Patient and practitioner satisfaction with tele-dermatology including Australia’s indigenous population: A systematic review of the literature

AbstractBackgroundAustralia’s health disparity, combined with evolving technologies, has evoked increasing interest and funding in health services that could address inequities. One such emerging service is tele-medicine.ObjectiveThe purpose of this report is to discuss and evaluate the current literature regarding patient and practitioner satisfaction with tele-medicine, and more specifically tele-dermatology.MethodsWe searched for literature relevant to tele-dermatology use among Australia’s indigenous population. We synthesized the literature in our report and identified elements of tele-dermatology not yet researched.ResultsMost significantly, all available research is currently based on descriptive studies and there is no validated tool to assess the efficacy of tele-dermatology.LimitationsNo published research currently exists on the use of tele-dermatology among Australia’s indigenous population.ConclusionA review of the literature shows that tele-dermatology is considered a valuable service, particularly to patients living in rural areas who might not otherwise have access to specialist care

Diversidade e distribuição espacial de bromeliáceas epifíticas do Altíssimo Rio Tibagi - Paraná - Brasil.

O presente estudo teve como objetivo caracterizar a diversidade e a distribuição espacial das bromeliáceas epifíticas na região do altíssimo rio Tibagi, considerando os fatores geomorfológicos, pedológicos, climáticos e vegetacionais. A avaliação fitossociológica das bromeliáceas foi realizada mediante instalação de parcelas em número variável nas três áreas de estudo. O levantamento florístico foi complementado por observações nas áreas adjacentes às parcelas, respeitando a compartimentação geomorfológica, pedológica e vegetacional. Foram registradas onze espécies de bromeliáceas no total, tendo sido sete delas observadas na área da cabeceira do rio Tibagi, oito no cânion e nove na floresta da foz do rio Bugio. A riqueza foi relacionada, principalmente, com as condições macro e microclimáticas. A umidade fornecida pelas nuvens e chuvas formadas na cuesta do segundo planalto, assim como, em microescala, a umidade atmosférica gerada pelas cachoeiras existentes no cânion e originada da evaporação da água dos Organossolos, é o fator climático fundamental na definição dos padrões encontrados. Considerando a distribuição horizontal das espécies, a diminuição de bromeliáceas da porção mais próxima ao canal para a mais distante está atrelada ao gradiente microclimático, formado pela redução em umidade relativa associada à diminuição em luminosidade

Vascular grassland plants of Tibagi River Spring, Ponta Grossa, Brazil.

A systematic survey was carried out on wet grasslands found over Histosols at Upper Tibagi River basin, between Ponta Grossa and Palmeira municipalities, in the state of Paraná, Brazil, place of high importance because of soil water retention capability and soil carbon pool composition. We provide a checklist containing 146 species, 96 genera and 42 plant families for the area. Families with higher species richness were Asteraceae (27 species; 21 genera), Poaceae (24; 16) and Cyperaceae (18; 6). Four species were classified as endangered or rare, and one as exotic. The specific richness in wet grassland environments at the state of Paraná underlines the need for conservation efforts encompassing these formations

Florística do banco de sementes do solo em ambiente ripário da floresta ombrófila mista.

Resumo

Amyloid precursor protein drives down-regulation of mitochondrial oxidative phosphorylation independent of amyloid beta

Amyloid precursor protein (APP) and its extracellular domain, soluble APP alpha (sAPPα) play important physiological and neuroprotective roles. However, rare forms of familial Alzheimer’s disease are associated with mutations in APP that increase toxic amyloidogenic cleavage of APP and produce amyloid beta (Aβ) at the expense of sAPPα and other non-amyloidogenic fragments. Although mitochondrial dysfunction has become an established hallmark of neurotoxicity, the link between Aβ and mitochondrial function is unclear. In this study we investigated the effects of increased levels of neuronal APP or Aβ on mitochondrial metabolism and gene expression, in human SH-SY5Y neuroblastoma cells. Increased non-amyloidogenic processing of APP, but not Aβ, profoundly decreased respiration and enhanced glycolysis, while mitochondrial DNA (mtDNA) transcripts were decreased, without detrimental effects to cell growth. These effects cannot be ascribed to Aβ toxicity, since higher levels of endogenous Aβ in our models do not cause oxidative phosphorylation (OXPHOS) perturbations. Similarly, chemical inhibition of β-secretase decreased mitochondrial respiration, suggesting that non-amyloidogenic processing of APP may be responsible for mitochondrial changes. Our results have two important implications, the need for caution in the interpretation of mitochondrial perturbations in models where APP is overexpressed, and a potential role of sAPPα or other non-amyloid APP fragments as acute modulators of mitochondrial metabolism

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study.

BACKGROUND: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. RESULTS: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. CONCLUSIONS: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)