Setting the standard for pressure sore prevention on a trauma orthopaedic ward

This article describes an innovation used to tackle the problem of high prevalence and severity of pressure sores on an orthopaedic trauma ward. Simple data from the pressure sore prevalence survey were used to build the case and provide the rationale for action. Actions taken included targeting the elderly with hip fractures and having the prevention strategy start in Accident and Emergency (A&E) Department. A standard with a monitoring tool was devised at ward level to review and monitor our practice in pressure sore prevention. This has resulted in the reduction of the prevalence rate of pressure sores on the ward from 21% to 8% over four years. The severity of pressure sores also decreased.     

真实世界证据与随机对照试验：RCT DUPLICATE项目启动、实施、进展解读与启示（二）

随着医疗大数据的推广与应用,监管机构开始使用非随机化的真实世界证据（RWE）来评估医疗产品的有效性。本文简要介绍了哈佛大学研究团队于2018年发起RCT DUPLICATE项目的最新进展与研究成果,并结合我国医疗服务特点总结了相关研究经验,为国内学者今后开展相关RWE研究提供借鉴。     

Efficiency of a novel forensic room-temperature DNA storage medium

The success of forensic genetics has led to considerable numbers of DNA samples that must be stored. Thus, the ability to preserve the integrity of forensic samples is essential. The possibility of retesting these samples after many years should be guaranteed. DNA storage typically requires the use of freezers. Recently, a new method that enables DNA to be stored at room temperature was developed. This technology is based on the principles of anhydrobiosis and thus permits room-temperature storage of DNA. This study evaluates the ability of this technology to preserve DNA samples mimicking true mixture casework samples for long periods of time. Mixed human DNA from 2 or 3 persons and at low concentrations was dried and stored for a period ranging from 6 months to 2 years in the presence of a desiccant. The quality of the stored DNA was evaluated based on quantitative peak height results from Short Tandem Repeat (STR) genotyping and the number of observed alleles. Furthermore, we determined whether this matrix has a potential inhibitory or enhancing effect on the PCR genotyping reactions. In our previous work, we demonstrated the considerable potential of this new technology. The present study complements our previous work. Our results show that after 2 years of aging at room temperature, there is a decrease in the number of observed alleles and in the peak height of these alleles.     

Performance of WHO updated cardiovascular disease risk prediction charts in a low-resource setting – Findings from a community-based survey in Puducherry,India

Background and aimThe World Health Organization has revised the cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. These charts (non-lab and lab versions) estimate the total CVD risk in an individual, of which the non-lab is for low-resource settings. We aimed to estimate the burden of ten-year risk of fatal or non-fatal CVD event in the district of Puducherry in India using ‘non-lab’ and ‘lab’ versions of WHO CVD risk prediction charts, and to evaluate the agreement between them.Methods and resultsWe included 710 individuals aged 40–69 years who participated in a district wide non-communicable diseases survey conducted in Puducherry, India, during 2019–20. Both charts use information on age, gender, systolic blood pressure and smoking status. Additionally, lab-chart requires individual's status on diabetes mellitus and total cholesterol while non-lab requires body mass index. Population in different CVD risk levels was presented using proportions (95% confidence intervals). Agreement between lab and non-lab charts was evaluated using Cohen's Kappa (k).The lab and non-lab charts estimated 3% (95% CI: 1.7–4.2) and none of the population respectively, to have high risk (≥20%) for fatal or non-fatal CVD event over the next ten years. Both the charts showed 89.4% (95% CI:87.2%–91.7%) concordance in CVD risk prediction indicating a good level of agreement (k = 0.653).ConclusionWHO updated CVD risk prediction charts are feasible to apply when data is available and there is good agreement between non-lab and lab based charts.     

真实世界证据与随机对照试验：RCT DUPLICATE项目启动、实施、进展解读与启示（一）

近些年,医疗产品监管机构开始重新审视真实世界证据（RWE）对监管决策的潜在价值。RWE能否代替金标准随机对照试验（RCT）产生的证据尚不确定。哈佛大学研究团队于2018年发起了RCT DUPLICATE项目,旨在利用医疗索赔数据库模拟30个RCT,以探索效力-效果差距的量化方法并解释其潜在来源,增强RWE的可信度。本文回顾了RCT DUPLICATE项目的产生背景,重点介绍RCT DUPLICATE项目的研究目的、研究设计和实施流程,以期帮助国内学者更好地理解RWE的适用范围和应用价值。     

Body composition assessment in athletes with physical impairment who have been practicing a wheelchair sport regularly and for a prolonged period

BackgroundToday several important aspects related to the impact of long-term wheelchair sports on whole-body and regional body composition in athletes with a physical impairment are poorly understood.ObjectiveThis cross-sectional study aimed at investigating the impact of the long-term regular practice of wheelchair sports on body composition in male wheelchair athletes (WA) as compared with both non-athletic participants with a physical impairment and non-athletic able-bodied participants.MethodsNine WA were each matched pairwise by age, duration of injury and body mass index (BMI) with a participant with a physical impairment not engaged in any wheelchair sport (N-WA) and by age and BMI with an able-bodied (AB) participant. Whole-body and regional bone mineral content (BMC), fat-free soft tissue mass (FFSTM), fat mass (FM) and percentage FM (%FM) were assessed by means of Dual-Energy X-ray Absorptiometry.ResultsWA had significantly lower FM and %FM vs. N-WA at the whole-body level (P = 0.01 for both) and in the trunk region (P = 0.001 and P = <0.001, respectively). The only difference in body composition variables between WA and AB was found in the legs where WA had significantly higher FM (P = 0.014) along with lower BMC (P = 0.009) and FFSTM (P = 0.005) vs. AB in the legs.ConclusionsThe results of the present study showed that the regular, long-term practice of wheelchair sport may be associated with beneficial body composition adaptations in athletes with a physical impairment at the whole-body and trunk level.     

Participation in leisure activities among boys with attention deficit hyperactivity disorder

ADHD is a neural developmental disorder expressed in various life settings. Yet, previous studies have focused mainly on children's function in school and academic achievement. The purpose of the present study was, therefore, to examine participation patterns in outside formal school activities among boys with ADHD compared to typical boys. Participants included 25 boys aged 8–11 years with ADHD and 25 age-matched typical boys. All participants completed the Children's Assessment of Participation and Enjoyment (CAPE). Several aspects of participation were examined: diversity, intensity, enjoyment, place, and partners in 49 extra curricular activities. The findings indicate that boys with ADHD reported significant lower intensity rates of participation in most activity domains. Furthermore, boys with ADHD also reported higher diversity scores and lower enjoyment in ‘formal’ activities. Yet, no significant differences were found with regard to activity place and partners. These findings enhance the importance of providing therapy that refers to after school activities. Accordingly, CAPE can be useful for assessing boys with ADHD and planning appropriate intervention programs.