Abstract
We estimated the effectiveness of a fourth dose of messenger RNA coronavirus disease 2019 vaccine against Omicron infections and severe outcomes over time among long-term care residents in ...Ontario, Canada. Fourth doses provide additional protection against Omicron-related outcomes, but the protection wanes over time, with more waning seen against infection than severe outcomes.
The proneural gene, Atoh1, is necessary and in some contexts sufficient for early inner ear hair cell development. Its function is the subject of intensive research, not least because of the ...possibility that it could be used in therapeutic strategies to reverse hair cell loss in deafness. However, it is clear that Atoh1’s function is highly context dependent. During inner ear development, Atoh1 is only able to promote hair cell differentiation at specific developmental stages. Outside the ear, Atoh1 is required for differentiation of a variety of other cell types, for example in the intestine and cerebellum. The reasons for this context dependence are poorly understood. So far, the pathways and key players that instruct Atoh1 to act as a mechanosensory cell fate determinant in the context of the inner ear are largely unknown. Here we review evidence that suggests that Atoh1 function in hair cell differentiation is modulated by interaction with other transcription factors. We particularly focus on the possible roles of Gfi1 and Pou4f3, drawing from studies in mouse, Drosophila and C. elegans.
With society’s growing awareness of climate change, novel renewable and naturally sourced materials have received increasing attention as substitutes for petroleum-based products. Laminarin (LAM–OH) ...is a highly abundant, nontoxic, degradable polysaccharide found in marine organisms and hence is a promising sustainable polymeric candidate. This work reports on a simple, environmentally friendly, and customizable functionalization strategy for producing a toolbox of LAM–OH derivatives under mild conditions. Herein, natural-origin macromolecules exhibiting specific chemical moieties, namely, allyl, amine, carboxylic acid, thiol, aldehyde, and catechol, were prepared and chemically characterized. Furthermore, the obtained polymers were processed into cytocompatible hydrogels, obtained by employing distinct cross-linking mechanisms, to assess their potential for biomedical purposes. The application scope of such polymers could be extended to fields such as catalysis, cosmetics, life sciences, and food packaging, which can also benefit from having sustainable, nontoxic, and degradable materials. Moreover, it is anticipated that the methodology employed to create this library of new natural-based products could be adapted to modify other polysaccharides and biopolymers in general.
•Frailty is a robust predictor of patient-important health outcomes and is often overlooked.•Individuals with frailty have approximately 3× the odds of dying during hospitalization after in-hospital ...cardiac arrest.•Frailty should be considered during shared-decision making about end-of-life care.
To synthesize the current evidence examining the association between frailty and a series of post-arrest outcomes following the provision of cardiopulmonary resuscitation (CPR).
We searched MEDLINE, PubMed (exclusive of MEDLINE), EMBASE, CINAHL, and Web of Science from inception to August 2020 for observational studies that examined an association between frailty and post-arrest health outcomes, including in-hospital and post-discharge mortality. We conducted citation tracking for all eligible studies.
Our search yielded 20,480 citations after removing duplicate records. We screened titles, abstracts and full-texts independently and in duplicate.
The prognosis research strategy group (PROGRESS) and the critical appraisal and data extraction for systematic review of prediction modelling studies (CHARMS) guidelines were followed. Study and outcome-specific risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) instrument. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) recommendations for prognostic factor research.
Four studies were included in this review and three were eligible for statistical pooling. Our sample comprised 1,134 persons who experienced in-hospital cardiac arrest (IHCA). The mean age of the sample was 71 years. The study results were pooled according to the specific frailty instrument. Three studies used the Clinical Frailty Scale (CFS) and adjusted age (our minimum confounder); the presence of frailty was associated with an approximate three-fold increase in the odds of dying in-hospital after IHCA (aOR = 2.93; 95% CI = 2.43–3.53, high certainty). Frailty was also associated with decreased incidence of ROSC (return of spontaneous circulation) and discharge home following IHCA. One study with high risk of bias used the Hospital Frailty Risk Score and reported a 43% decrease in the odds of discharge home for patients with frailty following IHCA.
High certainty evidence was found for an association between frailty and in-hospital mortality following IHCA. Frailty is a robust prognostic factor that contributes valuable information and can inform shared-decision making and policies surrounding advance care directives.
Registration: PROSPERO Registration # CRD42020212922
The COVID-19 pandemic led to a decline in emergency department (ED) visits and a subsequent return to baseline pre-pandemic levels. It is unclear if this trend extended to paramedic services and if ...patient cohorts accessing paramedics changed. We examined trends and associations between paramedic utilization (9-1-1 calls and ED transports) and the COVID-19 timeframe.OBJECTIVESThe COVID-19 pandemic led to a decline in emergency department (ED) visits and a subsequent return to baseline pre-pandemic levels. It is unclear if this trend extended to paramedic services and if patient cohorts accessing paramedics changed. We examined trends and associations between paramedic utilization (9-1-1 calls and ED transports) and the COVID-19 timeframe.We conducted a retrospective cross-sectional study using paramedic call data from the Hamilton Paramedic Services from January 2016 to December 2023. We included all 9-1-1 calls where paramedics responded to an incident, excluding paramedic interfacility transfers. We calculated lines of best fit for the pre-pandemic period (January 2016 to January 2020) and compared their predictions to the actual volumes in the post-pandemic period (May 2021 to December 2023). We used an interrupted time series regression model to determine the association between pandemic timeframes (pre-, during-, post-COVID-19) and paramedic utilization (9-1-1 calls and ED transports), while testing for annual seasonality.METHODSWe conducted a retrospective cross-sectional study using paramedic call data from the Hamilton Paramedic Services from January 2016 to December 2023. We included all 9-1-1 calls where paramedics responded to an incident, excluding paramedic interfacility transfers. We calculated lines of best fit for the pre-pandemic period (January 2016 to January 2020) and compared their predictions to the actual volumes in the post-pandemic period (May 2021 to December 2023). We used an interrupted time series regression model to determine the association between pandemic timeframes (pre-, during-, post-COVID-19) and paramedic utilization (9-1-1 calls and ED transports), while testing for annual seasonality.During the study timeframe, 577,278 calls for paramedics were received and 413,491 (71.6%) were transported to the ED. Post-pandemic, 9-1-1 calls exceeded predicted pre-pandemic levels by 1,298 per month, while ED transports exceeded by 543 per month. The pandemic significantly reduced monthly 9-1-1 calls (-588.2, 95% CI -928.8 to -247.5) and ED transports (-677.3, 95% CI -927.0 to -427.5). Post-pandemic, there was a significant and sustained resurgence in monthly 9-1-1 calls (1,208.0, 95% CI 822.1 to 1,593.9) and ED transports (868.8, 95% CI 585.8 to 1,151.7). Both models exhibited seasonal variations.RESULTSDuring the study timeframe, 577,278 calls for paramedics were received and 413,491 (71.6%) were transported to the ED. Post-pandemic, 9-1-1 calls exceeded predicted pre-pandemic levels by 1,298 per month, while ED transports exceeded by 543 per month. The pandemic significantly reduced monthly 9-1-1 calls (-588.2, 95% CI -928.8 to -247.5) and ED transports (-677.3, 95% CI -927.0 to -427.5). Post-pandemic, there was a significant and sustained resurgence in monthly 9-1-1 calls (1,208.0, 95% CI 822.1 to 1,593.9) and ED transports (868.8, 95% CI 585.8 to 1,151.7). Both models exhibited seasonal variations.Post-pandemic, 9-1-1-initiated paramedic calls experienced a substantial increase, surpassing pre-pandemic growth rates. ED transports returned to pre-pandemic levels but with a steeper and continuous pattern of growth. The resurgence in paramedic 9-1-1 calls and ED transports post-COVID-19 emphasizes an urgent necessity to expedite development of new care models that address how paramedics respond to 9-1-1 calls and transport to overcrowded EDs.CONCLUSIONSPost-pandemic, 9-1-1-initiated paramedic calls experienced a substantial increase, surpassing pre-pandemic growth rates. ED transports returned to pre-pandemic levels but with a steeper and continuous pattern of growth. The resurgence in paramedic 9-1-1 calls and ED transports post-COVID-19 emphasizes an urgent necessity to expedite development of new care models that address how paramedics respond to 9-1-1 calls and transport to overcrowded EDs.
Study objective We examine functional profiles and presence of geriatric syndromes among older patients attending 13 emergency departments (EDs) in 7 nations. Methods This was a prospective ...observational study of a convenience sample of patients, aged 75 years and older, recruited sequentially and mainly during normal working hours. Clinical observations were drawn from the interRAI Emergency Department Screener, with assessments performed by trained nurses. Results A sample of 2,282 patients (range 98 to 549 patients across nations) was recruited. Before becoming unwell, 46% were dependent on others in one or more aspects of personal activities of daily living. This proportion increased to 67% at presentation to the ED. In the ED, 26% exhibited evidence of cognitive impairment, and 49% could not walk without supervision. Recent falls were common (37%). Overall, at least 48% had a geriatric syndrome before becoming unwell, increasing to 78% at presentation to the ED. This pattern was consistent across nations. Conclusion Functional problems and geriatric syndromes affect the majority of older patients attending the ED, which may have important implications for clinical protocols and design of EDs.
IntroductionOntario ambulances are restricted from patient transportation to sub-acute levels of care when these facilities may be more suitable than emergency departments for non-emergent ...conditions. There is no known patient classification specifically constructed to inform ED diversion protocols and guidance for sub-acute centre transportation for primary care–like patient conditions.ObjectiveTo construct a novel patient classification of potentially preventable emergency department visits following transport by ambulance, and analyse patient-level characteristic associations with this classification based in Ontario secondary data.Methods and analysisThe Primary Care–like Ambulance transports following Response for 911-Emergencies (PriCARE) patient classification will be constructed using a two-phase RAND/UCLA modified Delphi design. All experts included are physicians with relevant experience in emergency and/or primary care in Ontario. The first phase of the study will determine consensus of the expert committee on which ED interventions performed on patients with non-emergent acuities could be conducted in sub-acute healthcare centres. The second phase will assess consensus of which patient, hospital and acuity factors are most appropriate to be incorporated into a PriCARE classification. We will also investigate secondary outcomes on consensus of which ED interventions could be transferred to a paramedic context given an expanded scope of practice and patient-level characteristics of PriCARE classified individuals.Ethics and disseminationThis study received a research ethics board exemption waiver from the Hamilton Integrated Research Ethics Board; review reference 2020-11451-GRA. Results will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. The results will be shared with Ontario paramedic services and governing institutions. This study will be used to inform patient classification protocols and clinical decision tools for ambulances to transport to sub-acute healthcare centres.Trial registration numberISRCTN22901977.
IntroductionIn population-based research, disease ascertainment algorithms can be as accurate as, and less costly than, performing supplementary clinical examinations on selected participants to ...confirm a diagnosis of a neurocognitive disorder (NCD), but they require cohort-specific validation. To optimise the use of the Canadian Longitudinal Study on Aging (CLSA) to understand the epidemiology and burden of NCDs, the CLSA Memory Study will validate an NCD ascertainment algorithm to identify CLSA participants with these disorders using routinely acquired study data.Methods and analysisUp to 600 CLSA participants with equal numbers of those likely to have no NCD, mild NCD or major NCD based on prior self-reported physician diagnosis of a memory problem or dementia, medication consumption (ie, cholinesterase inhibitors, memantine) and/or self-reported function will be recruited during the follow-up 3 CLSA evaluations (started August 2021). Participants will undergo an assessment by a study clinician who will also review an informant interview and make a preliminary determination of the presence or absence of an NCD. The clinical assessment and available CLSA data will be reviewed by a Central Review Panel who will make a final categorisation of participants as having (1) no NCD, (2) mild NCD or, (3) major NCD (according to fifth version of the Diagnostic and Statistical Manual of Mental Disorders criteria). These will be used as our gold standard diagnosis to determine if the NCD ascertainment algorithm accurately identifies CLSA participants with an NCD. Weighted Kappa statistics will be the primary measure of agreement. Sensitivity, specificity, the C-statistic and the phi coefficient will also be estimated.Ethics and disseminationEthics approval has been received from the institutional research ethics boards for each CLSA Data Collection Site (Université de Sherbrooke, Hamilton Integrated Research Ethics Board, Dalhousie University, Nova Scotia Health Research Ethics Board, University of Manitoba, McGill University, McGill University Health Centre Research Institute, Memorial University of Newfoundland, University of Victoria, Élisabeth Bruyère Research Institute of Ottawa, University of British Columbia, Island Health (Formerly the Vancouver Island Health Authority, Simon Fraser University, Calgary Conjoint Health Research Ethics Board).The results of this work will be disseminated to public health professionals, researchers, health professionals, administrators and policy-makers through journal publications, conference presentations, publicly available reports and presentations to stakeholder groups.
The aim of this study is to identify the types of community paramedicine programs and the training for each.
A systematic review of MEDLINE, Embase, grey literature, and bibliographies followed a ...search strategy using common community paramedicine terms. All studies published in English up to January 22, 2018, were captured. Screening and extraction were completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies' methodological quality (full methodology on PROSPERO: CRD42017051774).
From 3,004 papers, there were 64 papers identified (58 unique community paramedicine programs). Of the papers with an appraisable study design (40.6%), the median MMAT score was 3 of 4 criteria met, suggesting moderate quality. Programs most often served frequent 911 callers (48.3%) and individuals at risk for emergency department admission, readmission, or hospitalization (41.4%); and 70.7% of programs were preventive home visits. Common services provided were home assessment (29.5%), medication management (39.7%), and referral and/or transport to community services (37.9%); and 77.6% of programs involved interprofessional collaboration. Community paramedicine training was described by 57% of programs and expanded upon traditional paramedicine training and emphasized technical skills. Study heterogeneity prevented meta-analysis.
Community paramedicine programs and training were diverse and allowed community paramedics to address a spectrum of population health and social needs. Training was poorly described. Enabling more programs to assess and report on program and training outcomes would support community paramedicine growth and the development of formalized training or education frameworks.
IntroductionRedirecting suitable patients from the emergency department (ED) to alternative subacute settings may assist in reducing ED overcrowding while delivering equivalent care. The Emergency ...Department Avoidance Classification (EDAC) was constructed to retrospectively classify ED visits that may have been suitable for safe management in a subacute or virtual clinical setting. The EDAC has established face and content validity but has not been tested against a reference standard as a criterion.ObjectivesOur primary objective is to examine the agreement between the EDAC and ED physician judgements in retrospectively identifying ED visits suitable for subacute care management. Our secondary objective is to assess the validity of ED physicians’ judgement as a criterion standard. Our tertiary objective is to examine how the ED physician’s perception of a virtual ED care alternative correlates with the EDAC.Methods and analysisA randomised single-centre, single-blinded agreement study. We will randomly select ED charts between 1 January and 31 December 2019 from an academic hospital in Hamilton, Canada. ED charts will be randomly assigned to participating ED physicians who will evaluate if this ED visit could have been managed appropriately and safely in a subacute and/or virtual model of care. Each chart will be reviewed by two physicians independently. We compute our needed sample size to be 79 charts. We will use kappa statistics to measure inter-rater agreement. A repeated measures regression model of physician ratings will provide variance estimates that we will use to assess the intraclass correlation of ED physician ratings and the EDAC.Ethics and disseminationThis study has been approved by the Hamilton Integrated Research Ethics Board (2022-14625). If validated, the EDAC may provide an ED-based classification to identify potentially avoidable ED visits, monitor ED visit trends, and proactively delineate those best suited for subacute or virtual care models.
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