Evidence-based development of a post-surgical lumbar discectomy leaflet intervention: a Delphi consensus study

OBJECTIVE

To produce free, expert-informed postoperative information for lumbar discectomy patients, satisfying UK National Health Service Information Standards.

DESIGN

A mixed methods approach utilising the Delphi technique and focus groups.

SETTING

Five spinal centres across the UK.

PARTICIPANTS

Panel members included 23 physiotherapists, 11 patients and 17 spinal surgeons.

INTERVENTION

Three rounds of questionnaires including open and closed questions and attendance at a clinician/patient focus group.

RESULTS

Response rates of 85%, 26% and 35% were achieved for the Delphi rounds. Ten clinicians and six patients participated in the focus groups. Consensus for leaflet sections was achieved in round 1 and content in round 3. The focus groups informed further revisions.

CONCLUSIONS

A consensually agreed, Information Standard compliant, patient lumbar discectomy leaflet was produced containing: (1) normal spine anatomy; (2) anatomy disc herniation and surgery; (3) back protection strategies and (4) frequently asked questions. Illustrations of exercises enable tailoring to the individual patient.

Monitoring mesenteric tissue oxygenation with near-infrared spectroscopy during packed red blood cell transfusion in preterm infants

OBJECTIVE

To monitor altered mesenteric tissue oxygen saturation (StO2) before and after blood transfusion.

METHODS

We placed a 4-wavelength NIRS sensor (FORE-SIGHT, CASMED, Branford, CT USA) on the right lower abdominal quadrant prior to transfusion and measured StO2 for up to 48 hours post transfusion. Pulse oximetry (SpO2) data was collected simultaneously, with fractional tissue oxygen extraction (FTOE) and the [SpO2-StO2] difference calculated to normalize for hypoxic episodes. All data was combined and averaged in 30 minute windows for events before, during, and post transfusion to determine long term trends and analyzed using Repeated Measures ANOVA. 24 infants were enrolled in this study with 36 hours of data collected for 23 subjects and 48 hours for 16 subjects.

RESULTS

We found no significant differences in any of the parameters when compared pre and post transfusion values at 3, 6, 12, 24 and 36 hours post transfusion. For the 16 subjects monitored to 48 hours, there was a significant decrease in FTOE and near significant increase in StO2 and reciprocal decrease in [SpO2 - StO2] at 48 hours post transfusion.

CONCLUSIONS

There are several plausible mechanisms that may explain the relationship between necrotizing enterocolitis and PRBC transfusion; however, mesenteric tissue oxygen saturation changes did not clearly show that ischemia or re-perfusion injury to be one of the potential mechanisms.

Competitive evaluation of data mining algorithms for use in classification of leukocyte subtypes with Raman microspectroscopy

In this study Raman spectral data from peripheral blood mononuclear cells (PBMCs) is used for the competitive evaluation of three data-mining models in discriminating a highly pure population of T-cell lymphocytes from other myeloid cells within the PBMCs fraction.

The psychological and social impact of camp for children with chronic illnesses: a systematic review update

Advances in medicine have reduced mortality among children with complex medical conditions, resulting in a growing number of young patients living with chronic illnesses. Despite an improved prognosis, these children experience significant psychosocial morbidity, such as depression and anxiety. Therapeutic summer recreation camps have been proposed as an intervention to enhance quality of life among these children. The purpose of this systematic review was to assess the psychosocial impact of camp for children with chronic illnesses. A systematic review of central databases was undertaken using key words, and a rating tool – the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies – was employed to rate methodological quality. 21 studies were included in this systematic review. Although overall methodological quality was weak, camp participation appeared to offer short-term psychosocial benefits on some parameters in children with a variety of chronic illnesses. There was some consistency in improved social outcomes, such as social interaction and acceptance. Based on the available evidence, it is premature to make robust claims regarding the psychosocial impact of camp as a therapeutic intervention. Theoretically informed camp programs, long-term follow-up, and incorporating camp-based messaging into routine hospital care,may enhance the utility of camp as a potential psychosocial intervention in paediatrics.

Use of community-based participatory research in primary care to improve healthcare outcomes and disparities in care

Community-based participatory research (CBPR) has emerged to bridge the gap between research and primary-care practice through community engagement and social action to increase health equity. It is widely acknowledged that access to high-quality primary care services is important to the overall health of a community. Here, CBPR studies in a primary care setting are reviewed to assess the use of CBPR associated with common health problems seen in primary care such as access to care and disparities in chronic disease management across vulnerable populations. CBPR involves building relationships with local communities, determining areas of need and establishing priorities for health concerns. Studies showing improved access to care for a Hispanic population, reduced asthma symptoms and weight loss are highlighted.

The drive to life on wet and icy worlds

This paper presents a reformulation of the submarine alkaline hydrothermal theory for the emergence of life in response to recent experimental findings. The theory views life, like other self-organizing systems in the Universe, as an inevitable outcome of particular disequilibria. In this case, the disequilibria were two: (1) in redox potential, between hydrogen plus methane with the circuit-completing electron acceptors such as nitrite, nitrate, ferric iron, and carbon dioxide, and (2) in pH gradient between an acidulous external ocean and an alkaline hydrothermal fluid. Both CO2 and CH4 were equally the ultimate sources of organic carbon, and the metal sulfides and oxyhydroxides acted as protoenzymatic catalysts. The realization, now 50 years old, that membrane-spanning gradients, rather than organic intermediates, play a vital role in life's operations calls into question the idea of "prebiotic chemistry." It informs our own suggestion that experimentation should look to the kind of nanoengines that must have been the precursors to molecular motors-such as pyrophosphate synthetase and the like driven by these gradients-that make life work. It is these putative free energy or disequilibria converters, presumably constructed from minerals comprising the earliest inorganic membranes, that, as obstacles to vectorial ionic flows, present themselves as the candidates for future experiments. Key Words: Methanotrophy-Origin of life. Astrobiology 14, 308-343. The fixation of inorganic carbon into organic material (autotrophy) is a prerequisite for life and sets the starting point of biological evolution. (Fuchs, 2011 ) Further significant progress with the tightly membrane-bound H(+)-PPase family should lead to an increased insight into basic requirements for the biological transport of protons through membranes and its coupling to phosphorylation. (Baltscheffsky et al., 1999 ).

Comparing disease activity indices in ulcerative colitis

BACKGROUND

Comparisons between disease activity indices for ulcerative colitis (UC) are few. This study evaluates three indices, to determine the potential impact of inter-observer variation on clinical trial recruitment or outcome as well as their clinical relevance.

METHODS

One hundred patients with UC were prospectively evaluated, each by four specialists, followed by videosigmoidoscopy, which was later scored by each specialist. The Simple Clinical Colitis Activity (SCCAI), Mayo Clinic and Seo indices were compared by assigning a disease activity category from published thresholds for remission, mild, moderate and severe activity. Inter-observer variation was evaluated using Kappa statistics and its effect for each patient on recruitment and outcome measures for representative clinical trials calculated. Clinical relevance was assessed by comparing an independently assigned clinical category, taking all information into account as if in clinic, with the disease activity assigned by the indices.

RESULTS

Inter-observer agreement for SCCAI (κ=0.75, 95% CI 0.70-0.81), Mayo Clinic (κ=0.72, 95% CI 0.67-0.78) and Seo (κ=0.89, 95% CI 0.83-0.95) indices was good or very good as was the agreement for rectal bleeding (κ=0.77) and stool frequency (κ=0.90). Endoscopy in the Mayo Clinic index had the greatest variation (κ=0.38). Inter-observer variation alone would have excluded up to 1 in 5 patients from recruitment or remission criteria in representative trials. Categorisation by the SCCAI, Mayo Clinic and Seo indices agreed with the independently assigned clinical category in 61%, 67% and 47% of cases respectively.

CONCLUSIONS

Trial recruitment and outcome measures are affected by inter-observer variation in UC activity indices, and endoscopic scoring was the component most susceptible to variation.

Older Adult Golf Cart and All-Terrain Vehicle (ATV)–Related Craniofacial Injuries

Objectives:

Analyze the etiologies of craniofacial and temporal bone injury in older adults involved in recreational vehicle trauma.

Methods:

A chart review at a level one trauma center from 2000-2012 included 58 patients over 50 years old. Data obtained include the following variables: age, gender, race, mechanism of injury, intoxication, hospital stay, vehicle type, Glasgow coma score (GCS), injury severity score (ISS), and helmet use.

Results:

Of the 58 patients identified, the mean age was 60.5, and the majority were white (90%) and male (78%). Eleven patients (19.3%) had a craniofacial injury (CFI), and two patients (3%) had a temporal bone fracture. The most common CFI was an orbital wall fracture (64%), followed by maxilla (27%) and nasal bone fracture (27%). Patients with a closed head injury are nearly ten times as likely to incur a CFI ( P = 0.0346), and those injured while intoxicated are over seven times more likely to have CFI ( P = 0.0084). Patients with a temporal bone fracture are more likely to suffer concurrent additional CFI ( P = 0.035). There were no statistical differences in the incidence of CFI in relation to age, race, sex, ISS, GCS, or vehicle type. CFI was not a predictor of the length of hospital stay or mortality. Helmet use and mechanism of injury are not related to the incidence of CFI.

Conclusions:

Recreational vehicle trauma is a risk to older patients. Alcohol is a strong risk factor for CFI. For patients with close head injuries and/or a temporal bone fracture, concurrent CFI should be anticipated.

Oviposition site selection in Aedes albopictus (Diptera: Culicidae): are the effects of predation risk and food level independent?

For organisms lacking parental care and where larval dispersal is limited, oviposition site selection decisions are critical fitness-enhancing choices. However, studies usually do not consider the interdependence of the two. In this study, we evaluated the effect of food level on the oviposition behavior of Aedes albopictus (Skuse) in the presence or the absence of a nonlethal predator (caged dragonfly nymph). We also attempted to quantify the perceived cost of predation to ovipositioning mosquitoes. Mosquitoes were presented with oviposition cups containing four levels of larval food (fermented leaf infusion) with or without a caged libellulid nymph. By titrating larval food, we estimated the amount of food needed to attract the female mosquito to oviposit in the riskier habitat. As expected, oviposition rate increased with food level and decreased in the presence of a predator. However, the effect of food level did not differ between predator treatments. By calculating the difference in the amount of food for points of equal oviposition rate in the predator-present and predator-absent regression lines, we estimated the cost of predation risk to be 1950 colony-forming-units per milliliter. Our study demonstrated the importance of considering the possible interdependence of predation risk and food abundance for oviposition-site-seeking insects. This study also quantified the perceived cost of predation and found it to be relatively low, a fact with positive implications for biological control.

Use of community-based participatory research in primary care to improve healthcare outcomes and disparities in care

Community-based participatory research (CBPR) has emerged to bridge the gap between research and primary-care practice through community engagement and social action to increase health equity. It is widely acknowledged that access to high-quality primary care services is important to the overall health of a community. Here, CBPR studies in a primary care setting are reviewed to assess the use of CBPR associated with common health problems seen in primary care such as access to care and disparities in chronic disease management across vulnerable populations. CBPR involves building relationships with local communities, determining areas of need and establishing priorities for health concerns. Studies showing improved access to care for a Hispanic population, reduced asthma symptoms and weight loss are highlighted.

A phase I study to assess the effect of food on the single dose bioavailability of the THC/CBD oromucosal spray

PURPOSE

To assess the effect of food on the single-dose bioavailability of delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) spray, an endocannabinoid system modulator, when administered to healthy male subjects.

METHODS

Twelve subjects took part in this fed-fasted cross-over study and received a single dose of THC/CBD spray (4 sprays = 10.8 mg THC + 10 mg CBD) in the fasted then fed state (or vice versa) with a 3-day wash-out period between treatments. Plasma samples were collected at designated time-points for analysis of CBD, THC, and its active metabolite, 11-hydroxy delta-9-tetrahydrocannabinol (11-OH-THC).

RESULTS

Statistically significant increases in the mean area under the curve (AUC) and mean maximum plasma drug concentration (Cmax) were observed in subjects during fed conditions. Mean AUC and Cmax were one to three-fold higher for THC and 11-OH-THC, and five and three-fold higher for CBD respectively during fed conditions. A large inter-subject variability in exposure from the same dose was observed, particularly for THC. The Cmax for THC in fed versus fasted subjects was higher in 7 subjects (4.80-14.91 ng/ml) and lower in 5 subjects (2.81-3.51 ng/ml) compared with the mean Cmax of 3.98 ng/ml (range 0.97-9.34 ng/ml) observed in the fasted state. Increases in mean AUC(0-t), AUC(0-inf), and Cmax for THC, CBD, and 11-OH-THC in the fed state were within the range of inter-subject variability, which was considerable. Food also appeared to delay the time to peak concentration (Tmax) of all analytes by approximately 2-2.5 h. Only mild adverse events were reported.

CONCLUSIONS

The THC/CBD spray was well tolerated in male subjects at a single dose of four sprays. The large inter-subject variability in exposure suggests that the changes observed are unlikely to be clinically relevant.