Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174: 09/24/17

Κυριακή 24 Σεπτεμβρίου 2017

Using systematic review in occupational safety and health

Evaluation of scientific evidence is critical in developing recommendations to reduce risk. Healthcare was the first scientific field to employ a systematic review approach for synthesizing research findings to support evidence-based decision-making and it is still the largest producer and consumer of systematic reviews. Systematic reviews in the field of occupational safety and health are being conducted, but more widespread use and adoption would strengthen assessments. In 2016, NIOSH asked RAND to develop a framework for applying the traditional systematic review elements to the field of occupational safety and health. This paper describes how essential systematic review elements can be adapted for use in occupational systematic reviews to enhance their scientific quality, objectivity, transparency, reliability, utility, and acceptability.

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Efficacy and Tolerability of Phytomedicines in Multiple Sclerosis Patients: A Review

Abstract

Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disorder of the central nervous system (CNS) that can cause cognition, mobility, and sensory impairments. It is considered one of the most common non-traumatic causes of disability in the world. The aim of the present article was to review the clinical evidence related to medicinal plants in the management of MS symptoms. Electronic databases, including the Cochrane Library, Pubmed, and Scopus, were searched for entries from 1966 to February 2017. Only clinical studies were included in this review. Different medicinal plants have positive effects on MS, including Andrographis paniculata, Boswellia papyrifera, Ruta graveolens, Vaccinium spp., Camellia sinensis, Panax ginseng, Aloysia citrodora, Ginkgo biloba, Oenothera biennis, and Cannabis sativa. C. sativa had the highest level of clinical evidence, supporting its efficacy in MS symptoms. Proanthocyanidins, ginkgo flavone glycosides, ginsenosides, epigallocatechin-3-gallate, cannabinoids (including delta-9-tetrahydrocannabinol and cannabidiol), boswellic acid, and andrographolide were presented as the main bioactive components of medicinal plants with therapeutic benefits in MS. The main complications of MS in which natural drugs were effective include spasticity, fatigue, scotoma, incontinence, urinary urgency, nocturia, memory performance, functional performance, and tremor. Herbal medicines were mostly well tolerated, and the adverse effects were limited to mild to moderate. Further well-designed human studies with a large sample size and longer follow-up period are recommended to confirm the role of medicinal plants and their metabolites in the management of MS.

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Bilateral Simultaneous Cochlear Implant in Children and Adults—a Literature Review and Clinical Experience

Abstract

Purpose of review

This paper aims to conduct a literature review and clinical audit on bilateral simultaneous cochlear implant (CI) surgeries in our centre and to assess the hearing and speech outcomes among these patients.

Findings

Bilateral simultaneous cochlear implantation is a safe surgery in our centre with no major or permanent complications. The mean duration of surgery was 3.9 h. All paediatric patients showed increment in Meaningful Auditory Integration Scale (MAIS), Meaningful Use of Speech Scale (MUSS), Listening Progress Profile (LIP) and Parents' Evaluation of Aural/oral performance of Children (PEACH) score even though the rate of improvement varied, with the age at implantation and child's behaviour identified as factors. Post-lingually deafened adult performed well in hearing and speech test post-implantation.

Summary

Bilateral simultaneous CIs is recommended in bilateral profoundly deafened paediatric and adult patients in order to obtain the optimum hearing and speech outcome as evidenced by our clinical experience and literature review. Nevertheless, there are multiple other factors that will affect the outcomes.

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Bilateral Simultaneous Cochlear Implant in Children and Adults—a Literature Review and Clinical Experience

Abstract

Purpose of review

Findings

Summary

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Bilateral Simultaneous Cochlear Implant in Children and Adults—a Literature Review and Clinical Experience

Abstract

Purpose of review

Findings

Summary

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From research to practice: results of 7300 mortality retrospective case record reviews in four acute hospitals in the North-East of England

Introduction

Monitoring hospital mortality using retrospective case record review (RCRR) is being adopted throughout the National Health Service (NHS) in England with publication of estimates of avoidable mortality beginning in 2017. We describe our experience of reviewing the care records of inpatients who died following admission to hospital in four acute hospital NHS Foundation Trusts in the North-East of England.

Methods

RCRR of 7370 patients who died between January 2012 and December 2015. Cases were reviewed by consultant reviewers with support from other disciplines and graded in terms of quality of care and preventability of deaths. Results were compared with the estimates published in the Preventable Incidents, Survival and Mortality (PRISM) studies, which established the original method.

Results

34 patients (0.5%, 95% CI 0.3% to 0.6%) were judged to have a greater than 50% probability of death being preventable. 1680 patients (22.3%, 95% CI 22.4% to 23.3%) were judged to have room for improvement in clinical, organisational (or both) aspects of care or less than satisfactory care.

Conclusions

Reviews using clinicians within trusts produce lower estimates of preventable deaths than published results using external clinicians. More research is needed to understand the reasons for this, but as the requirement for NHS Trusts to publish estimates of preventable mortality is based on reviews by consultants working for those trusts, lower estimates of preventable mortality can be expected. Room for improvement in the quality of care is more common than preventability of death and so mortality reviews contribute to improvement activity although the outcome of care cannot be changed. RCRR conducted internally is a feasible mechanism for delivering quantitative analysis and in the future can provide qualitative insights relating to inhospital deaths.

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Improving access to City and Hackney adult mental health services

City and Hackney Adult Mental Health Referral and Assessment Service (CHAMHRAS) is the single point of entry for all mental health referrals to secondary services, with the exception of perinatal referrals, in the City and Hackney region of London, UK. CHAMHRAS was established in 2013 with the objective of providing a one-stop point of referral which screens urgent and non-urgent referrals of adults aged 18–65 to mental health services. This single point of entry simplifies the referral process to secondary mental health services—something service users have requested. It also enables rapid feedback on all referrals taken from general practitioners as well as other sources. The centralised nature of CHAMHRAS has also facilitated the monitoring of waiting times from receipt of referral to first face-to-face assessment across services. It was noted that the waiting time for the majority of patients was exceeding the 28-day target set by local commissioners. Indeed, in December 2014, only 30% of patients were being seen within this time frame. The aim of this quality improvement project has been to decrease the average waiting time from referral to first face-to-face assessment, and concomitantly increase the proportion of patients being assessed within the 28-day target period. The team identified potential sources of delay in the process of handling referrals, from receipt and triage, to forwarding to the relevant secondary service, and have tested change ideas such as the implementation of daily meetings to review referrals and the centralisation of appointment bookings to streamline the processes and minimise delays. The average waiting time from referral to first face-to-face assessment decreased by 34% and the proportion of patients being assessed within 28 days increased accordingly, exceeding 95% in the case of referrals from general practitioners (GP). We have listed changes that we intend to introduce with the aim of bringing waiting times down further.

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A local quality initiative to improve follow-up times for patients with heart failure

Introduction Heart failure is the most common cause of hospital admission in patients >65 years and around 50% of patients will be readmitted within 6 months. Inability to achieve timely outpatient follow-up may contribute to the high rates of avoidable rehospitalisation for this group of patients. Canadian guidelines recommend patients with heart failure should be seen within 14 days of discharge.

Methods An audit demonstrated that less than half of advanced heart failure patients were being followed up within 14 days. In an effort to improve postdischarge follow-up in our heart function clinic, we used process mapping and applied a series of iterative changes to the appointment booking system using Plan–Do–Study–Act cycles to reduce waste and standardise.

Results The primary outcome measure, tracked over a period of 20 months, was percentage of patients booked within 14 days. At baseline, 37% of patients were seen within 14 days. After our series of interventions related to streamlining and standardising the appointment booking process, 77% of patients were seen within 14 days and 100% of patients were seen within 21 days.

Conclusion The changes made to the appointment booking process were reproducible, sustainable, effective and required no additional resources or funding.

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Reliability of self-report measures of correlates of obesity-related behaviours in Hong Kong adolescents for the iHealt(H) and IPEN adolescent studies

This study examined the reliability of measures of correlates of dietary behaviours (DBs), physical activity (PA) and sedentary behaviour (SB) for Hong Kong adolescents.

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Integration of soil magnetometry and geochemistry for assessment of human health risk from metallurgical slag dumps

Abstract

The main objective of the study was an assessment of the pollution level of agricultural land located close to dumps of industrial waste remaining after former Zn and Pb ore processing in Poland. The integrated geophysical-geochemical methods were applied for assessment of soil quality with respect to trace element pollution. Additionally, human health risk induced by the contaminated arable soil and dusting slag heap was estimated. The investigations pointed out that soils in the vicinity of the metallurgical slag dump in Piekary were heavily polluted. Spatial distribution of magnetic susceptibility corresponding well with distribution of the content of potentially toxic elements indicated the local "pollution hotspots." Proper geophysical and geochemical data interpretation supported by statistical factor analysis enabled identification of three different sources of pollution including metallurgical slug dump as a main source, but also traffic pollution influencing the area located along the busy road and relatively strong influence of the geochemical background. Computed health hazard index revealed no adverse health effect to the farmers cultivating arable soil, but in the direct vicinity of dusting, slag dump health risk occurred, caused mostly by very toxic elements as As and Tl. In the future, investigation should be focused on contribution of different sources to the heavy metal pollution in soil-crop system in this area. It should be highlighted that a site-specific approach should be taken in order to redevelop this kind of area in order to reduce ecological and human health threat. The study proved the integrated two-stage geophysical-geochemical method to be a feasible, reliable, and cost-effective tool for identification of the extent of soil pollution and areas at risk.

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Development of a comprehensive screening method for more than 300 organic chemicals in water samples using a combination of solid-phase extraction and liquid chromatography-time-of-flight-mass spectrometry

Abstract

A comprehensive screening method for 311 organic compounds with a wide range of physicochemical properties (log Pow −2.2–8.53) in water samples was developed by combining solid-phase extraction with liquid chromatography–high-resolution time-of-flight mass spectrometry. Method optimization using 128 pesticides revealed that tandem extraction with styrene-divinylbenzene polymer and activated carbon solid-phase extraction cartridges at pH 7.0 was optimal. The developed screening method was able to extract 190 model compounds with average recovery of 80.8% and average relative standard deviations (RSD) of 13.5% from spiked reagent water at 0.20 μg L⁻¹, and 87.1% recovery and 10.8% RSD at 0.05 μg L⁻¹. Spike-recovery testing (0.20 μg L⁻¹) using real sewage treatment plant effluents resulted in an average recovery and average RSD of 190 model compounds of 77.4 and 13.1%, respectively. The method was applied to the influent and effluent of five sewage treatment plants in Kitakyushu, Japan, with 29 out of 311 analytes being observed at least once. The results showed that this method can screen for a large number of chemicals with a wide range of physicochemical properties quickly and at low operational cost, something that is difficult to achieve using conventional analytical methods. This method will find utility in target screening of hazardous chemicals with a high risk in environmental waters, and for confirming the safety of water after environmental incidents.

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Effects of tannery wastewater exposure on adult Drosophila melanogaster

Abstract

Our aim was to evaluate the effects of exposure to tannery wastewater on mortality and/or antioxidant enzyme system in adult wild-type Canton-S Drosophila melanogaster. Exposure to tannery wastewater induced a concentration-dependent lethality in adult Canton-S flies. Tannery wastewater was able to alter antioxidant enzyme activities, specifically glutathione peroxidase-like and glutathione S-transferase, in adult Canton-S D. melanogaster. We conclude that D. melanogaster is a reliable model to evaluate the toxicity induced by tannery wastewater.

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Case of multiple microcystic adnexal carcinomas on the sun-exposed area

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Total cell necrosis of metastatic malignant melanoma at the regional lymph node in a patient treatment with nivolumab

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Synergistic effects of interferon-beta and nivolumab in oral mucosal melanoma

Abstract

Mucosal melanoma is a rare aggressive cancer with a very poor prognosis. Clinical and pathological characteristics of mucosal melanoma differ from those of cutaneous melanoma and there are no established management guidelines for mucosal melanoma. Complete surgical excision is one of the most effective treatments for localized lesions, while targeted therapies and immunotherapies, such as monoclonal antibodies that target cytotoxic T-lymphocyte-associated molecule-4, and the programmed death (PD)-1/PD-ligand 1 pathway inhibitors, are treatment options for unresectable or metastatic lesions. Here, we describe the case of a patient with oral mucosal melanoma with multiple metastases. In our case, local injection of interferon (IFN)-β with dacarbazine–nimustine–vincristine therapy provided antitumor effects on an invasive tumor on the upper gingiva. Nivolumab therapy produced complete remission of lymph node and bone metastases. In contrast, the remaining in situ portion of oral mucosal melanoma on the hard palate was refractory to IFN-β monotherapy and nivolumab therapy. However, after administration of nivolumab, peritumoral injection of IFN-β showed rapid therapeutic effects. Our case suggested that nivolumab upregulated the antitumor effects of IFN-β, which induced the recruitment of CD8⁺ T cells into the tumor microenvironment contributing to the deletion of tumor cells. Combination therapy of IFN-β and nivolumab may be a potential treatment option for patients with oral mucosal melanoma.

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Immune reconstitution inflammatory syndrome in non-HIV immunosuppressed patients

Abstract

Immune reconstitution inflammatory syndrome (IRIS) represents a clinical phenomenon of immune-mediated inflammation against various antigens, including pathogenic microorganisms, drugs and unknown autoantigens, during recovery from immunosuppressed conditions. IRIS has become well recognized in HIV-infected populations. However, IRIS has seldom been recognized in HIV-negative immunocompromised patients. In the last 15 years, the immunopathogenesis of drug-induced hypersensitivity syndrome (DIHS) has been largely determined. Laboratory data and clinical observations support the idea that DIHS represents a prototype of non-HIV IRIS. Primary diseases in which non-HIV IRIS is secondary include severe cutaneous adverse drug reactions, such as DIHS, autoimmune diseases, collagen diseases, pregnancy and internal malignancies. Potential triggers of recovery from an immune deterioration state include a discontinuation or abrupt tapering of systemic steroids and/or immunosuppressants, withdrawal or reduced effects of anti-tumor necrosis factor-α antibodies, and the use of immune-checkpoint antagonists for the advanced stages of malignancies. Wide use of IRIS across large populations risks oversimplification but highlights a key unifying principle. Balanced sensitivity and specificity for its diagnostic criteria and classification are necessary for the establishment of clinical practice guidelines for non-HIV IRIS. Additionally, the development of a useful combination of biomarkers is currently an urgent issue.

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Bullous pemphigoid induced by ipilimumab in a patient with metastatic malignant melanoma after unsuccessful treatment with nivolumab

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Lymph node metastatic melanoma from ungual melanoma: Identification of somatic mutations in KIT and LZTR1

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Anaphylaxis due to ingestion of jellyfish with possible evidence of epicutaneous sensitization

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Seal those teeth from cavities

BRUSHING and flossing are the best ways to help prevent cavities, but it's not always easy to clean every nook and cranny of your teeth - especially those back teeth you use to chew. Still, there's another safety net to help keep those teeth clean.

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Foundations drill down into oral health

Brown County Public Health Nurse Teresa Severson, a member of the Early Childhood Dental Network, makes a "tooth fairy" visit to a local preschool to talk about good oral health. Source: Southern Minnesota Initiative Foundation ORG XMIT: _KAGN9r59hXNlIfDoIuc Several philanthropies are pouring millions of dollars into dental care for working class and low-income Minnesota families, seeking to give poor kids the kind of healthy smile that will boost self-esteem and ease entry into the workforce.

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Breastfeeding and caries: New review supports earlier findings

This new review on the effect of breastfeeding on caries supports the findings of earlier reviews that breastfeeding up to the age of 12 months has a protective effect for dental caries.

The post Breastfeeding and caries: New review supports earlier findings appeared first on National Elf Service.

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Adult Langerhans cell histiocytosis with pulmonary and colorectoanal involvement: a case report

Langerhans cell histiocytosis is a rare systemic disease characterized by the abnormal overproduction of histiocytes that tend to infiltrate single or multiple organ systems leading to significant tissue damag...

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Holistic First Nations health strategy: Canada [Letters]

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Trends in deceased organ donation in Canada [Commentary]

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Effect of organ donation after circulatory determination of death on number of organ transplants from donors with neurologic determination of death [Research]

BACKGROUND:

To increase the available pool of organ donors, Ontario introduced donation after circulatory determination of death (DCD) in 2006. Other jurisdictions have reported a decrease in donations involving neurologic determination of death (NDD) after implementation of DCD, with a drop in organ yield and quality. In this study, we examined the effect of DCD on overall transplant activity in Ontario.

METHODS:

We examined deceased donor and organ transplant activity during 3 distinct 4-year eras: pre-DCD (2002/03 to 2005/06), early DCD (2006/07 to 2009/10) and recent DCD (2010/11 to 2013/14). We compared these donor groups by categorical characteristics.

RESULTS:

Donation increased by 57%, from 578 donors in the pre-DCD era to 905 donors in the recent DCD era, with a 21% proportion (190/905) of DCD donors in the recent DCD era. However, overall NDD donation also increased. The mean length of hospital stay before declaration for NDD was 2.7 days versus 6.0 days before withdrawal of life support and subsequent asystole in cases of DCD. The average organ yield was 3.73 with NDD donation versus 2.58 with DCD (p < 0.001). Apart from hearts, all organs from DCD donors were successfully transplanted. From the pre-DCD era to the recent DCD era, transplant activity in each era increased for all solid-organ recipients, including heart (from 158 to 216), kidney (from 821 to 1321), liver (from 477 to 657) and lung (from 160 to 305).

INTERPRETATION:

Implementation of DCD in Ontario led to increased transplant activity for all solid-organ recipients. There was no evidence that the use of DCD was pre-empting potential NDD donation. In contrast to groups receiving other organs, heart transplant candidates have not yet benefited from DCD.

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Think sepsis to stop deaths, urge advocates [News]

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Human papillomavirus vaccines [Practice]

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Drug importation into the United States: impact on Canada [Letters]

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Laryngeal stridor in rheumatoid arthritis [Practice]

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Call for more Lyme disease research [News]

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Always on call [Humanities]

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Enjoy every sandwich [Coda]

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Use of glucocorticoids during pregnancy and risk of attention-deficit/hyperactivity disorder in offspring: a nationwide Danish cohort study

Objective

Prenatal exposure to excess endogenous glucocorticoid (GC) has been linked to attention-deficit/hyperactivity disorder (ADHD). We investigated whether prenatal exposure to exogenous GC is associated with ADHD.

Design

Nationwide cohort study.

Setting

A cohort of 875 996 singletons born alive between 1996 and 2009 in Denmark. Data were obtained from national registries.

Exposures

We identified children exposed prenatally to GCs, children unexposed prenatally and born to maternal former users, and children unexposed and born to maternal never users.

Main outcome measures

We compared ADHD risk in children prenatally exposed to GCs and in children of former GC users with risk in unexposed children of never users. We computed cumulative incidence at 10 years of age and adjusted HRs (aHRs). In addition, we compared exposed children with unexposed siblings in a sibling design.

Results

We identified 875 996 children, among whom 5319 were prenatally exposed to systemic GCs and 36 780 to local/inhaled GCs. Cumulative incidences of ADHD at 10 years of age were 2.65% in prenatally exposed children and 2.03% in unexposed children of never users. At the general population level, prenatal exposure was associated with ADHD compared with unexposed, with aHR of 1.43(95% CI 1.24 to 1.65) for systemic exposure and 1.23 (95% CI 1.15 to 1.31) for local/inhaled exposure. However, our former user analysis (aHR of 1.25 (95% CI 1.20 to 1.29)) and sibling design (aHR of 1.03 (95% CI 0.87 to 1.20)) indicated that these findings were due to confounding.

Conclusion

This study provides no evidence of a causal association between prenatal exposure to GCs and risk of ADHD.

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What makes a sustainability tool valuable, practical and useful in real-world healthcare practice? A mixed-methods study on the development of the Long Term Success Tool in Northwest London

Objectives

Although improvement initiatives show benefits to patient care, they often fail to sustain. Models and frameworks exist to address this challenge, but issues with design, clarity and usability have been barriers to use in healthcare settings. This work aimed to collaborate with stakeholders to develop a sustainability tool relevant to people in healthcare settings and practical for use in improvement initiatives.

Design

Tool development was conducted in six stages. A scoping literature review, group discussions and a stakeholder engagement event explored literature findings and their resonance with stakeholders in healthcare settings. Interviews, small-scale trialling and piloting explored the design and tested the practicality of the tool in improvement initiatives.

Setting

National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL).

Participants

CLAHRC NWL improvement initiative teams and staff.

Results

The iterative design process and engagement of stakeholders informed the articulation of the sustainability factors identified from the literature and guided tool design for practical application. Key iterations of factors and tool design are discussed. From the development process, the Long Term Success Tool (LTST) has been designed. The Tool supports those implementing improvements to reflect on 12 sustainability factors to identify risks to increase chances of achieving sustainability over time. The Tool is designed to provide a platform for improvement teams to share their own views on sustainability as well as learn about the different views held within their team to prompt discussion and actions.

Conclusion

The development of the LTST has reinforced the importance of working with stakeholders to design strategies which respond to their needs and preferences and can practically be implemented in real-world settings. Further research is required to study the use and effectiveness of the tool in practice and assess engagement with the method over time.

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Youth friendliness in mental health and addiction services: protocol for a scoping review

Introduction

To better reach youth in need of mental health and addiction (MHA) services, there is increasing emphasis on making MHA services 'youth friendly.' However, it is unclear what youth friendliness means on a practical level. This scoping review explores (1) how youth friendliness in mental health services is defined in the literature, (2) what characteristics make MHA services youth friendly and (3) how youth friendliness is expected to impact service use by young people.

Methods

A search will be conducted of eight electronic bibliographic databases over the last 15 years (2002–2017) to identify literature on youth friendliness consistent with the modern youth experience. Grey literature will also be searched. The search and literature selection process will include all study designs, as well as non-research literature. Two independent raters will determine eligibility based on a review of the titles and abstracts of the identified literature, followed by full text reviews when required. Data will be extracted from the identified literature and then synthesised using qualitative and quantitative approaches. As a final step, we will conduct stakeholder consultations with youth, family members and service provider groups to validate the findings and identify any characteristics of youth friendliness that they deem important that were not reported in the findings.

Ethics and dissemination

Results will be disseminated through a peer-reviewed publication, as well as international, national and local conference presentations. Agency reports will be developed to present the findings in a user-friendly format, including a youth-friendliness checklist for youth-serving organisations. Research ethics approval has been obtained for the consultation component of this study.

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Medical school predictors of later perceived mastery of clinical work among Norwegian doctors: a cohort study with 10-year and 20-year follow-up

Objective

Doctors' self-perceived mastery of clinical work might have an impact on their career and patient care, in addition to their own health and well-being. The aim of this study is to identify predictors at medical school of perceived mastery later in doctors' careers.

Design

A cohort of medical students (n=631) was surveyed in the final year of medical school in 1993/1994 (T1), and 10 (T2) and 20 (T3) years later.

Setting

Nationwide healthcare institutions.

Participants

Medical students from all universities in Norway.

Main outcome measures

Perceived mastery of clinical work was measured at T2 and T3. The studied predictors measured at T1 included personality traits, medical school stress, perceived medical recording skills, identification with the role of doctor, hazardous drinking and drinking to cope, in addition to age and gender. Effects were studied using multiple linear regression models.

Results

Response rates: T1, 522/631 (83%); T2, 390/522 (75%); and T3, 303/522 (58%). Mean scores at T2 and T3 were 22.3 (SD=4.2) and 24.5 (3.0) (t=8.2, p<0.001), with no gender difference. Adjusted associations at T2 were: role identification (β=0.16; p=0.006; 95% CI 0.05 to 0.28), perceived medical recording skills (β=0.13; p=0.02; 95% CI 0.02 to 0.24) and drinking to cope (β=–2.45; p=0.001; 95% CI –3.88 to –1.03). Adjusted association at T3 was perceived medical recording skills (β=0.11; p=0.015; 95% CI 0.02 to 0.21).

Conclusions

Perceived medical recording skills and role identification were associated with higher perceived mastery. Medical schools should provide experiences, teaching and assessment to enhance students' physician role identification and confidence in their own skills. Drinking to cope was associated with lower perceived mastery, which indicates the importance of acquiring healthier coping strategies in medical school.

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Use pattern and predictors of use of highly caffeinated energy drinks among South Korean adolescents: a study using the Health Belief Model

Objectives

Concerns about the use of highly caffeinated energy drinks among Korean adolescents remains. We compared adolescents' perceptions regarding the use of drinks to their behaviours and factors.

Design

A structured questionnaire based on the Health Belief Model was administered to 850 freshmen and sophomores at three high schools in Bucheon, South Korea. Benefits were defined as beneficial effects from the use of highly caffeinated energy drinks (eg, awakening from sleepiness) and harms as adverse effects of the drinks (eg, cardiac palpitation). Likelihood of action represents the likelihood of taking actions that are perceived to be more beneficial after comparison of the benefits and harms of caffeine use. Descriptive analysis was used to quantify the relationship between their beliefs about highly caffeinated energy drinks and their use. We conducted hierarchical logistic regression to compute ORs and 95% CIs for: (1) demographic factors, (2) health threat, (3) likelihood of action and (4) cues to act.

Results

Altogether, 833 students responded to the questionnaire (effective response rate=98.0%). About 63.0% reported use of highly caffeinated energy drinks and 35.2% had used them as needed and habitually. The more susceptible the respondents perceived themselves to be to the risk of using these drinks, the less likely they were to use them (OR: 0.73, 95% CI 0.50 to 1.06). The more severe the perception of a health threat, the less that perception was associated with use (OR: 0.44, 95% CI 0.29 to 0.67). Likelihood of action was the strongest predictor of use, explaining 12.5% in use. Benefits and harms (OR: 4.43, 95% CI 2.77 to 7.09; OR: 1.86, 95% CI 1.16 to 2.99) also were significant predictors.

Conclusions

Enhancing adolescents' perceptions of benefits and harms regarding using highly caffeinated energy drinks could be an effective way to influence the use of these drinks.

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Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors?

Introduction

Despite common assumptions that doctors are well placed to lead hospitals and healthcare organisations, the peer-reviewed literature contains little evidence on the performance of doctors in leadership roles in comparison with that of non-medical managers.

Objectives

To determine whether there is an association between the leader's medical background and management performance in terms of organisational performance or patient outcomes.

Methods

We searched for peer-reviewed, English language studies using Medline, Embase and Emerald Management between 2005 and 2017. We included quantitative, qualitative and mixed method empirical studies on the performance of senior healthcare managers where participants were described as doctors or leaders and where comparative performance data were provided on non-medical leaders. Studies without full text available, or no organisational, leadership behaviour or patient measures, were excluded.

Results

The search, conducted in Medline (n=3395), Embase (n=1913) and Emerald Management (n=454) databases, yielded 3926 entries. After the application of inclusion and exclusion criteria, 16 studies remained. Twelve studies found that there were positive differences between medical and non-medical leaders, and eight studies correlated those findings with hospital performance or patient outcomes. Six studies examined the composition of boards of directors; otherwise, there were few common areas of investigation. Five inter-related themes emerged from a narrative analysis: the impact of medical leadership on outcomes; doctors on boards; contribution of qualifications and experience; the medical leader as an individual or part of a team and doctors transitioning into the medical leadership role.

Discussion and conclusion

A modest body of evidence supports the importance of including doctors on organisational governing boards. Despite many published articles on the topic of whether hospitals and healthcare organisations perform better when led by doctors, there were few empirical studies that directly compared the performance of medical and non-medical managers. This is an under-researched area that requires further funding and focus.

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The long-term (24-month) effect on health and well-being of the Lifestyle Matters community-based intervention in people aged 65 years and over: a qualitative study

Objectives

To assess the long-term effect on health and well-being of the Lifestyle Matters programme.

Design

Qualitative study of a subset of intervention arm participants who participated in the Lifestyle Matters randomised controlled trial (RCT).

Setting

The intervention took place at community venues within two sites in the UK.

Participants

A purposeful sample of 13 participants aged between 66 and 88 years from the intervention arm of the RCT were interviewed at 24 months post randomisation. Interviews aimed to understand how participants had used their time in the preceding 2 years and whether the intervention had any impact on their lifestyle choices, participation in meaningful activities and well-being.

Intervention

Lifestyle Matters is a 4-month occupational therapy intervention, consisting of group and individual sessions, designed to enable community living older people to make positive lifestyle choices and participate in new or neglected activities through increasing self-efficacy.

Results

Interviews revealed that the majority of interviewed participants were reportedly active at 24 months, with daily routines and lifestyles not changing significantly over time. All participants raised some form of benefit from attending Lifestyle Matters, including an improved perspective on life, trying new hobbies and meeting new friends. A number of intervention participants spoke of adapting to their changing circumstances, but there were significant and lasting benefits for 2 of 13 intervention participants interviewed.

Conclusion

The majority of those who experienced the Lifestyle Matters intervention reported minor benefits and increases in self-efficacy, but they did not perceive that it significantly improved their health and well-being. The two participants who had experienced major benefits also reported having had life-changing events, suggesting that this intervention is most effective at the time when lifestyle has to be reconsidered if mental well-being is to be sustained.

Trial registration

ISRCTN, ISRCTN67209155, post results.

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Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

Objective

This study aimed to investigate the association between splenectomy and empyema in Taiwan.

Methods

A population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20–84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities.

Results

The overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone.

Conclusion

The incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities.

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Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

Objectives

To investigate the impact of vascular access flow (Qa) on vascular and all-cause mortality in chronic haemodialysis (HD) patients.

Design

Observational cohort study.

Setting

Single centre.

Participants

Adult chronic HD patients at the HD unit of Shin Kong Wu Ho-Su Memorial Hospital between 1 January 2003 and 31 December 2003 were recruited. Patients were excluded if they had arteriovenous fistula or arteriovenous graft failure within 3 months before the date of Qa measurement, were aged <18 years and had Qa levels of ≥2000mL/min. A total of 378 adult chronic HD patients were eventually enrolled for the study.

Interventions

The selected patients were evaluated with Qa and cardiac index (CI). They were divided into four groups according to three Qa cut-off points (500, 1000 and 1500 mL/min).

Primary and secondary outcome measures

Short-term and long-term vascular (cardiovascular or cerebrovascular) and all-cause mortality.

Results

Qa was positively correlated with CI (r=0.48, p<0.001). A Qa level of <1000 mL/min was independently associated with 1-year all-cause mortality (adjusted OR, 6.04; 95% CI 1.64 to 22.16; p=0.007). Kaplan-Meier analysis revealed that the cumulative incidence rates of all-cause and vascular mortality were significantly higher in the patients with a Qa level of <1000 mL/min (log-rank test; all p<0.01). Furthermore, a Qa level of <1000 mL/min was independently associated with long-term all-cause mortality (adjusted HR, 1.62; 95% CI 1.11 to 2.37; p=0.013); however, the risk of vascular mortality did not significantly increase after adjustment for confounders.

Conclusions

Qa is moderately correlated with cardiac function, and a Qa level of <1000 mL/min is an independent risk factor for both short-term and long-term all-cause mortality in chronic HD patients.

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Improving health, well-being and parenting skills in parents of children with medical complexity: a scoping review protocol

Introduction

Less than 1% of children have complex medical conditions but account for one-third of all child health spending. The impact of suboptimal management of this group of children can have a considerable effect on families as well as services. Some families appear to cope more easily than others do, but there are compelling reasons to suggest that effective interventions may improve family coping and ultimately outcomes. Hospitalisation of their child presents a unique set of pressures and challenges for parents, but also an opportunity to intervene. However, the evidence is not well described in relation to this group of families. The primary objective of this scoping review is to identify parent and family-based interventions available to improve parental health, well-being, functioning or skills in the context of a child's medically complex hospital admission and hospital care.

Methods and analysis

Nine bibliographic databases will be searched spanning medicine, nursing, psychology, education, social work and the grey literature using a combination of index terms and text words related to parents, childhood, chronic illness and interventions. Study eligibility will be assessed by two researchers against preset inclusion and exclusion criteria. Key information from each study will be extracted and charted including year of publication, condition, severity, geographical setting, key concepts and definitions, aims, study population and sample size, methodology/methods, interventions, outcomes and key findings. Directed qualitative content analysis will be used to make sense of narrative findings within the included studies. Results will be presented which summarise the scope of the literature and identify key findings, potential areas for evidence synthesis and research gaps.

Ethics and dissemination

Ethical approval is not required. The results of this review will be disseminated through publication in a peer-reviewed journal and feedback to stakeholders during the development of a hospital-based intervention.

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What are the essential features of a successful surgical registry? a systematic review

Objective

The regulation of surgical implants is vital to patient safety, and there is an international drive to establish registries for all implants. Hearing loss is an area of unmet need, and industry is targeting this field with a growing range of surgically implanted hearing devices. Currently, there is no comprehensive UK registry capturing data on these devices; in its absence, it is difficult to monitor safety, practices and effectiveness. A solution is developing a national registry of all auditory implants. However, developing and maintaining a registry faces considerable challenges. In this systematic review, we aimed to identify the essential features of a successful surgical registry.

Methods

A systematic literature review was performed adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis recommendations. A comprehensive search of the Medline and Embase databases was conducted in November 2016 using the Ovid Portal. Inclusion criteria were: publications describing the design, development, critical analysis or current status of a national surgical registry. All registry names identified in the screening process were noted and searched in the grey literature. Available national registry reports were reviewed from registry websites. Data were extracted using a data extraction table developed by thematic analysis. Extracted data were synthesised into a structured narrative.

Results

Sixty-nine publications were included. The fundamentals to successful registry development include: steering committee to lead and oversee the registry; clear registry objectives; planning for initial and long-term funding; strategic national collaborations among key stakeholders; dedicated registry management team; consensus meetings to agree registry dataset; established data processing systems; anticipating challenges; and implementing strategies to increase data completion. Patient involvement and awareness of legal factors should occur throughout the development process.

Conclusions

This systematic review provides robust knowledge that can be used to inform the successful development of any UK surgical registry. It also provides a methodological framework for international surgical registry development.

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Overview of the uptake and implementation of non-medical prescribing in Wales: a national survey

Objectives

To identify (1) the non-medical healthcare professionals in Wales qualified to prescribe medicines (including job title, employer, where the prescribing qualification is used, care setting and service provided); (2) the mode of prescribing used by these healthcare professionals, the frequency with which medicines are prescribed and the different ways in which the prescribing qualification is used; and (3) the safety and clinical governance systems within which these healthcare professionals practise.

Design

National questionnaire survey.

Setting

All three National Health Service (NHS) Trusts and seven Health Boards (HB) in Wales.

Participants

Non-medical prescribers.

Results

379 (63%) participants responded to the survey. Most of these prescribers (41.1%) were specialist nurses who work in a variety of healthcare settings (primarily in secondary care) within each HB/NHS Trust, and regularly use independent prescribing to prescribe for a broad range of conditions. Nearly a quarter of the sample (22%) reported that prior to undertaking the prescribing programme, they had completed master's level specialist training and 65.5% had 5 years qualified experience. Over half (55.8%) reported that there were plans to increase non-medical prescriber numbers within the team in which they worked. Only 7.1% reported they did not prescribe and the median number of items prescribed per week was between 21 and 30. Nearly all (87.8%) of the sample reported that they perceived prescribing to have ensured better use of their skills and 91.5% indicated that they believed it had improved the quality of care they were able to provide.

Conclusion

Non-medical prescribing has been implemented across the whole of Wales; however, its uptake within HBs and NHS Trusts has been inconsistent, and it has not been considered across all services, particularly those in primary care. Opportunities therefore exist to share learning across organisations.

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Cohort profile: the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) in Korea

Purpose

The National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) is a cohort of participants who participated in health screening programmes provided by the NHIS in the Republic of Korea. The NHIS constructed the NHIS-HEALS cohort database in 2015. The purpose of this cohort is to offer relevant and useful data for health researchers, especially in the field of non-communicable diseases and health risk factors, and policy-maker.

Participants

To construct the NHIS-HEALS database, a sample cohort was first selected from the 2002 and 2003 health screening participants, who were aged between 40 and 79 in 2002 and followed up through 2013. This cohort included 514 866 health screening participants who comprised a random selection of 10% of all health screening participants in 2002 and 2003.

Findings to date

The age-standardised prevalence of anaemia, diabetes mellitus, hypertension, obesity, hypercholesterolaemia and abnormal urine protein were 9.8%, 8.2%, 35.6%, 2.7%, 14.2% and 2.0%, respectively. The age-standardised mortality rate for the first 2 years (through 2004) was 442.0 per 100 000 person-years, while the rate for 10 years (through 2012) was 865.9 per 100 000 person-years. The most common cause of death was malignant neoplasm in both sexes (364.1 per 100 000 person-years for men, 128.3 per 100 000 person-years for women).

Future plans

This database can be used to study the risk factors of non-communicable diseases and dental health problems, which are important health issues that have not yet been fully investigated. The cohort will be maintained and continuously updated by the NHIS.

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Serum levels of chemical elements in esophageal squamous cell carcinoma in Anyang, China: a case-control study based on machine learning methods

Objectives

Esophageal squamous cell carcinoma (ESCC) is the predominant form of esophageal carcinoma with extremely aggressive nature and low survival rate. The risk factors for ESCC in the high-incidence areas of China remain unclear. We used machine learning methods to investigate whether there was an association between the alterations of serum levels of certain chemical elements and ESCC.

Settings

Primary healthcare unit in Anyang city, Henan Province of China.

Participants

100 patients with ESCC and 100 healthy controls matched for age, sex and region were included.

Primary and secondary outcome measures

Primary outcome was the classification accuracy. Secondary outcome was the p Value of the t-test or rank-sum test.

Methods

Both traditional statistical methods of t-test and rank-sum test and fashionable machine learning approaches were employed.

Results

Random Forest achieves the best accuracy of 98.38% on the original feature vectors (without dimensionality reduction), and support vector machine outperforms other classifiers by yielding accuracy of 96.56% on embedding spaces (with dimensionality reduction). All six classifiers can achieve accuracies more than 90% based on the single most important element Sr. The other two elements with distinctive difference are S and P, providing accuracies around 80%. More than half of chemical elements were found to be significantly different between patients with ESCC and the controls.

Conclusions

These results suggest clear differences between patients with ESCC and controls, implying some potential promising applications in diagnosis, prognosis, pharmacy and nutrition of ESCC. However, the results should be interpreted with caution due to the retrospective design nature, limited sample size and the lack of several potential confounding factors (including obesity, nutritional status, and fruit and vegetable consumption and potential regional carcinogen contacts).

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The importance of maternal diet quality during pregnancy on cognitive and behavioural outcomes in children: a systematic review and meta-analysis

Objectives

This systematic review and meta-analysis provides a quantitative summary of the literature exploring the relationship between maternal diet quality during pregnancy and child cognitive and affective outcomes. We investigate whether there are indications for robust associations and aim to identify methodological strengths and challenges of the current research to provide suggestions of improvement for future research.

Design and participants

Relevant studies were identified through a systematic literature search in relevant databases. All studies investigating maternal diet quality during pregnancy in relation to child cognitive or affective functioning in children of elementary school age or younger were assessed for inclusion.

Results

18 relevant studies, comprising 63 861 participants were identified. The results indicated a small positive association between better maternal diet quality during pregnancy and child functioning. We observed publication bias and significant heterogeneity between studies, where type of diet classification, publication year and outcome domain together accounted for about 30% of this heterogeneity. Trim and fill analysis substantiated the presence of publication bias for studies in the affective domain and showed an adjusted effect size of Hedge's g=0.088 (p=0.0018) (unadjusted g=0.093 (p=0.03)). We observed no publication bias in the cognitive domain, where results indicated a slightly larger effect size (g=0.14 (p<0.0001)) compared with that of the affective domain. The overall summary effect size was g=0.075 (p<0.0001) adjusted for publication bias (unadjusted g=0.112 (p=0.0001)). Child diet was not systematically controlled for in the majority of the studies.

Conclusion

The results indicated that a better maternal diet quality during pregnancy has a small positive association with child neurodevelopment, with more reliable results seen for cognitive development. These results warrant further research on the association between maternal diet quality during pregnancy and cognitive and affective aspects of child neurodevelopment, whereby it is crucial that future studies account for child diet in the analysis.

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UK-based prospective cohort study to anglicise and validate the FACE-Q Skin Cancer Module in patients with facial skin cancer undergoing surgical reconstruction: the PROMISCR (Patient-Reported Outcome Measure in Skin Cancer Reconstruction) study

Introduction

Skin cancer is the most common malignancy worldwide, often occurring on the face, where the cosmetic outcome of treatment is paramount. A number of skin cancer-specific patient-reported outcome measures (PROMs) exist, however none adequately consider the difference in type of reconstruction from a patient's point of view. It is the aim of this study to 'anglicise' (to UK English) a recently developed US PROM for facial skin cancer (the FACE-Q Skin Cancer Module) and to validate this UK version of the PROM. The validation will also involve an assessment of the items for relevance to facial reconstruction patients. This will either validate this new measure for the use in clinical care and research of various facial reconstructive options, or provide evidence that a more specific PROM is required.

Methods and analysis

This is a prospective validation study of the FACE-Q Skin Cancer Module in a UK facial skin cancer population with a specific focus on the difference between types of reconstruction. The face and content validity of the FACE-Q questionnaire will initially be assessed by a review process involving patients, skin cancer specialists and methodologists. An assessment of whether questions are relevant and any missing questions will be made. Initial validation will then be carried out by recruiting a cohort of 100 study participants with skin cancer of the face pre-operatively. All eligible patients will be invited to complete the questionnaire preoperatively and postoperatively. Psychometric analysis will be performed to test validity, reliability and responsiveness to change. Subgroup analysis will be performed on patients undergoing different forms of reconstruction postexcision of their skin cancer.

Ethics and dissemination

This study has been approved by the West Midlands, Edgbaston Research Ethics Committee (Ref 16/WM/0445). All personal data collected will be anonymised and patient-specific data will only be reported in terms of group demographics. Identifiable data collected will include the patient name and date of birth. Other collected personal data will include their diagnosis, treatment performed, method of reconstruction and complications. A unique identifier will be applied to each patient so that pretreatment and post-treatment questionnaire results can be compared. All data acquisition and storage will be in accordance with the Data Protection Act 1998. Following completion of the study, all records will be stored in the Abertawe Bro Morgannwg University (AMBU) Health Board archive facility. Only qualified personnel working on the project will have access to the data.

The outputs from this work will be published as widely as possible in peer-review journals and it is our aim to make this open access.

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A hospital-based observational cohort study exploring pain and biomarkers in patients with hand osteoarthritis in Norway: The Nor-Hand protocol

Introduction

We have limited knowledge about the underlying disease mechanisms and causes of pain in hand osteoarthritis (OA). Consequently, no disease-modifying drug exists, and more knowledge about the pathogenesis of hand OA is needed, as well as a validation of different outcome measures. Our first aim of this study is to explore the validity of various imaging modalities for the assessment of hand OA. Second, we want to gain a better understanding of the disease processes, with a special focus on pain mechanisms.

Methods and analysis

The Nor-Hand study is a hospital-based observational study including 300 patients with evidence of hand OA by ultrasound and/or clinical examination. The baseline examination consists of functional tests and joint assessment of the hands, medical assessment, pain sensitisation tests, ultrasound (hands, acromioclavicular joint, hips, knees and feet), CT and MRI of the dominant hand, conventional radiographs of the hands and feet, fluorescence optical imaging of the hands, collection of blood and urine samples as well as self-reported demographic factors and OA-related questionnaires. Two follow-up examinations are planned. Cross-sectional analyses will be used to investigate agreements and associations between different relevant measures at the baseline examination, whereas the longitudinal data will be used for evaluation of predictors for clinical outcomes.

Ethics and dissemination

The protocol is approved by the Norwegian Regional Committee for Medical and Health Research Ethics (Ref. no: 2014/2057). The participants receive oral and written information about the project and sign a consent form before participation. They can, whenever they want, withdraw from the study, and all de-identified data will be safely stored on the research server at Diakonhjemmet Hospital. Results will be presented at international and national congresses and in peer-reviewed rheumatology journals.

Trial registration number

NCT03083548; Pre-results.

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Comparison of ethnic group classification using naming analysis and routinely collected data: application to cancer incidence trends in children and young people

Objective

Inpatient Hospital Episode Statistics (HES) ethnicity data are available but not always collected and data quality can be unreliable. This may have implications when assessing outcomes by ethnicity. An alternative method for assigning ethnicity is using naming algorithms. We investigate if the association between ethnicity and cancer incidence varied dependent on how ethnic group was assigned.

Design

Population-based cancer registry cohort study.

Setting

Yorkshire, UK.

Participants

Cancer registrations from 1998 to 2009 in children and young people (0–29 years) from a specialist cancer register in Yorkshire, UK (n=3998) were linked to inpatient HES data to obtain recorded ethnicity. Patients' names, recorded in the cancer register, were matched to an ethnic group using the naming algorithm software Onomap. Each source of ethnicity was categorised as white, South Asian (SA) or Other, and a further two indicators were defined based on the combined ethnicities of HES and Onomap, one prioritising HES results, the other prioritising Onomap.

Outcomes

Incidence rate ratios (IRR) between ethnic groups were compared using Poisson regression for all cancers combined, leukaemia, lymphoma and central nervous system (CNS) tumours.

Results

Depending on the indicator used, 7.1%–8.6% of the study population were classified as SA. For all cancers combined there were no statistically significant differences between white and SA groups using any indicator; however, for lymphomas significant differences were only evident using one of the 'Combined' indicators (IRR=1.36 (95% CI 1.08 to 1.71)), and for CNS tumours incidence was lower using three of the four indicators. For the other ethnic group the IRR for all cancers combined ranged from 0.78 (0.65 to 0.94) to 1.41 (1.23 to 1.62).

Conclusions

Using different methods of assigning ethnicity can result in different estimates of ethnic variation in cancer incidence. Combining ethnicity from multiple sources results in a more complete estimate of ethnicity than the use of one single source.

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Relationship of altitude mountain sickness and smoking: a Catalan travellers cohort study

Objectives

The aim of this study is to analyse the relationship between smoking and altitude mountain sickness in a cohort of travellers to 2500 metres above sea level (masl) or higher.

Setting

Travel Health Clinic at the Hospital Universitari de Bellvitge, in Barcelona, Spain.

Participants

A total of 302 adults seeking medical advice at the travel clinic, between July 2012 and August 2014, before travelling to 2500 masl or above, who agreed to participate in the study and to be contacted after the trip were included. Individuals who met the following criteria were excluded: younger than 18 years old, taking carbonic anhydrase inhibitors for chronic use, undergoing treatment with systemic corticosteroids and taking any medication that might prevent or treat altitude mountain sickness (AMS) prior to or during the trip. The majority of participants were women (n=156, 51.7%). The mean age was 37.7 years (SD 12.3). The studied cohort included 74 smokers (24.5%), 158 (52.3%) non-smokers and 70 (23.2%) ex-smokers. No statistical differences were observed between different sociodemographic characteristics, constitutional symptoms or drug use and smoking status.

Outcomes

The main outcome was the development of AMS, which was defined according to the Lake Louise AMS criteria.

Results

AMS, according to the Lake Louise score, was significantly lower in smokers; the value was 14.9%, 95% CI (6.8 to 23.0%) in smokers and 29.4%, 95% CI (23.5 to 35.3%) in non-smokers with an adjusted OR of 0.54, 95% CI (0.31 to 0.97) independent of gender, age and maximum altitude reached.

Conclusions

These results suggest that smoking could reduce the risk of AMS in non-acclimated individuals. Further studies should be performed in larger cohorts of travellers to confirm these results. Despite the results, smoking must be strongly discouraged because it greatly increases the risk of cardiorespiratory diseases, cancer and other diseases.

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A study protocol for a multicentre randomised clinical trial evaluating the safety and feasibility of a bioengineered human allogeneic nanostructured anterior cornea in patients with advanced corneal trophic ulcers refractory to conventional treatment

Introduction

There is a need to find alternatives to the use of human donor corneas in transplants because of the limited availability of donor organs, the incidence of graft complications, as well as the inability to successfully perform corneal transplant in patients presenting limbal deficiency, neo-vascularized or thin corneas, etc. We have designed a clinical trial to test a nanostructured fibrin-agarose corneal substitute combining allogeneic cells that mimics the anterior human native cornea in terms of optical, mechanical and biological behaviour.

Methods and analysis

This is a phase I-II, randomised, controlled, open-label clinical trial, currently ongoing in ten Spanish hospitals, to evaluate the safety and feasibility, as well as clinical efficacy evidence, of this bioengineered human corneal substitute in adults with severe trophic corneal ulcers refractory to conventional treatment, or with sequelae of previous ulcers. In the initial phase of the trial (n=5), patients were sequentially recruited, with a safety period of 45 days, receiving the bioengineered corneal graft. In the second phase of the trial (currently ongoing), subjects are block randomised (2:1) to receive either the corneal graft (n=10), or amniotic membrane (n=5), as the control treatment. Adverse events, implant status, infection signs and induced neovascularization are evaluated as determinants of safety and feasibility of the bioengineered graft (main outcomes). Study endpoints are measured along a follow-up period of 24 months, including 27 post-implant assessment visits according to a decreasing frequency. Intention to treat, and per protocol, and safety analysis will be performed.

Ethics and dissemination

The trial protocol received written approval by the corresponding Ethics Committee and the Spanish Regulatory Authority and is currently recruiting subjects. On completion of the trial, manuscripts with the results of phases I and II of the study will be published in a peer-reviewed journal.

Trial registration

CT.gov identifier: NCT01765244 (Jan2013). EudraCT number: 2010-024290-40 (Dec2012).

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Workplace sexual harassment and depressive symptoms: a cross-sectional multilevel analysis comparing harassment from clients or customers to harassment from other employees amongst 7603 Danish employees from 1041 organizations

Previous research has reported that sexual harassment can lead to reduced mental health. Few studies have focused on sexual harassment conducted by clients or customers, which might occur in person-related occ...

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« Une semaine de coloscopie en France » : résultats 2017 de l’enquête annuelle de la Société française d’endoscopie digestive

Résumé

Objectifs

Les enquêtes de la Société française d'endoscopie digestive (SFED), initiées en 1998 et réalisées annuellement depuis 2001, ont pour objectif de décrire les caractéristiques des patients bénéficiant d'une coloscopie, les conditions de prise en charge, le rendement diagnostique et les éventuelles complications.

Méthodes

À partir d'un questionnaire envoyé par voie électronique, la pratique de l'endoscopie est évaluée pendant cinq jours consécutifs. Les données de l'enquête sont extrapolées sur la population totale des 2 600 gastroentérologues pratiquant des endoscopies digestives, puis comparées aux années d'exercice précédentes. L'enquête a été réalisée du 16 au 22 janvier 2017.

Résultats

L'enquête SFED 2017 sur l'exercice de la coloscopie en France met en évidence plusieurs points: une participation en hausse, une augmentation du nombre de coloscopies réalisées, une amélioration constante de la qualité des coloscopies, liée à plusieurs facteurs: une meilleure prise en charge des patients avant l'examen, une meilleure adaptation des produits de préparation en fonction du profil des patients, l'utilisation plus importante des laxatifs chez les patients constipés avant examen, un meilleur respect des recommandations sauf pour la gestion des traitements anticoagulants avant examen.

Conclusion

Les données fournies par les enquêtes de la SFED représentent un outil important dans l'évaluation de l'activité endoscopique en France et sont une image quasi unique en Europe. L'amélioration de la qualité permet d'améliorer les performances de la coloscopie et montre la pertinence de respecter au mieux les recommandations.

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Response of the freshwater diatom Halamphora veneta (Kützing) Levkov to copper and mercury and its potential for bioassessment of heavy metal toxicity in aquatic habitats

Abstract

This study investigates the effects of copper and mercury on growth rate, chlorophyll a content, superoxide dismutase (SOD) activity, SOD mRNA gene expression, and frustule morphology of the benthic freshwater diatom Halamphora veneta (Kützing) Levkov and the potential utility of each for toxicity assessment in aquatic habitats. Results showed the following: (1) Compared to mercury, exposure to copper resulted in greater growth inhibition of H. veneta even at low concentrations and after short durations of exposure; (2) high accumulation of chlorophyll a in H. veneta is a stress response to the presence of heavy metals; (3) SOD activity and SOD gene expression varied in H. veneta according to the concentration, exposure time, and type of heavy metal; and (4) exposure to mercury resulted in deformity in the shape and an increase in size of the frustule of H. veneta. Growth rate, chlorophyll a content, SOD activity and gene expression, and frustule morphology of H. veneta are all potential candidates for the toxicological assessment of copper and mercury in aquatic habitats.

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Brugada syndrome

Brugada syndrome: a genetic condition that results in abnormalities of the heart rhythm. These irregular heartbeats are present in the lower chambers of the heart (ventricles) and can lead to fainting, difficulty breathing, or sudden death. Brugada syndrome is inherited in an autosomal dominant pattern, meaning that one affected parent can pass the condition along to offspring. Other cases can occur due to new mutations in the genes and are not inherited from a parent. The genetic problem in Brugada syndrome can occur in several different genes. It is most common in people of Asian descent and is more common in men than in women. The signs and symptoms of Brugada syndrome, including sudden death, can occur from early infancy to late adulthood.

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Effect of mechanical extraction parameters on the yield and quality of tobacco ( Nicotiana tabacum L.) seed oil

Abstract

The aim of this study was to investigate how the combination of extraction parameters, such as extraction temperature seeds preheating and screw rotation speed, influenced the yield and chemical quality of tobacco seed oil (TSO). For its peculiar properties, TSO can be used for several purposes, as raw material in the manufacturing of soap, paints, resins, lubricants, biofuels and also as edible oil. TSO was obtained using a mechanical screw press and the quality of the oil was evaluated by monitoring the free fatty acids (FFA), the peroxide value (PV), the spectroscopic indices K₂₃₂, K₂₇₀ and ΔK and the fatty acid composition. The maximum extraction yield, expressed as percent of oil mechanically extracted respect to the oil content in the seeds, determined by solvent extraction, was obtained with the combination of the highest extraction temperature, the slowest screw rotation speed and seeds preheating. Under these conditions yield was 80.28 ± 0.33% (w/w), 25% higher than the lowest yield obtained among investigated conditions. The extraction temperature and seed preheating showed a significant effect on FFA, on spectroscopic indices K₂₃₂, K₂₇₀ and ΔK values. The average values of these parameters slightly increased rising the temperature and in presence of preheating, the screw rotation speed did not affect the chemical characteristic tested. In the extraction conditions investigated no significant changes in PV and fatty acids composition of oil were observed.

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Pharmacogenetics of Lipid-Lowering Agents: an Update Review on Genotype-Dependent Effects of HDL-Targetingand Statin Therapies

Abstract

Purpose of Review

High-density lipoproteins (HDL) are involved in reverse cholesterol transport. Results from randomized trials of HDL-targeting therapies, including cholesteryl ester transfer protein (CETP) inhibitors, have shown a lack of benefit in unsegmented populations. These observations could be explained by inter-individual variability of clinical responses to such agents depending on the patients' genotypes. In parallel, although lowering of LDL cholesterol (LDL-c) with statin therapy reduces the risk of vascular events in a wide range of individuals, inter-individual variability exists with regard to LDL-c-lowering response as well as efficacy in reducing major cardiovascular events.

Recent Findings

Pharmacogenomic analyses were performed in the dal-OUTCOMES and dal-PLAQUE-2 studies. Beneficial and concordant results were observed in patients with the favorable genotype when treated with the CETP inhibitor dalcetrapib. Similarly, previous studies revealed genetic variants associated with differential LDL-c response to statin therapy.

Summary

In this review, we discuss the pharmacogenetic determinants of HDL-targeting and statin therapy responses in light of the latest available published data, and their potential therapeutic applications.

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Polymorphism of Matrix Metalloproteinases Genes MMP1 , MMP2 , MMP3 , and MMP7 and the Risk of Varicose Veins of Lower Extremities

We studied the effects of single nucleotide polymorphisms in the promoter regions of matrix metalloproteinase genes rs1799750 (-1607dupG) MMP1, rs243865 (C-1306T) MMP2, rs3025058 (-1171dupA) MMP3, and rs11568818 (A-181G) MMP7 on the risk of varicose vein of the lower extremities in ethnical Russians, residents of the Russian Federation. We genotyped 536 patients with this pathology and 273 healthy participants without history of chronic venous disease. Association was examined using logistic regression analysis. None of the studied polymorphisms showed statistically significant association with the risk of varicose veins of the lower extremities. Our results provide evidence that these polymorphisms are not involved in the pathogenesis of varicose veins and cannot serve as markers of predisposition to this pathology.

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Effects of Physiological Nitric Oxide Donor on Oxidative Metabolism in Rat Blood

The effects of exogenous dinitrosyl iron complexes with glutathione ligands on the parameters of oxidative metabolism in the rat blood are studied. The intensity of LPO, total antioxidant activity, and MDA level in the plasma are compared in rats receiving intraperitoneal injections of saline without and with dinitrosyl iron complexes in various concentrations (0.15, 0.30, 0.45, and 0.60 mM). Glutathione—containing dinitrosyl iron complexes are characterized by antioxidant effect that non-linearly depended of the dose with optimum at 0.30-0.45 mM.

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Relationship between Hypoxic Resistance and the Phase of 4-Day Corticosterone Biorhythm in Adult Male Rats

The relationship between the phase of 4-day serum corticosteroid biorhythm and resistance to acute hypobaric hypoxia was studied in male rats. Single evaluations of hypoxic resistance of Wistar rats during the same time of the day have shown that the lifespan of animals is significantly longer during the 4-day biorhythm acrophase than during the bathyphase. Daily testing for 12 days has detected a 4-day rhythm of hypoxic resistance, synphasic with corticosterone biorhythm, irrespective of the wave-like course of the adaptation process phase from the beginning of daily testing and hypoxic resistance. Experiments on Sprague-Dawley rats have shown that animals highly resistant and medium resistant to hypoxia during the infradian biorhythm acrophase become medium resistant and poorly resistant during the bathyphase. In order to detect the animals with the least hypoxic resistance in the population, the studies should be carried out during the 4-day infradian biorhythm acrophase, while detection of the most resistant animals should be carried out during the bathyphase.

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Morphological Changes in the Thymus, Composition of Its Cells, and Subpopulations of Peripheral Blood Lymphocytes during Experimental Acute Ulcerative Colitis

Morphological changes in the thymus and composition of its cells and peripheral blood lymphocytes were studied in experiments on C57Bl/6 mice with sodium dextran sulfate-induced acute ulcerative colitis. Severe acute ulcerative colitis in rats was accompanied by stage III-IV accidental involution of the thymus. This state was characterized by inversion of the layers, death of thymocytes, and increase in the number and area of thymic corpuscles from CK19⁺ epithelial cells. Flow cytofluorometry revealed an increase in the relative number of F4/80⁺ macrophages in the thymus stroma and CD4^—CD8^—CD45⁺CD11c⁺ dendritic cells and CD326⁺UEA⁺CD205^— epithelial cells in the medulla. By contrast, the count of CD326⁺UEA^—CD205⁺ epithelial cells remained unchanged in the cortex. Accidental involution of the thymus was accompanied by an increase in the number of apoptotic AnnV⁺PI^— cells, but decrease in the count of lymphocytes, CD3^—CD19⁺ B lymphocytes, CD3⁺CD8⁺ cytotoxic T lymphocytes, immature CD4⁺CD8⁺ lymphocytes, and CD3⁺CD4⁺ T helpers. The level of peripheral blood endotoxin in adult male C57Bl/6 mice with fibrinous ulcerative colitis was 10-fold lower than in the control. Moreover, we observed a decrease in the absolute number of leukocytes, lymphocytes, CD3⁺CD4⁺ T helpers, CD3⁺CD8⁺ cytotoxic T lymphocytes, CD4⁺CD25⁺FOXP3⁺ regulatory T lymphocytes, and CD3^—CD19⁺ B lymphocytes in the peripheral blood of animals.

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Effect of GRP119 Receptor Agonist, Compound MBX-2982, on Activity of Human Glucokinase

Validation of the method for studies of glucokinase activators by the spectrophotometric method in an in vitro test system is carried out. The advantage of NAD coenzyme vs. thio-NAD is proven. Manifest activation of glucokinase by MBX-2982 compound (GPR119 agonist) in a wide range of concentrations is demonstrated experimentally.

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Role of Glutathione-S-Transferase Family Genes in Male Infertility

Polymorphisms of xenobiotic detoxification genes GSTT1 and GSTM1 and activity of glutathione system enzymes were studied in men with infertility. The frequency of deletion variant of GSTT1 gene in men with infertility was by 2 times higher than in fertile men. Deletion variant of GSTM1 gene was 1.4-fold more frequent in infertile men than in fertile men. Complete deletion of two genes was found in 19% men with infertility and only in 6% fertile men. The balance of activity of glutathione system enzymes essential for the effective detoxification of exogenous xenobiotics and toxic endogenous metabolites was impaired in infertile carriers of deletion variants of genes. Our results suggest that adaptation mechanisms are disordered in infertile men.

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Experimental Evaluation of the Efficiency of Lipid Module Enriched with Docosahexaenoic Acid and Astaxantin

Rats of the experimental group for 30 days received a ration in which the fat component (sunflower oil) was completely substituted with a lipid module enriched with docosahexaenoic acid and astaxanthin. Anxiety of animals in elevated plus-maze test and muscle tone in the grip strength test were evaluated before and after the experiment. Exhausting treadmill exercise was simulated after 30 days of feeding the lipid module. Modification of the lipid component of the diet (enrichment with docosahexaenoic acid and astaxanthin) reduced fatigue during exhausting physical exercise, increased muscle tone, and produced an anxiolytic effect. The results indicate the prospects of using the lipid module as a functional food ingredient in the composition of specialized food products.

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Differential DNA Hydroxymethylation in Human Uterine Leiomyoma Cells Depending on the Phase of Menstrual Cycle and Presence of MED12 Gene Mutations

Using immunofluorescence with specific antibodies, we analyzed DNA hydroxymethylation in uncultured cells from 25 human uterine leiomyomas considering the menstrual cycle phase during surgery and the presence of MED12 gene mutations. It was found that each tumor node had specific DNA hydroxymethylation level that did not depend on the presence of mutations in MED12 gene, but depended on the phase of menstrual cycle. The degree of DNA hydroxymethylation was significantly lower in cells of leiomyomas excised during the luteal phase compared to the follicular phase (p=0.0431). Hormonal status changing at various phases of menstrual cycle is a factor affecting DNA hydroxymethylation in leiomyoma cells.

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Effect of Skin Application of Dorogov’s Antiseptic-Stimulant on Behavioral Reactions in Rats

Local application of the Dorogov's antiseptic-stimulant onto the skin of 2-month-old male Sprague-Dawley rats in a low dose (0.5 g/kg/day) for 1 week increased motor and ultrasonic activity of experimental animals and the content of activated c-Fos⁺ neurons on the cingular, motor, insular, and pyriform cortex and in the striatum.

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Search of MicroRNAs Regulating the Receptor Status of Breast Cancer In Silico and Experimental Confirmation of Their Expression in Tumors

MicroRNA whose expression depends on the receptor status of breast cancer were selected using bioinformatic analysis. The expression of 9 microRNAs (16, 17, 21, 27, 125, 146, 155, 200a, and 221) was analyzed in 76 samples of breast cancer with various receptor phenotypes. The expression of microRNAs 155, 27, and 200a did not differ in various types of breast cancer. The data on positive correlation between the expression of microRNA-21 and microRNA-221 and negative receptor status of the tumor were confirmed. The expression of the tumor suppressing microRNA-125b decreased in samples of breast cancer expressing HER2 and ER and in triple negative breast cancer, which characterizes it as a universal marker of breast cancer. An increase in the expression of microRNA-16 was shown in samples of breast cancer expressing HER2 and ER. The expression of microRNA-17 decreased in triple negative breast cancer and increased in ER⁺, PR⁺, and HER⁺ types of breast cancer. MicroRNAs 16, 17, 21, 125b, 146b, and 221 can be promising markers for differential diagnostics of various phenotypes of breast cancer.

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Pregnant woman

The in-vitro fertilization unit lab at Poriya Medical Center in Tiberias has purchased a time-lapse embryoscope that allows continuous monitoring of embryos without removing the embryo from the incubator. This new technology, say doctors, will increase the rate of successful pregnancies.

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Effects of Orthognathic Surgery on TMJ Function and Dysfunction

The existing literature related to orthognathic surgery and temporomandibular disorders (TMD) is inconclusive with lack of prospective trials. Our study was designed to evaluate outcomes of orthognathic surgery in individuals with dentofacial deformities (DFD) who have pre-existing TMD.

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Temporomandibular Disorders in Orthognathic Surgery Patients

To determine prevalence, type and severity of pre-existing temporomandibular disorders (TMD) in individuals with dentofacial deformities (DFD) requiring orthognathic surgery.

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Clinical Evaluation of Kaban’s Protocol for the Treatment of TMJ Ankylosis

Modified Kaban's protocol (2009) uses autogenous reconstruction of ramus condyle unit (RCU) with costochondral graft (CCG) and transport disc distraction osteogenesis (TDDO) in children with TMJ ankylosis. There is a need to evaluate the protocol in terms of reankylosis, maximal incisal opening and continued growth of the mandible. A study was undertaken to prospectively evaluate the protocol given by Kaban.

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Pharmacogenetic Testing: A Pilot Study for 19 Genes and 180 Commonly Prescribed Medications

Pharmacogenetic testing allows for investigation of genes associated with metabolism and interaction of commonly prescribed medications. Clinically, pharmacogenetic testing would allow for tailoring of treatment based upon a patient's genetic ability to metabolize medications.

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A Cluster Randomized Controlled Clinical Trial to Evaluate Fate and Volumetric Shrinkage of Interposed Pedicled Buccal Pad of Fat and Abdominal Fat in the Treatment of TMJ Ankylosis

The autogenous fat grafts and dermal fat grafts show good results as compared to others various interpositional material. Though fat interpositioning in TMJ ankylosis is an emerging practice, we had no knowledge what happens to the interposed fat, whether abdominal fat is better than buccal pad of fat or vice versa. Hence the study was done to evaluate the fate of interposed fat graft as a interpositional arthroplasty with the help of MRI.

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Peri-Implant Osteogenesis Behavior in Ovariectomized Rats Treated with Strontium Ranelate

The aim of this study was to evaluate the bone repair and biomechanical responss after installation of implants in tibia of ovariectomized rats treated with strontium ranelate (RE). 30 Wistar adult rats were divided into 3 groups (n = 10): Group OVX, rats submitted to bilateral ovariectomy; SHAM group, rats sham submitted surgery of ovariectomy; OVX group RE, rats submitted to ovariectomy and treated with RE. 30 days after ovariectomy, RE OVX rats were orally gavage 625 mg / kg / day of RE until euthanasia of the animals.

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Oral Health-Related Quality of Life in Patients with JIA: Parents’ Perspective

The prevalence of TMJ arthritis in patients with JIA ranges from 29% to 78%, yet little is known about its effect on a child's oral health-related quality of life (OHRQoL). The objective of this study was to develop a valid and reliable proxy scale that can be used to assess oral health-related quality of life in pediatric patients with JIA between 6 and 13 years of age.

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The Impact of Intraoperative CT on Decision Making in Craniomaxillofacial Trauma Surgery

Reconstruction of complex injuries and deformities of the facial skeleton requires accurate restoration of three-dimensional anatomic relationships, stable fixation and appropriate post-operative wound healing. Intraoperative assessment is often difficult due to distortion of predictable surgical landmarks, loss of tissue and/or swelling associated with trauma. If the initial reconstruction is not accurate and fails to restore normal craniomaxillofacial relationships, patients may require multiple secondary operations to correct and refine the deformity.

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Stem Cell Based Tissue Regeneration of the Temporomandibular Joint

The ultimate goal of regenerative medicine is to faithfully recreate structures and organs with autogenously derived stem cells. Current technology involves creating a scaffold derived from various materials, populating it with mesenchymal stem cells harvested from fat or bone marrow, and then utilizing sophisticated cell culture techniques to coax the system to develop into a bone or organ. Progress in this area has been promising, but there are potential road blocks. When tissue is harvested and processed, the available stem cell populations may not include progenitors of the desired type.

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Differential Diagnosis of Fever in Patients with Hematologic Malignancy Receiving Chemotherapy: A Retrospective Cohort Study in Japan

Patients with hematologic malignancies are susceptible to infection due to myelosuppression during chemotherapy administration. In addition, presentation of various fevers in conjunction with chemotherapy is well known, these include tumor fever, drug fever, febrile neutropenia, and systemic bacterial infections. Dental focal infections such as severe periodontitis have been reported to cause life-threatening systemic morbidity and an adverse impact on the chemotherapy schedule. It is challenging for clinicians to make a diagnosis and identify the source of the fever as an adverse oral event.

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Should We Screen for Fibromyalgia and Neuropathic Pain in Patients with TMD?

There is overlap between TMD and other comorbid conditions such as fibromyalgia (FM), chronic fatigue syndrome, and chronic headaches. Lorduy KM et al found that 75% of patients with FM also have a diagnosis of TMD per the RDC/TMD criteria. The objective of this study was to determine the incidence of central sensitization and neuropathic pain conditions in patients with TMD and determine how these findings correlate with signs and symptoms based on JFLS scores and RDC/TMD criteria.

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Osteonecrosis of the Jaw Unrelated to Radiation or Medications

Recently osteonecrosis of the jaw (ONJ) has seen a sharp rise due to drug-induced causes from both bone modulating therapy and anti-angiogenic medication (medication related osteonecrosis of the jaw – MRONJ) as well has head and neck radiotherapy (osteoradionecrosis – ORN). The pathophysiology1,2 for both differ; however, they appear to share many similarities in their presentation, symptoms and risk factors for their occurrence.

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TMJ Reconstruction in Patients with Autoimmune Disease

To evaluate the clinical outcomes of temporomandibular joint (TMJ) surgery in patients with autoimmune/connective tissue (CT) disease treated with autogenous vs alloplastic reconstruction.

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Grafting of Alveolar Cleft Defects in Preparation for Endosseous Dental Implant Placement and Orthodontic Tooth Movement

Prosthodontic rehabilitation of patients with edentulous sites secondary to cleft palate has shown a paradigm shift towards implant placement in skeletally mature patients. Patients with residual alveolar cleft defects after secondary grafting at the optimal age of 8-11 years old have presented with persistent defects precluding implant placement. The purpose of this article is to revisit an approach to augmentation bone grafting of the residual maxillary alveolar cleft defect in preparation for endosseous dental implant placement.

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Buffered 1% Lidocaine with Epinephrine Can be As Effective As Non-Buffered 2% Lidocaine with Epinephrine for Maxillary Field Block

Buffering local anesthetics with epinephrine offers clinicians' options not often considered. This study assessed outcomes for pulpal anesthesia, pain on injection, and time to sensation for Buffered 1% lidocaine with 1/100k epinephrine (Epi) vs. Non-buffered 2% lidocaine with 1/100k Epi.

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Αρχειοθήκη ιστολογίου

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Κυριακή 24 Σεπτεμβρίου 2017

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Αναζήτηση αυτού του ιστολογίου

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