Understanding the needs and preferences for cancer care among First Nations people: An integrative review

AIM

This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people.

DESIGN

Integrative review.

DATA SOURCES

An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted.

RESULTS

Forty-two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person-centred cancer care services that address practical needs.

CONCLUSION

Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs.

PATIENT OR PUBLIC CONTRIBUTION

Our team includes both First Nations people, non-First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work.

IMPLICATIONS FOR NURSING PRACTICE

Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up-to-date cultural safety training and stand together with Indigenous and non-Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP.

De novo FRMD5 Missense Variants in Patients with Childhood-Onset Ataxia, Prominent Nystagmus, and Seizures

BACKGROUND

FRMD5 variants were recently identified in patients with developmental delay, ataxia, and eye movement abnormalities.

OBJECTIVES

We describe 2 patients presenting with childhood-onset ataxia, nystagmus, and seizures carrying pathogenic de novo FRMD5 variants. Weighted gene co-expression network analysis (WGCNA) was performed to gain insights into the function of FRMD5 in the brain.

METHODS

Trio-based whole-exome sequencing was performed in both patients, and CoExp web tool was used to conduct WGCNA.

RESULTS

Both patients presented with developmental delay, childhood-onset ataxia, nystagmus, and seizures. Previously unreported findings were diffuse choreoathetosis and dystonia of the hands (patient 1) and areas of abnormal magnetic resonance imaging signal in the white matter (patient 2). WGCNA showed that FRMD5 belongs to gene networks involved in neurodevelopment and oligodendrocyte function.

CONCLUSIONS

We expanded the phenotype of FRMD5-related disease and shed light on its role in brain function and development. We recommend including FRMD5 in the genetic workup of childhood-onset ataxia and nystagmus. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

[Use of antimicrobials in a mother-child university hospital center in Canada: An observational study]

INTRODUCTION

The proper use of antimicrobials is a challenge in healthcare establishments.

OBJECTIVES

Describe the detailed antimicrobial consumption profile in 2021-2022. Describe the annual evolutionary profile of the use of antimicrobials in days of therapy/1000 patient days, antibiotic spectrum index/1000 patients days and according to the proportion of days of therapy administered by parenteral route from 2005-2006 to 2021-2022.

METHOD

Descriptive and retrospective study. All patients admitted to our mother-child hospital center between April 1, 2005 and March 31, 2022 were included. The study covers the consumption of all antimicrobials through the AWare classification of the World Health Organization and antibiotic spectrum index.

RESULTS

A total of 673.9 days of therapy/1000 patients days was calculated in 2021-2022, i.e. 550.8 for antibiotics, 46.5 for antivirals, 67.9 for antifungals and 8.7 for others. A total of 2436 ASI/1000 patient days was calculated in 2021-2021. According to the AWaRe classification, in 2021-2022, 52.1% (287/551) of days of therapy/1000 patients days referred to the "Access" group, 47.8% (263/551) to the "Watch" group and 0.2% (1/551) to the "Reserve" group.

CONCLUSION

This study aims to explore the use of antimicrobials in a mother-child hospital center. It puts into perspective a stable or even slightly decreasing use of a selection of antimicrobials and compares favorably with published data. Antibiotic governance is based in particular on the periodic evaluation of consumption. Our study illustrates different approaches to quantify and describe this use.

Exploring the Impact of Bereavement During the COVID-19 Pandemic on Children and Young People: A Scoping Review

Experiencing bereavement as a child or young person (CYP) can have long-lasting effects. The societal and environmental burdens of the SARS-CoV-2 pandemic exacerbated the experience of loss and grief for many CYP, who were unable to access their usual the support networks. However, it is still unclear what is currently known and not known about the experiences of CYP bereaved during the SARS-CoV-2 pandemic. This review used the framework of Arksey and O'Malley and included five stages: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results. The methodological quality of the included studies was also assessed using the Critical Appraisal Skills Programme tool. The PRISMA framework was used for reporting the results. The electronic databases Medline, PsychINFO, CINAHL, and PubMed were searched for relevant articles. A total of three papers meeting the inclusion criteria were included in this review and two main themes identified: (1) support (which included sub-themes; social isolation and the impact on support; support from family and friends; wider support networks); (2) Emotional impact of bereavement during a pandemic. Access to support networks is crucial for CYP to understand and process their emotions relating to their bereavement experience. The pandemic meant that many usual support networks such as family and friends were inaccessible to CYP, who struggled to deal with their experience of grief during this time. Schools are a valuable support mechanism and can help CYP understand their emotions through open discussions about their bereavement. The limited empirical evidence currently available in this area of research demonstrates an important need to further understanding of the long-term impacts of dealing with pandemic-related loss in childhood.

Preventing and recognising skin tears using a standardised approach

Skin tears, defined as traumatic wounds caused by mechanical forces, can be debilitating for individuals, causing pain and reduced mobility. Although skin tears can develop throughout the lifespan, older age can make the skin increasingly susceptible to this type of injury. Studies have found wide variation in the incidence and prevalence of skin tears, in part because of suboptimal recognition and reporting practices among healthcare professionals. Effective prevention of skin tears requires a standardised approach to risk assessment, prevention, recognition and classification, such as that offered by the International Skin Tear Advisory Panel (ISTAP) best practice recommendations. This article examines the literature on the incidence, prevalence, prevention and recognition of skin tears, and outlines some of the ISTAP best practice recommendations on risk assessment, prevention and recognition. The authors also consider the need for patient and healthcare professional education to optimise the prevention of skin tears.

The comfort and functional performance of personal protective equipment for police officers: a systematic scoping review

This scoping review aimed to identify and summarise evidence on the comfort and functional performance of police officer personal protective equipment (PPE). The Arksey and O'Malley (2005) five-stage framework for scoping reviews was followed. PubMed, CINAHL, Scopus, and Web of Science were searched, and 35 articles were included in the review. The findings show that increased police PPE mass increases heart rate, metabolic energy expenditure, and perceived exertion in response to exercise. Unisex armour designs cause increased discomfort for females with larger bra sizes. PPE reduces joint-specific range of motion, with the design and location impairing movement more than mass. Jumping and sprinting performance is decreased with heavy PPE but unaffected by lighter protection, while agility is compromised with most forms of protection. Future research is needed on the fit and function of PPE for specialist police units, such as mounted police, along with further investigations on how fit can affect functional performance.

A survey in the West Midlands of the United Kingdom of current practice in managing hypotension in lower segment caesarean section under spinal anaesthesia

BACKGROUND

Spinal anaesthesia, the most common form of anaesthesia for caesarean section, leads to sympathetic blockade and profound maternal hypotension resulting in adverse maternal and neonatal outcomes. Hypotension, nausea and vomiting remain common but until the publication of the National Institute of Health and Care Excellence (NICE) 2021 guidance, no national guideline existed on how best to manage maternal hypotension following spinal anaesthesia for caesarean section. A 2017 international consensus statement recommended prophylactic vasopressor administration to maintain a systolic blood pressure of >90% of an accurate pre-spinal value, and to avoid a drop to <80% of this value. This survey aimed to assess regional adherence to these recommendations, the presence of local guidelines for management of hypotension during caesarean section under spinal anaesthesia, and the individual clinician's treatment thresholds for maternal hypotension and tachycardia.

METHODS

The West Midlands Trainee-led Research in Anaesthesia and Intensive Care Network co-ordinated surveys of obstetric anaesthetic departments and consultant obstetric anaesthetists across 11 National Health Service Trusts in the Midlands, England.

RESULTS

One-hundred-and-two consultant obstetric anaesthetists returned the survey and 73% of sites had a policy for vasopressor use; 91% used phenylephrine as the first-line drug but a wide range of recommended delivery methods was noted and target blood pressure was only listed in 50% of policies. Significant variation existed in both vasopressor delivery methods and target blood pressures.

CONCLUSIONS

Although NICE has since recommended prophylactic phenylephrine infusion and a target blood pressure, the previous international consensus statement was not adhered to routinely.

Chronic striatal cholinergic interneuron excitation induces clinically-relevant dystonic behavior in mice

Dystonia is common, debilitating, often medically refractory, and difficult to diagnose. The gold standard for both clinical and mouse model dystonia evaluation is subjective assessment, ideally by expert consensus. However, this subjectivity makes translational quantification of clinically-relevant dystonia metrics across species nearly impossible. Many mouse models of genetic dystonias display abnormal striatal cholinergic interneuron excitation, but few display subjectively dystonic features. Therefore, whether striatal cholinergic interneuron pathology causes dystonia remains unknown. To address these critical limitations, we first demonstrate that objectively quantifiable leg adduction variability correlates with leg dystonia severity in people. We then show that chemogenetic excitation of striatal cholinergic interneurons in mice causes comparable leg adduction variability in mice. This clinically-relevant dystonic behavior in mice does not occur with acute excitation, but rather develops after 14 days of ongoing striatal cholinergic interneuron excitation. This requirement for prolonged excitation recapitulates the clinically observed phenomena of a delay between an inciting brain injury and subsequent dystonia manifestation and demonstrates a causative link between chronic striatal cholinergic interneuron excitation and clinically-relevant dystonic behavior in mice. Therefore, these results support targeting striatal ChIs for dystonia drug development and suggests early treatment in the window following injury but prior to dystonia onset.

One Sentence Summary

Chronic excitation of dorsal striatal cholinergic interneuron causes clinically-relevant dystonic phenotypes in mice.

The Impact of Care Bundles on the Incidence of Surgical Site Infections: A Systematic Review

OBJECTIVE

This systematic review assesses the effects of care bundles on the incidence of surgical site infections (SSIs).

DATA SOURCES

The search was conducted between February and May 2021, using PubMed, CINAHL, SCOPUS, Cochrane, and EMBASE databases.

STUDY SELECTION

Studies were included if they used systematic review methodology, were in English, used a quantitative design, and explored the use of care bundles for SSI prevention. A total of 35 studies met the inclusion criteria, and 26 provided data conducive to meta-analysis.

DATA EXTRACTION

Data were extracted using a predesigned extraction tool, and analysis was undertaken using RevMan (Cochrane, London, UK). Quality appraisal was undertaken using evidence-based librarianship.

DATA SYNTHESIS

The mean sample size was 7,982 (median, 840) participants. There was a statistically significant difference in SSI incidence in favor of using a care bundle (SSI incidence 4%, 703/17,549 in the care bundle group vs 7%, 1,157/17,162 in the usual care group). The odds ratio was 0.55 (95% confidence interval, 0.41-0.73; P < .00001), suggesting that there is a 45% reduction in the odds of SSI development for the care bundle group. The mean validity score for all studies was 84% (SD, 0.04%).

CONCLUSIONS

The results indicate that implementing care bundles reduced SSI incidence. However, because there was clinically important variation in the composition of and compliance with care bundles, additional research with standardized care bundles is needed to confirm this finding.

Sub-epidermal moisture assessment as a prompt for clinical action in treatment of pressure ulcers in at-risk hospital patients

Objective:

This study assesses anonymous patient-level data on the use of sub-epidermal moisture (SEM) assessment technology as a tool in the prevention of pressure ulceration in at-risk hospital patients.

Method:

The relationship between technology-generated prompts for clinical action (patient turning, application of pressure redistributing equipment, heel protection or cream) and consequent clinical action was evaluated using data cross-tabulations (using data aggregated over multiple anatomical sites); in a multilevel model with patients clustered within wards, clustered in turn within hospitals, and controlling for additional patient- and institution-level factors; and using receiver operating characteristic (ROC) analyses of anatomy-specific data. The ability of the SEM assessment technology to detect deep and early-stage pressure ulcers/injuries on specific anatomical areas of a patient's body on admission, earlier than visual and tactile skin tissue assessments (STA), was assessed.

Results:

A total of 15,574 patient assessments (‘cases’) were reported on 1995 patients. Most incidences of nurse action were in response to a prompt from SEM assessments (4944/5494; 90.0%). An SEM delta (Δ)≥0.6 resulted in nurse action in 4944/13,071 cases (37.8%). The multilevel model revealed strong evidence that SEM Δ prompts were significantly associated with nurse action (p<0.001; adjusted odds ratio: 1.99).

Conclusion:

In this study, SEM assessment technology effectively prompted nurse action moreso than skin reddening diagnosed via trained clinician judgement and STAs. While baseline responses of nurses' actions remained low, with or without SEM Δ prompts, findings verified the ‘clinical utility’ of SEM assessment technology as an objective prompt for early clinical action over and above existing mechanisms.

Sub-epidermal moisture assessment as an adjunct to visual assessment in the reduction of pressure ulcer incidence

OBJECTIVE

To assess the effectiveness of sub-epidermal moisture (SEM) assessment technology as an adjunct to visual assessment to reduce pressure ulcer (PU) incidence alongside standard PU care pathways.

METHOD

Data were obtained from wards located within 28 institutions in the UK, Canada, Belgium, Spain and Ireland. At each ward, the proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a pre-Pressure Ulcer Reduction Programme (PURP) implementation period starting between November 2017 and July 2018 was recorded. The proportion of patients scanned who were observed to have one or more PUs of Category 2 or above during a post-PURP implementation period starting between November 2018 and July 2019 was also recorded. A meta-analysis was conducted on the data using wards as the unit of analysis, to facilitate overall estimate of the PURP. A sensitivity study was also conducted to assess the sensitivity of results to data from specific institutions.

RESULTS

A synthesised estimate of the overall relative risk (RR) was calculated to be 0.38 (95% confidence interval 0.26 to 0.56). Hence the risk of PU in the post-PURP cohort was about one-third that of the corresponding risk in the pre-PURP cohort. The sensitivity analysis revealed no evidence that any individual ward exerted excessive influence on the findings.

CONCLUSION

The analysis has revealed strong evidence that implementation of the PURP was associated with reduction in incidence of Category 2 or above PUs across a wide range of clinical settings.

Exploring the impact of experiencing a long lie fall on physical and clinical outcomes in older people requiring an ambulance: A systematic review

BACKGROUND

The long term impacts of experiencing a 'long lie' following a fall in the older person are poorly understood. This systematic review explored the impact of a long lie fall on physical and clinical outcomes in older people requiring an ambulance.

METHODS

PRISMA guidelines were followed.

RESULTS

70 studies were identified. Nine studies were suitable for full review. Four studies meeting the inclusion criteria were included. The Critical Appraisal Skill Programme (CASP) assessed the quality of all included studies. Three studies reported on people aged 65 years and older. One study reported on people aged over 90 years. Personal alarm use was examined in two studies. One study explored patient characteristics of people confirmed to have fallen by paramedics at the scene. One study examined re-contact and characteristics of fallers referred to a falls prevention service.

DISCUSSION

Cognitive impairment and long lie were a caveat for falls and repeated falls. Personal alarm use was infrequent, suggesting a need for supporting the older patient in appropriate alarm use and exploration of newer technologies to alleviate their need. Future research should focus on interventions for wearable, smart and e-technology for automatic fall detection and qualitative exploration of the lived experience.

[Exploration of the evolution of antibiotic consumption according to the WHO AWaRe classification, in a mother-child university hospital]

BACKGROUND

Different measures of antimicrobial are used to ensure proper usage, as part of structured antimicrobial stewardship programs.

OBJECTIVE

The main objective of this study is to describe the consumption of antibiotics in a mother-child teaching hospital using the AWaRe classification over a period of 15 years.

METHODS

This descriptive and retrospective study included all the data on antibiotic consumption of patients admitted to mother-child University Hospital from April 1st 2005 to March 31st, 2021. Of the 180 international non-proprietary names of antibiotics proposed by the World Health Organization (WHO), 54 were used. The number of days of treatment (DOT) per 1000 patient-days (PD) was calculated per year, per patientele (e.g. surgery, pediatrics, oncology, intensive care, neonatal intensive care, nursery, psychiatry, rehabilitation and obstetrics and gynecology) and globally. The data was classified per the WHO AWaRe classification.

RESULTS

A total of 10,489 DOT/1000PD were used globally in 15 years, corresponding to 53.9% of the "Access" group, 45.2% of the "Watch" group and 0.9% of the "Reserve" group. A reduction in the use of antibiotics was noted. The ratios of antibiotic consumptions in DOT/1000PD of 2020-2021 to 2005-2006 were 0.84 globally (1713/5653), 0.79 for the "Access" group (286/361), 0.89 for the "Watch" group (270/302) and 0.88 for the "Reserve" group (2.1/2.4).

CONCLUSION

The AWaRe classification was used to describe the consumption of antibiotics in a mother-child center. Our consumption compared favorably with international data and is in line with the WHO targets. This position may be linked to the presence of a structured anti-biogovernance program that has been in place for several years within our hospital. More work is needed to more precisely identify the antibiotics that should benefit from better supervision.

Incidence and Risk Factors for Surgical Site Infection following Emergency Cesarean Section: A Retrospective Case-Control Study

OBJECTIVE

To assess the incidence, risk, and associated factors that contribute to an acquired surgical site infection (SSI) after emergency cesarean section (CS).

METHODS

This retrospective case-control study was conducted in an acute district general hospital in England with 206 patients (101 SSI patients and 105 non-SSI patients) who had an emergency CS in 2017. Grade of surgeon, smoking status, preoperative vaginal swab status (positive or negative), diabetes status, age, body mass index, membrane rupture to delivery interval, and length of surgery were recorded. Risk factors were identified using simple and multiple logistic regression.

RESULTS

Body mass index was significantly associated with SSI (odds ratio, 1.17; 95% confidence interval, 1.11 to 1.24; P < .001). Further, substantive nonsignificant associations were recorded between SSI and patient age and vaginal swab status.

CONCLUSIONS

Body mass index was the only significant risk factor for the development of an SSI after emergency CS, possibly because of the impact of excessive adipose tissue on the immune system and reduced effectiveness of antibiotics. Diabetes status, patient age, and preoperative vaginal swab status were not significantly associated with SSI. Improved guidelines and strategies for managing at-risk patients would enable clinicians to reduce the risk of SSI development. The importance of wound management including frequent wound cleaning, appropriate dressings, dressing changes, and education is highlighted. Future research on larger samples should be conducted to validate these findings.

Using past performance to improve future clinical outcomes in pressure ulcer prevention

OBJECTIVE

Episodes of inpatient care-related pressure ulcers (PU) lead to deleterious effects on patient quality of life, and additional costs associated with wound dressings, staff visits and hospitalisation. Accurate prediction of future incidence may be helpful in defining strategies for benchmarking and resource management. Observations of category 2 or above PUs during episodes of care at an NHS Foundation Trust were recorded monthly from 2010 to 2020. Trust-specific interventions designed to reduce PU incidence, such as procurement of specialised staff and equipment, were also recorded. This study aimed to investigate the historical pattern of PU incidence in the Trust to assess intervention effectiveness in reducing PU incidence, and to use historical data to derive estimates of future incidence.

METHOD

Time-series analysis was conducted on monthly PU incidence data to quantify underlying trends, seasonality and effect of interventions, and to derive a suitable model to predict future incidence levels.

RESULTS

Mean monthly PU incidence gradually reduced from 20.3 during 2012 to 5.08 during 2019; with a negative linear trend in the presence of concurrent seasonal effects. There was limited evidence that implementation of specific interventions was associated with raised rates of reduction; however, incidence reductions during intervention periods continued from lower baselines. Best estimate predictions revealed that incidence is likely to stay at current levels or below for the foreseeable future.

CONCLUSION

Past data can be used to model future episodes of inpatient care PU occurrence. Interventions may be effective in reducing PU incidence rates.

The Impact of Surgical Site Infection on Health-related Quality of Life: A Systematic Review

BACKGROUND: Surgical site infection (SSI) is a common postoperative concern. PURPOSE: To provide an in-depth understanding of the lived experience and quality of life (QoL) of individuals with SSI. METHODS: A systematic search for published studies that explored the impact of SSI on QoL among adult patients (older than 18 years) who had undergone any type of surgery was performed in June 2020. The search included but was not limited to MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane databases using the terms “surgical site infection” OR “hospital-acquired infection” OR “nosocomial infection” OR “wound site infection” OR “surgical wound site infection” AND “Quality of Life” OR “Life quality” OR “Health-Related Quality of Life” OR “Life Style” OR “QOL” OR “HRQoL” OR “Short-form questionnaire 36” OR “Questionnaire SF-36” OR “SF-36.” All quantitative and qualitative study designs were included; no language or date of publication restrictions were imposed. The Critical Appraisal Skills Program Qualitative Checklist was used to assess the methodological quality of the included studies. Study author, date, setting, sample size, population, and design and type of surgery as well as QoL instrument scores were extracted. A narrative thematic synthesis, which comprised the physical, psychological, social, economic, and spiritual effects as well as the health care worker–patient relationship, was undertaken for qualitative studies. Outcome measures were collected and assessed using a range of established health QoL instruments and reported in terms of QoL for quantitative studies. In addition, the type of QoL instrument employed within the studies was elucidated for comparing the scores of the instruments. RESULTS: A total of 696 publications were found; 690 were eliminated, leaving 4 quantitative and 2 qualitative studies conducted between 2002 and 2018 that met the inclusion criteria. The total number of participants in the assessed studies was 785. The mean sample size for the included studies was 131 participants (SD = 192.5; median, 95). Thematic synthesis showed 6 overarching themes: physical, psychological, social, spiritual, and economic effects of SSI as well as the health care worker–patient relationship. Short Form-36 was used to assess QoL in 3 of the 4 quantitative studies; these studies showed that there were decrements in scores of Short Form-36. CONCLUSION: Although this systematic review included heterogeneous groups of patients who underwent different surgical procedures and completed different QoL assessment tools, patients with SSI experienced low QoL, with limitations in physical, social, and psychological functioning. The health care worker–patient relationship was predominantly perceived negatively. Further prospective research is warranted.

The Impact of Surgical Site Infection on Health-related Quality of Life: A Systematic Review

BACKGROUND

Surgical site infection (SSI) is a common postoperative concern.

PURPOSE

To provide an in-depth understanding of the lived experience and quality of life (QoL) of individuals with SSI.

METHODS

A systematic search for published studies that explored the impact of SSI on QoL among adult patients (older than 18 years) who had undergone any type of surgery was performed in June 2020. The search included but was not limited to MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane databases using the terms "surgical site infection" OR "hospital-acquired infection" OR "nosocomial infection" OR "wound site infection" OR "surgical wound site infection" AND "Quality of Life" OR "Life quality" OR "Health-Related Quality of Life" OR "Life Style" OR "QOL" OR "HRQoL" OR "Short-form questionnaire 36" OR "Questionnaire SF-36" OR "SF-36." All quantitative and qualitative study designs were included; no language or date of publication restrictions were imposed. The Critical Appraisal Skills Program Qualitative Checklist was used to assess the methodological quality of the included studies. Study author, date, setting, sample size, population, and design and type of surgery as well as QoL instrument scores were extracted. A narrative thematic synthesis, which comprised the physical, psychological, social, economic, and spiritual effects as well as the health care worker-patient relationship, was undertaken for qualitative studies. Outcome measures were collected and assessed using a range of established health QoL instruments and reported in terms of QoL for quantitative studies. In addition, the type of QoL instrument employed within the studies was elucidated for comparing the scores of the instruments.

RESULTS

A total of 696 publications were found; 690 were eliminated, leaving 4 quantitative and 2 qualitative studies conducted between 2002 and 2018 that met the inclusion criteria. The total number of participants in the assessed studies was 785. The mean sample size for the included studies was 131 participants (SD = 192.5; median, 95). Thematic synthesis showed 6 overarching themes: physical, psychological, social, spiritual, and economic effects of SSI as well as the health care worker-patient relationship. Short Form-36 was used to assess QoL in 3 of the 4 quantitative studies; these studies showed that there were decrements in scores of Short Form-36.

CONCLUSION

Although this systematic review included heterogeneous groups of patients who underwent different surgical procedures and completed different QoL assessment tools, patients with SSI experienced low QoL, with limitations in physical, social, and psychological functioning. The health care worker-patient relationship was predominantly perceived negatively. Further prospective research is warranted.

Tics, tremors and other movement disorders in childhood

Movement disorders presenting in childhood include tics, dystonia, chorea, tremor, stereotypy, myoclonus, and parkinsonism, each of which can be part of various clinical syndromes with distinct etiologies.  Some of these conditions are benign and require only reassurance; others are bothersome and require treatment, or may be clues that herald underlying pathology.  Answers lie in the inherent characteristics of the movements themselves, together with the clinical context provided in the history obtained by the examiner.  The aim of this review is to present an overview of the categories of involuntary movements, along with examples of common acquired and genetic causes, and an approach to history-taking, examination, and treatment.

The relationship between common risk factors and the pathology of pressure ulcer development: a systematic review

OBJECTIVE

The aim of this systematic review was to examine the associations and relationship between commonly cited risk factors and the pathology of pressure ulcer (PU) development.

METHOD

Using systematic review methodology, original research studies, prospective design and human studies written in English were included. The search was conducted in March 2018, using Ovid, Ovid EMBASE and CINAHL databases. Data were extracted using a pre-designed extraction tool and all included studies were quality appraised using the evidence-based librarianship critical appraisal.

RESULTS

A total of 382 records were identified, of which five met the inclusion criteria. The studies were conducted between 1994 and 2017. Most studies were conducted in hospital and geriatric wards. The mean sample size was 96±145.7 participants. Ischaemia, recovery of blood flow and pathological impact of pressure and shear was mainly found as the cited risk factor and PU aetiology.

CONCLUSION

This review systematically analysed five papers exploring the relationship between risk factors for PU development and aetiology. It identified many risk factors and underlying pathological mechanisms that interact in the development of PU including ischaemia, stress, recovery of blood flow, tissue hypoxia and the pathological impact of pressure and shear. There are several pathways in which these pathological mechanisms contribute to PU development and identifying these could establish potential ways of preventing or treating the development of PU for patients.

SAT0012 ANTIBODY REACTIVITY AGAINST NATIVE PROTEINS IN RHEUMATOID ARTHRITIS

Background:

The majority of patients with rheumatoid arthritis (RA) produce autoantibodies against proteins that have undergone post-translational modfication, e.g. citrullination or carbamylation. There is growing evidence of their relevance and their potential utility to improve diagnosis, patient stratification, and prognosis for precision medicine. Investigating new autoantibody patterns may allow further stratification of patients and identifying subsets of patients that benefit from different treatment modalities. Following the discovery of high autoantibody reactivity against multiple modified proteins the interest in native targets decreased. Even though antibodies reacting with native proteins may also have a role in RA pathogenesis, their reactivity patterns are much less studied.

Objectives:

To identify novel native autoantigens in RA patients and elucidate patterns within autoantibody reactivity against native autoantigens.

Methods:

We investigated the reactivity of autoantibodies in plasma pools from 15 anti-CCP positive and 10 anti-CCP negative RA patients and 10 healthy donors against more than 1600 human proteins in native configuration using the Immunome high-density protein microarray.

Results:

We identified 86 native proteins that were recognized by IgG antibodies from anti-CCP positive RA patients and 76 native proteins recognized by IgG antibodies from anti-CCP negative RA patients, but not by antibodies from healthy donors. Examples of proteins recognized by both patient subgroups are calcium/calmodulin-dependent protein kinase type II subunits, histone deacetylases, keratin, and vimentin. Reactivity against the ribonucleic protein SSB was observed in anti-CCP negative RA patients only.

Conclusion:

Several human proteins in their native conformation are recognized by autoantibodies from anti-CCP positive as well as anti-CCP negative RA patients. In general, anti-CCP positive patients had higher autoantibody activity than anti-CCP negative patients and healthy donors.

References:

[1] Konig, M.F., Giles, J.T., Nigrovic, P.A., Andrade, F., 2016. Antibodies to native and citrullinated RA33 (hnRNP A2/B1) challenge citrullination as the inciting principle underlying loss of tolerance in rheumatoid arthritis. Ann. Rheum. Dis. 75, 2022–2028.

[2] Zheng, Z., Mergaert, A.M., Fahmy, L.M., Bawadekar, M., Holmes, C.L., Ong, I.M., Bridges, A.J., Newton, M.A., Shelef, M.A., 2019. Disordered Antigens and Epitope Overlap Between Anti-Citrullinated Protein Antibodies and Rheumatoid Factor in Rheumatoid Arthritis. Arthritis Rheumatol. art.41074.

[3] Sirotti, S., Generali, E., Ceribelli, A., Isailovic, N., De Santis, M., Selmi, C., 2017. Personalized medicine in rheumatology: the paradigm of serum autoantibodies. Autoimmun. Highlights 8.

Acknowledgments :

The Department of Clinical Immunology at Rigshospitalet Copenhagen is acknowledged for providing the healthy donor blood. The study is part of the PROCIT study financed by the Danish Council for Independent Research (grant no. DFF - 7016-00233). Moreover, the Obelske Family Foundation, the Svend Andersen Foundation, the Spar Nord Foundation and the Danish National Mass Spectrometry Platform for Functional Proteomics (PRO-MS; grant no. 5072-00007B) are acknowledged for grants to the analytical platform are acknowledged for the funding to enabling parts of this study.

Disclosure of Interests:

Thomas B.G. Poulsen: None declared, Dres Damgaard: None declared, Malene Møller Jørgensen: None declared, Ladislav Senolt: None declared, Jonathan Blackburn Shareholder of: Sengenics Corporation, Consultant of: Director of Sengenics Corporation, Employee of: Director of Sengenics Corporation, Claus Henrik Nielsen: None declared, Allan Stensballe: None declared

Emergency department nurse's attitudes towards patients who self-harm: A meta-analysis

Self-harm is a major challenge to public health. Emergency department (ED) nurses treat significant proportions of patients with self-harm injuries, and positive therapeutic patient-nurse interactions are imperative to the physical and psychological outcome of this vulnerable patient group. Research, both nationally and internationally, suggests that treating those with self-harm injuries is emotionally challenging, and ambivalence, powerlessness, and ineffectiveness are commonly manifested in negative attitudes towards these patients. Following the PRISMA guidelines, this systematic review with meta-analyses examined the attitudes of ED nurses towards patients who self-harm, based on currently available evidence. The following databases were searched: CINAHL complete; Medline complete; PsycARTICLES; PsycINFO; The Allied and Complementary Medicine Database; Health Source: Nursing/Academic Edition; PsycEXTRA; and Psychology and Behavioural Sciences Collection. Clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant reports to identify additional studies, were also searched. Five studies were included in the meta-analysis. The Self-Harm Antipathy Scale (SHAS) was used as an outcome in two studies appropriate for meta-analysis. The Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) scale was used as an outcome in three studies appropriate for meta-analysis. Results demonstrated limited empathy and negativity towards patients who self-harm, indicating a requirement for education and supervision of ED staff, where the SHAS or the ADSHQ can be used to monitor attitude change. Self-harm educational content for ED staff should include areas of knowledge building including explanations and causes of self-harm; range, forms, and functions of self-harm; staff responses to self-harm; assessment, management, and interventions; professional practice issues.

Pressure ulcer definitions and core curricula-how does this affect wound care and the older patient?

Chronic wounds are associated with a significant patient, healthcare and financial burden and can have extensive implications for healthcare. Age is a significant risk factor for developing chronic wounds, due to physical changes in skin integrity and several age-related complex comorbidities, including poor nutrition and mobility. Pressure ulcers (PU) are a common type of chronic wound that can have a substantial impact on health-related quality of life and patient outcomes. Understanding the extent of PU harm is problematic, due to discrepancies in the definition, recording and reporting of PUs on both a local and national level. Education and training are central to ensuring the risk factors associated with PU development are recognised, and a consistent and coherent structure to the definition, measurement and reporting of PUs across the NHS is developed.

Movement Disorders in Childhood Thalamic Tumors

Investigators from St. Jude Children’s Research Hospital in Memphis, Tennessee analyzed movement disorder outcomes in patients with childhood thalamic tumors.

The effect of numbness on outcome from total knee replacement

INTRODUCTION Some patients report continuing pain and functional limitations after total knee replacement (TKR). While numbness around the TKR scar is common, the impact of numbness is less clear. One particular activity that could be influenced by numbness is kneeling. The aim of this study was to explore the impact of numbness around TKR scars on health related quality of life and kneeling ability. METHODS Fifty-six patients were recruited one year after primary TKR. Sensation around the knee was assessed through patient self-reporting, monofilament testing and vibration, and patients' distress was measured on a visual analogue scale. Patient reported outcome measures (PROMs) including the Western Ontario and McMaster Universities (WOMAC^®) index, the Knee injury and Osteoarthritis Outcome Score (KOOS), the painDETECT^® (Pfizer, Berlin, Germany) questionnaire and the EQ-5D™ (EuroQol, Rotterdam, Netherlands) questionnaire were used. Participants were also asked about kneeling ability. RESULTS While 68% of patients reported numbness around their TKR scar, there was no statistically significant correlation between numbness and distress at numbness (self-report: 0.23, p=0.08; monofilament: 0.15, p=0.27). Furthermore, numbness did not correlate significantly with joint specific PROMs (WOMAC^®: 0.21, p=0.13; KOOS: 0.18, p=0.19). However, difficulty with kneeling did correlate with both self-reported numbness (0.36, p=0.020) and worse PROM scores (WOMAC^® pain subscale: 0.62, p<0.001; KOOS: 0.64, p<0.001). CONCLUSIONS Numbness after knee replacement is common but is not associated with worse patient reported outcomes.

Cohort Profile: The Yorkshire Health Study

The Yorkshire Health Study is a longitudinal observational regional health study collecting health information on the residents from the Yorkshire and Humberside region in England. The second wave of data collection is currently under way. The study aims to inform National Health Service (NHS) and local authority health-related decision making in Yorkshire, with wider implications from findings as well. The first wave contains records for 27 806 individuals (2010-12), aged between 16 and 85, from one part of Yorkshire (South Yorkshire), with the second wave expanding data collection to the whole of the Yorkshire and Humberside region. Data were collected on current and long-standing health, health care usage and health-related behaviours, with a particular focus on weight and weight management. The majority of individuals have also given consent for record linkage with routine clinical data, allowing the linking to disease diagnosis, medication use and health care usage. The study encourages researchers to utilize the sample through the embedding of randomized controlled trials, other controlled trials and qualitative studies. To access the anonymized data or use the sample to recruit participants to studies, researchers should contact Clare Relton (c.relton@sheffield.ac.uk).

Development of an electrochemical surface-enhanced Raman spectroscopy (EC-SERS) aptasensor for direct detection of DNA hybridization

Rapid detection of disease biomarkers at the patient point-of-care is essential to timely and effective treatment. The research described herein focuses on the development of an electrochemical surface-enhanced Raman spectroscopy (EC-SERS) DNA aptasensor capable of direct detection of tuberculosis (TB) DNA. Specifically, a plausible DNA biomarker present in TB patient urine was chosen as the model target for detection. Cost-effective screen printed electrodes (SPEs) modified with silver nanoparticles (AgNP) were used as the aptasensor platform, onto which the aptamer specific for the target DNA was immobilized. Direct detection of the target DNA was demonstrated through the appearance of SERS peaks characteristic for adenine, present only in the target strand. Modulation of the applied potential allowed for a sizeable increase in the observed SERS response and the use of thiol back-filling prevented non-specific adsorption of non-target DNA. To our knowledge, this work represents the first EC-SERS study of an aptasensor for the direct, label-free detection of DNA hybridization. Such a technology paves the way for rapid detection of disease biomarkers at the patient point-of-care.

The effects of state-level expenditures for home- and community-based services on the risk of becoming a long-stay nursing home resident after hip fracture

SUMMARY

This study measures the effect of spending policies for long-term care services on the risk of becoming a long-stay nursing home resident after a hip fracture. Relative spending on community-based services may reduce the risk of long-term nursing home residence. Policies favoring alternative sources of care may provide opportunities for older adults to remain community-bound.

INTRODUCTION

This study aims to understand how long-term care policies affect outcomes by investigating the effect of state-level spending for home- and community-based services (HCBSs) on the likelihood of an individual's nursing home placement following hip fracture.

METHODS

This study uses data from the 5% sample of Medicare beneficiaries from 2005 to 2010 to identify incident hip fractures among dual-eligibility, community-dwelling adults aged at least 65 years. A multilevel generalized estimating equation (GEE) model estimated the association between an individual's risk of nursing home residence within 1 year and the percent of states' Medicaid long-term support service (LTSS) budget allocated to HCBS. Other covariates included expenditures for Title III services and individual demographic and health status characteristics.

RESULTS

States vary considerably in HCBS spending, ranging from 17.7 to 83.8% of the Medicaid LTSS budget in 2009. Hip fractures were observed from claims among 7778 beneficiaries; 34% were admitted to a nursing home and 25% died within 1 year. HCBS spending was associated with a decreased risk of nursing home residence by 0.17 percentage points (p 0.056).

CONCLUSIONS

Consistent with other studies, our findings suggest that state policies favoring an emphasis on HCBS may reduce nursing home residence among low-income older adults with hip fracture who are at high risk for institutionalization.

Synthesis, conformation and antiproliferative activity of isothiazoloisoxazole 1,1-dioxides

Isothiazoles (I) reacted with 1,3-dipoles or NaN₃ to give cycloadducts (II) or thiazete (III). Thiazete (III) rearranged to give 1,2,3-oxathiazoline (IV).

Excess NF-κB induces ectopic odontogenesis in embryonic incisor epithelium

Nuclear factor kappa B (NF-κB) signaling plays critical roles in many physiological and pathological processes, including regulating organogenesis. Down-regulation of NF-κB signaling during development results in hypohidrotic ectodermal dysplasia. The roles of NF-κB signaling in tooth development, however, are not fully understood. We examined mice overexpressing IKKβ, an essential component of the NF-κB pathway, under keratin 5 promoter (K5-Ikkβ). K5-Ikkβ mice showed supernumerary incisors whose formation was accompanied by up-regulation of canonical Wnt signaling. Apoptosis that is normally observed in wild-type incisor epithelium was reduced in K5-Ikkβ mice. The supernumerary incisors in K5-Ikkβ mice were found to phenocopy extra incisors in mice with mutations of Wnt inhibitor, Wise. Excess NF-κB activity thus induces an ectopic odontogenesis program that is usually suppressed under physiological conditions.

Examining the incremental impact of long-standing health conditions on subjective well-being alongside the EQ-5D

BACKGROUND

Generic preference-based measures such as the EQ-5D and SF-6D have been criticised for being narrowly focused on a sub-set of dimensions of health. Our study aims to explore whether long-standing health conditions have an incremental impact on subjective well-being alongside the EQ-5D.

METHODS

Using data from the South Yorkshire Cohort study (N = 13,591) collected between 2010 and 2012 on the EQ-5D, long-standing health conditions (self-reported), and subjective well-being measure--life satisfaction using a response scale from 0 (completely dissatisfied) to 10 (completely satisfied), we employed generalised logit regression models. We assessed the impact of EQ-5D and long-standing health conditions together on life satisfaction by examining the size and significance of their estimated odds ratios.

RESULTS

The EQ-5D had a significant association with life satisfaction, in which anxiety/depression and then self-care had the largest weights. Some long-standing health conditions were significant in some models, but most did not have an independent impact on life satisfaction. Overall, none of the health conditions had a consistent impact on life satisfaction alongside the EQ-5D.

CONCLUSIONS

Out study suggests that the impact of long-standing health conditions on life satisfaction is adequately captured by the EQ-5D, although the findings are limited by reliance on self-reported conditions and a single item life satisfaction measure.

South Yorkshire Cohort: a 'cohort trials facility' study of health and weight - protocol for the recruitment phase

Background

Growing levels of both obesity and chronic disease in the general population pose a major public health problem. In the UK, an innovative 'health and weight' cohort trials facility, the 'South Yorkshire Cohort', is being built in order to provide robust evidence to inform policy, commissioning and clinical decisions in this field. This protocol reports the design of the facility and outlines the recruitment phase methods.

Method/Design

The South Yorkshire Cohort health and weight study uses the cohort multiple randomised controlled trial design. This design recruits a large observational cohort of patients with the condition(s) of interest which then provides a facility for multiple randomised controlled trials (with large representative samples of participants, long term outcomes as standard, increased comparability between each trial conducted within the cohort and increased efficiency particularly for trials of expensive interventions) as well as ongoing information as to the natural history of the condition and treatment as usual.

This study aims to recruit 20,000 participants to the population based South Yorkshire Cohort health and weight research trials facility. Participants are recruited by invitation letters from their General Practitioners. Data is collected using postal and/or online patient self completed Health Questionnaires. NHS numbers will be used to facilitate record linkage and access to routine data. Participants are eligible if they are: aged 16 - 85 years, registered with one of 40 practices in South Yorkshire, provide consent for further contact from the researchers and to have their information used to look at the benefit of health treatments. The first wave of data is being collected during 2010/12 and further waves are planned at 2 - 5 year intervals for the planned 20 year duration of the facility.

Discussion

The South Yorkshire Cohort combines the strengths of the standard observational, longitudinal cohort study design with a population based cohort facility for multiple randomised controlled trials in a range of long term health and weight related conditions (including obesity). This infrastructure will allow the rapid and cheap identification and recruitment of patients, and facilitate the provision of robust evidence to inform the management and self-management of health and weight.

Mortality following bone metastasis and skeletal-related events among men with prostate cancer: a population-based analysis of US Medicare beneficiaries, 1999-2006

Information on the impact of bone metastasis and skeletal-related events (SREs) on mortality among prostate cancer patients is limited. Using the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database, we identified men aged 65 years or older diagnosed with prostate cancer between July 1 1999 and December 31 2005 and followed to determine deaths through December 31 2006. We classified subjects as having bone metastasis and SREs as indicated by Medicare claims. Using Cox regression, we estimated mortality hazards ratios (HR) among men with bone metastasis with or without SRE, compared with men without bone metastasis. Among 126,978 men with prostate cancer (median follow-up, 3.3 years), 9746 (7.7%) had bone metastasis at prostate cancer diagnosis (1.7%) or during follow-up (5.9%). SREs occurred in 4296 (44%) men with bone metastasis. HRs for risk of death were 6.6 (95% CI=6.4-6.9) and 10.2 (95% CI=9.8-10.7), respectively, for men with bone metastasis but no SRE and for men with bone metastasis plus SRE, compared with men without bone metastasis. Bone metastasis was associated with mortality among prostate cancer patients. This association appeared to be stronger for bone metastasis plus SRE than for bone metastasis without SRE.