The associated impact of standardized admission screening on vancomycin-resistant Enterococci bloodstream infections.

OBJECTIVE: To determine whether discontinuing active screening for vancomycin-resistant Enterococcus (VRE) in Alberta, Canada, acute-care facilities had an associated impact on the rate of rise of hospital-acquired (HA) VRE bloodstream infection (VRE-BSI). SETTING: Acute-care facilities in Alberta, Canada. PATIENTS: All patients who were admitted to Alberta Health Services or Covenant Health acute-care facilities between January 1, 2013, and March 31, 2020, and who met the definition for hospital-acquired VRE-BSI were included in the analyses. METHODS: An intervention time-series Poisson regression was used to determine the slope change in VRE incidence between the pre- and postintervention (screening) periods. The patient population was separated into 3 cohorts: group 1 (low risk, VRE screening stopped), group 2 (high risk, VRE screening stopped), and group 3 (high risk, VRE screening continued). For all groups, a level- and slope-change model was used. RESULTS: We did not find a statistically significant difference in the slope change or rate of rise in VRE-BSI before and after the intervention, with incidence rate ratio (IRRs) of 1.015 (95% confidence interval [CI], 0.982-1.049), 1.025 (95% CI, 0.967-1.086), and 0.989 (95% CI, 0.924-1.059) for groups 1, 2 and 3, respectively. CONCLUSIONS: In Alberta, the rate of HA VRE-BSI has remained consistent, and our findings indicate that there has been no increase in the rate of rise of HA VRE-BSI in sites or units that discontinued screening for VRE, regardless of patient risk group.

The Prevalence and Severity of Chronic Pain in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Chronic pain is a common and distressing symptom reported by patients with chronic kidney disease (CKD). Clinical practice and research in this area do not appear to be advancing sufficiently to address the issue of chronic pain management in patients with CKD. OBJECTIVES: To determine the prevalence and severity of chronic pain in patients with CKD. DESIGN: Systematic review and meta-analysis. SETTING: Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity. PATIENTS: Adults with glomerular filtration rate (GFR) category 3 to 5 CKD including dialysis patients and those managed conservatively without dialysis. MEASUREMENTS: Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of pain, and severity of pain. METHODS: Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library, last searched on February 3, 2020. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of overall chronic pain, musculoskeletal pain, bone/joint pain, muscle pain/soreness, and neuropathic pain and the I 2 statistic was computed to measure heterogeneity. Random effects models were used to account for variations in study design and sample populations and a double arcsine transformation was used in the model calculations to account for potential overweighting of studies reporting either very high or very low prevalence measurements. Pain severity scores were calibrated to a score out of 10, to compare across studies. Weighted mean severity scores and 95% confidence intervals were reported. RESULTS: Sixty-eight studies representing 16 558 patients from 26 countries were included. The mean prevalence of chronic pain in hemodialysis patients was 60.5%, and the mean prevalence of moderate or severe pain was 43.6%. Although limited, pain prevalence data for peritoneal dialysis patients (35.9%), those managed conservatively without dialysis (59.8%), those following withdrawal of dialysis (39.2%), and patients with earlier GFR category of CKD (61.2%) suggest similarly high prevalence rates. LIMITATIONS: Studies lacked a consistent approach to defining the chronicity and nature of pain. There was also variability in the measures used to determine pain severity, limiting the ability to compare findings across populations. Furthermore, most studies reported mean severity scores for the entire cohort, rather than reporting the prevalence (numerator and denominator) for each of the pain severity categories (mild, moderate, and severe). Mean severity scores for a population do not allow for "responder analyses" nor allow for an understanding of clinically relevant pain. CONCLUSIONS: Chronic pain is common and often severe across diverse CKD populations providing a strong imperative to establish chronic pain management as a clinical and research priority. Future research needs to move toward a better understanding of the determinants of chronic pain and to evaluating the effectiveness of pain management strategies with particular attention to the patient outcomes such as overall symptom burden, physical function, and quality of life. The current variability in the outcome measures used to assess pain limits the ability to pool data or make comparisons among studies, which will hinder future evaluations of the efficacy and effectiveness of treatments. Recommendations for measuring and reporting pain in future CKD studies are provided. TRIAL REGISTRATION: PROSPERO Registration number CRD42020166965.

CONTEXTE: La douleur chronique est un symptôme affligeant fréquemment rapporté par les patients atteints d'insuffisance rénale chronique (IRC). Pourtant, la recherche et la pratique clinique dans ce domaine ne semblent pas progresser suffisamment pour aborder sa gestion dans cette population. OBJECTIF: Déterminer la prévalence et l'intensité de la douleur chronique chez les patients atteints d'IRC. TYPE D'ÉTUDE: Revue systématique et méta-analyse. SOURCES: Les études observationnelles et interventionnelles présentant des données depuis l'an 2000. Ont été exclus les cas d'insuffisance rénale aigüe et les études portant sur une population ayant une cause, un symptôme ou une maladie concomitante en particulier. SUJETS: Des adultes atteints d'IRC de stade 3 à 5, y compris des patients dialysés et des patients non dialysés pris en charge de façon conservatrice. MESURES: Les données extraites comprenaient le titre de l'article, le nom de l'auteur principal, le type d'étude, le pays où s'est tenue l'étude, l'année de collection des données, l'année de publication, l'âge médian des sujets, le stade de l'IRC, la prévalence de la douleur et son intensité. MÉTHODOLOGIE: Les données ont été colligées dans MEDLINE, CINAHL, EMBASE et la bibliothèque Cochrane. La dernière consultation date du 3 février 2020. Deux examinateurs ont, de façon indépendante, trié les titres et les abrégés, évalué les articles potentiellement pertinents et extrait les données. La prévalence combinée de la douleur chronique globale, de la douleur musculo-squelettique, de la douleur osseuse/articulaire, de la douleur musculaire et de la douleur neuropathique a été évaluée, et le calcul de la statistique I 2 a servi à mesurer l'hétérogénéité. Des modèles à effets aléatoires ont été employés pour tenir compte des variations selon le type d'étude et les populations échantillonnées. Les calculs de ces modèles ont subi une double transformation arc-sinus pour tenir compte d'une potentielle surpondération des études comportant des mesures de prévalence très importantes ou très faibles. Pour fins de comparaison, les scores d'intensité de la douleur ont été étalonnés à un score sur 10. Des scores d'intensité moyenne pondérée et des intervalles de confiance à 95 % ont été mentionnés. RÉSULTATS: Soixante-huit études ont été incluses, lesquelles portaient sur un total de 16 558 patients dans 26 pays. La prévalence moyenne de la douleur chronique chez les patients hémodialysés était de 60,5 %; la prévalence moyenne de la douleur modérée ou sévère était de 43,6 %. Quoique limitées, les données portant sur des patients sous dialyse péritonéale (35,9 %), des patients suivant des traitements conservateurs sans dialyse (59,8 %), des patients ayant arrêté la dialyse (39,2 %) ou des patients atteints d'un stade inférieur d'IRC (61,2 %) suggèrent une prévalence tout aussi élevée. LIMITES: Les études incluses manquaient de cohérence dans leur approche pour définir la chronicité et la nature de la douleur. Les mesures utilisées pour déterminer l'intensité de la douleur étaient variables, ce qui a limité la comparaison des résultats entre les populations. La plupart des études indiquaient des scores moyens d'intensité pour l'ensemble de la cohorte plutôt que la prévalence (numérateur et dénominateur) de chacune des catégories d'intensité (légère, modérée et sévère). Les scores moyens d'intensité pour une population ne permettent pas « les analyses de répondants ¼ et la compréhension de la douleur cliniquement pertinente. CONCLUSION: La douleur chronique est fréquente et souvent intense dans les diverses populations de patients atteints d'IRC, ce qui confirme la gestion de la douleur chronique comme priorité clinique et de recherche. Les recherches futures devraient permettre une meilleure compréhension des déterminants de la douleur chronique et évaluer l'efficacité des stratégies de gestion de la douleur en accordant une attention particulière aux résultats des patients, notamment au fardeau global des symptômes, à la fonction physique et à la qualité de vie. La capacité de regrouper des données ou de faire des comparaisons entre les études est limitée par la variabilité actuelle des mesures utilisées pour évaluer la douleur, ce qui entravera les futures évaluations de l'efficacité des traitements. Des recommandations pour mesurer et signaler la douleur dans les futures études sur l'IRC sont fournies.

Clostridioides difficile infections in Alberta: The validity of administrative data using ICD-10 diagnostic codes for CDI surveillance versus clinical infection surveillance.

BACKGROUND: Clostridioides difficile infection (CDI) is one of the most common health care-associated infections. This study assessed the validity of the Discharge Abstract Database (DAD) compared to a traditional clinical surveillance method for identifying CDI. METHODS: Retrospective analysis of all DAD records with International Statistical Classification of Diseases and Related Health Problems 10th Revision (ie, ICD-10) diagnostic code A04.7 (enterocolitis due to CDI) between April 2015 and March 2019 were compared to a clinical dataset of positive inpatient CDI for all acute care facilities in Alberta, Canada. Sensitivity and positive predictive values were calculated using R version 3.6.0. RESULTS: The DAD had a sensitivity of 85.0% (95% confidence interval: 84.1%-85.8%) and a positive predictive value of 80.0% (95% confidence interval: 79.2%-80.0%). The CDI rate per 1,000 admissions over the study period was 28% higher in the DAD compared to Infection Prevention and Control surveillance. DISCUSSION: The DAD does not distinguish symptomatic cases from asymptomatic cases and so indicators to identify symptomatic disease would need to be applied, potentially through a linkage to antibiotic treatment orders available in patient management systems. CONCLUSIONS: The DAD is moderately sensitive for identifying symptomatic CDI cases in Alberta, Canada and caution should be applied when interpreting rates based on administrative data.

Comparison of two accelerometers for measuring physical activity and sedentary behaviour.

PURPOSE: A central aspect of physical activity and sedentary behaviour research is accurate exposure assessment in the context of disease outcomes. The primary objectives of this study were to evaluate the convergent validity and test-retest reliability of the ActiGraph GT3X+ and activPAL3 accelerometers. METHODS: Participants from the Breast Cancer and Exercise Trial in Alberta (n=266) wore both devices concurrently during waking hours for 7 days. Summary measures of time (hours/day) for physical activity and sedentary behaviour were compared between devices using Student's t-tests. Bland-Altman plots were used to assess or evaluate the mean differences and limits of agreement between monitors, and intraclass correlation coefficients (ICCs) were used to assess the test-retest reliability of two 7-day activity monitor administrations separated by 2 weeks (n=29). RESULTS: When comparing the ActiGraph Vector Magnitude (VM), which incorporates all three axes of movement (x, y, z), and the Vertical Axis (VT), which detects movement on the vertical or y-axis only, with the activPAL3, all measures of physical activity were statistically significantly different. The difference in measured time in sedentary behaviour was not statistically significant different when comparing the activPAL3 and ActiGraph (VT) estimates (p=0.47) but was statistically significant different for activPAL3 compared with ActiGraph (VM) (p<0.001). ICCs were high and consistent for each method across all behaviours, ranging from 0.87 to 0.93, with the exception of moderate activity and moderate-to-vigorous activity by the ActiGraph (VT) at 0.66 and 0.67, respectively. CONCLUSION: Despite small mean differences and comparable recordings by both devices at the group level, the precision of estimates between methods was low with wide limits of agreement, suggesting these devices may not be used interchangeably for measuring physical activity and sedentary behaviour using common data reduction methods.

The incidence of concussion in youth sports: a systematic review and meta-analysis.

OBJECTIVE: To conduct a comprehensive systematic review and meta-analysis of studies assessing the incidence of concussion in youth athletes. Specifically, we estimate the overall risk of concussion in youth sports and compare sport-specific estimates of concussion risk. DESIGN: Systemic review and meta-analysis. DATA SOURCES: A search of Medline, Embase (1980 through September 2014), and SportDiscus (1985 through September 2014) supplemented by manual searches of bibliographies and conference proceedings. INCLUSION CRITERIA: We included studies if they met the inclusion criteria of study design (prospective cohort study), relevant sports identified from the literature (eg, American football, rugby, hockey, lacrosse, soccer/football, basketball, baseball, softball, wrestling, field hockey, track, taekwondo, volleyball and cheerleading), population (males and females ≤18 years old), and outcome (concussion). RESULTS: Of the 698 studies reviewed for eligibility, 23 articles were accepted for systematic review and 13 of which were included in a meta-analysis. Random effects models were used to pool overall and sport-specific concussion incidence rates per 1000 athlete exposures (AEs). The overall risk of concussion was estimated at 0.23 (95% CI 0.19 to 0.28). The three sports with the highest incidence rates were rugby, hockey and American football at 4.18, 1.20 and 0.53, respectively. Lowest incidence rates per 1000 AEs occurred in volleyball, baseball and cheerleading at 0.03, 0.06 and 0.07, respectively. Quality of the included studies varied, with the majority of studies not reporting age and gender-specific incidence rates or an operational definition for concussion. CONCLUSIONS: There are striking differences in the rates of incident youth concussion across 12 sports. This systematic review and meta-analysis can serve as the current sport-specific baseline risk of concussion among youth athletes.

Can muscle shortening alone, explain the energy cost of muscle contraction in vivo?

PURPOSE: Decreased whole-body energy cost of running has been associated with an increased Achilles tendon stiffness. It is usually assumed that this lower energy cost can be attributed to less muscle fascicle shortening with a stiffer tendon. Increased fiber shortening is an important determinant of muscle energetics in vitro. However, other factors, like increased muscle activation may be important when considering whole muscle energetics in vivo. METHODS: To determine the effects of a small additional muscle shortening on skeletal muscle energy requirement, 19 subjects performed 30 plantarflexions on two separate occasions: isometric (ISO) and isokinetic (KIN, 6.98 rad s(-1)), each with a target of 50 % of maximum isometric torque. Medial gastrocnemius muscle fascicle length (FL) was measured by ultrasound and rate of oxyhemoglobin (HbO2) desaturation was measured during blood flow occlusion using near-infrared spectroscopy. RESULTS: KIN resulted in significantly greater muscle shortening (23.8 ± 1.3 mm) than ISO (18.3 ± 1.0 mm, p < 0.001, mean ± SEM), and greater shortening velocity (KIN = 2.5 ± 0.3 FL s(-1), ISO = 1.1 ± 0.1 FL s(-1), p < 0.001). Rate of HbO2 desaturation was 19 ± 7 %, greater in KIN than ISO (p < 0.01), despite 19 ± 2 % lower mean torque (p < 0.001) and 9.8 ± 1.6 Nm s lower mean impulse per contraction (p < 0.001) in KIN compared to ISO. Root mean square for EMG was significantly greater (p < 0.05) during KIN (73 ± 3 %) than during ISO (63 ± 2 %). CONCLUSION: These results illustrate that muscle energy requirement is greater when muscle fascicle shortening and/or velocity of shortening is increased, and suggest that greater activation contributes to that increased energy requirement.

Familial amyotrophic lateral sclerosis in Alberta, Canada.

Systematic review data demonstrate that 5% of ALS cases are familial (FALS). Causative superoxide dismutase-1 (SOD1) mutations are identified in 10-20% of FALS. Few reports of FALS epidemiology exist in Canada. We completed a retrospective review of all FALS cases within the province of Alberta between 2002 and 2011. Descriptive summaries of genotypes identified and calculation of prevalences were performed. We reviewed 946 clinic database records and 49 subjects with FALS were identified (5.2%). Clinic charts for 47/49 were available and reviewed. Causative SOD1 mutations were observed in 17/47 (36%). The SOD1 I113T mutation was identified in 11/47 unrelated patients and was associated with a less variable survival than previously reported. The period and point prevalences of FALS in Alberta are approximately 2.05 per 100,000 (95% CI 1.51-2.73) and 4.68 per 1,000,000 (95% CI 2.42-8.18), respectively. In conclusion, we report 47 cases of FALS in Alberta over the past decade. The proportion of SOD1-positive FALS cases is higher than reported elsewhere. The high proportion of I113T mutations is comparable to that previously observed in the adjacent province of British Columbia.

Energy cost of running and Achilles tendon stiffness in man and woman trained runners.

The energy cost of running (E run), a key determinant of distance running performance, is influenced by several factors. Although it is important to express E run as energy cost, no study has used this approach to compare similarly trained men and women. Furthermore, the relationship between Achilles tendon (AT) stiffness and E run has not been compared between men and women. Therefore, our purpose was to determine if sex-specific differences in E run and/or AT stiffness existed. E run (kcal kg(-1) km(-1)) was determined by indirect calorimetry at 75%, 85%, and 95% of the speed at lactate threshold (sLT) on 11 man (mean ± SEM, 35 ± 1 years, 177 ± 1 cm, 78 ± 1 kg, [Formula: see text]1 = 56 ± 1 mL kg(-1) min(-1)) and 18 woman (33 ± 1 years, 165 ± 1 cm, 58 ± 1 kg, [Formula: see text]2 = 50 ± 0.3 mL kg(-1) min(-1)) runners. AT stiffness was measured using ultrasound with dynamometry. Man E run was 1.01 ± 0.06, 1.04 ± 0.07, and 1.07 ± 0.07 kcal kg(-1) km(-1). Woman E run was 1.05 ± 0.10, 1.07 ± 0.09, and 1.09 ± 0.10 kcal kg(-1) km(-1). There was no significant sex effect for E run or RER, but both increased with speed (P < 0.01) expressed relative to sLT. High-range AT stiffness was 191 ± 5.1 N mm(-1) for men and 125 ± 5.5 N mm(-1), for women (P < 0.001). The relationship between low-range AT stiffness and E run was significant at all measured speeds for women (r (2) = 0.198, P < 0.05), but not for the men. These results indicate that when E run is measured at the same relative intensity, there are no sex-specific differences in E run or substrate use. Furthermore, differences in E run cannot be explained solely by differences in AT stiffness.