Exploring the role of pain as an early predictor of category 2 pressure ulcers: a prospective cohort study

Objective To explore pressure area related pain as a predictor of category ≥2 pressure ulcer (PU) development. Design Multicentre prospective cohort study. Setting UK hospital and community settings. Participants inclusion Consenting acutely ill patients aged ≥18 years, defined as high risk (Braden bedfast/chairfast AND completely immobile/very limited mobility; pressure area related pain or; category 1 PU). Exclusion Patients too unwell, unable to report pain, 2 or more category ≥2 PUs. Follow-up Twice weekly for 30 days. Primary and secondary outcome measures Development and time to development of one or more category ≥2 PUs. Results Of 3819 screened, 1266 were eligible, 634 patients were recruited, 32 lost to follow-up, providing a 602 analysis population. 152 (25.2%) developed one or more category ≥2 PUs. 464 (77.1%) patients reported pressure area related pain on a healthy, altered or category 1 skin site of whom 130 (28.0%) developed a category ≥2 PU compared with 22 (15.9%) of those without pain. Full stepwise variable selection was used throughout the analyses. (1) Multivariable logistic regression model to assess 9 a priori factors: presence of category 1 PU (OR=3.25, 95% CI (2.17 to 4.86), p<0.0001), alterations to intact skin (OR=1.98, 95% CI (1.30 to 3.00), p=0.0014), pressure area related pain (OR=1.56, 95% CI (0.93 to 2.63), p=0.0931). (2) Multivariable logistic regression model to account for overdispersion: presence of category 1 PU (OR=3.20, 95% CI (2.11 to 4.85), p<0.0001), alterations to intact skin (OR=1.90, 95% CI (1.24 to 2.91), p=0.0032), pressure area related pain (OR=1.85, 95% CI (1.07 to 3.20), p=0.0271), pre-existing category 2 PU (OR=2.09, 95% CI (1.35 to 3.23), p=0.0009), presence of chronic wound (OR=1.66, 95% CI (1.06 to 2.62), p=0.0277), Braden activity (p=0.0476). (3) Accelerated failure time model: presence of category 1 PU (AF=2.32, 95% CI (1.73 to 3.12), p<0.0001), pressure area related pain (AF=2.28, 95% CI (1.59 to 3.27), p<0.0001). (4) 2-level random-intercept logistic regression model: skin status which comprised 2 levels (versus healthy skin); alterations to intact skin (OR=4.65, 95% CI (3.01 to 7.18), p<0.0001), presence of category 1 PU (OR=17.30, 95% CI (11.09 to 27.00), p<0.0001) and pressure area related pain (OR=2.25, 95% CI (1.53 to 3.29), p<0.0001). Conclusions This is the first study to assess pain as a predictor of category ≥2 PU development. In all 4 models, pain emerged as a risk factor associated with an increased probability of category ≥2 PU development

A ward-round non-technical skills for surgery (WANTSS) taxonomy.

Background: Around half of surgical adverse events occur outside the operating room. However the majority of non-technical skills (NTS) training programs have been developed for the intra-operative environment. Ward rounds are a crucial part of extra-operative care and to date no specific NTS training manual has been developed targeting emergency general surgical ward rounds. Aim: To develop a NTS taxonomy for emergency general surgical ward rounds that can be used to improve surgical team members’ NTS and improve outcomes. Methods: A literature review of existing NTS taxonomies was conducted, followed by semi-structured interviews and observational data collection, to determine good and poor surgical ward round behaviours. These behaviours were reviewed by a panel of subject matter experts and categorised into a taxonomy, using the Non-Technical Skills for Surgeons (NOTSS) taxonomy framework as a guide. Results: The Ward-round Non-Technical Skills for Surgery (WANTSS) taxonomy includes examples of good and poor ward round specific behaviours, grouped into elements and categories. The taxonomy can be used as both a training and teaching manual for the surgical team. Conclusion: Ward rounds are a crucial part of extra-operative surgical care. The WANTSS taxonomy provides surgical teams with a manual to help them improve their ward round NTS

Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT

Background: Pressure ulcers (PUs) are a burden to patients, carers and health-care providers. Specialist mattresses minimise the intensity and duration of pressure on vulnerable skin sites in at-risk patients. Primary objective: Time to developing a new PU of category ≥ 2 in patients using an alternating pressure mattress (APM) compared with a high-specification foam mattress (HSFM). Design: A multicentre, Phase III, open, prospective, planned as an adaptive double-triangular group sequential, parallel-group, randomised controlled trial with an a priori sample size of 2954 participants. Randomisation used minimisation (incorporating a random element). Setting: The trial was set in 42 secondary and community inpatient facilities in the UK. Participants: Adult inpatients with evidence of acute illness and at a high risk of PU development. Interventions and follow-up: APM or HSFM – the treatment phase lasted a maximum of 60 days; the final 30 days were post-treatment follow-up. Main outcome measures: Time to event. Results: From August 2013 to November 2016, 2029 participants were randomised to receive either APM (n = 1016) or HSFM (n = 1013). Primary end point – 30-day final follow-up: of the 2029 participants in the intention-to-treat population, 160 (7.9%) developed a new PU of category ≥ 2. There was insufficient evidence of a difference between groups for time to new PU of category ≥ 2 [Fine and Gray model HR 0.76, 95% confidence interval (CI) 0.56 to 1.04; exact p-value of 0.0890 and 2% absolute difference]. Treatment phase sensitivity analysis: 132 (6.5%) participants developed a new PU of category ≥ 2 between randomisation and end of treatment phase. There was a statistically significant difference in the treatment phase time-to-event sensitivity analysis (Fine and Gray model HR 0.66, 95% CI 0.46 to 0.93; p = 0.0176 and 2.6% absolute difference). Secondary end points – 30-day final follow-up: new PUs of category ≥ 1 developed in 350 (17.2%) participants, with no evidence of a difference between mattress groups in time to PU development, (Fine and Gray model HR 0.83, 95% CI 0.67 to 1.02; p-value = 0.0733 and absolute difference 3.1%). New PUs of category ≥ 3 developed in 32 (1.6%) participants with insufficient evidence of a difference between mattress groups in time to PU development (Fine and Gray model HR 0.81, 95% CI 0.40 to 1.62; p = 0.5530 and absolute difference 0.4%). Of the 145 pre-existing PUs of category 2, 89 (61.4%) healed – there was insufficient evidence of a difference in time to healing (Fine and Gray model HR 1.12, 95% CI 0.74 to 1.68; p = 0.6122 and absolute difference 2.9%). Health economics – the within-trial and long-term analysis showed APM to be cost-effective compared with HSFM; however, the difference in costs models are small and the quality-adjusted life-year gains are very small. There were no safety concerns. Blinded photography substudy – the reliability of central blinded review compared with clinical assessment for PUs of category ≥ 2 was ‘very good’ (kappa statistic 0.82, prevalence- and bias-adjusted kappa 0.82). Quality-of-life substudy – the Pressure Ulcer Quality of Life – Prevention (PU-QoL-P) instrument meets the established criteria for reliability, construct validity and responsiveness. Limitations: A lower than anticipated event rate. Conclusions: In acutely ill inpatients who are bedfast/chairfast and/or have a category 1 PU and/or localised skin pain, APMs confer a small treatment phase benefit that is diminished over time. Overall, the APM patient compliance, very low PU incidence rate observed and small differences between mattresses indicate the need for improved indicators for targeting of APMs and individualised decision-making. Decisions should take into account skin status, patient preferences (movement ability and rehabilitation needs) and the presence of factors that may be potentially modifiable through APM allocation, including being completely immobile, having nutritional deficits, lacking capacity and/or having altered skin/category 1 PU. Future work: Explore the relationship between mental capacity, levels of independent movement, repositioning and PU development. Explore ‘what works for whom and in what circumstances’. Trial registration: Current Controlled Trials ISRCTN01151335. Funding: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 52. See the NIHR Journals Library website for further project information

Combating Cancer Through Public Health Practice in the United States: An In-Depth Look at the National Comprehensive Cancer Control Program

Cancer is the second leading cause of the death in the United States (U.S.). The National Comprehensive Cancer Control Program (NCCCP) is a national, public health practice program funded by the U.S. Centers for Disease Control and Prevention. The NCCCP has been planning and implementing interventions to reduce the burden of cancer since 1998. Interventions are implemented across three areas primary prevention, early detection, and survivorship using health systems and environmental changes to promote sustainable cancer control. The aim of this chapter is to provide a summary of the NCCCP, and highlight specific examples of interventions and successes to aid cancer planning in other countries. Cancer plan analyses show that all NCCCP participant cancer plans address reducing tobacco use for cancer prevention and 98% contain activities to increase colorectal cancer screening. The vast majority implement activities to improve the quality of life following a cancer diagnosis (94%). Relatively fewer cancer plans contain activities to reduce radon exposure (42%), promote human papilloma virus vaccination (62%), and incorporate the use of genomics in cancer control (56%). The examples of NCCCP activities demonstrate success in controlling cancer and other non-communicable diseases through public health practice

Synthesis of the fungal metabolite YWA1 and related constructs as tools to study MelLec-mediated immune response to Aspergillus infections

Funding Sources Funding was provided by the Wellcome Trust (102705, 097377), the Medical Research Council Centre for Medical Mycology and the University of Aberdeen (MR/N006364/1). ACKNOWLEDGMENT We thank Ian Fraser Flow Cytometry and Microscopy and Histology facilities, University of Aberdeen.Peer reviewedPostprin

Consensus workshops on the development of an ADHD medication management protocol using QbTest: developing a clinical trial protocol with multidisciplinary stakeholders

BackgroundThe study design and protocol that underpin a randomised controlled trial (RCT) are critical for the ultimate success of the trial. Although RCTs are considered the gold standard for research, there are multiple threats to their validity such as participant recruitment and retention, identifying a meaningful change, and non-adherence to the protocol. For clinical RCTs, involving patients and clinicians in protocol design provides the opportunity to develop research protocols that are meaningful to their target audience and may help overcome some of the inherent threats in conducting RCTs. However, the majority of protocols do not describe the methodology underpinning their development, limiting the amount of learned experience shared between research groups.MethodWith the purpose of reporting a collaborative approach towards developing a protocol, we present the findings from three sequential workshops that were conducted with the aim of developing a protocol to investigate the feasibility of adding a computerised test of attention, impulsivity and activity (QbTest) to medication management of children and young people with Attention deficit hyperactivity disorder (ADHD). Based on previous qualitative interviews with clinicians and families, each workshop prioritised topics for focused discussion. Information from the workshops was fed back to the participants for reflection in advance of the next workshop.ResultsThe workshops involved 21 multi-disciplinary ADHD experts, including clinicians, patient and public involvement (PPI) members, parents of young people with ADHD and researchers. The consensus workshops addressed key research issues such as: the most relevant outcome measures/ resource drivers; methods and time points for data collection; and the clinical protocol for utilising the QbTest, including when best to use this within the medication management process. The resulting protocol details a feasibility RCT design describing these factors.ConclusionProtocols which are co-developed may help overcome some of the risks associated with RCT completion (e.g. recruitment, retention, protocol adherence) and help prioritise outcomes of greater relevance to the populations under study. The methodology has potential value for researchers and organisations developing clinical guidelines, and offers insights into the valuable impact of PPI upon trial design

Effects of harvesting and stubble management on abundance of pest rodents (Mus musculus) in a conservation agriculture system

BACKGROUND: The shift to more environmentally sensitive agricultural practices over the last several decades has changed farmland landscapes worldwide. Changes including no-till and retaining high biomass mulch has been coincident with an increase in rodent pests in South Africa, India, South America and Europe, indicating a possible conflict between conservation agriculture (CA) and rodent pest management. Research on effects of various crop management practices associated with CA on pest rodent population dynamics is needed to anticipate and develop CA-relevant management strategies. RESULTS: During the Australian 2020–2021 mouse plague, farmers used postharvest stubble management practices, including flattening and/or cutting, to reduce stubble cover in paddocks to lessen habitat suitability for pest house mice. We used this opportunity to assess the effects of both harvest and stubble management on the movement and abundance of mice in paddocks using mouse trapping and radio tracking. We found that most tracked mice remained resident in paddocks throughout harvest, and that mouse population abundance was generally unaffected by stubble management. CONCLUSION: Recent conversions to CA practices have changed how pest house mice use cropped land. Management practices that reduce postharvest habitat complexity do not appear to reduce the attractiveness of paddocks to mice, and further research into new management strategies in addition to toxic bait use is required as part of an integrated pest management approach.</p

Biodiversity 2020: climate change evaluation report

In 2011, the government published Biodiversity 2020: A strategy for England’s wildlife and ecosystem services [1]. This strategy for England builds on the 2011 Natural Environment White Paper - NEWP [2] and provides a comprehensive picture of how we are implementing our international and EU commitments. It sets out the strategic direction for biodiversity policy between 2011-2020 on land (including rivers and lakes) and at sea, and forms part of the UK’s commitments under the ‘the Aichi targets’ agreed in 2010 under the United Nations Convention of Biological Diversity’s Strategic Plan for Biodiversity 2011-2020 [3]. Defra is committed to evaluating the Biodiversity 2020 strategy and has a public commitment to assess climate change adaptation measures. This document sets out the information on assessing how action under Biodiversity 2020 has helped our wildlife and ecosystems to adapt to climate change. Biodiversity 2020 aims to halt the loss of biodiversity and restore functioning ecosystems for wildlife and for people. The outcomes and actions in Biodiversity 2020, although wider in scope, aimed to increase resilience of our wildlife and ecosystems in the face of a changing climate. In order to inform the assessment, we have defined which of the measurable outputs under Biodiversity 2020 contribute to resilience. Biodiversity 2020 included plans to develop and publish a dedicated set of indicators to assess progress towards the delivery of the strategy. The latest list (at the time of writing), published in 2017, contains 24 biodiversity indicators [4] that would help inform progress towards achieving specific outcomes, they are also highly relevant to the outputs (detailed below) that form the basis for this evaluation. The Adaptation Sub-Committee’s 2017 UK Climate Change Risk Assessment Evidence Report [5] sets out the priority climate change risks and opportunities for the UK. The ASC also produced a review of progress in the National Adaptation Programme - “Progress in preparing for climate change” [6], which highlights adaptation priorities and progress being made towards achieving them. The UK Government’s response to the ASC [7] review includes a set of recommendations, of which Recommendation 6 states that “Action should be taken to enhance the condition of priority habitats and the abundance and range of priority species”. The recommendation further iterated that “This action should maintain or extend the level of ambition that was included in Biodiversity 2020” and that “An evaluation should be undertaken of Biodiversity 2020 including the extent to which goals have been met and of the implications for resilience to climate change.” To this, end an evaluation process has been put in place to define: a. What worked and why? Which actions or activities have had the greatest benefit in terms of delivering the desired outcomes? And, conversely, what prevented progress? b. Where are the opportunities? What are the financial, political, scientific and social opportunities for furthering the desired outcomes in the future? These objectives underpin the evaluation process for actions to date, and will also inform future actions and the iteration of a new nature strategy for England

The Grizzly, April 23, 2015

Mayday Concert Returning • Not on My Campus Campaign Launches • Student Art Show to Open on CoSA Day • Elections Results • Holocaust Survivor to Share Her Story to Campus • CoSA Spurs Second Annual Creative Exchange in Myrin • CoSA to Celebrate Wide Variety of Student Work • Opinion: Crigler Beneficial But Needs Improvements; What Makes Crigler Worthwhile for Students? • Sibling Stickhandlers Stayed Side by Side • UCWR Sticks it to Gender Normshttps://digitalcommons.ursinus.edu/grizzlynews/1932/thumbnail.jp