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The aim of this review is to assess the efficacy and safety of using heat and cold therapy for adults with lymphoedema. A multi-database search was undertaken. Only studies which included adults with lymphoedema who were treated with heat or cold therapy reporting any outcome were included. Screening, data extraction, and assessment of bias were undertaken by a single reviewer and verified by a second. Due to the substantial heterogeneity, a descriptive synthesis was undertaken. Eighteen studies were included. All nine studies which assessed the effects of heat-therapy on changes in limb circumference reported a point estimate indicating some reduction from baseline to end of study. Similarly, the five studies evaluating the use of heat-therapy on limb volume demonstrated a reduction in limb volume from baseline to end-of-study. Only four studies reported adverse events of which all were deemed to be minor. Only two studies explored the effects of cold therapy on lymphoedema. Tentative evidence suggests heat-therapy may have some benefit in treating lymphoedema with minimal side effects. However, further high-quality randomised controlled trials are required, with a particular focus on moderating factors and assessment of adverse events. This review highlights the potential benefit that heat therapy may have on reducing limb circumference and volume for adults with lymphoedema. There was no evidence that controlled localised heat therapy was unsafe. The current evidence-base is at a point where no specific clinical recommendations can be made. The use of heat therapy should only be applied as part of a methodologically robust study to treat lymphoedema. [ABSTRACT FROM AUTHOR]

Introduction: Overweight and obesity are growing public health problems worldwide. Both diet and physical activity have been the primary interventions for weight reduction over the past decade. With increasing rates of overweight and obesity, it is evident that a primary focus on diet and exercise has not resulted in sustained obesity reduction within the global population. There is now a case to explore other weight management strategies such as psychological therapies. However, there is a dearth of literature that has mapped the types of psychological interventions and the characteristics of these interventions as a means of achieving weight reduction., Objectives: The key objectives focused on mapping the types and characteristics of psychological interventions versus usual care for weight reduction and sustained weight reduction in adults with overweight or obesity. The study followed the scoping review methodology by Arksey and O'Malley and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines., Eligibility Criteria: Intervention studies were included if participants were 18 years and over, classified as overweight or obese (body mass index ≥25 kg/m 2 ) and had received a psychological therapy intervention. Studies were excluded if they included a comparison with other active lifestyle interventions (unless classified as usual care), were not available in English, were not full-text articles or were non-peer-reviewed articles., Sources of Evidence: Six electronic databases were searched from inception to April 2023 to identify relevant articles., Charting Methods: The study employed a systematic charting method and narrative synthesis to organise and synthesise the data., Results: A total of 31 studies met the eligibility criteria and were included in the review. 13 unique psychological interventions for weight reduction in adults with overweight or obesity were identified, with cognitive-behavioural therapy and motivational interviewing being the most common. Eight types of usual care were identified, which largely included education and training on nutrition and physical activity. Gaps in the current research were also identified., Conclusion: The findings highlighted several gaps within the existing literature, largely due to a lack of evidence relating to adults with low socioeconomic status, non-white participants, individuals under 40 years of age and the integration of digital health technologies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objectives: In this multi-center study, we proposed a structured reporting (SR) framework for non-small cell lung cancer (NSCLC) and developed a software-assisted tool to automatically translate image-based findings and annotations into TNM classifications. The aim of this study was to validate the software-assisted SR tool for NSCLC, assess its potential clinical impact in a proof-of-concept study, and evaluate current reporting standards in participating institutions., Methods: A framework for SR and staging of NSCLC was developed in a multi-center collaboration. SR annotations and descriptions were used to generate semi-automated TNM classification. The SR and TNM classification tools were evaluated by nine radiologists on n = 20 representative [18F]FDG PET/CT studies and compared to the free text reporting (FTR) strategy. Results were compared to a multidisciplinary team reference using a generalized linear mixed model (GLMM). Additionally, participants were surveyed on their experience with SR and TNM classification., Results: Overall, GLMM analysis revealed that readers using SR were 1.707 (CI: 1.137-2.585) times more likely to correctly classify TNM status compared to FTR strategy (p = 0.01) resulting in increased overall TNM correctness in 71.9% (128/178) of cases compared to 62.8% (113/180) FTR. The primary source of variation in classification accuracy was explained by case complexity. Participants rated the potential impact of SR and semi-automated TNM classification as positive across all categories with improved scores after template validation., Conclusion: This multi-center study yielded an effective software-assisted SR framework for NSCLC. The SR and semi-automated classification tool improved TNM classification and were perceived as valuable., Critical Relevance Statement: Software-assisted SR provides robust input for semi-automated rule-based TNM classification in non-small-cell lung carcinoma (NSCLC), improves TNM correctness compared to FTR, and was perceived as valuable by radiology physicians., Key Points: SR and TNM classification are underutilized across participating centers for NSCLC staging. Software-assisted SR has emerged as a promising strategy for oncologic assessment. Software-assisted SR facilitates semi-automated TNM classification with improved staging accuracy compared to free-text reports in NSCLC., (© 2024. The Author(s).)

Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) in sensitized individuals caused by a large variety of inhaled antigens. The clinical form of acute HP is often misdiagnosed, while the chronic form, especially the chronic fibrotic HP, is difficult to differentiate from other fibrotic ILDs. The present guideline for the diagnosis and treatment of HP replaces the former German recommendations for the diagnosis of HP from 2007 and is amended explicitly by the issue of the chronic fibrotic form, as well as by treatment recommendations for the first time. The evidence was discussed by a multidisciplinary committee of experts. Then, recommendations were formulated for twelve questions on important issues of diagnosis and treatment strategies. Recently published national and international guidelines for ILDs and HP were considered. Detailed background information on HP is useful for a deeper insight into HP and the handling of the guideline., Competing Interests: Eine Übersicht der Interessenkonflikte findet sich im Internet unter http://awmf.org; AWMF-Registriernummer 020-036., (Thieme. All rights reserved.)

Objective: The primary aim of this systematic review is to assess the effectiveness of evidence-based healthcare (EBHC) educational interventions on healthcare professionals' knowledge, skills, attitudes, behaviour of EBHC, clinical process and care outcomes. A secondary aim of the review is to assess the effects of important pedagogical moderating factors for EBHC educational interventions., Method: This systematic review used a forward and backward citation search strategy on the Web of Science platform (date of inception to 28 April 2023). Only randomised controlled trials (RCTs) and cluster RCTs which compared EBHC educational interventions for healthcare professionals were included. A random effects meta-analysis was undertaken for EBHC compared with an active and nonactive control for all outcomes., Results: Sixty-one RCTs were identified which included a total of 5208 healthcare professionals. There was a large effect for EBHC educational interventions compared with waiting list/no treatment/sham control on knowledge (SMD, 2.69; 95% CI, 1.26-4.14, GRADE Low), skills (SMD, 0.88; 95% CI, 0.25-1.73, Very Low Certainty), attitude (SMD, 0.81; 95% CI, 0.16-1.47, Very Low Certainty) and behaviour of EBHC (SMD, 0.82; 95% CI, 0.25-1.40, Very Low Certainty). Over time the effect of EBHC educational interventions substantially decreased with no evidence of effect at 6 months for any outcome except behaviour (SMD,1.72; 95% CI, 0.74-2.71, Low Certainty). There was some evidence that blended learning, active learning and consistency in the individual delivering the intervention may be important positive moderating factors., Conclusion: These findings suggest that EBHC educational interventions may have a large short-term effect on improving healthcare professionals' knowledge, skills, attitude and behaviour of EBHC. These effects may be longer-lasting regarding EBHC behaviour. In terms of pedagogy, blended learning, active learning, and consistency of the individual delivering the intervention may be important positive moderating factors., (© 2024 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Purpose: CT-guided percutaneous core biopsy of the lung is usually performed under local anesthesia, but can also be conducted under additional systemic opioid medication. The purpose of this retrospective study was to assess the effect of intravenous piritramide application on the pneumothorax rate and to identify risk factors for post-biopsy pneumothorax., Materials and Methods: One hundred and seventy-one core biopsies of the lung were included in this retrospective single center study. The incidence of pneumothorax and chest tube placement was evaluated. Patient-, procedure- and target-related variables were analyzed by univariate and multivariable logistic regression analysis., Results: The overall incidence of pneumothorax was 39.2% (67/171). The pneumothorax rate was 31.5% (29/92) in patients who received intravenous piritramide and 48.1% (38/79) in patients who did not receive piritramide. In multivariable logistic regression analysis periinterventional piritramide application proved to be the only independent factor to reduce the risk of pneumothorax (odds ratio 0.46, 95%-confidence interval 0.24, 0.88; p = 0.018). Two or more pleura passages (odds ratio 3.38, 95%-confidence interval: 1.15, 9.87; p = 0.026) and prone position of the patient (odds ratio 2.27, 95%-confidence interval: 1.04, 4.94; p = 0.039) were independent risk factors for a higher pneumothorax rate., Conclusion: Procedural opioid medication with piritramide proved to be a previously undisclosed factor decreasing the risk of pneumothorax associated with CT-guided percutaneous core biopsy of the lung. LEVEL OF EVIDENCE 4: small study cohort., (© 2024. The Author(s).)

Background: Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit., Aim: This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff., Study Design: A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes., Results: In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention., Conclusions: This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement., Relevance to Clinical Practice: This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience., (© 2022 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Arrhythmia-induced cardiomyopathy (AIC) is characterized by the reversibility of left ventricular (LV) systolic dysfunction (LVSD) after rhythm restoration. This study is a cardiac magnetic resonance tomography substudy of our AIC trial with the purpose to investigate whether left ventricular fibrosis affects the time to recovery (TTR) in patients with AIC., Method: Patients with newly diagnosed and otherwise unexplainable LVSD and tachyarrhythmia were prospectively recruited. LV ejection fraction (LVEF) was measured by echocardiography at baseline and 2, 4, and 6 months after rhythm control, and stress markers were assessed. After initial rhythm control, LV fibrosis was assessed through late gadolinium enhancement (LGE). Patients were diagnosed with AIC if their LVEF improved by ≥15% (or ≥10% when LVEF reached ≥50%). Non-responders served as controls (non-AIC)., Results: The LGE analysis included 39 patients, 31 of whom recovered (AIC). LV end-systolic diameters decreased and LVEF increased during follow-up. LV LGE content correlated positively with TTR (r = 0.63, p = 0.003), with less LGE favoring faster recovery, and negatively with ΔLVEF (i.e., LVEF at month 2 compared to baseline) as a marker of fast recovery (r = -0.55, p = 0.012), suggesting that LV fibrosis affects the speed of recovery., Conclusion: LV fibrosis correlated positively with the time to recovery in patients with AIC. This correlation may help in the estimation of the recovery period and in the optimization of diagnostic and therapeutic strategies for patients with AIC.

Infertility is a widespread issue which is estimated to affect up to 17.5% of the global population. Evidence suggests that the most common causes of female infertility are ovulation disorders (e.g., polycystic ovary syndrome). That said, lifestyle factors such as dietary patterns, stress, alcohol consumption, smoking, and obesity are key determinants which have been shown to impact female physiology and significantly decrease the chances of conception. Obesity has been widely recognized as a significant factor that negatively impacts ovarian stimulation in women and is associated with several reproductive disorders, including anovulation, subfertility, and infertility. Despite improvements in fertility treatments, obesity remains a challenge particularly for fertility clinics because of the poorer pregnancy outcomes observed within the population. In this article, we will explore the effects of weight loss on female fertility and review the various strategies that have been shown to be effective in reducing obesity and improving reproductive outcomes.

Hypertension (also known as high blood pressure), is a medical condition characterized as a persistently raised blood pressure of the pulmonary artery. Effective interventions to treat hypertension typically involve two approaches: lifestyle modifications and pharmacotherapy. One specific lifestyle intervention which aims to increase calcium uptake through dietary supplementation, has recently gained popularity because of its potential to be low-cost and population based. Research suggests that this intervention may be effective given that calcium has been found to have an inverse relationship with blood pressure and hypertension. That said, studies have shown that there may be potential risks to patient health through adverse events such as kidney stone formation and increased cardiovascular events. Association between calcium supplementation and adverse events could have an impact on population health and prevent widespread adoption of the intervention. Because of the need to establish the effectiveness of this intervention assessed against any possible harms, it is now necessary to review the current evidence and evaluate its implications for clinical practise.

Obesity is a well-established risk factor for infertility. Consequentially, women living with obesity may require fertility treatment to support them to conceive. Due to evidence suggesting obesity is also linked with poorer outcomes following in vitro fertilisation (IVF), local commissioning guidelines on assisted conception recommend a BMI of <30kg/m 2 before IVF can commence. However, it is currently unclear if these guidelines are evidence based. This commentary aims to critically appraise a recent systematic review by Sermondade et al, 2019 and expand upon the implications of the findings for clinical practice.

Introduction: Overweight and obesity are growing public health problems worldwide. Both diet and physical activity have been the primary interventions for weight reduction over the past decade. With increasing rates of overweight and obesity, it is evident that a primary focus on diet and exercise has not resulted in sustained obesity reduction within the global population. There is now a case to explore other weight management strategies, focusing on psychological factors that may underpin overweight and obesity. Psychological therapy interventions are gaining recognition for their effectiveness in addressing underlying emotional factors and promoting weight loss. However, there is a dearth of literature that has mapped the types of psychological interventions and the characteristics of these interventions as a means of achieving weight reduction and sustained weight reduction in adults with overweight or obesity., Methods and Analysis: The review will combine the methodology outlined by Arksey and O'Malley with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A total of six databases will be searched using a comprehensive search strategy. Intervention studies will be included if participants are 18 years and over, classified as overweight or obese (body mass index ≥25 kg/m 2 ), and have received a psychological therapy intervention. The review will exclude studies that are not available in English, not full text, none peer reviewed or combine a lifestyle and/or pharmacological intervention with a psychological intervention. Data will be synthesised using a narrative synthesis approach., Ethics and Dissemination: Ethical approval is not required to conduct this scoping review. The findings will be disseminated through journal publication(s), social media and a lay summary for key stakeholders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Leg ulcers pose a significant challenge to healthcare services, requiring effective wound cleansing strategies to promote healing and prevent complications. Large amounts of nursing time is spent managing patients with venous leg ulcers (VLUs), with an average appointment time of approximately 30 minutes. Yet, there is a lack of clear guidance for the treatment of VLUs, with nurses adopting a wide range of cleansing practices. This commentary provides an overview of existing evidence on wound cleansing and care in treating leg ulcers, for the benefit of healthcare professionals working within clinical practice.

Abdominal aortic aneurysm (AAA) is a condition in which the abdominal aorta becomes enlarged, posing a risk of rupture and life-threatening haemorrhage. Abdominal aortic aneurysm accounts for a substantial number of fatalities worldwide, with mortality rates of up to 80 percent. Abdominal aortic aneurysms are often asymptomatic and are frequently discovered incidentally during tests for unrelated conditions. Surgery is required for aneurysms exceeding 5.5cm in men and 5cm in women, but post-surgical complications such as intra-abdominal adhesions, limb ischaemia and renal failure are common. There is some evidence showing that exercise, including prehabilitation, may be effective in improving patient outcomes post-surgery. However, there is a dearth of literature that has synthesised existing evidence related to the effectiveness of prehabilitation on patient outcomes post-surgery, and which has expanded upon its implications for clinical practise. This commentary aims to critically appraise the most recent Cochrane review in this area, and expand upon these findings to inform clinical practice., Competing Interests: Conflicts of interest statement The authors declare no conflicts of interest.

Cardiovascular disease remains one of the most prevalent and preventable chronic conditions worldwide. Nutrition plays an important role in reducing several risk factors associated with cardiovascular disease. Intermittent fasting has been rapidly gaining interest among patients with cardiometabolic disease as a nutritional strategy for improving cardiovascular outcomes. However, research had yet to determine whether intermittent fasting provides greater cardiometabolic benefits compared to continuous daily caloric restriction. A recent Cochrane review has synthesised the benefits of intermittent fasting for the prevention of cardiovascular disease but is limited by its interpretation of the findings for clinical practice. This commentary aims to critically appraise the methods used within the review by Allaf et al, 2021 and expand upon the findings to determine its implications for clinical practice.

There is a long history of BAME under-representation in medical research. Underrepresentation of minority ethnic groups have been assessed by several studies, showing that black and minority ethnic groups were less likely to participate and engage in medical research when compared to white British groups (in relation to education, occupation, health, belief, and attitudes to medical research).There may be several strategies that improve inclusivity, including translation of participant information, culturally specific recruitment, and adaptations to the invitation process. However, with a dearth of literature in the area, there is now a need to contextualise these strategies in relation to renal research.

Globally, hypertension is a significant contributor to cardiovascular, renal diseases and death. Increased dietary salt intake raises the risk of hypertension, which in turn raises the risk of cardiovascular disease, stroke, and kidney disorders. A practical approach to minimising salt intake to lower blood pressure is to use low salt sodium substitutes. However, there is some evidence that salt substitutes may lead to adverse events such as hyperkalaemia, which can cause arrythmias and cardiac arrests. Existing evidence is unclear as to whom is at risk of harm from low sodium salt substitutes, and thus there is now a need for a concise synthesis of evidence to guide healthcare practitioners. The aim of this commentary is to summarise the efficiency of substituting low sodium salt substitutes with regular salt for lowering blood pressure in adult, children, and pregnant women.

The aim of this study was to evaluate if CT findings in patients with pulmonary Post Covid syndrome represent residua after acute pneumonia or if SARS-CoV 2 induces a true ILD. Consecutive patients with status post acute Covid-19 pneumonia and persisting pulmonary symptoms were enrolled. Inclusion criteria were availability of at least one chest CT performed in the acute phase and at least one chest CT performed at least 80 days after symptom onset. In both acute and chronic phase CTs 14 CT features as well as distribution and extent of opacifications were independently determined by two chest radiologists. Evolution of every single CT lesion over time was registered intraindividually for every patient. Moreover, lung abnormalities were automatically segmented using a pre-trained nnU-Net model and volume as well as density of parenchymal lesions were plotted over the entire course of disease including all available CTs. 29 patients (median age 59 years, IQR 8, 22 men) were enrolled. Follow-up period was 80-242 days (mean 134). 152/157 (97 %) lesions in the chronic phase CTs represented residua of lung pathology in the acute phase. Subjective and objective evaluation of serial CTs showed that CT abnormalities were stable in location and continuously decreasing in extent and density. The results of our study support the hypothesis that CT abnormalities in the chronic phase after Covid-19 pneumonia represent residua in terms of prolonged healing of acute infection. We did not find any evidence for a Post Covid ILD.

In the UK, more than 38,000 preterm infants are admitted to Neonatal Intensive Care Units every year. NICU stays, along with perceived vulnerability, have been shown to increase parental stress. Parental stress at this stage of infant development has been associated with a deterioration of the long-term parent-infant relationship. Parental stress may be reduced by early educational, behavioural, and psychological support interventions. However, there is a dearth of literature that has synthesised whether these early discharge (supported transfer to home) interventions are clinically effective. This commentary aims to critically appraise a recent systematic review by Hamer et al, 2022 and expand upon the implications of the findings for clinical practice., Competing Interests: Conflict of interest statement Dr Oliver Hamer and James Hill are the authors of the systematic review which this commentary is based upon. They were not involved in the commentary section or critical appraisal of this review, and only assisted with the write up of the methods.

Hypertension affects more than 1 in 4 adults, equating to around 1.39 billion people worldwide. Hypertension is defined as an elevation in systolic blood pressure above 140mmHg. This can increase cardiovascular and stroke risk. By lowering blood pressure, individuals can mitigate an increased risk of stroke and end-organ damage. While medications have proven beneficial to lowering blood pressure, they do have the potential for side effects. Other non-pharmacological lifestyle and dietary changes exist. This article critically appraises a systematic review which assesses whether walking can reduce blood pressure.

It is estimated that 200 million people are living with coronary heart disease, which remains one of the leading causes of mortality and morbidity worldwide. Those living with coronary heart disease are at an increased risk of cardiovascular events such as stroke, myocardial infarction, and cardiovascular death. Pathophysiology of coronary heart disease revolves around inflammation which leads to plaque build-up. Antibiotics are known to hold anti-inflammatory and anti-oxidative properties. It is theorized that reductions in inflammation could prevent cardiovascular events which may reduce suffering, risk of death and hospital admission rates in patients with coronary heart disease. This article critically appraises a systematic review that assessed the risk of antibiotics used as secondary prevention for coronary heart disease.

Delirium is a common presentation after acute stroke. Post-stroke delirium is related to poor recovery, higher rates of mortality, falls, and longer hospital stays. Delirium can lead to challenging behaviour such as anger, aggression, and confusion. As such, it is important to identify delirium promptly for early management and to reduce the negative impact on post-stroke recovery and outcomes. An important aspect of identifying delirium depends on the use of efficient, easy to use and validated assessment tools. A wide range of tools are available, although it is not known how accurately they can identify post-stroke delirium. This article critically appraises a systematic review which identified delirium screening tools for patients with acute stroke, and summarised their accuracy.

Background: During the COVID-19 pandemic, there have been concerns regarding potential bias in pulse oximetry measurements for people with high levels of skin pigmentation. We systematically reviewed the effects of skin pigmentation on the accuracy of oxygen saturation measurement by pulse oximetry (SpO 2 ) compared with the gold standard SaO 2 measured by CO-oximetry., Methods: We searched Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform (up to December 2021) for studies with SpO 2 -SaO 2 comparisons and measuring the impact of skin pigmentation or ethnicity on pulse oximetry accuracy. We performed meta-analyses for mean bias (the primary outcome in this review) and its standard deviations (SDs) across studies included for each subgroup of skin pigmentation and ethnicity and used these pooled mean biases and SDs to calculate accuracy root-mean-square (A rms ) and 95% limits of agreement. The review was registered with the Open Science Framework ( https://osf.io/gm7ty )., Results: We included 32 studies (6505 participants): 15 measured skin pigmentation and 22 referred to ethnicity. Compared with standard SaO 2 measurement, pulse oximetry probably overestimates oxygen saturation in people with the high level of skin pigmentation (pooled mean bias 1.11%; 95% confidence interval 0.29 to 1.93%) and people described as Black/African American (1.52%; 0.95 to 2.09%) (moderate- and low-certainty evidence). The bias of pulse oximetry measurements for people with other levels of skin pigmentation or those from other ethnic groups is either more uncertain or suggests no overestimation. Whilst the extent of mean bias is small or negligible for all subgroups evaluated, the associated imprecision is unacceptably large (pooled SDs > 1%). When the extent of measurement bias and precision is considered jointly, pulse oximetry measurements for all the subgroups appear acceptably accurate (with A rms  < 4%)., Conclusions: Pulse oximetry may overestimate oxygen saturation in people with high levels of skin pigmentation and people whose ethnicity is reported as Black/African American, compared with SaO 2 . The extent of overestimation may be small in hospital settings but unknown in community settings. REVIEW PROTOCOL REGISTRATION: https://osf.io/gm7ty., (© 2022. The Author(s).)

Stroke remains one of the leading causes of death worldwide. In order to tackle the negative impacts of stroke, a high standard of clinical practice and a commitment to continuous quality improvement is needed across the stroke care pathway. One approach to quality improvement is the formation and implementation of quality improvement collaboratives (QIC's). However, there are several barriers to the implementation of a QIC for stroke care which may impact on their success. This article critically appraises a systematic review which assessed the effectiveness of QIC's for driving improvements in stroke care and explored the barriers to implementing a QIC's to improve care., Competing Interests: Conflict of interest statement Hayley Lowther and James Hill are the authors of the systematic review which this commentary is based upon. Hayley Lowther and James Hill were not involved in the commentary section or critical appraisal of this review.

One to two percent of the population in developed countries are affected by chronic heart failure and this increases to greater than 10% in those over 70 years old. Heart failure (HF) predisposes patients to thromboembolic events. Anticoagulants are often used to prevent thromboembolic events in specific patient populations, such as those with atrial fibrillation. Currently, no guidance exists on the long-term use of anticoagulants for patients with HF in sinus rhythm. This article critically appraises a systematic review which assesses whether the long-term use of oral anticoagulants reduces total mortality and stroke in patients with HF in sinus rhythm., Competing Interests: Conflicts of interest statement The authors declare no conflicts of interest.

Pressure ulcers can affect multiple aspects of an individual's life. Though preventable, pressure ulcers place a substantial economic burden on healthcare services. Countries around the world have set pressure ulcer prevention and treatment as a high priority. National Clinical Guidelines recommend a wide range of preventative and curative treatments. However, there is still much uncertainty regarding the effectiveness of preventative and curative treatments. This overview of systematic reviews aims to describe the findings of 15 Cochrane reviews on the treatment and prevention of pressure ulcers included in a previous umbrella review and to expand upon their findings in the context of clinical practice.

Aims: Sleep disordered breathing (SDB) is known to cause left atrial (LA) remodeling. However, the relationship between SDB severity and LA dysfunction is insufficiently understood and may be elucidated by detailed feature tracking (FT) strain analysis of cardiac magnetic resonance images (CMR). After myocardial infarction (MI), both the left ventricle and atrium are subjected to increased stress which may be substantially worsened by concomitant SDB that could impair consequential healing. We therefore analyzed atrial strain in patients at the time of acute MI and 3 months after., Methods and Results: 40 patients with acute MI underwent CMR and polysomnography (PSG) within 3-5 days after MI. Follow-up was performed 3 months after acute MI. CMR cine data were analyzed using a dedicated FT software. Atrial strain (ε) and strain rate (SR) for atrial reservoir ([ε s ]; [SR s ]), conduit ([ε e ]; [SR e ]) and booster function ([ε a ]; [SR a ]) were measured in two long-axis views. SDB was defined by an apnea-hypopnea-index (AHI) ≥15/h. Interestingly, LA ε s and ε e were significantly reduced in patients with SDB and correlated negative with AHI as a measure of SDB severity at both baseline and follow-up. Intriguingly, patients that exhibited a reduced AHI at follow-up were more likely to have developed improved atrial reservoir and conduit strain (linear regression, p =0.08 for ε s and ε e ). Patients with improved SDB (ΔAHI < -5/h) exhibited a mean improvement of LA reservoir strain of +7.2 ± 8.4% whereas patients with SDB deterioration (ΔAHI> + 5/h) showed a mean decrease of -5.3 ± 11.0% ( p = 0.0131). Similarly, the difference for LA conduit function was +4.8 ± 5.9% (ΔAHI < -5/h) vs -3.6 ± 8.8% (ΔAHI> +5/h). Importantly, conventional volumetric parameters for atrial function (LA area, LA volume index) did not correlate with AHI at baseline or follow-up., Conclusion: Our results show that LA function measured by CMR strain but not by volumetry is impaired in patients with SDB during acute cardiac injury. Consistent with a mechanistic association, improvement of SBD at follow-up resulted in improved LA strain. LA strain measurement might thus provide insight into atrial function in patients with SDB., Competing Interests: MA received lecture and consulting fees from ResMed, Philips Respironics, Boehringer-Ingelheim, NRI, Novartis, JAZZ pharmaceuticals, Bayer, Inspire and Bresotec and grant support from ResMed Foundation, ResMed, and Philips Respironics outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Wester, Pec, Lebek, Fisser, Debl, Hamer, Poschenrieder, Buchner, Maier, Arzt and Wagner.)

Background: Even after more than 100 years, the chest X‑ray is still an important technique to detect important pathological changes of lungs, heart and vessels in a fast and low-dose manner. For the German-speaking regions, there are only recommendations available published by the "Ständigen Strahlenschutzkommission (SSK)" regarding the indication. These recommendations are not updated on a regular basis and more recent developments are only integrated with delayed., Methods: The chest division of the German Radiological Society has summarized their expertise for the usage and indication of the chest X‑ray. Especially within the field of oncology the usage of chest X‑ray is evaluated differently to the aforementioned recommendations; here chest computed tomography (CT) is much more sensitive for evaluation of metastasis and local invasion of tumors. Also, within the area of infectious diseases in non-immunocompetent patients, CT is the method of choice. Based on the structure of the current recommendations, many current guidelines and indications are summarized and presented within the context of the usage of chest X‑ray., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)