Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients

Background: Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics—with and without the direct involvement of a pharmacist. Methods: A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist. Results: MACS clinic patients were significantly older (80 vs. 73 years, p <.001), more likely to be female (p <.001), and had significantly higher systolic (123 vs. 112 mmHg, p <.001) and diastolic (67 vs. 60 mmHg, p <.05) blood pressures compared to the GCHF clinic patients. Moreover, the MACS clinic patients showed more polypharmacy and higher prevalence of multiple comorbidities. Both clinics had similar prescribing rates of GDMT and achieved maximal tolerated doses of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HFrEF. However, HFpEF patients in the MACS clinic were significantly more likely to be prescribed ACEIs/ARBs (70.5% vs. 56.2%, p = 0.0314) than the GCHFS patients. Patients with both HFrEF and HFpEF (MACS clinic) were significantly less likely to be prescribe

The burden of peripheral intravenous catheters in older hospital inpatients : a national cross-sectional study part of the One Million Global Peripheral Intravenous Catheters Collaboration

Objectives: To investigate the burden of peripheral intravenous catheters (PIVCs) in older hospitalised patients. Methods: A cross-sectional prospective observational study (2014/2015) to describe the characteristics, indications and outcomes of PIVCs among patients aged ≥65 from 65 Australian hospitals. Results: Amongst 2179 individual PIVCs (in 2041 patients, mean age 77.6 years, 45% female, 58% in NSW), 43% were inserted by doctors and 74% used that day, meaning 25% were ‘idle’. Overall, 18% (393/2179) exhibited signs of PIVC-related complications. Most commonly exhibited PIVC-related complications were tenderness (4.1%) and local redness (1.8%). Nearly one in three (29.1%) dressings was soiled, loosened or had come off, and only 36.8% had the time and date documented on the dressing. Both infusing IV medications (aOR 1.74, 95% CI 1.28–2.38, p 84 years) was independently associated with lower likelihood of a high score (aOR 0.71, 95% CI 0.54–0.94, p = 0.02). Conclusions: Given 1 in 5 PIVCs were identified with having complications, further research should focus on optimising PIVC use in older patients

Use of short peripheral intravenous catheters: characteristics, management, and outcomes worldwide

BACKGROUND: Peripheral intravenous catheter (PIVC) use in health care is common worldwide. Failure of PIVCs is also common, resulting in premature removal and replacement. OBJECTIVE: To investigate the characteristics, management practices, and outcomes of PIVCs internationally. DESIGN: Cross-sectional study. SETTING/PATIENTS: Hospitalized patients from rural, regional, and metropolitan areas internationally. MEASUREMENTS: Hospital, device, and inserter characteristics were collected along with assessment of the catheter insertion site. PIVC use in different geographic regions was compared. RESULTS: We reviewed 40,620 PIVCs in 51 countries. PIVCs were used primarily for intravenous medication (n = 28,571, 70%) and predominantly inserted in general wards (n = 22,167, 55%). Two-thirds of all devices were placed in non-recommended sites such as the hand, wrist, or antecubital veins. Nurses inserted most PIVCs (n = 28,575, 71%); although there was wide regional variation (26% to 97%). The prevalence of idle PIVCs was 14% (n = 5,796). Overall, 10% (n = 4,204) of PIVCs were painful to the patient or otherwise symptomatic of phlebitis; a further 10% (n = 3,879) had signs of PIVC malfunction; and 21% of PIVC dressings were suboptimal (n = 8,507). Over one-third of PIVCs (n = 14,787, 36%) had no documented daily site assessment and half (n = 19,768, 49%) had no documented date and time of insertion. CONCLUSIONS: In this study, we found that many PIVCs were placed in areas of "exion, were symptomatic or idle, had suboptimal dressings, or lacked adequate documentation. This suggests inconsistency between recommended management guidelines for PIVCs and current practice

Population-Attributable Risk Estimates for Risk Factors Associated with Campylobacter Infection, Australia

One-sentence summary: Each year, an estimated 50,500 cases in persons >5 years of age can be directly attributed to consumption of chicken

High-content siRNA screening of the kinome identifies kinases involved in Alzheimer's disease-related tau hyperphosphorylation

<p>Abstract</p> <p>Background</p> <p>Neurofibrillary tangles (NFT), a cardinal neuropathological feature of Alzheimer's disease (AD) that is highly correlated with synaptic loss and dementia severity, appear to be partly attributable to increased phosphorylation of the microtubule stabilizing protein tau at certain AD-related residues. Identifying the kinases involved in the pathologic phosphorylation of tau may provide targets at which to aim new AD-modifying treatments.</p> <p>Results</p> <p>We report results from a screen of 572 kinases in the human genome for effects on tau hyperphosphorylation using a loss of function, high-throughput RNAi approach. We confirm effects of three kinases from this screen, the eukaryotic translation initiation factor 2 α kinase 2 (EIF2AK2), the dual-specificity tyrosine-(Y)-phosphorylation regulated kinase 1A (DYRK1A), and the A-kinase anchor protein 13 (AKAP13) on tau phosphorylation at the 12E8 epitope (serine 262/serine 356). We provide evidence that EIF2AK2 effects may result from effects on tau protein expression, whereas DYRK1A and AKAP13 are likely more specifically involved in tau phosphorylation pathways.</p> <p>Conclusions</p> <p>These findings identify novel kinases that phosphorylate tau protein and provide a valuable reference data set describing the kinases involved in phosphorylating tau at an AD-relevant epitope.</p

Slip-resistant footwear reduces slips among National Health Service workers in England : a randomised controlled trial

Objectives Assess the effectiveness of 5* GRIP-rated slip-resistant footwear in preventing slips in the workplace compared to usual footwear (control group). Methods A multicentre, randomised controlled trial; 4553 National Health Service (NHS) staff were randomised 1:1 to the intervention group (provided with 5* GRIP-rated slip-resistant footwear) or the control group. The primary outcome of incidence rate of self-reported slips in the workplace over 14 weeks was analysed using a mixed-effects negative binomial model. Secondary outcome measures included incidence rate of falls from a slip, falls not from a slip, proportion of participants reporting a slip, fall or fracture and time to first slip and fall. Results 6743 slips were reported: 2633 in the intervention group (mean 1.16 per participant, range 0 to 36) and 4110 in the control group (mean 1.80 per participant, range 0 to 83). There was a statistically significant reduction in slip rate in the intervention group relative to the control group (incidence rate ratio (IRR) 0.63, 95% CI 0.57 to 0.70, p<0.001). Statistically significant differences, in favour of the intervention group, were observed in falls from a slip (IRR 0.51, 95% CI 0.28 to 0.92, p=0.03), the proportion of participants who reported a slip (OR 0.58, 95% CI 0.50 to 0.66, p<0.001) or fall (OR 0.73, 95% CI 0.54 to 0.99, p=0.04) and time to first slip (HR 0.73, 95% CI 0.67 to 0.80, p<0.001). Conclusions The offer and provision of 5* GRIP-rated footwear reduced slips in NHS staff in the workplace. Trial registration number ISRCTN33051393

Developing a competency-based approach to facilitate teaching and learning of antimicrobial stewardship as part of environmental sustainability in higher education

Presented at the HETL 2023 conferenceThe environmental impact of the inappropriate use of antimicrobials and antimicrobial resistance (AMR) is recognised by global organisations such as the World Health Organisation and the European Union. Antimicrobial stewardship (AMS) is one strategy to promote appropriate use of antimicrobials to minimise AMR and is a priority for the NHS to ensure sustainable prescribing. It is therefore imperative to support and empower future health care professionals by providing them with the knowledge to be leaders in the field of AMS. National consensus-based competencies for teaching AMS to undergraduate healthcare professionals in the UK were launched 2018. This generic framework includes competencies relating to specific aspects of antimicrobial prescribing, infection control and emphasizes the importance of collaborative interprofessional working. The aim of this project is to determine which AMS competencies are required to be met by student pharmacists. This pedagogic approach will provide a guiding tool for curricula development and will allow identification of gaps and strengths within the undergraduate pharmacy curriculum. To enable the development of a UK-wide national AMS competency framework specifically for student pharmacists, a working group of academics and pharmacy practitioners with expertise in AMS was set up in September 2022. The diverse background of group members allows a healthy mix of ideas with academics informing the group of what may be achievable within the constraints and professional requirements of the pharmacy curriculum, and pharmacy practitioners providing input into essential AMS competencies for early career pharmacists. Student pharmacists from a national organisation are being invited to join the group to encourage co-designing of this curriculum. Considering the UN commitment to act on global antimicrobial resistance and the NHS Sustainable Development management plan, this project is timely and of great importance to support development of future pharmacists as leaders in environmental sustainability

Border Insecurity: Reading Transnational Environments in Jim Lynch’s Border Songs

This article applies an eco-critical approach to contemporary American fiction about the Canada-US border, examining Jim Lynch’s portrayal of the British Columbia-Washington borderlands in his 2009 novel Border Songs. It argues that studying transnational environmental actors in border texts—in this case, marijuana, human migrants, and migratory birds—helps illuminate the contingency of political boundaries, problems of scale, and discourses of risk and security in cross-border regions after 9/11. Further, it suggests that widening the analysis of trans-border activity to include environmental phenomena productively troubles concepts of nature and regional belonging in an era of climate change and economic globalization. Cet article propose une lecture écocritique de la fiction étatsunienne contemporaine portant sur la frontière entre le Canada et les États-Unis, en étudiant le portrait donné par Jim Lynch de la région frontalière entre la Colombie-Britannique et Washington dans son roman Border Songs, paru en 2009. L’article soutient que l’étude, dans les textes sur la frontière, des acteurs environnementaux transnationaux – dans ce cas-ci, la marijuana, les migrants humains et les oiseaux migratoires – jette un jour nouveau sur la contingence des limites territoriales politiques, des problèmes d’échelle et des discours sur le risque et la sécurité des régions transfrontalières après les évènements du 11 septembre 2001. Il suggère également qu’en élargissant l’analyse de l’activité transfrontalière pour y inclure les phénomènes environnementaux, on brouille de façon productive les concepts de nature et d’appartenance régionale d’une époque marquée par les changements climatiques et la mondialisation de l’économie

AD-linked R47H-TREM2 mutation induces disease-enhancing microglial states via AKT hyperactivation

The hemizygous R47H variant of triggering receptor expressed on myeloid cells 2 (TREM2), a microglia-specific gene in the brain, increases risk for late-onset Alzheimer’s disease (AD). Using transcriptomic analysis of single nuclei from brain tissues of patients with AD carrying the R47H mutation or the common variant (CV)–TREM2, we found that R47H-associated microglial subpopulations had enhanced inflammatory signatures reminiscent of previously identified disease-associated microglia (DAM) and hyperactivation of AKT, one of the signaling pathways downstream of TREM2. We established a tauopathy mouse model with heterozygous knock-in of the human TREM2 with the R47H mutation or CV and found that R47H induced and exacerbated TAU-mediated spatial memory deficits in female mice. Single-cell transcriptomic analysis of microglia from these mice also revealed transcriptomic changes induced by R47H that had substantial overlaps with R47H microglia in human AD brains, including robust increases in proinflammatory cytokines, activation of AKT signaling, and elevation of a subset of DAM signatures. Pharmacological AKT inhibition with MK-2206 largely reversed the enhanced inflammatory signatures in primary R47H microglia treated with TAU fibrils. In R47H heterozygous tauopathy mice, MK-2206 treatment abolished a tauopathy-dependent microglial subcluster and rescued tauopathy-induced synapse loss. By uncovering disease-enhancing mechanisms of the R47H mutation conserved in human and mouse, our study supports inhibitors of AKT signaling as a microglial modulating strategy to treat AD

Preferences across the Menstrual Cycle for Masculinity and Symmetry in Photographs of Male Faces and Bodies

Background: Previous studies have shown that women increase their preference for masculinity during the fertile phase of the menstrual cycle. Evidence for a similar preference shift for symmetry is equivocal. These studies have required participants to choose between subtle variations in computer-generated stimuli, and preferences for more natural stimuli have not been investigated. Methodology/Principal Findings: Our study employed photographs of individual males to investigate women’s preferences for face and body masculinity and symmetry across the menstrual cycle. We collected attractiveness ratings from 25 normally cycling women at high- and low-fertility days of the menstrual cycle. Attractiveness ratings made by these women were correlated with independent ratings of masculinity and symmetry provided by different sets of raters. We found no evidence for any cyclic shift in female preferences. Correlations between attractiveness and masculinity, and attractiveness and symmetry did not differ significantly between high- and low-fertility test sessions. Furthermore, there was no significant difference between high- and low-fertility ratings of attractiveness. Conclusions: These results suggest that a menstrual cycle shift in visual preferences for masculinity and symmetry may be too subtle to influence responses to real faces and bodies, and subsequent mate-choice decisions