Barriers and facilitators to vascular access point-of-care ultrasound in haemodialysis: An international survey of haemodialysis clinicians.

BACKGROUND: Utilising point-of-care ultrasound for assessment and cannulation of vascular access in people receiving haemodialysis has shown positive clinical results. Nonetheless, there is variation in how renal health care professionals worldwide embrace this method, and there's a lack of research on the factors that promote or hinder its adoption. OBJECTIVES: To explore regional differences, and barriers and facilitators, to the use of point-of-care ultrasound for assessment and cannulation of vascular access in haemodialysis. DESIGN: Exploratory descriptive cross-sectional web-based survey. PARTICIPANTS: Healthcare clinicians working in haemodialysis responsible for cannulation of arteriovenous fistula or grafts. RESULTS: The survey was completed by 645 health care clinicians from 38 countries. 75% to 93% of respondents from Australia/New Zealand, Canada, Europe and United Kingdom/Ireland reported access to ultrasound, compared to 26% (n = 43/167) from the United States respondent's reported lower levels of ultrasound training than other regions. Facilitators for using ultrasound were: the availability of ultrasound training (87%, n = 558), to reduce miscannulations (76%, n = 255/336) and to improve patient outcomes (73%, n = 246/336). Point-of-care ultrasound barriers were lack of access to ultrasound education (82%, n = 196/239), lack of ultrasound machines (33%, n = 212/645) or believing that ultrasound was someone else's role (38%, n = 29/86). CONCLUSIONS: This study revealed national and regional differences related to haemodialysis point-of-care ultrasound. Understanding the regions requiring more education and implementation of ultrasound and what motivates staff, or deters from using ultrasound, is crucial for effectiveness of future implementation and workplace change initiatives.

Comorbid depression among adults with heart failure in Ethiopia: a hospital-based cross-sectional study.

BACKGROUND: Depression is a common comorbidity in adults with heart failure. It is associated with poor clinical outcomes, including decreased health-related quality of life and increased morbidity and mortality. There is a lack of data concerning the extent of this issue in Ethiopia. Consequently, this study aimed to assess the prevalence of comorbid depression and associated factors among adults living with heart failure in Ethiopia. METHODS: A hospital-based cross-sectional study was conducted at the cardiac outpatient clinics of two selected specialist public hospitals in Addis Ababa, Ethiopia: St. Paul's Hospital Millennium Medical College and St. Peter Specialized Hospital. An interviewer-administered questionnaire was used to collect data from 383 adults with heart failure who attended the clinics and met the inclusion criteria. Depression was measured using the Patient Health Questionnaire (PHQ-9). A binary logistic regression model was fitted to identify factors associated with depression. All statistical analyses were conducted using STATA version 17 software. RESULTS: The mean age of the participants was 55 years. On average, participants had moderate depression, as indicated by the mean PHQ-9 score of 11.02 ± 6.14, and 217 (56.6%, 95%CI 51.53-61.68) had comorbid depression. Significant associations with depression were observed among participants who were female (AOR: 2.31, 95%CI:1.30-4.08), had comorbid diabetes mellitus (AOR: 3.16, 95%CI: 1.47-6.82), were classified as New York Heart Association (NYHA) class IV (AOR: 3.59, 95%CI: 1.05-12.30), reported poor levels of social support (AOR: 6.04, 95%CI: 2.97-12.32), and took more than five medications per day (AOR: 5.26, 95%CI: 2.72-10.18). CONCLUSIONS: This study indicates that over half of all adults with heart failure in Ethiopia have comorbid depression, influenced by several factors. The findings have significant implications in terms of treatment outcomes and quality of life. More research in the area, including interventional and qualitative studies, and consideration of multifaceted approaches, such as psychosocial interventions, are needed to reduce the burden of comorbid depression in this population.

Mental health recovery in a collectivist society: Saudi consumers, carers and nurses' shared perspectives.

In 2019, the World Health Organization urged a global shift towards recovery-focused practices in mental health care. In Western nations, this transition often prioritised individualism over collectivism. In contrast, collectivist societies prioritise recovery through community and social support. This study explored mental health recovery from the perspectives of consumers, carers and registered nurses in a mainly collectivist society (Saudi Arabia) using a qualitative exploratory descriptive design. Sixteen consumers, ten carers and eight registered nurses participated in online semi-structured interviews. Inductive thematic analysis was employed to analyse English-translated versions of the 34 interviews. Consolidated criteria for reporting qualitative studies 32-item checklist were used. The study found that recovery was perceived as a process of transforming towards living a meaningful life of goals and values supported by trusted people who share moments of comfort and empowerment. A unique finding was the 'bond of recovery' a collectivist value that aid consumers' community integration in society. Saudi consumers' experiences of recovery were similar to consumers' movement narratives of recovery. Future research should establish a recovery-focused educational program that incorporates our findings into a recovery-oriented approach. This will facilitate providing a collaborative care between consumers, carers and nurses that centres around consumers' recovery goals and values.

Satisfaction with asynchronous e-learning: An exploratory factor analysis of the Learner Satisfaction with Asynchronous e-Learning (LSAeL) instrument.

AIM: To describe the development and psychometric testing of the Learner Satisfaction with Asynchronous e-Learning (LSAeL) instrument. BACKGROUND: Existing satisfaction with e-learning instruments may not accurately evaluate learner satisfaction with constructs associated with asynchronous e-learning. DESIGN: Methodological study. METHODS: Content, face and construct validity of the instrument were evaluated using a two-stage process. A five-member expert panel evaluated the instrument's content and face validity. A content validity index and a modified kappa co-efficient was used to calculate the content validity of individual test items and the global instrument and to adjust for chance agreement between raters. These data were then reviewed and individual items were removed, retained or refined accordingly. Using an empirically informed wholly asynchronous e-learning program 237 nursing students from a regional university in New South Wales, Australia completed the 35 item LSAeL instrument. An exploratory factor analysis (EFA) was then conducted to explore the dimensionality of the instrument. RESULTS: Exploratory factor analysis identified a seven-factor solution with 30 items, explaining an 86.1% of the total variance, was the best fit for the data. CONCLUSION: The study demonstrates that the construct validity of the LSAeL instrument is acceptable. Instrument development is an iterative process and further testing with other cohorts and in other settings is required.

Health-related quality of life of people with heart failure in low- and middle-income countries: a systematic review and meta-analysis.

PURPOSE: Heart failure is a global health concern and associated with poor health-related quality of life and increased mortality. There is a disproportionate burden on patients and health systems in low- and middle-income countries. This systematic review and meta-analysis estimates the health-related quality of life of people with heart failure in low- and middle-income countries. METHODS: A systematic literature search was conducted to identify relevant studies from January 2012 to November 2022 using the following databases: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, Scopus and JBI EBP database. Study screening, quality appraisal and data extraction were conducted using JBI methodology. A random-effects model was used to perform the meta-analysis. Heterogeneity was assessed using the I2 statistic. All statistical analyses were done in STATA version 17. RESULTS: A total of 33 studies with 5612 participants were included in this review. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Short-Form-36 questionnaire (SF-36) were the most used instruments across 19 and 8 studies, respectively. The pooled mean MLHFQ and SF-36 scores using the random-effects model were 46.08 (95% CI 35.06, 57.10) and 41.23 (95% CI 36.63, 45.83), respectively. In a subgroup analysis using both instruments, the highest health-related quality-of-life scores occurred in studies with inpatient participants. CONCLUSION: The overall health-related quality of life of people with heart failure in low- and middle-income countries is poor. Strategies should be strategically developed to improve the health-related quality of life of people with heart failure in these countries. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022377781.

Health-related quality of life and its influencing factors among people with heart failure in Ethiopia: using the revised Wilson and Cleary model.

Heart failure is a challenging public health problem associated with poor health-related quality of life (HRQoL). Data on the quality of life of people with heart failure are limited in Ethiopia. This study aimed to assess the HRQoL and its influencing factors in people with heart failure in Ethiopia. A hospital-based, cross-sectional study design was conducted in the cardiac outpatient clinics of two tertiary-level hospitals in Addis Ababa, Ethiopia. Data were collected from people with heart failure who met the inclusion criteria using an interviewer-administered questionnaire. The HRQoL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). A multiple linear regression model was fitted to identify factors that influenced HRQoL. All statistical analyses were conducted using STATA version 17 software. A total of 383 people with heart failure participated in the study. The mean age of the participants was 55 years. The MLHFQ score was 48.03±19.73, and 54% of participants had poor HRQoL. Multiple linear regression analysis revealed that age (ß= 0.12, 95% CI 0.11, 0.28), diabetes mellitus comorbidity (ß= 4.47, 95% CI 1.41, 7.54), social support score (ß= - 1.48, 95% CI - 1.93, - 1.03), and depression score (ß = 1.74, 95% CI 1.52, 1.96) were significant factors influencing overall HRQoL (p < 0.05). This study found that people in Ethiopia with heart failure had poor HRQoL, influenced by several factors. The findings can help health professionals identify appropriate interventions to improve the HRQoL of people with heart failure.

Prevalence of depression and its association with health-related quality of life in people with heart failure in low- and middle-income countries: A systematic review and meta-analysis.

INTRODUCTION: Heart failure is a growing public health concern around the world. People with heart failure have a high symptom burden, such as depression, which affects health-related quality of life (HRQoL). The objective of this systematic review and meta-analysis was to estimate the pooled prevalence of depression and evaluate its association with HRQoL among people with heart failure in low- and middle-income countries (LMICs). METHODS: This systematic review was conducted in accordance with the JBI methodology. Electronic databases such as MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, Scopus and JBI EBP were searched to identify relevant studies published from January 2012 to August 2022. The methodological quality of each article was assessed using relevant JBI critical appraisal instruments. A random-effects model was employed to estimate the pooled prevalence of depression. Heterogeneity across the studies was investigated using Cochrane's Q test and I2 statistic. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines 2020 were followed for reporting the results. All statistical analyses were performed using STATA version 17 software. RESULTS: After screening, a total of 21 eligible articles with 5074 participants with heart failure were included in this review. The pooled prevalence of depression among people with heart failure in LMICs was 51.5% (95% CI = 39.7, 63.3%, I2 = 99.00%). Subgroup analysis revealed, the highest prevalence in studies whose participants were in-patients, and from the Middle East and North Africa, and studies utilizing Becks Depression Inventory (BDI). Depression was positively associated with HRQoL. CONCLUSION: This review revealed that almost half of all people with heart failure in low- and middle-income countries have comorbid depression. People with heart failure and depressive symptoms had poor HRQoL. Therefore, early screening of depression is critical for improving HRQoL in this population. Systematic review registration: PROSPERO CRD42022361759.

Is torso twist production the primary role of the torso muscles in front crawl swimming?

The torso muscles play important roles in longitudinal rotation between the upper and lower torso on land but demands on these muscles at different swimming speeds and their role in torso twist in front crawl remains unclear. We aimed to compare torso muscle activity at different front crawl speeds and to assess the relationships between torso muscle activity and torso twist. Three-dimensional kinematics and torso muscle EMG data were collected from 15 male swimmers during middle-distance and sprint front crawl. Internal oblique, external oblique, and rectus abdominis, but not erector spinae, activities were greater at sprint than middle-distance pace. Sprint swimmers are likely to benefit from focusing training on the abdominal muscles. Cross-correlation peak coefficients between muscle activity and torso twist occurred with 517-775 and 400-600 ms lag at middle-distance and sprint paces (respectively). These lags are beyond the torso muscle electromechanical delay (~220 ms) and are too long for these muscles to produce movement changes. Further, peak coefficients coincided with both positive and negative shifts, indicating that muscle activity did not always precede kinematic changes. The torso muscles are therefore likely to play a greater role in maintaining stability and controlling posture in front crawl than producing torso twist.

A continuous times-series and discrete measure analysis of two individual divers performing the 3½ pike somersault dive.

Springboard diving training is often focused upon skill repetition to establish movement accuracy, stability and consistency. Within-participant study designs provide the ability to understand how individuals create these skills under different movement strategies. IMUs measured angular velocity time-series data of two athletes performing multiple repetitions of forward 3½ somersault pike dives. Functional Principal Component Analyses (fPCA) were performed to examine individual movement structure and variability. The first five fPC's represented approximately 98% of the variability in angular velocity for both divers. To determine the relative importance of angular velocity variability, Pearson's correlations for pairwise comparisons were used to assess the relationship between fPC scores and discrete performance variables during takeoff, flight and entry. Divers exhibited a different number and types of significant correlations (International = 4; National = 11). Only one correlation was common for both divers; higher angular velocity during Initial Flight and/or Somersault phases resulted in more vertically aligned entry posture (International: fPC1 r = -0.761, p < 0.05; National: fPC3 r = -0.796, p < 0.01). Findings identify individualised angular velocity time-series structure and kinematic performance variables (International = angular; National = linear) that can be used by coaching/sport science teams to optimisation performance success.

Video analysis of jockey fall characteristics in horse racing.

OBJECTIVES: To identify characteristics of jockey falls associated with high-risk landings using a modified Equestrian Fall Assessment Instrument. DESIGN: Cross-sectional study. METHODS: Video footage of 22 flat and 58 jump racing falls (N = 80) which occurred in Great Britain, Ireland, and New Zealand from 2013 to 2018 was systematically analysed using the modified Equestrian Fall Assessment Instrument. Race, horse, and jockey-level factors, including the nature of ground contact (landings), were characterised identifying factors associated with high-risk landings. High-risk landings refer to cases where the jockey's head impacted the ground or where there was potential horse impact on the jockey. A multivariable logistic regression model was applied identifying independent variables associated with high-risk landings. RESULTS: In 79 % (63/80) of race falls examined, at least one high-risk landing factor was present. Three independent variables explained 40.3 % of variance in high-risk landings. Lower race class (odds ratio 1.5; 95 % confidence interval 0.96, 2.39; p = 0.054), hanging onto the reins upon ground impact (odds ratio 7.5; 95 % confidence interval 1.04, 53.63; p = 0.028), and no jockey tuck-and-roll behaviour following ground impact (odds ratio 4.9; 95 % confidence interval 1.65, 14.44; p = 0.001) were associated with high-risk landings. CONCLUSIONS: Jockeys who ride in lower race classes, who hung onto the reins before landing, and who didn't tuck-and-roll during a fall had increased risk of a high-risk landing. Further examination of relationships between race, jockey experience and fall behaviour characteristics upon injury outcomes, and evaluation of potential protective benefits of fall training are required.

The long-term effects of wearing moderate minimalist shoes on a child's foot strength, muscle structure and balance: A randomised controlled trial.

BACKGROUND: From retrospective research, it is believed that children who predominantly spend their time shod have poorer foot strength and performance than those who are predominantly barefoot. Children's foot motion has been shown to be adversely affected by standard school shoes; however, the long-term effect of moderate minimalist shoes on foot strength, muscle structure and balance in children is unknown. RESEARCH QUESTION: Does wearing moderate minimalist shoes, compared to stiff shoes, benefit a child's foot strength, muscle structure and performance over time? METHODS: Seventy healthy children (9-12 yr) were randomly assigned to wear standard (control), or minimalist shoes (experimental) at school, for nine months. Cross-sectional areas (CSA) of Abductor Hallucis (AH) and Flexor Digitorum Brevis (FDB) muscles, and toe flexor strength (TFS) of hallux and lesser toes separately, were primary outcome measures. Single leg balance (SLB), Y-balance test (YBT) and standing long jump (SLJ) were secondary outcome measures. Pre- and post-intervention measurements were analysed for between group differences with ANCOVA. RESULTS: Minimalist shoes resulted in moderate but statistically non-significant increases in muscle CSA (AH η2p =.04, FDB η2p =.05) and TFS (hallux η2p =.05, lesser toes η2p =.04). Significant moderate to large improvements in YBT in the experimental group were found in the postero-medial (P = .04, η2p =.07) and postero-lateral (P = .01, η2p =.10) directions. YBT (anterior, postero-medial and postero-lateral) was correlated with hallux TFS (R =.29,.27 and.33 respectively), lesser toes TFS (R =.28,.35 and.38 respectively) and SLJ (R =.30,.39 and.57 respectively). CSA of FDB was correlated with SLJ (R =.34) and SLB (R =.42). SIGNIFICANCE: Wearing moderate minimalist shoes long-term improves balance in children. TFS is correlated with better balance and SLJ. Moderate minimalist school shoes are recommended for children.

Development of a video analysis protocol and assessment of fall characteristics in equestrian cross-country eventing.

Cross-country eventing is one of the highest-risk sporting activities for serious injury outcomes. This study investigated relationships between fall characteristics and high-risk falls at jumps in cross-country eventing. A video analysis protocol was systematically developed to analyze 87 video recordings of high-risk rider falls; defined as when the rider's head impacted the ground and/or where there was potential horse impact with the rider. Falls were classified according to competition type, jump type, horse-related, and rider-related factors. At least one high-risk fall characteristic was observed in 45 of 87 examined falls. Multivariable best subsets regression identified five independent variables explaining 38.4% of the variance in the number of high-risk falls. Increased likelihood of high-risk falls was associated with continuation of horse direction or speed upon rider ground impact, higher jump approach speed, changes in rider body posture upon landing, rider air jacket usage, and reduced rider fall time. The Eventing Fall Assessment Instrument (EFAI) video analysis protocol (attached as supplementary material) facilitated systematic examination of multiple characteristics associated with high-risk falls and identified likely influential characteristics. Based on EFAI and subsequent data analyses, findings suggest optimized approach speed for correct striding and take-off; jump design to enable run-out; and rider training could help reduce the occurrence of high-risk falls. Air jacket usage and their design characteristics warrant further investigation.

Invention of MK-8262, a Cholesteryl Ester Transfer Protein (CETP) Inhibitor Backup to Anacetrapib with Best-in-Class Properties.

Cholesteryl ester transfer protein (CETP) represents one of the key regulators of the homeostasis of lipid particles, including high-density lipoprotein (HDL) and low-density lipoprotein (LDL) particles. Epidemiological evidence correlates increased HDL and decreased LDL to coronary heart disease (CHD) risk reduction. This relationship is consistent with a clinical outcomes trial of a CETP inhibitor (anacetrapib) combined with standard of care (statin), which led to a 9% additional risk reduction compared to standard of care alone. We discuss here the discovery of MK-8262, a CETP inhibitor with the potential for being the best-in-class molecule. Novel in vitro and in vivo paradigms were integrated to drug discovery to guide optimization informed by a critical understanding of key clinical adverse effect profiles. We present preclinical and clinical evidence of MK-8262 safety and efficacy by means of HDL increase and LDL reduction as biomarkers for reduced CHD risk.

Racket orientation angle differences between accurate and inaccurate squash shots, as determined by a racket embedded magnetic-inertial measurement unit.

Ascertaining how racket orientation angle differences at ball-impact influence the accuracy of different squash strokes could assist player skill development and possibly reduce the number of unforced errors hit within a match. The purpose of this study was to identify differences in racket orientation angles of accurate and inaccurate forehand and backhand drive, volley and drop shots. A magnetic-inertial measurement unit embedded in a racket output orientation angles of twelve male junior players, with five accurate and five inaccurate shots per player per stroke analysed. Paired samples t-tests revealed that inaccurate backhand drop shots exhibited significantly (p < 0.05) less racket roll angle (racket face less open) at impact than accurate shots, indicating this parameter was a determining factor in the accuracy of this stroke. Racket orientation angle differences between accurate and inaccurate shots of the remaining strokes were too small to be used to distinguish shot accuracy. There was significantly greater variability in racket orientation angles during inaccurate forehand drop and backhand drive shots compared to accurate shots. These findings demonstrate how racket orientation angle differences at ball-impact can influence the accuracy of shots and highlights the need for consistent racket orientations to allow for an accurate shot.

Excellent reliability of toe strength measurements in children aged ten to twelve years achieved with a novel fixed dynamometer.

BACKGROUND: Stronger toe flexor muscles improve performance outcomes in children, including balance, sprinting, jumping and side stepping. Toe flexor strength (TFS) is recommended as part of the clinical assessment of foot function in children. Fixed dynamometry, rather than handheld, is the gold standard of measurement; however, it can be prohibitively costly. No fixed dynamometer reliability studies on toe flexion have been conducted in children to date. RESEARCH QUESTIONS: Does the novel fixed hand-held dynamometer (HHD) protocol provide reliable intra-rater and test-retest measurements of toe flexor strength in children aged 10 to 12? METHODS: Two trials were recorded from 14 healthy children (10-12 years), 7-14 days apart by the same rater. A Lafayette HHD (model 01163) measured peak force. The HHD was secured in a mobile custom mould below a step with a strap, which secured the foot of the participant. The receptor pads of the HHD were level with the upper surface of the step, maintaining neutral toe joints at rest. The participant was seated on an adjustable stool to ensure the hip, knee and ankle were each at 90° flexion, with the testing foot flat on the upper surface of the step. The averages of three maximal five second efforts were used for data analysis using a two-way mixed effects model with repeated measures ANOVA (intraclass correlation coefficient ICC 3,3). Standard error of measurement (SEM) was calculated to determine the absolute between trial variability. RESULTS: The novel fixed HHD protocol provided excellent test-retest reliability with small measurement error for hallux (ICC 3,3 = 0.93, 95 % CI 0.78-0.98, SEM = 4.31 N) and lesser toe flexor strength testing (ICC 3,3 = 0.96, 95 % CI 0.87-0.99, SEM = 1.86 N). SIGNIFICANCE: The fixed HHD protocol described in this study has excellent reliability for the test-retest evaluation of children's toe flexor strength.

Education-based interventions for anxiety during the treatment and management of chronic disease: a systematic review protocol.

OBJECTIVE: The objective of this systematic review is to evaluate the effectiveness of education-based interventions to decrease patient anxiety during the treatment and management of a chronic disease. INTRODUCTION: Anxiety is a major contributor to poor patient outcomes in self-managed chronic disease. Health care manage anxiety prior or during education can adversely affect patient outcomes. By identifying interventions that effectively decrease anxiety, clinicians may be able to consider and implement strategies as standard practice within the education-based programs. INCLUSION CRITERIA: The proposed systematic review will consider studies reporting the effectiveness of any intervention aimed at decreasing participant anxiety prior to a medical procedure or prior to undertaking an education-based program to address a technical aspect of self-management in a health care setting. It will consider studies whose participants are 18 years and older and who are diagnosed with a chronic disease. METHODS: The systematic review aims to find published and unpublished studies in English from 1972 onward. Databases to be searched included MEDLINE, CINAHL, Embase, ERIC, Mosby's index, Cochrane Library, and Scopus. Studies will be reviewed and data extracted by two independent reviewers. The data will include details about the interventions, populations, study methods, and outcomes of significance to the review objectives. Where possible, data will be pooled in a statistical meta-analysis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019142260.

The evidence for improving balance by strengthening the toe flexor muscles: A systematic review.

BACKGROUND: Poor postural balance in the upright position is strongly correlated to morbidities, such as falls in older adult populations and to lower limb injuries in the younger populations. Good postural balance depends on muscular strength and the integration of neurological and muscular feedback mechanisms throughout the body. Since the interface with the ground is the plantar surface of each foot, an improved understanding of the role of foot muscles in postural balance is warranted. RESEARCH QUESTION: Does improved toe flexor strength result in better postural balance, across the lifespan? METHODS: A systematic review was conducted of papers from 1900 to 2019 inclusive, from five databases. Inclusion and exclusion criteria were established prior to selection. Inclusion criteria were: observational and longitudinal studies, healthy subjects, at least one balance and one toe flexor strength test conducted. Exclusion criteria were: subjects with a pathology/disability, case study, systematic or literature review. Two examiners assessed a study's suitability for inclusion in this review, based on the above criteria. Study quality was assessed using the Critical Appraisal Skills Program Tools. The type of studies and methodological heterogeneity precluded the feasibility of conducting a meta-analysis. RESULTS: Nine studies were included. In each study, participants were over sixty years of age, and over 73 % of them were female. No study was found for a younger population group. There were seven cross-sectional studies, two randomized control trials and there was one case-control study. All studies provided evidence of directly proportional, clinically significant correlations between toe flexor strength and postural balance. SIGNIFICANCE: Toe flexor strength contributes to improved postural balance for people over the age of 60. Research is needed to establish the relationship between foot muscle strength and balance in younger adults and children.