Economic evaluation of Optilume, a drug-coated balloon for recurrent anterior male urethral stricture

Objectives

We aim to conduct an economic evaluation of the Optilume urethral drug-coated balloon (DCB) compared with endoscopic management for the treatment of recurrent anterior male urethral stricture in England.

Patients and Methods

A cohort Markov model was developed to estimate the costs and savings to the NHS over a 5-year time horizon of adopting Optilume for the treatment of anterior urethral male stricture versus current endoscopic standard of care. A scenario analysis was conducted which compared Optilume to urethroplasty. Probabilistic and deterministic sensitivity analyses were performed to estimate the impact of uncertainties in model parameters.

Results

When compared with current endoscopic standard of care Optilume resulted in an estimated cost saving of £2502 per patient if introduced in the NHS for the treatment of recurrent anterior male urethral stricture. In the scenario analysis, the use of Optilume compared with urethroplasty resulted in an estimated cost saving of £243. Results were robust to changes in individual input parameters as demonstrated in the deterministic sensitivity analyses, with the monthly probability of symptom recurrence associated with endoscopic management the only exception. Probabilistic sensitivity analysis results demonstrated that Optilume was cost saving in 93.4% of model iterations, when running 1000 iterations.

Conclusion

Our analysis suggests that the Optilume urethral DCB treatment can be a cost-saving alternative management option for the treatment of recurrent anterior male urethral stricture within the NHS in England.

'Please help me, I am so miserable!': sexual health, emotions and counselling in teen and young adult problem pages in late 1980s Ireland

In 1984, the Irish Family Planning Association (IFPA) established a youth group comprised of young volunteers aged between 16 years and 20 years. The IFPA was responding to a perceived need for sexual health advice for young people in the absence of any formal sex education in Irish schools. The group established a telephone helpline and, from late 1987, was commissioned to provide advice columns for two Irish magazines for young people called Hot Press and Fresh The advice columns run by the IFPA youth group provided an important educational and counselling service for young people on matters relating to sexual health and relationships. Letters to the two magazines also attest to a significant degree of ignorance around sexual and reproductive health among young people and the prevalence of risk taking with regard to contraception. Moreover, the letters were often frank and deeply honest about the feelings and emotions experienced by the letter writer. Replies to the letter writers from the IFPA group were sensitive and empathetic, but clear and unambiguous, highlighting the team's approaches to sexual health counselling and 'risk' which were modelled on approaches by British groups such as the Samaritans, Grapevine and Brook. Drawing on the uncatalogued letters received by the youth group, as well as the published replies in the magazine advice columns, this article will shed light on the key sexual health concerns of young Irish people in the late 1980s. Ultimately, it will examine what these queries reveal about the impact of Ireland's social and moral climate on teenagers' emotional health. More broadly, the letters to these magazines illuminate the stigma, shame and silences around these issues in 1980s' Ireland, and highlight the importance of magazines as a source of communication and an outlet for young people to express their emotions relating to sexuality, relationships and sexual health.

Assessing the quality of data for drivers of disease emergence

Drivers are factors that have the potential to directly or indirectly influence the likelihood of infectious diseases emerging or re-emerging. It is likely that an emerging infectious disease (EID) rarely occurs as the result of only one driver; rather, a network of sub-drivers (factors that can influence a driver) are likely to provide conditions that allow a pathogen to (re-)emerge and become established. Data on sub-drivers have therefore been used by modellers to identify hotspots where EIDs may next occur, or to estimate which sub-drivers have the greatest influence on the likelihood of their occurrence. To minimise error and bias when modelling how sub-drivers interact, and thus aid in predicting the likelihood of infectious disease emergence, researchers need good-quality data to describe these sub-drivers. This study assesses the quality of the available data on sub-drivers of West Nile virus against various criteria as a case study. The data were found to be of varying quality with regard to fulfilling the criteria. The characteristic with the lowest score was completeness, i.e. where sufficient data are available to fulfil all the requirements for the model. This is an important characteristic as an incomplete data set could lead to erroneous conclusions being drawn from modelling studies. Thus, the availability of good-quality data is essential to reduce uncertainty when estimating the likelihood of where EID outbreaks may occur and identifying the points on the risk pathway where preventive measures may be taken.

Epidemiology of invasive Haemophilus influenzae disease in northwestern Ontario: comparison of invasive and noninvasive H. influenzae clinical isolates

In the post-Haemophilus influenzae type b (Hib) vaccine era, invasive H. influenzae type a (Hia) disease emerged in North American Indigenous populations. The role of Hia in noninvasive disease is uncertain; it is unknown whether noninvasive Hia infections are prevalent in populations with a high incidence of invasive disease, and whether invasive and noninvasive Hia isolates have different characteristics. We analyzed all invasive and noninvasive clinical H. influenzae isolates collected in a northwestern Ontario hospital serving 82% Indigenous population over 5.5 years. Serotyping, clonal analysis, and antimicrobial sensitivity testing were conducted on 233 noninvasive and 20 invasive isolates. Among noninvasive isolates, 91% were nontypeable (NTHi) and 3% were Hia; Hia was the most frequent invasive isolate (60%). Incidence rates of invasive H. influenzae disease (12.5/100 000/year) greatly exceeded average provincial data, with the highest found in <6-year-old children (63.9/100 000/year); the proportion of Hia among invasive isolates was seven times larger than in Ontario. No difference in clonal characteristics between invasive and noninvasive Hia isolates was found. Antibiotic resistance was more common among NTHi than among encapsulated isolates, without differences between invasive and noninvasive isolates. Considering the significance of Hia in Indigenous populations, pediatric immunization against Hia will be useful to prevent serious infections in young Indigenous children.

Differential attainment: how can we close the gap in paediatrics?

Differential attainment is the gap in attainment between different demographic groups undertaking the same assessment. Across the UK, we see differences in outcome in undergraduate and postgraduate medical education on the basis of gender, age, ethnicity and country of primary medical qualification which cannot be explained by a difference in ability. The largest gaps appear when we look at the variation in outcome between UK and international medical graduates (IMGs) and between white British and black, Asian and minority ethnic (BAME) doctors in postgraduate medical education. If we look to postgraduate medical examinations, the differences in attainment are stark and occur across all medical specialties, with paediatrics being no exception. The differences are also seen in the rates of relative success in recruitment to training posts and in a trainee's likelihood of getting a satisfactory outcome at the Annual Review of Competence Progression. Ensuring all doctors reach their full potential is undoubtedly an issue of fairness that is of particular significance to paediatrics as IMGs make up 47% of our medical workforce and 36% of the paediatric workforce identifies as being from a BAME group. It is clear that if we fail to close the gap in differential attainment, there will be both a personal cost to affected individuals, but also a cost to the wider paediatric profession and the children they serve. This paper hopes to summarise the background and causes to differential attainment and look towards possible interventions that might tackle this issue.

In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation.

METHODS

EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing.

FINDINGS

Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms.

INTERPRETATION

Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required.

FUNDING

None.

Underdiagnosis of internal anal sphincter trauma following vaginal delivery

OBJECTIVE

Damage to the anal sphincter during childbirth remains the leading cause of fecal incontinence in women. Defects in the internal (IAS) or external anal sphincter, alongside symptoms and sphincter tone, will generally dictate the suggested mode of delivery in any successive pregnancy. This study aimed to examine using endoanal ultrasonography the prevalence of IAS damage in women referred with Grade-3a or -3b obstetric anal sphincter injury (OASI) in a tertiary-referral perineal clinic.

METHODS

This was a retrospective observational study of all women referred to a tertiary-referral perineal clinic after primary repair of OASI (Grade 3a-c, 4) diagnosed for the first time following vaginal delivery between January 2016 and December 2019, inclusive. Women were assessed using the Wexner bowel continence questionnaire, digital examination of sphincter tone and endoanal ultrasound. Injuries in each sphincter were classified as a scar (≤ 30°) or defect (> 30-90° or > 90°) on endoanal imaging in the axial plane.

RESULTS

In total, 615 women were referred following primary repair of OASI. Sonographic evidence of damage to the IAS was seen in 9.1% (46/506) of women diagnosed with a Grade-3a/3b injury. In women referred with a Grade-3a/3b tear, symptom scores were statistically higher (P = 0.025) in those with an IAS defect > 30° compared to those with an intact or scarred IAS, although the median score was zero in both groups. The proportion of women in each group with severe symptoms (score > 9) was similar (2.6% vs 6.5%; P = 0.148). Among women referred with a Grade-3a/3b tear, sphincter tone was reduced more frequently in those with a defect of the IAS than in those with an intact or scarred IAS (52.2% vs 11.7%; odds ratio, 8.14 (95% CI, 4.26-15.67); P < 0.001). Regardless of the reason for referral, women with reduced sphincter tone on rectal examination were four times as likely to have had an IAS defect > 30° than were those with normal resting tone (risk ratio, 4.58 (95% CI, 3.25-6.45); P < 0.001).

CONCLUSIONS

One in 11 women diagnosed with a Grade-3a or -3b tear have evidence of damage to their IAS on endoanal ultrasound. Damage to this muscle is linked to fecal incontinence in women and can have a significant impact on the planning of any future deliveries. This study highlights the importance of established perineal clinics with access to ultrasound. Nonetheless, if reduced sphincter tone is felt on rectal examination, a clinician should have a high index of suspicion for an occult IAS injury. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

251 PREVALENCE AND CHARACTERISTICS OF SWALLOWING/COMMUNICATION IMPAIRMENTS IN FRAIL OLDER ADULTS ATTENDING THE EMERGENCY DEPARTMENT: A RETROSPECTIVE COHORT STUDY

Background

The presentation of frail older adults to the Emergency Department (ED) may be complicated by swallowing and/or communication impairment. Adults with communication impairment may experience difficulty accessing healthcare. Dysphagia is associated with frailty irrespective of age and/or number of chronic diseases [1]. This study aims to determine the prevalence and characteristics of swallowing and/or communication impairments among frail older adults attending the ED.

Methods

A retrospective cohort study of consecutive ED attendees aged ≥ 75 years assessed by an interdisciplinary Gerontological ED team between October 2021 – February 2022 was conducted. A swallow/communication screening tool determined requirement for Speech and Language Therapy (SLT) referral. Data related to demographics and SLT interventions was extracted. Data analysis was completed using STATA Version 12. Ethical approval was obtained.

Results

Among 518 patients, 118 (23%) (mean age 82.4 (+/-6.4) years, 54% male) required SLT assessment. These patients had high rates of frailty (Median CFS= 6 (IQR 5-7), suspected delirium (4AT ≥ 4 in 45%), suspected malnutrition (MNA score 0-11 in 75%), and probable sarcopenia (SARC-F= ≥ 4 in 75%). Therapy Outcome Measurement Scales and the Functional Oral Intake Scale were used in this first episode of SLT care. Oropharyngeal dysphagia was identified for 43% (27% mild, 10% moderate, 3% moderate-severe, 3% severe), with 6% presenting with signs/symptoms of oesophageal dysphagia. Changes in baseline communication was identified for 57%; cognitive communication difficulties (38%), dysarthria (11%), dysphonia (8%). SLT intervention and management approaches were initiated in the ED.

Conclusion

Findings indicate a high prevalence of swallowing/communication impairment in frail older adults attending the ED. Future research should explore SLT outcomes at point of discharge to refine these swallowing/communication presentations.

Reference

1. Bahat G et al. Association between dysphagia and frailty in community-dwelling older adults. The Journal of Nutrition, Health & Ageing. 2019:23, 571–577.

The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity

Background

Insufficient physical activity (PA) is a global issue for health. A multifaceted response, including government action, is essential to improve population levels of PA. The purpose of this study was to develop the ‘Physical Activity Environment Policy Index’ (PA-EPI) monitoring framework to assess government policies and actions for creating a healthy PA environment.

Methods

An iterative process was undertaken. This involved a review of policy documents from authoritative organisations, a policy audit of four European countries, and systematic reviews of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops where quantitative and qualitative data alongside theoretical and pragmatic considerations were used to inform PA-EPI development.

Results

The PA-EPI is conceptualised as a two-component ‘policy’ and ‘infrastructure support’ framework. The two components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development, and health-in-all-policies. Forty-five ‘good practice statements’ (GPS) or indicators of ideal good practice within each domain concludes the PA-EPI. A potential eight-step process for conducting the PA-EPI is described.

Conclusions

Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI GPS will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.

Assessing the Validity of the Long-Term Conditions Questionnaire (LTCQ) in Women During Pregnancy and the First Year Following Birth

Background

The aim of this study was to validate a generic patient-reported outcome measure, the Long-Term Conditions Questionnaire (LTCQ), among pregnant and postpartum women living with a pre-existing long-term condition (LTC).

Methods

Cognitive interviews were conducted with women who were currently pregnant or had given birth within the past year and living with a pre-existing LTC (n=11) and with healthcare professionals working in maternal care (n=11) to explore the acceptability of LTCQ items. An online survey was subsequently administered among women who were pregnant or had given birth within the past year and living with a pre-existing LTC (n=718). Tests of validity were performed including assessing correlations between the LTCQ and reference measures, the Well-being in Pregnancy (WiP) Questionnaire and the EuroQol EQ-5D-5L. Internal consistency was assessed using the Cronbach's alpha statistic.

Results

All LTCQ items were considered relevant and appropriate for use with women who were pregnant or had given birth within the past year. The most commonly reported LTC among the online survey sample (n=718) was a mental health condition (n=350, 48.7%) followed by joint, bone and connective tissues (n= 212, 29.5%) and gastrointestinal (n=143, 19.9%) condition. Data indicated LTCQ scores behaved in a predictable pattern, demonstrating poorer scores for women reporting a greater number of LTCs; mean (SD) scores, one LTC= 61.86 (17.8), two LTCs= 55.29 (16.0), three LTCs= 49.84 (15.52) and four LTCs= 44.94 (12.2). Poorer scores were also reported for women living with at least one mental health condition compared to those reporting no mental health condition, mean score = 66.18 (SD 16.7) v 48.64 (SD 13.3), p<0.001 respectively. As anticipated, LTCQ scores demonstrated significant correlations in the expected direction with both the EQ-5D-5L and WiP scores. For all LTCQ items, the Cronbach's alpha statistic was 0.93.

Conclusion

Data presented here indicate that the LTCQ, which assesses living well with one or more LTC, is suitable for use among pregnant and postpartum women, from both the woman's perspective and from the perspectives of maternity healthcare professionals. Use of the LTCQ would facilitate the identification of unmet needs within this high-risk cohort and support the exploration of how LTCs may affect women throughout the pregnancy and post-natal period. Understanding unmet needs within this cohort of women provides an opportunity to link up specialist care within maternity services and enhance personalised care.

Refinement of the Well-being in Pregnancy (WiP) questionnaire: cognitive interviews with women and healthcare professionals and a validation survey

Background

Measuring positive and negative aspects of well-being during pregnancy and childbirth is important for both healthy women and women who are living with long-term health conditions (LTCs). This study aimed to further refine the Well-being in Pregnancy (WiP) questionnaire and to incorporate LTC specific items where appropriate.

Methods

A multi-method study. Cognitive interviews with pregnant or postpartum women (n = 11) and consultations with healthcare professionals (n = 11) and public representatives (n = 4) were conducted to explore the acceptability of existing WiP items and content. Items were refined and subsequently administered on an online survey (n = 768). Item reduction steps and exploratory factor analysis were performed on survey data. Convergent validity was examined using Pearson correlation coefficients to compare relationships with other included validated assessments.

Results

Following amendments to three items, the addition of eight core WiP items and five LTC specific items, a total of 25 items were considered relevant and appropriate for use with pregnant women. Analysis of survey data reduced the questionnaire to 12 items measuring three core WiP scales; 1) Concerns over support after birth, 2) Positive pregnancy and, 3) Confidence about motherhood, and a five item standalone LTC specific scale. All scales demonstrated good validity and internal reliability. Scores for the three core scales moderately correlated with established well-being measures indicating that they were measuring similar, yet distinct concepts.

Conclusions

Analyses confirmed good psychometric properties of the refined WiP questionnaire. The use of pregnancy specific well-being measures, such as the WiP, provide a route into asking women in more detail about how their care may be tailored to support them and also facilitates positive conversations with women about how care and experience of pregnancy and childbirth may be enhanced further.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04626-x.

Evaluating a psychological support service focused on the needs of critical care and theatres staff in the first wave of COVID-19

BACKGROUND

In response to COVID-19, the authors used clinical psychology resources from their hospital's Pain Medicine Department to provide direct support to critical areas.

AIMS

The degree to which the service met the needs of staff and managers between March and August 2020 was evaluated.

METHODS

A total of 51 staff were referred. Most were nurses (43%), followed by theatre practitioners (36%), healthcare assistants (9%), consultants (8%), administrative (2%) and support staff (2%). Working status, reason for referral and presenting difficulties at first appointment and outcome were recorded. Staff were sent an anonymous survey following intervention.

FINDINGS

Staff reported high rates of burnout, anxiety and low mood, with 22% experiencing exacerbation of pre-existing mental health problems. All staff reported benefit from the intervention and managers provided positive feedback.

CONCLUSION

Establishing a supportive service that included psychology benefited both staff and managers at the peak of the pandemic. Recommendations are provided.

Utility of Whole Genome Sequencing in Assessing and Enhancing Partner Notification of Neisseria gonorrhoeae Infection

BACKGROUND

Gonorrhea is a sexually transmitted infection of global concern. We investigated whole-genome sequencing (WGS) as a tool to measure and enhance partner notification (PN) in gonorrhea management.

METHODS

Between May and November 2018, all N. gonorrhoeae isolated from patients attending Leeds Sexual Health, United Kingdom, underwent WGS. Reports listing sequences within 20 single-nucleotide polymorphisms (SNPs) of study isolates within a database containing select isolates from April 1, 2016, to November 15, 2018, were issued to clinicians. The proportion of cases with a potential transmission partner identified by PN was determined from patient and PN data. The WGS reports were reviewed to identify additional cases within 6 SNPs or less and verified for PN concordance.

RESULTS

Three hundred eighty isolates from 377 cases were successfully sequenced; 292 had traceable/contactable partners and 69 (18%) had a potential transmission partner identified by PN. Concordant PN and WGS links were identified in 47 partner pairs. Of 308 cases with no transmission partner by PN, 185 (60%) had a case within 6 SNPs or less; examination of these cases' PN data identified 7 partner pairs with previously unrecognized PN link, giving a total of 54 pairs; all had 4 or less SNP differences. The WGS clusters confirmed gaps in partner finding, at individual and group levels. Despite the clinic providing sexual health services to the whole city, 35 cases with multiple partners had no genetically related case, suggesting multiple undiagnosed infections.

CONCLUSIONS

Whole-genome sequencing could improve gonorrhea PN and control by identifying new links and clusters with significant gaps in partner finding.

Exploring the use of health and wellbeing measures during pregnancy and the first year following birth in women living with pre-existing long-term conditions: qualitative interviews with women and healthcare professionals

BACKGROUND

One way in which care for pregnant and postpartum women living with long-term health conditions (LTCs) may be improved is through the adoption of standardised measures to provide evidence of health outcomes and wellbeing from the woman's perspective.

AIM

The study explores the views of pregnant and postpartum women living with LTCs, and healthcare professionals to better understand the potential value of using standardised health and wellbeing measures within this patient population.

METHODS

Qualitative semi-structured telephone interviews were conducted to explore the perceived value of using measures with pregnant and postpartum women living with LTCs within maternity services. Participants were asked to provide feedback on three exemplar measures: the Long Term Conditions Questionnaire, the Wellbeing in Pregnancy Questionnaire and the EuroQol EQ-5D-5L instrument. Thematic analysis was used in the analysis of the transcripts.

RESULTS

Eleven women and 11 healthcare professionals took part in semi-structured interviews. Analysis identified five themes as relevant to the use of measures within maternity services: 1) Improving care, 2) Assessing outcomes, 3) Interpretation and application of data, 4) Engagement challenges and implementation and, 5) Women and healthcare professionals alignment.

CONCLUSIONS

Despite varying prior experience and expressing some questions about implementation, respondents were cautiously positive about the use of standardised health and wellbeing measures. Their use offers the opportunity for both affected women and healthcare professionals caring for them to collectively identify and assess important areas of unmet needs and improve outcomes. Incorporating the perspectives of women with LTC's will help bring awareness to elements of women centred care which health services may seek to address.

Investigating the Effects of Error Management Training versus Error Avoidance Training on the Performance of Veterinary Students Learning Blood Smear Analysis

Conventional veterinary training emphasizes correct methodologies, potentially failing to exploit learning opportunities that arise as a result of errors. Error management training (EMT) encourages mistakes during low-stakes training, with the intention of modifying perceptions toward errors and using them to improve performance in unfamiliar scenarios (adaptive transfer). Herein, we aimed to determine the efficacy of EMT, supplemented by a metacognitive module, for veterinary students learning blood smear preparation and interpretation. Our hypothesis was that EMT and metacognition are associated with improved adaptive transfer performance, as compared with error avoidance training (EAT). A total of 26 students were prospectively enrolled in this double-blind study. Performance was evaluated according to monolayer area, smear quality, cell identification, calculated white blood cell differential counts, and overall application/interpretation. Students were trained with normal canine blood and static photomicrographs. Participants tested 72 hours after training demonstrated improved performance in a test that directly recapitulated training (Wilcoxon matched-pairs signed-rank test; two-tailed p all ≤ .001). There were no significant differences between EAT and EMT in this test (Mann-Whitney U test and Welch's t-test; two-tailed p ≥ .26) or in short- and long-term adaptive transfer tests (p ≥ .22). Survey data indicate that participants found errors to be a valuable element of training, and that many felt capable of accurately reflecting on their own performance. These data suggest that EMT might produce outcomes comparable to EAT as it relates to blood smear analysis.

Perceived stress, resilience, well-being, and COVID 19 response in Isha yoga practitioners compared to matched controls: A research protocol

Objectives

The COVID-19 pandemic has been a significant stressor worldwide and reports of psychological distress, depression, sedentary lifestyles, and overall decreased wellbeing are increasing. Yoga practices have been found to improve mental and physical health. The purpose of this randomized controlled trial is to compare Isha yoga practitioners to controls on perceived stress, resilience, wellbeing, and protection and recovery from COVID-19. Trial Design. In this prospective randomized control trial, the effects of yoga practices are being compared between seasoned yoga practitioners with two controls who are age (±3 years), gender matched, and living in the same neighborhood.

Methods

Participants will be asked to complete a series of web-based surveys at baseline, six weeks, and 12 weeks. These surveys include validated scales and objective questions on COVID-19 infection and medical history. The validated questionnaires assess stress, mood states, resilience, and overall wellbeing. Questionnaires, weekly activity diaries, and medical history, will be collected using REDCap.

Results

We hypothesize that routine yoga practice during the COVID-19 pandemic will reduce stress, enhance well-being, and provide protective effects against COVID-19.

Conclusion

With the growing concern about the physical and mental impacts of COVID-19 and increased interest in alternative practices such as yogic practices, this study will contribute to the growing body of evidence about the safety and efficacy of yoga for emotional, mental, and physical health conditions.

Development of an Exercise-Specific Parkinson's Disease Questionnaire: The PDQ-Exercise

BACKGROUND

Exercise is now a significant and key component in the management of Parkinson's disease. However, no self-report, Parkinson's-specific measure of exercise currently exists.

OBJECTIVE

To develop a patient-reported outcome measure (PROM) for use in studies and clinical trials that aim to assess the efficacy of exercise therapy for people with Parkinson's (PwP).

METHODS

Participants were recruited via Parkinson's UK. To generate meaningful items, PwP participated in exploratory cognitive interviews. To pretest the items generated, PwP took part in two rounds of cognitive debrief interviews. Items were subsequently tested through an online survey that also included the eight-item Parkinson's Disease Questionnaire (PDQ-8) and Oxford Participation and Activities Questionnaire (Ox-PAQ).

RESULTS

Twenty PwP were interviewed for item generation. Analyses identified issues related to adopting and maintaining exercise, resulting in the generation of 10 items. Fourteen PwP took part in subsequent cognitive debrief interviews. Following the first 10 interviews, one item was removed, and minor adjustments were made to the wording of two items. Four final interviews verified that no further adjustments were required. Consequently, nine items were included in the validation survey, which was fully completed by 398 PwP. Inspection of floor and ceiling effects resulted in the removal of two further items. A principal component analysis identified a single seven-item factor explaining 61.6% of variance. Further analyses indicated that the measure demonstrates sound reliability and validity.

CONCLUSIONS

Results indicate that the PDQ-Exercise is an acceptable, reliable, and valid PROM. Further assessment of its psychometric properties is in progress. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Investigating the Effects of Error Management Training versus Error Avoidance Training on the Performance of Veterinary Students Learning to Tie Surgical Knots

Although errors can be a powerful impetus for learning, conventional pedagogy often emphasizes error-avoidance strategies that reward correct answers and disfavor mistakes. Error management training (EMT) takes an explicitly positive approach to errors, using them to create an active and self-directed learning environment. Using a surgical knot-tying model, we aimed to determine the efficacy of EMT among veterinary students with no prior surgical experience. We hypothesized that EMT would result in improved performance in unfamiliar scenarios (adaptive transfer) compared with an error-avoidance method. In this prospective double-blinded study, 42 students were equally divided between error avoidance training (EAT) and EMT groups. Performance in instrument- and hand-tied knots was evaluated for technique, time, number of attempts, and, when applicable, knot-leaking pressure. All participants demonstrated significant improvement between a pre-test and an analogous test 48 hours after training for all six outcomes (Wilcoxon matched pairs; two-tailed ps ≤ .013). An adaptive transfer test found no significant differences between EMT and EAT at 48 hours (ps ≥ .053). All participants demonstrated a significant performance decline in six of eight outcomes at 7 weeks post-training (ps ≤ .021). This decline was not significant for four of six EMT outcomes yet significant for five of six EAT outcomes. These data suggest that students trained in both EMT and EAT experience comparable gains in short-term performance, including adaptive transfer. Compared with EAT, EMT may help attenuate performance decline after a sustained period of quiescence. Educators may consider actively incorporating EMT into veterinary curricula.

Cancer and breast cancer awareness interventions in an intellectual disability context: A review of the literature

BACKGROUND

Women with an intellectual disability (ID) have a similar risk of developing breast cancer as women in the general population yet present with later stage breast cancers, which have poorer outcomes.

AIM

To identify whether there is a need to develop a breast cancer awareness intervention for women with an ID.

METHODS

Interventions aimed at increasing cancer awareness and breast cancer awareness for people with an ID were identified and critically appraised.

RESULTS

Five interventions to increase cancer awareness or breast cancer awareness in people with an ID were identified.

CONCLUSION

The review highlighted the paucity of theoretically underpinned breast cancer awareness interventions specifically aimed at women with an ID. Facilitating breast cancer awareness for women with an ID could potentially lead to earlier presentation of potential symptoms of breast cancer, earlier treatment, better prognosis and ultimately, improved survival. This article establishes that there is a need for an intervention underpinned by theory to increase breast cancer awareness in women with an ID.

Maintenance energy requirement and efficiency of utilisation of metabolisable energy for milk production of Bos taurus × Bos indicus crossbred tropical dairy cows: a meta-analysis

ContextDairy consumption has the ability to provide nutrient dense food in low-income countries. However, cows in the tropics may not be able to reach their full potential due to poor nutrition. In tropical regions, milk is mostly produced by Bos taurus × Bos indicus crossbred cattle for which no nutrient requirement tables have been fully developed. Although many novel feeds and feed additives have been tested, nutrient requirements specifically targeting energy and protein for these livestock need to be estimated accurately for milk production to increase sustainably. AimsTo determine the net energy for lactation (NEL) requirement for maintenance and efficiency of utilisation of metabolisable energy intake (MEI) for milk production (kL) of Bos taurus × Bos indicus crossbred dairy cows in the tropics. MethodsA meta-analysis using 141 observations from 38 independent studies in tropical regions with crossbred dairy cows was conducted. The energy produced in milk corrected for zero energy balance (EL0) was regressed by MEI including other covariates. This meta-regression analysis was conducted by frequentist inference via optimisation in RStan. Key resultsThe best-fit model contained only MEI as a covariate. This model predicted a net energy for lactation value at maintenance of 0.323 MJ/kg BW0.75.day (s.e. = 0.0004) with variations for each specific study. The efficiency with which MEI is used for milk production was estimated to be 0.554 (s.e. = 0.00008), which was common for all studies. ConclusionThe key energy parameters estimated in this study should replace commonly used values derived from Bos taurus breeds when formulating diets for crossbred tropical cattle. ImplicationsNutritional requirement tables need to be estimated specifically for Bos taurus × Bos indicus crossbred dairy cows as their requirements differ from Western breeds. Using appropriate nutritional requirements of crossbred cattle would lead to better nutrition and increased production as determined by their genetic merit.

Child Protection Social Work in COVID-19

This article brings together digital anthropology and social work scholarship to create an applied anthropology of everyday digital intimacy. Child protection social work involves home visits in the intimate spaces of others, where modes of sensorial and affective engagement combine with professional awareness and standards to constitute sensitive understandings of children’s well-being and family relationships. In the COVID-19 pandemic, social work practice has shifted, partly, to distance work where social workers engage digitally with service users in their homes while seeking to constitute similarly effective modes of intimacy and understanding. We bring practice examples from our study of social work and child protection during COVID-19 together with anthropologies of digital intimacy to examine implications for new modes of digital social work practice.

Debates on family planning and the contraceptive pill in the Irish magazine Woman's Way, 1963-1973

This article explores discussions of family planning and the contraceptive pill in the popular Irish women's magazine Woman's Way between 1963 and 1973. Contraception was criminalised in Ireland in 1935 and literature relating to birth control was banned under the 1929 Censorship of Publications Act. The contraceptive pill was marketed as a cycle regulator from 1963 until legalization in 1979. This article outlines how women accessed the contraceptive pill, the geographical and class inequalities around this access and how Woman's Way was an important vehicle for debates around the pill. The article assesses what discussions of the contraceptive pill can tell us about marriage dynamics, the role of sympathetic doctors, the power of the Catholic Church. Ultimately, it illustrates how the magazine was an important source of information on family planning for Irish women and how it also enabled women to air their views on the issue.

Toxic benthic freshwater cyanobacterial proliferations: Challenges and solutions for enhancing knowledge and improving monitoring and mitigation

1. This review summarises knowledge on the ecology, toxin production, and impacts of toxic freshwater benthic cyanobacterial proliferations. It documents monitoring, management, and sampling strategies, and explores mitigation options. 2. Toxic proliferations of freshwater benthic cyanobacteria (taxa that grow attached to substrates) occur in streams, rivers, lakes, and thermal and meltwater ponds, and have been reported in 19 countries. Anatoxin- and microcystin-containing mats are most commonly reported (eight and 10 countries, respectively). 3. Studies exploring factors that promote toxic benthic cyanobacterial proliferations are limited to a few species and habitats. There is a hierarchy of importance in environmental and biological factors that regulate proliferations with variables such as flow (rivers), fine sediment deposition, nutrients, associated microbes, and grazing identified as key drivers. Regulating factors differ among colonisation, expansion, and dispersal phases. 4. New -omics-based approaches are providing novel insights into the physiological attributes of benthic cyanobacteria and the role of associated microorganisms in facilitating their proliferation. 5. Proliferations are commonly comprised of both toxic and non-toxic strains, and the relative proportion of these is the key factor contributing to the overall toxin content of each mat. 6. While these events are becoming more commonly reported globally, we currently lack standardised approaches to detect, monitor, and manage this emerging health issue. To solve these critical gaps, global collaborations are needed to facilitate the rapid transfer of knowledge and promote the development of standardised techniques that can be applied to diverse habitats and species, and ultimately lead to improved management.

Systematic review examining the evidence for impact of school policies on physical activity

Background

Epidemiological evidence has demonstrated that physical activity can have substantive health benefits for children and young people. The 'Policy Evaluation Network' is a multi-disciplinary research network across 7 European countries and New Zealand aimed at building capacity and evaluating the level of impact of policy interventions for promoting healthy lifestyles. The Toronto Charter identified 'whole-of-school' programmes as one of seven key investments for promotion of PA. This paper presents results of a SLR, designed to assess the level of evidence for policies within the school setting that contribute directly or indirectly to increasing PA.

Methods

Researchers searched six online databases for scientific literature regarding PA policy interventions in the school setting using key concepts of policy, school, PA and evaluation. Risk of bias will be assessed with tools appropriate to the design of the studies considered. Evidence of actual or potential positive PA outcomes arising directly or indirectly from policy actions will be catalogued.

Results

Preliminary searches identified 2327 unique scientific articles. 1938 (83.3%) were excluded on first reading and 189 (8.8%) were included for full text analysis. Initial findings suggest that organisational policies, for example avoiding overcrowding in playgrounds during school breaks, may be a promising policy action. Detailed analysis revealing other potential policy actions supported by evidence will be presented (SLR in progress).

Conclusions

Preliminary findings suggest that few studies link policy actions in the school setting to PA outcomes. However, studies that have investigated the effects of changes to the school environment on PA levels may provide evidence for policy actions. Preliminary recommendations include strengthening the evidence base for school-based PA policy by supporting studies into the effects of particular policy or legislative changes on PA outcomes.

Key messages

School physical activity policies are an underappreciated public health intervention. More studies should link policy changes to physical activity outcomes.

Sub-national structures matter when evaluating physical activity promotion: Lessons from Germany

Background

Public policies are increasingly acknowledged as important part of promoting physical activity (PA). However, especially in states with sub-national administrative structures such as Germany, national and sub-national approaches differ considerably. In Germany, sport for all (SfA) promotion is mostly organized at sub-national level, which is usually not covered in national evaluations. Knowledge of these structures helps to understand national outcomes, enables comparisons and learning within and between countries, and assists in identifying support structures for effective PA promotion.

Methods

Data were collected in the PEN Policy Evaluation Network project. In addition to the WHO HEPA PAT, a questionnaire was sent to the sports representatives of the 16 federal states. Responses of 11 state representatives were included and overarching issues were identified using inductive thematic analysis.

Results

PA promotion in Germany is organized in three areas: SfA, professional sports and school sports. SfA promotion at sub-national level is assigned to different administrative bodies (ministries, senate administration, state chancellery) and policy areas: culture, health and care, home affairs with various aspects, education, social affairs and family. The priorities of the federal states are more diverse and specific compared to the national level. There is an overlap in the topics: urban planning, cycling, health prevention and targeting children. Cooperation mechanisms and partners vary between federal states, but some partners are active at sub-national and national level.

Conclusions

The results provide an insight into the complexity of PA and especially SfA promotion at sub-national level in Germany. Our results suggest that a broader range of approaches is used in the 16 German states than national overviews would suggest. These particularities must be taken into account when assessing and comparing the results from different countries.

Key messages

The promotion of SfA at German sub-national level is much more diverse than represented at national level evaluations. Knowledge of sub-national structures enables the understanding of national outcomes, the promotion of cross-national learning and the identification of supportive structures for effective PA promotion.

Web-Based and mHealth Technologies to Support Self-Management in People Living With Type 2 Diabetes: Validation of the Diabetes Self-Management and Technology Questionnaire (DSMT-Q)

BACKGROUND

A growing number of web-based and mobile health (mHealth) technologies have been developed to support type 2 diabetes self-management. Little is known about individuals' experiences with these technologies and how they support self-management. Appropriate tools are needed to understand how web-based and mHealth interventions may impact self-management.

OBJECTIVE

This study aimed to develop an instrument, the Diabetes Self-Management and Technology Questionnaire (DSMT-Q), to assess self-management among people living with type 2 diabetes who use web-based and mHealth technologies.

METHODS

A total of 36 candidate questionnaire items, drafted previously, were refined using cognitive debriefing interviews (n=8), expert consultation, and public patient involvement feedback. Item reduction steps were performed on survey data (n=250), and tests of validity and reliability were subsequently performed.

RESULTS

Following amendments, patients and experts found 21 items relevant and acceptable for inclusion in the instrument. Survey participants included 104 (41.6%) women and 146 (58.4%) men. Two subscales with high construct validity, internal consistency, and test-retest reliability were identified: "Understanding individual health and making informed decisions" and "Confidence to reach and sustain goals."

CONCLUSIONS

Analyses confirmed good psychometric properties in the DSMT-Q scales. This tool will facilitate the measurement of self-management in people living with type 2 diabetes who use web-based or mHealth technologies.

Measuring the benefits of the integration of health and social care: qualitative interviews with professional stakeholders and patient representatives

BACKGROUND

Integrated care has the potential to ease the increasing pressures faced by health and social care systems, however, challenges around measuring the benefits for providers, patients, and service users remain. This paper explores stakeholders' views on the benefits of integrated care and approaches to measuring the integration of health and social care.

METHODS

Twenty-five semi-structured qualitative interviews were conducted with professional stakeholders (n = 19) and patient representatives (n = 6). Interviews focused on the benefits of integrated care and how it should be evaluated. Data was analysed using framework analysis.

RESULTS

Three overarching themes emerged from the data: (1) integrated care and its benefits, with stakeholders defining it primarily from the patient's perspective; (2) potential measures for assessing the benefits of integration in terms of system effects, patient experiences, and patient outcomes; and (3) broader considerations around the assessment of integrated care, including the use of qualitative methods.

CONCLUSIONS

There was consensus among stakeholders that patient experiences and outcomes are the best measures of integration, and that the main measures currently used to assess integration do not directly assess patient benefits. Validated health status measures are readily available, however, a substantial shift in practices is required before their use becomes commonplace.

Measures for the integration of health and social care services for long-term health conditions: a systematic review of reviews

Background

As people are living longer with higher incidences of long-term health conditions, there is a move towards greater integration of care, including integration of health and social care services. Integrated care needs to be comprehensively and systematically evaluated if it is to be implemented widely. We performed a systematic review of reviews to identify measures which have been used to assess integrated care across health and social care services for people living with long-term health conditions.

Methods

Four electronic databases (PUBMED; MEDLINE; EMBASE; Cochrane library of systematic reviews) were searched in August 2018 for relevant reviews evaluating the integration of health and social care between 1998 and 2018. Articles were assessed according to apriori eligibility criteria. A data extraction form was utilised to collate the identified measures into five categories.

Results

Of the 18 articles included, system outcomes and process measures were most frequently identified (15 articles each). Patient or carer reported outcomes were identified in 13 articles while health outcomes were reported in 12 articles. Structural measures were reported in nine articles. Challenges to measuring integration included the identification of a wide range of potential impacts of integration, difficulties in comparing findings due to differences in study design and heterogeneity of types of outcomes, and a need for appropriate, robust measurement tools.

Conclusions

Our review revealed no shortage of measures for assessing the structures, processes and outcomes of integrated care. The very large number of available measures and infrequent use of any common set make comparisons between schemes more difficult. The promotion of core measurement sets and stakeholder consultation would advance measurement in this area.

Risk of colorectal cancer associated with BRCA1 and/or BRCA2 mutation carriers: systematic review and meta-analysis

BACKGROUND

Carriers of the BRCA1 and/or BRCA2 mutation incur a lifetime risk of up to 85 per cent for breast cancer, and between 20 and 40 per cent for ovarian cancer. Efforts to estimate the lifetime risk of developing colorectal cancer for BRCA mutation carriers have produced conflicting results. Consequently, there are no formal guidelines regarding the need for bowel screening for individuals with BRCA1 and/or BRCA2 mutations. This systematic review and meta-analysis determined the risk of colorectal cancer associated with BRCA carrier mutations.

METHODS

The primary outcome was incidence of colorectal cancer in BRCA mutation carriers. Secondary outcomes were the incidence in BRCA1 and BRCA2 carriers, Ashkenazi Jews, and age- and sex-matched cohorts.

RESULTS

Eleven studies were included in the review, with an overall population of 14 252 and 4831 colorectal cancers identified. Nine studies were included in the meta-analysis. There was no increase in colorectal cancer among patients carrying a BRCA mutation (odds ratio 1·03, 95 per cent c.i. 0·80 to 1·32; P = 0·82). After adjustment for Ashkenazi heritage, and age and sex estimates, there was no increased odds of developing colorectal cancer (with no heterogeneity, I²  = 0 per cent).

CONCLUSION

BRCA1 and/or BRCA2 mutation carriers are not at a higher risk of colorectal cancer.

The Contraceptive Pill in Ireland c.1964-79: Activism, Women and Patient-Doctor Relationships

The twentieth-century history of men and women's attempts to gain access to reproductive health services in the Republic of Ireland has been significantly shaped by Ireland's social and religious context. Although contraception was illegal in Ireland from 1935 to 1979, declining family sizes in this period suggest that many Irish men and women were practising fertility control measures. From the mid-1960s, the contraceptive pill was marketed in Ireland as a 'cycle regulator'. In order to obtain a prescription for the pill, Irish women would therefore complain to their doctors that they had heavy periods or irregular cycles. However, doing so could mean going against one's faith, and also depended on finding a sympathetic doctor. The contraceptive pill was heavily prescribed in Ireland during the 1960s and 1970s as it was the only contraceptive available legally, albeit prescribed through 'coded language'. The pill was critiqued by men and women on both sides of the debate over the legalisation of contraception. Anti-contraception activists argued that the contraceptive pill was an abortifacient, while both anti-contraception activists and feminist campaigners alike drew attention to its perceived health risks. As well as outlining these discussions, the paper also illustrates the importance of medical authority in the era prior to legalisation, and the significance of doctors' voices in relation to debates around the contraceptive pill. However, in spite of medical authority, it is clear that Irish women exercised significant agency in gaining access to the pill.

Contraception and Catholicism in the Twentieth Century: Transnational Perspectives on Expert, Activist and Intimate Practices

This special issue uses Catholicism as a thread to bring together five contributions to the transnational history of contraception. The articles, which cover examples from Western and East-Central Europe, East Africa and Latin America, all explore the complex interplay between users and providers of birth control in contexts marked by prevalence of the Catholic religion and/or strong political position of the Catholic Church. In the countries examined here, Brazil, Belgium, Poland, Ireland and Rwanda, Catholicism was the majority religion during the different moments of the long twentieth century the authors of this special issue focus on. Using transnationalism as a perspective to examine the social history of the entanglements between Catholicism and contraception, this special issue seeks to underscore the ways in which individuals and organisations used, adapted and contested local and transnational ideas and debate around family planning. It also examines the role of experts and activist groups in the promotion of family planning, while paying attention to national nuances in Catholic understandings of birth control. The contributions shed light on the motivations behind involvement in birth control activism and expertise, its modus operandi, networking strategies and interactions with men and women demanding contraceptive information and technology. Moreover, through the use of oral history, as well as other print sources such as women's magazines, this collection of articles seeks to illustrate 'ordinary' men and women's practices in the realm of reproductive health.

Evaluation of the BAX® System for Detection of Salmonella in Selected Foods: Collaborative Study

A multilaboratory study was conducted to compare the automated BAX® System to the standard cultural methods for detection of Salmonella in selected foods. Five food types—frankfurters, raw ground beef, mozzarella cheese, raw frozen tilapia fish, and orange juice—at 3 inoculation levels, were analyzed by each method. A sixth food type, raw ground chicken, was tested using 3 naturally contaminated lots. A total of 16 laboratories representing government and industry participated. In this study, 1386 samples were analyzed, of which 1188 were paired samples and 198 were unpaired samples. Of the 1188 paired samples, 461 were positive by both methods and 404 were negative by both methods. Thirty-seven samples were positive by the BAX System but negative by the standard reference method, and 11 samples were positive by standard cultural method and negative by the BAX System. Of the 198 unpaired samples, 106 were positive by the BAX System and 60 were positive by the standard cultural method. A Chi square analysis of each of the 6 food types, at the 3 inoculation levels tested, was performed. For all foods, the BAX System demonstrated results comparable to those of the standard reference methods based on the Chi square results.

P5572Percutaneous edge-to-edge repair for the treatment of acute decompensated severe mitral regurgitation: a single-centre experience

Background

Patients with acute, decompensated severe mitral regurgitation (MR) are poorly served by surgical or medical treatments and is associated with high mortality. Percutaneous edge-to-edge mitral valve repair (PMVR) with the MitraClip system is potentially a less-invasive life-saving procedure. While PMVR has demonstrated efficacy in stable patients with severe MR, there is limited evidence for its use in patients suffering from prolonged cardiogenic shock, recurrent or persistent pulmonary oedema, and haemodynamic instability.

Purpose

The aim of this study was to evaluate the effectiveness of emergency PMVR in haemodynamically unstable patients with decompensated MR who were unsuitable for surgical intervention.

Methods

We performed a retrospective review of all patients who underwent emergency PMVR from January 2015 to January 2019 in a single centre. Inclusion criteria were patients with acute decompensated severe MR and shock (defined at the time of procedure as dependence on one or more of: intravenous (IV) inotropes; afterload reduction for persistent pulmonary oedema; mechanical circulatory support; and invasive respiratory support). Outcome measures were pre- and post-procedural MR severity grade, mortality at six months, and incidence of further mitral valve intervention.

Results

Of 183 consecutive patients undergoing PMVR, 14 (8%) patients fulfilled the inclusion criteria. Median age was 70 (range 55–88, IQR 23), and 8 were female. At the time of admission, 7 (50%) were in cardiogenic shock and 7 were in persistent pulmonary oedema. MR was functional in 7 (50%) patients and degenerative in 7, of which 4 were secondary to acute papillary muscle rupture. All patients had Grade 4 MR at presentation and were considered too high-risk for surgery by the Heart Team. Median Euroscore II was 14.4 (8.1–54.6, IQR 9.1). Post-procedure, 13 patients (93%) of patients had Grade 3 MR or less. Eleven (79%) patients were successfully weaned from mechanical support and intravenous drugs. The remaining three patients died of persistent arrhythmia, stroke or heart failure within 4 weeks. At six-months, 9 out of 12 patients (75%) were alive and 2 were lost to follow-up. No patients underwent further mitral valve intervention.

Conclusions

This small case-series suggests that PMVR may be a feasible and life-saving procedure in patients presenting with acute, decompensated severe MR who were unsuitable for surgery. It was associated with reversal of cardiogenic shock and good short-term survival in the majority of patients. These patients are typically considered critically unwell with very high mortality. These promising results may inform larger, prospective studies to manage this otherwise under-served patient cohort.

Strengthening child and youth programs: A look at inter-organizational mentoring strategies

Community-based non-profit organizations rarely have access to research or evaluation evidence to inform their programs and often lack the capacity to gather or use this information independently. In 2016, Wisdom2Action-a network of knowledge mobilization (KMb) experts, policy makers and service providers across Canada-launched an inter-organizational mentorship program to facilitate the implementation and sharing of best and promising practices within community-based programs for young people. This article outlines the findings from a developmental evaluation of eight mentoring relationships. Drawing on the Promoting Action on Research in Health Sciences (PARiHS) model of KMb, we look at mentoring as a type of facilitation that supports the increased use of evidence and evaluation information by non-profit organizations and identify key themes that support effective organizational mentorship in this sector. Findings reinforce the importance of establishing connected relationships and understanding context in mentoring relationships, creating adaptive and responsive work plans, ensuring consistent communication, and maintaining a focus on capacity-building if knowledge mobilization is to occur.

Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea

BACKGROUND

The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking.

AIM

To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards.

METHODS

A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively.

FINDINGS

Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset.

CONCLUSION

HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.

The Oxford Participation and Activities Questionnaire (Ox-PAQ): development of a short form and index measure

Background

The Oxford Participation and Activities Questionnaire (Ox-PAQ) is a 23-item patient-reported outcome measure (PROM) theoretically grounded in the World Health Organisation International Classification of Functioning, Disability and Health. Initial validation of the Ox-PAQ identified three domains; routine activities (14 items), emotional well-being (5 items) and social engagement (4 items). The purpose of the analyses reported here were to determine whether an overall index score can be calculated from the measure, and then to determine whether a shorter form measure can replicate results on the index score.

Methods

Two surveys of people with long term conditions were undertaken. In the first study, higher order factor analysis is used to determine that a single index score can be calculated for the Ox-PAQ. Regression analyses are used to determine a sub-set of items selected for the Short Form Ox-PAQ (SF-Ox-PAQ). In the second study, results on the Ox-PAQ Single Index and SF-Ox-PAQ Single Index are compared with results from another generic measure, the EuroQol EQ-5D-5l.

Results

Higher order factor analysis confirmed that a single index score can be created from the Ox-PAQ. Further, linear regression indicated 14 items could reliably and accurately produce this index. The two methods of creating the index were highly correlated (ICC =0.99). The two indices were found to provide almost identical levels of correlation with EQ-5D-5L scores.

Conclusion

Results indicate that the Ox-PAQ can be summed to provide an index score, and, furthermore, a sub set of fourteen items can very closely replicate the results gained from the original parent form.

Use of the Skin Cancer Quality of Life Impact Tool (SCQOLIT) - a feasibility study in non-melanoma skin cancer

BACKGROUND

Incidence of non-melanoma skin cancers (NMSCs) is increasing and can significantly impact on quality of life (QOL), yet there are few studies evaluating patient-reported outcome measures (PROMs) in NMSC populations. We undertook a prospective feasibility study to evaluate a skin cancer-specific PROM, the Skin Cancer Quality of Life Impact Tool (SCQOLIT), in patients with a new diagnosis of NMSC.

OBJECTIVES

(i) To establish acceptability of SCQOLIT in dermatology clinics, (ii) a descriptive analysis of SCQOLIT scores in NMSC.

METHODS

Patients with histologically confirmed NMSC completed SCQOLIT, EQ-5D and a transition item. Questionnaires were completed at baseline and 3 months for group 1 ('low-risk' NMSC) and group 2 ('high-risk' NMSC) with additional questionnaires at 6-9 months for group 2. Patients participated in structured interviews. Clinician experience was captured through staff evaluation forms and a focus group. Acceptability and psychometric properties of SCQOLIT were assessed.

RESULTS

Overall, 318 patients consented to participate. Mean SCQOLIT score at baseline was 5.33, with 2.6% of patients scoring ≥20. No ceiling effects were observed, whilst 13.9% scored 0. Validity was demonstrated against EQ-5D. Cronbach's alpha 0.84 demonstrated internal consistency. Thirteen patients were interviewed and thought SCQOLIT was comprehensive, captured impact on health-related QOL and helped express their needs to clinicians. Most clinicians found SCQOLIT 'very useful' or 'useful to some extent' in facilitating discussions.

CONCLUSIONS

This feasibility study demonstrates that SCQOLIT is acceptable to patients and staff in dermatology skin cancer clinics. The psychometric properties of SCQOLIT confirm its utility in NMSC populations.

A qualitative risk assessment of cleansing and disinfection requirements after an avian influenza outbreak in commercial poultry

1. During an avian influenza (AI) outbreak in the United Kingdom, the joint aim of the poultry industry and the Government is to eliminate and prevent the spread of infection, through control measures based on the current European Union (EU) Council Directive (2005/94/EC). An essential part of these measures is the cleansing and disinfection (C&D) of infected premises.2. This risk assessment assessed the differences in re-infection in a repopulated flock if the EU Directive is interpreted to permit secondary C&D to be undertaken either with or without dismantling complex equipment. The assessment estimated the probability of virus survival on different types of equipment in a depopulated contaminated poultry house before and after preliminary and secondary C&D procedures. A risk matrix spreadsheet tool was used to carry out the assessment and concluded that, provided secondary C&D is carried out with due diligence (i.e. carried out to a defined code of practice as agreed by both industry and policymakers), the risk of re-infection from equipment is negligible, both with and without dismantling complex equipment in all farm types considered.3. By considering the equipment types individually, the assessment identified those areas of the house which may still contain viable virus post-preliminary C&D and on which attention should be focussed during secondary C&D. The generic risk pathway and matrix spreadsheet tool have the potential to be used for other pathogens and species, given appropriate data.

Measuring improvement in health-status with the Oxford Participation and Activities Questionnaire (Ox-PAQ)

Background: The Oxford Participation and Activities Questionnaire (Ox-PAQ) is a recently validated 23-item generic patient reported outcome measure that is theoretically grounded in the World Health Organisation International Classification of Functioning, Disability and Health (ICF), as well as fully FDA compliant. The measure comprises three domains, Routine Activities (14 items), Emotional Well-Being (5 items) and Social Engagement (4 items), and has been shown to be both valid and reliable. The aim of this study was to make a preliminary assessment of the sensitivity to the change of the Ox-PAQ.

Methods: Three hundred and seventy three people with either chronic pulmonary obstructive disease, motor neurone disease, multiple sclerosis or Parkinson’s disease completed the Ox-PAQ electronically on two occasions, six months apart. Participants completed an additional four questions during the second administration of the Ox-PAQ in order to assess any relevant changes since baseline. For each of the three Ox-PAQ domains, the minimally important difference (MID) and effect size (ES) was calculated from those participants indicating small, but meaningful positive improvement.

Results: Two hundred and ninety respondents were entered into the final analysis, 77.74% of the original sample. For those indicating “slight improvement” in Routine Activities (n=19), an MID of 7.51 and an ES of 0.32 was calculated. For Emotional Well-Being (n=26), the MID was 10.77 and the ES 0.44. For Social Engagement (n=16), the MID was 5.47 and the ES 0.28.

Conclusion: Data presented provides MID improvement and effect sizes for Ox-PAQ domains that will act as preliminary guidance for those powering clinical trials assessing activity and participation. Future research with larger samples will provide further sensitivity to change data for the Ox-PAQ.

In utero Exposure to Anesthetics Alters Neuronal Migration Pattern in Developing Cerebral Cortex and Causes Postnatal Behavioral Deficits in Rats

During fetal development, cerebral cortical neurons are generated in the proliferative zone along the ventricles and then migrate to their final positions. To examine the impact of in utero exposure to anesthetics on neuronal migration, we injected pregnant rats with bromodeoxyuridine to label fetal neurons generated at embryonic Day (E) 17 and then randomized these rats to 9 different groups receiving 3 different means of anesthesia (oxygen/control, propofol, isoflurane) for 3 exposure durations (20, 50, 120 min). Histological analysis of brains from 54 pups revealed that significant number of neurons in anesthetized animals failed to acquire their correct cortical position and remained dispersed within inappropriate cortical layers and/or adjacent white matter. Behavioral testing of 86 littermates pointed to abnormalities that correspond to the aberrations in the brain areas that are specifically developing during the E17. In the second set of experiments, fetal brains exposed to isoflurane at E16 had diminished expression of the reelin and glutamic acid decarboxylase 67, proteins critical for neuronal migration. Together, these results call for cautious use of anesthetics during the neuronal migration period in pregnancy and more comprehensive investigation of neurodevelopmental consequences for the fetus and possible consequences later in life.