bakuli chavan
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UMBER AND REGISTRY NAME ClinicalTrialsgov NCT03459664 RECOVER PROTOCOL VERSION 19 March 2020 V30 Authors or their employers 2020 Reuse permitted under CC BYNC No commercial reuse See rights and permissions Published by BMJOBJECTIVES The present study evaluates the extent of association between hepatitis C virus HCV infection and cardiovascular disease CVD risk and identifies factors mediating this relationship using Bayesian network BN analysis DESIGN AND SETTING A populationbased crosssectional survey in Canada PARTICIPANTS Adults from the Canadian Health Measures Survey n10 115 aged 30 to 74 years PRIMARY AND SECONDARY OUTCOME MEASURES The 10year risk of CVD was determined using the Framingham Risk Score in HCVpositive and HCVnegative subjects Using BN analysis variables were modelled to calculate the probability of CVD risk in HCV infection RESULTS When the BN is compiled and no variable has been instantiated 73 17 and 11 of the subjects had low moderate and high 10year CVD risk respectively The conditional probability of high CVD risk increased to 13916 p less then 221016 when the HCV variable is instantiated to Present state and decreased to 8602 when HCV was instantiated to Absent p less then 221016 HCV cases had 16fold higher prevalence of highCVD risk compared with noninfected individuals p0038 Analysis of the effect modification of the HCVCVD relationship using median KullbackLeibler divergence DKL showed diabetes as a major effect modifier on the joint probability distribution of HCV infection and CVD risk DKL 027 IQR 026 to 027 followed by hypertension 024 IQR 023 to 025 age 021 IQR 010 to 038 and injection drug use 019 IQR 006 to 059 CONCLUSIONS Exploring the relationship between HCV infection and CVD risk using BN modelling analysis revealed that the infection is associated with elevated CVD risk A number of risk modifiers were identified to play a role in this relationship Targeting these factors during the course of infection to reduce CVD risk should be studied further Authors or their employers 2020 Reuse permitted under CC BYNC No commercial reuse See rights and permissions Published by BMJINTRODUCTION Lowincome and middleincome settings like India have large treatment gaps in mental healthcare People with severe mental disorders face impediments to their clinical and functional recovery and have large unmet needs The infrastructure and standards of care are poor in colonial period psychiatric hospitals with no clear pathways to discharge and successfully integrate recovered individuals into the community Our aim is to study the impact of psychiatric hospital reform on individual patient outcomes in a psychiatric hospital in India METHODS AND ANALYSIS Structured Individualised inTervention And Recovery SITAR is a twoarm pragmatic randomised controlled trial focusing on patients aged 1860 years with a hospital stay of 12120 months and a primary diagnosis of psychosis It tests the effectiveness of structural and process reform with and without an individually tailored recovery plan on patient outcomes of disability primary outcome WHO Disability Assessment Scale symptom severityn the Central Trial Registry of India CTRI201901017267 Trial results will be published in accordance to CONSORT guidelines Authors or their employers 2020 Reuse permitted under CC BYNC No commercial reuse See rights and permissions Published by BMJOBJECTIVES To perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting The study has a twofold aim 1 to examine clinicians and directors perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre PCC and 2 to identify barriers and facilitators that influenced this implementation DESIGN A crosssectional study was performed in 20162017 in parallel with a clusterrandomised controlled trial SETTING 36 PCCs in southwest Sweden PARTICIPANTS PCCs directors and clinicians OUTCOME Data regarding the studys aims were collected by two webbased questionnaires directors clinicians Descriptive statistics and qualitative content analysis were used for analysis RESULTS Among the 36 PCCs 461 59 clinicians and 36 100 directors participated Fiftytwo per cent of clinicians could cooperate with the care manager without problems Forty per cent regarded to their knowledge of the care manager assignment as insufficient Around twothirds perceived that collaborating with the care manager was part of their duty as PCC staff Almost 90 of the PCCs directors considered that the assignment of the care manager was clearly designed around 70 considered the priority of the implementation to be high and around 90 were positive to the implementation Facilitators consisted of support from colleagues and directors cooperative skills and positive attitudes Buloxibutid agonist Barriers were high workload shortage of staff and extensive requirements and demands from healthcare management CONCLUSIONS Our study confirms that the care manager puts collaborative care into practice Facilitators and barriers of the implementation such as time information soft values and attitudes financial structure need to be considered when implementing care managers at PCCs Authors or their employers 2020 Reuse permitted under CC BYNC No commercial reuse See rights and permissions Published by BMJINTRODUCTION The number of inconclusive physical rehabilitation randomised controlled trials for patients with critical illness is increasing Evidence suggests critical illness patient subgroups may exist that benefit from targeted physical rehabilitation interventions that could improve their recovery trajectory We aim to identify critical illness patient subgroups that respond to physical rehabilitation and map recovery trajectories according to physical function and quality of life outcomes Additionally the utilisation of healthcare resources will be examined for subgroups identified METHODS AND ANALYSIS This is an individual participant data metaanalysis protocol A systematic literature review was conducted for randomised controlled trials that delivered additional physical rehabilitation for patients with critical illness during their acute hospital stay assessed chronic disease burden with a minimum followup period of 3 months measuring performancebased physical function and healthrelated quality of life outcomes