Interns and their smartphones: use for clinical practice

PURPOSE OF THE STUDY

Smartphone use among healthcare professionals has become widespread and will continue to grow in the coming years.

STUDY DESIGN

In October 2012, a survey was distributed to 230 interns at two of the national intern training networks in the Republic of Ireland, asking how they used smartphones to carry out their clinical work.

RESULTS

It was found that out of 108 interns (47.0% response rate, 108/230), 94.4% (102/108) owned a smartphone. Of those respondents who owned a smartphone, on at least a daily basis for the purposes of work, 83.3% (85/102) made or received phone calls, 87.2% (89/102) sent or received texts, and 41.2% (42/102) sent or received emails on their smartphone. A total of 52.9% (54/102) had used their smartphone to take a work related picture. The most commonly used app was the British National Formulary. It was used daily by 30.4% (31/102) of respondents with a smartphone. The most commonly used website was Wikipedia. It was accessed at least weekly by 38.2% (39/102) of respondents with a smartphone.

CONCLUSIONS

Smartphones are used by the majority of interns on a daily basis in order to perform their job. As such, there is a need for guidance on how patient information can be safely secured and transmitted using smartphones, their appropriate use, and any restrictions on the use of these devices in certain clinical settings. For interns in particular, advice is needed on the credibility of medical apps and websites.

The Hidradenitis Suppurativa Quality of Life (HiSQOL) score: development and validation of a measure for clinical trials

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic, inflammatory condition that can have a large negative impact on health-related quality of life (HRQOL). A reliable and validated measure of HS-specific HRQOL in clinical studies is needed.

OBJECTIVES

To develop and validate the Hidradenitis Suppurativa Quality Of Life (HiSQOL©) scale, for clinical trial measurement of HS-specific HRQOL.

METHODS

In stage 1, qualitative concept elicitation interviews were conducted with patients with HS in Denmark (n = 21) and the U.S.A. (n = 21). In stage 2, cognitive debriefing interviews were performed with U.S. (n = 30) and Danish patients with HS (n = 30). In stage 3 an observational study of 222 patients with HS in the U.S.A. was conducted for item reduction, measure validation and assessment of psychometric properties. In stage 4, an observational study of 215 patients with HS in Denmark was conducted to confirm the psychometric structure derived in stage 3. In both studies the Dermatology Life Quality Index, Hospital Anxiety and Depression Scale and numerical rating scale for pain were also included.

RESULTS

In concept elicitation, 99 items were generated, which were reduced to 41 after removing duplicates. In cognitive debriefing, two items were added and one item removed. A 42-item instrument was psychometrically assessed. Based on psychometric analyses and patient input, the instrument was reduced to 17 items that had strong psychometric properties in both the U.S. and Danish samples.

CONCLUSIONS

The HiSQOL is a reliable and valid instrument to measure HS-specific HRQOL in clinical trials.

Salicylic acid confers salt tolerance in potato plants by improving water relations, gaseous exchange, antioxidant activities and osmoregulation

BACKGROUND

Potato is an important vegetable; however, salt stress drastically affects its growth and yield. A pot experiment was therefore conducted to assess salicylic acid efficacy in improving performance of potato cultivars, grown under salt stress (50 mmol L^-1 ). Salicylic acid at 0.5 mmol L^-1 was sprayed on to potato plants after 1 week of salinity application.

RESULTS

Salt stress effects were ameliorated by salicylic acid effectively in both the studied cultivars. N-Y LARA proved more responsive to salicylic acid application than 720-110 NARC, which confirmed genetic variation between cultivars. Salicylic acid scavenged reactive oxygen species by improving antioxidant enzyme activities (superoxide dismutase, catalase, peroxidases) and regulating osmotic adjustment (proline, phenolic contents), which led to enhanced water relation and gaseous exchange attributes, and thereby increased potassium availability and reduced sodium content in potato leaves. Moreover, potato tuber yield showed a positive correlation with potassium content, photosynthesis and antioxidant enzyme activities.

CONCLUSION

Salt tolerance efficacy of salicylic acid is authenticated in improving potato crop performance under salt stress. Salicylic acid effect was more pronounced in N-Y LARA, reflecting greater tolerance than 720-110 NARC, which was confirmed as a susceptible cultivar. Hence salicylic acid at 0.5 mmol L^-1 and cultivation of N-Y LARA may be recommended in saline soil. © 2016 Society of Chemical Industry.

Internalized weight bias in patients presenting for bariatric surgery

INTRODUCTION

Internalized weight bias (IWB) is significantly related to poor psychosocial health outcomes in patients with increased body mass index (BMI). The objective of this study was to evaluate the psychometric properties and correlates of the Weight-Bias Internalization Scale in a pre-surgical bariatric population.

METHODS

Self-report measures were administered to patients prior to surgery. Measures assessed internalized weight bias, body dissatisfaction, depression, anxiety, quality of life, and eating behaviors. Statistical methods included confirmatory factor analysis to examine the factor structure [of the WBIS] in this population, descriptive statistics, correlations, and hierarchical linear regression between continuous variables to determine patterns of associations, and t-tests to compare levels of IWB between the current sample and previously documented samples.

RESULTS

Confirmatory factor analysis indicated an acceptable fit using a one-factor structure for the WBIS, with one item removed. Mean WBIS in the current sample was comparable to that documented in a community sample of adults with overweight and obesity, as well as a sample of adolescents seeking bariatric surgery. Additionally, IWB was positively associated with body dissatisfaction, restrained, emotional, and external eating, depression, and anxiety, and negatively associated with quality of life. Further, individuals endorsing episodes of loss of control over eating had significantly higher WBIS scores.

CONCLUSIONS

This study highlights the strong pattern of associations with measures of body image, disordered eating, and quality of life point toward the relevance of IWB to bariatric patients' experiences. Future studies to explore the longitudinal effects of IWB in a post-bariatric population are needed particularly to understand psychosocial and surgical health outcomes.

Validation of global item for assessing impact on quality of life of patients with hidradenitis suppurativa

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic inflammatory disease. The HS core outcome set calls for a patient global assessment (PtGA).

OBJECTIVES

To assess the validity, reliability and responsiveness of a candidate single-item PtGA for HS-specific health-related quality of life (HRQoL).

METHODS

Cognitive debriefing interviews were conducted with patients with HS in Denmark and the USA. A cross-sectional observational study was done with adults with HS in the USA and Denmark. Candidate PtGA item, demographic items and multiple patient-reported scales - the Hidradenitis Suppurativa Quality of Life (HiSQOL), Dermatology Life Quality Index (DLQI) and numerical rating scale (NRS) for pain - were concurrently administered to evaluate convergent and known-groups validity. Scales with a single-item assessment of change were readministered 24-72 h later, to evaluate reliability and responsiveness.

RESULTS

After cognitive debriefing, the candidate PtGA for HS-specific HRQoL was finalized with five response levels. Convergent validity of the PtGA was supported by significant correlations with HiSQOL score [r = 0·79, 95% confidence interval (CI) 0·75-0·82] and DLQI (r = 0·78, 95% CI 0·74-0·82). The PtGA displayed known-groups validity with DLQI score bands based on significance of an anova (P < 0·001). Good test-retest reliability was supported by the intraclass correlation coefficient (0·82, 95% CI 0·78-0·85) for those who reported stable HS. Responsiveness was assessed by differences in PtGA score against a patient-reported assessment of change, which showed significant differences towards improvement.

CONCLUSIONS

The single-item PtGA exhibits reliability, validity and responsiveness in assessing HS-specific HRQoL in HS, making it a good provisional tool for HS clinical research.

New antiplatelet drugs: beyond aspirin and clopidogrel

Antiplatelet therapy remains a cornerstone of modern management of atherothrombotic vascular disease. For many years, aspirin has been the mainstay of initial antiplatelet drug management in coronary heart disease, while the need for inhibition of other platelet activation pathways has led to the development of various other antiplatelet drugs, such as clopidogrel. An improved understanding of the underlying mechanisms involved in thrombogenesis has paved the way for further development of newer antiplatelet drug therapies. Various clinical studies have probed the effectiveness and risk profile of the newer antiplatelet drugs, such as prasugrel, in comparison with currently available drugs. Some newer agents such as prasugrel are close to being approved for clinical use, whereas other agents such as cangrelor and AZD6140 are in phase 3 clinical trials. New drug classes, such as the thromboxane receptor antagonists (such as NCX-4016 and S18886), as well as platelet adhesion antagonists and thrombin receptor antagonists are similarly being evaluated for their efficacy and risk profile in phase I and II trials.

Hidradenitis Suppurativa Area and Severity Index Revised (HASI-R): psychometric property assessment

BACKGROUND

Validated, reliable, globally accepted outcome measurement instruments for hidradenitis suppurativa (HS) are needed. Current tools to measure the physical signs domain for HS rely on lesion counts, which are time-consuming and unreliable.

OBJECTIVES

To assess the reliability and validity of the Hidradenitis suppurativa Area and Severity Index Revised (HASI-R) tool, a novel method for assessing HS severity, incorporating signs of inflammation and body surface area involved.

METHODS

The measurement properties of the HASI-R tool were evaluated. The tool was created by combining the previously published HASI and Severity and Area Score for Hidradenitis instruments. Twenty raters evaluated 15 patients with HS in a hospital-based ambulatory dermatology clinic. The objectives of the study were to assess inter- and intra-rater reliability of the HASI-R and its components, as well as its construct and known-groups validity. Existing lesion count-based clinician-reported measures of HS and their components were also assessed. Raters were also asked their preferences regarding the various HS severity assessment tools.

RESULTS

The HASI-R had moderate inter-rater reliability [intra-class correlation coefficients (ICC) 0·60]. This was better than all other HS physical sign outcome measures evaluated, which had poor inter-rater reliability (ICC < 0·5). HASI-R had the highest intra-rater reliability (ICC 0·91). The HASI-R had good construct validity and demonstrated known-groups validity. The HASI-R was also the most preferred tool by all raters.

CONCLUSIONS

Results from the clinometric assessment of the HASI-R are encouraging, and support continued evaluation of this clinician-reported outcome measure.

Effects of aspirin on human auditory filters

Auditory filter shapes were measured in eight male volunteers with normal hearing, using a notched-noise forward-masking paradigm and a signal frequency of 4 kHz. The measurements were made under three conditions: after listeners had taken eight doses of three 320 mg aspirin tablets every six hours; after an identical schedule of placebo ingestion; and one week after testing in the first two conditions had been completed. Half of the listeners did the placebo condition first, and half did the aspirin condition first. Aspirin and placebo were administered double-blind, and testing took place approximately one hour after the last dose. Filter shapes were significantly broader in the aspirin condition than in the placebo and post-test conditions, indicating that even a modest dose affects auditory frequency selectivity. Two-point measures of growth of masking did not differ significantly between conditions.

Severity and Area Score for Hidradenitis (SASH): a novel outcome measurement for hidradenitis suppurativa

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease with a large impact on patients' health-related quality of life. However, reliable and consistent outcome measures to assess body surface area (BSA) of HS have not been established.

OBJECTIVES

To develop and assess the reliability and validity of a novel outcome instrument for assessment of HS BSA in a clinical trial setting.

METHODS

Qualitative interviews and focus groups were conducted from July to August 2015 and October 2017 to January 2018. Evaluation of the measurement was assessed during a single-day grading session with patients in April 2018. Participants, who included clinicians or patients, were recruited from academic medical centres in the U.S. mid-Atlantic region.

RESULTS

Concept elicitation included input from 10 providers, of which 60% (n = 6) were female, 80% (n = 8) dermatology specialists and 20% (n = 2) gynaecology specialists. Cognitive debriefing was conducted with 11 providers, of which 82% (n = 9) were dermatologists and 18% (n = 2) gynaecologists. The evaluation stage included 10 clinicians and 23 patients. The intraclass correlation coefficient (ICC) for inter-rater reliability was 0·60 [95% confidence interval (CI) 0·44-0·74]. The ICC for intrarater reliability was 0·98 (95% CI 0·94-1·00). Transformation of the BSA score resulted in an increase in inter-rater reliability to 0·75 (95% CI 0·62-0·85) or 0·76 (95% CI 0·62-0·85). Scores all demonstrated concurrent validity, with statistically significant correlations with extant scoring methods.

CONCLUSIONS

This novel scale is a reliable and valid HS outcome instrument and may capture a wide range of patients by assessing BSA. Future research is necessary to demonstrate its responsiveness. What's already known about this topic? The major HS disease activity scales rely on lesions counts and have moderate-to-good reliability. Body surface area (BSA) is one of the physical signs included in the Core Outcome Set for HS, but is not a part of existing HS disease activity scales. What does this study add? A novel disease severity scale, the Severity and Area Score for Hidradenitis (SASH), was developed and the psychometric properties assessed. There was high inter-rater reliability of 0·75 and 0·76 when BSA was scored on an ordinal scale, and an excellent intrarater reliability of 0·98. The SASH score also demonstrated convergent validity with extant instruments. What are the clinical implications of this work? The ability of clinicians to accurately assess disease status will be improved. Implementation of the SASH score will help guide and assess the effectiveness of appropriate treatment choice.

Protective effect of jasmonic acid and potassium against cadmium stress in peas (Pisum sativum L.)

A combination of mineral nutrients and plant growth regulators should be assessed to improve crop performance under various abiotic stresses. There is a need to include plant growth regulators in fertilization regime of various crops along with essential mineral nutrients, especially when they are irrigated with polluted water with higher levels of heavy metals. The performance of pea was evaluated under cadmium (Cd) stress coupled with potassium (K) and jasmonic acid (JA) supplementation. The Cd stress (50 μM) was applied to soil (sandy loam) grown pea plants as basal dose after a month of sowing. The control and stressed plants were then supplemented with K (5 M), JA (0.5 mM) and their collective application along with control as distilled water. Cd stress showed a marked reduction in growth pattern, however, the collective supplementation sufficiently improved the growth pattern of stressed peas plants as evidenced by improvement in shoot length (cm), root length (cm), number of leaves per plant, leaf area (cm2), plant fresh and dry weight (gm). Potassium application under Cd stress significantly enhanced internodal distance (cm) while the number of seeds per pod and relative water contents remained nonsignificant. The applied treatment (JA + K) under Cd stress prominently improved enzymatic activities, which were measured as nitrate reductase activity (NRA), nitrite reductase activity (NiRA), superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT). Cd stress impacted the biochemical profile by enhancing antioxidant capacity (AC), antioxidant activity (AA), total phenols (TP), while reducing total soluble protein (TSP), chlorophyll 'a', chlorophyll 'b' and carotenoids. The combined application of JA and K under Cd stress enhanced AC, AA, TP, Chl a and b, TSP and carotenoids. The results indicate that foliar application of JA and K efficiently negated the harmful effects of Cd stress on peas.

Exogenous application of silicon improves the performance of wheat under terminal heat stress by triggering physio-biochemical mechanisms

Due to climate change, temperature in late February and early March raised up which cause heat stress at reproductive stage (terminal growth phase of wheat crop) which has become the major causative factor towards low wheat production in arid and semiarid regions. Therefore; strategies need to be adopted for improving terminal heat stress tolerance in wheat. In this study, we assessed whether foliar application of silicon (Si) (2 and 4 mM) at terminal growth phase i.e. heading stage of wheat imposed to heat stress (37 ± 2 °C) under polythene tunnel could improve the performance of wheat. Results of the study revealed that heat stress significantly reduced the photosynthetic pigments (chlorophyll a, b and a + b and carotenoids) leading to a lower grain yield. However, a 4 mM Si application (foliar applied) at heading stage prominently increased the chlorophyll a, b and a + b and carotenoids of flag leaf by improving the activities of enzymatic antioxidants (catalase, peroxidase and superoxide dismutase) and osmoprotectants (soluble sugar protein and proline) under terminal heat stress. Improvements in the performance of wheat (chlorophyll contents, carotenoids, soluble sugar and proteins and proline and yield) with foliar application of Si were also observed under control conditions. Correlation analysis revealed strong association (r > 0.90) of chlorophyll contents and carotenoids with grain and biological yield. Negative correlation (-0.81 < r > -0.63) of physio-biochemical components (antioxidants, proline, soluble sugars and proteins) with yield revealed that under heat stress these components produced in more quantities to alleviate the effects of heat, and Si application also improved these physio biochemical components. In crux, foliar application of Si alleviates the losses in the performance of wheat caused by terminal heat stress by improving the antioxidant mechanism and production of osmoprotectants.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Engraftment of bovine leukemia virus infected lymphocytes into SCID mice

SCID mice inoculated with peripheral blood lymphocytes from a tumor-bearing BLV-positive cow developed lymphosarcomas after 6 months. DNA from the splenic tumor specifically hybridized with a bovine Sstl satellite probe, showing that these tumor cells were of bovine origin. The clonality of the SCID splenic tumor, as measured by the integration pattern of BLV proviruses, was the same as that in the donor lymphocyte population.

5-(Prop-2-yn-yl)-5H-dibenzo[b,f]azepine

The asymmetric unit of the title compound, C₁₇H₁₃N, contains two independent butterfly-shaped mol­ecules. The seven-membered azepine rings both adopt a boat conformation. The dihedral angles between the benzene rings in the two mol­ecules are 46.95 (11) and 52.21 (11)°.

Morpho-physiological and biochemical attributes of Chili (Capsicum annum L.) genotypes grown under varying salinity levels

Climate change is causing soil salinization, resulting in huge crop losses throughout the world. Multiple physiological and biochemical pathways determine the ability of plants to tolerate salt stress. Chili (Capsicum annum L.) is a salt-susceptible crop; therefore, its growth and yield is negatively impacted by salinity. Irreversible damage at cell level and photo inhibition due to high production of reactive oxygen species (ROS) and less CO2 availability caused by water stress is directly linked with salinity. A pot experiment was conducted to determine the impact of five NaCl salinity levels, i.e., 0,1.5, 3.0, 5.0 and 7.0 dS m-1 on growth, biochemical attributes and yield of two chili genotypes ('Plahi' and 'A-120'). Salinity stress significantly reduced fresh and dry weight, relative water contents, water use efficiency, leaf osmotic potential, glycine betaine (GB) contents, photosynthetic rate (A), transpiration rate (E), stomatal conductance (Ci), and chlorophyll contents of tested genotypes. Salinity stress significantly enhanced malondialdehyde (MDA) contents and activities of the enzymatic antioxidants such as superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD). In addition, increasing salinity levels significantly reduced the tissue phosphorus and potassium concentrations, while enhanced the tissue sodium and chloride concentrations. Genotype 'Plahi' had better growth and biochemical attributes compared to 'A-120'. Therefore, 'Plahi' is recommended for saline areas to improve chili production.

FREQUENCY OF TRIPLE-VESSEL CORONARY ARTERY DISEASE IN ADULT TYPE 2 DIABETICS VERSUS NON-DIABETICS IN CORONARY ARTERY DISEASE POPULATION OF ISLAMABAD, PAKISTAN

Background: Coronary artery disease is a major cause of morbidity and mortality globally as well as in Pakistan. The objective of the study was to compare the frequency of triple-vessel coronary artery disease (triple-vessel CAD) in adult type 2 diabetics versus non-diabetics in coronary artery disease (CAD) population of Islamabad, Pakistan. Materials and Methods: This cross-sectional study was conducted in Department of Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from June 21, 2016 to December 20, 2016. 300 patients were selected from population including adult CAD patients who were candidates for coronary angiography. Those with conduction defects, renal failure and prior CABG surgery were excluded. 150 diabetics and 150 non-diabetics were subjected to coronary angiography. Age, sex and presence of triple-vessel CAD were research variables. Age was analyzed by mean and SD while sex and presence of triple-vessel CAD were analyzed by count and percentage for each group separately. Confidence interval for proportion was calculated at 80% confidence level for each group. Frequency of presence of triple-vessel CAD in two groups was compared using McNemar chi-square test at alpha 0.5. Results: Mean age was 55.02±8.48 for diabetics and 54.02±24.4 years for non-diabetics. Out of 300 patients with CAD, 184 (61.33%) were men and 116 (38.67%) were women. Triple-vessel CAD was present in 60/150 (40%) cases in diabetics and in 3/150 (2%) cases in non-diabetics. Frequency of triple-vessel CAD was significantly higher in adult type 2 diabetics versus non-diabetics in CAD population of Islamabad, Pakistan (p