SCA7 and SCA2, which aligns with global trends and reflects the specific genetic landscape of Brazil. A significant inverse relationship between the age of symptom onset and CAG repeat length in the mutated allele was observed across SCAs 2, 3, and 7. This study also highlights a trend towards paternal inheritance in SCA2 and details the distribution of CAG repeat expansions, which correlates larger expansions with earlier onset and specific symptomatology. This extensive analysis underscores the critical importance of genetic testing in the diagnosis and management of SCAs and enlightens the intricate genotype‒phenotype interplay within a genetically diverse population. Despite certain limitations, such as potential selection bias and the retrospective nature of the study, our research provides invaluable insights into the prevalence, genetic underpinnings, and clinical variability of SCAs in Brazil. We suggest a broader demographic scope and investigations into nonmotor symptoms in future studies to obtain a more comprehensive understanding of SCAs.

Clinical relevance and druggability of sole reciprocal kinase fusions: A large-scale study.

Building on our prior work that RNA alternative splicing modulates the druggability of kinase fusions, this study probes the clinical significance of sole reciprocal fusions. These rare genomic arrangements, despite lacking kinase domains at the DNA level, demonstrated potential RNA-level druggability in sporadic cases from our prior research. Utilizing the large-scale multicenter approach, we performed RNA sequencing and clinical follow-up to evaluate a broad spectrum of kinase fusions, including ALK, ROS1, RET, BRAF, NTRK, MET, NRG1, and EGFR, in 1943 patients. Our findings revealed 51 instances (2.57%) of sole reciprocal fusions, predominantly in lung (57%), colorectal (14%), and glioma (10%) cancers. Comparative analysis with an MSKCC cohort confirmed the prevalence in diverse cancer types and identified unique fusion partners and chromosomal locales. Cross-validation through RNA-NGS and FISH authenticated the existence of functional kinase domains in subsets including ALK, ROS1, RET, and BRAF, which correlated with positive clinical responses to targeted kinase inhibitors (KIs). Conversely, fusions involving EGFR, NRG1, and NTRK1/2/3 generated nonfunctional transcripts, suggesting the need for alternative therapeutic interventions. This inaugural multicenter study introduces a novel algorithm for detecting and treating sole reciprocal fusions in advanced cancers, expanding the patient population potentially amenable to KIs.

Phenotyping mitochondrial glutamyl-tRNA synthetase deficiency (EARS2): A case series and systematic literature review

Mitochondrial glutamyl-aminoacyl tRNA synthetase deficiency, stemming from biallelic mutations in the EARS2 gene, was first described in 2012. With <50 cases reported globally, this condition exhibits a distinct phenotype of neonatal or childhood-onset, often referred to as leukoencephalopathy with thalamus and brainstem involvement and high lactate (LTBL). It has also been one of the few reversible mitochondrial disorders described. The natural history of these patients is poorly documented, ranging from clinical and radiological improvement to early death.Herein, we detail three cases from our centre, including follow-up on the Portuguese patient reported by Steenweg et al., These cases illustrate the phenotypic spectrum: i) rapidly progressive neonatal presentation with lactic acidemia and corpus callosum agenesis, leading to early death; ii) early onset with a severe, slowly progressive course; iii) early onset with a milder phenotype, showing some improvement and mild neurological symptoms. Additionally, we conducted a systematic literature review on cases of EARS2-deficient patients, focusing on clinical manifestations, laboratory findings, radiological aspects, and disease progression over time, along with respective data analysis. “Patients with EARS2 deficiency typically present within the first year of life with a well-defined neurometabolic disorder picture, often including hypotonia and/or spasticity, along with neurodevelopmental delay or regression. There are no pathognomonic features specific to EARS2 deficiency, and no genotype-phenotype correlation has been identified.” Comparing to initial characterization by Steenweg et al., this analysis reveals an expanded disease spectrum. We propose a novel strategy for clustering phenotypes into severe, moderate, or mild disease based on initial presentation, seemingly correlating with disease progression. The paucity of data on the disease's natural history highlights the need for a multicentric approach to enhance understanding and management. Take-home messageAnalysis of all cases published with EARS2 deficiency allows for establish disease spectrum and a novel strategy for clustering phenotypes which correlate to disease progression.

Targeting treatment resistance: unveiling the potential of RNA methylation regulators and TG-101,209 in pan-cancer neoadjuvant therapy

BackgroundTumor recurrence and mortality rates remain challenging in cancer patients despite comprehensive treatment. Neoadjuvant chemotherapy and immunotherapy aim to eliminate residual tumor cells, reducing the risk of recurrence. However, drug resistance during neoadjuvant therapy is a significant hurdle. Recent studies suggest a correlation between RNA methylation regulators (RMRs) and response to neoadjuvant therapy.MethodsUsing a multi-center approach, we integrated advanced techniques such as single-cell transcriptomics, whole-genome sequencing, RNA sequencing, proteomics, machine learning, and in vivo/in vitro experiments. Analyzing pan-cancer cohorts, the association between neoadjuvant chemotherapy/immunotherapy effectiveness and RNA methylation using single-cell sequencing was investigated. Multi-omics analysis and machine learning algorithms identified genomic variations, transcriptional dysregulation, and prognostic relevance of RMRs, revealing distinct molecular subtypes guiding pan-cancer neoadjuvant therapy stratification.ResultsOur analysis unveiled a strong link between neoadjuvant therapy efficacy and RNA methylation dynamics, supported by pan-cancer single-cell sequencing data. Integration of omics data and machine learning algorithms identified RMR genomic variations, transcriptional dysregulation, and prognostic implications in pan-cancer. High-RMR-expressing tumors displayed increased genomic alterations, an immunosuppressive microenvironment, poorer prognosis, and resistance to neoadjuvant therapy. Molecular investigations and in vivo/in vitro experiments have substantiated that the JAK inhibitor TG-101,209 exerts notable effects on the immune microenvironment of tumors, rendering high-RMR-expressing pan-cancer tumors, particularly in pancreatic cancer, more susceptible to chemotherapy and immunotherapy.ConclusionsThis study emphasizes the pivotal role of RMRs in pan-cancer neoadjuvant therapy, serving as predictive biomarkers for monitoring the tumor microenvironment, patient prognosis, and therapeutic response. Distinct molecular subtypes of RMRs aid individualized stratification in neoadjuvant therapy. Combining TG-101,209 adjuvant therapy presents a promising strategy to enhance the sensitivity of high-RMR-expressing tumors to chemotherapy and immunotherapy. However, further validation studies are necessary to fully understand the clinical utility of RNA methylation regulators and their impact on patient outcomes.

Towards multicenter β-amyloid PET imaging in mouse models: A triple scanner head-to-head comparison

Aimβ-amyloid (Aβ) small animal PET facilitates quantification of fibrillar amyloidosis in Alzheimer's disease (AD) mouse models. Thus, the methodology is receiving growing interest as a monitoring tool in preclinical drug trials. In this regard, harmonization of data from different scanners at multiple sites would allow the establishment large collaborative cohorts and may facilitate efficacy comparison of different treatments. Therefore, we objected to determine the level of agreement of Aβ-PET quantification by a head-to-head comparison of three different state-of-the-art small animal PET scanners, which could help pave the way for future multicenter studies. MethodsWithin a timeframe of 5 ± 2 weeks, transgenic APPPS1 (n = 9) and wild-type (WT) (n = 8) mice (age range: 13–16 months) were examined three times by Aβ-PET ([18F]florbetaben) using a Siemens Inveon DPET, a MedisonanoScan PET/MR, and a MedisonanoScan PET/CT with harmonized reconstruction protocols. Cortex-to-white-matter 30–60 min p.i. standardized uptake value ratios (SUVRCTX/WM) were calculated to compare binding differences, effect sizes (Cohen's d) and z-score values of APPPS1 relative to WT mice. Correlation coefficients (Pearson's r) were calculated for the agreement of individual SUVR between different scanners. Voxel-wise analysis was used to determine the agreement of spatial pathology patterns. For validation of PET imaging against the histological gold standard, individual SUVR values were subject to a correlation analysis with area occupancy of methoxy‑X04 staining. ResultsAll three small animal PET scanners yielded comparable group differences between APPPS1 and WT mice (∆PET=20.4 % ± 2.9 %, ∆PET/MR=18.4 % ± 4.5 %, ∆PET/CT=18.1 % ± 3.3 %). Voxel-wise analysis confirmed a high degree of congruency of the spatial pattern (Dice coefficient (DC)PETvs.PET/MR=83.0 %, DCPETvs.PET/CT=69.3 %, DCPET/MRvs.PET/CT=81.9 %). Differences in the group level variance of the three scanners resulted in divergent z-scores (zPET=11.5 ± 1.6; zPET/MR=5.3 ± 1.3; zPET/CT=3.4 ± 0.6) and effect sizes (dPET=8.5, dPET/MR=4.5, dPET/CT=4.1). However, correlations at the individual mouse level were still strong between scanners (rPETvs.PET/MR=0.96, rPETvs.PET/CT=0.91, rPET/MRvs.PET/CT=0.87; all p ≤ 0.0001). Methoxy-X04 staining exhibited a significant correlation across all three PET machines combined (r = 0.76, p < 0.0001) but also at individual level (PET: r = 0.81, p = 0.026; PET/MR: r = 0.89, p = 0.0074; PET/CT: r = 0.93, p = 0.0028). ConclusionsOur comparison of standardized small animal Aβ-PET acquired by three different scanners substantiates the possibility of moving towards a multicentric approach in preclinical AD research. The alignment of image acquisition and analysis methods achieved good overall comparability between data sets. Nevertheless, differences in variance of sensitivity and specificity of different scanners may limit data interpretation at the individual mouse level and deserves methodological optimization.

Performing Lower-Limb Strength Exercises Before or After Training Does not Influence Fatigue Indices in Competitive Youth Soccer Players.

Gantzer, C, Huff, D, Butterick, B, Chalmers, S, Marshall, P, Lovell, R, and Siegler, JC. Performing lower-limb strength exercises before or after training does not influence fatigue indices in competitive youth soccer players. J Strength Cond Res XX(X): 000-000, 2024-A multicenter approach was used to conduct a controlled, laboratory-based study (Part A) in conjunction with an ecologically focused, field-based study (Part B) of the influence of timing on hamstring fatigue induced by lower-limb strength exercises. Part A required players to perform the FIFA 11+ warm-up before a simulated soccer training session, whereas the other session involved removing the lower-limb strength exercises from the warm-up and delivering them after the simulated session. For Part B, players completed 2 live training sessions, where one session included the Nordic hamstring exercise (NHE) as part of a standardized warm-up before training and the other session incorporated the NHE at the end of training. Maximal hamstring force (MVC), rate of force development (RFD), countermovement jump (CMJ), and sprint speed (SS) were assessed before, during, and after the simulation and field training, respectively, to quantify fatigue across both study cohorts. There was no suggestion that timing of the intervention had an influence fatigue in either Part A or B, with no condition (MVC [Part A & B]: p > 0.43; RFD: p = 0.43; CMJ: p = 0.10; SS: p = 0.62), time (MVC: p > 0.30; RFD: p = 0.72; CMJ: p = 0.87; SS: p = 0.85), or interactions (MVC: p > 0.93; RFD: p = 0.78; CMJ: p = 0.99; SS: p = 0.94) evident. Our findings suggest youth soccer coaches should not be concerned with the timing of interventions, allowing them to focus instead on adherence and player buy-in.

A qualitative, multi-centre approach to the current state of digitalisation and automation of surveillance in infection prevention and control in German hospitals

BackgroundHealthcare associated infections (HAI) pose a major threat to healthcare systems resulting in an increased burden of disease. Surveillance plays a key role in rapidly identifying these infections and preventing further transmissions. Alas, in German hospitals, the majority of surveillance efforts have been heavily relying on labour intensive processes like manual chart review. In order to be able to identify further starting points for future digital tools and interventions to aid the surveillance of HAI we aimed to gain an understanding of the current state of digitalisation in the context of the general surveillance organisation in German clinics across all care-levels. The end user perspective of infection prevention and control (IPC) professionals was chosen to identify digital interventions that have the biggest impact on the daily surveillance work routines of IPC professionals. Perceived impediments in the advancement of surveillance digitalisation should be explored.MethodsFollowing the development of an interview guideline, eight IPC professionals from seven German hospitals of different care levels were questioned in semi- structured interviews between December 2022 and January 2023. These included questions about general surveillance organisation, access to digital data sources, software to aid the surveillance process as well as current issues in the surveillance process and implementation of software systems. Subsequently, after full transcription, the interview sections were categorized in code categories (first deductive then inductive coding) and analysed qualitatively.ResultsResults were characterised by high heterogeneity in terms of general surveillance organisation and access to digital data sources. Software configuration of hospital and laboratory information systems (HIS/LIS) as well as patient data management systems (PDMS) varied not only between hospitals of different care levels but also between hospitals of the same care level. Outside research projects, neither fully automatic software nor solutions utilising artificial intelligence have currently been implemented in clinical routine in any of the hospitals.ConclusionsAccess to digital data sources and software is increasingly available to aid surveillance of HAI. Nevertheless, surveillance processes in hospitals analysed in this study still heavily rely on manual processes. In the analysed hospitals, there is an implementation and funding gap of (semi-) automatic surveillance solutions in clinical practice, especially in healthcare facilities of lower care levels.

Improving lung point-of-care ultrasound (POCUS) training and accreditation - a multidisciplinary, multi-centre and multi-pronged approach to development and delivery using the action learning process

BackgroundPoint-of-Care Ultrasound (POCUS) consists of a range of increasingly important imaging modalities across a variety of specialties. Despite a variety of accreditation pathways available in the UK, lung POCUS training remains difficult to deliver and accreditation rates remain suboptimal. We describe a multidisciplinary, multi-centre, and multi-pronged approach to lung POCUS education within a region.MethodsA survey was conducted in a region. From these results, bottlenecks were identified for improvement. We utilised key stages in an established accreditation pathway, and the Action Learning process. Analysing participant feedback, consensus amongst the team, regional educational needs, and leveraging the expertise within the faculty, we implemented several solutions which were multidisciplinary, multi-centre, and multi-pronged. We also set up a database across several accreditation pathways to facilitate supervision and assessment of rotational trainees.ResultsUtilising the Action Learning process, we implemented several improvements at elements of the lung ultrasound accreditation pathways. An initial regional survey identified key barriers to accreditation: lack of courses (52%), lack of mentors (93%), and difficulty arranging directly supervised scans (73%). A multidisciplinary team of trainers was assembled. Regular courses were organised and altered based on feedback and anecdotal educational needs within the region. Courses were set up to also facilitate continuing professional development and exchange of knowledge and ideas amongst trainers. The barrier of supervision was removed through the organisation of regular supervision sessions, facilitating up to fifty scans per half day per trainer. We collected feedback from courses and optimised them. Remote mentoring platforms were utilised to encourage asynchronous supervision. A database of trainers was collated to facilitate triggered assessments. These approaches promoted a conducive environment and a commitment to learning. Repeat survey results support this.ConclusionLung ultrasound accreditation remains a complex educational training pathway. Utilising an education framework, recruiting a multidisciplinary team, ensuring a multi-pronged approach, and fostering a commitment to learning can improve accreditation success.

Antimicrobial resistance surveillance of Bacteroides fragilis isolated from blood cultures, Europe, 2022 (ReSuBacfrag)

ObjectivesBacteroides fragilis is the most frequent cause of anaerobic bacteraemia. Although recent data suggest a rise in antimicrobial resistance (AMR) of this and other anaerobic bacteria, surveillance remains limited due to a lack of both data availability and comparability. However, a newly introduced standardised method for antimicrobial susceptibility testing (AST) of anaerobic bacteria has made larger scale surveillance possible for the first time. The aim of this study was to investigate phenotypic AMR of Bacteroides fragilis isolates from bacteraemia across Europe in 2022. MethodsIn a multicentre approach, clinical microbiology laboratories in Europe were invited to contribute results of AST for Bacteroides fragilis blood culture isolates (including only the first isolate per patient and year). AST of a selection of four antibiotics was performed locally by participating laboratories in a prospective or retrospective manner, using the new EUCAST disc diffusion method on fastidious anaerobe agar (FAA-HB). ResultsA total of 16 European countries reported antimicrobial susceptibilities in 449 unique isolates of Bacteroides fragilis from blood cultures in 2022. Clindamycin demonstrated the highest resistance rates (20.9%, range 0 - 63.6%), followed by piperacillin-tazobactam (11.1%, 0–54.5%), meropenem (13.4%, 0–45.5%), and metronidazole (1.8%, 0–20.0%), all with wide variation between countries. ConclusionConsidering that the mean resistance rates across Europe were higher than expected for three of the four anti-anaerobic antibiotics under surveillance, both local AST of clinically relevant isolates of Bacteroides fragilis and continued surveillance on an international level is warranted.

Dedicated anticoagulation management protocols in fragility femoral fracture care – a source of significant variance and limited effectiveness in improving time to surgery: The hip and femoral fracture anticoagulation surgical timing evaluation (HASTE) study

IntroductionApproximately 20 % of femoral fragility fracture patients take anticoagulants, typically warfarin or Direct Oral AntiCoagulant (DOAC). These can impact timing of surgery affecting patient survival. Due to several possible approaches and numerous factors to consider in the preoperative workup of anticoagulated patients, potential for variations in clinical practice exist. Some hospitals employ dedicated anticoagulation management protocols to address this issue, and to improve time to surgery. This study aimed to determine the proportion of hospitals with such protocols, compare protocol guidance between hospitals, and evaluate the effectiveness of protocols in facilitating prompt surgery. MethodsData was prospectively collected through a collaborative, multicentre approach involving hospitals across the UK. Femoral fragility fracture patients aged ≥60 years and admitted to hospital between 1st May to 31st July 2023 were included. Information from dedicated anticoagulation management protocols were collated on several domains relating to perioperative care including administration of reversal agents and instructions on timing of surgery as well as others. Logistic regression was used to evaluate effects of dedicated protocols on time to surgery. ResultsDedicated protocols for management of patients taking warfarin and DOACs were present at 41 (52.6 %) and 43 (55.1 %) hospitals respectively. For patients taking warfarin, 39/41 (95.1 %) protocols specified the dose of vitamin k and the most common was 5 milligrams intravenously (n=21). INR threshold values for proceeding to surgery varied between protocols; 1.5 (n=28), 1.8 (n=6), and 2 (n=6). For patients taking DOACs, 35/43 (81.4 %) and 8/43 (18.6 %) protocols advised timing of surgery based on renal function and absolute time from last dose respectively. Analysis of 10,197 patients from 78 hospitals showed fewer patients taking DOACs received surgery within 36 h of admission at hospitals with a dedicated protocol compared to those without (adjusted OR 0.73, 95% CI 0.54–0.99, p=0.040), while there were no differences among patients taking warfarin (adjusted OR 1.64, 95% CI 0.75–3.57, p=0.219). ConclusionsAround half of hospitals employed a dedicated anticoagulation management protocol for femoral fragility fracture patients, and substantial variation was observed in guidance between protocols. Dedicated protocols currently being used at hospitals were ineffective at improving the defined targets for time to surgery.

Multicenter continuum-state approach to molecular-frame photoelectron angular distributions: From plane-wave to twisted photons

Multicenter continuum-state approach to molecular-frame photoelectron angular distributions: From plane-wave to twisted photons