A review of diabetic patients’ knowledge in a high prevalent European country : Malta

Education is the first milestone in the care pathway of all diabetic patients. The aim of this study was to assess the educational knowledge and awareness among a diabetic patient cohort and compare this knowledge to a previously conducted study. Acquiring information on diabetes knowledge is essential for both clinicians and policy makers. Interviews using validated questionnaires covering various aspects of diabetes knowledge were conducted among a diabetic cohort between August and September of 2014 at the state hospital in Malta. The majority exhibited correct knowledge on diabetes and related complications. Knowledge levels appeared to have improved and were influenced by gender, type of diabetes and length of diabetes awareness. We conclude that educational approaches should be targeted towards every diabetic individual and should start immediately after diagnosis. This would lead to improved self-care, with a reduction in diabetic complications and a decrease in health-care expenditure.peer-reviewe

Use and misuse of urine cultures and antibiotics in catheterised patients at a rehabilitation hospital in Malta

Background One of the most common samples submitted to microbiology laboratories are urine specimens for culture. Objectives To assess the indications for obtaining urine cultures in a cohort of catheterised patients. The appropriateness of antimicrobial therapy in response to urine culture results was also studied. Method All catheterised inpatients at Karin Grech Rehabilitation Hospital in Malta who had urine cultures taken over a 3- month period in 2016 were included. Data included the indication for sample collection, any documented urinary symptoms, culture results, antibiotic use before and after culture result and any change in antibiotic. A departmental presentation on the appropriate care of catheterised patients was delivered and a re-audit was carried out in 2017. Results There were a total of 38 patients who were catheterised and had one or more urine cultures taken in 2016 and 55 in 2017. The commonest indications documented were fever and retention. Their indication was not documented in the medical notes in around 50% of samples taken for both years. The culture result was documented in 15% of cases in 2016 increasing to 40% in 2017. The commonest bacteria cultivated included E.Coli and Klebsiella. Empirical antibiotics were given in approximately 45% of cases who had a urine culture taken. In both 2016 and 2017, antibiotics were switched due to resistance in around 10% of all episodes when urine cultures were taken. Conclusion Lack of documentation of the indication and culture result was evident. This improved in the re-audit. A high percentage of cultures taken did not influence the clinical management. The study clearly shows inappropriate use of urine culture requests and the need to follow available guidelines.peer-reviewe

Assessment of the interaction of Portland cement-based materials with blood and tissue fluids using an animal model

Portland cement used in the construction industry improves its properties when wet. Since most dental materials are used in a moist environment, Portland cement has been developed for use in dentistry. The first generation material is mineral trioxide aggregate (MTA), used in surgical procedures, thus in contact with blood. The aim of this study was to compare the setting of MTA in vitro and in vivo in contact with blood by subcutaneous implantation in rats. The tissue reaction to the material was also investigated. ProRoot MTA (Dentsply) was implanted in the subcutaneous tissues of Sprague-Dawley rats in opposite flanks and left in situ for 3 months. Furthermore the material was also stored in physiological solution in vitro. At the end of the incubation time, tissue histology and material characterization were performed. Surface assessment showed the formation of calcium carbonate for both environments. The bismuth was evident in the tissues thus showing heavy element contamination of the animal specimen. The tissue histology showed a chronic inflammatory cell infiltrate associated with the MTA. MTA interacts with the host tissues and causes a chronic inflammatory reaction when implanted subcutaneously. Hydration in vivo proceeds similarly to the in vitro model with some differences particularly in the bismuth oxide leaching patterns.peer-reviewe

Assessing appropriateness of drug therapy in older persons : development and application of a medication assessment tool for long-term management of atrial fibrillation

Background: Atrial fibrillation (AF) is highly prevalent in older persons and is associated with considerable morbidity and mortality. Assessing appropriateness of drug therapy in AF may be facilitated by application of medication assessment tools (MATs). Objective: To develop, psychometrically evaluate and apply an innovative MAT for the long-term management of AF with particular relevance to older persons. Methods: Key recommendations from clinical practice guidelines for the long-term management of AF were selected and review criteria defining appropriate drug therapy were constructed as a ‘qualifying statement’ followed by a ‘standard’. The developed MAT was given the designation MAT-AF. An application guide was compiled where justifications for non-adherence were specified. Content validity was tested by an expert group using a three-round Delphi process. Inter- and intra-observer reliability testing was conducted with agreement expressed by Cohen’s kappa and application time measured to assess feasibility. MAT-AF was applied to 150 patients with a diagnosis of AF admitted to a rehabilitation hospital. Results: MAT-AF consists of 15 criteria sectioned into antithrombotic, rate control and rhythm control therapy. Content validity was demonstrated for all criteria. Reliability was confirmed with kappa values of 0.84 and 0.91 for inter- and intra-observer agreements. Mean application time for the two observers was 3.9 and 2.4 minutes, which decreased significantly in the second application conducted after a four-week interval (p<0.001). Overall adherence to applicable criteria was 59.8%. Non-adherence was evident for prescription of anticoagulation in patients with a CHA2DS2VASc score ≥1 (29.5%). Monitoring of laboratory parameters for digoxin was suboptimal. Ophthalmic and pulmonary monitoring and patient counselling regarding amiodarone therapy could not be assessed since relevant records were not readily available. Conclusion: MAT-AF application highlighted key aspects which need to be addressed to improve patient care.peer-reviewe

Reliability of Upper Limb Pin-Prick Stimulation With Electroencephalography: Evoked Potentials, Spectra and Source Localization

In order for electroencephalography (EEG) with sensory stimuli measures to be used in research and neurological clinical practice, demonstration of reliability is needed. However, this is rarely examined. Here we studied the test-retest reliability of the EEG latency and amplitude of evoked potentials and spectra as well as identifying the sources during pin-prick stimulation. We recorded EEG in 23 healthy older adults who underwent a protocol of pin-prick stimulation on the dominant and non-dominant hand. EEG was recorded in a second session with rest intervals of 1 week. For EEG electrodes Fz, Cz, and Pz peak amplitude, latency and frequency spectra for pin-prick evoked potentials was determined and test-retest reliability was assessed. Substantial reliability ICC scores (0.76–0.79) were identified for evoked potential negative-positive amplitude from the left hand at C4 channel and positive peak latency when stimulating the right hand at Cz channel. Frequency spectra showed consistent increase of low-frequency band activity (&amp;lt; 5 Hz) and also in theta and alpha bands in first 0.25 s. Almost perfect reliability scores were found for activity at both low-frequency and theta bands (ICC scores: 0.81–0.98). Sources were identified in the primary somatosensory and motor cortices in relation to the positive peak using s-LORETA analysis. Measuring the frequency response from the pin-prick evoked potentials may allow the reliable assessment of central somatosensory impairment in the clinical setting

Reliability of Upper Limb Pin-Prick Stimulation With Electroencephalography : Evoked Potentials, Spectra and Source Localization

In order for electroencephalography (EEG) with sensory stimuli measures to be used in research and neurological clinical practice, demonstration of reliability is needed. However, this is rarely examined. Here we studied the test-retest reliability of the EEG latency and amplitude of evoked potentials and spectra as well as identifying the sources during pin-prick stimulation. We recorded EEG in 23 healthy older adults who underwent a protocol of pin-prick stimulation on the dominant and non-dominant hand. EEG was recorded in a second session with rest intervals of 1 week. For EEG electrodes Fz, Cz, and Pz peak amplitude, latency and frequency spectra for pin-prick evoked potentials was determined and test-retest reliability was assessed. Substantial reliability ICC scores (0.76-0.79) were identified for evoked potential negative-positive amplitude from the left hand at C4 channel and positive peak latency when stimulating the right hand at Cz channel. Frequency spectra showed consistent increase of low-frequency band activity (< 5 Hz) and also in theta and alpha bands in first 0.25 s. Almost perfect reliability scores were found for activity at both low-frequency and theta bands (ICC scores: 0.81-0.98). Sources were identified in the primary somatosensory and motor cortices in relation to the positive peak using s-LORETA analysis. Measuring the frequency response from the pin-prick evoked potentials may allow the reliable assessment of central somatosensory impairment in the clinical setting

CYP2C19 genetic polymorphisms in Maltese patients on clopidogrel therapy

Introduction and Aims: The prevalence of CYP2C19 genetic polymorphisms in the Maltese population is not reported. The aims were to determine CYP2C19 *2 and *17 allele frequencies and CYP2C19 genotype distribution in a cohort of Maltese patients on clopidogrel and to compare observed frequencies of the CYP2C19 *2 allele and *2/*2 genotype to other populations bordering the Mediterranean Sea. Methods: Genotyping for the CYP2C19 *2 and *17 alleles in Maltese patients on clopidogrel was performed using TaqMan® drug metabolism assays. The frequency of both alleles and six genotypes (*1/*1, *1/*2, *2/*2, *1/*17, *17/*17, *2/*17) were determined. Observed frequencies of the CYP2C19 *2 allele and *2/*2 genotype were compared to fourteen populations bordering the Mediterranean Sea (p>0.05 indicated similar prevalence) Results: Frequencies of the CYP2C19 *2 and *17 alleles in the 244 patients genotyped were 12.3% and 15.4% respectively. CYP2C19 genotype distribution was: *1/*1 (52.1%), *1/*17 (22.5%), *1/*2 (18.0%), 2/*17 (6.6%), *17/*17 (0.8%) and *2/*2 (0). Prevalence of the *2 allele in the Maltese cohort was similar to all fourteen populations bordering the Mediterranean Sea, while prevalence of *2/*2 was similar to Egyptian, Moroccan, Southern French, Slovenian, Turkish and Tunisian populations (p>0.05). Conclusions: This study provides an indication of the prevalence of CYP2C19 polymorphisms in Maltese patients. The high percentage of patients with CYP2C19 IM or UM phenotype demonstrates that CYP2C19 genotyping could aid clinicians to individualise treatment with clopidogrel and other drugs metabolised by the CYP2C19 enzyme.peer-reviewe

Multidisciplinary Psychosomatic Assessment for UX Design Evaluation

“In the mirror of the Wonder of Luca Giordano” was a multi-sensorial experience created in the gallery frescoed by Luca Giordano in Palazzo Medici Riccardi, in Florence; the project involved different disciplines and researchers. The entire experience was subjected to an impact analysis, combining principally psycho-physiological, qualitative psychological and neuro-physiological aspects. In most of the visitors who participated in the study the experience evoked a sense of pleasure, enjoyment, relaxation, lightness, space-time suspension, involvement and immersiveness. In many of the visitors, the devices detected changes in heartbeat with a stastically significant decrease in blood pressure and heart rate, demontrating that the impact of artwork in a multi-sensorial experience and in an augmented perception environment is a psycho-somatic impact. Our experience suggests that projects such as "In the mirror of the Wonder of Luca Giordano" could be a very useful tool for cultivating emotional intelligence and could be developed in museums alongside the more classical paths of fruition

CYP2C19*2 allele carrier status and coronary in-stent restenosis : is there an association?

Background and objective: The CYP2C19*2 allele is associated with reduced clopidogrel bioactivation, increasing the risk of complications after percutaneous coronary intervention (PCI), particularly stent thrombosis. Recently published data suggests that CYP2C19*2 allele carriers have a higher risk for in-stent restenosis (ISR) after endovascular treatment. Very few studies have investigated the relationship between CYP2C19*2 and coronary ISR, with no significant association reported. The objective of this study was to assess the relationship between CYP2C19*2 allele carrier status and coronary ISR. Methods: Patients with previous PCI with stenting and who were scheduled for elective PCI after coronary angiogram were recruited from the cardiac catheterization suite over a 12-month period. The angiography report of each patient was perused to identify patients requiring PCI due to ISR. For patients with angiography-confirmed ISR, date of previous PCI to the restenosed stent was noted. CYP2C19*2 genotyping was undertaken using a TaqMan® Drug Metabolism assay. The association between CYP2C19*2 allele carrier status and incidence of coronary ISR within 1 year was assessed using Fisher’s exact test (p < 0.05 significance) and by calculating the odds ratio (OR) with a 95% confidence interval (CI). Results: Of the 82 patients with previous PCI, 29 (35.4%) had angiography-confirmed ISR (12 carriers, 17 noncarriers of CYP2C19*2). In 13 (44.8%) of these patients, the restenosed stent was deployed within 1 year and the patients were on clopidogrel therapy at the time of repeat PCI (8 carriers, 5 non-carriers of CYP2C19*2). The association between CYP2C19*2 allele carrier status and ISR within 1 year was not statistically significant (Fisher’s exact p = 0.067; OR: 4.80, 95% CI: 0.98–23.54, p = 0.053). Conclusions: Despite a higher proportion of CYP2C19*2 allele carriers exhibiting ISR within 1 year compared to non-carriers, the association was not statistically significant. This result may be attributed to the small sample size, and larger prospective studies are recommended to further assess this association.peer-reviewe

Assessment tools for the admission of older adults to inpatient rehabilitation : a scoping review

(1) Objective: To identify the assessment tools and outcome measures used to assess older adults for inpatient rehabilitation. (2) Design: Scoping review. (3) Data sources: ProQuest, PEDro, PubMed, CINAHL Plus with full text (EBSCO), Cochrane Library and reference lists from included studies. (4) Review method: The inclusion of studies covering patients aged >60, focusing on rehabilitation assessments delivered in hospitals in community settings. Studies reporting on rehabilitation specifically designed for older adults—testing for at least one domain that affects rehabilitation or assessments for admission to inpatient rehabilitation—were also included. Results were described both quantitatively and narratively. (5) Results: 1404 articles were identified through selected databases and registers, and these articles underwent a filtering process intended to identify and remove any duplicates. This process reduced the number to 1186 articles. These, in turn, were screened for inclusion criteria, as a result of which 37 articles were included in the final review. The majority of assessments for geriatric rehabilitation were carried out by a multidisciplinary team. Multiple studies considered more than one domain during assessment, with a high percentage evaluating a specific outcome measure used in geriatric rehabilitation. The most common domains assessed were function, cognition and medical status—with communication, vision and pain being the least common. A total of 172 outcome measures were identified in this review, with MMSE, BI, FIM and CCI being the most frequent. (6) Conclusions: This review highlights the lack of standardised approaches in existing assessment processes. Generally, older-adult-rehabilitation assessments struggle to capture rehabilitation potential in a holistic manner. Hence, a predictive model of rehabilitation for assessing patients at the initial stages would be useful in planning a patient-specific programme aimed at maximising functional independence and, thus, quality of life.peer-reviewe