Electronic Data Capture for Registries and Clinical Trials in Orthopaedic Surgery: Open Source versus Commercial Systems

Background  

Collection and analysis of clinical data can help orthopaedic surgeons to practice evidence based medicine. Spreadsheets and offline relational databases are prevalent, but not flexible, secure, workflow friendly and do not support the generation of standardized and interoperable data. Additionally these data collection applications usually do not follow a structured and planned approach which may result in failure to achieve the intended goal.     

Impact of COVID-19 outbreak on lifestyle behaviour: A review of studies published in India

Background and aimsThe entire globe is undergoing an unprecedented challenge of COVID-19 which has affected the lifestyle behaviour of individuals. The present review is an attempt to summarize the effect of pandemic COVID-19 on lifestyle behaviour among the Indian population.MethodsA review was carried out to summarize the effect of pandemic COVID-19 on lifestyle behaviour focusing on changes in dietary or eating behaviour, stress, sleep pattern, and level of physical activity among the Indian population. Literature searches were conducted in PubMed and Google Scholar from inception till October 2020 to identify all relevant studies.ResultsA total of 11 studies (n = 5957, age group 18–70 years, comprising both genders) consisting of 1 hospital and 10 community based, were included in the present review. A change in lifestyle behaviour was observed due to COVID-19. Psychosocial or any kind of mental stress among the participants was found to be prevalent. Weight gain and decline in physical activity were also observed. Not only sleep quantity but sleep quality was also found to be affected due to COVID-19.ConclusionThe present review indicates the need for lifestyle behaviour programmes via using the platform of E-media and also for the dissemination of health education.     

“Vitamin D supplementation and COVID-19 treatment: A systematic review and meta-analysis”

BackgroundVitamin-D is an immune-modulator which might be linked to disease severity by SARS-CoV-2.MethodsMeta-analysis of RCTs and quasi-experimental studies, evaluating the role of vitamin-D supplementation in COVID patients was done.ResultsTotal 5 studies (3 RCTs and 2 Quasi-experimental) including n = 467 patients were included. Vitamin D didn't reduce mortality (RR 0.55, 95%CI 0.22 to 1.39, p = 0.21), ICU admission rates (RR 0.20, 95% CI 0.01–4.26, p = 0.3) and need for invasive ventilation (RR 0.24, 95% CI 0.01–7.89, p = 0.42).ConclusionNo significant difference with vitamin-D supplementation on major health related outcomes in COVID-19. Well-designed RCTs are required addressing this topic.     

Identification of insulin resistance in Asian Indian adolescents: classification and regression tree (CART) and logistic regression based classification rules

Objective Biochemical measures for assessment of insulin resistance are not cost‐effective in resource‐constrained developing countries. Using classification and regression tree (CART) and multivariate logistic regression, we aimed to develop simple predictive decision models based on routine clinical and biochemical parameters to predict insulin resistance in apparently healthy Asian Indian adolescents. Design Community based cross‐sectional study. Subjects and patients Data of apparently healthy 793 adolescents (aged 14–19 years) were used for analysis. WHO's multistage cluster sampling design was used for data collection. Methods and measurements Homeostasis Model of Assessment value > 75th centile was used as cut‐off for defining the main outcome variable insulin resistance. CART was used to develop the decision tree models and multivariate logistic regression used to develop the clinical prediction score. Results Three classification trees and an equation for prediction score were developed and internally validated. The three decision trees were termed as CART I, CART II and CART III, respectively. CART I based on anthropometric parameters alone has sensitivity 88·2%, specificity 50·1% and area under receiver operating characteristic curve (aROC) 77·8%. CART II based on anthropometric and routine biochemical parameters has sensitivity 94·5%, specificity 38·3% and aROC 73·6%. CART III based on all anthropometric, biochemical and clinical parameters together has sensitivity 70·7%, specificity 79·2% and aROC 77·4%. Prediction score for insulin resistance = 1 × (waist circumference) + 1·1 × (percentage body fat) + 1·6 × (triceps skin‐fold thickness) – 1·9 × (gender). A score cut‐off of > 0 (using values marked for each) was a marker of insulin resistance in the study population (sensitivity 82·4%, specificity 56·7%, and aROC 73·4%). Conclusion These simple and cost‐effective classification rules may be used to predict insulin resistance and implement population based preventive interventions in Asian Indian adolescents.     

Original research: Improving safety and reducing error in endoscopy (ISREE): a survey of UK services

BackgroundThe Joint Advisory Group on Gastrointestinal Endoscopy (JAG) ‘Improving Safety and Reducing Error in Endoscopy’ (ISREE) strategy was developed in 2018. In line with the strategy, a survey was conducted within the JAG census in 2019 to gain further insights and understanding of key safety-related areas within UK endoscopy.MethodsQuestions were developed using the ISREE strategy as a guide and adapted by key JAG stakeholders. They were incorporated into the 2019 JAG census of UK endoscopy services. Quantitative and qualitative statistical methods were employed to analyse the results.ResultsThere was a 68% response rate. There was regional variability in the provision of out-of-hours GIB services (p<0.001). Across 1 month, 1535 incidents were reported across all services. There was a significantly higher proportion of reported incidents in acute services compared with others (p<0.001). Technical and training incidents were likely to be reported significantly differently to all other incident types. 74% of services have an endoscopy-specific sedation policy and 42% have a named sedation or anaesthetic lead for endoscopy. Services highlighted a desire for more anaesthetic-supported lists. Only 66% of services stated they have an effective strategy for supporting upskilling of endoscopists. Across acute services, 56% have access to human factors and endoscopic non-technical skills (ENTS) training. Patient feedback is used in several ways to improve services, develop training and promote shared learning among endoscopy users.ConclusionsThe census provides a benchmark for key safety-related characteristics of endoscopy services. These results have highlighted key areas to develop, guided by the ISREE strategy.     

High intake of saturated fat and early occurrence of specific biomarkers may explain the prevalence of chronic disease in northern Mexico

To investigate whether the high prevalence of coronary heart disease (CHD) and type II diabetes prevalent in Northern Mexico could be related to the presence at a young age of biomarkers for chronic disease, 25 boys and 29 girls (8-12 y old) from a low socioeconomic group were recruited. Plasma lipids, LDL phenotype, apolipoproteins (apos), glucose, and insulin were evaluated. Analysis of 3-d dietary records indicated the typical intake of this region to be high in total fat (37-43% energy) and saturated fat (11-13% energy). Boys and girls had an average of 6623 +/- 2892 and 6112 +/- 2793 steps/d, respectively, as measured by a pedometer, suggesting a low level of activity. Plasma total and LDL cholesterol (LDL-C) were within the 50th percentile. In contrast, the study population was characterized by having high triglycerides (TG) (95th percentile, 1.25 +/- 0.37 mmol/L in boys and 1.19 +/- 0.38 mmol/L in girls). HDL cholesterol (HDL-C) concentrations were low (25th percentile), 1.22 +/- 0.20 mmol/L in girls and 1.29 +/- 0.20 mmol/L in boys. There was also a high prevalence of the small dense LDL phenotype B (69%), which is associated with increased risk for CHD. These results suggest that the population of children studied may have 2 different components of risk, one being the high-fat diet, which could be associated with the elevated levels of plasma LDL-C present in the adult population. A second component, related to the insulin resistance syndrome, may be principally genetic and associated with the high TG, low HDL, and LDL phenotype B observed in these Mexican children.     

Drug utilization in the pediatric intensive care unit: monitoring prescribing trends and establishing prioritization of pharmacotherapeutic evaluation of critically ill children

The primary objective of this study was to characterize the drug exposure for children hospitalized in the authors' institution's pediatric intensive care unit for the year 2002. Secondary objectives included the examination of drug utilization differences among various age criteria and the suitability of the most prevalent resources for pediatric dosing guidance. Many of the most commonly prescribed agents in the pediatric intensive care unit fall into the broad categories of pain management/sedation and anti-infectives. Based on the generally narrow windows afforded by each of these drug classes, it is obvious that more, well-defined investigations in critically ill children are warranted. The existing dosing guidance for many of these agents is neither generalizable nor sufficient to accommodate the diversity in pediatric intensive care unit patients, and the current drug monographs fall short of any practical dosing information.