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الإعداد والانتحال
يتناول الكتاب التعريفات المتعددة للإعداد والانتحال والسياسات الثقافية والجمالية وراء الدافع للإعداد والطرائق المتنوعة التي يعد بها الأدب المعاصر والسينما الأعمال الفنية الأخرى، وتأثير الحركات النظرية بما فيها البنيوية وما بعد البنيوية وما بعد الكولونيالية وما بعد الحداثة والنزعة الأنوثية ودراسة النوع على الإعداد والانتحال وانتحال نصوص تراثية معينة وأيضا أنماط أدبية أصيلة مثل الأسطورة وحكايات الجنيات عبر الزمن وعبر الثقافات.
Book
Predictors of health-related quality of life after cardiac surgery: a systematic review
Background
Health-related quality of life (HRQoL) is important in determining surgical success, particularly from the patients’ perspective.
Aims
To identify predictors for HRQoL outcome after cardiac surgery in order to identify potentially modifiable factors where interventions to improve patient outcomes could be targeted.
Methods
Electronic databases (including MEDLINE, CINAHL, Embase) were searched between January 2001 and December 2020 for studies determining predictors of HRQoL (using a recognised and validated tool) in adult patients undergoing cardiac surgery. Data extraction and quality assessments were undertaken and data was summarised using descriptive statistics and narrative synthesis, as appropriate.
Results
Overall, 3924 papers were screened with 41 papers included in the review. Considerable methodological heterogeneity between studies was observed. Most were single-centre (75.6%) prospective observational studies (73.2%) conducted in patients undergoing coronary artery bypass graft (CABG) (n = 51.2%) using a version of the SF-36 (n = 63.4%). Overall, 103 independent predictors (62 pre-operative, five intra-operative and 36 post-operative) were identified, where 34 (33.0%) were reported in more than one study. Potential pre-operative modifiable predictors include alcohol use, BMI/weight, depression, pre-operative quality of life and smoking while in the post-operative period pain and strategies to reduce post-operative complications and intensive care and hospital length of stay are potential therapeutic targets.
Conclusion
Despite a lack of consistency across studies, several potentially modifiable predictors were identified that could be targeted in interventions to improve patient or treatment outcomes. This may contribute to delivering more person-centred care involving shared decision-making to improve patient HRQoL after cardiac surgery.
Journal Article
Impact of maintaining serum potassium concentration ≥ 3.6mEq/L versus ≥ 4.5mEq/L for 120 hours after isolated coronary artery bypass graft surgery on incidence of new onset atrial fibrillation: Protocol for a randomized non-inferiority trial
Atrial Fibrillation After Cardiac Surgery (AFACS) occurs in about one in three patients following Coronary Artery Bypass Grafting (CABG). It is associated with increased short- and long-term morbidity, mortality and costs. To reduce AFACS incidence, efforts are often made to maintain serum potassium in the high-normal range (≥ 4.5mEq/L). However, there is no evidence that this strategy is efficacious. Furthermore, the approach is costly, often unpleasant for patients, and risks causing harm. We describe the protocol of a planned randomized non-inferiority trial to investigate the impact of intervening to maintain serum potassium ≥ 3.6 mEq/L vs ≥ 4.5 mEq/L on incidence of new-onset AFACS after isolated elective CABG.
Patients undergoing isolated CABG at sites in the UK and Germany will be recruited, randomized 1:1 and stratified by site to protocols maintaining serum potassium at either ≥ 3.6 mEq/L or ≥ 4.5 mEq/L. Participants will not be blind to treatment allocation. The primary endpoint is AFACS, defined as an episode of atrial fibrillation, flutter or tachycardia lasting ≥ 30 seconds until hour 120 after surgery, which is both clinically detected and electrocardiographically confirmed. Assuming a 35% incidence of AFACS in the 'tight control group', and allowing for a 10% loss to follow-up, 1684 participants are required to provide 90% certainty that the upper limit of a one-sided 97.5% confidence interval (CI) will exclude a > 10% difference in favour of tight potassium control. Secondary endpoints include mortality, use of hospital resources and incidence of dysrhythmias not meeting the primary endpoint (detected using continuous heart rhythm monitoring).
The Tight K Trial will assess whether a protocol to maintain serum potassium ≥ 3.6 mEq/L is non inferior to maintaining serum potassium ≥ 4.5 mEq/L in preventing new-onset AFACS after isolated CABG.
ClinicalTrials.gov Identifier: NCT04053816. Registered on 13 August 2019. Last update 7 January 2021.
Journal Article
Ben Jonson's walk to Scotland : an annotated edition of the 'foot voyage'
\"At the heart of this book is a previously unpublished account of Ben Jonson's celebrated walk from London to Edinburgh in the summer of 1618. This unique firsthand narrative provides us with an insight into where Jonson went, whom he met, and what he did on the way. James Loxley, Anna Groundwater and Julie Sanders present a clear, readable and fully annotated edition of the text. An introduction and a series of contextual essays shed further light on topics including the evidence of provenance and authorship, Jonson's contacts throughout Britain, his celebrity status, and the relationships between his 'foot voyage' and other famous journeys of the time. The essays also illuminate wider issues such as early modern travel and political and cultural relations between England and Scotland. It is an invaluable volume for scholars and upper-level students of Ben Jonson studies, early modern literature, seventeenth-century social history, and cultural geography\"-- Provided by publisher.
Book
Correction: Impact of maintaining serum potassium concentration ≥ 3.6mEq/L versus ≥ 4.5mEq/L for 120 hours after isolated coronary artery bypass graft surgery on incidence of new onset atrial fibrillation: Protocol for a randomized non-inferiority trial
[This corrects the article DOI: 10.1371/journal.pone.0296525.].
Journal Article
Predicting cardiac surgical site infection: development and validation of the Barts Surgical Infection Risk tool
The objective of this study was to develop and validate a new risk tool (Barts Surgical Infection Risk (B-SIR)) to predict surgical site infection (SSI) risk after all types of adult cardiac surgery, and compare its predictive ability against existing (but procedure-specific) tools: Brompton-Harefield Infection Score (BHIS), Australian Clinical Risk Index (ACRI), National Nosocomial Infection Surveillance (NNIS).
Single-center retrospective analysis of prospectively collected data including 2,449 patients undergoing cardiac surgery between January 2016 and December 2017 in a European tertiary hospital. Thirty-four variables associated with SSI risk after cardiac surgery were collated from three local databases. Independent predictors were identified using stepwise multivariable logistic regression. Bootstrap resampling was conducted to validate the model. Hosmer-Lemeshow goodness-of-fit test was performed to assess calibration of scores.
The B-SIR model was constructed from six independent predictors female gender, body mass index >30, diabetes, left ventricular ejection fraction <45%, peripheral vascular disease and operation type, and the risk estimates were derived. The receiver operating characteristics curve for B-SIR was 0.682, vs. 0.603 for BHIS, 0.618 for ACRI, and 0.482 for the NNIS tool.
B-SIR provides greater predictive power of SSI risk after cardiac surgery compared with existing tools in our population.
•The new tool is a better predictor of surgical site infection risk in cardiac surgery.•Prediction tool can be useful to support patients' informed decision.•Risk tool can be useful in targeted intervention development to prevent infection.•Clinicians can be guided in triaging decision on surgical site infection prevention.•Use of bias-corrected coefficient is a more robust procedure of risk modeling.
Journal Article
Cardiac surgery outcome during the COVID-19 pandemic: a retrospective review of the early experience in nine UK centres
Background
Early studies conclude patients with Covid-19 have a high risk of death, but no studies specifically explore cardiac surgery outcome. We investigate UK cardiac surgery outcomes during the early phase of the Covid-19 pandemic.
Methods
This retrospective observational study included all adult patients undergoing cardiac surgery between 1st March and 30th April 2020 in nine UK centres. Data was obtained and linked locally from the National Institute for Cardiovascular Outcomes Research Adult Cardiac Surgery database, the Intensive Care National Audit and Research Centre database and local electronic systems. The anonymised datasets were analysed by the lead centre. Statistical analysis included descriptive statistics, propensity score matching (PSM), conditional logistic regression and hierarchical quantile regression.
Results
Of 755 included individuals, 53 (7.0%) had Covid-19. Comparing those with and without Covid-19, those with Covid-19 had increased mortality (24.5% v 3.5%,
p
< 0.0001) and longer post-operative stay (11 days v 6 days,
p
= 0.001), both of which remained significant after PSM. Patients with a pre-operative Covid-19 diagnosis recovered in a similar way to non-Covid-19 patients. However, those with a post-operative Covid-19 diagnosis remained in hospital for an additional 5 days (12 days v 7 days,
p
= 0.024) and had a considerably higher mortality rate compared to those with a pre-operative diagnosis (37.1% v 0.0%,
p
= 0.005).
Conclusions
To mitigate against the risks of Covid-19, particularly the post-operative burden, robust and effective pre-surgery diagnosis protocols alongside effective strategies to maintain a Covid-19 free environment are needed. Dedicated cardiac surgery hubs could be valuable in achieving safe and continual delivery of cardiac surgery.
Journal Article
Mitochondrial Dysfunction Contributes to Sustained Muscle Loss After Cardiac Surgery: A Prospective Observational Study
Background As a major systemic insult, cardiac surgery can lead to significant muscle loss, which increases the time to recovery as well as being correlated with mortality. Highly variable loss of muscle mass (0%–40% rectus femoris cross‐sectional area [RFcsa]) and strength in the week after surgery has aided understanding of mechanisms of sarcopenia after acute illness. To include muscle recovery, patients' muscle phenotype beyond the first week after surgery and up to their return as outpatients was studied and correlated with protein and metabolomic markers. Methods Patients undergoing elective aortic valve surgery were recruited. Muscle mass (RFcsa), strength (handgrip, knee extension and spirometry), body composition (by bioimpedance) and health‐related quality of life (generic questionnaire EQ‐5D‐5L) were determined pre‐operatively, 7 days after surgery and at outpatient follow‐up. Blood samples were taken on Days 0, 1, 3, 7 and follow‐up. The plasma metabolome was determined in 20 patients at Days 0, 3, 7 and follow‐up. Results Of 31 participants, 20 were male: mean age 68.8 years with a range between 48 and 85 years. Proportionate mean loss of RFcsa between pre‐op and Day 7 values was 6.44% [95% CI 4.21 to 8.68, n = 31]; between pre‐op and follow‐up 9.69% [95% CI 4.92 to 14.96, n = 22]; and between Day 7 and follow‐up 3.60% [95% CI −1.30 to 8.48, n = 22]. By contrast to measures of muscle bulk, the strength and functionality assessments (knee extension, handgrip, spirometry and short physical performance battery) decreased in the first week after surgery (pre‐op to Day 7) followed by a return to baseline (Day 7 to follow‐up). Health‐related quality of life (cross‐walk index) changed little over the course of the study but correlated positively at follow‐up with muscle bulk (RFcsa: r = 0.58 [95% CI 0.19 to 0.81] p = 0.005) and strength of knee extension (r = 0.54 [95% CI 0.14 to 0.79] p = 0.010) and handgrip (r = 0.63 [95% CI 0.27 to 0.83] p = 0.002: n = 22). Both pre‐operative and peak (Day 3) plasma levels of short‐chain acyl‐carnitine markers of mitochondrial dysfunction correlated with proportional muscle loss at follow‐up and with strength at all timepoints. Conclusions Prolonged follow‐up after aortic surgery demonstrated a divergence between the consistent recovery of strength and a significant proportion of patients continuing to lose muscle bulk. Markers of baseline and acute mitochondrial dysfunction predicted poor muscle outcomes up to outpatient follow‐up.
Journal Article
Global sex-equity and the health gap challenge
Sex-equity and increased women’s leadership is critical for global economic, environmental and societal success.1 Over the last 25 years, women’s representation in politics has doubled,2 twice the number of Nobel prizes have been honoured to women compared with the entirety of the 20th century3 and in the last decade there is an increased number of women holding senior board level positions.4 Despite these gains, overall progress on delivering sex parity has been slow and no country yet fully provides equal opportunity for women.5 Globally, women still have fewer rights, receive less education, are more likely to live in poverty, are twice as likely to undertake unpaid work6 and remain significantly underrepresented across influential sectors of society including business and politics.2 Furthermore, this is not expected to be rectified any time soon. On average, only one-third of CVD research participants are women,12 often excluded due to the acceptance of the ‘male norm’ in research culture and the perceived complexities of including women.13 Similarly, women have experienced insufficient opportunity and considerable barriers to participation, predominantly aligned to women’s societal position, making involvement in CVD research too costly and burdensome.12 However, increased recruitment of women into CVD studies is observed when the lead researcher is a woman.14 Unfortunately, less than 20% of CVD lead investigators are women, a proportion that has remained unchanged for over 14 years.14 Therefore, calls for greater consideration to sex equity in trial design and delivery, plus the development of women CVD research leaders have been made.15 Nonetheless, for them to be effective wider societal and policy development must occur in parallel.15 It is claimed that Winston Churchill said ‘The optimist sees opportunity in every difficulty’. [...]to achieve global sex parity and progress sex inequity in health, there is considerable opportunity to inspire, lead and influence for continued, dynamic and sustainable transformational change. Extensive investment and strategic planning have been highlighted to address worldwide sex disparities to tackle discrimination, violence and leadership in societal life.8 16 Similarly, health-specific strategies exist focusing on elevating women in the health and care workforce, increasing women’s participation and leadership in science and public health, reducing non-communicable diseases among women and ensuring sexual and reproductive health for all.8 The nursing profession is ideally placed to strongly advocate for women in all aspects of health and well-being, advancement of the profession (educationally, clinically and in healthcare leadership) and generate a research-base on which to promote the recognition, diagnosis and treatment of disease in women across all specialties.
Journal Article