Development and validation of a prediction index for recent mortality in advanced COPD patients

The primary barrier to initiating palliative care for advanced COPD patients is the unpredictable course of the disease. We enroll 752 COPD patients into the study and validate the prediction tools for 1-year mortality using the current guidelines for palliative care. We also develop a composite prediction index for 1-year mortality and validate it in another cohort of 342 patients. Using the current prognostic models for recent mortality in palliative care, the best area under the curve (AUC) for predicting mortality is 0.68. Using the Modified Medical Research Council dyspnea score and oxygen saturation to define the combined dyspnea and oxygenation (DO) index, we find that the AUC of the DO index is 0.84 for predicting mortality in the validated cohort. Predictions of 1-year mortality based on the current palliative care guideline for COPD patients are poor. The DO index exhibits better predictive ability than other models in the study.

ImproveCog, a cognitive stimulation program for people with mild cognitive impairment and dementia: First stage of development

Cognitive stimulation seems to be an important tool to slow the rate of cognitive decline due to dementia. This study describes the development of a cognitive stimulation program (ImproveCog) for people with Mild Cognitive Impairment, Alzheimer’s Disease, and behavioral variant Frontotemporal Dementia, within the Medical Research Council framework. Stage 1 established the theoretical and evidence basis of the program through a review of the existing cognitive stimulation programs as well as cognitive exercises and their efficacy (Pre-Clinical Phase) and includes qualitative testing through five focus group with eighteen health professionals and twelve individual interviews with people with cognitive impairment (Phase I - Modeling). An initial version of the program, which consisted of twelve 90-min weekly sessions and included a manual with cognitive stimulation exercises to be performed at home, was ready to be implemented in a pilot study to create a final version of ImproveCog.

First person – Alessandra da Silva Dantas

ABSTRACT First Person is a series of interviews with the first authors of a selection of papers published in Journal of Cell Science, helping early-career researchers promote themselves alongside their papers. Alessandra da Silva Dantas is first author on ‘ Crosstalk between the calcineurin and cell wall integrity pathways prevents chitin overexpression in Candida albicans’, published in JCS. Alessandra is a postdoctoral fellow in the lab of Prof. Neil Gow at the Medical Research Council Centre for Medical Mycology at the University of Exeter, UK, and is interested in the mechanisms controlling cell division and death in human fungal pathogens.

Efficacy of FFP3 respirators for prevention of SARS-CoV-2 infection in healthcare workers

Background: Respiratory protective equipment recommended in the UK for healthcare workers (HCWs) caring for patients with COVID-19 comprises a fluid resistant surgical mask (FRSM), except in the context of aerosol generating procedures (AGPs). We previously demonstrated frequent pauci- and asymptomatic SARS-CoV-2 infection HCWs during the first wave of the COVID-19 pandemic in the UK, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020). Methods: Here, we use observational data and mathematical modelling to analyse infection rates amongst HCWs working on 'red' (COVID-19) and 'green' (non-COVID-19) wards during the second wave of the pandemic, before and after the substitution of filtering face piece 3 (FFP3) respirators for FRSMs. Results: Whilst using FRSMs, HCWs working on red wards faced an approximately 31-fold (and at least 5-fold) increased risk of direct, ward-based infection. Conversely, after changing to FFP3 respirators, this risk was significantly reduced (52-100% protection). Conclusions: FFP3 respirators may therefore provide more effective protection than FRSMs for healthcare workers caring for patients with COVID-19, whether or not AGPs are undertaken. Funding: Wellcome Trust, Medical Research Council, Addenbrooke's Charitable Trust, NIHR Cambridge Biomedical Research Centre, NHS Blood and Transfusion, UKRI.

Using the Medical Research Council framework and public involvement in the development of a communication partner training intervention for people with primary progressive aphasia (PPA): Better Conversations with PPA

Background Primary progressive aphasia is a language-led dementia resulting in a gradual dissolution of language. Primary progressive aphasia has a significant psychosocial impact on both the person and their families. Speech and language therapy is one of the only available management options, and communication partner training interventions offer a practical approach to identify strategies to support conversation. The aim of this study was to define and refine a manual and an online training resource for speech and language therapists to deliver communication partner training to people with primary progressive aphasia and their communication partners called Better Conversations with primary progressive aphasia. Methods The Better Conversations with primary progressive aphasia manual and training program were developed using the Medical Research Council framework for developing complex interventions. The six-stage development process included 1. Exploratory review of existing literature including principles of applied Conversation Analysis, behaviour change theory and frameworks for chronic disease self-management, 2. Consultation and co-production over 12 meetings with the project steering group comprising representatives from key stakeholder groups, 3. Development of an initial draft, 4. Survey feedback followed by a consensus meeting using the Nominal Group Techniques with a group of speech and language therapists, 5. Two focus groups to gather opinions from people with PPA and their families were recorded, transcribed and Thematic Analysis used to examine the data, 6. Refinement. Results Co-production of the Better Conversations with primary progressive aphasia resulted in seven online training modules, and a manual describing four communication partner training intervention sessions with accompanying handouts. Eight important components of communication partner training were identified in the aggregation process of the Nominal Group Technique undertaken with 36 speech and language therapists, including use of video feedback to focus on strengths as well as areas of conversation breakdown. Analysis of the focus groups held with six people with primary progressive aphasia and seven family members identified three themes 1) Timing of intervention, 2) Speech and language therapists’ understanding of types of dementia, and 3) Knowing what helps. These data informed refinements to the manual including additional practice activities and useful strategies for the future. Conclusions Using the Medical Research Council framework to develop an intervention that is underpinned by a theoretical rationale of how communication partner training causes change allows for the key intervention components to be strengthened. Co-production of the manual and training materials ensures the intervention will meet the needs of people with primary progressive aphasia and their communication partners. Gathering further data from speech and language therapists and people living with primary progressive aphasia and their families to refine the manual and the training materials enhances the feasibility of delivering this in preparation for a phase II NHS-based randomised controlled pilot-feasibility study, currently underway.

Força muscular e funcionalidade de pacientes hospitalizados admitidos por afecções respiratórias

Objetivo: Analisar a força muscular e a funcionalidade de pacientes hospitalizados admitidos por afecções respiratórias. Metodologia: Estudo transversal, realizado em pacientes diagnosticados e internados com doenças respiratórias. As avaliações foram realizadas por meio da Medical Research Council (MRC), Medida de independência funcional (MIF), World Health Disability Assessment Schedule (WHODAS), manovacuometria e dinamometria em pacientes internados no Hospital Universitário de Lagarto. Resultados: Participaram do respectivo estudo 97 pacientes, onde observou-se redução das forças musculares periféricas e respiratórias. Ao analisar a funcionalidade, notou-se moderada dificuldade funcional, sendo ambos instrumentos correlatos (r= -722; p<0,01). Ao analisar a relação entre média de MRC (MMSS) e FPP D e E, demostrou-se que houve correlação alta e positiva (p<0,01) entre as mesmas. Notou-se uma correlação alta e positiva (p< 0,01) entre MRC e MIF, e alta e negativa com o WHODAS (r= -598; p<0,01). Ao avaliar as médias da FPP e do MRC entre os grupos acima de 60 anos e abaixo de 60 anos, verificou-se que o fator idade contribui para a perda da força muscular e, consequentemente, da funcionalidade (p= 0.000). Conclusão: Os pacientes internados por afecções respiratórias agudas ou crônicas agudizadas apresentaram redução da força muscular periférica e respiratória. Esta realidade ressalta a importância de uma assistência fisioterapêutica precoce, pautada na funcionalidade e no ganho de força muscular desses pacientes.

Meeting report: South African Medical Research Council Standard of Care in Clinical Research in Low- And Middle-Income Settings Summit, November 2017

A cornerstone of HIV prevention clinical trials is providing a combination prevention package to all trial participants. The elements included in that standard of care (SoC) package evolve as new prevention modalities are developed. Pre-exposure prophylaxis (PrEP) was recommended by the World Health Organization for persons at high risk of acquiring HIV, but not all countries immediately adopted those recommendations. The South African Medical Research Council (SAMRC) convened a summit to discuss issues relating to SoC and PrEP in HIV prevention clinical trials taking place in lower- to middle-income countries (LMIC). Policymakers, regulators, ethicists, experts in law, researchers, representatives of advocacy groups, and the HIV Vaccine Trials Network (HVTN) presented a framework within which SoC principles could be articulated. A group of subject matter experts presented on the regulatory, ethical, scientific, and historic framework of SoC in clinical trials, focusing on PrEP in South Africa. Summit participants discussed how and when to include new HIV treatment and prevention practices into existing clinical guidelines and trial protocols, as well as the opportunities for and challenges to scaling up interventions. The summit addressed challenges to PrEP provision, such as inconsistent efficacy amongst different populations and various biological, virological, and immunological explanations for this heterogeneity. Advocates and community members propagated the urgent need for accessible interventions that could avert HIV infection. The meeting recommended supporting access to PrEP in HIV prevention trials by (1) developing PrEP access plans for HIV vaccine trials, (2) creating a PrEP fund that would supply PrEP to sites conducting HIV prevention trials via a central procurement mechanism, and (3) supporting the safety monitoring of PrEP. This report summarizes the presentations and discussions from the summit in order to highlight the importance of SoC in HIV prevention clinical trials.

A Case Report on Managing the Side Effects of Anti-tuberculosis Drugs for Nontuberculous Mucobacteriosis (NTM) by Concurrently using Traditional Korean Medicine and Antibiotics

Objectives: This study investigated the effect of combined Korean medical treatment and antibiotics on a patient diagnosed with nontuberculous mycobacterial lung disease.Methods: The patient had been treated with antibiotics since July 2020 concurrently with Maekmoondong-tang, Banhasasim-tang, Gwakhyangjunggi-san and Bojungikgi-tang. The improvement of symptoms was evaluated using scores for the numerical rating scale (NRS), the Medical Research Council (MRC) dyspnea scale, C-reactive protein (CRP) levels, and computed tomography (CT).Results: Following treatment, the NRS, MRC dyspnea scale and CT images significantly improved. Also, CRP levels remained in the normal range during treatment.Conclusions: Traditional Korean medical treatment combined with antibiotics could be effective for treating patients with nontuberculous mycobacterial lung disease.