A meta-analysis of the sources of variation in the environmental impacts of different broiler production systems

1. Shifting to higher welfare systems is expected to increase their environmental impact and mitigation strategies need to be identified. The environmental impacts associated with various broiler production systems (BPS: conventional, higher welfare indoors, free-range or organic) and the characteristics of BPS which contribute to these impacts were investigated via a literature review and meta-analysis.2. The impact metrics considered were global warming (GWP), acidification and eutrophication potentials, NH3 emissions, land use, water use, energy use (EU) and biodiversity. Due to the paucity of data, analysis was limited to the impacts of the characteristics of the BPS: stocking density (STD), slaughter weight (SW), feed conversion ratio (FCR), on GWP, NH3 emissions and EU.3. After correction for system boundaries and functional units, no statistical effects of BPS on GWP were found, while higher welfare systems were associated with higher EU. Reduced STD was associated with reductions in GWP and EU. The SW was positively associated with GWP and NH3 emissions, while higher FCR was associated with increased NH3 emissions and EU.4. Environmental impacts arose from feed-associated activities (>75%). Most of the GWP impacts were associated with land use change (LUC), especially when associated with 'unsustainable' soya. High variation in values for different environmental metrics within BPS indicated a lack of standardisation in the assessment of environmental impact across the industry.5. The results suggested that practices within a system contributed greatly to the environmental impact of the system. Rather than comparing systems, it may be more productive to focus on improving practices that have the potential to reduce environmental impacts within a system, without compromising animal welfare.

Emotion word repertoire in the adult attachment interview is linked to reduced suicide attempts in patients with borderline personality disorder

Background

This study explored the association between emotion word repertoire (EWR), attachment, reflective functioning and personality organization (PO) and suicidal behavior in borderline personality disorder (BPD) patients.

Methods

The current study performed a secondary data analysis from a randomized control trial for BPD patients (all female; n = 87; age: m = 27; SD = 7.42). EWR was assessed via machine-scoring transcripts of Adult Attachment Interviews (AAI) for affective words using the VETA electronic scoring software for the Levels of Emotional Awareness Scale (LEAS). Generated scores were related to impairments in PO (Structured Interview for Personality Organization; STIPO), attachment organization (AAI) and mentalization (Reflective Functioning Scale), general symptom severity (Brief Symptom Inventory; BSI-53), self-harm and suicidal behavior. Independent effects of the investigated predictors were studied using Bayesian path analysis.

Results

Corrected for education, findings in Bayesian path analysis suggest an independent negative association between EWR and suicide attempts (BE = -.32; 95 % CI [-.51, -.12]) and positive associations of deficits in PO with psychiatric symptoms (BE = .23; 95 % CI [.01, .44]) as well as suicide attempts (BE = .30; 95 % CI [.08, .49]).

Discussion

The findings underscore the potential role of high EWR and PO as a protective factor for suicidal behavior in individuals with BPD.

Facilitating the use of routine data to evaluate artificial intelligence solutions: lessons from the NIHR/RCR data curation workshop

Radiology currently stands at the forefront of artificial intelligence (AI) development and deployment over many other medical subspecialities within the scope of both research and clinical practice. Given this current leadership position, it is imperative that we foster collaboration and knowledge sharing to ensure the ethical, responsible and effective continued progress of AI technologies in our field, ultimately leading to enhanced patient care. To achieve this objective, three workshops have been planned through a coordinated effort by the NIHR/RCR committee. These workshops aim to convene key stakeholders including eminent academics, departmental leaders and industry partners to provide insights from their own experiences and strategies to overcome common challenges faced. In this article, we describe the outcomes from the first workshop, which addresses the topic of "facilitating the use of routine data to evaluate AI solutions". The main key insights uncovered include the need for ethical considerations, detailing of methods for data curation and storage depending on the need and requirements for de-identification. We provide resources for how to de-identify data and also a list of concerns to think about before curating your data. Finally, we address secure data-sharing methods and explore the need for quality assurances, the role of the data access committee and the patient perspectives in this task.

A qualitative investigation of experiences of breastfeeding twins and multiples

BACKGROUND

Research has found that twins and multiples are less likely to be breastfed than singleton babies. Exploration of the experience of breastfeeding twins and multiples from parents' perspectives is limited, and we know little about the experiences of those who breastfeed twins and multiples and the possible barriers they face.

AIM

The aim of the research was to explore experiences of breastfeeding twins and multiples in the UK from the perspective of birthing parents.

METHODS

A qualitative online survey was carried out (n = 94), followed by online semi-structured interviews (n = 18). The data were analysed using reflexive thematic analysis.

FINDINGS

Four themes were developed from the data: (1) "It's one of the things I'm most proud of in my life" (2) The importance of support: "it definitely takes a village with twins" (3) Barriers and the pressure to formula feed: "all they wanted to do was stuff 'em full of formula" and (4) The dynamic experience of breastfeeding twins.

DISCUSSION

Many of the participants were able to feed their babies in part due to sheer determination and the refusal to give up when met with challenges. Breastfeeding was an important part of their identity as a mother, however mental health was often impacted by their experiences, as well as the challenges they faced when seeking support.

CONCLUSION

Breastfeeding twins and multiples is a challenging yet rewarding experience. Our findings indicate that further training and support is needed to enable healthcare providers to support parents of twins on their breastfeeding journey.

Evaluation of environmental features that support breastfeeding: A photovoice study

The United Kingdom (UK) has some of the lowest breastfeeding rates in the world, and Stoke-on-Trent has some of the lowest breastfeeding rates and highest infant mortality rates in the UK. Vicarious experience of formula feeding, formula feeding culture, and a lack of physical environments to support breastfeeding are known barriers to uptake and maintenance. Improving physical environments and increasing the visibility of breastfeeding in public would help to challenge these barriers. This research employs a participatory approach to understand the facilitators and barriers to breastfeeding in public. Nine breastfeeding peer supporters were recruited as co-researcher for a photovoice study. Co-researchers collated images of features in environments which they felt either supported or acted as a barrier to public breastfeeding. An analysis workshop was held to review the data collected and produce collaboratively agreed findings. Various environmental features were highlighted as facilitators to breastfeeding including family rooms, welcoming signage, supportive staff members, and displays of information about breastfeeding. In addition, poorly designed family rooms, lack of inclusivity within breastfeeding spaces, breastfeeding spaces within toilets and a lack of information were barriers to public breastfeeding. This research illustrates that while some environments are well designed to support breastfeeding many others are not. Environments often lack basic provision and/or make token gestures towards breastfeeding support, such as welcome signage, without providing the infrastructure needed to support breastfeeding. More education about breastfeeding friendly spaces and resources for putting this information into practice are needed for environment owners, managers, and policy makers.

Characteristics, enablers, and barriers to the community health and well-being assessment component of the health promotion practice cycle: a scoping review protocol

OBJECTIVE

The proposed review will describe the characteristics, enablers, and barriers to the community health and well-being assessment (CHWA) component of the health promotion practice cycle.

INTRODUCTION

CHWA guides health promotion action in communities and populations. A "critical" approach to CHWA can be adopted, which addresses the social, political, cultural, economic, commercial, and environmental determinants of health and well-being to enhance health equity for priority communities and populations. Although tools exist to guide such a critical approach, little is known about the extent to which these tools are being used or the barriers and enablers to applying best practice CHWA. Such evidence is needed to inform future health promotion CHWA and research.

INCLUSION CRITERIA

This review will consider literature that describes CHWA conducted in health promotion practice, focusing on an organizational, social, or geographical community or population. Literature that focuses on clinical practice or a specific health condition will be excluded.

METHODS

Scopus, PubMed, Web of Science, and CINAHL (EBSCOhost) will be searched to identify peer-reviewed articles. Google Scholar and Google, as well as Public Health, Health and Medical, and Nursing and Allied Health (ProQuest) databases will be searched for gray literature. Articles will be screened and data extracted by 2 or more independent reviewers. The data extraction tool will be developed by the reviewers based on the JBI template and a critical health promotion approach to CHWA. Data will be analyzed and presented as frequency tables and narrative summaries of the characteristics, enablers, and barriers to CHWA.

REVIEW REGISTRATION

Open Science Framework osf.io/jq8th/.

Communicating about sexual activity and intimacy after a heart attack: a cross-sectional survey of Australian health professionals

AIMS

Sexual activity and intimacy improve quality of life for heart attack survivors. After a heart attack, patients frequently experience sexual dysfunction and anxiety about resuming sexual activity. However, most health professionals do not discuss sex or intimacy with their patients. The aim of this research was to explore the perceptions and practices of Australian health professionals in discussing sexual activity and intimacy with heart attack survivors and the barriers to achieving this.

METHODS AND RESULTS

This study employed a cross-sectional study design and online self-administered survey questionnaire. Study participants were a convenience sample of Australian health professionals working with cardiac patients, including general practitioners, cardiologists, cardiac rehabilitation specialists, registered nurses, and allied health professionals. Data were analysed using descriptive statistics and cross-tabulations to understand the different perspectives of health professional groups and the overall sample. Of 252 respondents, almost all believed discussing sex and intimacy with heart attack survivors was important, yet less than a quarter reported regularly doing so. About three-quarters reported feeling comfortable discussing sex and intimacy with either men or women, with half comfortable to do so with patients from diverse cultures. Barriers included lack of time, privacy, consumer resources, and protocols to guide discussions.

CONCLUSION

This research supports the need for structural changes such as a clinical protocol, longer and more private consultations, staff training, and culturally appropriate patient-oriented resources to support health professionals to guide discussions about sexual activity and intimacy with patients who have had a heart attack.

Australian health professionals' perspectives on discussing sexual activity and intimacy with people who have had a heart attack: a qualitative study

BACKGROUND

Sexual activity and intimacy contribute to wellbeing throughout adult life, including after a heart attack. Providing support and information about sexual activity and intimacy after a heart attack is recognised as part of a comprehensive approach to cardiac rehabilitation. Previous research shows that patients expect health professionals to initiate discussions about sexual activity and intimacy, but that this seldom occurs.

METHODS

Drawing on qualitative survey responses from a range of Australian health professionals working in cardiac care and rehabilitation, this research examined their perspectives on discussing sexual activity and intimacy with their patients, and patients' partners. Using a social constructionist approach, thematic analysis was used to identify themes expressed by participants.

RESULTS

Discussions about sexual activity and intimacy after heart attack were perceived as nebulous and taboo. The predominance of an illness - rather than wellness - framing of these discussions and a tendency for health professionals to make judgement calls contributed to discussions not occurring. Health professionals also identified a range of intrapersonal, interpersonal and structural obstacles to discussions, including embarrassment, fear of patients' embarrassment, a lack of role clarity, the absence of a clear protocol or training to guide practice, and a lack of time, privacy and patient resources.

CONCLUSIONS

Such discussions require normalisation, careful timing, sufficient time and adequate privacy. Staff training, a protocol and appropriate patient resources are needed to support health professionals to initiate discussions. Further research is required that investigates the impact of specific resources and training on health professionals' practice and patient outcomes.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Wrong-route drug administration errors: A review of the literature

Oral drug formulations and enteral feeds may inadvertently be administered intravenously. Intravenous medications may be inadvertently administered intra-arterially. These examples of wrong-route drug administration errors have the potential to cause significant organ dysfunction and even death. This narrative review aims to explore the pathophysiological mechanisms underlying such errors and investigate preventive strategies and potential therapeutic options.

Characterization of critical health promotion: a scoping review protocol

OBJECTIVE

This scoping review will explore how critical health promotion is characterized in the health promotion literature.

INTRODUCTION

Critical health promotion has emerged as a social justice approach to health promotion to address the persistent global issue of health inequity. Whilst critical health promotion is not conceptually new and the term has been used in the literature, albeit sparingly, this approach has not been adopted as standard health promotion practice, compromising the advancement of health equity. Given that language shapes the understanding and practice of health promotion, it is imperative to explore how critical health promotion is characterized in the literature to increase uptake of the approach.

INCLUSION CRITERIA

This review will consider sources that explore critical health promotion and are explicitly positioned as health promotion sources.

METHODS

Scopus, CINAHL (EBSCOhost), PubMed, Global Health (CABI), and the Public Health Database (ProQuest) will be searched to identify relevant full-text papers, including original research, reviews, editorials, and opinion papers. Searches of Google Scholar, Google, and ProQuest Dissertations & Theses Global (ProQuest) will be undertaken to identify gray literature. No language or date restrictions will be applied. Two reviewers will screen sources and extract data using a tool that will be pilot tested, modified, and revised, as necessary. Analysis will involve basic frequency counts and descriptive qualitative content analysis through basic coding. The results will be presented in tables, charts, and word clouds, accompanied by a narrative summary.

Initial Experience with the Commercial Electron FLASH Research Extension

PURPOSE/OBJECTIVE(S)

The purpose of this study was to introduce a new commercial electron FLASH system that has the potential to become widely available for FLASH researchers globally. In this study, we first present the initial acceptance and commissioning tests for the FLASH system, and second, we highlight preliminary FLASH effect results from our cell studies.

MATERIALS/METHODS

A linear accelerator was converted into a commercial research platform with the FLASH Research Extension, enabling the generation of a powerful 16 MeV electron FLASH beam. The dosimetric and stability tests were conducted using various dosimeters (i.e., radiochromic film, optically stimulated luminescent dosimeters (OSLDs), and a plane-parallel ionization chamber). To evaluate the FLASH effect, normal and cancer cell lines were FLASH irradiated using different pulse repetition frequencies (PRF) of 18 pulses/s and 180 pulses/s.

RESULTS

The electron FLASH mode was able to generate over 1 Gy per pulse at the isocenter and a dose rate of up to 690 Gy/s near the accessory mount of the Linac gantry head. The charge collected by the plane-parallel ionization chamber at the highest PRF (i.e., 180 pulses/s) showed a linear relationship with the delivered number of pulses (i.e., 1 to 99 pulses) with a coefficient of determination (R2) of 0.9996. The absorbed dose measured using radiochromic film and OSLDs agreed within 3%, on average, and followed an inverse square law as the source-to-axis distance (SAD) varied for which the R2 values were 0.9972 and 0.9955 for radiochromic film and OSLDs, respectively. The profile of the FLASH beam was symmetrical but was not as flat as the conventional 16 MeV electron beam due to the use of a thinner custom scattering foil to reduce the degradation of the ultra-high dose rate. The depth-dose curve beyond the build-up region for the FLASH beam was similar to the conventional 16 MeV electron beam for which the range at 50% the maximum dose (R50) agreed within 0.5 mm. The FLASH beam output remained consistent over a 4-month period with a variation of 2.5%, on average. The FLASH sparing effect was observed in vitro for healthy human pancreatic cells. Furthermore, we observed that the highest PRF beam (180 pulses/s) was more effective at destroying pancreatic cancerous cells while minimizing damage to healthy cells compared to the lowest PRF beam (18 pulses/s).

CONCLUSION

The novel commercial FLASH Research Extension system was dosimetrically characterized for pre-clinical FLASH research, and preliminary in vitro results demonstrated the FLASH effect. Given the prevalence of linear accelerators, this new commercial system has the potential to greatly increase the access to FLASH research.

Azimuthal Correlations within Exclusive Dijets with Large Momentum Transfer in Photon-Lead Collisions

The structure of nucleons is multidimensional and depends on the transverse momenta, spatial geometry, and polarization of the constituent partons. Such a structure can be studied using high-energy photons produced in ultraperipheral heavy-ion collisions. The first measurement of the azimuthal angular correlations of exclusively produced events with two jets in photon-lead interactions at large momentum transfer is presented, a process that is considered to be sensitive to the underlying nuclear gluon polarization. This study uses a data sample of ultraperipheral lead-lead collisions at sqrt[s_{NN}]=5.02  TeV, corresponding to an integrated luminosity of 0.38  nb^{-1}, collected with the CMS experiment at the LHC. The measured second harmonic of the correlation between the sum and difference of the two jet transverse momentum vectors is found to be positive, and rising, as the dijet transverse momentum increases. A well-tuned model that has been successful at describing a wide range of proton scattering data from the HERA experiments fails to describe the observed correlations, suggesting the presence of gluon polarization effects.

High-'n'-dry? A comparison of cannabis and alcohol use in drivers presenting to hospital after a vehicular collision

DESIGN

This was a prospective observational study.

BACKGROUND AND AIMS

The characteristics of cannabis-involved motor vehicle collisions are poorly understood. This study of injured drivers identifies demographic and collision characteristics associated with high tetrahydrocannabinol (THC) concentrations.

SETTING

The study was conducted in 15 Canadian trauma centres between January 2018 and December 2021.

CASES

The cases (n = 6956) comprised injured drivers who required blood testing as part of routine trauma care.

MEASUREMENTS

We quantified whole blood THC and blood alcohol concentration (BAC) and recorded driver sex, age and postal code, time of crash, crash type and injury severity. We defined three driver groups: high THC (THC ≥ 5 ng/ml and BAC = 0), high alcohol (BAC ≥ 0.08% and THC = 0) and THC/BAC-negative (THC = 0 = BAC). We used logistic regression techniques to identify factors associated with group membership.

FINDINGS

Most injured drivers (70.2%) were THC/BAC-negative; 1274 (18.3%) had THC > 0, including 186 (2.7%) in the high THC group; 1161 (16.7%) had BAC > 0, including 606 (8.7%) in the high BAC group. Males and drivers aged less than 45 years had higher adjusted odds of being in the high THC group (versus the THC/BAC-negative group). Importantly, 4.6% of drivers aged less than 19 years had THC ≥ 5 ng/ml, and drivers aged less than 19 years had higher unadjusted odds of being in the high THC group than drivers aged 45-54 years. Males, drivers aged 19-44 years, rural drivers, seriously injured drivers and drivers injured in single-vehicle, night-time or weekend collisions had higher adjusted odds ratios (aORs) for being in the high alcohol group (versus THC/BAC-negative). Drivers aged less than 35 or more than 65 years and drivers involved in multi-vehicle, daytime or weekday collisions had higher adjusted odds for being in the high THC group (versus the high BAC group).

CONCLUSIONS

In Canada, risk factors for cannabis-related motor vehicle collisions appear to differ from those for alcohol-related motor vehicle collisions. The collision factors associated with alcohol (single-vehicle, night-time, weekend, rural, serious injury) are not associated with cannabis-related collisions. Demographic factors (young drivers, male drivers) are associated with both alcohol and cannabis-related collisions, but are more strongly associated with cannabis-related collisions.

Examining service utilisation and impact among consumers of a national mental health stepped care programme in Australia: a protocol using linked administrative data

INTRODUCTION

Mental well-being is a global public health priority with increasing mental health conditions having substantial burden on individuals, health systems and society. 'Stepped care', where services are provided at an intensity to meet the changing needs of the consumer, is the chosen approach to mental health service delivery in primary healthcare in Australia for its efficiencies and patient outcomes; yet limited evidence exists on how the programme is being rolled out and its impact in practice. This protocol outlines a data linkage project to characterise and quantify healthcare service utilisation and impacts among a cohort of consumers of a national mental health stepped care programme in one region of Australia.

METHODS AND ANALYSIS

Data linkage will be used to establish a retrospective cohort of consumers of mental health stepped care services between 1 July 2020 and 31 December 2021 in one primary healthcare region in Australia (n=approx. 12 710). These data will be linked with records from other healthcare service data sets (eg, hospitalisations, emergency department presentations, community-based state government-delivered mental healthcare, hospital costs). Four areas for analysis will include: (1) characterising the nature of mental health stepped care service use; (2) describing the cohort's sociodemographic and health characteristics; (3) quantifying broader service utilisation and associated economic costs; and (4) assessing the impact of mental health stepped care service utilisation on health and service outcomes.

ETHICS AND DISSEMINATION

Approval from the Darling Downs Health Human Research Ethics Committee (HREA/2020/QTDD/65518) has been granted. All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals, conference presentations and industry meetings.

Search for light Higgs bosons from supersymmetric cascade decays in pp collisions at s=13TeV

A search is reported for pairs of light Higgs bosons (H 1 ) produced in supersymmetric cascade decays in final states with small missing transverse momentum. A data set of LHC pp collisions collected with the CMS detector at s = 13 TeV and corresponding to an integrated luminosity of 138fb - 1 is used. The search targets events where both H 1 bosons decay into pairs that are reconstructed as large-radius jets using substructure techniques. No evidence is found for an excess of events beyond the background expectations of the standard model (SM). Results from the search are interpreted in the next-to-minimal supersymmetric extension of the SM, where a "singlino" of small mass leads to squark and gluino cascade decays that can predominantly end in a highly Lorentz-boosted singlet-like H 1 and a singlino-like neutralino of small transverse momentum. Upper limits are set on the product of the squark or gluino pair production cross section and the square of the branching fraction of the H 1 in a benchmark model containing almost mass-degenerate gluinos and light-flavour squarks. Under the assumption of an SM-like branching fraction, H 1 bosons with masses in the range 40-120GeV arising from the decays of squarks or gluinos with a mass of 1200-2500GeV are excluded at 95% confidence level.

A Multielectrode Nerve Cuff for Chronic Velocity Selective Recording in a sheep model

Supra-sacral spinal cord injury (SCI) causes loss of bladder fullness sensation and bladder over-activity, leading to retention and incontinence respectively. Velocity selective recording (VSR) of nerve roots innervating the bladder might enable identification of bladder activity. A 10-electrode nerve cuff for sacral nerve root VSR was developed and tested in a sheep model during acute surgeries and chronic implantation for 6 months. The cuff performed well, with 5.90±1.90 kΩ electrode, and <~800 Ω tissue impedance after 189 days implantation with a stable device and tissues. This is important information for assessing the feasibility of chronic VSR.Clinical Relevance-This demonstrates the manufacturing and performance of a neural interface for chronic monitoring of bladder nerve afferents with applications in urinary incontinence and retention management following SCI.

Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update

BACKGROUND

Despite evidence supporting its use, many Enhanced Recovery After Surgery (ERAS) recommendations remain poorly adhered to and barriers to ERAS implementation persist. In this second updated ERAS® Society guideline, a consensus for optimal perioperative care in gynecologic oncology surgery is presented, with a specific emphasis on implementation challenges.

METHODS

Based on the gaps identified by clinician stakeholder groups, nine implementation challenge topics were prioritized for review. A database search of publications using Embase and PubMed was performed (2018-2023). Studies on each topic were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded by an international panel according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

RESULTS

All recommendations on ERAS implementation challenge topics are based on best available evidence. The level of evidence for each item is presented accordingly.

CONCLUSIONS

The updated evidence base and recommendations for stakeholder derived ERAS implementation challenges in gynecologic oncology are presented by the ERAS® Society in this consensus review.

Anxiety, stress, and depression in Australian pregnant women during the COVID-19 pandemic: A cross sectional study

BACKGROUND

The COVID-19 pandemic necessitated rapid responses by health services to suppress transmission of the virus.

AIM

This study aimed to investigate predictors of anxiety, stress and depression in Australian pregnant women during the COVID-19 pandemic including continuity of carer and the role of social support.

METHODS

Women aged 18 years and over in their third trimester of pregnancy were invited to complete an online survey between July 2020 and January 2021. The survey included validated tools for anxiety, stress, and depression. Regression modelling was used to identify associations between a range of factors including continuity of carer, and mental health measures.

FINDINGS

1668 women completed the survey. One quarter screened positive for depression, 19% for moderate or higher range anxiety, and 15.5% for stress. The most significant contribution to higher anxiety, stress, and depression scores was a pre-existing mental health condition, followed by financial strain and a current complex pregnancy. Protective factors included age, social support, and parity.

DISCUSSION

Maternity care strategies to reduce COVID-19 transmission restricted women's access to their customary pregnancy supports and increased their psychological morbidity.

CONCLUSION

Factors associated with anxiety, stress and depression scores during the COVID-19 pandemic were identified. Maternity care during the pandemic compromised pregnant women's support systems.

Developing day-case units: imperative for optimal patient care in interventional radiology

As interventional radiology (IR) treatments have evolved, they have become less invasive, enabling rapid recovery, which expedites ambulation and promotes same-day discharge. As a result of this, a significant proportion of IR elective work can be provided using a day-case service model. Reconfiguration of IR services to increase day-case procedures using a dedicated IR day-case unit (RDU) to facilitate the passage of patients is vital to ensure best medical practice. The aim of this review is to discuss the benefits of day-case IR procedures, the optimal structure of an RDU, and to inform radiologists how to introduce and/or improve day-case IR services in their IR practice.

Access to beds for interventional radiology patients: improving patient care

This review describes the rationale in support of admitting rights for interventional radiologists and presents options for the management of interventional radiology (IR) inpatients. The manuscript also discusses wider aspects of IR involvement in inpatient treatment, such as income and funding for IR services, and the implications for IR as a clinical specialty.