bluuebunny/crossref_metadata_2025 huggingface dataset:
Protocol of a multimethod descriptive study: adapting hospital-to-home transitional care interventions to the rural healthcare context in Ontario, Canada
Authors: Fox Mary T , Sidani Souraya , Butler Jeffrey I , Skinner Mark W , Alzghoul Manal
Published: May 2019

Introduction

Faced with costly hospital readmissions of increasingly complex patient populations, transitional care is a priority throughout Ontario, Canada; yet, rural patients have significantly more hospital readmissions and emergency department visits during the first 30 days following hospitalisation than urban patients. Because transitional care (TC) was designed and evaluated with urban patients, addressing urban-rural disparities in TC effectiveness requires increasing the alignment of TC with the needs of patients and families in rural communities and the rural nursing practice context. The study objectives are to (1) determine the perceived acceptability of evidence-based TC interventions targeting postdischarge care management to patients, families and nurses and (2) adapt the interventions to patients’ and families’ needs and the rural nursing practice context.

Methods and analysis

This multimethod study has two phases. In phase I, 32–48 patients and families will rate their level of preparedness for discharge and the acceptability of evidence-based TC interventions. Participants will be engaged in semi-structured interviews about their care management needs, their perspectives on the interventions in fitting those needs and in providing suggestions for adapting the interventions to fit their needs. TC interventions perceived as acceptable to patients and families will be examined in phase II. In phase II, 32–48 hospital and home care nurses will rate the acceptability of the interventions identified by patients and families and attend focus group discussions on the feasibility of providing the interventions. Phase I and II data will be analysed using descriptive statistics and qualitative content analysis.

Ethics and dissemination

Ethics approval was obtained from the Research Ethics Board at York University and participating hospital sites. Findings will be communicated through plain language fact sheets, policy briefs, press-releases and peer-reviewed conference presentations and manuscripts.
Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: a realist evaluation case study
Authors: Lovink Marleen Hermien , Laurant Miranda GH , van Vught Anneke JAH , Maassen Irma , Schoonhoven Lisette , Persoon Anke , Koopmans Raymond TCM
Published: May 2019

Objectives

This study aimed to gain insight into how substitution of elderly care physicians (ECPs) by nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs) in nursing homes is modelled in different contexts and what model in what context contributes to perceived quality of healthcare. Second, this study aimed to provide insight into elements that contribute to an optimal model of substitution of ECPs by NPs, PAs or RNs.

Design

A multiple-case study was conducted that draws on realist evaluation principles.

Setting

Seven nursing homes in the Netherlands

Participants

The primary participants were NPs (n=3), PAs (n=2) and RNs (n=2), working in seven different nursing homes and secondary participants were included; ECPs (n=15), medical doctors (MDs) (n=2), managing directors/managers/supervisors (n=11), nursing team members (n=33) and residents/relatives (n=78).

Data collection

Data collection consisted of: (1) observations of the NP/PA/RN and an ECP/MD, (2) interviews with all participants, (3) questionnaires filled out by the NP/PA/RN, ECPs/MDs and managing directors/managers and (4) collecting internal policy documents.

Results

An optimal model of substitution of ECPs seems to be one in which the professional substitutes for the ECP largely autonomously, well-balanced collaboration occurs between the ECP and the substitute, and quality of healthcare is maintained. This model was seen in two NP cases and one PA case. Elements that enabled NPs and PAs to work according to this optimal model were among others: collaborating with the ECP based on trust; being proactive, decisive and communicative and being empowered by organisational leaders to work as an independent professional.

Conclusions

Collaboration based on trust between the ECP and the NP or PA is a key element of successful substitution of ECPs. NPs, PAs and RNs in nursing homes may all be valuable in their own unique way, matching their profession, education and competences.
Prognostic factors for acute exacerbation of idiopathic pulmonary fibrosis: protocol for a systematic review and meta-analysis
Authors: Kamiya Hiroyuki , Panlaqui Ogee Mer
Published: May 2019

Introduction

Idiopathic pulmonary fibrosis (IPF) is a form of chronic fibrosing interstitial pneumonia with unknown disease aetiology. Acute exacerbation (AE) of IPF is an accelerated disease progression beyond its expected course. A 30-day mortality of AE of IPF is 40%. While death may occur, there is much variation in the clinical progression of this condition. Previous attempts have been made to investigate various possible prognostic factors for AE of IPF; however, they have yet to be confirmed. The aim of this systematic review is to clarify these prognostic factors.

Methods and analysis

In this review, AE of IPF is the condition of interest, which has been defined according to previously established diagnostic criteria. The primary outcomes of interest include short-term all-cause mortality and pulmonary-cause mortality. The secondary outcomes of interest include long-term mortality and hospital separation for the disease. Primary studies investigating prognostic factors for AE of IPF are eligible for inclusion in this review. All study types are permitted except case reports. Two reviewers will search electronic databases, such as Medline and EMBASE, from 2002 to the 1 April 2019 and extract data independently. Risk of bias in individual studies will be assessed using the Quality in Prognostic Studies tool. Meta-analysis will be conducted for univariate data if at least three studies report the effect of a specific prognostic factor using similar statistical methods. Multivariate results will be reported qualitatively. Subgroup analysis and sensitivity analysis will be considered with the aim of generalising findings to the clinical settings and drawing more robust conclusions. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) method will be applied to evaluate the quality of evidence for each prognostic factor.

Ethics and dissemination

Ethical approval will not be required. Results will be reported in a peer-reviewed scientific journal.

PROSPERO registration number

CRD42018106172
Longitudinal circulating placental growth factor (PlGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1) concentrations during pregnancy in Asian women: a prospective cohort study
Authors: Ng Qiu Ju , Han Jonathan Youxiang , Saffari Seyed Ehsan , Yeo George Seow-Heong , Chern Bernard Su Min , Tan Kok Hian
Published: May 2019

Objectives

To analyse the placental growth factor (PlGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1) trends in the normal pregnant Asian population in Singapore.

Design

A prospective study was conducted.

Setting

The largest tertiary hospital in Singapore.

Methods

Women with single viable pregnancies, less than 14 weeks of gestation, were recruited between September 2010 and November 2013 in KK Women’s and Children’s Hospital. They were followed up from recruitment till their postnatal discharge from the hospital. There were four antenatal visits: gestational age (GA) less than 14+0 weeks of gestation (V1), GA 18+0 to 22+0 weeks (V2), GA 28+0 to 32+0 weeks (V3) and GA 34+0 and above (V4). Serum biochemical markers (sFlt-1, PlGF) were measured at each visit.

Results

There were 934 participants in the study, of which 674 had normal pregnancy outcomes. The sFlt-1 remained relatively constant till GA 28–32 weeks before it increased (p<0.001). The sFlt-1 levels increased earlier before 30 weeks’ of gestation among the Malay participants and the other ethnicities. For PlGF, the levels increased from the first to the third trimester, peaking at 30–32 weeks before decreasing (p<0.001). Its serum levels significantly differed among the Indian participants and other ethnicities as compared with the Malay and Chinese participants at V3 and V4, (p=0.04 and p<0.001, respectively).

Conclusion

There are significant differences in the PlGF and sFlt-1 concentrations during pregnancy between different ethnicities, which should be taken into consideration when using these references values for further research.
Characteristics of self-management among patients with complex health needs: a thematic analysis review
Authors: Gobeil-Lavoie Annie-Pier , Chouinard Maud-Christine , Danish Alya , Hudon Catherine
Published: May 2019

Objective

There is a gap of knowledge among healthcare providers on characteristics of self-management among patients with chronic diseases and complex healthcare needs. Consequently, the objective of this paper was to identify characteristics of self-management among patients with chronic diseases and complex healthcare needs.

Design

Thematic analysis review of the literature.

Methods

We developed search strategies for the MEDLINE and CINAHL databases, covering the January 2000–October 2018 period. All articles in English or French addressing self-management among an adult clientele (18 years and older) with complex healthcare needs (multimorbidity, vulnerability, complexity and frequent use of health services) were included. Studies that addressed self-management of a single disease or that did not have any notion of complexity or vulnerability were excluded. A mixed thematic analysis, deductive and inductive, was performed by three evaluators as described by Mileset al.

Results

Twenty-one articles were included. Patients with complex healthcare needs present specific features related to self-management that can be exacerbated by deprived socioeconomic conditions. These patients must often prioritise care based on one dominant condition. They are at risk for depression, psychological distress and low self-efficacy, as well as for receiving contradictory information from healthcare providers. However, the knowledge and experiences acquired in the past in relation to their condition may help them improve their self-management skills.

Conclusions

This review identifies challenges to self-management for patients with complex healthcare needs, which are exacerbated in contexts of socioeconomic insecurity and proposes strategies to help healthcare providers better adapt their self-management support interventions to meet the specific needs of this vulnerable clientele.
Promoting physical activity in regional and remote cancer survivors (PPARCS) using wearables and health coaching: randomised controlled trial protocol
Authors: Hardcastle Sarah J , Hince Dana , Jiménez-Castuera Ruth , Boyle Terry , Cavalheri Vinicius , Makin Greg , Tan Patrick , Salfinger Stuart , Tan Jason , Mohan Ganendra Raj , Levitt Michael , Cohen Paul A , Saunders Christobel , Platell Cameron
Published: May 2019

Introduction

Physically active cancer survivors have substantially less cancer recurrence and improved survival compared with those who are inactive. However, the majority of survivors (70%–90%) are not meeting the physical activity (PA) guidelines. There are also significant geographic inequalities in cancer survival with poorer survival rates for the third of Australians who live in non-metropolitan areas compared with those living in major cities. The primary objective of the trial is to increase moderate-to-vigorous PA (MVPA) among cancer survivors living in regional and remote Western Australia. Secondary objectives are to reduce sedentary behaviour and in conjunction with increased PA, improve quality of life (QoL) in non-metropolitan survivors. Tertiary objectives are to assess the effectiveness of the health action process approach (HAPA) model variables, on which the intervention is based, to predict change in MVPA.

Methods and analysis

Eighty-six cancer survivors will be randomised into either the intervention or control group. Intervention group participants will receive a Fitbit and up to six telephone health-coaching sessions. MVPA (using Actigraph), QoL and psychological variables (based on the HAPA model via questionnaire) will be assessed at baseline, 12 weeks (end of intervention) and 24 weeks (end of follow-up). A general linear mixed model will be used to assess the effectiveness of the intervention.

Ethics and dissemination

Ethics approval has been obtained from St John of God Hospital Subiaco (HREC/#1201). We plan to submit a manuscript of the results to a peer-reviewed journal. Results will be presented at conferences, community and consumer forums and hospital research conferences.

Trial registration number

ACTRN12618001743257; pre-results, U1111-1222-5698
‘I would never have done it if it hadn’t been digital’: a qualitative study on patients’ experiences of a digital management programme for hip and knee osteoarthritis in Sweden
Authors: Cronström Anna , Dahlberg Leif E , Nero Håkan , Ericson Jennifer , Hammarlund Catharina Sjödahl
Published: May 2019

Objectives

To investigate the experiences of a digital management programme for hip and knee osteoarthritis (OA), including education and exercises as well as an option to chat with an assigned physical therapist for feedback, questions and support.

Setting

This study was conducted at a regional hospital in the southern part of Sweden.

Methods

Nineteen patients (10 women), median age of 66 (q1–q3, 57–71) years, with confirmed hip or knee OA were interviewed after completing their first 6 weeks in the programme, using a semistructured interview guide. The interviews were transcribed verbatim and were qualitatively analysed using systematic text condensation.

Results

Three categories emerged during the interviews:

(1) Management options for mitigating the consequences of OA; (2) Experiences of the digital programme and (3) Perceived effects of the digital programme over time. The participants had mostly positive experiences of the programme. Particularly important for these experiences were no waiting list, the flexibility of taking part in the programme with regards to location and time and the possibility to have daily contact with a physical therapist. These aspects were also emphasised as advantages compared with traditional care.

Conclusions

Digital management of OA, including education and exercise, was experienced as a valid alternative to traditional treatment in enabling the implementation of OA guidelines in a wider community. Easy access, exercising at one’s own convenience, flexible options, daily follow-up and support by a physical therapist were mentioned as the most important features. In addition, the results will contribute to further development and improvement of digital OA management programmes.
Randomised, placebo-controlled, double-blind, double-dummy, multicentre trial comparing electronic cigarettes with nicotine to varenicline and to electronic cigarettes without nicotine: the ECSMOKE trial protocol
Authors: Berlin Ivan , Dautzenberg Bertrand , Lehmann Blandine , Palmyre Jessica , Liégey Emmanuelle , De Rycke Yann , Tubach Florence
Published: May 2019

Introduction

Electronic cigarettes (EC) mainly with nicotine content are widely used worldwide. Although the number of publications about its use is increasing exponentially, evidence-based, unbiased, conclusive, head-to-head comparisons about its efficacy and safety as an aid for smoking cessation are lacking.

Methods and analysis

Design:randomised, placebo and reference treatment-controlled, multicentre, double-blind, double-dummy, parallel-group trial.Participants:smokers smoking at least 10 cigarettes/day in the past year and motivated to quit, aged 18–70 years.Interventions: (A) EC without nicotine (ECwoN) plus placebo tablets of varenicline administered by oral route:placebo condition, (B) EC with nicotine (ECwN) plus placebo tablets of varenicline:ECwN condition.Voltage regulated EC will be used with liquid containing 12 mg/mL of nicotine for ad libitum use.Flavour: blond tobacco. (C)Reference: ECwoN plus 0.5 mg varenicline tablets:varenicline condition.Varenicline administered according to the marketing authorisationauthorisation.Treatment duration: 1 week+3 months.Primary outcome:continuous smoking abstinence rate (CAR) (abstinence from conventional/combustible cigarettes) during the last 4 weeks (weeks 9–12) of the treatment period defined as self-report of no smoking during the previous 2 weeks and expired air carbon monoxide ≤8 at visit 4 at week 10 after target quit date (TQD), that is, 11 weeks after treatment initiation AND at visit 5, week 12 after TQD, that is, 13 weeks after treatment initiation.Secondary outcomes: safety profile; point prevalence abstinence rate; CAR confirmed by urinary anabasine concentration; changes in cigarettes/day consumption; craving for tobacco and withdrawal symptoms with respect of baseline.

Ethics and dissemination

The ethics committee approval was obtained on 17 April 2018. All data collected about the study participants will be anonymised. Investigators will communicate trial results to participants, health authorities, healthcare professionals, the public and other relevant groups without any publication restrictions.

Trial registration number

NCT03630614; Pre-results.
Creation of a database to assess effects of omega-3, omega-6 and total polyunsaturated fats on health: methodology for a set of systematic reviews
Authors: Hooper Lee , Abdelhamid Asmaa , Brainard Julii , Deane Katherine H O , Song Fujian
Published: May 2019

Objective

To create a database of long-term randomised controlled trials (RCTs) comparing higher with lower omega-3, omega-6 or total polyunsaturated fatty acid (PUFA), regardless of reported outcomes, and to develop methods to assess effects of increasing omega-6, alpha-linolenic acid (ALA), long-chain omega-3 (LCn3) and total PUFA on health outcomes.

Design

Systematic review search, methodology and meta-analyses.

Data sources

Medline, Embase, CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov and trials in relevant systematic reviews.

Eligibility criteria

RCTs of ≥24 weeks' duration assessing effects of increasing ALA, LCn3, omega-6 or total PUFAs, regardless of outcomes reported.

Data synthesis

Methods included random-effects meta-analyses and sensitivity analyses. Funnel plots were examined, and subgrouping assessed effects of intervention type, replacement, baseline diabetes risk and use of diabetic medications, trial duration and dose. Quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results

Electronic searches generated 37 810 hits, de-duplicated to 19 772 titles and abstracts. We assessed 2155 full-text papers, conference abstracts and trials registry entries independently in duplicate. Included studies were grouped into 363 RCTs comparing higher with lower omega-3, omega-6 and/or total PUFA intake of at least 6 months’ duration—the Database.

Of these 363 included RCTs, 216 RCTs were included in at least one of our reviews of health outcomes, data extracted and risk of bias assessed in duplicate. Ninety five RCTs were included in the Database but not included in our current reviews. Of these 311 completed trials, 27 altered ALA intake, 221 altered LCn3 intake and 16 trials altered omega-3 intake without specifying whether ALA or LCn3. Forty one trials altered omega-6 and 59 total PUFA.The remaining 52 trials are ongoing though 13 (25%) appear to be outstanding, or constitute missing data.

Conclusions

This extensive database of trials is available to allow assessment of further health outcomes.
Observer-based tools for non-technical skills assessment in simulated and real clinical environments in healthcare: a systematic review
Authors: Higham Helen , Greig Paul R , Rutherford John , Vincent Laura , Young Duncan , Vincent Charles
Published: May 2019

Background

Over the past three decades multiple tools have been developed for the assessment of non-technical skills (NTS) in healthcare. This study was designed primarily to analyse how they have been designed and tested but also to consider guidance on how to select them.

Objectives

To analyse the context of use, method of development, evidence of validity (including reliability) and usability of tools for the observer-based assessment of NTS in healthcare.

Design

Systematic review.

Data sources

Search of electronic resources, including PubMed, Embase, CINAHL, ERIC, PsycNet, Scopus, Google Scholar and Web of Science. Additional records identified through searching grey literature (OpenGrey, ProQuest, AHRQ, King’s Fund, Health Foundation).

Study selection

Studies of observer-based tools for NTS assessment in healthcare professionals (or undergraduates) were included if they: were available in English; published between January 1990 and March 2018; assessed two or more NTS; were designed for simulated or real clinical settings and had provided evidence of validity plus or minus usability. 11,101 articles were identified. After limits were applied, 576 were retrieved for evaluation and 118 articles included in this review.

Results

One hundred and eighteen studies describing 76 tools for assessment of NTS in healthcare met the eligibility criteria. There was substantial variation in the method of design of the tools and the extent of validity, and usability testing. There was considerable overlap in the skills assessed, and the contexts of use of the tools.

Conclusion

This study suggests a need for rationalisation and standardisation of the way we assess NTS in healthcare and greater consistency in how tools are developed and deployed.
Drug-associated valvular heart diseases and serotonin-related pathways: a meta-analysis
Authors: Fortier Jacqueline H , Pizzarotti Beatrice , Shaw Richard E , Levy Robert J , Ferrari Giovanni , Grau Juan
Published: May 2019

Objective

Serotonergic appetite suppressants and ergot-derived dopamine agonists have been associated with drug-induced valvular heart disease. The purpose of this meta-analysis is to synthesise the current evidence of a link between several medications affecting sertonergic pathways and valvular heart disease.

Methods

PubMed was searched to identify studies evaluating an association between medications with serotonergic activity and cardiac valvular pathology. Case reports, uncontrolled studies and in vitro studies were excluded. Relevant studies were assessed for quality and potential bias; those of adequate quality were included in a quantitative synthesis. Sensitivity analyses were conducted, and potential publication bias was examined.

Results

There was a consistent, significant relationship between certain medications and heart valve disease, including serotonergic medications (OR 3.30, 95% CI 1.99 to 5.49) and dopaminergic medications (OR 2.56, 95% CI 1.68 to 3.91). Subanalyses, including analyses that limited exposure to a single medication or effects to a single heart valve were also consistently significant. Most studies were retrospective or observational in nature, with a higher risk of selection and presentation biases. There was significant heterogeneity and variability between studies, particularly when it came to dose and duration of exposure.

Conclusions

There was a consistent, significant association between many medications that affect serotonergic pathways and valvular heart disease. Although many of these medications have been withdrawn from the market, some small studies suggest that recreational drug 3,4-methylenedioxy​methamphetamine and widely prescribed selective serotonin reuptake inhibitors may affect similar pathways.
Pathogenic variants in PLOD3 result in a Stickler syndrome-like connective tissue disorder with vascular complications
Authors: Ewans Lisa Jean , Colley Alison , Gaston-Massuet Carles , Gualtieri Angelica , Cowley Mark J , McCabe Mark James , Anand Deepti , Lachke Salil A , Scietti Luigi , Forneris Federico , Zhu Ying , Ying Kevin , Walsh Corrina , Kirk Edwin P , Miller David , Giunta Cecilia , Sillence David , Dinger Marcel , Buckley Michael , Roscioli Tony
Published: May 2019

Background

Pathogenic PLOD3 variants cause a connective tissue disorder (CTD) that has been described rarely. We further characterise this CTD and propose a clinical diagnostic label to improve recognition and diagnosis of PLOD3-related disease.

Methods

Reported PLOD3 phenotypes were compared with known CTDs utilising data from three further individuals from a consanguineous family with a homozygous PLOD3 c.809C>T; p.(Pro270Leu) variant. PLOD3 mRNA expression in the developing embryo was analysed for tissue-specific localisation. Mouse microarray expression data were assessed for phylogenetic gene expression similarities across CTDs with overlapping clinical features.

Results

Key clinical features included ocular abnormalities with risk for retinal detachment, sensorineural hearing loss, reduced palmar creases, finger contractures, prominent knees, scoliosis, low bone mineral density, recognisable craniofacial dysmorphisms, developmental delay and risk for vascular dissection. Collated clinical features showed most overlap with Stickler syndrome with variable features of Ehlers-Danlos syndrome (EDS) and epidermolysis bullosa (EB). Human lysyl hydroxylase 3/PLOD3 expression was localised to the developing cochlea, eyes, skin, forelimbs, heart and cartilage, mirroring the clinical phenotype of this disorder.

Conclusion

These data are consistent with pathogenic variants in PLOD3 resulting in a clinically distinct Stickler-like syndrome with vascular complications and variable features of EDS and EB. Early identification of PLOD3 variants would improve monitoring for comorbidities and may avoid serious adverse ocular and vascular outcomes.
CD28 deficiency attenuates primary blast-induced renal injury in mice via the PI3K/Akt signalling pathway
Authors: Liu Ying , Liu Y E , Tong C C , Cong P F , Shi X Y , Shi L , Jin X H , Wang Q
Published: May 2019

Introduction

Primary blast affects the kidneys due to direct shock wave damage and the production of proinflammatory cytokines without effective treatment. CD28 has been reported to be involved in regulating T cell activation and secretion of inflammatory cytokines. The aim of this study was to investigate the influence of primary blast on the kidney and the effect of CD28 in mice.

Methods

A mouse model of primary blast-induced kidney injury was established using a custom-made explosive device. The severity of kidney injury was investigated by H&E staining. ELISA was applied to study serum inflammation factors’ expression. Western blot assays were used to analyse the primary blast-induced inflammatory factors’ expression in the kidney. Immunofluorescence analysis was used to examine the PI3K/Akt signalling pathway.

Results

Histological examination demonstrated that compared with the primary blast group, CD28 deficiency caused a significant decrease in the severity of the primary blast-induced renal injury. Moreover, ELISA and western blotting revealed that CD28 deficiency significantly reduced the levels of interleukin (IL)-1β, IL-4 and IL-6, and increased the IL-10 level (p<0.05). Finally, immunofluorescence analysis indicated that PI3K/Akt expression also changed.

Conclusions

CD28 deficiency had protective effects on primary blast-induced kidney injury via the PI3K/Akt signalling pathway. These findings improve the knowledge on primary blast injury and provide theoretical basis for primary blast injury treatment.
Can a weight management conditioning course help with armed forces recruitment?
Authors: Cumpsty Richard , Makin S , Woodhouse J
Published: May 2019

British Armed Forces are facing the most significant recruitment crisis since 2010. An important contributing factor to the recruitment crisis is the rise in obesity of the UK population. At Army Training Centre Pirbright, a weight management programme (WMP) has been established for recruits who have failed their initial medical assessment (IMA). To determine the proportion of recruits who entered the WMP and passed basic and initial trade training, allowing entry into the British Army. Retrospective service evaluation of recruits entering WMP from inception in April 2015 to August 2018. Medical records were used to assess whether recruits completed initial training. 72.3% of recruits included in the WMP who would have previously failed their IMA because of a high body mass index (BMI) passed basic and initial trade training. This evaluation demonstrates potential for candidates otherwise excluded based on BMI. This WMP delivers structured nutritional support and encourages physical training. Once a BMI enters the accepted range, recruits could enter basic training. This WMP would deliver structured nutritional support and encourage physical training, with the aim of promoting healthy lifestyles. Neither the Royal Navy nor the Royal Air Force currently have a WMP. There is potential for WMPs to be introduced to all three services. UK Armed Forces face a recruitment crisis and need to be adaptable with a population where obesity is prevalent. At Pirbright 72.3% of candidates in the WMP passed basic and initial trade training.
Reducing the severity of stroke
Authors: Meredith Georgina , Rudd Anthony
Published: May 2019

Stroke remains one of the most important causes of death and disability worldwide. Effective prevention could reduce the burden of stroke dramatically. The management of stroke has undergone a revolution over the last few decades, particularly with the development of techniques for revascularisation of patients with ischaemic stroke. Advanced imaging able to identify potentially salvageable brain is further increasing the potential for effective acute treatment. However, the majority of stroke patients won’t benefit from these treatments and will need effective specialist stroke care and ongoing rehabilitation to overcome impairments and adapt to living with a disability. There are still many unanswered questions about the most effective way of delivering rehabilitation. Likewise, research into how to manage primary intracerebral haemorrhage has yet to transform care.
Evaluation of acute myocardial infarction patients with mid-range ejection fraction after emergency percutaneous coronary intervention
Authors: Jiang Yufeng , Hu Shengda , Cao Mingqiang , Li Xiaobo , Zhou Jing , Ding Bing , Zhang Fangfang , Chen Tan , Zhou Yafeng
Published: May 2019

Background

There is currently no classification for acute myocardial infarction (AMI) according to left ventricular ejection fraction (LVEF). We aimed to perform a retrospective analysis of patients undergoing emergency percutaneous coronary intervention (PCI), comparing the clinical characteristics, in-hospital acute heart failure and all-cause death events of AMI patients with mid-range ejection fraction (mrEF), preserved ejection fraction (pEF) and reduced ejection fraction (rEF).

Material and methods

Totally 1270 patients were stratified according to their LVEF immediately after emergency PCI into pEF group (LVEF 50% or higher), mrEF group (LVEF 40%–49%) and rEF group (LVEF <40%). Kaplan-Meier curves and log rank tests were used to assess the effects of mrEF, rEF and pEF on the occurrence of acute heart failure and all-cause death during hospitalisation. The Cox proportional hazards model was used for multivariate correction.

Results

Compared with mrEF, rEF was an independent risk factor for acute heart failure events during hospitalisation (HR 5.01, 95% CI 3.53 to 7.11, p<0.001), and it was also an independent risk factor for all-cause mortality during hospitalisation (HR 7.05, 95% CI 4.12 to 12.1, p<0.001); Compared with mrEF, pEF was an independent protective factor for acute heart failure during hospitalisation (HR 0.49, 95% CI 0.30 to 0.82, p=0.01), and it was also an independent protective factor for all-cause death during hospitalisation (HR 0.33, 95% CI 0.11 to 0.96, p=0.04).

Conclusions

mrEF patients with AMI undergoing emergency PCI share many similarities with pEF patients in terms of clinical features, but the prognosis is significantly worse than that of pEF patients, suggesting that we need to pay attention to the management of mrEF patients with AMI.
TnI and IL-18 levels are associated with prognosis of sepsis
Authors: Wu Qinghua , Xiao Zhaoyang , Pu Yanan , Zhou Jianwen , Wang Dehuai , Huang Zhiyong , Hou Dongnan
Published: May 2019

Aim

To evaluate the diagnostic value of interleukin-18 (IL-18) and troponin (TnI) in sepsis.

Methods

This retrospective analysis included 117 patients with sepsis (patient group) and 92 subjects who attended regular physical examinations (control group). We compared IL-18 and TnI expressions before treatment (T1) and on day 5 (T2), day 10 (T3) and day 15 (T4) of treatment. Acute Physiology and Chronic Health Evaluation II (APACHE II) guidelines were used to analyse the correlation between IL-18, TnI and APACHE II scores.

Results

At T1, T2, T3 and T4, the IL-18 and TnI levels were all higher in the patient group than in the control group (p<0.001). In the patient group, peak IL-18 and TnI levels were noted at T1, followed by T2, T3 and T4 (p<0.001). The linear correlation analysis revealed positive correlations between IL-18 and TnI levels and APACHE II score (r =0.759, 0.866, p <0.001). The 3-year survival rates of subjects with high IL-18 or TnI expression levels were all lower than of those with low expression levels (p=0.047, 0.048). In patients with sepsis, the expression of TnI and IL-18 is high and is positively correlated with APACHE II scores.

Conclusions

Monitoring TnI and IL-18 levels can effectively evaluate the severity and recovery of patients with sepsis.
Neoureterocystostomy for the management of extramural ectopic ureter with concurrent contralateral renal aplasia in two dogs
Authors: Bresciani Luca , Aisa Josep , Bray Jonathan , Petite Audrey , Spence Susanna
Published: May 2019

Two male puppies were presented: one with urinary incontinence and the other with abdominal distension and discomfort. A diagnosis of unilateral extramural ectopic ureter with associated hydronephrosis/hydroureter and contralateral renal aplasia was confirmed in both patients by a combination of abdominal imaging and exploratory coeliotomy. Both patients were also diagnosed with cryptorchidism ipsilateral to the renal aplasia. Routine investigations, including complete blood count, biochemistry and urinalysis, were otherwise unremarkable. Neoureterocystostomy with an intravesical technique and castration were performed in both patients. One month following surgery, severity of clinical signs, the degree of hydronephrosis/hydroureter and elevation of renal blood values had all improved in both patients.
Successful treatment of a dog with recurrent nasopharyngeal stenosis using balloon dilation and a novel topical mitomycin delivery system
Authors: Tobias Karen , Johnson Kryssa , Whittemore Jacqueline
Published: May 2019

A 1.5‐year‐old German shorthair pointer dog was presented with nasopharyngeal stenosis secondary to aspiration rhinitis. Stenosis had recurred after all previous treatments, including balloon dilation and oral steroids, uncovered metal stent placement and covered metal stent placement. Successful outcome was obtained after balloon dilation and two topical applications of mitomycin, delivered one week apart, using a novel delivery system. Rechecks of the nasopharynx were performed with an inexpensive WiFi endoscope that provided a retroflexed view of the area.
Soil disturbance and juvenile Douglas-fir growth following stump removal on moderately coarse textured soils in southwestern British Columbia: 10-year results
Authors: Zeglen Stefan , Courtin Paul J.
Published: May 2019

Mechanized treatment for root diseases such as Coniferiporia sulphurascens (Pilát) L. W. Zhou & Y. C. Dai (syn. Phellinus sulphurascens Pilát) and Armillaria ostoyae (Romagn.) Herink (syn. Armillaria solidipes Peck) is often avoided due to cost or the perception that removal of stumps creates detrimental soil disturbance or degradation that hinders site productivity. Our study tested five diseased stands that were treated by extracting stumps following harvesting and replanted with susceptible Douglas-fir. Soil disturbance surveys were conducted in treated and untreated plots, and individual planted spots were assessed and categorized for soil disturbance using existing and proposed new categories specific to disturbance caused by the stump removal. Tree measurements were taken at intervals over the first 10 years of stand development, and foliage was sampled for nutrient analysis. The percentage of total and counted disturbance was 20%–46% and 8%–11% greater, respectively, in treated versus untreated plots; however, mean tree growth in height and diameter was not statistically different between treatments and was more positive for treated plots at all sites but one. Tree nutrition and survival to age 10 was not negatively affected by stump removal. Total site productivity represented by basal area and tree volume differed widely between sites but was not significantly different between treatments.
Lower Blood Pressure Is Not Associated With Decreased Arterial Spin Labeling Estimates of Perfusion in Intracerebral Hemorrhage
Authors: Klahr Ana C. , Kosior Jayme C. , Dowlatshahi Dariush , Buck Brian H. , Beaulieu Christian , Gioia Laura C. , Kalashyan Hayrapet , Wilman Alan H. , Jeerakathil Thomas , Emery Derek J. , Shuaib Ashfaq , Butcher Kenneth S.
Published: May 2019

Background

Subacute ischemic lesions in intracerebral hemorrhage (
ICH
) have been hypothesized to result from hypoperfusion. Although studies of cerebral blood flow (
CBF
) indicate modest hypoperfusion in
ICH
, these investigations have been limited to early time points. Arterial spin labeling (
ASL
), a magnetic resonance imaging technique, can be used to measure
CBF
without a contrast agent. We assessed
CBF
in patients with ICH using
ASL
and tested the hypothesis that
CBF
is related to systolic blood pressure (
SBP
).

Methods and Results

In this cross‐sectional study, patients with ICH were assessed with
ASL
at 48 hours, 7 days, and/or 30 days after onset. Relative
CBF
(
rCBF
; ratio of ipsilateral/contralateral perfusion) was measured in the perihematomal regions, hemispheres, border zones, and the perilesional area in patients with diffusion‐weighted imaging hyperintensities. Twenty‐patients (65% men; mean±
SD
age, 68.5±12.7 years) underwent imaging with
ASL
at 48 hours (N=12), day 7 (N=6), and day 30 (N=11). Median (interquartile range) hematoma volume was 13.1 (6.3–19.3) mL. Mean±
SD
baseline
SBP
was 185.4±25.5 mm Hg. Mean perihematomal
rCBF
was 0.9±0.2 at 48 hours at all time points. Baseline
SBP
and other
SBP
measurements were not associated with a decrease in
rCBF
in any of the regions of interest (
P
≥0.111). r
CBF
did not differ among time points in any of the regions of interest (
P
≥0.097). Mean perilesional
rCBF
was 1.04±0.65 and was unrelated to baseline
SBP
(
P
=0.105).

Conclusions

ASL
can be used to measure
rCBF
in patients with acute and subacute
ICH
. Perihematomal
CBF
was not associated with
SBP
changes at any time point.

Clinical Trial Registration

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00963976.
O‐GlcNAc Transferase Promotes Compensated Cardiac Function and Protein Kinase A O‐GlcNAcylation During Early and Established Pathological Hypertrophy From Pressure Overload
Authors: Zhu Wei‐Zhong , El‐Nachef Danny , Yang Xiulan , Ledee Dolena , Olson Aaron K.
Published: May 2019

Background

Protein posttranslational modifications by
O
‐linked β‐N‐acetylglucosamine (O‐GlcNAc) increase with cardiac hypertrophy, yet the functional effects of these changes are incompletely understood. In other organs, O‐GlcNAc promotes adaptation to acute physiological stressors; however, prolonged O‐GlcNAc elevations are believed to be detrimental. We hypothesize that early O‐GlcNAcylation improves cardiac function during initial response to pressure overload hypertrophy, but that sustained elevations during established pathological hypertrophy negatively impact cardiac function by adversely affecting calcium handling proteins.

Methods and Results

Transverse aortic constriction or sham surgeries were performed on littermate controls or cardiac‐specific, inducible O‐GlcNAc transferase knockout (OGTKO) mice to reduce O‐GlcNAc levels. O‐GlcNAc transferase deficiency was induced at different times. To evaluate the initial response to pressure overload, OGTKO was completed preoperatively and mice were followed for 2 weeks post‐surgery. To assess prolonged O‐GlcNAcylation during established hypertrophy, OGTKO was performed starting 18 days after surgery and mice were followed until 6 weeks post‐surgery. In both groups, OGTKO with transverse aortic constriction caused significant left ventricular dysfunction. OGTKO did not affect levels of the calcium handling protein SERCA2a. OGTKO reduced phosphorylation of phospholamban and cardiac troponin I, which would negatively impact cardiac function. O‐GlcNAcylation of protein kinase A catalytic subunit, a kinase for phospholamban, decreased with OGTKO.

Conclusions

O‐GlcNAcylation promotes compensated cardiac function in both early and established pathological hypertrophy. We identified a novel O‐GlcNAcylation of protein kinase A catalytic subunit, which may regulate calcium handling and cardiac function.
Long‐Term Outcomes in Patients With Turner Syndrome: A 68‐Year Follow‐Up
Authors: Fuchs Margaret M. , Attenhofer Jost Christine , Babovic‐Vuksanovic Dusica , Connolly Heidi M. , Egbe Alexander
Published: May 2019

Background

Turner syndrome (
TS
) is the most common sex chromosome abnormality in women and is associated with increased morbidity and mortality. We describe long‐term outcomes in a large cohort of patients with
TS
.

Methods and Results

Retrospective review of patients with
TS
followed at Mayo Clinic Rochester from 1950 to 2017 was performed. Clinical, imaging, surgical, and genetic data were analyzed. Survival analysis was performed with the Kaplan–Meier method using age‐ and sex‐matched Olmsted County residents as the reference group. The study cohort comprised 317 patients with
TS
. Average age at diagnosis was 9 (range, 2–12) years, genetic testing was performed in 202 (64%), and pure monosomy X was present in 75 (37%). Congenital heart disease occurred in 131 (41%), with the most frequent lesions being bicuspid aortic valve (n=102, 32%) and coarctation of the aorta (n=43, 14%). Ascending aortic dilation was common, with mean aortic root size index 2 cm/m
2
, and aortic dissection occurred in 6 (2%) patients. The average follow‐up was 11 (range, 2–26) years, yielding 3898 patient‐years, and during this period 46 (14%) patients died; mean age at the time of death was 53±17 years. Patients
with TS
had reduced survival compared with the control group (82% versus 94% at 30 years;
P
<0.001), and the leading causes of death were cardiovascular disease, liver disease, and malignancy.

Conclusions

Patients with
TS
have reduced survival compared with age‐matched controls, and cardiovascular disease is the major cause of death. Further studies are required to determine if targeted cardiovascular risk factor modification will result in improved survival in this population.
Cumulative Rheumatic Inflammation Modulates the Bone–Vascular Axis and Risk of Coronary Calcification
Authors: Chan Yap‐Hang , Ngai Michael Cheong , Chen Yan , Wu Mei‐Zhen , Yu Yu‐Juan , Zhen Zhe , Lai Kevin , Cheung Tommy , Ho Lai‐Ming , Chung Ho‐Yin , Lau Chak‐Sing , Tse Hung‐Fat , Yiu Kai‐Hang
Published: May 2019

Background

Rheumatic diseases are related to both abnormal bone turnover and atherogenesis, but a mechanistic link was missing.

Methods and Results

We investigated the effect of cumulative rheumatic inflammation (
CRI
) on risk of coronary calcification in a retrospective cohort of 145 rheumatoid arthritis patients. A time‐adjusted aggregate
CRI
score was derived by conglomerating all quarterly biomarker encounters of serum C‐reactive protein over 60 months immediately preceding computed tomography coronary angiography. Flow cytometry was performed to measure the osteocalcin‐positive (
OCN
+
)
CD
34
+
KDR
+
and
OCN
+
CD
34
+
circulating endothelial progenitor cells (
EPCs
). Conventional early circulating
EPCs CD
34
+
CD
133
+
KDR
+
was determined. Coronary calcification was defined as any Agatston score >0. 50% of patients (n=72/145) had coronary calcification.
CRI
score was associated with presence of coronary calcification (
P
=0.004) (multivariable‐adjusted: highest versus lowest quartile: odds ratio=5.6 [95%
CI
1.1–28.9],
P
=0.041). Receiver operating characteristics curve revealed divergent behavior of
OCN
‐expressing circulating
EPCs
(
OCN
+
CD
34
+
EPCs
: area under the curve=0.60,
P
=0.034;
OCN
+
CD
34
+
KDR
+
EPCs
: area under the curve=0.59,
P
=0.053, positive predictors) versus conventional early
EPCs
(
CD
34
+
CD
133
+
KDR
+
: area under the curve=0.60,
P
=0.034, negative predictor) for coronary calcification, which persisted after multivariable adjustments (
OCN
+
CD
34
+
KDR
+
[>75th percentile]: odds ratio=7.2 [95%
CI
1.8–27.9],
P
=0.005;
OCN
+
CD
34
+
EPCs
[>75th percentile]: odds ratio=6.0 [95%
CI
1.5–23.3],
P
=0.010;
CD
34
+
CD
133
+
KDR
+
[>75th percentile: odds ratio=0.3 [95%
CI
0.1–1.0],
P
=0.053). Intriguingly, the
CRI
score was associated with increased
OCN
+
CD
34
+
EPCs
(highest versus lowest quartile: B=+25.6 [95%
CI
0.8–50.5] [×10
3
/mL peripheral blood],
P
=0.043), but reduced
CD
34
+
CD
133
+
KDR
+
EPCs
(highest versus lowest quartile: B=−16.2 [95%
CI
−31.5 to −0.9],
P
=0.038).

Conclusions

Preceding 60 months of
CRI
is associated with increased risk of coronary calcification and altered
OCN
expression in circulating
EPCs
.
Impact of a Community Health Worker Program to Support Caregivers of Children With Special Health Care Needs and Address Social Determinants of Health
Authors: Costich Marguerite A. , Peretz Patricia J. , Davis Jaimee A. , Stockwell Melissa S. , Matiz Luz A.
Published: May 2019

Few studies have evaluated the effects of a community health worker (CHW) intervention on social determinants and caregiver distress. This study assesses the impact of a CHW program for caregivers of children with special health care needs (CSHCN) on these factors in addition to confidence in self-management. A retrospective, pre-post analysis was conducted for those who completed a CHW program. Caregivers reported high levels of distress, low educational attainment, linguistic isolation, positive depression screens, and food and housing issues at baseline. On completion of the program, there was significant improvement in caregiver distress scores ( P < .001) and in understanding of their children’s diagnoses ( P < .001). Furthermore, the number of caregivers reporting food or housing issues was significantly reduced ( P < .01 and P < .01, respectively). This study demonstrates the feasibility and potential effects of a CHW intervention for CSHCN and highlights the need for a large-scale controlled trial to further evaluate impact.