Scoping Review of Neuromonitoring practices for neonates with congenital heart disease
Protocol for Scoping Review of Neuromonitoring in Neonates with Congenital Heart Disease
We seek to synthesize the known literature for neuromonitoring with EEG, aEEG, NIRS, transcranial doppler (TCD) and other multimodal neuromonitoring techniques for neonates with congenital heart disease to clarify current practices, document available studies, investigate gaps in research that may inform the care of this population.
NO WAIT: new organised well-adapted immediate triage: a lean improvement project
Original Bibliographic Citation:
Elkholi A, Althobiti H, Al Nofeye J, et al. NO WAIT: new organised well-adapted immediate triage: a lean improvement project. BMJ Open Quality 2021;10:e001179. doi:10.1136/bmjoq-2020-001179
Long waiting times in the emergency department (ED) are associated with decreased patient satisfaction and increased morbidity and mortality. Triage may be a contributing factor to prolonged wait times in the ED. At Alhada Armed Forces Hospital (Taif, Saudi Arabia), patients other than level 1 and 2 on the Canadian Triage and Acuity Scale are requested to wait until triage. During peak hours (08:0022:00), the waiting time prior to triage is prolonged, and several patients leave the ED before triage. In this project, a multidisciplinary team was assembled to revise patient flow from the time of arrival at the ED to the time of triage. Lean methodology was used to identify the redundancies and design a seamless flow process for ED patients. Through reorganising the triage area using minimal additional resources, the project team devised a novel floor plan for the triage area which provided a unique patient flow in the ED. The median patient wait time from arrival to triage was reduced from 27 min to 4.09 min and the percentage of patients leaving the ER before triage was reduced to 0%. This project is the first of its kind in Saudi Arabia, as well as in the Gulf region, and provides a radical solution to the problem of patient waiting in the ED during peak hours.
The Use of Patient-Reported Outcome Measures (PROMs) for Care of People with Cardiovascular Disease in African Countries A Scoping Review Protocol
The persistence of poor healthcare outcomes from cardiovascular disease has caused a shift towards measuring patientreported outcomes (PROMs) as a method to improve quality of care. Some patientreported outcomes have been associated with improved mortality and readmission-rates; however, the majority of research in this field originates from high-income and/or nonAfrican countries.This protocol is for a scoping review of the current use of PROMs in care of patients with cardiovascular disease within African countries. The goal of this review is to determine the extent of published literature on the measurement and use of PROMs for cardiovascular care within Africa. In doing this, the aim is to identify: strengths and weaknesses in PROM use, barriers and assets into implementation, the pool of PROM tools in use in the setting, and gaps in the current literature.Eligible studies will have at least one study site located in an African country and use a PROM in clinical care or research of patients with any of the following primary cardiovascular diseases: coronary artery disease, heart failure, arrhythmias, cardiomyopathy, and/or congenital heart disease. Examples of patientreported outcome measures include: symptoms, functional status, depression, selfefficacy, ADLs.Methods: The search will utilize seven databases, searching from the earliest available article until the day of the final search. Each title/abstract will be screened by two reviewers, with a third reviewer serving as a tie-breaker in the case of a disagreement about the inclusion criteria. Articles which make it past the titles/abstract screen will moved to the full text review. During this phase, relevant evidence from each article will be charted on an excel sheet. Results will categorized and published in a per-reviewed manuscript.
patient-centered care, patient-reported outcome, patient voice, cultural adaptation, Africa
An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summary of evidence
Original Bibliographic Citation:
Hasan MM, Zhang M, Beal M, et al. An umbrella review comparing computer-assisted and conventional total joint arthroplasty: quality assessment and summaryof evidence. BMJ Surg Interv Health Technologies2020;2:e000016. doi:10.1136/bmjsit-2019-000016
Background Systematic reviews (SRs) of computer-assisted (CA) total knee arthroplasty (TKA) and total hip arthroplasty (THA) report conflicting evidence on its superiority over conventional surgery. Little is known about the quality of these SRs; variability in their methodological quality may be a contributing factor. We evaluated the methodological quality of all published SRs to date, summarized and examined the consistency of the evidence generated by these SRs.Methods We searched four databases through December 31, 2018. A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) was applied to assess the methodological quality. Evidence from included meta-analyses on functional, radiological and patient-safety outcomes was summarized. The corrected covered area was calculated to assess the overlap between SRs in including the primary studies.Results Based on AMSTAR 2, confidence was critically low in 39 of the 42 included SRs and low in 3 SRs. Low rating was mainly due to failure in developing a review protocol (90.5%); providing a list of excluded studies (81%); accounting for risk of bias when discussing the results (67%); using a comprehensive search strategy (50%); and investigating publication bias (50%). Despite inconsistency between SR findings comparing functional, radiological and patient safety outcomes for CA and conventional procedures, most TKA meta-analyses favored CA TKA, whereas most THA meta-analyses showed no difference. Moderate overlap was observed among TKA SRs and high overlap among THA SRs.Conclusions Despite conclusions of meta-analyses favoring CA arthroplasty, decision makers adopting this technology should be aware of the low confidence in the results of the included SRs. To improve confidence in future SRs, journals should consider using a methodological assessment tool to evaluate the SRs prior to making a publication decision.
overview of systematic review, total joint arthroplasty, computer-assisted surgery, meta-analysis
SARS-CoV-2 ORF8 Forms Intracellular Aggregates and Inhibits IFN-Induced Antiviral Gene Expression in Human Lung Epithelial Cells
Original Bibliographic Citation:
Geng H, Subramanian S, Wu LT, Bu HF, Wang X, Du C, De Plaen IG, Tan XD. SARS-CoV-2 ORF8 Forms Intracellular Aggregates and Inhibits IFN gamma-Induced Antiviral Gene Expression in Human Lung Epithelial Cells. Frontiers in Immunology. 2021;12:11.
Infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19, a disease that involves significant lung tissue damage. How SARS-CoV-2 infection leads to lung injury remains elusive. The open reading frame 8 (ORF8) protein of SARS-CoV-2 (ORF8(SARS-CoV-2)) is a unique accessory protein, yet little is known about its cellular function. We examined the cellular distribution of ORF8(SARS-CoV-2) and its role in the regulation of human lung epithelial cell proliferation and antiviral immunity. Using live imaging and immunofluorescent staining analyses, we found that ectopically expressed ORF8(SARS-CoV-2) forms aggregates in the cytosol and nuclear compartments of lung epithelial cells. Using in silico bioinformatic analysis, we found that ORF8(SARS-CoV-2) possesses an intrinsic aggregation characteristic at its N-terminal residues 1-18. Cell culture did not reveal any effects of ORF8(SARS-CoV-2) expression on lung epithelial cell proliferation and cell cycle progression, suggesting that ORF8(SARS-CoV-2) aggregates do not affect these cellular processes. Interestingly, ectopic expression of ORF8(SARS-CoV-2) in lung epithelial cells suppressed basal expression of several antiviral molecules, including DHX58, ZBP1, MX1, and MX2. In addition, expression of ORF8(SARS-CoV-2) attenuated the induction of antiviral molecules by IFN gamma but not by IFN beta in lung epithelial cells. Taken together, ORF8(SARS-CoV-2) is a unique viral accessory protein that forms aggregates when expressing in lung epithelial cells. It potently inhibits the expression of lung cellular anti-viral proteins at baseline and in response to IFN gamma in lung epithelial cells, which may facilitate SARS-CoV-2 escape from the host antiviral innate immune response during early viral infection. In addition, it seems that formation of ORF8(SARS-CoV-2) aggregate is independent from the viral infection. Thus, it would be interesting to examine whether any COVID-19 patients exhibit persistent ORF8 SARS-CoV-2 expression after recovering from SARS-CoV-2 infection. If so, the pathogenic effect of prolonged ORF8(SARS-CoV-2) expression and its association with post-COVID symptoms warrant investigation in the future.