Ferric carboxymaltose (Ferinject®) associated hypophosphataemia: case report illustrating the need for increased awareness to minimise incidence and risk.

Ferric carboxymaltose (Ferinject®) is an infusion administered for the treatment of iron deficiency anaemia. A number of previous case reports have shown the occurrence of hypophosphataemia after Ferinject® treatment, supposedly managed though high dose phosphate therapy. This case report highlights the risk associated with, and futility of, managing this adverse effect through high dose phosphate infusion. A review of the available literature suggests that if hypophosphataemia develops as a result of Ferinject®, through upregulation of the renal protein Fibroblast Growth Factor-23, it cannot be readily reversed and on average persists for circa 50 days. Acute medical units should be aware of this – likely underreported – adverse effect, and avoid treating these hypophosphataemic patients with high dose phosphate since it can compound symptoms

Patients admitted to more research-active hospitals have more confidence in staff and are better informed about their condition and medication: results from a retrospective cross-sectional study

Rationale, aims and objectives: Clinical research activity in hospitals is associated with reduced mortality and improved overall care quality. In England, the latter is a compound score of several elements and both staff and inpatient feedback form part of the Care Quality Commission (CQC) ratings. The objective of this study was to determine if NHS Trusts' National Institute for Health Research (NIHR) study activity data correlates with specific outcomes from national NHS staff and patient surveys. Method: Retrospective cohort design involving data for 129 English NHS hospital Trusts, including scores from recent national NHS staff and inpatient surveys and NIHR data. Statistical approach involved Spearman correlation analyses, with cut‐off P value ≤ 0.01 for qualification for subsequent principal component analysis (correlation coefficient cut‐off value 0.20). Results: Outcomes of one staff survey question (staff recommendation of the organization as a place to work or receive treatment) and multiple outcomes of inpatient survey questions were positively associated with increased NIHR‐adopted clinical research activity. Better quality of information provision to patients was the dominant theme, though a higher degree of observed staff teamwork, more confidence in the treating doctors, and a better overall inpatient experience also correlated significantly. The number of different studies contributed more to positive associations with survey outcomes compared with the number of recruited participants into research. Conclusions: Survey elements of the CQC appraisal of English NHS Hospital Trusts are significantly associated with increased clinical research activity levels; it appears to drive better information provision to inpatients—particularly around medicine management—and contribute to a better inpatient experience overall, whilst staff are more likely to recommend their own organization. Despite clinical research activity forming a very small fraction of overall NHS activity, it has an indirect positive effect on staff and Trust performance that is measurable at patient level

Experimental Demonstration of Quantum Fully Homomorphic Encryption with Application in a Two-Party Secure Protocol

A fully homomorphic encryption system hides data from unauthorized parties while still allowing them to perform computations on the encrypted data. Aside from the straightforward benefit of allowing users to delegate computations to a more powerful server without revealing their inputs, a fully homomorphic cryptosystem can be used as a building block in the construction of a number of cryptographic functionalities. Designing such a scheme remained an open problem until 2009, decades after the idea was first conceived, and the past few years have seen the generalization of this functionality to the world of quantum machines. Quantum schemes prior to the one implemented here were able to replicate some features in particular use cases often associated with homomorphic encryption but lacked other crucial properties, for example, relying on continual interaction to perform a computation or leaking information about the encrypted data. We present the first experimental realization of a quantum fully homomorphic encryption scheme. To demonstrate the versatility of a a quantum fully homomorphic encryption scheme, we further present a toy two-party secure computation task enabled by our scheme

Experimental Demonstration of Quantum Fully Homomorphic Encryption with Application in a Two-Party Secure Protocol

A fully homomorphic encryption system hides data from unauthorized parties, while still allowing them to perform computations on the encrypted data. Aside from the straightforward benefit of allowing users to delegate computations to a more powerful server without revealing their inputs, a fully homomorphic cryptosystem can be used as a building block in the construction of a number of cryptographic functionalities. Designing such a scheme remained an open problem until 2009, decades after the idea was first conceived, and the past few years have seen the generalization of this functionality to the world of quantum machines. Quantum schemes prior to the one implemented here were able to replicate some features in particular use-cases often associated with homomorphic encryption but lacked other crucial properties, for example, relying on continual interaction to perform a computation or leaking information about the encrypted data. We present the first experimental realisation of a quantum fully homomorphic encryption scheme. We further present a toy two-party secure computation task enabled by our scheme. Finally, as part of our implementation, we also demonstrate a post-selective two-qubit linear optical controlled-phase gate with a much higher post-selection success probability (1/2) when compared to alternate implementations, e.g. with post-selective controlled-$Z$ or controlled-$X$ gates (1/9).Comment: 11 pages, 16 figures, 2 table

Evaluation of progression to diabetes in high-risk patients eligible to attend the ‘Walking Away from Diabetes’ educational intervention: a retrospective cohort study

Aims: To retrospectively assess the efficacy of a pragmatic education programme called ‘Walking Away from Diabetes’ (WAD), a single-session intervention aimed at patients who are at risk of developing type 2 diabetes mellitus (T2DM).Methods: Baseline and follow-up data for 6,116 patients, identified as ‘at risk of diabetes’ in the period April 2012 to March 2016, were assessed for T2DM status in January 2018. Any differences in outcome between WAD attenders and non-attenders was explored using Kaplan–Meier, log rank testing and Cox regression analyses.Results: During the follow-up period, 426 of 3,470 (12.3%) WAD attenders and 349 of 2,646 (13.2%) non-attenders were diagnosed with T2DM (p=0.068, log rank test). Cox regression showed that HbA1c (hazard ratio (HR) 1.23, p<0.001) and high density lipid levels (HR 0.67, p<0.001) rather than WAD attendance (HR 0.89, p=0.11) were the two main factors associated with progress from ‘at risk’ to T2DM.Conclusions: Although the wider health impact of the WAD programme was not considered here, session attendance does not appear to reduce the risk of developing T2DM. However, other factors influence the risk of developing T2DM. It is essential for educational programmes, designed to have a preventative effect for people at risk of diabetes, to be assessed for short- and long-term efficacy

The correlation between National Health Service trusts' clinical trial activity and both mortality rates and care quality commission ratings: a retrospective cross-sectional study

Objectives: Evidence supporting the notion that clinical research activity in itself is of benefit to organisations as a whole is inconclusive. In the recent past, a positive association between research activity and reduced mortality has been shown. This study aimed to ascertain if clinical research activity is associated with established organisational outcome measures. Study design: Retrospective cross-sectional study. Methods: For 129 English National Health Service hospital Trusts, National Institute for Health Research study activity data, Summary Hospital-level Mortality Indicator (SHMI) scores and Care Quality Commission (CQC) ratings were collected. Research activity was controlled for Trust size by dividing it by clinical staffing levels. Multiple linear regression and Spearman correlation analyses were performed. Results: Although there is a significant association between the number of studies and participants with both SHMI score and CQC rating, one particular variable is correlated more significantly than others: the number of participants recruited into interventional studies. It shows a significant correlation with better CQC ratings (standardised coefficient beta 0.26, P-value 0.003) and lower SHMI scores (standardised coefficient beta −0.50, P-value 0.001). Conclusions: The mortality-related results corroborate with other published data showing a correlation between increased research and reduced deaths. Furthermore, there is also a statistically significant association between clinical trials activity and improved CQC ratings. However, these tie-ins are predominantly driven by the number of participants in interventional research rather than observational research activity

Open-label, randomised, multicentre crossover trial assessing two-layer compression bandaging for chronic venous insufficiency: results of the APRICOT trial

Background Compression bandaging is the mainstay therapy for chronic venous insufficiency and venous leg ulcers, but patient compliance can be challenging due to associated discomfort. Aims Comparison of AndoFlex® TLC Calamine versus Coban2® compression bandaging in relation to patient comfort and related pruritus symptomology, with severity of pruritus scale as primary outcome. Methods Multi-centre, prospective, non-blinded, randomised controlled crossover trial involving 39 randomised participants. Two periods for chronic venous insufficiency patients, to wear either AndoFlex® TLC Calamine or Coban2® for three weeks each. Findings No significant differences in validated pruritus outcome measures were observed, including a non-significant treatment effect for the severity of pruritus scale (n = 35 trial completers, p-value 0.24, Wilcoxon test). However, after trying both bandages, 21 out of 35 patients (60%) definitely preferred AndoFlex® TLC Calamine whereas 4 patients (11%) definitely preferred Coban2®. Conclusion AndoFlex® TLC Calamine compression bandage therapy is preferred by the majority of patients, although this observation could not be confirmed using validated patient-reported outcome measures for pruritus. Further research is indicated to establish if patient preference translates into favourable clinical outcomes