Translation, cultural adaptation and validation of the revised patients' attitudes towards deprescribing (rPATD) questionnaire in Romanian older adults

BACKGROUND

Deprescribing is part of ensuring appropriate medication use and may reduce medication-related harm. Capturing the beliefs and attitudes of patients towards deprescribing by using a validated tool may support optimizing medication use in practice.

OBJECTIVES

To translate, culturally adapt and validate the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire in Romanian and to investigate the attitudes and beliefs of older adults towards deprescribing.

METHODS

The rPATD questionnaire was translated using forward-backward translation into Romanian and culturally adapted. The psychometric properties were evaluated in older adults ≥65 years of age. Structural validity was assessed by item load on factors using an exploratory factor analysis (EFA) which was compared to the original English version and the internal consistency by Cronbach's alpha. Construct validity was evaluated by calculating the Spearman's rank correlation coefficients between the factor scores obtained using the revised version of the Romanian rPATD and scores on the Beliefs about Medicines Questionnaire (BMQ) Specific Concerns Romanian version. Floor and ceiling effect were also examined.

RESULTS

We translated the questionnaire and administered it to 224 participants (median age 72 years [interquartile range: 68.0; 77.0]). In the EFA individual items loaded onto 4 factors, grouped similarly to the English version (Involvement, Burden, Appropriateness, Concerns about Stopping factors). Two items from each of the Involvement and Appropriateness factors were removed to improve factor loading and avoid cross-loading. The Cronbach's alpha values for the 4 factors ranged between 0.522 and 0.773. The scores for Burden and Concerns about Stopping factors were found to be positively correlated with BMQ Specific Concerns score. We identified a ceiling effect for one of the four factors (Involvement) and no floor effects.

CONCLUSIONS

The Romanian rPATD was validated in 4 factor structure similar to the original English questionnaire. The Romanian version of the questionnaire may support the health care professionals in Romania to initiate and support patient-centered deprescribing.

The outcomes of open anterior component separation versus posterior component separation with transversus abdominis release for complex incisional hernias: a systematic review and meta-analysis

PURPOSE

The main objective was to assess the prevalence of hernia recurrence, wound complications (surgical site infections [SSI], seroma and hematoma) and mortality after anterior component separation (ACS) and posterior component separation via transversus abdominis muscle release (PCSTAR) in patients with complex incisional hernias. The so-called complex IH is a serious medical and societal challenge due to its direct and indirect costs; it is also hampered by the use of different surgical techniques, different type of meshes, and different results heterogeneously reported and interpreted. According to actual data, the best approach seems to be a mesh reinforcement component separation procedure augmented or not with an adjuvant technique (preoperative progressive pneumoperitoneum and/or Botulin toxin type A infiltration).

METHODS

A systematic search of four databases (MEDLINE, PubMed, Web of Science, and Google Scholars) was conducted to identify studies reporting on outcomes of component separation techniques and which were published before December 2021. A systematic review and a meta-analysis of postoperative outcomes were performed.

RESULTS

Nineteen studies including 3412 patients (1709 with ACS and 1703 with PCSTAR) were selected. Pooled hernia recurrence rate after a minimum 1-year follow-up was evaluated at 5.15% (odds ratio [OR] 0.68; 95% confidence interval [CI] 0.5-0.9; p = 0.0175). Pooled surgical site infection rate was 10.6% (OR 1.32; 95% CI 1.06-1.65; p = 0.0119). Seroma and hematoma were estimated at 9.75% (OR 1.93; 95% CI 1.52-2.44; p = 0.0001) and 3.83% (OR 1.81; 95% CI 1.26-2.61; p = 0.0012), respectively. ACS was associated with increased wound morbidity, seroma and hematoma. PCSTAR displayed higher recurrence rate (4.27% vs 6.11%).

CONCLUSIONS

PCSTAR was superior to ACS in terms of wound morbidity, surgical site infections, seroma and hematoma incidence. The procedure should be further evaluated in comparative head-to-head randomized controlled trials.

Integrated sensor-based monitoring system for pest and disease control in greenhouses

Diseases and pests are a problem even in greenhouse crops, problem which has to be solved without threatening the plant. Crop protection requires frequent updates in information and therefore sensor networks that are real time monitoring systems are the ones that can deliver such information. The purpose of this paper is to present a way of preventing the appearance of diseases and pests in a greenhouse by using a monitoring system composed of an integrated sensor network. Our sensor system is doing a real time monitoring of the following parameters in the greenhouse: light intensity, soil moisture and temperature, air temperature and humidity and air temperature at canopy level; all of the data being stored using a software made by "Tedelco". A real time monitoring camera is also used for pest and disease detection. A pot experiment, using beans, was established inside the greenhouse to test the applicability of the system. In order to assure the optimal conditions for the inhibition of pests, the greenhouse is also equipped with an artificial lighting system specially designed for greenhouses, an irrigation system and an artificial fog system. Sensor systems are the ideal support for preventive monitoring and at the same time it offers all the support data necessary for decision making regarding crops development.

Hippocampal dependent learning ability correlates with N-methyl-D-aspartate (NMDA) receptor levels in CA3 neurons of young and aged rats

Hippocampal N-methyl-D-Aspartate (NMDA) receptors mediate mechanisms of cellular plasticity critical for spatial learning in rats. The present study examined the relationship between spatial learning and NMDA receptor expression in discrete neuronal populations, as well as the degree to which putative age-related changes in NMDA receptors are coupled to the effects of normal aging on spatial learning. Young and aged Long-Evans rats were tested in a Morris water maze task that depends on the integrity of the hippocampus. Levels of NR1, the obligatory subunit for a functional NMDA receptor, were subsequently quantified both biochemically by Western blot in whole homogenized hippocampus, and immunocytochemically by using a high-resolution confocal laser scanning microscopy method. The latter approach allowed comprehensive, regional analysis of discrete elements of excitatory hippocampal circuitry. Neither method revealed global changes, nor were there region-specific differences in hippocampal NR1 levels between young and aged animals. However, across all subjects, individual differences in spatial learning ability correlated with NR1 immunofluorescence levels selectively in CA3 neurons of the hippocampus. Parallel confocal microscopic analysis of the GluR2 subunit of the alpha-amino-3-hydroxy-5-methyl-4-isoxazole proprionic acid (AMPA) receptor failed to reveal reliable differences as a function of age or spatial learning ability. This analysis linking age, performance, and NR1 levels demonstrates that although dendritic NR1 is generally preserved in the aged rat hippocampus, levels of this receptor subunit in selective elements of hippocampal circuitry are linked to spatial learning. These findings suggest that NMDA receptor abundance in CA3 bears a critical relationship to learning mediated by the hippocampus throughout the life span.

[The newborn infant of a diabetic mother]

The authors present a case of a newborn of a diabetic mother with fatal outcome in the 6th day postnatally. The principal troubles in newborn were: fetal macrosomy, hypoglycemia and a lot of congenital malformations. They discuss the relationship between the maternal alteration of hydrocarbonate metabolism and the troubles in fetus and newborn.

[A case of acute hyaline membrane pneumopathy in a 3-month-old infant]

The authors discuss the anatomoclinical case of an infant 3 months and 2 weeks old, presenting a clinical picture of interstitial pneumonia, in shock. Microscopic histologic examination of the lung revealed a lung disease with hyaline membranes, an unusual entity after the neonatal period. The authors assume the formation of hyaline membranes to be due to prolonged shock and the inadequate alveolar surfactant.

Multilobated B-cell lymphoma. Report of a case with immunocytologic diagnosis in pleural fluid

The cytologic, histologic and immunocytochemical findings in an aggressive case of multilobated lymphoma in an 89-year-old man are described. This unusual variant of non-Hodgkin's lymphoma is morphologically distinct but may be of either T-cell or B-cell origin. A battery of immunocytologic stains on pleural fluid specimens allowed determination of a B-cell (follicular center cell) origin to be made. Previous literature on this neoplasm is briefly reviewed, and the unreliability of morphologic findings in predicting a T-cell or B-cell origin is discussed.