BackgroundThis study is designed to provide detailed knowledge on cognitive impairment after out-of-hospital cardiac arrest (OHCA) and its relation to associated factors, and to validate the neurocognitive screening of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2-trial), assessing effectiveness of targeted temperature management after OHCA.MethodsThis longitudinal multi-center clinical study is a sub-study of the TTM2-trial, in which a comprehensive neuropsychological examination is performed in addition to the main TTM2-trial neurocognitive screening. Approximately 7 and 24months after OHCA, survivors at selected study sites are invited to a standardized assessment, including performance-based tests of cognition and questionnaires of emotional problems, fatigue, executive function and insomnia. At 1:1 ratio, a matched control group from a cohort of acute myocardial infarction (MI) patients is recruited to perform the same assessment. We aim to include 100 patients per group. Potential differences between the OHCA patients and the MI controls at 7 and 24months will be analyzed with a linear regression, using composite z-scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions) as primary outcome measures. Results from OHCA survivors on the main TTM2-trial neurocognitive screening battery will be compared with neuropsychological test results at 7months, using sensitivity and specificity analyses.DiscussionIn this study we collect detailed information on cognitive impairment after OHCA and compare this to a control group of patients with acute MI. The validation of the TTM2 neurocognitive screening battery could justify its inclusion in routine follow-up. Our results may have a potential to impact on the design of future follow-up strategies and interventions after OHCA.Trial registrationClinicalTrials.gov, NCT03543371. Registered 1 June 2018
Lecanemab is an anti-amyloid monoclonal antibody, recently approved in the UK as a treatment for mild cognitive impairment (MCI) and mild dementia due to Alzheimer’s disease (AD) in adults who are apolipoprotein E ε4 gene ( APOE4 ) heterozygotes or non-carriers. A group of UK neurologists, old age psychiatrists and geriatricians with expertise in AD convened to agree appropriate use recommendations for lecanemab in UK clinical practice. The primary focus of these recommendations is safety. Eligibility criteria for lecanemab in the UK include (a) a clinical diagnosis of MCI or mild dementia due to AD, (b) the presence of amyloid-β pathology, confirmed using approved methods (ie, an amyloid positron emission tomography scan or cerebrospinal fluid assay) and (c) APOE4 heterozygous or non-carrier status. Eligibility screening should be conducted in secondary care and those identified as being potentially eligible for lecanemab should be referred to a specialist centre for confirmation of the likely pathological diagnosis, APOE4 counselling and testing and a multidisciplinary consensus decision regarding treatment eligibility. Lecanemab is administered as an intravenous infusion every 2 weeks, and those eligible for treatment should have brain magnetic resonance imaging (MRI) scans prior to the 1st, 5th, 7th and 14th infusions. Specific guidance is provided for safety monitoring and management of potential adverse reactions, including amyloid-related imaging abnormalities and infusion-related reactions. The introduction of lecanemab into UK clinical practice provides an important opportunity to improve services for all people living with dementia, not just those eligible for lecanemab treatment.
OBJECTIVES:Timely access to sexual health screening and contraception is an important public health issue. Substantial funding reductions for sexual and reproductive health services (SRHS) and COVID-19 have led to significant changes in service delivery, including the rapid introduction of remote consultations, as a substitute for in-person contact. There is limited evidence relating to the barriers to remote consultations and how these may impact sexual health outcomes and wider health inequalities. This study synthesises existing evidence on remote consultations to examine effectiveness, cost-effectiveness, experiences, access and equity. METHODS:Eighteen electronic databases were systematically searched to locate relevant studies published from OECD (Organisation for Economic Co-operation and Development) countries after 2010. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. RESULTS:Out of 8690 studies identified, 48 met the inclusion criteria. The included studies were heterogeneous and covered a range of topics; however, few focused on health inequalities and remote consultations, with satisfaction and quality of care being the most common outcome measures. Many of the studies were completed post-2020 in response to COVID-19 and were of medium to low quality. Access to technology and communication challenges were found to impact inequality when accessing SRHS via remote consultations, although they enhance convenience for service users and service providers. CONCLUSIONS:Overall, the review shows that a range of studies have investigated remote consultations in SRHS, but there remains limited evidence on the impact on health inequalities and sexual health outcomes. The surge in post-2020 research, spurred by COVID-19, indicates the necessity for further high-quality research into equitable SRHS delivery in the post-COVID era, particularly in addressing technological and communication barriers. There is a need to further optimise access and the delivery of remote consultations in SRHS, considering the needs of service users, and minimising inequality (observed differences) and inequity (unfair differences).CRD42023397288.
