Swollen limbs and bone pain : a case report

A 50 year old man presented with peripheral oedema, abdominal distension and a pulmonary opacity on CXR. He subsequently perforated his sigmoid colon as a complication of diverticulitis with pericolic abscess. After colectomy his postoperative period was marked by severe hypokalaemia, metabolic alkalosis, hyperglycaemia and recurrent chest infections. Paraneoplastic Cushing's syndrome was diagnosed after finding elevated serum cortisol and ACTH levels. CT-guided biopsy of the lung lesion revealed small-cell carcinoma. Bone scan disclosed collapse of numerous thoracic vertebrae possibly due to osteoporosis or oncogenic osteomalacia. Treatment with steroid-synthesis blockers was commenced but the patient died before tumour-directed therapy could be started. Ectopic ACTH syndrome and oncogenic osteomalacia are discussed.peer-reviewe

A legacy of solidaric critique and hope for a better world: A meditation on the scholarly contribution of Ronald Sultana

In this article, we reflect on the legacy of Ronald Sultana who died on Friday 24th November 2023. We argue that he was a major figure in the development of career guidance theory and practice of the late 20th and early 21st century. The article begins by reflecting on and summarising his contribution to the fields of education and career guidance. While we focus on his contribution in the field of career guidance, we also acknowledge that this work sits in a wider body of work in which Sultana’s sociological imagination addressed the operation of the education system around the Mediterranean, across Europe and in the Global South. We explore Sultana’s contribution to theory, policy and practice. We argue that in relation to theory he situated careers in context, carefully traced the range of political roles that career guidance could play and argued for career guidance as a force for social justice. In relation to policy, we highlight his role in international reviews and his critical commentary on this kind of policy borrowing and lending. In relation to practice, we focus on Sultana’s development of resources and study programmes promoting lifelong guidance, and the leveraging of networking to develop a united community of professionals. Finally, we consider the challenges that Ronald left for us and discuss what those who seek to build on his legacy could do

A Web-Based Service Delivery Model for Communication Training After Brain Injury: Protocol for a Mixed Methods, Prospective, Hybrid Type 2 Implementation-Effectiveness Study.

BackgroundAcquired brain injuries (ABIs) commonly cause cognitive-communication disorders, which can have a pervasive psychosocial impact on a person's life. More than 135 million people worldwide currently live with ABI, and this large and growing burden is increasingly surpassing global rehabilitation service capacity. A web-based service delivery model may offer a scalable solution. The Social Brain Toolkit is an evidence-based suite of 3 web-based communication training interventions for people with ABI and their communication partners. Successful real-world delivery of web-based interventions such as the Social Brain Toolkit requires investigation of intervention implementation in addition to efficacy and effectiveness.ObjectiveThe aim of this study is to investigate the implementation and effectiveness of the Social Brain Toolkit as a web-based service delivery model.MethodsThis is a mixed methods, prospective, hybrid type 2 implementation-effectiveness study, theoretically underpinned by the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework of digital health implementation. We will document implementation strategies preemptively deployed to support the launch of the Social Brain Toolkit interventions, as well as implementation strategies identified by end users through formative evaluation of the Social Brain Toolkit. We will prospectively observe implementation outcomes, selected on the basis of the NASSS framework, through quantitative web analytics of intervention use, qualitative and quantitative pre- and postintervention survey data from all users within a specified sample frame, and qualitative interviews with a subset of users of each intervention. Qualitative implementation data will be deductively analyzed against the NASSS framework. Quantitative implementation data will be analyzed descriptively. We will obtain effectiveness outcomes through web-based knowledge tests, custom user questionnaires, and formal clinical tools. Quantitative effectiveness outcomes will be analyzed through descriptive statistics and the Reliable Change Index, with repeated analysis of variance (pretraining, posttraining, and follow-up), to determine whether there is any significant improvement within this participant sample.ResultsData collection commenced on July 2, 2021, and is expected to conclude on June 1, 2022, after a 6-month sample frame of analytics for each Social Brain Toolkit intervention. Data analysis will occur concurrently with data collection until mid-2022, with results expected for publication late 2022 and early 2023.ConclusionsEnd-user evaluation of the Social Brain Toolkit's implementation can guide intervention development and implementation to reach and meet community needs in a feasible, scalable, sustainable, and acceptable manner. End user feedback will be directly incorporated and addressed wherever possible in the next version of the Social Brain Toolkit. Learnings from these findings will benefit the implementation of this and future web-based psychosocial interventions for people with ABI and other populations.Trial registrationAustralia and New Zealand Clinical Trials Registry ACTRN12621001170819; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001170819, Australia and New Zealand Clinical Trials Registry ACTRN12621001177842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001177842, Australia and New Zealand Clinical Trials Registry ACTRN12621001180808; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001180808.International registered report identifier (irrid)DERR1-10.2196/31995

Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review.

BACKGROUND: More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. OBJECTIVE: This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. METHODS: From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. RESULTS: We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. CONCLUSIONS: Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1177/20552076211035988

Is erectile dysfunction a sentinel symptom for cardiovascular autonomic neuropathy in patients with type 2 diabetes?

The study investigated whether there is a significant association between erectile dysfunction (ED) secondary to autonomic failure, and cardiovascular autonomic neuropathy (CAN) in male patients suffering from type 2 diabetes. Twenty‐two patients suffering from type 2 diabetes were recruited for this study after satisfying the stringent exclusion criteria used in the first stage. They had no evidence of overt cardiovascular disease, hypertension, neurological, renal or thyroid disease. Each subject was assessed for ED and CAN using standardized tests. Six patients were suffering from CAN while 10 patients were suffering from ED. There was no significant association between CAN and autonomic ED (P = 1). Three patients with normal erectile function had CAN, whilst three patients with ED had CAN. Further analysis demonstrates a significant increase in association between ED and CAN with age (P = 0.036). These results show that ED secondary to autonomic neuropathy is not significantly associated with CAN in this specific group of patients. Nonetheless, the study reveals that ED is a sentinel symptom for future development of CAN.peer-reviewe

ShortNotice and Unannounced Survey Methods: Literature review

The Commission’s role is to lead and coordinate national improvements in the safety and quality of health care. The Commission works in partnership with the Australian Government, state and territory governments and the private sector to achieve a safe and high -qu ality, sustainable health system. In doing so, the Commission also works closely with patients, carers, clinicians, managers, policymakers and healthcare organisations. The Commission is responsible under the National Health Reform Act 2011 for the formul ation of standards relating to health care safety and quality matters and for formulating and coordinating national models of accreditation for health service organisations. The Commission developed the National Safety and Quality Health Service (NSQHS) Standards in consultation with the Australian Government , state and territory governments, technical experts and other stakeholders. They aim to protect the public from harm and to improve the quality of health service provision. To become accredited, health service organisations must pass assessments to show they have implemented the NSQHS Standards. The assessments are conducted by independent accrediting agencies, approved by the Commission, as part of the AHSSQA Scheme. However, state and territory regulators and chief executives of health service organisations have raised concerns about several aspects of the accreditation process

Attestation by Governing Bodies: Literature review

Preface This preface was written by the Australian Commission on Safety and Quality in Health Care (the Commission) to provide context and background to the report which follows, Attestation by Governing Bodies: Literature review. The Commission contracted the University of Technology Sydney (UTS) to prepare the literature review, as part of the review of the Australian Health Service Safety and Quality Accreditation (AHSSQA) Scheme. Background The Commission’s role is to lead and coordinate national improvements in the safety and quality of health care. The Commission works in partnership with the Australian Government, state and territory governments and the private sector to achieve a safe and high-quality, sustainable health system. In doing so, the Commission also works closely with patients, carers, clinicians, managers, policymakers and healthcare organisations. The Commission is responsible under the National Health Reform Act 2011 for the formulation of standards relating to healthcare safety and quality matters and for formulating and coordinating national models of accreditation for health service organisations. The Commission developed the National Safety and Quality Health Service (NSQHS) Standards in consultation with the Australian Government, state and territory governments, technical experts and stakeholders. They aim to protect the public from harm and to improve the quality of health service provision. To become accredited, health service organisations must pass assessments to show they have implemented the NSQHS Standards. The assessments are conducted by independent accrediting agencies approved by the Commission as part of the AHSSQA Scheme. However, state and territory regulators and chief executives of health service organisations have raised concerns about several aspects of the accreditation process. The Commission is undertaking a review to update and improve the accreditation process. In May 2017, the Commission contracted four literature reviews to provide an evidence base to inform the Commission’s review of the AHSSQA Scheme. The reviews explored the potential use of the following methods to improve the veracity of health service organisations: • Attestation by a governing body • Short-notice and unannounced surveys • Patient journey and tracer methodologies • Safety culture assessment. The report that follows this preface presents the findings of a literature review that explored the potential use of attestation by governing bodies during accreditation of health service organisations. Key findings The report on attestation by governing bodies includes a definition of attestation, a review of the evidence of the effectiveness of attestation by governing bodies as part of accreditation in healthcare, and examples of the use of attestation in practice

Patient Journey and Tracer Methodologies: Literature review

Preface This preface was written by the Australian Commission on Safety and Quality in Health Care (the Commission) to provide context and background to the report which follows, Patient Journey and Tracer Methodologies: Literature review. The Commission contracted the University of Technology Sydney (UTS) to prepare the literature review, as part of the review of the Australian Health Service Safety and Quality Accreditation (AHSSQA) Scheme. Background The Commission’s role is to lead and coordinate national improvements in the safety and quality of health care. The Commission works in partnership with the Australian Government, state and territory governments and the private sector to achieve a safe and high-quality, sustainable health system. In doing so, the Commission also works closely with patients, carers, clinicians, managers, policymakers and healthcare organisations. The Commission developed the National Safety and Quality Health Service (NSQHS) Standards in consultation with the Australian Government, state and territory governments, technical experts and stakeholders. They aim to protect the public from harm and to improve the quality of health service provision. To become accredited, health service organisations must pass assessments to show they have implemented the NSQHS Standards. The assessments are conducted by independent accrediting agencies, approved by the Commission, as part of the AHSSQA Scheme. However, state and territory regulators and chief executives of health service organisations have raised concerns about several aspects of the accreditation process. The Commission is undertaking a review to update and improve the accreditation process. In May 2017, the Commission contracted four literature reviews to provide an evidence base to inform the Commission’s review of the AHSSQA Scheme. The reviews explored the potential use of the following methods to improve the veracity of health service organisations: • Attestation by a governing body • Short-notice and unannounced surveys • Patient journey and tracer methodologies • Safety culture assessment. The report that follows this preface presents the findings of a literature review that explored the potential use of patient journey and tracer methodologies as part of health service organisation accreditation. Key findings The key findings of the report on patient journey and tracer methodologies (hereafter referred to as ‘patient journey methodologies’) are discussed according to the evidence of its effectiveness and considerations for its use in the AHSSQA Scheme

Developing oral chronotherapy for cortisol replacement in congenital adrenal hyperplasia

The sun imposes a 24-h periodicity to life and circadian rhythms have evolved to maintain homoeostasis through the day/night cycle. In humans, there is a central clock that controls the sleep/wake cycle which is paralleled metabolically by a fast/feed cycle. The clock maintains homoeostasis by synchronising metabolism to the time of feeding. Loss of synchrony between the clock and hormonal rhythms results in loss of homoeostasis as evidenced by obesity, depression, and diabetes in people undertaking shift work. Cortisol has a distinct circadian rhythm; peaking on waking and low at sleep onset. Loss of this rhythm in adrenal insufficiency is associated with a poor quality of life and increased mortality. To replace the cortisol rhythm requires chronotherapy and for this you need to define the key parameters of the target rhythm, create a formulation to replicate that rhythm, and then prove clinical benefit. The physiology of hormones is more complex than that of nonnative drugs. Hormones are secreted with varied rhythms, bound to multiple cognate binding proteins, and actively transported and cleared through enzymatic pathways in multiple organs. We have examined the diurnal rhythm of cortisol in healthy volunteers, created physiologically-based pharmacokinetic models, and tested various oral delayed and sustained formulations of hydrocortisone (development name, Chronocort) in clinical trials. The outcome from this work was the manufacture of modified-release hydrocortisone hard capsules (tradename Efmody, Diurnal Ltd), that replicate the cortisol diurnal rhythm and improve the disease control of congenital adrenal hyperplasia the commonest hereditary form of adrenal insufficiency

Cosmic Shear Tomography and Efficient Data Compression using COSEBIs

Context. Gravitational lensing is one of the leading tools in understanding the dark side of the Universe. The need for accurate, efficient and effective methods which are able to extract this information along with other cosmological parameters from cosmic shear data is ever growing. COSEBIs, Complete Orthogonal Sets of E-/B-Integrals, is a recently developed statistical measure that encompasses the complete E-/B-mode separable information contained in the shear correlation functions measured on a finite angular range. Aims. The aim of the present work is to test the properties of this newly developed statistics for a higher-dimensional parameter space and to generalize and test it for shear tomography. Methods. We use Fisher analysis to study the effectiveness of COSEBIs. We show our results in terms of figure-of-merit quantities, based on Fisher matrices. Results. We find that a relatively small number of COSEBIs modes is always enough to saturate to the maximum information level. This number is always smaller for 'logarithmic COSEBIs' than for 'linear COSEBIs', and also depends on the number of redshift bins, the number and choice of cosmological parameters, as well as the survey characteristics. Conclusions. COSEBIs provide a very compact way of analyzing cosmic shear data, i.e., all the E-/B-mode separable second-order statistical information in the data is reduced to a small number of COSEBIs modes. Furthermore, with this method the arbitrariness in data binning is no longer an issue since the COSEBIs modes are discrete. Finally, the small number of modes also implies that covariances, and their inverse, are much more conveniently obtainable, e.g., from numerical simulations, than for the shear correlation functions themselves.Comment: 17 pages, 15 figure