Quality Improvement of Clinical Handover in a Liaison Psychiatry Department: A Three-Phase Audit

Aims To audit and improve quality of clinical handover in a Liaison Psychiatry Department. Methods An 11-item Handover Checklist was used to carry out a baseline audit and immediate and delayed post-intervention re-audits. The intervention consisted of checklist posters, an electronic database and staff training. Results There was an immediate and sustained improvement in most areas, including baseline demographics and components of SBAR communication (Situation, Background, Assessment, Recommendation). The improvement between baseline and delayed re-audit was statistically significant (P=0.007). Conclusion Poor handover practices contribute to negative outcomes in healthcare but there remains a dearth of guidelines in most specialties.This audit is important as it describes an intervention which improved clinical handover at a time of significant clinical risk. This practice could be applied effectively to other services and is relevant to all specialties. Six to twelve-monthly re-audit and longitudinal assessment of clinical outcomes are recommended to maintain the practices implemented in this audit.

Comparison of microscopic and molecular enumeration methods for insect viruses: Cryptophlebia leucotreta granulovirus as a case study

Enumeration techniques were compared for quantification of the South African isolate of Cryptophlebia leucotreta granulovirus (CrleGV-SA), used as a biopesticide to control false codling moth (Thaumatotibia leucotreta), an insect pest of various fruits and nuts, including citrus. The routine enumeration method for CrleGV-SA virus particles in experimentation and production of CrleGV-SA biopesticides is dark field microscopy. This method was compared with spectrophotometry, scanning electron microscopy (SEM) and real time quantitative polymerase chain reaction (qPCR). The purpose was to develop an accurate and reliable routine enumeration method for CrleGV-SA occlusion bodies (OBs) and to validate the use of dark field microscopy. Purified and semi-purified CrleGV-SA viral stocks were used. Spectrophotometry was not a suitable or accurate enumeration method. Dark field microscopy and SEM were accurate and statistically comparable (p = 0.064), validating the use of dark field microscopy as an enumeration method for granulovirus (GV). However, SEM has superior resolution and the advantage of easily distinguishing virus particles from debris in semi-purified viral stock preparations. A quantitative PCR technique has been developed based on use of specific oligonucleotide primers for the granulin gene. This has the advantage of not being affected by contamination with non-biological debris or biological material, which impact on the other methods.

Abstract P2-13-06: Pancreatic nutrition program (PNP): A novel weight reduction program for breast cancer survivors

BACKGROUND: Breast cancer survivors have a high prevalence of metabolic dysfunction—characterized by high glucose and weight gain. Regardless of menopausal status, overweight and obese women are at increased risk for developing breast cancer and those who are diagnosed with breast cancer experience adverse cancer-related outcomes. The underlying principle of the Pancreatic Nutrition Program (PNP) is that bio-individualized healthy food choices—eating the correct foods and food combinations for an individual's body—can minimize fluctuations in insulin by keeping blood glucose regulated (70-100 mg/dL) and this will promote sustained weight loss, improved health, and quality of life. METHODS: The primary endpoint was change in body weight at 24 weeks post-PNP. The study was powered to detect a 10% loss of weight from baseline. Secondary endpoints included change in: glucose levels, insulin resistance, body composition, body chemistry, physical fitness, biological markers, quality of life, and compliance. Postmenopausal, non-diabetic breast cancer survivors (stages I-III) within 5 years of completion of treatment who had a body mass index of 25-33 kg/m2 were recruited. For the first 12 weeks, patients wore a glucometer (Abbott), which recorded glucose every 15 minutes continuously, and kept a food journal. During weekly meetings, glucometer data was reviewed with journal entries to identify food choices and combinations that would kept the subject's glucose levels between 70-100 mg/dL. At the end of the 12-weeks, the weekly meetings and glucometer were discontinued and patients were expected to maintain the PNP for an additional 12 weeks. Study endpoints were measured at baseline, 12-week and 24-week visits. RESULTS: Of the 21 patients enrolled in the study, 12 were non-Hispanic Caucasian, 5 were Hispanic, 2 were African-American, and 2 were Asian. The median age was 56 years (43-76 years). Twenty were estrogen-receptor positive, 18 progesterone-receptor positive, and 8 were HER2/neu positive. The mean body weight at baseline was 170.9 lbs (±20.4 lbs). Two patients dropped out prior to 12-weeks and 1 developed recurrent disease. Among the 18 eligible women who completed the first 12 weeks, the median weight loss at 12-weeks was 10.1 lbs (1.5-19.6 lbs). The median waist circumference lost was 2.5 inches (gain of 0.4 inches-loss of 5.5 inches). Among the women whose total cholesterol was above 200 mg/dL, 71% reduced their cholesterol below 200 mg/dL by 12-weeks. All women who had triglyceride levels above 150 mg/dL reduced their levels below 150 mg/dL by 12-weeks. Likewise, among women who were identified as being pre-diabetic based on fasting glucose or hemoglobin A1c levels, all were within normal range at 12-weeks. 6-month testing will be completed in August. Among the 15 women eligible for 6-month testing, 8 (53%) completed the testing. Of those, 7 (88%) maintained their positive results. CONCLUSIONS: Bio-individualized food choices based on glucose response combined with culturally-sensitive nutrition counseling may provide a feasible mechanism for sustainable weight loss in a population at high-risk of metabolic dysfunction. However, to increase adherence, a tapering strategy should be developed after the first 12-weeks of health counseling.

Citation Format: Clague DeHart J, Rosen C, Wong L, Moore S, Flores S, Salehian B, Mortimer J. Pancreatic nutrition program (PNP): A novel weight reduction program for breast cancer survivors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-13-06.

Multiple-trait genomewide mapping and gene network analysis for scrotal circumference growth curves in Brahman cattle

Fertility traits are economically important in cattle breeding programs. Scrotal circumference (SC) measures are repeatable, easily obtained, highly heritable, and positively correlated with female fertility traits and sperm quality traits in males. A useful approach to summarize SC measures over time is using nonlinear models, which summarize specific measures of SC in a few parameters with biological interpretation. This approach facilitates the selection of bulls with larger SC and maturity index (K), that is, early maturing animals. Because SC is a sex-limited trait, identifying the underlying genomics of growth curve parameters will allow selection across both males and females. We reported the first multitrait genomewide association study (GWAS) of estimated growth curve parameters for SC data in Brahman cattle. Five widely used nonlinear models were tested to fit a total of 3,612 SC records, measured at 6, 12, 18, and 24 mo of age. The von Bertalanffy model, individually fitted for each animal, best fit this SC data. Parameter estimates SC at maturity (A) and K as well as SC at all ages were jointly analyzed in a GWAS to identify 1-Mb regions most strongly associated with each trait. Heritabilities were 0.25 for K and 0.32 for A and ranged from 0.51 to 0.72 for SC at 6 (SC6), 12 (SC12), 18 (SC18), and 24 mo of age (SC24). An overlapping window on chromosome 14 explaining around 0.8% of genetic variance for K, SC12, SC18, and SC24 was observed. The major positional candidate genes within 1 Mb upstream and downstream of this overlapping window were , , , and . Windows of 1 Mb explaining more than 0.4% of each trait on chromosomes 1, 3, 6, 7, 14, 17, 18, 24, 25, and 26 were identified. Pathways and net-work analyses were indicated through transcription factors playing a role on fertility traits: , , , , , , and . Further validation studies on larger populations or other breeds are required to validate these findings and to improve our understanding of the biology and complex genetic architecture of traits associated with scrotal growth and male fertility in cattle.

Successful ureteroscopy for kidney stone disease leads to resolution of urinary tract infections: Prospective outcomes with a 12-month follow-up

Introduction

To investigate the resolution of urinary tract infection (UTI) with the successful treatment of kidney stone disease (KSD).

We reviewed the outcomes of ureteroscopy (URS) and stone treatment for patients with positive urine culture or recurrent UTIs and evaluated whether the infection resolved with the clearance of their urinary stones.

Material and methods

Between March 2012 and July 2016, consecutive patients who underwent URS for stone disease with a history of recurrent UTIs or culture proven UTIs were identified from a prospective database. Data was recorded on stone free rate (SFR) and infection free rate (IFR) during the follow-up period at 3, 6 and 12-months.

Results

During the study period, 103 consecutive patients with stone disease and associated UTI underwent URS over a 52-month period (mean age: 60 years, Female: Male ratio of 2:1). The mean cumulative stone size was 16 mm (range: 3–107 mm) and a positive pre-operative urine culture was found in 81 (79%) patients. While the overall SFR was 96%, the total complication rate was 12.6% (n = 13) and these were all Clavien I/II complications.

At follow-up, the SFR and IFR was 96% and 88% at 3-months, and 82% and 71% at 12-months, respectively (p <0.001). While almost three-quarters of patients were stone and infection free at 12-months, the majority of those with stones recurrence also had recurrence of their UTI.

Conclusions

The majority of patients will remain infection free at the 12-month follow-up if they are stone free after their initial treatment. Stone recurrence, which is more likely in high-risk patients, is also linked to the recurrence of their UTI.

Twenty years of social capital and health research: a glossary

Research on social capital in public health is approaching its 20th anniversary. Over this period, there have been rich and productive debates on the definition, measurement and importance of social capital for public health research and practice. As a result, the concepts and measures characterising social capital and health research have also evolved, often drawing from research in the social, political and behavioural sciences. The multidisciplinary adaptation of social capital-related concepts to study health has made it challenging for researchers to reach consensus on a common theoretical approach. This glossary thus aims to provide a general overview without recommending any particular approach. Based on our knowledge and research on social capital and health, we have selected key concepts and terms that have gained prominence over the last decade and complement an earlier glossary on social capital and health.

Modelling apical columnar epithelium mechanics from circumferential contractile fibres

Simple columnar epithelia are formed by individual epithelial cells connecting together to form single cell high sheets. They are a main component of many important body tissues and are heavily involved in both normal and cancerous cell activities. Prior experimental observations have identified a series of contractile fibres around the circumference of a cross section located in the upper (apical) region of each cell. While other potential mechanisms have been identified in both the experimental and theoretical literature, these circumferential fibres are considered to be the most likely mechanism controlling movement of this cross section. Here, we investigated the impact of circumferential contractile fibres on movement of the cross section by creating an alternate model where movement is driven from circumferential contractile fibres, without any other potential mechanisms. In this model, we utilised a circumferential contractile fibre representation based on investigations into the movement of contractile fibres as an individual system, treated circumferential fibres as a series of units, and matched our model simulation to experimental geometries. By testing against laser ablation datasets sourced from existing literature, we found that circumferential fibres can reproduce the majority of cross-sectional movements. We also investigated model predictions related to various aspects of cross-sectional movement, providing insights into epithelium mechanics and demonstrating the usefulness of our modelling approach.

Genomic analyses of tropical beef cattle fertility based on genotyping pools of Brahman cows with unknown pedigree

We introduce an innovative approach to lowering the overall cost of obtaining genomic EBV (GEBV) and encourage their use in commercial extensive herds of Brahman beef cattle. In our approach, the DNA genotyping of cow herds from 2 independent properties was performed using a high-density bovine SNP chip on DNA from pooled blood samples, grouped according to the result of a pregnancy test following their first and second joining opportunities. For the DNA pooling strategy, 15 to 28 blood samples from the same phenotype and contemporary group were allocated to pools. Across the 2 properties, a total of 183 pools were created representing 4,164 cows. In addition, blood samples from 309 bulls from the same properties were also taken. After genotyping and quality control, 74,584 remaining SNP were used for analyses. Pools and individual DNA samples were related by means of a "hybrid" genomic relationship matrix. The pooled genotyping analysis of 2 large and independent commercial populations of tropical beef cattle was able to recover significant and plausible associations between SNP and pregnancy test outcome. We discuss 24 SNP with significant association ( < 1.0 × 10) and mapped within 40 kb of an annotated gene. We have established a method to estimate the GEBV in young herd bulls for a trait that is currently unable to be predicted at all. In summary, our novel approach allowed us to conduct genomic analyses of fertility in 2 large commercial Brahman herds managed under extensive pastoral conditions.

Factors influencing the variation in GMS prescribing expenditure in Ireland

BACKGROUND

Pharmaceutical expenditure growth is a familiar feature in many Western health systems and is a real concern for policymakers. A state funded General Medical Services (GMS) scheme in Ireland experienced an increase in prescription expenditure of 414 % between 1998 and 2012. This paper seeks to explore the rationale for this growth by investigating the composition (Anatomical Therapeutic Chemical (ATC) Group level 1 & 5) and drivers of GMS drug expenditure in Ireland in 2012.

METHODS

A cross-sectional study was carried out on the Health Service Executive-Primary Care Reimbursement Service (HSE-PCRS) population prescribing database (n = 1,630,775). Three models were applied to test the association between annual expenditure per claimant whilst controlling for age, sex, region, and the pharmacology of the drugs as represented by the main ATC groups.

RESULTS

The mean annual cost per claimant was €751 (median = €211; SD = €1323.10; range = €3.27-€298,670). Age, sex, and regions were all significant contributory factors of expenditure, with gender having the greatest impact (β = 0.107). Those aged over 75 (β =1.195) were the greatest contributors to annual GMS prescribing costs. As regards regions, the South has the greatest cost increasing impact. When the ATC groups were included the impact of gender is diluted by the pharmacology of the products, with cardiovascular prescribing (ATC 'C') most influential (β = 1.229) and the explanatory power of the model increased from 40 % to 60 %.

CONCLUSION

Whilst policies aimed at cost containment (co-payment charges; generic substitution; reference pricing; adjustments to GMS eligibility) can be used to curtail expenditure, health promotional programs and educational interventions should be given equal emphasis. Also policies intended to affect physicians' prescribing behaviour include guidelines, information (about price and less expensive alternatives) and feedback, and the use of budgetary restrictions could yield savings in Ireland and can be easily translated to the international context.