Phenotypic virulence characterization of avian pathogenic Escherichia coli (APEC) isolates from broiler breeders with colibacillosis in Mississippi

AIMS

In this study, we evaluated the phenotypic virulence characteristics of avian pathogenic Escherichia coli (APEC) isolates from broiler breeders with colibacillosis in Mississippi. Also, the relationship between phenotypic and genotypic virulence patterns was determined.

METHODS AND RESULTS

Twenty-eight APEC isolated from lesions of broiler breeders diagnosed with colibacillosis were used for embryo lethality assay and chick challenge study. The percentage of embryo mortality following embryo lethality assay and pathogenicity score following the chick challenge study were used to categorize the isolates based on virulence. Pearson correlation analysis was performed to determine the relationship between embryo mortality, chick pathogenicity, and the presence of virulence-associated genes in the isolates. Overall, 39.3% of the isolates were highly virulent and 3.5% were avirulent, following both assays. There existed a positive correlation between embryo mortality and chick pathogenicity (r = 0.73, P < .01), as well as percentage embryo mortality and pathogenicity score with the presence of some virulence genes.

CONCLUSIONS

Even though all the APEC were isolated from lesions of diseased breeders, the virulence potential varied from being avirulent to highly virulent. Further, we identified a positive relationship between phenotypic virulence and the frequency of virulence-associated genes.

Outcomes of elective and emergency surgical repair of incisional hernia: a comparative observational study

PURPOSE

Incisional hernia (IH) is a common complication following abdominal surgery. Surgical repair of IH is associated with the alleviation of symptoms and improvement of quality of life. Operative intervention can pose a significant burden to the patient and healthcare facilities. This study aims to describe and compare outcomes of elective and emergency surgical repair of IH.

METHODS

This study is a single-centre comparative retrospective study including patients who had repair of IH. Patients were divided into Group I (Emergency) and Group II (Elective), and a comparison was conducted between them.

RESULTS

Two hundred sixty-two patients were identified with a mean age of 61.8 ± 14.2 years, of which 152 (58%) were females. The mean BMI was 31.6 ± 7.2 kg/m2. More than 58% had at least one comorbidity. 169 (64.5%) patients had an elective repair, and 93 (35.5%) had an emergency repair. Patients undergoing emergency repair were significantly older and had higher BMI, p = 0.031 and p = 0.002, respectively. The significant complication rate (Clavien-Dindo III and IV) was 9.54%. 30 and 90-day mortality rates were 2.3% (n = 6) and 2.68% (n = 7), respectively. In the emergency group, the overall complications, 30-day and 90-day mortality rates were significantly higher than in the elective group, p ≤ 0.001, 0.002 and 0.001, respectively. Overall, 42 (16.1%) developed wound complications, 25 (9.6%) experienced a recurrence, and 41 (15.71%) were readmitted within 90 days, without significant differences between the two groups.

CONCLUSION

Patients who underwent emergency repair were significantly older and had a higher BMI than the elective cases. Emergency IH repair is associated with higher complication rates and mortality than elective repair.

198 Caveat Chirurgicus- Opioid Use Following Surgery

Introduction

Over the last 20-years there has been increasing opioid related deaths, in the context of a worldwide epidemic of misuse including addiction and overdose. Startlingly, opioid commencement is usually iatrogenic. Most published data is from the USA with little evidence from UK surgical practice.

Method

Retrospective analysis of surgical unit opioid prescriptions. Data included opioids prescribed on discharge, 1, 3- and 6-months post-discharge usage and milligrams-of-morphine equivalence(mgEq) used to compare regimes.

Results

One hundred cases reviewed. 35% of patients were opioid naïve on admission and of these 20%, 5.71% and 8.57% remained on opioids at 1, 3- and 6-months post discharge respectively.

Females more likely to remain on long-term opioids at 6 months at lower doses (42% v 30%).

Only 6% of discharge summaries recommended GP follow-up and assessment of opioid requirements. Furthermore, none were prescribed a tapering dosage regime on-discharge.

Patients receiving Acute Pain Team reviews, more likely to remain on long-term opioids, at lower doses (30.67mgEq, 29.25mgEq and 32.63mgEq at 1-, 3- and 6-months post-discharge) compared to those without (69.16mgEq, 74.25mgEq and 65.13mgEq).

Only 11% of patients with pre-existing opioid prescriptions were reviewed by the acute pain team.

Worryingly, there was no documented assessment of opioid misuse risk in patients.

Conclusions

Standardised assessments i.e., opioid Risk Assessment Tools and mgEq need to be documented and monitored in primary and tertiary care. Acute pain team services should be offered to more patients. Our study hopes to raise awareness of the need for effective opioid stewardship in surgical patients.

211 A Snapshot Audit of Time to Intervention for Gallstone Pancreatitis During the First Wave of COVID-19

Aim

We evaluated time to definitive treatment of Gallstone Pancreatitis (GSP) against the BSG guidelines during the first wave of COVID-19, comparing it to data of the same time period the previous year. Did the first wave of Covid-19 impact on time to intervention for patients diagnosed with GSP?

Method

Data were obtained retrospectively for 40 patients identified via the hospital coding department that presented with GSP between March 2019 - June 2019 and March 2020 – June 2020. Patient demographics, length of stay, time to intervention and re-admission awaiting intervention were recorded.

Results

Twenty-three patients were admitted during the non-COVID period. 30% (n = 7) of the non-COVID cohort had definitive management of GSP during index admission or within 2 weeks.

Seventeen patients were admitted during the first wave of Covid-19. 64.7% (n = 11) of the COVID-19 cohort had definitive management of GSP during the index admission or within 2 weeks.

Conclusions

Prior to COVID-19, we were not meeting guidelines for definitive management on index admission / within 2 weeks. During the first wave of COVID-19, more patients received definitive management of GSP during index admission / within 2 weeks than during the non-COVID period. A higher percentage of patients received surgical management within 2 weeks than in the non-COVID cohort. Those that did not receive management within 2 weeks, waited longer for intervention and had higher rates of re-admission than the non-COVID cohort. Despite anticipated future waves of COVID-19, prioritisation of urgent OP services is essential for those diagnosed with GSP to help reduce re-admission rates whilst awaiting intervention.

302 Metastatic: Benign Lymph Node Ratio (LNR) and Lymph Node Yield (LNY) as Predictors of Survival in Resected Colorectal Cancer (CRC)

Background

Lymphadenectomy is central to tumor prognosis. 12 LNY during CRC resection is a standard of good oncological resection, but 30–50 percent of resections do not achieve this. LNR was suggested to be a more accurate predictive factor.

Aim

To examine the prognostic significance of LNY and LNR on survival in patients with non-metastatic CRC.

Method

A retrospective study on patients with CRC treated at a DGH from January 2015 to February 2017. Outcome measures were Disease-Free (DFS) and Overall Survival (OS).

Results

265 cases were identified. The mean age was (71.4±11.3) years with a median follow-up of 56 (range 0–72) months. Median LNY was 18 (range 0–66) nodes. 74.9% of the cases have&gt; 12 LNY and only 25.1% of the cases have &lt; 12 LN yielded in the specimen; however, 76.4% have LNR of 0-&lt;0.25. Increasing LNR was associated with poorer OS and

DFS (p-value 0.0001). An LNR of (0.75–1) was associated with a very poor prognosis (p-value 0.0001); it showed 30 and 33 months less in median OS and DFS retrospectively than LNR

(0-&lt;0.25). LNY did not show any statistically significant predictive factor in survival.

Multivariate analysis showed OS and DFS are affected (R2 = 27.3% and 26.1% retrospectively) mainly by LNR. It did not show statistical significance with the other variables, including TNM, LNY, and Dukes' stages.

Conclusions

Increasing LNR was a marker of poor survival; however, LNY was not a statistically significant predictive factor. LNR is better in predicting survival than TNM and Dukes' staging.

Vocational peer support for adults with psychiatric disabilities: Results of a randomized trial

Objective: Peer support services for individuals with psychiatric conditions have burgeoned and now are proliferating within mental health systems nationally and internationally. More recently, variations of peer support have been developed, including those that focus on vocational outcomes. Methods: We conducted a randomized clinical trial in two mental health programs to test a newly developed model of vocationally oriented peer support. We recruited, randomly assigned, and followed 166 individuals for 12 months; 83 received Vocational Peer Support (the experimental condition, VPS) and 83 received peer support services-as-usual. Peer support specialists (PSS) delivering VPS were trained and supervised. We examined vocational and educational outcomes as well as work hope, quality of life, and work readiness at baseline, 6- and 12-month postrandomization. We assessed the working alliance as well. Results: We found a group-by-time effect on domains of work readiness and modest differences in vocational activity. Secondary analyses revealed that VPS resulted in a stronger working alliance with the peer specialist, which mediated some aspects of a better quality of life and greater work hope. Conclusions and Implications for Practice: In the context of the peer relationship, peer specialists are often called upon to support individuals who are pursuing employment, often without adequate preparation or training. Our findings suggest that vocationally oriented peer support affects several aspects of readiness to pursue work-related goals and mediates some aspects of vocational hope and quality of life. VPS may assist individuals receiving peer support as they choose, get, and keep employment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

719 The Routine Use of Opioid Medication for Post-Operative Pain Relief Can Risk Long Term Dependence, In Patients Previously Opiate Naive

Introduction

Post-operative pain relief commonly involves opiates. Rising concerns about misuse has increased scrutiny of prescribing practices. In the UK, 12.5% of prescriptions are for opiates. In the US, the Department of Health and Human Services has declared an epidemic of opiate misuse. We aimed to evaluate opiate prescribing practices post-operatively, within a UK teaching hospital, and establish the risk of prolonged opiate use.

Method

A pan-speciality retrospective observational cohort study was performed. Patients who underwent surgery in the year 2018 were included. Patients were opiate naïve if their admission Medicine reconciliation and GP record described no opiates for the previous year. Endpoints: the proportion of patients discharged with opiates and the proportion of patients remaining on opiates at 1- and 2-years post admission.

Results

20526 operations were performed on 17524 patients, across pan-specialities. 8772 patients were discharged on opiates. 673 required further opiates from their GP after discharge, of which 331 were previously opiate naive. At 1 year post op, 180 previously naive patients remained on opiates.

Conclusions

Attention needs to be given to the risk of developing opiate dependence post-operatively. An evidence-based approach should support clinicians in preventing an opiate crisis in the UK.

Effects of feeder space on broiler feeding behaviors

Providing adequate feeder space in broiler production is important to ensure bird performance and well-being; however, the effect of feeder space on behavior responses of broilers remains unclear. The objective of this research was to investigate feeding behaviors of broilers provided with 4 feeder spaces, that are 2.3 cm/bird with one feeder (2.3FSO); and 2.3, 4.6, and 6.9 cm/bird with 3 feeders (2.3FST, 4.6FST, and 6.9FST, respectively). Number of feeder slots per feeder was 14 at 2.3FSO, 5 at 2.3FST, 9 at 4.6FST, and 14 at 6.9FST. Sixteen identical pens, each with 45 broilers (Ross 708, mixed sex), were used to accommodate the 4 feeder space treatments. Feeding behaviors were continuously monitored from weeks 4 to 8 using an ultra-high-frequency radio frequency identification system. The results show that the daily feeding time and number of feeder visits for broilers at 2.3FST were similar to those at 4.6FST and 6.9FST but higher than those at 2.3FSO (P < 0.01). The feeder utilization ratio was the highest at 2.3FST, indicating the feeder being used most efficiently among the 4 treatments (P < 0.01). Coefficient of variations (33.0-65.1%) of the feeding behavior responses was similar among the treatments (P ≥ 0.06), suggesting similar group uniformity of feeding behaviors of individual broilers. Feeders among all treatments may not be fully used because for most of the time, less than 6 birds chose to eat simultaneously at a more-than-five-slot feeder in all treatments. Given the same feeder space, increasing feeder number can accommodate more birds to eat simultaneously. The outcomes of this study provide insights into improvement of feeder design and management for broiler production.

Research Note: Effect of stocking density on crop fill progression in broilers grown to 14 d

Crop fill rates are measured as an indirect means of assessing management during the brooding phase. Primary breeder guidelines indicate that 95% of the chicks assessed should present a crop that is full, soft, and rounded after 24 h, which indicates chicks have successfully located feed and water. Crop fill progression has received little attention in the scientific literature and is primarily discussed in trade literature, and thus, the dynamic nature of crop fill progression has not been previously characterized. This study examined the role of 2 market weight stocking density treatments (29.3 kg/m2 and 43.9 kg/m2) on performance and crop fill of broilers grown to 14 d. Crop fill progression was observed at 2, 4, 8, 12, 24, and 48 h after placement and tracked BW of birds that presented empty crops at 24 h; chicks with empty crops were identified to track postplacement BW. Stocking density had no significant effect on bird performance or crop fill. At 24 h, 86% of birds in this study had full, soft, and rounded crops, while only 3% of birds had crops that were devoid of food or water at 24 h. BW for birds with empty crops was significantly lower at 7 d (P = 0.006) but not at 14 d (P = 0.535). The data herein indicate that crop fill rates of 95% or higher at 24 h may be difficult to achieve in typical commercial broiler settings. In addition, assessing crop fill may be a useful tool to diagnose conspicuous management problems during brooding, but it does not appear to be a direct predictor of early performance.

Vocational Peer Support: Results of a Qualitative Study

Peer-delivered services for individuals with psychiatric conditions are becoming an established part of the mental health workforce. Given the growing focus on evidence-based supported employment, peer specialists are often assisting individuals who are choosing, getting, or keeping employment. As part of a larger randomized clinical trial examining the effectiveness of an innovative intervention called vocational peer support, 13 semi-structured qualitative interviews were conducted to examine how recipients perceived peer support, and whether or how it was useful for pursuing vocational goals. A thematic analysis approach was utilized for identifying major themes and sub-themes. Results suggest that a key factor in the effectiveness of vocational peer support is the identification with another individual's "lived experience," which then promotes engagement and a sense of normalcy. Vocational peer support may be particularly useful for individuals with psychiatric disabilities wishing to pursue a vocational goal.

Investigating the relationships between social capital, chronic health conditions and health status among Australian adults: findings from an Australian national cohort survey

BACKGROUND

Social capital is a collective attribute of communities that determines health and well-being of populations. The collective resources in a high social capital community have been reported to result in better health outcomes. While evidence supports the links between social capital and various health outcomes, it is not clear about underlying mechanisms connecting multiple dimensions of social capital to health.

METHODS

Using the two-wave data from a nationally representative cohort study of Australian adults (N = 16,637), this study examined the effects of two dimensions of social capital (i.e., structural and cognitive social capital) on physical and mental health in the Australian adult population. Based on prior literature and theoretical reasoning, it was anticipated that the structural and cognitive social capital would influence self-assessed health status (physical and mental health). Additionally, these two dimensions of social capital were hypothesized to moderate the relationships between chronic health conditions and these two aspects of health status.

RESULTS

Analyses showed that the effects of chronic health conditions on mental health status were moderated by the structural social capital (β = .652, SE = .249, p = .009). Additionally, it was found that perceived community cohesion was predictive of mental health (β = .295, SE = .103, p = .004). Our analysis also indicated that perceptions of disadvantaged neighbourhood environment contributed to poorer mental health status (β = -.461, SE = .144, p = .001). However, none of the social capital variables significantly predicted physical health status.

CONCLUSIONS

Findings suggest that the structural dimension of social capital would function as a buffer against the malicious effects of chronic health conditions, impairments and disabilities. Specifically, community participation (structural social capital) is indispensable to develop an effective community-based program to improve health and well-being of those with chronic health conditions or disabilities, as increasing active participation may generate beneficial effects in this vulnerable population. Subjective perceptions about communities can also play an important role in improving better health outcomes. Further research is needed to examine underlying mechanisms linking the multiple dimensions of social capital to health outcomes among individuals who are vulnerable to external stressors.

90 Establishment and characterization of Day 30 equine chorionic girdle and allantochorion cell lines

Establishing cell lines is a good model for experimental applications to study molecular mechanisms and cell-specific gene expression. Equids have a diffuse epitheliochorial placenta, where the invasive trophoblast is represented by the chorionic girdle (CG) and the noninvasive trophoblast by the allantochorion (AC). Embryonic CG cells are unique to horses and have a crucial role in equine chorionic gonadotropin (eCG) production and maintenance of pregnancy during the first trimester. This study had three objectives: (1) establishing a stable cell line from Day 30 CG cells and AC using lentivirus encoding hTERT; (2) characterisation of Day 30 CG cells and AC cell morphology and expression of eCG α (eCGA) and β (eCGB) subunits, major histocompatibility complex class II (MHCII), and Kisspeptin receptor (KISS1R) in CG and AC cells; (3) investigating eCG protein production invitro from Day 30 CG and AC cells. Three mares (n=3) were used to collect Day 30 conceptuses by non-surgical uterine lavage on Day 30 of pregnancy. All 3 conceptuses were dissected for CG and AC cells then cultured invitro to confluency in cell culture plates. Second-generation lentiviral particles were generated using a three-vector system including transfer vector pLV-hTERT-IRES-hygro, and human telomerase reverse transcriptase (hTERT) lentivirus was utilised to establish stable hygromycin-resistant equine embryonic cell lines. Reverse-transcription PCR (RT-PCR) was used to study gene expression in cells and radioimmunoassay was used to investigate protein presence in the media. We established a hygromycin-resistant Day 30 CG and AC cell lines that express eCGA, eCGB, and hTERT and confirmed using RT-PCR yielding the predicted bands. The cell lines were maintained for 16 passages (7±2 days/passage), 10 of which were cultured after the lentiviral infection steps. Also, we characterised CG cells as fast-growing, large, binucleated, and epithelioid, and AC cells as rapid-growing showing smaller, squamous, mononucleate, epithelioid, and elongated fibroblastic cells. The RT-PCR results showed eCGA and eCGB subunits are expressed by both Day 30 CG and AC cells, but MHCII and KISS1R genes were not expressed in either of cells. Moreover, radioimmunoassay results showed that Day 30 CG cells did produce eCG protein (35.42ngmL−1) invitro earlier than what previous literature has shown. However, Day 30 AC cells did not produce eCG protein (0.042ngmL−1) invitro, and both CG and AC cell lines stopped secreting eCG in the media after the lentiviral infection. To conclude, establishing stable and hygromycin-resistant cell lines from Day 30 equine CG and AC cells using lentivirus encoding pLV-hTERT-IRES-hygro is attainable. Also, equine chorionic gonadotropin eCG protein is produced invitro as early as Day 30 from CG cells.

Impact of Introduction of a Clinical Pathway for the Management of Pyelonephritis on Obstetric Patients: a Quality Improvement Project

Aim To determine whether the introduction of a clinical pathway for the treatment of pyelonephritis in obstetric patients would improve outcomes. Methods This was a retrospective study conducted in a maternity hospital using quantitative analysis methods. Patients who met laboratory and clinical criteria for pyelonephritis during data collection were included. Results The study included analysis of 23 patients pre-intervention and 19 post-intervention. Baseline and patient characteristics were similar for both groups. A statistically significant difference was seen in 3 of 7 outcome measures. Increased use of gentamicin (13% Vs 52% p=0.006), Increased number of renal ultrasounds (17% Vs 47%, p=0.04) and increased use of prophylaxis (21% Vs 68%, p=0.003). The proportion of patients receiving ≥ 10 days of IV antimicrobials decreased from 48% to 21% post-intervention (p=0.07). Discussion This study has shown that the introduction of a pathway for the treatment of pyelonephritis in pregnancy had a positive impact on several important clinical outcomes.

The treatment of achalasia patients with esophageal varices: an international study

Background

Treatment options for achalasia include endoscopic and surgical techniques that carry the risk of esophageal bleeding and perforation. The rare coexistence of esophageal varices has only been anecdotally described and treatment is presumed to carry additional risk.

Methods

Experience from physicians/surgeons treating this rare combination of disorders was sought through the International Manometry Working Group.

Results

Fourteen patients with achalasia and varices from seven international centers were collected (mean age 61 ± 9 years). Five patients were treated with botulinum toxin injections (BTI), four had dilation, three received peroral endoscopic myotomy (POEM), one had POEM then dilation, and one patient underwent BTI followed by Heller's myotomy. Variceal eradication preceded achalasia treatment in three patients. All patients experienced a significant symptomatic improvement (median Eckardt score 7 vs 1; p < 0.0001) at 6 months follow-up, with treatment outcomes resembling those of 20 non-cirrhotic achalasia patients who underwent similar therapy. No patients had recorded complications of bleeding or perforation.

Conclusion

This study shows an excellent short-term symptomatic response in patients with esophageal achalasia and varices and demonstrates that the therapeutic outcomes and complications, other than transient encephalopathy in both patients who had a portosystemic shunt, did not differ to disease-matched patients without varices.

Artificial intelligence for the real-time classification of intrapapillary capillary loop patterns in the endoscopic diagnosis of early oesophageal squamous cell carcinoma: A proof-of-concept study

Background

Intrapapillary capillary loops (IPCLs) represent an endoscopically visible feature of early squamous cell neoplasia (ESCN) which correlate with invasion depth - an important factor in the success of curative endoscopic therapy. IPCLs visualised on magnification endoscopy with Narrow Band Imaging (ME-NBI) can be used to train convolutional neural networks (CNNs) to detect the presence and classify staging of ESCN lesions.

Methods

A total of 7046 sequential high-definition ME-NBI images from 17 patients (10 ESCN, 7 normal) were used to train a CNN. IPCL patterns were classified by three expert endoscopists according to the Japanese Endoscopic Society classification. Normal IPCLs were defined as type A, abnormal as B1-3. Matched histology was obtained for all imaged areas.

Results

This CNN differentiates abnormal from normal IPCL patterns with 93.7% accuracy (86.2% to 98.3%) and sensitivity and specificity for classifying abnormal IPCL patterns of 89.3% (78.1% to 100%) and 98% (92% to 99.7%), respectively. Our CNN operates in real time with diagnostic prediction times between 26.17 ms and 37.48 ms.

Conclusion

Our novel and proof-of-concept application of computer-aided endoscopic diagnosis shows that a CNN can accurately classify IPCL patterns as normal or abnormal. This system could be used as an in vivo, real-time clinical decision support tool for endoscopists assessing and directing local therapy of ESCN.

The role of the neutrophil:lymphocyte ratio (NLR) and the CRP:albumin ratio (CAR) in predicting mortality following emergency laparotomy in the over 80 age group

INTRODUCTION

Emergency laparotomy in the elderly is an increasingly common procedure which carries high morbidity and mortality. Risk prediction tools, although imperfect, can help guide management decisions. Novel markers of surgical outcomes may contribute to these scoring systems. The neutrophil:lymphocyte ratio (NLR) and CRP:albumin ratio (CAR) have been associated with outcomes in malignancy and sepsis. We assessed the use of ratio NLR and CAR as prognostic indicators in patients over the age of 80 undergoing emergency laparotomy.

METHODS

A retrospective analysis of all patients over the age of 80 who underwent emergency laparotomy during a 3 year period was conducted. Pre and post-operative NLR and CAR were assessed in relation to outcome measures including inpatient, 30-day and 90-day mortality. Statistical analysis was conducted with Mann-Whitney U, receiver operating characteristics, Spearmans rank correlation coefficient and chi-squared tests.

RESULTS

One hundred and thirty-six patients over the age of 80 underwent emergency laparotomy. Median age was 84 years (range 80-96 years). Overall inpatient mortality was 19.2%. Pre-operative and post-operative NLR and CAR were significantly raised in patients with sepsis v no sepsis (p < 0.05). Pre-operative NLR was significantly associated with inpatient (p = 0.046), 30-day (p = 0.02) and 90-day mortality (p = 0.01) in patients with visceral perforation. A pre-operative NLR value of greater than 8 was associated with significantly increased mortality (p = 0.016, AUC:0.78). CAR was not associated with mortality.

CONCLUSION

Pre-operative NLR is associated with mortality in patients with visceral perforation undergoing emergency laparotomy. NLR > 8 is associated with a poorer outcome in this group of patients. CAR was not associated with mortality in over-80s undergoing emergency laparotomy.

Burnout and the work-family interface

Purpose

– The purpose of this paper is to examine whether work-to-family conflict (WFC) and work-to-family enrichment (WFE) predicted burnout in working mothers using conservation of resources theory. The authors also examined whether these relationships varied between sole and partnered working mothers.

Design/methodology/approach

– In total, 516 partnered and 107 sole mothers in paid employment completed an online survey twice, six months apart.

Findings

– WFC was significantly positively related to burnout, and WFE significantly negatively related to burnout. Marital status moderated the inverse relationship between WFE and personal burnout, and this relationship was significant for partnered mothers only.

Research limitations/implications

– Limitations include self-report data, and the sample being highly educated thereby limiting generalizability.

Practical implications

– Providing an enriching and supportive work environment may be an important strategy for minimizing burnout in mothers, particularly for sole mothers.

Social implications

– Employed sole mother’s risks of burnout may be higher than for other mothers even when experiencing WFE, which can have implications for their functioning and for family well-being.

Originality/value

– This two-wave study is the first to highlight that sole mothers, who are at risk of greater socio-economic disadvantages, do not benefit from WFE to the same degree as partnered mothers. Future work-family and burnout research should further examine differences based family structure.

Dementia attitudes and help-seeking intentions: an investigation of responses to two scenarios of an experience of the early signs of dementia

OBJECTIVES

To investigate associations between dementia-attitudes and help-seeking intentions.

METHOD

An online survey of 611 Australian adults (45-60 years) assessed dementia-related attitudes and help-seeking intentions in response to two scenarios of an experience of early dementia: for themselves (Scenario 1); and for a significant other (proxy help-seeking) (Scenario 2). Logistic regression models examined the relationship between four dementia-related attitudes (labelled Personal Avoidance, Fear of Labelling, Fear of Discrimination and Person Centredness) and help-seeking intentions.

RESULTS

Most participants indicated they would seek help from a general practitioner (GP) for themselves (82.2%) or for a proxy (78.7%) in response to the scenarios. Whilst only 7.2% indicated they would seek help from no-one, 21.3% would delay seeking help. In response to Scenario 1, Personal Avoidance and Fear of Labelling were associated with intentions to delay help-seeking. Fear of both Labelling and Discrimination were associated with intentions to seek help from no-one. In response to Scenario 2, Personal Avoidance was associated with intentions to delay proxy help-seeking and a reduced likelihood of seeking help by phone or and with Fear of Discrimination, via a GP. Fear of Labelling was also associated with an intention to delay proxy help-seeking.

CONCLUSION

Efforts to improve help-seeking for dementia should address attitudes relating to stigma including negative labelling and a desire for the avoidance of people with dementia. Fears relating to discrimination indicate a need to build public confidence regarding the capacity of the health and workforce sectors to support people with dementia ethically and appropriately.

Bladder cancer in renal allograft recipients: risk factors and outcomes

BACKGROUND

Solid organ transplant recipients have an increased cancer risk owing to immunosuppression and oncogenic viral infections. We report on the incidence and types of bladder cancer in kidney transplant recipients in Ireland, describing possible additional risk factors and outcomes in these patients.

METHODS

We identified kidney transplant recipients diagnosed with de novo bladder cancer between January 1, 1994, and July 31, 2012, by integrating data from the Irish National Cancer Registry and National Renal Transplant Registry. We calculated the standardized incidence ratio (SIR) and examined patient and tumor characteristics and 1-year survival rate.

RESULTS

Fifteen patients were diagnosed with de novo bladder cancer during the study period, representing 0.48% of kidney transplant recipients. The SIR was 2.5 (95% CI, 1.4-4.2; P < .001). The mean interval between transplantation and diagnosis of bladder tumor was 8.6 years and mean age at time of diagnosis was 55.7 years. Sixty percent of patients were male. The tumor types were transitional cell carcinoma (9 patients), squamous cell carcinoma (3 patients), adenocarcinoma (1 patient), carcinoma in situ (1 patient), and diffuse large B-cell lymphoma (1 patient). Beside immunosuppression, risk factors associated with bladder cancer were urogenital disease (6 patients), cyclophosphamide exposure (2 patients), BK nephropathy (1 patient), analgesic nephropathy (1 patient), and extensive smoking (1 patient). Eight patients underwent radical cystectomy for invasive tumors, with resection of other pelvic organs in 7 patients. Mortality rate within the first year was 40%.

CONCLUSION

Bladder cancer occurred more commonly in kidney transplant recipients with a predominance of aggressive tumors and a high mortality. In patients with preexisting risk factors such as urologic abnormalities and cyclophosphamide exposure careful assessment before transplantation and vigilant monitoring posttransplantation with a low threshold for cystoscopy may improve outcomes.

Measuring mental well-being: A validation of the Short Warwick-Edinburgh Mental Well-Being Scale in Norwegian and Swedish

AIMS

Mental health, currently one of the biggest challenges worldwide, requires attention and research. The aim of this study was to examine the psychometric properties of the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), and validate the scale for use in Norway and Sweden. SWEMWBS, which includes both hedonic and eudemonic principles of mental well-being, could facilitate useful future studies.

METHOD

Data were collected among Norwegian and Swedish hotel managers (N=600) through self-rated online questionnaires. Tests used to examine the psychometric properties of the scale included descriptive statistics, correlations, reliability analyses, and explorative factor analyses in SPSS, as well as confirmatory factor analyses in AMOS. Robustness tests were run for gender and country subsamples.

RESULTS

The scale showed adequate internal consistency and reliability. Results of the confirmatory factor analysis showed moderate fit in Norway and Sweden. In addition, the scale showed acceptable construct, criterion-related, and discriminant validity.

CONCLUSION

The psychometric properties of the SWEMWBS were acceptable in both the Norwegian and the Swedish translations of the scale.

Lack of sleep could increase obesity in children and too much television could be partly to blame

AIM

To examine the bidirectional relationship between short sleep duration and body mass index (BMI). A secondary aim was to investigate whether reduced physical activity and increased screen time (television and computer use) mediated these associations.

METHODS

This study utilised data from the Longitudinal Study of Australian Children, which is an observational cohort study of Australian children. The sample included 2984 (52.4% boys) children followed from 4 to 5 years of age until 8 to 9 years of age. Sleep duration, screen time and covariates were reported by parents, with BMI measured objectively. Cross-lagged modelling investigated the bidirectional association between sleep duration and BMI; lagged panel mediation modelling examined physical activity and screen time as potential mediators.

RESULTS

Short sleep duration at 4 to 5 years of age was significantly associated with higher BMI at 8 to 9 years of age (β= -.07, p = .044). The relationship between short sleep duration at 4 to 5 years of age and higher BMI at 8 to 9 years of age was partially mediated by increased television viewing at 6 to 7 years of age (β = -.01, 95% confidence interval [-.02, -.002]).

CONCLUSION

Short sleep duration could be a risk factor for obesity in children. Increased television viewing may be one mechanism underlying this longitudinal relationship.

A review of the factors associated with the non-use of respite services by carers of people with dementia: implications for policy and practice

The use of respite services by carers has been shown to extend the length of time people with dementia can remain living in the community with family support. However, the use of respite services by informal carers of people with dementia is often low and does not appear to match carer need. To better understand how to address carers' unmet need for respite, the factors that impede respite service use must be identified. To achieve this, a narrative synthesis of published academic literature (1990-2011) was undertaken regarding factors associated with not utilising different types of respite services utilising Anderson's Behavioural Model of Service Use. The review reinforces the importance of the assessment and matching of services to the needs of individual carers and care recipients at the local level. It also highlights the need to move beyond care pathways for individuals. To support respite use there is a need for local action to be augmented at a community or population level by strategies to address attitudinal and resource barriers that influence sub-groups of the carer population who may be more vulnerable to service non-use.

Cross-sectional survey of older patients’ views regarding multidisciplinary care for chronic conditions in general practice

The ageing population and increasing prevalence of chronic illness have contributed to the need for significant primary care reform, including increased use of multidisciplinary care and task substitution. This cross-sectional study explores conditions under which older patients would accept having health professionals other than their general practitioner (GP) involved in their care for chronic disease management (CDM). Ten practices were randomly sampled from a contiguous major city and inner regional area. Questionnaires were distributed to consecutive patients aged 60 years and over in each practice. Agency theory was used to inform analyses. Statistical analysis was undertaken using Wald’s test, growth modelling and linear regression, controlling for the clustered design. The response rate was 53% (n = 272). Most respondents (79%) had at least one chronic health condition. Respondents were more comfortable with GP than with practice nurse management in the CDM scenario (Wald’s test = 105.49, P < 0.001). Comfort with practice nurse CDM was positively associated with increased contact with their GP at the time of the visit (β = 0.41, P < 0.001), negatively associated with the number of the respondent’s chronic conditions (β = –0.13, P = 0.030) and not associated with the frequency of other health professional visits. Agency theory suggests that patients employ continuity of care to optimise factors important in CDM: information symmetry and goal alignment. Our findings are consistent with the theory and lend support to ensuring that interpersonal continuity of care is not lost in health care reform. Further research exploring patients’ acceptance of differing systems of care is required.

Trust, continuity and agency: keys to understanding older patients' attitudes to general practice trainees

BACKGROUND

Populations are ageing and therefore non-communicable diseases are becoming leading causes of global morbidity, which need to be the focus of primary care services and training. Some older patients are uncomfortable with general practitioner (GP) trainees managing their chronic conditions, reducing clinical experience opportunities for trainees. This Australian cross-sectional study explored the factors underlying patients' attitudes to trainees in an agency theory framework.

METHODS

Fifty patients aged 60 and over from each of 38 training practices were offered a questionnaire after their consultation. Principal component analysis of the results was undertaken. Factor scores were calculated. Binary logistic modelling was used to identify relationships between participant characteristics, behaviours, attitude items and factor scores.

RESULTS

The response rate was 47.9% (n = 911). Three factors were identified: 'Interpersonal Trust' (IPT); 'Institution/system Trust' (ST); and 'Interpersonal Continuity' (IPC). Lower self-rated health (SRH) was associated with higher IPT factor scores (P = 0.023); higher SRH with higher ST scores (P = 0.001); and chronic illness with higher IPC scores (P = 0.005). Higher ST scores were associated with greater comfort with trainees' involvement in chronic care (P < 0.001) and frequency of trainee visits (P < 0.001), while higher IPC scores were negatively associated (P < 0.001 and P = 0.003, respectively). High IPT scores were associated with lower satisfaction with trainee visits (P = 0.001).

DISCUSSION

These results indicate that better SRH, via higher institution/ST, is associated with favourable attitudes and attendance with trainees. In addition, chronic illness, via a higher need for IPC, is associated with lower comfort and attendance. These findings are consistent with agency theory, which shows potential as a framework for future interventions and research into older patient-trainee interactions.

Synthesis of fluorinated alkoxyamines and alkoxyamine-initiated nitroxide-mediated precipitation polymerizations of styrene in supercritical carbon dioxide

The first controlled/living precipitation NMP in supercritical carbon dioxide in the absence of nitroxide and comparisons with fluorinated alkoxyamines.

Organ donation following the circulatory determination of death (DCD): an audit of donation and outcomes following renal transplantation

Organ Donation following the Circulatory determination of Death was introduced in Beaumont Hospital during 2011. The Intensive Care Society of Ireland formally endorsed a national DCD clinical practice guideline in 2012. This retrospective audit covers a 2-year period during which eleven patients were considered suitable for DCD and where consent was obtained. Nine patients died within the ninety-minute period following the withdrawal of life sustaining therapies and subsequently donated organs (82%). Eighteen kidneys were recovered and seventeen patients received renal transplants--one patient received a nephron-dosing dual renal transplant. Lungs were recovered on two occasions and one patient received a lung transplant. Heart valves were recovered on one occasion. To date sixteen of seventeen recipient patients have functioning renal transplants (94%). In conclusion, this model of deceased donation has proven acceptable to families, nursing and medical staff and the outcomes reported are consistent with international best practice.

Why carers of people with dementia do not utilise out-of-home respite services

While many people with dementia require institutional care, having a co-resident carer improves the likelihood that people can live at home. Although caregiving can have positive aspects, carers still report a high need for respite. Despite this need, the use of respite services for carers of people with dementia is often low. This article investigates carer beliefs regarding out-of-home respite services and why some carers do not utilise them. A total of 152/294 (51.7%) carers of community-dwelling people with dementia (NSW, Australia) who were sent a survey completed it (November 2009-January 2010). Despite reporting unmet need for both services, 44.2% of those surveyed were not utilising day respite and 60.2% were not utilising residential respite programmes. Binary logistic regression models were used to examine factors associated with non-use using the Theory of Planned Behaviour within an expanded Andersen Behavioural Model on a final sample of 113 (due to missing data). The model explained 66.9% of the variation for day centres, and 42% for residential respite services. Beliefs that service use would result in negative outcomes for the care recipient were strongly associated with non-use of both day care [OR 13.11; 95% CI (3.75, 45.89)] and residential respite care [OR 6.13; 95% CI (2.02, 18.70)] and were more strongly associated with service non-use than other predisposing, impeding and need variables. For some carers who used services despite negative outcome beliefs, the benefits of respite service use may also be diminished. To improve use of out-of-home respite services in this vulnerable group, service beliefs should be addressed through service development and promotion that emphasises benefits for both carer and care recipients. Future research utilising behavioural service models may also be improved via the inclusion of service beliefs in the study of health and social service use.

Twenty-year survivors of kidney transplantation

There have been few studies of patients with renal allografts functioning for more than 20 years. We sought to identify clinical factors associated with ultra long-term (>20 year) renal allograft survival and to describe the clinical features of these patients. We performed a retrospective analysis of the Irish Renal Transplant Database and included 1174 transplants in 1002 patients. There were 255 (21.74%) patients with graft function for 20 years or more. Multivariate analysis identified recipient age (HR 1.01, CI 1.01-1.02), gender (male HR 1.25, CI 1.08-1.45), acute rejection (HR 1.26, CI 1.09-1.45) and transplant type (living related donor vs. deceased donor) (HR 0.52, CI 0.40-0.66) as significantly associated with long-term graft loss. Median serum creatinine was 115 μmol/L. The 5-year graft survival in 20-year survivors was 74.7%. The mean age at death was 62.7 years (±10.6). The most common causes of death were cardiovascular disease and malignancy. The two major causes of graft loss were death (with function) and interstitial fibrosis/tubular atrophy. Comorbidities included skin cancer (36.1%), coronary heart disease (17.3%) and other malignancies (14.5%). This study identifies factors associated with long-term allograft survival and a high rate of morbidity and early mortality in long-term transplant recipients.

Pleuroperitoneal leak complicating peritoneal dialysis: a case series

Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.

An assessment of the long-term health outcome of renal transplant recipients in Ireland

BACKGROUND

Renal transplantation remains the preferred method of renal replacement therapy in terms of patient survival, quality of life and cost. However, patients have a high risk of complications ranging from rejection episodes, infection and cancer, amongst others.

AIMS AND METHODS

In this study, we sought to determine the long-term health outcomes and preventive health measures undertaken for the 1,536 living renal transplant patients in Ireland using a self-reported questionnaire. Outcomes were divided into categories, namely, general health information, allograft-related information, immunosuppression-related complications and preventive health measures.

RESULTS

The results demonstrate a high rate of cardiovascular, neoplastic and infectious complications in our transplant patients. Moreover, preventive health measures are often not undertaken by patients and lifestyle choices can be poor.

CONCLUSIONS

This study highlights the work needed by the transplantation community to improve patient education, adjust immunosuppression where necessary and aggressively manage patient risk factors.

Nephrogenic systemic fibrosis

Nephroaenic systemic fibrosis (NSF) is a potentiallv fatal dermatiological condition found exclusively in patients with advanced renal I failure. There is minimal literature regarding the epidemiology and outcomes of patients with NSF in Ireland. A retrospective chart review was performed for all patients with NSF in Ireland. Ireland's experience with the disease was examined in light of international reports. There have been three cases of NSF in Ireland; an area which serves 1915 dialysis patients--giving a point prevalence among Irish end-stage kidney disease patients of 0.002. There was a large variation in disease severity between the three patients. All three patients had significant exposure to gadolinium chelate. Caution with gadolinium administration must be exercised in patients with advanced renal failure.

An interim prosthesis program for lower limb amputees: comparison of public and private models of service

This study compared the outcomes of an interim mechanical prosthesis program for lower limb amputees operated under a public and private model of service. Over a two-year period, 60 transtibial amputees were fitted with an interim prosthesis as part of their early amputee care. Thirty-four patients received early amputee care under a public model of service, whereby a prosthetist was employed to provide the interim mechanical prosthesis service. The remaining 26 patients received early amputee care under a private model of service, where an external company was contracted to provide the interim mechanical prosthesis service. The results suggested comparable clinical outcomes between the two patient groups. However, the public model appeared to be less expensive with the average labour cost per patient being 29.0% lower compared with the private model. The results suggest that a public model of service may provide a more comprehensive and less expensive interim prosthesis program for lower limb amputees.