Older, vulnerable patient view: a pilot and feasibility study of the patient measure of safety (PMOS) with patients in Australia

Objectives

The UK-developed patient measure of safety (PMOS) is a validated tool which captures patient perceptions of safety in hospitals. We aimed (1) to investigate the extent to which the PMOS is appropriate for use with stroke, acute myocardial infarction (AMI) and hip fracture patients in Australian hospitals and (2) to pilot the PMOS for use in a large-scale, national study 'Deepening our Understanding of Quality in Australia' (DUQuA).

Participants

Stroke, AMI and hip fracture patients (n=34) receiving care in 3 wards in 1 large hospital.

Methods

2 phases were conducted. First, a 'think aloud' study was used to determine the validity of PMOS with this population in an international setting, and to make amendments based on patient feedback. The second phase tested the revised measure to establish the internal consistency reliability of the revised subscales, and piloted the recruitment and administration processes to ensure feasibility of the PMOS for use in DUQuA.

Results

Of the 43 questions in the PMOS, 13 (30%) were amended based on issues patients highlighted for improvement in phase 1. In phase 2, a total of 34 patients were approached and 29 included, with a mean age of 71.3 years (SD=16.39). Internal consistency reliability was established using interitem correlation and Cronbach's α for all but 1 subscale. The most and least favourably rated aspects of safety differed between the 3 wards. A study log was categorised into 10 key feasibility factors, including liaising with wards to understand operational procedures and identify patterns of patient discharge.

Conclusions

Capturing patient perceptions of care is crucial in improving patient safety. The revised PMOS is appropriate for use with vulnerable older adult groups. The findings from this study have informed key decisions made for the deployment of this measure as part of the DUQuA study.

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Does employee participation in workplace health promotion depend on the working environment? A cross-sectional study of Danish workers

Objectives

To investigate if participation in workplace health promotion (WHP) depends on the work environment.

Methods

Questionnaire data on participation in WHP activities (smoking cessation, healthy diet, exercise facilities, weekly exercise classes, contact with health professionals, health screenings) and the work environment (social support, fatiguing work, physical, quantitative and emotional demands, job control and WHP availability setting) were collected cross-sectionally in 2010 in a representative sample (n=10 605) of Danish workers. Binary regression analyses of the association between work environment characteristics and participation in WHP were conducted and adjusted for age, gender and industry.

Results

WHP offered during leisure time was associated with lower participation in all measured activities compared with when offered during working hours. Low social support and fatiguing work were associated with low participation in WHP. No associations with participation in WHPs were observed for physical work or quantitative demands, work pace or job strain. However, high physical demands/low job control and high emotional demands/low job control were associated with low participation.

Conclusions

Lower participation in WHP was associated with programmes during leisure, low social support, very fatiguing work and high physical or emotional demands with low job control. This suggests that to obtain proper effect of health promotion in a workplace setting, a good work environment is essential.

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Consumer concerns about paracetamol: a retrospective analysis of a medicines call centre

Objectives

To identify consumer information needs about paracetamol, the most commonly used analgesic and antipyretic worldwide.

Design

Retrospective analysis of medicines questions from the public.

Setting

Australian consumer medicines call centre.

Participants

Callers to National Prescribing Service Medicines Line between September 2002 and June 2010 (n=123 217).

Main outcome measures

Enquiry profile: demographics, enquiry type and concurrent medicines included in paracetamol calls; question themes derived from subset of call narratives.

Results

Paracetamol comprised part of the enquiry in 5.2% of calls (n=6367). The caller age distribution for paracetamol calls was skewed towards a younger cohort, with 45.2% made by those aged 25–44 vs 37.5% in 'rest of calls'. Significantly more paracetamol-related calls were made for a child (23.7%) compared with 'rest of calls' (12.7%, p<0.001). The most frequent concurrently asked about medicines were codeine (11%, n=1521) and ibuprofen (6.4%, n=884). Questions underpinned by paracetamol risk (interaction, use in pregnancy/lactation or other safety concerns) predominated (55.8%). When individual paracetamol enquiry types were compared with 'rest of calls', efficacy was most frequent (24.9% vs 22.8%); however, interaction (21.5% vs 14.8%), administration (15.5% vs 11%) and pregnancy/lactation (13.8% vs 8.3%) categories were more prevalent for paracetamol calls (all p<0.001). Enquiry type frequency also varied by patient age group, with questions about administration more common in younger groups and efficacy dominating in those over 45. Narrative analysis of over-represented paracetamol enquiry types showed specific concerns relevant to life stages: young children, those of reproductive age and the elderly.

Conclusions

Consumers have many concerns about the use of paracetamol that may be under-recognised by healthcare providers, with the nature of enquiries differing across life stages. These concerns are not adequately addressed by available consumer information. Improving access to targeted information about paracetamol would promote the safe and effective use of this common medicine.

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Dietary flavonoid intake and the risk of stroke: a dose-response meta-analysis of prospective cohort studies

Objective

To clarify and quantify the potential association between intake of flavonoids and risk of stroke.

Design

Meta-analysis of prospective cohort studies.

Data source

Studies published before January 2016 identified through electronic searches using PubMed, Embase and the Cochrane Library.

Eligibility criteria for selecting studies

Prospective cohort studies with relative risks and 95% CIs for stroke according to intake of flavonoids (assessed as dietary intake).

Results

The meta-analysis yielded 11 prospective cohort studies involving 356 627 participants and more than 5154 stroke cases. The pooled estimate of the multivariate relative risk of stroke for the highest compared with the lowest dietary flavonoid intake was 0.89 (95% CI 0.82 to 0.97; p=0.006). Dose-response analysis indicated that the summary relative risk of stroke for an increase of 100 mg flavonoids consumed per day was 0.91 (95% CI 0.77 to 1.08) without heterogeneity among studies (I²=0%). Stratifying by follow-up duration, the relative risk of stroke for flavonoid intake was 0.89 (95% CI 0.81 to 0.99) in studies with more than 10 years of follow-up.

Conclusions

Results from this meta-analysis suggest that higher dietary flavonoid intake may moderately lower the risk of stroke.

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Trends of CT utilisation in an emergency department in Taiwan: a 5-year retrospective study

Objectives

To investigate the association between the trends of CT utilisation in an emergency department (ED) and changes in clinical imaging practice and patients' disposition.

Setting

A hospital-based retrospective observational study of a public 1520-bed referral medical centre in Taiwan.

Participants

Adult ED visits (aged ≥18 years) during 2009–2013, with or without receiving CT, were enrolled as the study participants.

Main outcome measures

For all enrolled ED visits, we retrospectively analysed: (1) demographic characteristics, (2) triage categories, (3) whether CT was performed and the type of CT scan, (4) further ED disposition, (5) ED cost and (6) ED length of stay.

Results

In all, 269 239 adult ED visits (148 613 male patients and 120 626 female patients) were collected during the 5-year study period, comprising 38 609 CT scans. CT utilisation increased from 11.10% in 2009 to 17.70% in 2013 (trend test, p<0.001). Four in 5 types of CT scan (head, chest, abdomen and miscellaneous) were increasingly utilised during the study period. Also, CT was increasingly ordered annually in all age groups. Although ED CT utilisation rates increased markedly, the annual ED visits did not actually increase. Moreover, the subsequent admission rate, after receiving ED CT, declined (59.9% in 2009 to 48.2% in 2013).

Conclusions

ED CT utilisation rates increased significantly during 2009–2013. Emergency physicians may be using CT for non-emergent studies in the ED. Further investigation is needed to determine whether increasing CT utilisation is efficient and cost-effective.

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Nerve-insulating cells more diverse than previously thought

Oligodendrocytes, a type of brain cell that plays a crucial role in diseases such as multiple sclerosis, are more diverse than have previously been thought, according to a new study by researchers at Karolinska Institutet in Sweden. The findings, published in the journal Science, will help increase our understanding of diseases in which these cells are affected and possibly provide clues to future treatment strategies. In multiple sclerosis and similar neurological diseases, the electrical signals in the brain propagate more slowly. The reduced speed of information flow contributes to symptoms such as numbness, balance and walking difficulties and blurred vision. Loss of myelin Multiple sclerosis is characterised by the loss of myelin, a protective sheath that insulates nerve cells and allows rapid transmission of electrical signals in the brain. Myelin is produced by a specialized cell type, the oligodendrocyte. While oligodendrocytes have thus far been thought to be a homogenous population, a different view emerges from the current study. The researchers, led by Dr. Gonçalo Castelo-Branco and Dr. Sten Linnarsson, used the recently developed technique of single cell RNA-sequencing. This method allows investigators to get a snapshot of gene activity in individual cells. In this way, they could reveal differences between cells that may not be visible using classical methods. The researchers analysed more than five thousand oligodendrocytes from several regions of the brain and spinal cord in adolescent and adult mice, which allowed them to see the diversity of these cells with unprecedented detail and clarity.  "We uncovered an unexpected diversity within the oligodendrocyte population", says Sten Linnarsson from the Department of Medical Biochemistry and Biophysics. "In this study, we have identified 12 subclasses of oligodendrocytes and a novel cell distinct from oligodendrocytes residing in the blood vessels" Specific regions They found that the initial stages of maturation in oligodendrocyte development were similar across the central nerve system in juvenile mice, whereas different subsets of mature oligodendrocytes were enriched in specific regions in adult brains. "The uncovering of this unexpected oligodendrocyte diversity might bring new insights on mechanisms of degeneration and regeneration of diseases where myelin is lost, such as multiple sclerosis", says Gonçalo Castelo-Branco at the same department. The research has been supported by, among others, the Swedish Research Council, Swedish Brain Foundation (Hjärnfonden), Swedish Society of Medicine (SLS), Åke Wiberg, Clas Groschinsky, Petrus och Augusta Hedlunds foundations and European Union. Publication Oligodendrocyte heterogeneity in the mouse juvenile and adult central nervous system Sueli Marques, Amit Zeisel, Simone Codeluppi, David van Bruggen, Ana Mendanha, Falcão, Lin Xiao, Huiliang Li, Martin Häring, Hannah Hochgerner, Roman A. Romanov, Daniel Gyllborg, Ana Muñoz Manchado, Gioele La Manno, Peter Lönnerberg, Elisa M. Floriddia, Fatemah Rezayee, Patrik Ernfors, Ernest Arenas, Jens Hjerling-Leffler, Tibor Harkany, William D. Richardson, Sten Linnarsson, Gonçalo Castelo-Branco Science, published online 10th of June 2016, doi 10.1126/science.aaf6463.

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The essential function of the Trypanosoma brucei Trl1 homolog in procyclic cells is maturation of the intron-containing tRNATyr [ARTICLE]

Trypanosoma brucei, the etiologic agent of sleeping sickness, encodes a single intron-containing tRNA, tRNA^Tyr, and splicing is essential for its viability. In Archaea and Eukarya, tRNA splicing requires a series of enzymatic steps that begin with intron cleavage by a tRNA-splicing endonuclease and culminates with joining the resulting tRNA exons by a splicing tRNA ligase. Here we explored the function of TbTrl1, the T. brucei homolog of the yeast Trl1 tRNA ligase. We used a combination of RNA interference and molecular biology approaches to show that down-regulation of TbTrl1 expression leads to accumulation of intron-containing tRNA^Tyr and a concomitant growth arrest at the G1 phase. These defects were efficiently rescued by expression of an "intronless" version of tRNA^Tyr in the same RNAi cell line. Taken together, these experiments highlight the crucial importance of the TbTrl1 for tRNA^Tyr maturation and viability, while revealing tRNA splicing as its only essential function.

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