'The palliative care ambulance' : a qualitative study of patient and caregiver perspectives of an ambulance service

Background: The need for home-based palliative care is accelerating internationally. At the same time, health systems face increased complexity, funding constraints and global shortages in the healthcare workforce. As such, ambulance services are increasingly tasked with providing palliative care. Where paramedics with additional training in palliative care have been integrated into models of care, evaluations have been largely positive. Studies of patient and family carer experiences of paramedic involvement, however, are limited. Aim: To explore patient and family caregiver experiences of paramedics’ contribution to palliative care at home. Design: Qualitative interview study. We analysed data within a social constructionist epistemology using reflexive thematic analysis. Setting/participants: Participants receiving specialist palliative care in the community of a metropolitan city of Australia who requested an ambulance between January and August 2018, inclusive. Results: Participants considered paramedics with expertise and experience in palliative care as an extension of the specialist community palliative care team and held them in high regard. Participants highlighted the importance of: critical palliative care at home and a timely, responsive approach; person-centred paramedics; as well as safety and security. Conclusion: Patients and carers feel safe and secure when they know that highly responsive skilled professional support is available when an unexpected problem or sudden change arises, especially out-of-hours, and that support is delivered in an empathic and person-centred manner

Expression of cannabinoid receptors in human osteoarthritic cartilage: implications for future therapies

Introduction: Cannabinoids have shown to reduce joint damage in animal models of arthritis and reduce matrix metalloproteinase expression in primary human steoarthritic (OA) chondrocytes. The actions of cannabinoids are mediated by a number of receptors, including cannabinoid receptors 1 and 2 (CB1 and CB2), Gprotein-coupled receptors 55 and 18 (GPR55 and GPR18), transient receptor potential vanilloid-1 (TRPV1), and peroxisome proliferator-activated receptors alpha and gamma (PPARa and PPARc). However, to date very few studies have investigated the expression and localization of these receptors in human chondrocytes, and expression during degeneration, and thus their potential in clinical applications is unknown. Methods: Human articular cartilage from patients with symptomatic OA was graded histologically and the expression and localization of cannabinoid receptors within OA cartilage and underlying bone were determined immunohistochemically. Expression levels across regions of cartilage and changes with degeneration were investigated. Results: Expression of all the cannabinoid receptors investigated was observed with no change with grade of degeneration seen in the expression of CB1, CB2, GPR55, PPARa, and PPARc. Conversely, the number of chondrocytes within the deep zone of cartilage displaying immunopositivity for GPR18 and TRPV1 was significantly decreased in degenerate cartilage. Receptor expression was higher in chondrocytes than in osteocytes in the underlying bone. Conclusions: Chondrocytes from OA joints were shown to express a wide range of cannabinoid receptors even in degenerate tissues, demonstrating that these cells could respond to cannabinoids. Cannabinoids designed to bind to receptors inhibiting the catabolic and pain pathways within the arthritic joint, while avoiding psychoactive effects, could provide potential arthritis therapies. Key words: articular cartilage; cannabinoid receptors; cannabinoids; osteoarthriti

Evaluation of extracellular matrix formation in polycaprolactone and starch-compounded polycaprolactone nanofiber meshes when seeded with bovine articular chondrocytes

Cartilage defects are a major health problem. Tissue engineering has developed different strategies and several biomaterial morphologies, including natural-based ones, for repairing these defects. We used electrospun polycaprolactone (PCL) and starch-compounded PCL (SPCL) nanofiber meshes to evaluate extracellular matrix (ECM) formation by bovine articular chondrocytes (BACs). The main aim of this work was to evaluate the suitability of PCL and SPCL nanofiber meshes in chondrocyte cultures, and their capability to produce ECM when seeded onto these nanostructured materials. The effect of culture conditions (static vs dynamic) on ECM formation was also assessed. BACs were seeded onto PCL and SPCL nanofiber meshes using a dynamic cellseeding procedure and cultured under static or dynamic conditions for 4 weeks. Constructs were characterized using scanning electron microscopy, histology, immunolocalization of collagen types I and II, and glycosaminoglycan (GAG) quantification. Results show an extensive cell colonization of the entire nanofiber mesh, for both materials, and that chondrocytes presented typical spherical morphology. Some degree of cell infiltration inside the nanofiber meshes was noticeable for both materials. ECM formation and GAG were detected throughout the materials, evidencing typical construct maturation. PCL and SPCL nanofiber meshes are suitable as supports for ECM formation and therefore are adequate for cartilage tissue-engineering approaches.M. Alves da Silva would like to acknowledge the Portuguese Foundation for Science and Technology (FCT) for her grant (SFRH/BD/28708/2006), Marie Curie Actions-ALEA JACTA EST (MEST-CT-2004-008104), European NoE EXPERTISSUES (NMP3-CT-2004-500283), IP GENOSTEM (LSHB-CT-2003-503161) and NATURALLY NANO (POCTI/EME/58982/2004)

Design and Properties of Novel Substituted Borosilicate Bioactive Glasses and Their Glass-Ceramic Derivatives

Three novel borosilicate bioactive glasses (BBGs) of general formula of 0.05Na2O·0.35x·0.20B2O3·0.40SiO2 (molar ratio, where x = MgO or CaO or SrO) were prepared and used to investigate the effect of crystallization on their properties including cytotoxicity. The three postmelt compositions were determined using X-ray fluorescence spectroscopy, and crystallization events were studied using differential thermal analysis and X-ray diffraction. This information was used to determine heat treatments to prepare glass-ceramics by controlled crystallization. X-ray diffraction analysis and Fourier transform infrared spectroscopy showed that, after higher heat treatment temperatures (800–900 °C), borosilicate bioactive glass-ceramics (BBGCs) contained mainly borate and silicate crystalline phases. Specifically, BBG-Mg, BBG-Ca, and BBG-Sr glass-ceramics detected the presence of magnesium silicate-Mg2(SiO3)2 and magnesium borate-Mg2B2O5; wollastonite-2M-CaSiO3 and calcium borate-Ca(BO2)2; and strontium silicate-SrSiO3 and strontium borate-Sr2B2O5, respectively. In vitro cytotoxicity tests were performed using the mouse fibroblast cell line (L929). Glass and glass ceramic at concentrations lower than 50 mg/mL did not exhibit any level of cytotoxicity when compared with the control. However, quantitative evaluation indicated that greater cell growth occurred in the presence of materials with crystalline phases. Control of BBGs crystallization may therefore be used to influence the biocompatibility of these glass-ceramic systems

Virtuous opinion change in structured groups

Although the individual has been the focus of most research into judgment and decision-making (JDM), important decisions in the real world are often made collectively rather than individually, a tendency that has increased in recent times with the opportunities for easy information exchange through the Internet. From this perspective, JDM research that factors in this social context has increased generalizability and mundane realism relative to that which ignores it. We delineate a problem-space for research within which we locate protocols that are used to study or support collective JDM, identify a common research question posed by all of these protocols—‘What are the factors leading to opinion change for the better (‘virtuous opinion change’) in individual JDM agents?’—and propose a modeling approach and research paradigm using structured groups (i.e., groups with some constraints on their interaction), for answering this question. This paradigm, based on that used in studies of judge-adviser systems, avoids the need for real interacting groups and their attendant logistical problems, lack of power, and poor experimental control. We report an experiment using our paradigm on the effects of group size and opinion diversity on judgmental forecasting performance to illustrate our approach. The study found a U-shaped effect of group size on the probability of opinion change, but no effect on the amount of virtuous opinion change. Implications of our approach for development of more externally valid empirical studies and theories of JDM, and for the design of structured-group techniques to support collective JDM, are discussed

Virtuous opinion change in structured groups

Although the individual has been the focus of most research into judgment and decision-making (JDM), important decisions in the real world are often made collectively rather than individually, a tendency that has increased in recent times with the opportunities for easy information exchange through the Internet. From this perspective, JDM research that factors in this social context has increased generalizability and mundane realism relative to that which ignores it. We delineate a problem-space for research within which we locate protocols that are used to study or support collective JDM, identify a common research question posed by all of these protocols—‘What are the factors leading to opinion change for the better (‘virtuous opinion change’) in individual JDM agents?’—and propose a modeling approach and research paradigm using structured groups (i.e., groups with some constraints on their interaction), for answering this question. This paradigm, based on that used in studies of judge-adviser systems, avoids the need for real interacting groups and their attendant logistical problems, lack of power, and poor experimental control. We report an experiment using our paradigm on the effects of group size and opinion diversity on judgmental forecasting performance to illustrate our approach. The study found a U-shaped effect of group size on the probability of opinion change, but no effect on the amount of virtuous opinion change. Implications of our approach for development of more externally valid empirical studies and theories of JDM, and for the design of structured-group techniques to support collective JDM, are discussed

Structured groups make more accurate veracity judgements than individuals

Groups often make better judgements than individuals, and recent research suggests that this phenomenon extends to the deception detection domain. The present research investigated whether the influence of groups enhances the accuracy of judgements, and whether group size influences deception detection accuracy. Two-hundred fifty participants evaluated written statements with a pre-established detection accuracy rate of 60% in terms of veracity before viewing either the judgements and rationales of several other group members or a short summary of the written statement and revising or restating their own judgements accordingly. Participants' second responses were significantly more accurate than their first, suggesting a small positive effect of structured groups on deception detection accuracy. Group size did not have a significant effect on detection accuracy. The present work extends our understanding of the utility of group deception detection, suggesting that asynchronous, structured groups outperform individuals at detecting deception

Drug loaded homogeneous electrospun PCL/gelatin hybrid nanofiber structures for anti-infective tissue regeneration membranes

YesInfection is the major reason for guided tissue regeneration/guided bone regeneration (GTR/GBR) membrane failure in clinical application. In this work, we developed GTR/GBR membranes with localized drug delivery function to prevent infection by electrospinning of poly(ε-caprolactone) (PCL) and gelatin blended with metronidazole (MNA). Acetic acid (HAc) was introduced to improve the miscibility of PCL and gelatin to fabricate homogeneous hybrid nanofiber membranes. The effects of the addition of HAc and the MNA content (0, 1, 5, 10, 20, 30, and 40 wt.% of polymer) on the properties of the membranes were investigated. The membranes showed good mechanical properties, appropriate biodegradation rate and barrier function. The controlled and sustained release of MNA from the membranes significantly prevented the colonization of anaerobic bacteria. Cells could adhere to and proliferate on the membranes without cytotoxicity until the MNA content reached 30%. Subcutaneous implantation in rabbits for 8 months demonstrated that MNA-loaded membranes evoked a less severe inflammatory response depending on the dose of MNA than bare membranes. The biodegradation time of the membranes was appropriate for tissue regeneration. These results indicated the potential for using MNA-loaded PCL/gelatin electrospun membranes as anti-infective GTR/GBR membranes to optimize clinical application of GTR/GBR strategies

It's time for a minimum synoptic operation template in patients undergoing laparoscopic cholecystectomy : a systematic review

Background Despite the call to enhance accuracy and value of operation records few international recommended minimal standards for operative notes documentation have been described. This study undertook a systematic review of existing operative reporting systems for laparoscopic cholecystectomy (LC) to fashion a comprehensive, synoptic operative reporting template for the future. Methods A search for all relevant articles was conducted using PubMed version of Medline, Scopus and Web of Science databases in June 2021, for publications from January 1st 2011 to October 25th 2021, using the keywords: laparoscopic cholecystectomy AND operation notes OR operative notes OR proforma OR documentation OR report OR narrative OR audio-visual OR synoptic OR digital. Two reviewers (NOC, GMC) independently assessed each published study using a MINORS score of >= 16 for comparative and >= 10 for non-comparative for inclusion. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Synoptic operative templates from published data were assimilated into one "ideal" laparoscopic operative report template following international input from the World Society of Emergency Surgery board. Results A total of 3567 articles were reviewed. Following MINORS grading 25 studies were selected spanning 14 countries and 4 continents. Twenty-two studies were prospective. A holistic overview of the operative procedure documentation was reported in 6/25 studies and a further 19 papers dealt with selective surgical aspects of LC. A unique synoptic LC operative reporting template was developed and translated into Chinese/Mandarin, French and Arabic. Conclusion This systematic review identified a paucity of publications dealing with operative reporting of LC. The proposed new template may be integrated digitally with hospitals' medical systems and include additional narrative text and audio-visual data. The template may help define new OR (operating room) recording standards and impact on care for patients undergoing LC.Peer reviewe

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy