Enhancing the experience and outcomes of children with complex care needs in acute paediatric settings: a realist review protocol.

Introduction: The number of babies, children and young people with complex care needs (henceforth children with complex care needs (CCCN)) in England has increased in recent decades, and this has also been recognised globally. CCCN may have frequent and lengthy hospital admissions, but during these episodes, their needs are not always met, potentially resulting in suboptimal experiences and outcomes. Despite increased numbers of CCCN accessing acute care and displaying greater complexity, much of the contemporary literature has focused on primary care coordination between health, education and social care.

FFR-Guided Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Diabetes.

Importance: Outcomes in patients with diabetes after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown.

Objectives: To investigate the relative treatment effect of PCI vs CABG according to diabetes status with respect to major adverse cardiac and cerebrovascular events (MACCE) at 3 years and to evaluate the impact of the SYNTAX score.

Design, Setting, And Participants: This is a prespecified subgroup analysis of the FAME (Fractional Flow Reserve vs Angiography for Multivessel Evaluation) 3 trial, an investigator-initiated, randomized clinical trial conducted at 48 centers worldwide.

The environmental impact of intravenous antimicrobial therapies: a comparison of OPAT and inpatient administration care pathways.

Objectives: The urgent global threats of the climate crisis and antimicrobial resistance have the potential to be addressed in part by increasing the use of outpatient antimicrobial therapy (OPAT). Our study aimed to appraise the environmental impact of three commonly used OPAT pathways, and the traditional inpatient model of IV antimicrobial therapy.

Methods: We assessed the CO, waste and water footprint associated with self-care, nurse assisted and outpatient OPAT care pathways and inpatient administration of intravenous antibiotics to adult patients for whom OPAT was a viable treatment option.

A systematic review and meta-analysis of preoperative carbohydrate drink loading prior to elective hip and knee arthroplasty.

Background: The Enhanced Recovery After Surgery (ERAS) program has significantly reduced complication rates and hospital length of stay (LOS) for various surgical procedures. A key aspect is the reduction of pre-operative fasting through carbohydrate-loading protocols. There is limited research on the effects of pre-operative carbohydrate loading in elective lower limb arthroplasty.

Osimertinib long-term tolerability in patients with EGFRm NSCLC enrolled in the AURA program or FLAURA study.

Introduction: This post-hoc analysis of the registrational FLAURA study and AURA program reports long-term safety data in epidermal growth factor receptor-mutated (EGFRm), advanced non-small cell lung cancer (NSCLC) treated with osimertinib for ≥ 36 months.

Methods: Patients from FLAURA who received first-line osimertinib and from the AURA program (AURA, AURA2, AURA3) who received ≥ second-line osimertinib were included. Patients received osimertinib 80 mg once daily.

Implementing digital pathology: qualitative and financial insights from eight leading European laboratories.

Digital Pathology (DP) revolutionizes the diagnostic workflow. Digitized scanned slides enhance operational efficiency by facilitating remote access, slide storage, reporting and automated AI image analysis, and enabling collaboration and research. However, substantial upfront and maintenance costs remain significant barriers to adoption.

Machine learning models compared with current clinical indices to predict the outcome of high flow nasal cannula therapy in acute hypoxemic respiratory failure.

Background: Early identification of patients with acute hypoxemic respiratory failure (AHRF) who are at risk of failing high-flow nasal cannula (HFNC) therapy could facilitate closer monitoring, and timely adjustment/escalation of treatment. We aimed to establish whether machine learning (ML) models could predict HFNC outcome, early in the course of treatment, with greater accuracy than currently used clinical indices.

Methods: We developed ML models trained using measurements made within the first 2 h of treatment from 184 AHRF patients (37% HFNC failures) treated at the respiratory ICU of the University Hospital of Modena between 2018 and 2023.

Comparing the Treatment Outcomes of Oral and Injectable Iron Therapies for Anemia in Pregnancy: A Meta-Analysis.

Iron deficiency anemia (IDA) during pregnancy is a global public health concern, associated with significant maternal and neonatal complications. Intravenous (IV) iron therapy has emerged as a potential alternative to oral iron for rapid correction of anemia, but its impact on clinical outcomes remains unclear. This meta-analysis aimed to evaluate the effectiveness and safety of IV iron compared to oral iron in improving maternal and neonatal outcomes during pregnancy.

Modification of the course of disease progression in idiopathic pulmonary fibrosis by pirfenidone: evidence of the potential for disease reversal.

Idiopathic pulmonary fibrosis (IPF) is a fibrosing pneumonia of unknown causation with a chronic, progressive course that may be modified by treatment with the antifibrotic agents, pirfenidone and nintedanib. Both drugs have been shown to slow disease progression, but, in rare cases, pirfenidone has been shown to stabilise and even improve lung function. We present a case of a patient whose lung function and pathognomonic features on CT imaging improved significantly on commencement of treatment with pirfenidone.

Comparison of Efficacy of the Combination of Topical Tazarotene Gel and Oral Fluconazole Versus Oral Fluconazole Monotherapy in the Treatment of Onychomycosis.

Background: Onychomycosis is a chronic fungal infection of the nails of toes and fingers, with an ongoing search for appropriate and more officious treatment modalities because the currently applied regimens are far from perfect.

Objective: The objective of this study was to compare the efficacy of the combination of topical tazarotene 0.1% gel and oral fluconazole with weekly oral fluconazole monotherapy in the treatment of OM.

Optimisation of the deployment of automated external defibrillators in public places in England.

Background: Ambulance services treat over 32,000 patients sustaining an out-of-hospital cardiac arrest annually, receiving over 90,000 calls. The definitive treatment for out-of-hospital cardiac arrest is defibrillation. Prompt treatment with an automated external defibrillator can improve survival significantly.

Interventions that challenge established and accepted clinical practice: lessons learnt from a process evaluation of the STOP-APE trial.

Background: Developing and implementing interventions that change clinical practice can be challenging and complex. Such interventions can be particularly difficult when attempting to change established behaviours and practices. While extensive literature on implementation of interventions that focus on changing clinical practice exists, understanding of the difficulties involved in implementing interventions that go against accepted clinical practice is limited.

Unraveling Metabolic Dysfunction-Associated Steatotic Liver Disease Through the Use of Omics Technologies.

Non-alcoholic fatty liver disease (NAFLD), now referred to as metabolic dysfunction-associated steatotic liver disease (MASLD), is the most prevalent liver disorder globally, linked to obesity, type 2 diabetes, and cardiovascular risk. Understanding its potential progression from simple steatosis to cirrhosis and hepatocellular carcinoma (HCC) is crucial for patient management and treatment strategies. The disease's complexity requires innovative approaches for early detection and personalized care.

Patient and Family Involvement in Nursing Bedside Handover: A Qualitative Descriptive Study of Consumer Perceptions of Nursing Care.

Patient and family involvement in bedside handover is a requirement of the national standards on patient safety and quality in Australia. To ensure patient-and-family-centred care, it is essential to understand how patients and families perceive their involvement in nursing bedside handover and what difficulties they face when participating. This study aimed to explore patient and family perceptions of their involvement in nursing bedside handover.

Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management.

The 'Body Mass Index' (BMI) is an anachronistic and outdated ratio that is used as an internationally accepted diagnostic criterion for obesity, and to prioritise, stratify, and outcome-assess its management options. On an individual level, the BMI has the potential to mislead, including inaccuracies in cardiovascular risk assessment. Furthermore, the BMI places excessive emphasis on a reduction in overall body weight (rather than optimised body composition) and contributes towards a misunderstanding of the quiddity of obesity and a dispassionate societal perspective and response to the global obesity problem.

Patient Perception of Involvement in Nursing Bedside Handover: A Cross-Sectional Study.

Background: In Australia, aligned to safety and quality standards, the health system implements standardised practices that include patient involvement in nursing bedside handover. Despite this mandate, it remains unclear whether patients are genuinely participating in nursing bedside handovers and whether their perspectives are being considered.

Aim: To explore patient perceptions of their involvement in nursing bedside handovers.

Exercise rehabilitation for people with postural tachycardia syndrome at two secondary care centres in the UK: the PULSE feasibility randomised controlled trial.

Objectives: The aim of the study was to assess the feasibility of conducting a definitive multicentre randomised controlled trial (RCT) testing an online exercise rehabilitation and behavioural/motivational support intervention for people with postural tachycardia syndrome (PoTS).

Design: Feasibility RCT.

Setting: Two secondary care centres.

The recovery trajectory of anterior cruciate ligament ruptures in randomised controlled trials: A systematic review and meta-analysis of operative and nonoperative treatments.

Purpose: The purpose of this research was to understand the trajectory of recovery following anterior cruciate ligament (ACL) reconstruction compared to nonoperative treatments.

Methods: A systematic review and meta-analysis approach was used to evaluate randomised controlled trials (RCTs). A comprehensive search was conducted on databases including Medline, Embase, Web of Science and The Cochrane Central Register of Controlled Trials up until 18 May 2023.