Identification of keratin 19-positive cancer stem cells associating human hepatocellular carcinoma using CYFRA 21-1

Abstract

The current lack of an easily measurable surrogate marker of cancer stem cells (CSCs) prevents the clinical application of CSCs for hepatocellular carcinoma (HCC). We previously reported that keratin 19 (K19) is a novel HCC-CSC marker associated with transforming growth factor beta (TGFβ)/Smad signaling, and that K19⁺ HCC-CSCs could be a new therapeutic target of TGFβ receptor 1 inhibitor LY2157299. In this study, we examined whether K19⁺ HCC-CSCs can be tracked using cytokeratin 19 fragment CYFRA 21-1. In 147 HCC patients who underwent curative resection and evaluated K19 expression by immunohistochemistry, preoperative serum CYFRA 21-1 levels were significantly higher in K19⁺ patients than in K19⁻ patients (P < 0.01). Receiver operating characteristic analyses revealed that serum CYFRA 21-1 was the statistically significant and the most sensitive predictor of tumor K19 expression among preoperative laboratory test values (P < 0.001). In HCC cells encoding with a K19 promoter-driven enhanced green fluorescent protein, fluorescence-activated cell sorting (FACS)-isolated K19⁺ cells displayed significantly higher levels of supernatant CYFRA 21-1 than K19⁻ cells (P < 0.01). Gain/loss of K19 function experiments confirmed that CYFRA 21-1 levels were regulated by K19 function in HCC cells. Furthermore, CYFRA 21-1 levels reflected the treatment efficacy of LY2157299 in K19⁺ cells. In conclusion, CYFRA 21-1 can be used to predict K19 expression in HCC, and should thereby aid in the development of novel therapeutic strategies targeting K19⁺ HCC-CSCs.

Keratin 19 (K19) is known to be a cancer stem cells (CSCs) marker in hepatocellular carcinoma (HCC). However, easily-measurable surrogate marker of K19 +  HCC-CSCs has not been identified. This study showed that serum CYFRA 21-1 is the significant predictor of K19 expression in human HCC, and that CYFRA 21-1 levels reflect K19 function and TGFβ receptor 1 inhibitor treatment efficacy in HCC cells.

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Masthead

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Editorial Board

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Table of Contents

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In This Issue

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Risk factors for multidrug-resistant pathogens in bronchiectasis exacerbations

Non-cystic fibrosis bronchiectasis is a chronic structural lung condition that courses with recurrent infectious exacerbations that lead to frequent antibiotic treatment making this population more susceptible...

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A dual regimen of ritonavir/darunavir plus dolutegravir for rescue or simplification of rescue therapy: 48 weeks’ observational data

Dolutegravir (DTG) plus darunavir/ritonavir (DRV/r) is a simple combination of drugs that has the best genetic barrier to HIV-1 resistance and may be fit for salvage therapy.

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Is acetaminophen associated with a risk of Stevens Johnson Syndrome and Toxic Epidermal Necrolysis? Analysis of the French Pharmacovigilance database.

Summary

Aim

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but severe mostly drug-induced cutaneous reactions. Acetaminophen is an over the counter drug worldwide used to treat pain and reduce fever. In 2013, the FDA informed the public that acetaminophen was associated with a rare risk of SJS/TEN. The aim of this retrospective study is to analyse reports of acetaminophen as a possible suspect in the development of SJS/TEN from the French Pharmacovigilance Database (FPDB).

Methods

Cases of TEN/SJS with acetaminophen as a suspect drug registered in the FPDB collected from January 2002 to December 2013 were analysed by an expert group. The Algorithm of Drug causality for Epidermal Necrolysis (ALDEN) was used as a reference tool for SJS/TEN to assess the causality of each suspect drug.

Results

After exclusion of 16 non-validated cases, 112 cases (47 TEN, 51 SJS, 14 SJS/TEN overlaps) involving 574 suspected drugs (5⋅1/case) were analysed. In 80 cases, the acetaminophen ALDEN score was inferior or equal to other more suspected drugs. In 32 cases, acetaminophen had the highest score but matched with a "very unlikely" or "unlikely" causality in 12 cases. For the 20 remaining cases with a "possible" or "probable" causality, a protopathic or a confounding bias was likely in 14 cases.

Conclusions

After analysis of the French pharmacovigilance data using the ALDEN algorithm, we did not find an obvious SJS/TEN risk related to the use of acetaminophen in this large national series.

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Development of one paediatric and one neonatal formulary list in hospital settings

SUMMARY

Aim

To describe the stepwise process towards creating two formulary lists – one for paediatric and one for neonatal patients covering common diseases in hospital settings.

Methods

This study presents the concept for developing a formulary list. How to: 1) organize the editorial board, 2) procure drug consumption data and database management, including information on labelling status, dosing options, excipients and problematic adverse events, current guidelines, evidence and price, 3) develop the first edition for the formulary list and formulary manual, 4) to establish a paediatric sub-committee within the Regional Drug and Therapeutic Committee to maintain and continually develop the two formularies.

Results

The total number of drugs was 411 ATC level 5, which covers 1097 unique item numbers prior to the paediatric formulary list, 263 item numbers were included in the final list. In neonates, 201 drugs ATC level 5 were evaluated covering 348 unique item numbers of which 104 item numbers were included in the final neonatal formulary list. Eighty-eight percent of the included drugs in the paediatric formulary were licensed to children (not specified by age group), 2% were unlicensed in Denmark and 7% were extemporaneous preparations. For neonates, the percentage was 48%, 4% and 16%, correspondingly.

Conclusion

The process is time consuming as studies are lacking and age appropriate dosage forms and concentrations differ amongst countries. Nevertheless, the process should be somewhat similar between countries albeit, different drugs may be selected for the final formulary lists.

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How to obtain and use chromoendoscopy dyes for surveillance colonoscopy: A technical guide

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P 40 Correlation between hypothalamus and third ventricle of patients with affective disorders

Former studies proved the key role of the hypothalamus in the pathophysiology of affective disorders. Because of limited imaging methods and difficult delineation, attested volumetric changes has only been verified post-mortem, so in vivo studies made use of the adjacent third ventricle as an indirect marker of hypothalamic changes. Considering that these former ventricle studies leave sufficient scope for methodical improvements, it was our aim to replicate and complement these findings by using a high-resolution 7T-MRI for the first time.

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P 75 Movement-induced γ oscillations in the subthalamic nucleus are increased by dopamine and scaled by velocity in patients with Parkinson’s disease

Parkinson's disease (PD) is a basal ganglia disorder that results in general slowness of movement and an effective treatment option consists in subthalamic deep brain stimulation (DBS). Postoperatively, DBS-electrodes are externalized which gives the unique opportunity of recording local field potentials (LFP). Previous studies have shown that there are disease specific oscillatory patterns at rest, most prominently an increased β synchronization (Kühn, 2006) that correlates with clinical symptoms of PD such as rigidity and bradykinesia (Neumann, 2016).

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P 91 Changes of cerebral perfusion and cerebral pressure induced by rapid altitude changes of 1000m in an alpine region? – results of a neurosonographic study of volume flow rate and optic sheath diameter

As the clinical implications of altitude sickness are well known, the etiology of this potential life threatening disease is far from understood completely. We studied noninvasively by means of Neurosonography the effects of a rapid change of altitude in the alpine region on the cerebral volume flow and intracranial pressure.

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P 57 The influence of sports expertise on the extent of physiological mirror-EMG-activity in the upper and lower extremity

During unimanual motor tasks, muscle activity may not be restricted to the contracting muscle, but has also been reported to occur involuntarily in the contralateral resting limb in healthy subjects, referred to as physiological mirror electromyographic (MEMG) activity (Sehm et al., 2015). To date, however, it is unknown if the physiological form of MEMG can also be observed in lower extremities during the performance of unilateral isometric leg contractions. Furthermore it still remains elusive if and how MEMG is affected by long-term exercise training.

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P 83 Parasomnia, parkinsonism, impulse control disorder and bulbar palsy with IgLON5 antibodies: A new case report

In 2014 a complex neurological syndrome with parasomnia, sleep breathing dysfunction and variable bulbar symptoms associated with antibodies to IgLON5, a neuronal cell-adhesion protein, was described (Sabater et al., 2016). Postmortal studies revealed tauopathy predominately involving the hypothalamus and tegmentum of the brainstem (Gelpi et al., 2016). To the best of our knowledge, there are 16 published cases so far.

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P 67 Electrophysiological correlates of language improvements after intensive language therapy in patients with chronic post-stroke aphasia

Aphasia affects approximately one third of all stroke patients and may lead to chronic disability. Effective neurorehabilitation programs focusing on improving speech and language in patients with post-stroke aphasia are essential. A better understanding of the neurobiological processes accompanying language deficits and rehabilitation may bear fruit in the advancement of neurorehabilitation programs.

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P 48 The time of the ALSFRS-R to decrease to 50% (D50) in a sigmoidal decay model sufficiently describes the complete disease course of amyotrophic lateral sclerosis

The progression of ALSFRS-R is not linear (Gordon et al., 2010; Proudfoot et al., 2016); the often used calculated progression rate using PR=((48-ALSFRS-R)/disease duration) presents the progression at a certain time point rather than reflecting the entire disease course. A model describing the disease progression at different time points would facilitate the stratification of ALS patients according to disease severity and progression type and will in combination with other biomarkers enable identification of effective drugs in clinical trials.

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P 32 Insufficient evidence for structural gray matter alterations in late life minor depression – results from LIFE-adult study

Minor depressive episode is diagnosed when two to four depressive symptoms (including depressed mood or loss of interest) disturb the patient during at least two weeks. In late life minor depression is more prevalent than major depression. Newertheless, publications investigating pathophysiology of minor depression are missing.

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P 87 The perfusion changes in temporal and parietal lobe epilepsy

The aim of this study was to assess the regional relative interictal and postictal perfusion changes in temporal and parietal lobe epilepsy.

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P 79 Physiological assessment of the sense of agency in psychogenic movement disorders

Psychogenic movement disorders (PMD) are conditions characterized by the occurrence of unwanted motoric symptoms in which a somatic reason cannot be found. As patients suffering from PMD experience their pathological movements as non-voluntary, it is hypothesized that those patients have an altered sense of agency (SoA). SoA is defined as the feeling of controlling ones own actions and through them controlling events in the external world (Haggard and Tsakiris, 2009). SoA can be assessed by measuring the intentional binding (IB) effect.

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P 71 Levodopa modulates beta and gamma oscillations in the cortico-basal ganglia loop with a higher efficacy than the dopamine receptor agonist apomorphine in experimental Parkinsonism

The pharmacotherapy of Parkinson's disease (PD) is based on levodopa, and dopamine receptor agonists, such as apomorphine. Although both types of agents provide beneficial clinical effects on motor and non-motor symptoms in PD clinical efficiency and side effects differ substantially between levodopa and dopamine receptor agonists. Levodopa is known to provide a greater symptomatic relief than dopamine receptor agonists. Since long-term levodopa treatment often results in debilitating motor fluctuations, dopamine receptor agonists are recommended in younger patients.

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P 63 Investigating the effects of tRNS variants and task dependency on cortical excitability

Transcranial random noise stimulation (tRNS) has specific benefits and is fundamentally different as compared to more established methods such as transcranial direct current stimulation (tDCS) in modulating brain function (Terney et al., 2008; Ambrus et al., 2010). For example, previous research in the motor system has shown corticospinal excitability (CSE) to be task-dependent (Terney et al., 2008). It remains unresolved and largely unaddressed what the critical stimulation parameters of tRNS are, e.g.

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P 53 Impact of acoustic stimulation on motor response inhibition and error monitoring

Previous studies suggested that acoustic stimulation can be used to modulate cognition, to reduce anxiety level as well as to enhance mood. In this study we investigated whether acoustic stimulation can modulate response inhibition and error monitoring in a continuous performance task. Using the Go-NoGo paradigm in healthy adults during MEG recordings, Mazaheri et al. (2009) was able to predict errors during response inhibition by theta-alpha coupling. Thus, it seems likely that frontal theta activity after an error may boost an adjustment of the mental state of individuals towards more preparatory alertness resulting in alpha decrease and better sustained performance.

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P 44 Brisk jerk reflexes in a CMT case – novel heterozygous variant c.785T>C; p.Leu262Pro in KIF5A explaining the mixed phenotype

Charcot-Marie-Tooth (CMT) disease is a progressively disabling syndrome phenotypically comprising distal muscle weakness and atrophy, foot deformities, sensory loss, and reduced or absent tendon reflexes. In spastic paraplegia (SPG), a hereditary disorder affecting the upper motor neuron only, pareses are spastic, and deep tendon reflexes increased. Mixed forms between both diseases have been previously described (Liu et al., 2014). By multiple gene panel based analysis using next-generation-sequencing (NGS), we herein identified the novel variant c.785T>C; p.Leu262Pro in KIF5A as the putative cause of a mixed CMT and SPG phenotype.

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P 36 Structural and functional imaging findings in somatoparaphrenia

With regard to somatosensory delusion, neglect or deficits of body integrity a great number of overlapping pathophysiological concepts exist. Moreover, the range of assumed underlying psychiatric and neurologic syndromes only partially is thought to be related to even diverse neuroanatomical structures so far: Alien Hand Syndrome, Body Dysmorphic Disorder (BDD), Body Integrity Identity Disorder (BIID), Depersonalization, Somatoparaphrenia and Xenomelia. Specific deafferentiation within temporal regions, the insula or representational structures of the somatosensory cortex of the right parietal lobe is thought to be related only in some variants.

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P 28 Voxel-based Morphometry (VBM) subcortical white matter changes correlate with disease progression in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive, multisystemic disorder.Signs of lower motor neurone involvement are readily detectable but the involvement of the upper motor neurone is elusive.Hence, we must identify the extent and development of ALS related changes in the brain in different subtypes of ALS to facilitate an early diagnosis and stratification for clinical trials.Previous studies applying Voxel-based morphometry (VBM) provided inconsistent results.

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P 89 Case presentation – Clinically unrecognized status epilepticus in neuronal ceroid lipofuscinosis (CLN 3 gene)

On the previous day the 12-year-old boy P.-J. had a convulsive spasm (duration about 30s) in the morning and at noon. After that, he recovered and went outside for a walk. Before the evening meal P.-J. cramped again. Since then, he was not really awake, was not responsive, and had repeatedly convulsions (seven times on the day of admission). In between he was always sleepy and unresponsive. Since noon on the previous day, P. Luca did not eat and drink any more and did not take his medication. In the evening, the emergency physician was called, who did not administer any medicines because of stable vital parameters and only a short convulsive spasm when drawing blood from the vein.

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P 85 KCNQ-2 missense mutations and phosphatidylinositol 4,5-bisphosphate in familial epilepsy

The KCNQ2/3 channel is a slowly activating, non-inactivating voltage-gated potassium channel. It causes the M-current and sustains the resting membrane potential. Therefore, it is crucial for the regulation of neuronal plasticity. If a neuron does not reach the resting-potential after activation, excitation may spread throughout the neuronal network and a seizure may follow.In this work we study the influence of the intracellular second messenger phosphatidylinositol 4,5-bisphosphate (PIP2) on channels containing mutant KCNQ2 subunits associated with Benign Familial Neonatal Convulsions (BFNC).

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P 81 Voiding disorder – almond or walnut?

Limbic encephalitis is an inflammatory disease of the central nervous system. The subacute development of short-term memory deficit is typical of this disease, as are psychiatric symptoms and seizures. Limbic encephalitis is caused by auto -immunity and is associated with cancer in about 60 per cent of cases. Since 1999, several antibodies associated with limbic encephalitis have been identified.

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P 77 Optogenetic stimulations of striatal cholinergic interneurons in an animal model of dystonia

Dystonias are movement disorders, defined by sustained or intermittent muscle contractions causing twisting movements and postures. The most prevalent inherited form of dystonia is caused by a mutation in the gene for torsin A (DYT1, ΔGAG) with incomplete penetrance. It has been hypothesized that an increased activity of cholinergic interneurons in the striatum, resulting in abnormal synaptic plasticity, plays an important role in the disease pathophysiology. However, this hypothesis is merely based on ex vivo electrophysiological recordings in brain slices of animal models which do not show a dystonic phenotype.

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iSepsis – Death by Fluids, Part 1

A recent study demonstrating the harm from aggressive fluid resuscitation of septic shock

EMCrit by Paul Marik.

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Establishment of Larval Zebrafish as an Animal Model to Investigate Trypanosoma cruzi Motility In Vivo

In this protocol, fluorescently labeled T. cruzi were injected into transparent zebrafish larvae, and parasite motility was observed in vivo using light sheet fluorescence microscopy.

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Intratracheal Inoculation of Fischer 344 Rats with Francisella tularensis

This protocol describes intratracheal inoculations of Fischer 344 rats with Francisella tularensis. This procedure mimics pulmonary exposure of humans to this potential biothreat agent and can be used to test vaccine and therapeutic efficacy against pulmonary tularemia.

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A Technique for Subcutaneous Abdominal Adipose Tissue Biopsy via a Non-diathermy Method

We standardized an abdominal adipose tissue biopsy using a non-diathermy method performed under local anesthesia. Three cases of excessive post-operation bleeding out of 115 operations (2.61%) occurred.We conclude that an abdominal adipose tissue surgical biopsy using a non-diathermy method can be safely applied to healthy men.

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Tidal Carbon Dioxide as a Prognostic Feature in Inoperable Chronic Thromboembolic Pulmonary Hypertension

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1603-1604, October 2017.


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Six-Month Morbidity and Mortality among Intensive Care Unit Patients Receiving Life-Sustaining Therapy. A Prospective Cohort Study

Annals of the American Thoracic Society, Volume 14, Issue 10, Page 1562-1570, October 2017.


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Analysis of the maximum likelihood channel estimator for OFDM systems in the presence of unknown interference

This paper is a theoretical analysis of the maximum likelihood (ML) channel estimator for orthogonal frequency-division multiplexing (OFDM) systems in the presence of unknown interference. The following theore...

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Simulation-based education to ensure provider competency within the healthcare system

Abstract

The acquisition and maintenance of individual competency is a critical component of effective emergency care systems. This article summarizes consensus working group deliberations and recommendations focusing on the topic: "Simulation-based education to ensure provider competency within the healthcare system." The authors presented this work for discussion and feedback at the 2017 Academic Emergency Medicine Consensus Conference on ''Catalyzing System Change through Healthcare Simulation: Systems, Competency, and Outcomes,'' held on May 16, 2017, in Orlando, FL. Although simulation-based training is a quality and safety imperative in other high-reliability professions such as aviation, nuclear power, and the military, health care professions still lag behind in applying simulation more broadly. This is likely a result of a number of factors, including cost, assessment challenges, and resistance to change. This consensus subgroup focused on identifying current gaps in knowledge and process related to the use of simulation for developing, enhancing, maintaining individual provider competency. The resulting product is a research agenda informed by expert consensus and literature review.

This article is protected by copyright. All rights reserved.

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Cancers, Vol. 9, Pages 134: The Epithelial-to-Mesenchymal Transition in Breast Cancer: Focus on Basal-Like Carcinomas

Cancers, Vol. 9, Pages 134: The Epithelial-to-Mesenchymal Transition in Breast Cancer: Focus on Basal-Like Carcinomas

Cancers doi: 10.3390/cancers9100134

Authors: Monica Fedele Laura Cerchia Gennaro Chiappetta

Breast cancer is a heterogeneous disease that is characterized by a high grade of cell plasticity arising from the contribution of a diverse range of factors. When combined, these factors allow a cancer cell to transition from an epithelial to a mesenchymal state through a process of dedifferentiation that confers stem-like features, including chemoresistance, as well as the capacity to migrate and invade. Understanding the complex events that lead to the acquisition of a mesenchymal phenotype will therefore help to design new therapies against metastatic breast cancer. Here, we recapitulate the main endogenous molecular signals involved in this process, and their cross-talk with paracrine factors. These signals and cross-talk include the extracellular matrix; the secretome of cancer-associated fibroblasts, macrophages, cancer stem cells, and cancer cells; and exosomes with their cargo of miRNAs. Finally, we highlight some of the more promising therapeutic perspectives based on counteracting the epithelial-to-mesenchymal transition in breast cancer cells.

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Preclinical rationale for combination of crizotinib with mitomycin C for the treatment of advanced colorectal cancer

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MicroRNA signature in the chemoprevention of functionally-enriched stem and progenitor pools (FESPP) by Active Hexose Correlated Compound (AHCC)

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Activation of estrogen receptor α by estradiol and cisplatin induces platinum-resistance in ovarian cancer cells

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The European Journal of Neuroscience's mission to increase the visibility and recognition of women in science

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Low-Dose CCT to Exclude Contraindications to Lumbar Puncture

Abstract

Background

Low-dose cranial computed tomography (LD-CCT) based on iterative reconstruction has been shown to have sufficient image quality to assess cerebrospinal fluid spaces (CSF) and midline structures but not to exclude subtle parenchymal pathologies. Patients without focal neurological deficits often undergo CCT before lumbar puncture (LP) to exclude contraindications to LP including brain herniation or increased CSF pressure. We performed LD-CCT to assess if image quality is appropriate for this indication.

Methods

A total of 58 LD-CCT (220 mA/120 kV) of patients before LP were retrospectively evaluated and compared to 79 normal standard dose cranial computed tomography (SD-CCT) (350 mA/120 kV). Iterative reconstruction used for both dose levels was increased by one factor for LD-CCT. We assessed the signal-to-noise (SNR) and contrast-to-noise ratio (CNR), the dose estimates and scored diagnostic image quality by two raters independently. Significance level was set at p < 0.05.

Results

The inner and outer CSF spaces except the sulci were equally well depicted by the LD-CCT and SD-CCT; however, depiction of the subtle density differences of the brain parenchyma and the sulci was significantly worse in the LD-CCT (p < 0.0001). The SNR in the gray matter (9.35 vs. 10.61, p < 0.05) and white matter (7.23 vs. 8.15, p < 0.001) were significantly lower in LD-CCT than in SD-CCT with significantly lower dose estimates (1.04 vs. 1.69 mSv, respectively p < 0.0001).

Conclusion

The use of LD-CCT with a dose reduction of almost 50% is sufficient to exclude contraindications to LP; however, LD-CCT cannot exclude subtle parenchymal pathologies. Therefore, in patients with suspected parenchymal pathology, SD-CCT is still the method of choice.

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Anti-vascular endothelial growth factor therapy for the treatment of myopic choroidal neovascularization

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Readiness for antimicrobial resistance (AMR) surveillance in Pakistan; a model for laboratory strengthening

Limited capacity of laboratories for antimicrobial susceptibility testing (AST) presents a critical diagnostic bottleneck in resource limited countries. This paper aims to identify such gaps and to explore whe...

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Treatment of Blepharospasm/Hemifacial Spasm

Opinion statement

The treatment of both hemifacial spasm (HFS) and blepharospasm (BEB) requires making the appropriate clinical diagnosis. Advance imaging and electrophysiologic studies are useful; however, one's clinical suspicion is paramount. The purpose of this review is to summarize current and emerging therapies for both entities. Botulinum toxin (BTX) remains the first-line therapy to treat both conditions. If chemodenervation has failed, surgery may be considered. Due to the risks associated with surgery, the benefits of this option must be carefully weighed. Better surgical outcomes are possible when procedures are performed at tertiary centers with experienced surgeons and advanced imaging techniques. Microvascular decompression is an efficacious method to treat HFS, and myectomy is an option for medication-refractory BEB; the risks of the latter may outweigh any meaningful clinical benefits. Oral agents only provide short-term relief and can cause several unwanted effects; they are reserved for patients who cannot receive BTX and/or surgery. Transcranial magnetic stimulation has gained some traction in the treatment of BEB and may provide safer non-invasive options for refractory patients in the future.

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Quality of Electronic Nursing Records: The Impact of Educational Interventions During a Hospital Accreditation Process.

Hospital accreditation is a strategy for the pursuit of quality of care and safety for patients and professionals. Targeted educational interventions could help support this process. This study aimed to evaluate the quality of electronic nursing records during the hospital accreditation process. A retrospective study comparing 112 nursing records during the hospital accreditation process was conducted. Educational interventions were implemented, and records were evaluated preintervention and postintervention. Mann-Whitney and [chi]2 tests were used for data analysis. Results showed that there was a significant improvement in the nursing documentation quality postintervention. When comparing records preintervention and postintervention, results showed a statistically significant difference (P

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Deliberate acquisition of competence in physiological breech birth: A grounded theory study

Publication date: Available online 29 September 2017
Source:Women and Birth
Author(s): Shawn Walker, Mandie Scamell, Pam Parker
ProblemResearch suggests that the skill and experience of the attendant significantly affect the outcomes of vaginal breech births, yet practitioner experience levels are minimal within many contemporary maternity care systems.BackgroundDue to minimal experience and cultural resistance, few practitioners offer vaginal breech birth, and many practice guidelines and training programmes recommend delivery techniques requiring supine maternal position. Fewer practitioners have skills to support physiological breech birth, involving active maternal movement and choice of birthing position, including upright postures such as kneeling, standing, squatting, or on a birth stool. How professionals learn complex skills contrary to those taught in their local practice settings is unclear.QuestionHow do professionals develop competence and expertise in physiological breech birth?MethodsNine midwives and five obstetricians with experience facilitating upright physiological breech births participated in semi-structured interviews. Data were analysed iteratively using constructivist grounded theory methods to develop an empirical theory of physiological breech skill acquisition.ResultsAmong the participants in this research, the deliberate acquisition of competence in physiological breech birth included stages of affinity with physiological birth, critical awareness, intention, identity and responsibility. Expert practitioners operating across local and national boundaries guided less experienced practitioners.DiscussionThe results depict a specialist learning model which could be formalised in sympathetic training programmes, and evaluated. It may also be relevant to developing competence in other specialist/expert roles and innovative practices.ConclusionDeliberate development of local communities of practice may support professionals to acquire elusive breech skills in a sustainable way.



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The experiences of Burmese healthcare interpreters (Iam) in maternity services in Thailand

Publication date: Available online 29 September 2017
Source:Women and Birth
Author(s): Titaree Phanwichatkul, Elaine Burns, Pranee Liamputtong, Virginia Schmied
BackgroundInterpreters (lam in Thai) have been employed in maternity services in Thailand due to increasing numbers of Burmese women migrating to Thailand. Access to healthcare interpreters is crucial for health professionals and Burmese migrant women using Thai maternity services but no studies have examined the role of the lam.AimThis paper explores the role and experiences of healthcare interpreters (lam) working in Thailand. The perspectives of nurse-midwives and migrant Burmese women regarding the role of the lam are also included.MethodsEthnographic methods including observation of interactions between women, nurse-midwives, other health professionals and the lam were used. Individual interviews were conducted with four Burmese lam, nine health professionals, and 10 Burmese women. The data were analysed using thematic analysis.FindingsThree major themes captured the role and experiences of the Burmese lam; 'more than an interpreter', 'challenges in sustaining the role of the lam', and 'benefits for me and my community'. The Burmese lam had two key components to their role: interpreter and, healthcare worker. Key challenges included lack of clarity around role boundaries, limited training, and, low remuneration.Discussion and conclusionsDespite the challenges, the lam believed their presence encouraged Burmese women to attend antenatal care. They described benefits for themselves, including 'on-the-job' training. Community trust in the lam meant that Burmese women and families sought their advice within the community. This study demonstrates the important role that migrant workers play in collaborating with nurse-midwives to ensure access to maternity services in middle-income countries.



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Exploring routine hospital antenatal care consultations — An ethnographic study

Publication date: Available online 29 September 2017
Source:Women and Birth
Author(s): Diane Wright, Jan. Pincombe, Lois McKellar
BackgroundListening to women as part of their antenatal care has been recognized as valuable in understanding the woman's needs. Conversations as part of routine antenatal interactions offer ideal opportunities for women to express themselves and for midwives to learn about the woman's issues and concerns. The antenatal visit and the convention of antenatal consultations for midwives have not been well explored or defined and much of what takes place replicate medical consultative processes. As a consequence, there is little to assist midwives construct woman-centred care consultations for their routine antenatal care practice. This study showed how some practices were better in promoting the woman's voice and woman-centred care in the hospital setting.MethodContemporary focused ethnography using both interview and observations, explored how midwives from six different public antenatal clinics in South Australia organized their antenatal care consultations with pregnant women.FindingsThematic analysis of the data provided insights into professional interpretation of woman-centred practice. How midwives interacted with women during routine antenatal care events demonstrated that some practices in a hospital setting could either support or undermine a woman-centred philosophy.ConclusionIndividual midwives adopted practices according to their own perceptions of actions and behaviors that were considered to be in accordance with the philosophy of woman-centred care. Information arising from this study has shown ways midwives may arrange antenatal care consultations to maximize women's participation.



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Angiopoietin-like protein as a novel marker for liver fibrosis in chronic hepatitis B patients with normal to minimally raised ALT

For hepatitis B patients who do not meet the treatment criteria recommended by guidelines, therapy decisions depend on hepatic histology. Angiopoietin-like protein 2 (Angptl2) is a mediator of chronic inflamma...

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Laboratory-acquired infections of Salmonella enterica serotype Typhi in South Africa: phenotypic and genotypic analysis of isolates

Workers in clinical microbiology laboratories are exposed to a variety of pathogenic microorganisms. Salmonella species is among the most commonly reported bacterial causes of laboratory-acquired infections. We r...

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Species distribution and antibiotic susceptibility profile of bacterial uropathogens among patients complaining urinary tract infections

Urinary tract infection is the second most common type of infection and the problem is further compounded by the emergence of drug resistance in bacterial uropathogens. The aim of this study was to determine t...

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Protocol and baseline data for a multi-year cohort study of the effects of different mass drug treatment approaches on functional morbidities from schistosomiasis in four African countries

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) focus is on randomized trials of different approaches to mass drug administration (MDA) in endemic countries in Africa. Because th...

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B-type brain natriuretic peptide as a measure of the severity of hand-foot-mouth disease: a case-control study

Hand-foot-mouth disease (HFMD) is an acute infectious disease caused by enteroviruses, and HFMD complicated by cardiopulmonary failure has a high mortality. B type natriuretic peptide (BNP) is widely applied i...

http://ift.tt/2x3hp4j

Assessment of heavy metal tolerance and biosorptive potential of Klebsiella variicola isolated from industrial effluents

Heavy metal contamination now a day is one of the major global environmental concerns. Textile effluents of Faisalabad Pakistan are heavily contaminated with heavy metals and demands to explore native microorg...

http://ift.tt/2kdpFsC

Utilization of simultaneous saccharification and fermentation residues as feedstock for lipid accumulation in Rhodococcus opacus

Use of oleaginous microorganisms as "micro-factories" for accumulation of single cell oils for biofuel production has increased significantly to mitigate growing energy demands, resulting in efforts to upgrade...

http://ift.tt/2xNNUlP

Novel archaeal thermostable cellulases from an oil reservoir metagenome

Microbial assemblages were sampled from an offshore deep sub-surface petroleum reservoir 2.5 km below the ocean floor off the coast of Norway, providing conditions of high temperature and pressure, to identify...

http://ift.tt/2kaUe1R

Overexpression of CsLEA11, a Y3SK2-type dehydrin gene from cucumber (Cucumis sativus), enhances tolerance to heat and cold in Escherichia coli

As the group II LEA (late embryogenesis abundant) proteins, dehydrins (DHNs) play an important role in plant growth and development, as well as in response to abiotic or biotic stress challenges. In this study...

http://ift.tt/2xNdbMW

Resumption of Anticoagulation After Intracranial Hemorrhage

Opinion statement

Anticoagulation is a vital therapy in a number of different disease processes, and is strongly recommended for the prevention of stroke in patients with atrial fibrillation and/or with mechanical prosthetic heart valves. Studies involving patients on oral anticoagulants (OACs) have revealed that ICH can occur eight times more frequently in this population, with an annual estimated incidence of 0.25 to 1.1%. The decision of whether and when to resume anticoagulation following intracranial hemorrhage is challenging and requires an assessment of associated risks and benefits. Clinical data, imaging, and risk factors for both ischemic and hemorrhagic complications may aid in decision-making. Baseline functional status, life expectancy, compliance with therapy, and family support also impact decision analyses. Currently available data suggest that anticoagulation could be safely restarted in select groups of OAC-ICH patients within 4 weeks of intracranial hemorrhage; however, high-quality randomized, clinical trials are needed.

http://ift.tt/2fXKLX9

Current Treatment Options: Vestibular Migraine

Opinion statement

Vestibular migraine (VM) is a disorder with a spectrum of clinical presentations and among the most common causes of chronic vestibular symptoms. Some present with attacks before or during typical migraine, but many others have fluctuating or daily symptoms. While the symptoms and pathogenesis of vestibular migraine may have elements of both central and peripheral disorders, hearing loss should be absent. VM typically worsens with activity and head movements in general, and encompasses symptoms of vertigo, disequilibrium, or imbalance. While it is possible to confuse other disorders such as Meniere's disease with migraine, it is worth making the diagnosis of vestibular migraine on clinical grounds after ruling out other possible causes. For acute attack treatment, migraine-specific medications such as triptans may be effective. In patients with frequent or disabling attacks, preventive treatment is essential. Vestibular rehabilitation may be helpful as well as medications used for migraine prevention such as including propranolol, venlafaxine, topiramate, and amitriptyline. For refractory patients, use of acetazolamide or lamotrigine may be reasonable.

http://ift.tt/2xMWRM4

Comprehensive and Methodical: Diagnostic and Management Approaches to Rapidly Progressive Dementia

Abstract

Purpose of review The sudden emergence of a change in cognitive abilities or behavior is an important symptom that warrants medical evaluation and may represent the early stages of a rapidly progressive dementia (RPD). To correctly ascertain the cause of RPD in a given patient, the clinician must be methodical and knowledgeable about the range of potential causes and must move forward with supportive treatment, and in some cases empiric treatment, based on clinical features alone.

Recent findings Significant advances in prion disease biomarkers, the molecular features of rapidly progressive Alzheimer's disease, and new detection of autoimmune limbic encephalitis disease entities have caused a shift in the diagnostic and treatment framework of RPD. Additionally, in the past decade, emerging retrospective data have led to suggested treatments in autoimmune encephalitis that, if instituted early, can protect patients against residual deficits and disease relapse.

Summary Here, we provide an integrative clinical and diagnostic treatment approach that is applicable to the various forms of RPD. We have highlighted the clinical features of selected types of RPD that have experienced advances in the last 10–15 years.

http://ift.tt/2fYLg38

You Will Never Walk Alone: A Simulation Experience for Caregiver's Family and Friends.

No abstract available

http://ift.tt/2x4iwf2

Maternal Death Due to Amniotic Fluid Embolism: A National Study in France.

BACKGROUND: A structured definition of amniotic fluid embolism (AFE) based on 4 criteria was recently proposed for use in research by the Society for Maternal-Fetal Medicine (SMFM) and the Amniotic Fluid Embolism Foundation. The main objective of this study was to review all AFE-related maternal deaths in France during 2007-2011 according to the presence or not of all these 4 diagnostic criteria. METHODS: Maternal deaths due to AFE were identified by the national experts committee of the French Confidential Enquiry into Maternal Deaths during 2007-2011 (n = 39). The maternal mortality ratio for AFE was calculated. We applied the structured definition proposed by the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation to AFE-related maternal deaths identified by the national experts committee. Characteristics of women, pregnancies and deliveries; clinical and biological features of AFE; and specific laboratory tests used were described by the presence or not of all 4 diagnostic criteria. Management of obstetric hemorrhage and quality of care according to the experts were also described. RESULTS: The maternal mortality ratio from AFE was 0.95/100,000 live births (95% confidence interval, 0.67-1.3). Detailed clinical data were collected for 36 women who died from AFE: 21 (58%) had all 4 proposed diagnostic criteria and 15 (42%) had 1 or more missing criterion. Documented early disseminated intravascular coagulopathy was missing for 14 women, and 2 women exhibited more than 1 missing criterion. Ten of the 15 women with missing criteria had clinical coagulopathy, with standard hemostasis tests performed in only 3. Specific diagnostic examinations for AFE were performed in similar proportions by the presence or not of all diagnostic criteria. Opportunities to improve care included timely performance of indicated hysterectomy (n = 13) and improved transfusion practices (n = 9). In the context of maternal cardiac arrest, for 5 of 13 women, fetal extraction was performed within 5 minutes. CONCLUSIONS: The structured definition of AFE for research studies would exclude more than one-third of AFE-related maternal deaths identified by the national experts committee. Inclusion of clinical coagulopathy as a diagnostic criterion for AFE would reduce this proportion to 14%. There is still room for improvement in the management of obstetric hemorrhage and timely fetal extraction in the context of maternal cardiac arrest, frequently observed in AFE-related maternal death. (C) 2017 International Anesthesia Research Society

http://ift.tt/2x4As9j

Monte Carlo Simulations Comparing Fisher Exact Test and Unequal Variances t Test for Analysis of Differences Between Groups in Brief Hospital Lengths of Stay.

BACKGROUND: We examined type I and II error rates for analysis of (1) mean hospital length of stay (LOS) versus (2) percentage of hospital LOS that are overnight. These 2 end points are suitable for when LOS is treated as a secondary economic end point. METHODS: We repeatedly resampled LOS for 5052 discharges of thoracoscopic wedge resections and lung lobectomy at 26 hospitals. RESULTS: Unequal variances t test (Welch method) and Fisher exact test both were conservative (ie, type I error rate less than nominal level). The Wilcoxon rank sum test was included as a comparator; the type I error rates did not differ from the nominal level of 0.05 or 0.01. Fisher exact test was more powerful than the unequal variances t test at detecting differences among hospitals; estimated odds ratio for obtaining P

http://ift.tt/2wq1IzQ

70th World Health Assembly, Geneva, Switzerland.

No abstract available

http://ift.tt/2x3WGZc

Research Productivity and Rankings of Anesthesiology Departments in Canada and the United States: The Relationship Between the h-Index and Other Common Metrics.

BACKGROUND: To evaluate the relative research productivity and ranking of anesthesiology departments in Canada and the United States, using the Hirsch index (h-index) and 4 other previously validated metrics. METHODS: We identified 150 anesthesiology departments in Canada and the United States with an accredited residency program. Publications for each of the 150 departments were identified using Thomson's Institute for Scientific Information Web of Science, and the citation report for each department was exported. The bibliometric data were used to calculate publication metrics for 3 time periods: cumulative (1945-2014), 10 years (2005-2014), and 5 years (2010-2014). The following group metrics were then used to determine the publication impact and relative ranking of all 150 departments: h-index, m-index, total number of publications, sum of citations, and average number of citations per article. Ranking for each metric were also stratified by using a proxy for departmental size. The most common journals in which US and Canadian anesthesiology departments publish their work were identified. RESULTS: The majority (23 of the top 25) of top-ranked anesthesiology departments are in the United States, and 2 of the top 25 departments (University of Toronto; McGill University) are in Canada. There was a strong positive relationship between each of h-index, total number of publications, and the sum of citations (0.91-0.97; P

http://ift.tt/2woB4an

Neuro-protective effect of rutin against Cisplatin-induced neurotoxic rat model

Cisplatin is widely used chemotherapeutic agent for cancer treatment with limited uses due to its neurotoxic side effect. The aim of this study was to determine the potential preventive effects of rutin on the...

http://ift.tt/2yN2hVZ

Anti-inflammatory and analgesic activities of solvent fractions of the leaves of Moringa stenopetala Bak. (Moringaceae) in mice models

Many people still experience pain and inflammation regardless of the available drugs for treatments. In addition, the available drugs have many side effects, which necessitated a quest for new drugs from sever...

http://ift.tt/2yfISQx

Factor analyses of the Chinese Zarit Burden Interview among caregivers of patients with schizophrenia in a rural Chinese community

Objective

This study aimed to evaluate the factor structure of the Chinese version of the 22-item Zarit Burden Interview (ZBI) among family caregivers of patients with schizophrenia in China.

Methods

Using one-stage cluster-sampling design, 324 primary caregivers of patients with schizophrenia in Ningxiang County, Hunan Province, China, completed the Zarit Burden Interview face-to-face. Confirmatory factor analysis (CFA) was first performed based on existing models to check model fit. Owing to an unsatisfactory result of CFA, exploratory factor analysis (EFA) was then conducted to explore a new factor structure, and a subsequent CFA was run to examine its model fit.

Results

The CFA results showed that none of the existing models fit the data reasonably well. The EFA results suggested five dimensions: negative emotion (10 items), interpersonal relationship (4 items), time demand (3 items), patient's dependence (2 items) and self-accusation and guilt (2 items). The following CFA confirmed the five-factor solution in this study, and the goodness-of-fit for this model fell within the acceptable range. The overall internal consistency (Cronbach's alpha) was 0.88, and the internal consistency coefficients of individual dimensions were 0.68 to 0.84.

Conclusion

This study supported a 22-item ZBI scale, with a five-factor structure when applied to Chinese caregivers of patients with schizophrenia.

http://ift.tt/2xS3oFW

Does laryngeal reinnervation or type I thyroplasty give better voice results for patients with unilateral vocal fold paralysis (VOCALIST): study protocol for a feasibility randomised controlled trial

Introduction

A functioning voice is essential for normal human communication. A good voice requires two moving vocal folds; if one fold is paralysed (unilateral vocal fold paralysis (UVFP)) people suffer from a breathy, weak voice that tires easily and is unable to function normally. UVFP can also result in choking and breathlessness. Current treatment for adults with UVFP is speech therapy to stimulate recovery of vocal fold (VF) motion or function and/or injection of the paralysed VF with a material to move it into a more favourable position for the functioning VF to close against. When these therapies are unsuccessful, or only provide temporary relief, surgery is offered. Two available surgical techniques are: (1) surgical medialisation; placing an implant near the paralysed VF to move it to the middle (thyroplasty) and/or repositioning the cartilage (arytenoid adduction) or (2) restoring the nerve supply to the VF (laryngeal reinnervation). Currently there is limited evidence to determine which surgery should be offered to adults with UVFP.

Methods and analysis

A feasibility study to test the practicality of running a multicentre, randomised clinical trial of surgery for UVFP, including: (1) a qualitative study to understand the recruitment process and how it operates in clinical centres and (2) a small randomised trial of 30 participants recruited at 3 UK sites comparing non-selective laryngeal reinnervation to type I thyroplasty. Participants will be followed up for 12 months. The primary outcome focuses on recruitment and retention, with secondary outcomes covering voice, swallowing and quality of life.

Ethics and dissemination

Ethical approval was received from National Research Ethics Service—Committee Bromley (reference 11/LO/0583). In addition to dissemination of results through presentation and publication of peer-reviewed articles, results will be shared with key clinician and patient groups required to develop the future large-scale randomised controlled trial.

Trial registration number

ISRCTN90201732; 16 December 2015.

http://ift.tt/2fFdWBg

Permanent work disability before and after ischaemic heart disease or stroke event: a nationwide population-based cohort study in Sweden

Objectives

We examined the risk of disability pension before and after ischaemic heart disease (IHD) or stroke event, the burden of stroke compared with IHD and which factors predicted disability pension after either event.

Design

A population-based cohort study with follow-up 5 years before and after the event. Register data were analysed with general linear modelling with binary and Poisson distributions including interaction tests for event type (IHD/stroke).

Setting and participants

All people living in Sweden, aged 25-60 years at the first event year, who had been living in Sweden for 5 years before the event and had no indication of IHD or stroke prior to the index event in 2006-2008 were included, except for cases in which death occurred within 30 days of the event. People with both IHD and stroke were excluded, resulting in 18 480 cases of IHD (65%) and 9750 stroke cases (35%).

Primary outcome measures

Disability pension.

Results

Of those going to suffer IHD or stroke event, 25% were already on disability pension a year before the event. The adjusted OR for disability pension at first postevent year was 2.64-fold (95% CI 2.25 to 3.11) for people with stroke compared with IHD. Economic inactivity predicted disability pension regardless of event type (OR=3.40; 95% CI 2.85 to 4.04). Comorbid mental disorder was associated with the greatest risk (OR=3.60; 95% CI 2.69 to 4.83) after an IHD event. Regarding stroke, medical procedure, a proxy for event severity, was the largest contributor (OR=2.27, 95% CI 1.43 to 3.60).

Conclusions

While IHD event was more common, stroke involved more permanent work disability. Demographic, socioeconomic and comorbidity-related factors were associated with disability pension both before and after the event. The results help occupational and other healthcare professionals to identify vulnerable groups at risk for permanent labour market exclusion after such an event.

http://ift.tt/2fEsIsk

Attitudes and perceptions of GPs and community pharmacists towards their role in the prevention of bisphosphonate-related osteonecrosis of the jaw: a qualitative study in the North East of England

Background

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare, yet significant, adverse effect of bisphosphonate therapy. A multidisciplinary approach to the prevention of BRONJ is recommended due to the significant morbidity and difficulty treating the condition. Current evidence suggests that both general practitioners (GPs) and community pharmacists have limited knowledge relating to BRONJ and that preventative strategies are rarely implemented.

Objective

To explore the attitudes and perceptions of GPs and community pharmacists on the risks and preventative strategies for the development of BRONJ.

Design

Interpretivist methodological approach using qualitative semistructured interviews.

Participants

9 community pharmacists and 8 GPs.

Setting

Primary Care in North East England and Cumbria, UK.

Methods

Using a Grounded Theory methodology and integrating a process of constant comparison in the iterative enrichment of data sets, semistructured interviews were undertaken, transcribed and analysed using framework analysis. Salient themes were identified and related back to extant literature in the field.

Results

Four salient and inter-related themes emerged: (1) uncertain knowledge, indicating limited exposure of respondents to BRONJ, and limited awareness of the implications of its diagnosis, risk factors and preventative strategies; (2) patient specific, referring to the complexity of patients, patient education and prioritising aspects of care; (3) wider context, indicating a lack of interdisciplinary communication and referral processes between professions, workload pressures, access and patient receptivity to dental services; and (4) professional, reflecting professional roles and responsibilities, authority and educational initiatives

Conclusions

Effective communication or collaborative care between GPs and community pharmacists for the prevention of BRONJ is not apparent. Interventions to mitigate against the risk of developing BRONJ and clarity of GP and community pharmacy roles are required.

http://ift.tt/2xQZCwu

Effect of weekend admission on process of care and clinical outcomes for the management of acute coronary syndromes: a retrospective analysis of three UK centres

Objectives

The effect of weekend versus weekday admission following acute coronary syndrome (ACS) on process of care and mortality remains controversial. This study aimed to investigate the 'weekend-effect' on outcomes using a multicentre dataset of patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction/unstable angina (NSTEMI/UA).

Design

This retrospective observational study used propensity score (PS) stratification to adjust estimates of weekend effect for observed confounding. Logistic regression was used to estimate odds ratios (ORs) for binary outcomes and time-to-event endpoints were modelled using Cox proportional hazards to estimate hazard ratios (HRs).

Setting

Three tertiary cardiac centres in England and Wales that contribute to the Myocardial Ischaemia National Audit Project.

Participants

Between January 2010 and March 2016, 17 705 admissions met the study inclusion criteria, 4327 of which were at a weekend.

Primary and secondary outcomes

Associations were studied between weekend admissions and the following primary outcome measures: in-hospital mortality, 30-day mortality and long-term survival; secondary outcomes included several processes of care indicators, such as time to coronary angiography.

Results

After PS stratification adjustment, mortality outcomes were similar between weekend and weekday admission across patients with STEMI and NSTEMI/UA. Weekend admissions were less likely to be discharged within 1 day (HR 0.72, 95% CI 0.66 to 0.78), but after 4 days the length of stay was similar (HR 0.97, 95% CI 0.90 to 1.04). Fewer patients with NSTEMI/UA received angiography between 0 and 24 hours at a weekend (HR 0.71, 95% CI 0.65 to 0.77). Weekend patients with STEMI were less likely to undergo an angiogram within 1 hour, but there was no significant difference after this time point.

Conclusion

Patients with ACS had similar mortality and processes of care when admitted on a weekend compared with a weekday. There was evidence of a delay to angiography for patients with NSTEMI/UA admitted at the weekend.

http://ift.tt/2fFFjLy

Quantifying sociodemographic and income disparities in medical therapy and lifestyle among symptomatic patients with suspected coronary artery disease: a cross-sectional study in North America

Objectives

To evaluate potential gaps in preventive medical therapy and healthy lifestyle practices among symptomatic patients with suspected coronary artery disease (CAD) seeing primary care physicians and cardiologists and how gaps vary by sociodemographic characteristics and baseline cardiovascular risk.

Design

Cross-sectional study assessing potential preventive gaps.

Participants

10 003 symptomatic outpatients evaluated by primary care physicians, cardiologists or other specialists for suspected CAD.

Setting

PROspective Multicenter Imaging Study for Evaluation of Chest Painfrom 2010 to 2014.

Measures

Primary measures were absence of an antihypertensive, statin or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker for renal protection in patients with hypertension, dyslipidaemia or diabetes, respectively, and being sedentary, smoking or being obese.

Results

Preventive treatment gaps affected 14% of patients with hypertension, 36% of patients with dyslipidaemia and 32% of patients with diabetes. Overall, 49% of patients were sedentary, 18% currently smoked and 48% were obese. Women were significantly more likely to not take a statin for dyslipidaemia and to be sedentary. Patients with lower socioeconomic status were also significantly more likely to not take a statin. Compared with Whites, Blacks were significantly more likely to be obese, while Asians were less likely to smoke or be obese. High-risk patients sometimes experienced larger preventive care gaps than low-risk patients. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event (HR 1.35, 95% CI 1.02 to 1.82).

Conclusions

Among contemporary, symptomatic patients with suspected CAD, significant gaps exist in preventive care and lifestyle practices, and high-risk patients sometimes had larger gaps. Differences by sex, age, race/ethnicity, socioeconomic status and geography are modest but contribute to disparities and have implications for improving opulation health. For patients with dyslipidaemia, the presence of a treatment gap was associated with a higher risk of an adverse event.

Clinical trial registration

Clinical Trials.gov identifier NCT01174550.

http://ift.tt/2xRl2JV

Study protocol for a longitudinal study evaluating the impact of rape on womens health and their use of health services in South Africa

Introduction

South Africa is a country known for its high levels of HIV infection and sexual violence. Although the interface between gender-based violence, HIV and mental health has been described, there are substantial gaps in knowledge of the medium-term and long-term health impact. The 2010 Global Burden of Disease study excluded many health outcomes associated with rape and other forms of gender-based violence because systematic reviews revealed huge gaps in data and poor evidence of health effects. This study aims to describe the incidence and attributable burden of physical and mental health problems (including HIV acquisition) in adult women over a 2-year postrape period, through comparison with a cohort of women who have not been raped. The study will substantially advance our understanding of the impact of rape and will generate robust data to assist in the development of postrape health services and the delivery of evidence-based care.

Methods and analysis

This longitudinal study seeks to recruit 1008 rape-exposed and 1008 rape non-exposed women. Women were recruited from health services, and assessments were carried out at baseline, 3, 6, 9, 12, 18 and 24 months. Outcome measures include exposure to risk factors; mental health status; cardio-metabolic risks; and biomarkers for HIV, sexually transmitted infections, pregnancy and stress. The primary analysis will be to compare HIV incidence in the two groups using log-rank tests. Appropriate models to predict health outcomes over time will also be applied.

Ethics and dissemination

The South African Medical Research Council's Ethics Committee approved the study. As rape is a key element of the study, the safety and protection of participants guides the research process. We will adopt a research uptake strategy to ensure dissemination to policy makers, service providers and advocacy groups. Peer-reviewed journal articles will be published.

http://ift.tt/2xQZsoS

How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study

Objective

To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system.

Setting

ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million.

Participants

5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012. Patients were classified by the Abbreviated Injury Score as follows: (1) traumatic brain injury (2) multiple injuriesand (3) extracranial lesions. The SIATs were divided into those with at least one neurosurgical level II trauma centre (TC) and those with a neurosurgical unit in the level I TC only.

Results

A higher proportion of patients (out of all SIAT patients) were admitted to the level I TC at the head of the SIAT with no additional neurosurgical facilities (1083/1472, 73.6%) compared with the level I TCs heading SIATs with neurosurgical level II TCs (1905/3815; 49.9%). A similar percentage of patients were admitted to level I TCs (1905/3815; 49.9%) and neurosurgical level II TCs (1702/3815, 44.6%) in the SIATs with neurosurgical level II TCs. Observed versus expected mortality (OE) was not statistically different among the three types of centre with a neurosurgical unit; however, the best mean OE values were observed in the level I TC in the SIAT with no neurosurgical unit.

Conclusion

The Hub and Spoke concept was fully applied in the SIAT in which neurosurgical facilities were available in the level I TC only. The performance of this system suggests that competition among level I and level II TCs in the same Trauma System reduces performance in both. The density of neurosurgical centres must be considered by public health system governors before implementing trauma systems.

http://ift.tt/2fEsGRe

Evolution of pain at 3 months by oral resveratrol in knee osteoarthritis (ARTHROL): protocol for a multicentre randomised double-blind placebo-controlled trial

Introduction

Osteoarthritis (OA) pathophysiology is driven in part by joint inflammation. Resveratrol has in vitro anti-inflammatory properties. We aim to assess the efficacy of oral resveratrol for knee pain at 3 months in people with knee OA.

Methods and analysis

We will conduct a randomised double-blind placebo-controlled trial. Overall, 164 individuals with knee OA fulfilling 1986 American College of Rheumatology criteria will be recruited in three tertiary care centres in France and randomised to receive oral resveratrol, 40 mg (two caplets) two times per day for 1 week, then 20 mg (one caplet) two times per day or a matching placebo for a total of 6 months. Randomisation will be centralised and stratified by centre. The allocation ratio of assignments will be 1:1. The primary outcome will be the mean change from baseline in knee pain on a self-administered 11-point pain Numeric Rating Scale at 3 months. Secondary outcomes will be the mean change in knee pain at 6 months, the function subscore of the Western Ontario and McMaster Universities Arthritis Index score, patient global assessment, proportion of responders according to the Osteoarthritis Research Society International–Outcome Measures in Rheumatology criteria at 3 and 6 months, and self-reported number of intra-articular injections of corticosteroids or hyaluronic acid and consumption of analgesics and non-steroidal anti-inflammatory drugs since the last contact. Other interventions will be allowed and self-reported. Adherence will be monitored by capsule counts and a booklet and adverse events recorded at 3 and 6 months. Statisticians, treating physicians and participants will be blinded to the allocated treatment.

Ethics and dissemination

The oral resveratrol in knee osteoarthritis (ARTHROL) trial has been authorised by the AgenceNationale de Sécurité du Médicament et des Produits de Santé and ethics were approved by the Comité deProtection des Personnes Île-de-France III. The findings of the study will be published in a peer-reviewed journal and disseminated at conferences. The design of ARTHROL will warrant the translation of its findings into clinical practice.

Trial registration number

ClinicalTrials.gov identifier: NCT02905799. Pre-results. First received: 14 September 2016. Last updated: 16 September 2016. Status: not yet recruiting.

http://ift.tt/2xQZm0u

Understanding patients experiences of the wish to hasten death: an updated and expanded systematic review and meta-ethnography

Objectives

Patients with advanced disease sometimes express a wish to hasten death (WTHD). In 2012, we published a systematic review and meta-ethnography of qualitative studies examining the experience and meaning of this phenomenon. Since then, new studies eligible for inclusion have been reported, including in Europe, a region not previously featured, and specifically in countries with different legal frameworks for euthanasia and assisted suicide. The aim of the present study was to update our previous review by including new research and to conduct a new analysis of available data on this topic.

Setting

Eligible studies originated from Australia, Canada, China, Germany, The Netherlands, Switzerland, Thailand and USA.

Participants

Studies of patients with life-threatening conditions that had expressed the WTHD.

Design

The search strategy combined subject terms with free-text searching of PubMed MEDLINE, Web of Science, CINAHL and PsycInfo. The qualitative synthesis followed the methodology described by Noblit and Hare, using the 'adding to and revising the original' model for updating a meta-ethnography, proposed by France et al. Quality assessment was done using the Critical Appraisal Skills Programme checklist.

Results

14 studies involving 255 participants with life-threatening illnesses were identified. Five themes emerged from the analysis: suffering (overarching theme), reasons for and meanings and functions of the WTHD and the experience of a timeline towards dying and death. In the context of advanced disease, the WTHD emerges as a reaction to physical, psychological, social and existential suffering, all of which impacts on the patient's sense of self, of dignity and meaning in life.

Conclusions

The WTHD can hold different meanings for each individual—serving functions other than to communicate a genuine wish to die. Understanding the reasons for, and meanings and functions of, the WTHD is crucial for drawing up and implementing care plans to meet the needs of individual patients.

http://ift.tt/2fDNcBc

Association between eczema and major cardiovascular outcomes in population-based studies: a systematic review protocol

Introduction

Chronic inflammatory diseases such as eczema (also known as atopic dermatitis) have been inconsistently linked to cardiovascular disease and stroke in both mechanistic and epidemiological studies. There is a need to review the existing epidemiological data examining the association between eczema and major cardiovascular outcomes, including angina, myocardial infarction, coronary revascularisation, heart failure, cardiac arrhythmias, stroke and cardiovascular death, in order to improve our understanding of the comorbidities of eczema.

Methods and analysis

We will systematically review population-based studies, including cohort, case–control and cross-sectional studies, reporting on the association between eczema and cardiovascular outcomes. We will search Medline, Embase and Global Health, from their date of inception to April 2017, using a comprehensive search strategy formulated with the help of a librarian. Two reviewers will independently screen titles and abstracts in duplicate, followed by independent data extraction and quality assessment. We will group studies by the cardiovascular outcome under study and synthesise them narratively. If sufficient numbers of homogeneous studies are returned, we will perform meta-analyses to obtain pooled effect estimates. Preferred Reporting Items for Systematic Review and Meta-Analysis will be used to inform the reporting of this study.

Trial registration number

CRD42017060359.

http://ift.tt/2xSmewF

Risk factors and barriers to case management of neonatal pneumonia: protocol for a pan-India qualitative study of stakeholder perceptions

Introduction

India accounted for more neonatal deaths (estimated at 696 000) than any other country, as of 2015. Of these , most neonatal deaths due to infections can be attributed to pneumonia which accounts for 16% of all neonatal mortalities (2010). Despite simple, inexpensive case management strategies being available, pneumonia continues to cause significant mortality and morbidity among neonates. Understanding the perceptions and experiences of stakeholders of neonatal care can help find solutions to barriers to care and design tailored strategies for controlling neonatal pneumonia.

Methods and analysis

A pan-India qualitative study will be conducted. Participants include healthcare providers, programme officers, academicians, representatives of non-governmental organisations/bilateral agencies and policy makers. They will be recruited purposively from rural and urban, public and private, and facility and community healthcare settings across six Indian regions. Within each region, a minimum of one state will be selected. Districts will be based on neonatal mortality indicators, and will be subject to feasibility at the time of conducting the study. We plan to conduct in-depth interviews (IDI) and focus group discussions focusing on (a) burden, (b) risk factors, (c) case management, (d) treatment guidelines, (e) barriers to case management, (f) recommendations. The number of interviews will depend on the information saturation. Interviews will be audio-recorded with prior written consent and transcribed verbatim. Principles of thematic analysis will be applied for qualitative data analysis using R package for Qualitative Data Analysis (RQDA).

Ethics and dissemination

The protocol has been approved by the Health Ministry Screening Committee, Government of India and the Institutional Ethics Committee at the host institution. Confidentiality and privacy of the participants will be maintained. The findings of the study will be shared with all stakeholders of this research including the participants. Knowledge dissemination workshops will be conducted to ultimately transfer the evidence tailored to the stakeholders' need.

http://ift.tt/2fFF2s0