1
|
To understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer: a systematic review of qualitative studies. J Cancer Surviv 2023:10.1007/s11764-023-01508-9. [PMID: 38151586 DOI: 10.1007/s11764-023-01508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE This study aimed to understand the experiences, needs, and preferences for supportive care, among children and adolescents (0-19 years) diagnosed with cancer. METHODS A qualitative systematic review has been reported according to PRISMA guidelines. A comprehensive search was conducted across multiple databases (APA PsycINFO, CINAHL, and Medline) and citation searches. Studies were screened according to pre-determined inclusion and exclusion criteria. Methodological quality was evaluated. Findings were extracted in relation to the context of interest of experiences, needs, and preferences of supportive care. Each finding was accompanied by a qualitative verbatim illustration representing the participant's voice. RESULTS 4449 publications were screened, and 44 studies were included. Cancer populations represented in the included studies included lymphoma, leukaemia, brain cancer, sarcomas, and neuroblastoma. Two overarching synthesised findings were identified as (1) coping, caring relationships, communication, and impact of the clinical environment, and (2) experiences of isolation, fear of the unknown, restricted information, and changing self. Children and adolescents articulated that cancer care would be enhanced by developing a sense of control over their body and healthcare, being involved in communication and shared decision-making, and ensuring the clinical environment is age-appropriate. Many experienced a sense of disconnection from the rest of the world (including peers, school, and experiences of prejudice and bullying), and a lack of tailored support and information were identified as key unmet care needs that require further intervention. CONCLUSIONS Children and adolescent who are diagnosed with cancer are a unique and understudied group in oncological survivorship research, with the slowest progress in improvement of care over time. This review will facilitate the development of future interventions and promote the importance of tailored support for children and adolescents at all stages of the cancer journey. IMPLICATIONS FOR CANCER SURVIVORS Children and adolescents continue to experience a range of difficulties despite routine contact with cancer healthcare professionals. Children and adolescents should be carefully assessed about their individual circumstances and preferences for support given the clear implications from this review that "one size" does not fit all.
Collapse
|
2
|
Establishing proof of concept for utility of Trueprep ®-extracted DNA in line-probe assay testing. Int J Tuberc Lung Dis 2023; 27:742-747. [PMID: 37749831 PMCID: PMC10519390 DOI: 10.5588/ijtld.23.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/01/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES: With an increased demand for rapid, diagnostic tools for TB and drug resistance detection, Truenat® MTB-RIF assay has proven to be a rapid point of care molecular test. The present study aimed to establish a proof of concept of using Trueprep-extracted DNA for line-probe assay (LPA) testing.METHODS: A total of 150 sputum samples (MTB-positive at Truenat sites) were divided into two aliquots. One aliquot was used for DNA extraction using the Trueprep device and MTB testing. The second aliquot of the sample was subjected to GenoLyse® DNA extraction. DNA from both the Trueprep and GenoLyse methods was subjected to first-line (FL) and second-line (SL) LPA testing.RESULTS: Of 139 Trueprep-extracted DNA, respectively 135 (97%) and 105 (75%) had interpretable results by FL and SL-LPA testing. Of 128 GenoLyse-extracted DNA, all 128 (100%) had interpretable FL-LPA results and 114 (89%) had interpretable SL-LPA results.CONCLUSION: The results obtained in this study indicate that Trueprep-extracted DNA can be used in obtaining valid LPA results. However, the study needs to be conducted on a larger sample size before our recommendations can be used for policy-making decisions.
Collapse
|
3
|
Clinical examination subtleties in diagnosing an unwitnessed foreign body ingestion. IRISH MEDICAL JOURNAL 2023; 116:817. [PMID: 37606517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
|
4
|
Coverage, Apparent Consumption, and Monthly Use of Packaged Maize Flour in Morogoro Region, Tanzania. Food Nutr Bull 2023; 44:126-135. [PMID: 37016819 PMCID: PMC10634350 DOI: 10.1177/03795721231161395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
INTRODUCTION Tanzania aimed to reduce micronutrient deficiencies and neural tube defects by introducing mandatory fortification of large-scale packaged wheat and maize flour but not for small- and medium-scale mills. OBJECTIVES Ascertain the proportion of the population in Morogoro region, Tanzania, that consumes packaged maize flour from small-, medium- and large-mills; and understand the impact of monthly apparent purchase and consumption of packaged flour. METHODS In 2018, a regional, multistage cluster probability study was conducted among residents in Morogoro region living in households that reported consuming maize flour. Interviews collected information on sociodemographic factors and patterns of household flour consumption. Weighted medians estimated daily apparent flour consumption and the estimated average requirement (EAR), according to age. RESULTS Information was collected on 711 households. Packaged maize flour was purchased 10-12 months of the year by 22.9% of households, 6-9 months by 17.6% of households, 1-5 months by 25.1% of households, and 34.4% did not purchased maize flour. Median apparent daily consumption of maize flour was 209.7 g/d/adult male equivalent (AME). Apparent median daily consumption of maize flour was 230.1 g/d/AME in rural areas and 176.2 g/d/AME in urban areas; 228.7 g/d/AME among males and 196.4 g/d/AME among females. If all packaged maize flour were fortified according to standards, those consuming packaged maize flour 10-12 months of the year would apparently consume 199.9 µg folic acid/d representing 49.7% of daily EAR requirements. CONCLUSIONS Fortifying packaged maize flour at small-, medium- and large-mills is a promising strategy for increasing access to micronutrients, including folic acid.
Collapse
|
5
|
Acclimation, it's not just for research animals. Lab Anim (NY) 2023; 52:112. [PMID: 37264232 DOI: 10.1038/s41684-023-01184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
6
|
Association of SIPAT Score with Long-Term Psychosocial and Clinical Outcomes in Orthotopic Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
7
|
Openness to church-based firearm safety interventions among Protestant Christian firearm owners. Public Health 2023; 216:45-50. [PMID: 36796220 DOI: 10.1016/j.puhe.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/14/2022] [Accepted: 12/29/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVES Protestant Christians are more likely to own firearms and not store them locked/unloaded compared to those from other religions. This study examines how Protestant Christians view the relationship between their religious and firearm beliefs and how that informs openness to church-based firearm safety interventions. STUDY DESIGN Grounded theory analysis of 17 semi-structured interviews with Protestant Christians. METHODS Interviews, conducted August-October 2020, focused on firearms owned, carrying/discharge/storage behaviors, Christian belief compatibility with firearm ownership, and openness to church-based firearm safety interventions. Audio-recorded interviews were transcribed verbatim and analyzed using grounded theory techniques. RESULTS Participant perspectives varied on firearm ownership motivations and compatibility of Christian values with firearm ownership. Variation in these themes and in openness to church-based firearm safety interventions resulted in clustering of participants into three groups. Group 1 owned firearms for collecting/sporting purposes and intricately connected their Christian identity with firearm ownership, but they were not open to intervention due to perceived high firearm proficiency. Group 2 did not connect their Christian identity to their firearm ownership; some believed these identities were incompatible, so were also not open to intervention. Group 3 owned firearms for protection and believed church, as a community hub, was an excellent location for firearm safety interventions. CONCLUSIONS The clustering of participants into groups varying in openness to church-based firearm safety interventions suggests it is feasible to identify Protestant Christian firearm owners open to intervention. This study presents a first step in coupling firearm owner characteristics with community-based, tailored interventions with promise for efficacy.
Collapse
|
8
|
Living with Multiple Myeloma: Patient and Informal Caregiver Perspectives on the Impact of Physical Function Impairments and COVID-19 Restrictions on Social Activities. J Geriatr Oncol 2022. [PMCID: PMC9595427 DOI: 10.1016/s1879-4068(22)00422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
9
|
Moderators of cognitive behavioural therapy treatment effects and predictors of outcome in the CODES randomised controlled trial for adults with dissociative seizures. J Psychosom Res 2022; 158:110921. [PMID: 35617911 DOI: 10.1016/j.jpsychores.2022.110921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We explored moderators of cognitive behavioural therapy (CBT) treatment effects and predictors of outcome at 12-month follow-up in the CODES Trial (N = 368) comparing CBT plus standardised medical care (SMC) vs SMC-alone for dissociative seizures (DS). METHODS We undertook moderator analyses of baseline characteristics to determine who had benefited from being offered CBT 12 months post-randomisation. Outcomes included: monthly DS frequency, psychosocial functioning (Work and Social Adjustment Scale - WSAS), and health-related quality of life (Mental Component Summary (MCS) and Physical Component Summary (PCS) SF-12v2 scores). When moderating effects were absent, we tested whether baseline variables predicted change irrespective of treatment allocation. RESULTS Moderator analyses revealed greater benefits (p < 0.05) of CBT on DS frequency for participants with more (≥22) symptoms (Modified PHQ-15) or ≥ 1 current (M.I.N.I.-confirmed) comorbid psychiatric diagnosis at baseline. The effect of CBT on PCS scores was moderated by gender; women did better than men in the CBT + SMC group. Predictors of improved outcome included: not receiving disability benefits, lower anxiety and/or depression scores (PCS, MCS, WSAS); shorter duration, younger age at DS onset, employment, fewer symptoms and higher educational qualification (PCS, WSAS); stronger belief in the diagnosis and in CBT as a "logical" treatment (MCS). Some variables that clinically might be expected to moderate/predict outcome (e.g., maladaptive personality traits, confidence in treatment) were not shown to be relevant. CONCLUSION Patient complexity interacted with treatment. CBT was more likely to reduce DS frequency in those with greater comorbidity. Other patient characteristics predicted outcome regardless of the received intervention.
Collapse
|
10
|
Coverage and Seasonality Use of Fortifiable Maize Flour in Morogoro, Tanzania. Curr Dev Nutr 2022. [PMCID: PMC9193709 DOI: 10.1093/cdn/nzac051.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives Maize flour is a staple consumed by 93% of the population in Tanzania. In 2011, Tanzania aimed to reduce micronutrient deficiencies and neural tube defects by introducing mandatory fortification of large-scale industrially produced wheat and maize flour. However, maize production is often fragmented (produced at smaller commercial mills) that are not required to fortify under the existing mandate. Objective: 1. Ascertain the proportion of the population of Morogoro region, Tanzania, that consumes packaged maize flour from commercial, ills; 2. understand if consumption of packaged maize flour is affected by changes in seasons and 3. determine who might potentially be reached by point-of-milling fortification in smaller packaging mills. Methods In 2018, a regional, multistage cluster probability study was conducted among residents in Morogoro region, Tanzania, living in households that reported consuming maize flour as the main staple. Interviews collected information on socio-demographic factors and patterns of household flour consumption. Weighted medians estimated daily individual flour intake [g/day/Adult Male Equivalent (AME)]. Daily estimated intake of folic acid was reported in µg and as percentages of the estimated average requirements (EAR) according to age. Results Information was collected on 711 households (out of 984 households selected). Use of wheat flour was reported by 49.5% of households. Package maize flour was purchased 10–12 months, 6–9 months, and 1–5 months of the year by 22.9%, 17.6% and 25.1% of households, respectively; and 34.4% of households never purchased package maize flour. Per capita median daily consumption of any maize flour (including non-packaged flour) was 209.7 g/d/AME. Median daily intake was 230.1 g/d/AME among females. If all packaded maize flour were fortified according to mandate standards, those consuming packaded maize flour 10–12 months of the year would intake 199.9 µg folic acid/d representing 49.7% of daily EAR requirements. Conclusions Fortifying maize flour at small- and medium-packaging scale mills is a promising strategy for increasing household access to micronutrients including folic acid in Tanzania. Funding Sources N/A.
Collapse
|
11
|
The Dangers of Reused Personal Protective Equipment: Healthcare Workers and Workstation Contamination. J Hosp Infect 2022; 127:59-68. [PMID: 35688273 PMCID: PMC9172254 DOI: 10.1016/j.jhin.2022.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/07/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
Abstract
Background Personal protective equipment (PPE) is essential to protect healthcare workers (HCWs). The practice of reusing PPE poses high levels of risk for accidental contamination by HCWs. Scarce medical literature compares practical means or methods for safe reuse of PPE while actively caring for patients. Methods In this study, observations were made of 28 experienced clinical participants performing five donning and doffing encounters while performing simulated full evaluations of patients with coronavirus disease 2019. Participants' N95 respirators were coated with a fluorescent dye to evaluate any accidental fomite transfer that occurred during PPE donning and doffing. Participants were evaluated using blacklight after each doffing encounter to evaluate new contamination sites, and were assessed for the cumulative surface area that occurred due to PPE doffing. Additionally, participants' workstations were evaluated for contamination. Results All participants experienced some contamination on their upper extremities, neck and face. The highest cumulative area of fomite transfer risk was associated with the hook and paper bag storage methods, and the least contamination occurred with the tabletop storage method. Storing a reused N95 respirator on a tabletop was found to be a safer alternative than the current recommendation of the US Centers for Disease Control and Prevention to use a paper bag for storage. All participants donning and doffing PPE were contaminated. Conclusion PPE reusage practices pose an unacceptably high level of risk of accidental cross-infection contamination to healthcare workers. The current design of PPE requires complete redesign with improved engineering and usability to protect healthcare workers.
Collapse
|
12
|
Thermal Stress Has Minimal Effects on Bacterial Communities of Thermotolerant Symbiodinium Cultures. Front Ecol Evol 2022. [DOI: 10.3389/fevo.2022.764086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Algae in the dinoflagellate family Symbiodiniaceae are endocellular photosymbionts of corals and other cnidarians. This close relationship is disrupted when seawater temperature increases, causing coral bleaching eventually affecting entire coral reefs. Although the relationship between animal host and photosymbiont has been well-studied, little is known about the bacterial community associated with Symbiodiniaceae in culture. We compared the microbial communities of three isolates from different species of the genus Symbiodinium (formerly known as Symbiodinium clade A) with different ecophysiology, levels of interaction with the animal host, and thermal adaptations. Two species, Symbiodinium microadriaticum and Symbiodinium necroappettens, exhibit intermediate thermotolerance, with a decrease of both growth rate and photochemical efficiency with increased temperature. The third species, Symbiodinium pilosum, has high thermotolerance with no difference in growth rate or photochemical efficiency at 32°C. Microbial communities were characterized after 27 days of growth under control (26°C) and high temperature (32°C). Data shows stronger grouping of bacterial assemblages based on Symbiodinium species than temperature. Microbial communities did not group phylogenetically. We found a shared set of fifteen ASVs belonging to four genera and three families that remained in all three Symbiodiniaceae species. These included Labrenzia, Phycisphaeraceae (SM1A02), Roseovarius, and Muricauda, which are all commonly associated with corals and Symbiodiniaceae cultures. Few ASVs differed significantly by temperature within species. S. pilosum displayed significantly lower levels of microbial diversity and greater individual variability in community composition at 32°C compared to 26°C. These results suggest that bacteria associated or co-cultured with thermotolerant Symbiodinium might play an important role in thermotolerance. Further research on the functional metabolic pathways of these bacteria might hold the key to understanding Symbiodinium’s ability to tolerate thermal stress.
Collapse
|
13
|
PO-1513 Radiobiological corrections of dose-volume histograms for treatment gap calculations. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03477-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
PO-1551 Monte-Carlo modelling of Hp(10) in a superficial treatment room to inform radiation risk assessments. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
A survey-based comparison between clinical training pathways of Irish MPEs and the RP174 “European Guidelines on Medical Physics Expert”. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00566-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
16
|
105 COVID-19 IN OLDER ADULTS: INPATIENT OUTCOMES IN A LEVEL 3 IRISH HOSPITAL. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
COVID-19 has proved devastating in older persons. Previous studies reveal a mortality rate of 31% for hospitalised patients over 70.1 We examine outcomes for older COVID patients in our hospital.
Methods
We conducted a Hospital In Patient Enquiry Scheme review for patients coded as COVID-19 between 19/03/2020–19/02/2021 (n = 674). Older adults were defined as those aged over 65 years at time of admission. Age, sex, length of stay and survival were collected. Data was collated by ‘wave’: (Wave 1 n = 294, 2 n = 105, 3 n = 275). We reviewed whether patients had a CT pulmonary angiogram (CTPA) on the National Integrated Medical Imaging System.
Results
42.3% of COVID patients in our hospital were older persons (n = 285). This remained stable throughout the pandemic (Wave 1 44.2%, Wave 2 44.7%, Wave 3 39.3%). Mean length of stay was 19.7 days for older adults vs 7.4 for those under 65. Older persons had a higher mortality rate at 30.9% vs 3.6%. Overall incidence of PE was low at 1.9% (1.1% in older persons). However, the likelihood of a CTPA being positive for those over 65 was much higher at 42.9% vs 17.9%. While there was improvement in mortality rates in older persons from Wave 1 (31.5%) to 2 (19.1%), our data showed a significant rise in mortality in Wave 3 (35.2%). This compares to a different pattern in younger people, with mortality rates by wave at 6.7%, 0% and 1.7%.
Conclusion
In a large Irish cohort of patients hospitalised with COVID-19, 42.3% were older adults. Length of hospital stay was 3 times longer and mortality was 10 times higher than patients under 65. Older adults were also more likely to have a positive CTPA. Further study is needed to evaluate the long term effects of COVID-19 in our older population.
Reference
Zerah et al, Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2021 Feb 25; 76 (3): e4–e12.
Collapse
|
17
|
P16.02 Atezolizumab, Bevacizumab and Chemotherapy (IMpower150) in Stage IV Non-Small Cell Lung Cancer: The Australian Experience. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
18
|
981P Preliminary safety and efficacy results from phase Ib study of the anti-CTLA-4 monoclonal antibody (mAb) CS1002 in combination with anti-PD-1 mAb CS1003 in patients with advanced solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
19
|
Systematic Process Framework for Conducting Implementation Science Research in Food Fortification Programs. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:412-421. [PMID: 34038381 PMCID: PMC8324196 DOI: 10.9745/ghsp-d-20-00707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Many challenges still exist to fully scaling up food fortification in lower resource settings. To address this need, a collective group of experts in the fields of food fortification and implementation science developed a systematic process framework to provide a tool for identifying and working through challenges. Food fortification has proven to be an effective approach for preventing micronutrient deficiencies in many settings. Factors that lead to successful fortification programs are well established. However, due to the multisectoral nature of fortification and the added complexities present in many settings, the barriers to success are not always evident and the strategies to address them are not always obvious. We developed a systematic process for identifying and addressing gaps in the implementation of a food fortification program. The framework is composed of 4 phases: (1) connect program theory of change to program implementation; (2) develop an implementation research agenda; (3) conduct implementation research; and (4) analyze findings and develop/disseminate recommendations for next steps. We detail steps in each phase to help guide teams through the process. To our knowledge, this is the first attempt to outline a systematic process for applying implementation science research to food fortification. The development of this framework is intended to promote implementation research in the field of food fortification, thus improving access to and effectiveness of this key public health intervention.
Collapse
|
20
|
POS0305 PHYSICIAN AND PATIENT ATTITUDES TOWARDS TREAT-TO-TARGET, ITS IMPLEMENTATION AND STATED TREATMENT GOALS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN A REAL-WORLD SETTING ACROSS EUROPE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The principles of treat to target (T2T) include defining an appropriate treatment target, assessed at pre-defined intervals, with a commitment to changing therapeutic approach if the target is not met (1). T2T is recommended as a key strategy for the treatment of rheumatoid arthritis (RA).Objectives:To explore attitudes towards T2T, its implementation and stated treatment goals among physicians and their patients with RA.Methods:The Adelphi RA Disease Specific Programme™ was a large, quantitative, point-in-time survey conducted amongst rheumatologists (n=296) and their consulting patients with RA (n=3042) in Europe (France, Germany, Italy, Spain, UK) between Q4 2019–Q3 2020. Physicians were recruited via publicly available lists, completing an online survey and medical record extraction for their next 10–12 consecutive patients. The same patients were invited to voluntarily complete a self-report questionnaire (n=1098, 36% response), collecting data on attitudes towards T2T and treatment goals.Results:Physicians reported that 76% of patients were in remission (DAS28: <2.6) or had low disease activity (DAS28: 2.6 – 3.2), and 24% had moderate-high disease activity (DAS28: >3.2). Patient mean age was 53.0 years (SD 14.0), mean time since diagnosis was 7.2 years (SD 7.2). The proportion of patients currently receiving an advanced therapy (AT; defined as biologic or targeted synthetic DMARD) was 68%, of whom 70% were on a first line AT. No difference was observed between disease activity groups.In the physician survey, 86% of physicians stated they followed T2T principals in at least some of their RA patients, and would utilize a T2T approach in RA patients with moderate-high disease activity (61%), the most uncontrolled patients (37%) and those who do not respond well to initial therapy (34%). In this sample of real-world RA patients, 66% were reported by physicians to be on a T2T plan at the time of data collection. The most common physician-reported targets were remission (DAS28: <2.6) (75%), improvement of quality of life (QoL) (41%) and reduction of pain (31%), with 85% of physicians perceiving these treatment goals were fully or partially met. The most stated reasons for not implementing T2T was physician preference not to adjust current treatment (34%), patient preference not to adjust current treatment (23%), and there are no achievable goals for this patient (16%).Overall, 29% of patients reported they were involved in setting their T2T goals, while 34% stated their T2T goals were set by their physicians only, and 29% perceived no T2T goal had been set (n=620). The most common overall T2T goals from the patient perspective were remission (61%), controlling symptoms (41%), and reducing impact on QoL (34%). Of those patients who acknowledged a T2T goal had been set (n=407), 77% reported their T2T goal was fully or partially achieved.Of 719 patients who had moderate-high disease activity, 57% were on a T2T plan, with 46% of physicians perceiving these treatment goals were fully or partially met. The most common physician-stated reason for not implementing T2T was a lack of achievable targets (29%).Conclusion:Rheumatologists in this study reported a strong belief in T2T. The most common physician-set T2T goals were remission, improvement of QoL and reduction of pain, corresponding with T2T goals as reported by patients. However, a third of patients in this cohort were not aware of a defined T2T objective in their management, which may be a result of a perceived lack of achievable goals by physicians. It may be desirable to promote more patient involvement in defining achievable targets amongst those with moderate-high disease activity who despite best efforts may not reach a clinical state of remission. Further research is needed to identify and understand goals important to RA patients.References:[1]van Vollenhoven R. Treat-to-target in rheumatoid arthritis - are we there yet? Nat Rev Rheumatol. 2019;15(3):180-6.Acknowledgements:This study was funded by Galapagos NV, Belgium.Medical writing support was provided by Gary Sidgwick, PhD (Adelphi Real World, Bollington, UK) and editorial support was provided by Debbie Sherwood, BSc, CMPP (Aspire Scientific, Bollington, UK), both funded by Galapagos NV.Disclosure of Interests:Bruno Fautrel Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Celltrion, Fresenius Kabi, Gilead, Janssen, Lilly, Medac, MSD, Mylan, NORDIC Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi-Genzyme, SOBI, UCB, Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Roberto Caporali Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Celltrion, Galapagos, Gilead, Lilly, Pfizer, Roche, UCB, Sanofi, Fresenius Kabi, Samsung Bioepis, MSD, Consultant of: Galapagos, Gilead, Lilly, Janssen, MSD, Elizabeth Holdsworth Employee of: Adelphi Real World, Bethany Donaghy Employee of: Adelphi Real World, Mona Khalid Shareholder of: Galapagos, Employee of: Galapagos, Mark Moore Shareholder of: Gilead Sciences, Speakers bureau: Gilead Sciences (only as employee), Paid instructor for: Gilead Sciences (only as employee), Consultant of: Gilead Sciences (only as employee), Grant/research support from: Gilead Sciences (only as employee), Employee of: Gilead Sciences, and previously Sanofi and AstraZeneca, Katrien Van Beneden Shareholder of: Galapagos, Employee of: Galapagos, Yves Piette Consultant of: AbbVie, Amgen, Galapagos, Grünenthal and Sandoz, Grant/research support from: Amgen, Mylan and UCB, Susana Romero-Yuste Speakers bureau: AbbVie, Amgen, Bristol Myers Squibb, Grunenthal, Kern Pharma, Lilly, Roche, Sandoz, Sanofi, UCB, Janssen, Consultant of: AbbVie, Biogen, Fresenius, Galapagos, Gebro, Janssen, Lilly, Grant/research support from: Bristol Myers Squibb, MSD, Novartis, Pfizer, Jasper Broen Shareholder of: Pharming Group, Consultant of: Galapagos, Gilead, Novartis, Peter C. Taylor Consultant of: AbbVie, Biogen, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Pfizer, Roche, Sanofi, Nordic Pharma, Fresenius, UCB, Grant/research support from: Celgene, Galapagos, Gilead, Lilly
Collapse
|
21
|
92 Reshaping the Diagnostic Pathways for Investigation of Haematuria During and After The COVID-19 Pandemic: Diagnostic Accuracy of Strategies for Detection of Bladder Cancer from The IDENTIFY Cohort Study. Br J Surg 2021. [PMCID: PMC8135806 DOI: 10.1093/bjs/znab135.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway.
Method
The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway.
Results
8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer.
Conclusions
We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.
Collapse
|
22
|
Correction to: Nectar-dwelling microbes of common tansy are attractive to its mosquito pollinator, Culex pipiens L. BMC Ecol Evol 2021; 21:37. [PMID: 33685389 PMCID: PMC7941694 DOI: 10.1186/s12862-021-01769-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
23
|
Nectar-dwelling microbes of common tansy are attractive to its mosquito pollinator, Culex pipiens L. BMC Ecol Evol 2021; 21:29. [PMID: 33593286 PMCID: PMC7885224 DOI: 10.1186/s12862-021-01761-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/08/2021] [Indexed: 11/14/2022] Open
Abstract
Background There is widespread interkingdom signalling between insects and microbes. For example, microbes found in floral nectar may modify its nutritional composition and produce odorants that alter the floral odor bouquet which may attract insect pollinators. Mosquitoes consume nectar and can pollinate flowers. We identified microbes isolated from nectar of common tansy, Tanacetum vulgare, elucidated the microbial odorants, and tested their ability to attract the common house mosquito, Culex pipiens. Results We collected 19 microbial isolates from T. vulgare nectar, representing at least 12 different taxa which we identified with 16S or 26S rDNA sequencing as well as by biochemical and physiological tests. Three microorganisms (Lachancea thermotolerans, Micrococcus lactis, Micrococcus luteus) were grown on culture medium and tested in bioassays. Only the yeast L. thermotolerans grown on nectar, malt extract agar, or in synthetic nectar broth significantly attracted Cx. pipiens females. The odorant profile produced by L. thermotolerans varied with the nutritional composition of the culture medium. All three microbes grown separately, but presented concurrently, attracted fewer Cx. pipiens females than L. thermotolerans by itself. Conclusions Floral nectar of T. vulgare contains various microbes whose odorants contribute to the odor profile of inflorescences. In addition, L. thermotolerans produced odorants that attract Cx. pipiens females. As the odor profile of L. thermotolerans varied with the composition of the culture medium, we hypothesize that microbe odorants inform nectar-foraging mosquitoes about the availability of certain macro-nutrients which, in turn, affect foraging decisions by mosquitoes.
Collapse
|
24
|
Abstract
Blue whales Balaenoptera musculus at South Georgia were heavily exploited during 20th century industrial whaling, to the point of local near-extirpation. Although legal whaling for blue whales ceased in the 1960s, and there were indications of blue whale recovery across the wider Southern Ocean area, blue whales were seldom seen in South Georgia waters in subsequent years. We collated 30 yr of data comprising opportunistic sightings, systematic visual and acoustic surveys and photo-identification to assess the current distribution of blue whales in the waters surrounding South Georgia. Over 34000 km of systematic survey data between 1998 and 2018 resulted in only a single blue whale sighting, although opportunistic sightings were reported over that time period. However, since 2018 there have been increases in both sightings of blue whales and detections of their vocalisations. A survey in 2020 comprising visual line transect surveys and directional frequency analysis and recording (DIFAR) sonobuoy deployments resulted in 58 blue whale sightings from 2430 km of visual effort, including the photo-identification of 23 individual blue whales. Blue whale vocalisations were detected on all 31 sonobuoys deployed (114 h). In total, 41 blue whales were photo-identified from South Georgia between 2011 and 2020, none of which matched the 517 whales in the current Antarctic catalogue. These recent data suggest that blue whales have started to return to South Georgia waters, but continued visual and acoustic surveys are required to monitor any future changes in their distribution and abundance.
Collapse
|
25
|
Have whales returned to a historical hotspot of industrial whaling? The pattern of southern right whale Eubalaena australis recovery at South Georgia. ENDANGER SPECIES RES 2020. [DOI: 10.3354/esr01072] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Around 176500 whales were killed in the sub-Antarctic waters off South Georgia (South Atlantic) between 1904 and 1965. In recent decades, whales have once again become summer visitors, with the southern right whale (SRW) the most commonly reported species until 2011. Here, we assess the distribution, temporal pattern, health status and likely prey of SRWs in these waters, combining observations from a summertime vessel-based expedition to South Georgia, stable isotope data collected from SRWs and putative prey and sightings reports collated by the South Georgia Museum. The expedition used directional acoustics and visual surveys to localise whales and collected skin biopsies and photo-IDs. During 76 h of visual observation effort over 19 expedition days, SRWs were encountered 15 times (~31 individuals). Photo-IDs, combined with publicly contributed images from commercial vessels, were reconciled and quality-controlled to form a catalogue of 6 fully (i.e. both sides) identified SRWs and 26 SRWs identified by either left or right sides. No photo-ID matches were found with lower-latitude calving grounds, but 3 whales had gull lesions supporting a direct link with Península Valdés, Argentina. The isotopic position of SRWs in the South Georgia food web suggests feeding on a combination of copepod and krill species. Opportunistic reports of SRW sightings and associated group sizes remain steady over time, while humpback whales provide a strong contrast, with increased sighting rates and group sizes seen since 2013. These data suggest a plateau in SRWs and an increasing humpback whale presence in South Georgia waters following the cessation of whaling.
Collapse
|
26
|
PO-1625: Deformable image registration (DIR) and radiobiological recalculation for retreat plan evaluation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Novel Approach to Disseminate Educational Materials Using Technology. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Our facility initiated a modification to an existing on-site Specialist in Blood Bank Technology and Transfusion Medicine (SBB) Program, in July 2018. The modification changed a local program to a hybrid on-site and distance learning program. The curriculum was established using a dynamic repository of recorded presentations (video/audio recordings and PowerPoint/audio presentations) as part of the self-paced, didactic educational portion of the program. The challenge was to provide a primary method for accessing the didactic portion of the program that would be flexible and available through a variety of venues. Our SBB Program was awarded $2,500 by the ASCP Foundation Laboratory Science Program Director Educational Grant in 2018 in support of modifying the current SBB program to a modified, hybrid on-site plus on-line program.
Methods
The grant provided the necessary seed money to purchase iPads, seen as the method for delivery of the educational materials. The Apple iPad® (Apple, Inc., One Apple Park Way, Cupertino, CA 95014) was purchased to enable student access to on-line lecture materials through the company’s secure web portal. The SBB Program Director prepared the iPad for the students to ensure the on-line links were usable. The Directors demonstrated the use of the iPad to the students for accessing educational content during the orientation week.
Results
NA-Educational Practice Abstract
Conclusion
The acquisition of iPads offered the flexibility needed by the students to access learner materials throughout their day where Wi-Fi is available (at work, home, café, etc.) without being dependent upon work or home computers. Further, use of the iPads has opened the opportunity to access assignments, download required texts where electronically available, and access the company learner management system for completing quizzes related to the student assignments.
Collapse
|
28
|
WFPHA Immunisation position paper: advocating together for equitable and effective immunisation. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
M. Moore will present the solutions and next steps highlighted in WFPHA position paper to create a sense of ownership by all health professionals to align their efforts and advocacy for equitable and effective immunization.
Collapse
|
29
|
Adapting a Complex, Integrated Health and Social Services Intervention in Two Communities. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
30
|
Leukocyte Adhesion Deficiency Type 1 Due to Novel ITGB2 Mutation. IRISH MEDICAL JOURNAL 2020; 113:129. [PMID: 33957747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Aim Marked neutrophilia and omphalitis in an infant resulted in the diagnosis of the first case of leukocyte adhesion deficiency type 1 (LAD1) in Ireland. Diagnosis LAD1 requires specific molecular diagnostics for its correct identification. Results Early identification of this disorder allowed for rapid referral for haemotopoeitic stem cell transplant which has resulted in an excellent outcome for this patient. Conclusion The identification of a previously unknown ITGB2 mutation resulting in LAD1 in Ireland should alert physicians to the diagnostic possibility of this extremely rare disorder.
Collapse
|
31
|
Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
Collapse
|
32
|
Does infrared red intubation system improve the fibreoptic intubation conditions? A randomised control trial. Br J Anaesth 2020. [DOI: 10.1016/j.bja.2020.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
33
|
Combined AlloSure and AlloMap Testing in Multi-Organ Heart Transplantation Rejection Surveillance. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
34
|
Use of Cardiac Grafts from Suicidal Hanging Donors: Single-Center Experience. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
35
|
Use of a non-ICU specialty ward for immediate post-operative management of head and neck free flaps; a randomized controlled trial. Oral Oncol 2019; 99:104464. [DOI: 10.1016/j.oraloncology.2019.104464] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
|
36
|
Is the solution really the ‘Nanny State’. Arm wrestling with industry. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
M. Moore will discuss the nanny state approach and the arm wrestling with the food industry, providing examples and facilitating the development of key advocacy skills to play this power game.
Collapse
|
37
|
P2.01-52 Clinical Characteristics and Outcomes in NSCLC Patients Associated with Very High PD-L1 Expression. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
38
|
Complementary medicine (CM) use in phase III clinical trials (P3T) conducted by the Canadian Cancer Trials Group (CCTG). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
39
|
Quantum interference enables constant-time quantum information processing. SCIENCE ADVANCES 2019; 5:eaau9674. [PMID: 31334346 PMCID: PMC6641944 DOI: 10.1126/sciadv.aau9674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 06/14/2019] [Indexed: 05/27/2023]
Abstract
It is an open question how fast information processing can be performed and whether quantum effects can speed up the best existing solutions. Signal extraction, analysis, and compression in diagnostics, astronomy, chemistry, and broadcasting build on the discrete Fourier transform. It is implemented with the fast Fourier transform (FFT) algorithm that assumes a periodic input of specific lengths, which rarely holds true. A lesser-known transform, the Kravchuk-Fourier (KT), allows one to operate on finite strings of arbitrary length. It is of high demand in digital image processing and computer vision but features a prohibitive runtime. Here, we report a one-step computation of a fractional quantum KT. The quantum d-nary (qudit) architecture we use comprises only one gate and offers processing time independent of the input size. The gate may use a multiphoton Hong-Ou-Mandel effect. Existing quantum technologies may scale it up toward diverse applications.
Collapse
|
40
|
Bilateral Neonatal Suppurative Sialadenitis Progressing to Abscess Formation in a Preterm Neonate. IRISH MEDICAL JOURNAL 2019; 112:955. [PMID: 31538752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aims We report a case of bilateral neonatal suppurative sialadenitis (NSS) in an extremely low birth weight infant (ELBW). Methods The infant developed bilateral sub-mandibular swelling at 3 weeks of age. NSS with abscess was confirmed with ultrasound. Despite intravenous antibiotic therapy the masses increased in size and developed abscesses. Results Unilaterally the abscess discharged via Wharton’s duct necessitating intubation to protect the airway. The abscess remnant was incised and drained. Culture grew a methicillin sensitive staphyloccocus aureus. The NSS resolved following two weeks of antibiotics. Conclusion We wish to highlight the importance of early recognition of this rare condition in preterm neonates.
Collapse
|
41
|
Help seeking for antibiotics; is the influence of a personal social network relevant? BMC FAMILY PRACTICE 2019; 20:63. [PMID: 31088394 PMCID: PMC6518744 DOI: 10.1186/s12875-019-0955-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/30/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Health policy focuses on reducing antibiotic prescribing that in order to succeed requires the public to hold similar attitudes towards judicious use. Social network influences on health behaviour and attitudes are well established and yet these influences are not sufficiently acknowledged in the UK's antibiotic stewardship programmes. Therefore, the aim of this study was to evaluate individuals' attitudes and behaviours towards antibiotics and also identify the social network influences on these in the process of help seeking for self-limiting illnesses. METHODS From a social network approach the methods used were a personal community mapping exercise which was carried out ahead of a semi-structured interview. A purposive sample was drawn from across the Wessex region and participants were recruited via GP practices and pharmacists. In total 14 adults, and 10 parents of children, who had received a prescription for antibiotics for a self-limiting illness within the 3 months preceding the interview were recruited and interviewed. RESULTS Three network types were identified; diverse, family and friend and restricted. The type of network an individual has appears to have an influence on antibiotic attitudes and behaviours. Most notably, the more diverse a network the more likely the individual will delay in help seeking from healthcare professionals as they draw upon self-care strategies advised by network members. The role of the GP varies according to network type too. Individuals' with diverse networks draw upon GP network members to provide clarity and certainty following a period of self-care. People with restricted networks are more reliant upon the GP, seek help quicker and also more likely to prioritise the GPs advice over other sources of information. CONCLUSION The understanding a social network approach brings to help seeking behaviour for antibiotics could help practitioners modify their consultation approach to mitigate some uncertainties and perceptions around prescribing behaviour.
Collapse
|
42
|
Past is Not Prologue - Immune Function Assay Results as a Predictor of Malignancy Post-Heart Transplant (HT). J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
43
|
Is There a Mortality “Weekend Effect” in Cardiac Transplantation - A Single Center Experience? J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
44
|
Effectiveness of the probiotic Streptococcus salivarius K12 for the treatment and/or prevention of sore throat: a systematic review. Clin Microbiol Infect 2019; 25:673-680. [PMID: 30616011 DOI: 10.1016/j.cmi.2018.12.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/21/2018] [Accepted: 12/23/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Sore throat resulting from pharyngotonsillitis is one of the commonest reasons for primary care consultation and inappropriate antibiotic prescription and finding effective alternative treatments is important. OBJECTIVES To review the evidence for using the probiotic Streptococcus salivarius K12 (SsK12) for the prevention or treatment of pharyngotonsillitis. DATA SOURCES PubMed, Embase, CINAHL and Cochrane Library. STUDY ELIGIBILITY CRITERIA Randomized controlled trials (RCTs). PARTICIPANTS Adults or children. INTERVENTIONS SsK12 as active treatment or prophylaxis, against pharyngotonsillitis. METHODS Literature search. RESULTS Four articles were identified (1846 participants). All were deemed to be of poor quality using the Cochrane risk-of-bias assessment. Two trials studied SsK12 prophylaxis for streptococcal pharyngitis (children without history of recurrence). One compared daily administration of SsK12 to no treatment over 6 months (n = 222, age 33-45 months), reporting significantly lower incidence in the SsK12 group (16.2% vs. 48.6%, p < 0.01), whereas another placebo-controlled RCT over four school terms (n = 1314, 5-14 years) found no significant difference (7.8% vs. 8.8%, p 0.34) with SsK12 (administered on school days). Another trial found daily SsK12 to significantly protect children (n = 250, 6-7 years) against chronic adenoiditis exacerbation over 3 months compared to no treatment (71.7% vs. 100%, p < 0.0001). The one placebo-controlled RCT in adults that studied the use of SsK12 for acute pharyngotonsillitis (concurrently with penicillin) showed no significant benefit. In all trials, SsK12 was safe and well tolerated. CONCLUSIONS SsK12 appears safe and well tolerated. However, further RCTs are required to establish its role as a prophylactic therapy, particularly among patients experiencing frequent exacerbations of pharyngitis. In the acute setting, SsK12 is unlikely to be effective if given concurrently with antibiotics; however, further RCTs should establish its role as an alternative to antibiotics in nonsevere cases or when prescribed after antibiotic therapy for the prevention of disease recurrence and/or secondary infection.
Collapse
|
45
|
Health promotion in Australia: Dealing with a reluctant industry. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
46
|
Microscopic colitis: a population-based case series over a 9-year period in Northern Ireland. Colorectal Dis 2018; 20:1020-1027. [PMID: 29742325 DOI: 10.1111/codi.14247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/22/2018] [Indexed: 02/08/2023]
Abstract
AIM We report clinicopathological experience of microscopic colitis (MC) in a population-based case series in Northern Ireland over a 9-year period. METHOD The pathology laboratory information system within a large teaching centre serving two healthcare trusts was interrogated for cases coded between 2008 and 2016 as collagenous colitis (CC) or lymphocytic colitis (LC). Demographic, clinical and follow-up information was collected from healthcare records. RESULTS A total of 326 new diagnoses of MC were identified, an average annual incidence of 6.7 per 100 000 population. The average annual incidence of CC and LC was 5.0 and 1.7 per 100 000 population, respectively. For coding reasons it is likely that LC data are incomplete. Of 191 cases diagnosed by specialist gastrointestinal pathologists, 141 patients had CC and 50 patients had LC. Both CC and LC predominantly involved women aged 60-79. Some 15% demonstrated endoscopic abnormalities. Endoscopic sampling protocols varied widely: 30% of individuals with CC and 32% of those with LC had the right and left colon sampled separately, with histology concordant in 95% of cases. Of the 191 cases, only one case (of LC) was refractory to treatment; the rest exhibited a clinical response. Only 35 patients had follow-up endoscopy and biopsies, and three of each diagnosis showed persistent disease on histology. CONCLUSION Overall, CC and LC are benign conditions with similar demographics, clinical associations, management and outcomes. Separate sampling of the right and left colon is advised at colonoscopy if this diagnosis is being considered, but left colonic sampling, which can be performed at flexible sigmoidoscopy, will diagnose the vast majority of cases.
Collapse
|
47
|
A Comparison of Pain Scores in Patients Undergoing Transcervical Radiofrequency Ablation of Uterine Fibroids Under General Anesthesia or Conscious Sedation in the SONATA Pivotal IDE Trial. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
48
|
Embedding The Global Charter into Australian health strategies. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
49
|
Prognostic value of change in neutrophil-lymphocyte ratio during treatment with first-line anti-PD1 therapy in metastatic melanoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
50
|
Ultra-Rapid Reversal of Rocuronium-Induced Paralysis with Sugammadex in the Emergency Department. J Emerg Nurs 2018; 44:529-531. [PMID: 30236301 DOI: 10.1016/j.jen.2018.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|