bluuebunny/crossref_metadata_2025 huggingface dataset:
Distant supervision of trainee emergency physicians undertaking a remote placement: A preliminary evaluation
Authors: Gill Stephen D , Stella Julian , Blazeska Marija , Bartley Bruce
Published: February 2020

Objective

Clinical supervision is an essential part of post‐graduate medical training. The current study investigated emergency medicine trainees' experiences and preferences regarding distant supervision via information and communication technology (ICT).

Methods

Four emergency medicine trainees completed a 6‐month placement, one at a time, at a rural urgent care centre. Trainees were remotely supervised by emergency physicians located at another ED using ICT. Trainees recorded the frequency and content of their distant supervision experiences. Trainees also completed semi‐structured interviews before and after the placement to describe their experiences and preferences regarding distant supervision. Quantitative data were analysed descriptively using counts and proportions. Qualitative data were analysed using the principles of thematic analysis.

Results

Trainees provided care to 1458 patients and communicated with a supervisor for 126 (8.6%) patients. Phone or audio‐visual ICT was used for 111 (88.1%) and 12 (9.5%) patients, respectively. Trainees described the placement as a unique learning experience that demanded independent practice, enhanced their communication and leadership skills and increased their confidence. The trainees also described disadvantages to the placement such as reduced quality and quantity of communication with supervisors, ICT failure and the supervisor's inability to provide hands‐on assistance. Trainees provided their perspectives on the essential requirements of a successful remote placement that involved distant supervision.

Conclusions

According to trainees, distant supervision had positive and negative effects on their supervision experiences, professional development and on patient management. Trainees used ICT infrequently. The trainee's perspectives on the ideal components of a remote placement programme are presented.
Bioactive peptides from brown rice protein hydrolyzed by bromelain: Relationship between biofunctional activities and flavor characteristics
Authors: Selamassakul Orrapun , Laohakunjit Natta , Kerdchoechuen Orapin , Yang Liping , Maier Claudia S.
Published: February 2020

This study evaluated the biological properties of peptides from brown rice protein hydrolyzed by bromelain (eb‐RPH) in relation to flavor characteristic. The fractionation into peptides < 1 kDa was observed to improve the DPPH, ABTS, and hydroxyl radical‐scavenging activities (0.19, 2.28, and 24.64 mM Trolox, respectively), angiotensin‐converting enzyme (ACE)‐inhibitory activity (IC50 value of 0.20 ± 0.011 mg protein/mL), as well as bitter and umami tastes. The < 1 kDa fraction was further analyzed by liquid chromatography‐electrospray ionization/mass spectrometry to identify amino acid sequence associated with biological activities and flavor characteristics. Eight peptides were identified. Most of the identified peptides contained features of previously reported ACE inhibitory and antioxidant peptides, especially peptide FGGSGGPGG and FGGGGAGAGG. Evaluation of flavor characteristics using BIOPEP database demonstrated that they had high occurrence frequencies of umami peptides (ESDVVSDL, GSGVGGAK, and SSVGGGSAG) and low Q‐value (938.75 to 282.22), suggesting that these peptides may be used as a fortifying health ingredient with good taste.

Practical Application

The fractionated brown rice protein hydrolysate (< 1 kDa) has the potential to serve as a functional food ingredient in nutraceutical food and beverage products that can provide health benefits with good taste. Information on amino acid composition and spatial conformation of peptide may aid us to better understand the molecular mechanisms involved in bioactivities and flavor of brown rice peptide for industrial applications.
Percutaneous thermal ablation alone or in combination with cementoplasty for renal cell carcinoma osseous metastases: Pain palliation and local tumour control
Authors: Tomasian Anderanik , Madaelil Thomas P , Wallace Adam N , Wiesner Elizabeth , Jennings Jack W
Published: February 2020

Introduction

To evaluate the safety and efficacy of minimally invasive percutaneous thermal ablation alone or in combination with cementoplasty for pain palliation and local tumour control of renal cell carcinoma osseous metastases.

Methods

Imaging‐guided thermal ablation was performed in 59 renal cell carcinoma osseous metastatic tumours in 23 patients (concomitant cementoplasty in 43 tumours) selected following multidisciplinary consultations to achieve local tumour control and pain palliation (75%, 44/59) or pain palliation alone (25%, 15/59) in this retrospective study. Tumour characteristics, procedural details and complications were documented. Pain palliation was assessed using pre‐ and post‐procedural Numeric Rating Scale scores at 1‐week, 1‐month, 3‐month and 6‐month time intervals. Pre‐ and post‐procedural cross‐sectional imaging was reviewed to assess local tumour control rates at 3‐month, 6‐month, and 12‐month post‐treatment time intervals.

Results

All procedures were technically successful and performed as pre‐operatively planned. The median pre‐ and post‐procedural Numeric Rating Scale scores were 8.0 and 3.0 (at all time intervals), respectively (P < 0.001). Local tumour control rates were 100% (40/40), 100% (36/36) and 85% (28/33) at ≥3 months, ≥6 months and ≥12 months post‐procedural time intervals, respectively. There was 1 minor complication (1.7%, 1/59).

Conclusions

Percutaneous thermal ablation alone or in combination with cementoplasty is safe and effective for pain palliation and local tumour control of renal cell carcinoma osseous metastases.
Long‐term response with durvalumab after chemoradiotherapy for pulmonary pleomorphic carcinoma: A case report
Authors: Yorozuya Takafumi , Taya Tetsuya , Yasuda Kento , Nagano Yutaro , Shioya Makoto , Chiba Hirofumi , Takahashi Hiroki
Published: February 2020

Pulmonary pleomorphic carcinoma (PPC) is a non‐small‐cell lung cancer, resistant to chemotherapy and no standard therapy has as yet been established. We herein report the case of a 59‐year‐old man with PPC who showed a long‐term response with durvalumab after chemoradiotherapy. He was referred to our hospital with a mass shadow at the right upper lung. PPC clinical stage IIIB was diagnosed, and the tumor proportion score of programmed death‐ligand 1 (PD‐L1) was 100%. Six days after transbronchial biopsy, he had difficulty walking owing to sensory abnormalities. We found that the primary tumor had invaded the spinal cord and compressed the cord at T1–T4, resulting in the abnormalities. He underwent tumor resection and received chemotherapy involving cisplatin (CDDP) + S‐1 and concurrent radiotherapy (66 Gy). Subsequently, durvalumab treatment as consolidation therapy was commenced. After one year of durvalumab treatment had been completed, he had no apparent signs of relapse or severe adverse events. This case suggests that a long‐term response can be achieved with durvalumab after chemoradiotherapy for stage III inoperable PPC showing high PD‐L1 expression.

Key Points

Significant findings of the report

A long‐term response might be achieved with durvalumab after chemoradiotherapy in patients with stage III inoperable pulmonary pleomorphic carcinoma showing high expression of programmed death‐ligand

What this study adds

It is possible to continue durvalumab treatment for one year without any severe adverse events. Although pulmonary pleomorphic carcinoma is considered to have a poor prognosis, the combination therapy of immune checkpoint inhibitors and radiotherapy may be an effective treatment option.
Utility of CT radiomics for prediction of PD‐L1 expression in advanced lung adenocarcinomas
Authors: Yoon Jiyoung , Suh Young Joo , Han Kyunghwa , Cho Hyoun , Lee Hye‐Jeong , Hur Jin , Choi Byoung Wook
Published: February 2020

Background

We aimed to assess if quantitative radiomic features can predict programmed death ligand 1 (PD‐L1) expression in advanced stage lung adenocarcinoma.

Methods

This retrospective study included 153 patients who had advanced stage (>IIIA by TNM classification) lung adenocarcinoma with pretreatment thin section computed tomography (CT) images and PD‐L1 expression test results in their pathology reports. Clinicopathological data were collected from electronic medical records. Visual analysis and radiomic feature extraction of the tumor from pretreatment CT were performed. We constructed two models for multivariate logistic regression analysis (one based on clinical variables, and the other based on a combination of clinical variables and radiomic features), and compared c‐statistics of the receiver operating characteristic curves of each model to identify the model with the higher predictability.

Results

Among 153 patients, 53 patients were classified as PD‐L1 positive and 100 patients as PD‐L1 negative. There was no significant difference in clinical characteristics or imaging findings on visual analysis between the two groups (P > 0.05 for all). Rad‐score by radiomic analysis was higher in the PD‐L1 positive group than in the PD‐L1 negative group with a statistical significance (−0.378 ± 1.537 vs. −1.171 ± 0.822, P = 0.0008). A prediction model that uses clinical variables and CT radiomic features showed higher performance compared to a prediction model that uses clinical variables only (c‐statistic = 0.646 vs. 0.550, P = 0.0299).

Conclusions

Quantitative CT radiomic features can predict PD‐L1 expression in advanced stage lung adenocarcinoma. A prediction model composed of clinical variables and CT radiomic features may facilitate noninvasive assessment of PD‐L1 expression.

Key points

Significant findings of the study

Quantitative CT radiomic features can help predict PD‐L1 expression, whereas none of the qualitative imaging findings is associated with PD‐L1 positivity.

What this study adds

A prediction model composed of clinical variables and CT radiomic features may facilitate noninvasive assessment of PD‐L1 expression.
Language counts when learning mathematics with interactive apps
Authors: Outhwaite Laura A. , Gulliford Anthea , Pitchford Nicola J.
Published: February 2020

When available in multiple languages, educational apps can deliver the same mathematics instruction in the child’s first language or different language of instruction. This pilot study examined the feasibility of a maths app intervention compared to standard mathematical practice with 61 children aged 5–6 years attending a bilingual immersion school in Brazil. The apps were delivered in either the child’s first (L1, Brazilian Portuguese) or second (L2, English) language, while app content, time on task, and school setting were consistent across the two treatment groups. Time on task in the comparison group was less. After 10 weeks, results showed children made significant mathematical learning gains with the apps, for both languages of instruction, compared to standard practice: the finding is discussed in relation to the threat of time spent on task. Children using the apps in Brazilian Portuguese (L1) completed more app topics than children using the apps in English (L2) and proficiency in language of instruction correlated positively with app progress. As children’s L1 was significantly stronger than their L2 proficiency, this suggests the apps were most effectively implemented in their L1. This study advances the conjoining of bilingual educational theories to educational apps in a controlled, real‐world, bilingual immersion setting and highlights important directions for improving app‐based mathematics instruction for bilingual children.

Practitioner Notes

What is already known about this topic

Educational maths apps, available in multiple languages are increasingly popular.

Emerging evidence demonstrates the benefits of maths apps for supporting children’s mathematical development.

To understand “what works” in the use of maths apps we need to consider factors that may impact outcomes, including children’s proficiency in the language of instruction.

What this paper adds

When delivered in the child’s first or second language, maths apps can support the acquisition of basic maths skills.

To maximise engagement and learning with maths apps, children should have a sufficient level of proficiency in the language of instruction.

Implications for practice and/or policy

When deciding to implement maths apps with young children, educational practitioners and parents should consider the individual child’s proficiency in the languages spoken.
Platform switch hybrid zygoma implants improve prosthetics and marginal bone protection after extra‐sinus placement
Authors: Aleksandrowicz Paweł , Kusa‐Podkańska Marta , Tomkiewicz Witold , Kotuła Lidia , Perek Jan , Wysokińska‐Miszczuk Joanna
Published: February 2020

Purpose

The aim of our studdy is clinical evaluation of Platform switch hybrid zygoma implants.

Materials and Methods

117 zygomatic implants were followed up during this time. They included 55 Brånemark System zygoma implants, 38 Noris implants, and 24 novel iRES hybrid implants with platform switch.

Results

Bone quality and quantity are the prerequisite for successful implant treatment. Zygomatic implants are intended for patients with severely resorbed maxilla that cannot accommodate conventional implants without prior extensive bone grafting. Such regenerative procedures, like sinus lifts, prolong implant rehabilitation to several months (12–18). Furthermore, extensive grafts are less predictable showing varying degrees of graft resorption. Zygoma implants enable full, often immediate, reconstruction of the upper dental arch without the need for sinus lift treatment. The original zygoma protocol runs the implants through the sinus, requires general anesthesia, and positions the prosthetic platform of the implants on the palate, which makes prosthesis cumbersome. It also induces risk for post‐op sinusitis. Extra‐sinus approach with novel zygoma hybrid implants bypasses sinuses and positions the implant prosthetic platform on the crest allowing for same good prosthetics as on conventional dental implants. Furthermore, crestal threads and a platform‐switch, of the novel zygoma design, increase implant anchorage and minimize marginal bone loss. The study presents evolution of zygoma implant rehabilitation protocol and zygoma implant design in our clinical practice over 15 years (2004‐2019).

Conclusion

Extra‐sinus zygomatic implant placement lowers the risk of post‐op sinusitis and makes procedure possible to be done in local anesthesia.
Diaphragm thickening assessed by ultrasonography is lower than healthy adults in patients with chronic obstructive pulmonary disease
Authors: Okura Kazuki , Iwakura Masahiro , Shibata Kazuyuki , Kawagoshi Atsuyoshi , Sugawara Keiyu , Takahashi Hitomi , Satake Masahiro , Shioya Takanobu
Published: February 2020

Background

Ultrasound imaging has been widely used for imaging of the diaphragm thickness (Tdi) and thickening. Few studies assessed the Tdi using ultrasonography in patients with chronic obstructive pulmonary disease (COPD). We measured the Tdi and thickening in patients with COPD compared with healthy younger and healthy older adults to reveal the influence of ageing and/or COPD.

Methods

Thirty‐eight male patients with COPD (age 72 ± 8 years), 15 healthy younger (age 22 ± 1 years) and 15 healthy older (age 72 ± 5 years) male volunteers were recruited. We measured Tdi at total lung capacity (TdiTLC), functional residual capacity (TdiFRC) and residual volume (TdiRV) using B‐mode ultrasonography. We calculated the change ratio of TdiTLC and TdiRV (ΔTdi%). We used a one‐way analysis of variance and multiple comparison test for the comparison analysis.

Results

The TdiTLC and the ΔTdi% were significantly lower in patients with COPD compared to the healthy adults. There was no significant difference in these values with age. There was no between group difference in the TdiFRC or TdiRV.

Conclusions

Our results indicate significant differences in TdiTLC and ΔTdi% between patients with COPD and healthy adults. Therefore, diaphragm ultrasonography can assess diaphragm dysfunction associated with COPD. We suggest that it is better to use TdiTLC and ΔTdi% (not only Tdi at rest) to assess diaphragm function.
Identification of a novel cystic fibrosis mutation in three patients of South Asian descent
Authors: Semple Aisling , Clark Tara , Allen Nicholas M. , Krishnananthan Thanuja , Nwokoro Chinedu , Girodon Emmanuelle , Porzio Michele , Herzig Mary
Published: February 2020

Introduction

The cystic fibrosis (CF) clinical profile and associated CFTR mutation spectrum is poorly understood in the South Asian population. This is likely due to the lack of diagnostic resources and the absence of a centralised CF database and screening programme, despite a relatively large proportion of the global population.

Methods

Following identification of a previously unreported CFTR mutation (c.2805_2810delinsTCAGA; p.(Pro936Ginfs*6)) in a newly diagnosed patient of Indian descent, we interrogated national registries for other cases.

Results

We identified three European‐born subjects of South Asian descent with CF due to a novel CFTR mutation. All three subjects presented in infancy and each had a severe phenotype with intestinal complications as a presenting feature. Two subjects were diagnosed prior to the advent of universal screening. Preliminary genetic screening failed to identify the causative mutation in all three patients.

Conclusion

Our work highlights the value of extended or targeted genotyping in selected populations. It also demonstrates the benefit of routine collaboration between national registries. This will promote the identification of novel mutations; leading to greater understanding of genotype‐phenotype associations, improved individual prognostication and ultimately the improved availability of novel precision therapies. This collaboration is essential if we are to achieve health equality for people with CF living in resource‐limited settings.
A qualitative exploration of mental health service user and carer perspectives on safety issues in UK mental health services
Authors: Berzins Kathryn , Baker John , Louch Gemma , Albutt Abigail
Published: February 2020

Background

Service user and carer perspectives on safety issues in mental health services are not well known and may be important in preventing and reducing harm. The development of the Yorkshire Contributory Factors Framework—Mental Health (YCFF‐MH) provides a broad structure within which to explore these perspectives.

Objective

To explore what service users of mental health services and their carers consider to be safety issues.

Design, setting and participants

Qualitative interviews with 13 service users and 7 carers in the UK. Participants were asked about their experiences and perceptions of safety within mental health services. Perceived safety issues were identified using framework analysis, guided by the YCFF‐MH.

Results

Service users and carers identified a broad range of safety issues. These were categorized under ‘safety culture’ and included psychological concepts of safety and raising concerns; ‘social environment’ involved threatened violence and sexual abuse; ‘individual service user and staff factors’ dominated by not being listened to; ‘management of staff and staffing levels’ resulting in poor continuity of care; and ‘service process’ typified by difficulty accessing services during a crisis. Several examples of ‘active failures’ were also described.

Discussion and conclusions

Safety issues appear broader than those recorded and reported by health services and inspectorates. Many safety issues have also been identified in other care settings supporting the notion that there are overlaps between service users and carers’ perspectives of safety in mental health services and those of users in other settings. Areas for further research are suggested.
Post‐radiotherapy vascular lesions of the breast: immunohistochemical and molecular features of 74 cases with long‐term follow‐up and literature review
Authors: Corradini Angelo G , Asioli Sofia , Morandi Luca , Brotto Maurizio , Righi Alberto , Iommi Marica , Agostinelli Claudio , Rucci Paola , Asioli Silvia , Sapino Anna , Viale Giuseppe , Foschini Maria P
Published: February 2020

Aims

A wide range of post‐radiotherapy (RT) vascular lesions can occur, ranging from benign lymphangiomatous papules of the skin (BLAPs), to atypical vascular lesions (AVLs) and post‐RT angiosarcomas (ASs). The relationship between benign and malignant post‐RT breast lesions and their prognostic features are still controversial. The aims of this study were to investigate the relationship between benign and malignant mammary post‐RT vascular lesions and to define post‐RT AS prognostic features.

Methods and results

Seventy‐four post‐RT vascular lesion cases were obtained and stained with antibodies against CD34, CD31, D2‐40, Ki67, and c‐Myc. Mutational analysis was performed by deep sequencing for the following genes: KRAS, NRAS, HRAS, BRAF, PIK3CA, TP53, NOTCH1, PTEN, CDKN2A, EGFR, AKT1, CTNNB1, hTERT, and PTPRB. Post‐RT AS cases were graded according to a previously reported breast AS grading system. AVL cases showed a low number of HRAS and hTERT mutations, whereas post‐RT AS cases showed a high frequency of EGFR, TP53, HRAS and hTERT mutations. On follow‐up, all BLAP and AVL patients were alive with no evidence of disease. Post‐RT AS 5‐year overall survival declined with the increase in grade, as follows: 85.7% for grade 1, 83.3% for grade 2, and 40.4% for grade 3.

Conclusions

Our findings confirm that BLAP and AVL have a good prognosis, and that post‐RT AS prognosis is strongly related to histological grading. On molecular analysis, AVL and post‐RT AS shared HRAS and hTERT mutations, suggesting a relationship between the two lesions.
Association of metabolic syndrome with pediatric psoriasis: a case‐control study in Kabul, Afghanistan
Authors: Aalemi Ahmad Khalid , Hamdard Abdul Ghafar , Chen Hongxiang
Published: February 2020

Background

Limited studies have assessed the risk of metabolic syndrome in pediatric psoriasis. This study was aimed to investigate the association of obesity and metabolic syndrome with pediatric psoriasis in Afghanistan.

Methods

A case‐control study was conducted from March to December 2018 at the dermatology department of Maiwand Teaching Hospital in Kabul city. Participants were children aged less than 18 years; 113 children with psoriasis and 113 children without psoriasis were compared. Height, weight, waist circumference, and blood pressure were measured. Blood samples were taken following overnight fasting to test serum levels of glucose, triglyceride, cholesterol, and high‐density lipoprotein cholesterol. Analyses were done using Chi‐square test and independent t test. Odds ratio and 95% confidence interval were calculated.

Results

The mean age was 13.9 ± 3.7 and 13.4 ± 3.4 years in the psoriasis and control groups, respectively. Males comprised 54.9% of the psoriasis group and 41.6% of the control group. Family history of skin disorders was higher among children with psoriasis compared to the control group (23.0% vs. 13.7%; P < 0.001). Children with psoriasis were more likely to be overweight/obese (27.4% vs. 12.4%, OR = 2.67; P = 0.005), to have central adiposity with waist‐height ratio of 0.5 or greater (23% vs. 9.7%, OR = 2.77; P = 0.007), and to have metabolic syndrome (13.3% vs. 2.3%, OR = 5.23; P = 0.005).

Conclusion

The study revealed that children with psoriasis were more likely to have metabolic syndrome and cardiovascular risk factors compared to children without psoriasis.
Emotional attributes, social connectivity and quality of life associated with intermittent catheterization
Authors: Markiewicz Anna , Goldstine Jimena , Nichols Thom
Published: February 2020

Intermittent catheterization (IC) has benefits such as helping prevent urinary tract infections; however, there are physiological and psychological risk factors. To what extent this is a health burden is not well known and deserves investigation. The primary objective of this study was to explore emotional effects, social connectivity and quality of life (QoL) associated with IC. A search of peer reviewed literature finds adjustment to life after spinal cord injury impacted by emotional and behavioural changes. Some authors suggest that IC influences the emotional status of users. An IRB approved cross sectional survey, conducted through the United Spinal Association, investigated aspects of life, health and limitations associated with IC. Those surveyed (n = 393) were adults (≥18 years) performing IC as a primary method of bladder voiding. Potential respondents were sent email invitations explaining the study, rights and confidentiality and a non‐transferable link to the questionnaire. Opening the link and completing the questionnaire were considered consent to participate. Attributes of depression, anxiety, feeling bad about one's self, empowerment, independence and confidence associated with IC were investigated. The data suggests individuals with emotional distress are characterized by a lack of positive attributes rather than their ability to overcome negative attributes. The data indicates a positive correlation between social connectivity and QoL (r = 0.473, P < .001). We found respondents performing IC are generally socially connected, but characterized by decreased positive attributes while not necessarily negative attributes, and some attributes potentially being influenced by caregiver assisted catheterization. Increased social interactivity is linked to increase quality of life. We suggest that clinicians reinforce positive attributes and the need for social connectivity as part of patient education.
Efficacy of methotrexate in polymyalgia rheumatica in routine rheumatology clinical care
Authors: Ruediger Carlee , Nguyen Leanne , Black Rachel , Proudman Susanna , Hill Catherine
Published: February 2020

Background

Current guidelines recommend methotrexate (MTX) as a glucocorticoid‐sparing agent in patients with polymyalgia rheumatica (PMR) who relapse or suffer glucocorticoid adverse effects, although there is no level 1 evidence to support this recommendation.

Aims

To review the effect of MTX in PMR on inflammation and glucocorticoid dose.

Methods

Patients with PMR from rheumatology outpatient clinics at two tertiary centres were identified. A structured case note review was conducted for patient characteristics at diagnosis and medications including glucocorticoid and MTX use.

Results

There were 70 patients, 61% female; mean (range) age of 70 (51–87) years. At the time of diagnosis, median (±interquartile range) erythrocyte sedimentation rate (ESR) was 38.5 (26–74) mm/h and C‐reactive protein (CRP) 34.5 (6–74 mg/L) with median initiating prednisolone dose of 15 mg (range 5–60 mg). MTX was prescribed in 22 (31%) patients. Mean disease duration at MTX initiation was 2.5 years (1–7 years), with median (range) MTX dose of 10 mg (5–20 mg). At MTX initiation, median (interquartile range) (±standard deviation) ESR was 33 (13–60 mm/h) and CRP 19 (8–42 mg/L). Reasons for commencing MTX were disease relapse (34%) or inability to wean prednisolone dose (66%). Six months after MTX initiation, there was significant reduction in ESR (P = 0.012), CRP (P = 0.0003) and prednisolone dose (P < 0.0001). Eleven (50%) patients stopped MTX, five due to controlled PMR, and six due to adverse effects.

Conclusions

In this study of PMR patients in tertiary care, 31% were co‐prescribed MTX, after prolonged disease duration. MTX was associated with improved inflammatory activity and reduced prednisolone dose, with a relatively high risk of adverse events.
Reducing medication errors for hospital inpatients with Parkinsonism
Authors: Lance Sean , Travers Justin , Bourke David
Published: February 2020

Background

Patients with Parkinsonism are 1.5 times more likely than comparators to be hospitalised and have a significantly longer length of stay in hospital. Medication delays, inappropriate medication omission, and administration of contraindicated medications likely contribute to these poor outcomes. Education and hospital system interventions may reduce these errors.

Aim

To determine the effectiveness of a multimodal education and awareness campaign in reducing medication errors in patients with Parkinsonism at Hutt Hospital.

Methods

We performed an audit of hospital medication charts to establish the baseline medication error rate and patient outcomes over a 3‐month period. We then delivered an intervention consisting of staff education sessions, a sticker alert system and increased priority for pharmacist review of patient drug charts. We repeated the audit after the intervention.

Results

In the initial audit, the medication error rate was 22.5%, the clinical complication rate was 45% and one death was directly attributable to medication error. At follow up, the medication error and complication rates were 9.3% (absolute difference 13% (95% conflict of interest (CI) 10–16.4), P < 0.001) and 38% (absolute difference 7% (95% CI −19 to 34), P = 0.59), respectively, and there were no attributable deaths. The average length of stay before and after the intervention was 13 and 8 days respectively (absolute difference 5.7 days (95% CI −1.8 to 13.3), P = 0.135).

Conclusions

There was a high in‐hospital medication error rate for Parkinsonian patients. The intervention resulted in a statistically significantly improvement in the medication error rate. The estimated reductions in complication rate and length of stay may be clinically important. Similar interventions may be beneficial in other institutions.
Incidence and prevalence of pressure ulcers in cancer patients admitted to hospice: A multicentre prospective cohort study
Authors: Jakobsen Tina Bull Tafteberg , Pittureri Cristina , Seganti Patrizia , Borissova Elena , Balzani Isabella , Fabbri Samanta , Amati Piero , Donigaglia Sara , Gallina Silvia , Fabbri Elisabetta
Published: February 2020

Pressure ulcers lead to discomfort for patients and may have an important impact on a patient's quality of life. Measure the incidence and prevalence of pressure ulcers in a Hospice environment; evaluate the risk factors associated with pressure ulcers; and calculate the incidence of Kennedy Terminal Pressure Ulcers. This multicentre prospective cohort study enrolled 440 cancer patients in advanced phase, consecutively admitted to five hospices of the AUSL della Romagna (Italy), during a period of 1 year. Five hundred more patients were excluded from the study because of inability to sign the consent form or refusal to participate. All patients were adults above 18 years of age. The National Pressure Advisory Panel Classification System was used to evaluate the pressure ulcers. Potential risk predictors were evaluated through the Braden Scale, the Numerical Scale, and the Pain Assessment in Advanced Dementia Scale. Starting in September 2016, 214 (48.6%) females and 226 (51.4%) males were analysed. The incidence of pressure ulcers in the total population was 17.3%. The risk factors that influence the development of pressure ulcers were age, proximity to death, and duration of stay in Hospice. The incidence of Kennedy Terminal Pressure Ulcers was 2.7%. This study demonstrates that 17.3% of all patients admitted to a hospice setting developed a pressure ulcer. The longer the patients stay in hospice and the clinical condition deteriorates, the higher the risk of developing a pressure ulcer.
Gelatin/pectin‐based film incorporated with essential oils: Functional characteristics and shelf life extension of tilapia fillets under refrigeration
Authors: Aitboulahsen Mohamed , Chairi Hicham , Laglaoui Amine , Zantar Said , Abdelhay Arakrak , Bakkali Mohammed , Zerrouk Mounir Hassani
Published: February 2020

Fish gelatin‐pectin (GelExt/Pec) composite films incorporated with Mentha pulegium essential oil (MEO) and Lavandula angustifolia essential oil (LEO) at two concentrations (0.5% and 1.5%) were developed and their physicochemical, mechanical, and antimicrobial properties were determined. GelExt/Pec‐based film incorporated with 1.5% MEO (GelExt/Pec + 1.5% MEO) showed the highest antimicrobial activity against all bacterial strains tested. Incorporation of essential oils decreased significantly the tensile strength of all the films investigated. The film showing the best functional and antimicrobial properties (Gelext/Pec + 1.5% MEO) was used to prolong the shelf life of tilapia fillets under refrigeration. Control (unwrapped) and wrapped fillets were analyzed every 3 days in terms of microbiological (total viable count (TVC), psychrotrophic bacteria count (PC), lactic acid bacteria (LAB) and Enterobacteriaceae (ENT), and physicochemical parameters (total volatile base nitrogen [TVB‐N] and pH). Gelext/Pec + 1.5% MEO antimicrobial film retarded significantly (p < .05) the growth of TVC, LAB, PC, and ENT, throughout 12 days of storage compared with the control. Gelext/Pec + 1.5% MEO could be considered as an effective packaging to maintain the quality and extend the shelf life of tilapia fillets under refrigeration.
When a common language is missing: Nurse–mother communication in the NICU. A qualitative study
Authors: Kynoe Nina Margrethe , Fugelseth Drude , Hanssen Ingrid
Published: February 2020

Aims and objectives

To explore how communication in neonatal intensive care units (NICUs) between immigrant mothers and nurses take place without having a common language, and how these mothers experience their NICU stay.

Background

Admission of infants to NICU affects both parents and infants. Immigrant mothers constitute a vulnerable hospital population in need of culturally, linguistically and individually tailored information.

Design and methods

The study had a qualitative design reported according to the COREQ criteria. Eight mothers who spoke neither Scandinavian nor English went through individual semi‐structured interviews. Six mother–nurse interactions were observed, and eight nurses' experiences were explored through focus‐group interviews. All interviews were audio recorded and transcribed verbatim. The analysis was thematic and hermeneutic in character.

Results

Interpreters were present during the consultations with the physicians, but rarely during the daily nurse‐mother interactions. Nurses focused on daily routines, infant care guidance and mother–infant attachment. The mothers learned through demonstrations and hands‐on guidance. Language barriers made it difficult to assess the mothers' understanding, but the mothers expressed that they felt adequately included in the care of their infant and well informed and guided. Even so, both mothers and nurses expressed desire to use interpreters more regularly. The pictorial communication boards available lacked important vocabulary needed in neonatal nursing contexts and their use furthermore interrupted the mother–nurse conversation.

Conclusion

Body language, simple words, guesswork, trial and error characterised the nurse–mother interaction. The nurses adopted various communication strategies to help the mothers understand and give them a voice. Competent interpreters were used during meetings with physicians, but not during daily bedside guidance and information giving by nurses.

Relevance to clinical practice

Knowledge of immigrant mothers' and nurses' communication strategies and how both parties think, feel and act to overcome communication problem is necessary to improve clinical practice and reduce communication barriers.
Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective
Authors: Kuusisto Anne , Santavirta Jenni , Saranto Kaija , Korhonen Päivi , Haavisto Elina
Published: February 2020

Aims and objectives

To describe advance care planning (ACP) for patients with cancer in palliative care from professionals' perspective.

Background

The number of patients with cancer is increasing. Palliative care should be based on timely ACP so that patients receive the care they prefer.

Design

A scoping review.

Methods

A systematic literature search was conducted in January 2019. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist was used. The methodological quality of the studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Data were analysed with content analysis.

Results

Of 739 studies identified, 12 were eligible for inclusion. The settings were inpatient and outpatient facilities in special and primary care including oncology, palliative and hospice care. ACP consisted of patient‐oriented issues, current and future treatment, and end‐of‐life matters. The participants were nursing, medical or social professionals. ACP conversations rarely occurred; if they did, they took place at the onset, throughout and late in the cancer.

Conclusions

Professionals could not separate day‐to‐day care planning and ACP. ACP documentation was scattered and difficult to find and use. Professionals were unfamiliar with ACP, and established practices were lacking. ACP conversations mostly occurred in late cancer. Further research clarifying concepts and exploring the significance of ACP for patients and relatives is recommended.

Relevance to clinical practice

Our results support the use of ACP by a multidisciplinary team from the early stages of cancer as a discussion forum around patients' wishes and choices. We showed the need to raise professionals' awareness of ACP. Education and appropriate data tools for ACP are important as they may reduce reluctance and promote ACP use. This paper contributes to the wider global clinical community by pointing out the importance of standardising ACP contents and practices.
THE IMPACT OF THE EU EMISSIONS TRADING SYSTEM ON COMPETITIVENESS AND CARBON LEAKAGE: THE ECONOMETRIC EVIDENCE
Authors: Verde Stefano F.
Published: February 2020

This paper carefully surveys the econometric literature that tests for competitiveness effects and related carbon leakage caused by the EU Emissions Trading System (EU ETS). The results of this literature tell us that to date there is no evidence of the EU ETS having had widespread negative or positive effects on the competitiveness of regulated firms, nor is there evidence of significant carbon leakage. However, the paper also identifies three important caveats to this general conclusion. Firstly, the evidence we have still largely refers to the first two trading periods, namely Phases I (2005–2007) and II (2008–2012). Secondly, some heterogeneity of estimated effects is observed, but patterns, notably sectoral patterns, hardly emerge. Thirdly, very little explored is whether the EU ETS has had long‐term effects on the economy via investment leakage or firm dynamics. Further empirical studies investigating these long‐term effects are particularly desirable.
Network‐based recruitment of people who inject drugs for hepatitis C testing and linkage to care
Authors: Falade‐Nwulia Oluwaseun , Ward Kathleen M. , McCormick Sean , Mehta Shruti H. , Pitts Stephanie R. , Katz Stephanie , Chander Geetanjali , Thomas David L. , Sulkowski Mark , Latkin Carl A.
Published: February 2020

Although oral direct‐acting agent (DAA) therapies have the potential to reduce the burden of hepatitis C virus (HCV) infection, treatment uptake remains low, particularly among people who inject drugs (PWID). This study examined the feasibility of an innovative peer‐based recruitment strategy to engage PWID in HCV testing and treatment. We interviewed an initial set of HCV antibody‐positive PWID as ‘primary indexes’ to gather demographic, drug use, health information and drug network characteristics. Primary indexes were then briefly educated on HCV and its treatment and encouraged to recruit their injection drug ‘network members’ for HCV testing and linkage to care. Eligible network members were enrolled as ‘secondary indexes’ and completed the same index study procedures. In sum, 17 of 36 primary indexes initiated the recruitment of 64 network members who were HCV antibody positive and eligible to become indexes. In multivariable analysis, successful recruitment of at least one network member was positively associated with prior HCV treatment (OR 2.80; CI [1.01, 7.72]), daily or more injection drug use (OR 2.38; CI [1.04, 5.47]), and a higher number of injection drug network members (OR 1.20; CI [1.01, 1.42]). Among the 69 participants with chronic HCV not previously linked to HCV care at enrolment, 91% (n = 63) completed a linkage to HCV care appointment, 45% (n = 31) scheduled an appointment with an HCV provider, and 20% (n = 14) initiated HCV therapy. These findings suggest a potential benefit for peer‐driven, network‐based interventions focused on HCV treatment‐experienced PWID as a mechanism to increase HCV linkage to care.
Intravenous pharmacokinetics of moxifloxacin following simultaneous administration with flunixin meglumine or diclofenac in sheep
Authors: Altan Feray , Corum Orhan , Yildiz Ramazan , Eser Faki Hatice , Ider Merve , Ok Mahmut , Uney Kamil
Published: February 2020

In this study, the pharmacokinetics of moxifloxacin (5 mg/kg) was determined following a single intravenous administration of moxifloxacin alone and co‐administration with diclofenac (2.5 mg/kg) or flunixin meglumine (2.2 mg/kg) in sheep. Six healthy Akkaraman sheep (2 ± 0.3 years and 53.5 ± 5 kg of body weight) were used. A longitudinal design with a 15‐day washout period was used in three periods. In the first period, moxifloxacin was administered by an intravenous (IV) injection. In the second and third periods, moxifloxacin was co‐administered with IV administration of diclofenac and flunixin meglumine, respectively. The plasma concentration of moxifloxacin was assayed by high‐performance liquid chromatography. The pharmacokinetic parameters were calculated using a two‐compartment open pharmacokinetic model. Following IV administration of moxifloxacin alone, the mean elimination half‐life (t1/2β), total body clearance (ClT), volume of distribution at steady state (Vdss) and area under the curve (AUC) of moxifloxacin were 2.27 hr, 0.56 L h−1 kg−1, 1.66 L/kg and 8.91 hr*µg/ml, respectively. While diclofenac and flunixin meglumine significantly increased the t1/2β and AUC of moxifloxacin, they significantly reduced the ClT and Vdss. These results suggest that anti‐inflammatory drugs could increase the therapeutic efficacy of moxifloxacin by altering its pharmacokinetics.
A systematic review with meta‐analyses of text message‐delivered behaviour change interventions for weight loss and weight loss maintenance
Authors: Skinner Rebecca , Gonet Veronica , Currie Sinéad , Hoddinott Pat , Dombrowski Stephan U.
Published: February 2020

Short Message Service (SMS)‐delivered behaviour change interventions are frequently used to support weight management. This systematic review examines the effectiveness of SMS‐delivered behaviour change interventions for weight management. Electronic databases were searched for randomised controlled trials (RCTs) comparing SMS‐delivered adult weight management interventions to control groups, published between 1990 and 2018. Weight change was examined using random effects meta‐analyses at intervention cessation and postintervention follow‐up. Subgroup analyses examined intervention duration, SMS frequency, theory use, SMS interactivity, and SMS tailoring. Fifteen studies met inclusion criteria (2705 participants). For weight loss interventions (n = 12, 1977 participants), the mean difference in weight change was −2.28 kg (95% confidence interval [CI] −3.17 to −1.36 kg). No studies reported postintervention follow‐up. For weight loss maintenance interventions (n = 3, 728 participants), the mean difference in weight change was −0.68 kg (95% CI, −1.31 to −0.05 kg), and postintervention follow‐up (n = 2, 498 participants) effects were −0.57 kg (95% CI, −1.67 to 0.53 kg). No subgroup differences were found. SMS‐delivered behaviour change interventions for weight loss led to significant small to moderate weight loss and weight loss maintenance compared with control groups. Evidence on long‐term effects is limited. SMS‐delivered behaviour change interventions are a potentially effective and scalable intervention option for obesity treatment.
Streptococcus mutans SpxA2 relays the signal of cell envelope stress from LiaR to effectors that maintain cell wall and membrane homeostasis
Authors: Baker Jonathon L. , Saputo Sarah , Faustoferri Roberta C. , Quivey Robert G.
Published: February 2020

Streptococcus mutans is a major etiologic agent of dental caries, which is the most common chronic infectious disease worldwide. S. mutans is particularly adept at causing caries due to its exceptional capacity to form biofilms and its ability to survive acidic conditions that arrest acid production and growth in many more benign members of the oral microbiota. Two mechanisms utilized by S. mutans to tolerate acid are: modulation of the membrane fatty acid content and utilization of the F1F0‐ATPase to pump protons out of the cytosol. In this study, the role of the spxA2 transcriptional regulator in these two pathways, and overall cell envelope homeostasis, was examined. Loss of spxA2 resulted in an increase in the proportion of saturated fatty acids in the S. mutans membrane and altered transcription of several genes involved in the production of these membrane fatty acids, including fabT and fabM. Furthermore, activity of the F1F0‐ATPase was increased in the ∆spxA2 strain. Transcription of spxA2 was elevated in the presence of a variety of membrane stressors, and highly dependent on the liaR component of the LiaFSR system, which is known to sense cell envelope stress in many Gram‐positive bacteria. Finally, deletion of ∆spxA2 led to altered susceptibility of S. mutans to membrane stressors. Overall, the results of this study indicate that spxA2 serves a crucial role in transmitting the signal of cell wall/membrane damage from the LiaFSR sensor to downstream effectors in the SpxA2 regulon which restore and maintain membrane and cell wall homeostasis.
Internationalism, Peace, and Reconciliation: Anglo‐German Connections in the Youth Hostels Movement, 1930–1950
Authors: Cunningham Michael , Constantine Simon
Published: February 2020

This article examines the close relationship that existed between the English and Welsh Youth Hostel Association (YHA) and the Deutsche Jugendherbergswerk (DJH), the German pioneer movement, between 1930 and 1950, a period in which the hostelling movement also emerged as a transnational organization. It emphasizes the importance of shared cultural values and the influence that the German DJH had on the YHA from its beginnings. It argues that the internationalism and pacifism of the fledgling national association, its debt of gratitude to the parent organization, and close relationship between leading figures, all pushed it toward a position of accommodation with Germany, even when the German movement was subsumed within the racist, nationalist, and militarist Nazi movement in 1933. The YHA thus reinforced the spirit and policy of Appeasement between the wars. In the aftermath of war, however, the same commitment to peaceful cooperation between nations, and the same personal ties, saw the hostel movement re‐emerge as a vehicle for reconciliation. This case study thus highlights the ambivalent role that transnational associations have played (and continue to play) in normalizing relations with terroristic states, but also in facilitating peaceful co‐existence between nations.
Wittgenstein and Cassirer on Hinges and Relativity
Authors: Mion Giovanni
Published: February 2020

The paper explores the striking similarities between some of Wittgenstein’s core claims inOn Certainty(1969), including the famous hinge metaphor, and Cassirer’sEinstein’s Theory of Relativity(1921). Moreover, it suggests that Wittgenstein’s remark on relativity inOn Certaintymight have been triggered by his reading of Cassirer’s book.