The Family and Safety of the Hospitalized Patient: An Integrative Literature Review

Framework: Considering that the current data on health care safety remain alarming, there is an overwhelming urge for the ongoing study of this topic and for recommendations and differentiated strategies which aim to promote health and which prove effective. Some recommendations have been taken into consideration, such as patient-centered care, and consequently the need for greater involvement of patient and family in this process. However, we have identified arguments for and against the involvement of family in the care process, and consequently a greater or lesser openness towards hospital visits. Objective: What are the implications of the presence of family for the safety of hospitalized patients? What does the science say about these implications? Methods: We conducted an integrative literature review by referring to the Web of Science, CINAHL, Medline, and Scopus databases, according to the recommendations of the Joanna Briggs Institute for scoping review. Results: We found 115 articles. After selection, 13 articles were included in this review. There were 6 qualitative studies, 5 quantitative studies, and 2 literature reviews. Data were grouped according to: the perspective of patients and their families, the health professionals’ perspective, and statistical evidence. Conclusion: Families take efforts to protect the safety of hospitalized patients but feel unprepared; a lack of follow-up was reported. Some health professionals claim that the presence of the family can increase the risks for patient safety and the fear of an increased workload. The evidence of the presence of the family and its link to the safety of the hospitalized patient demonstrated that this relationship is not yet well understood. There were limited findings about this in the current literature. Relevance to Clinical Practice: Structured interventions about family integration in ensuring the safety of hospitalized patients may have the potential to contribute to the safety of health care.Enquadramento: Considerando que os dados atuais sobre segurança em saúde ainda são alarmantes, há uma urgência avassaladora pelo estudo contínuo desse tema e por recomendações e estratégias diferenciadas que visem a promoção da saúde. Existem algumas recomendações que têm sido levadas em consideração a esse respeito, como o cuidado centrado no paciente e, consequentemente, a necessidade de maior envolvimento do paciente e de sua família nesse processo. Porém, no contexto de trabalho, identificamos argumentos a favor e contra o envolvimento da família no processo de cuidado e, consequentemente, uma maior ou menor abertura para visitas no contexto hospitalar. Objetivo: Quais as implicações da presença da família na segurança do doente internado com o intuito de responder á questão de investigação: Qual a produção científica sobre as implicações da presença da família na segurança do doente hospitalizado? Métodos: Revisão integrativa da literatura através de pesquisa nas bases de dados Web of Science, CINAHL, Medline e Scopus, de acordo com as recomendações do Joanna Briggs Institute para scoping review. Resultados: Da pesquisa foram encontrados 115 artigos. Após a seleção foram incluidos neste estudo 13 artigos. Destes, 7 estudos qualitativos, 5 quantitativos e 2 revisões de literatura, cujos dados foram agrupados de acorco com: perspetiva da família e doente, a perspetiva dos profissionais de saúde e a evidência estatistica. Conclusão: A familia desenvolve esforços no sentido de proteger a segurança do doente internado mas sente-se despreparada e desacompanhada. Alguns profissionais de saúde alegam que a presença da familia pode aumentar os riscos para a segurança do doente e receiam aumento da carga de trabalho. A evidência encontrada sobre presença da família e a sua relação com a segurança do doente internado demonstra que esta relação ainda não é bem compreendida, com achados disponíveis limitados na literatura atual. Relevância para a Prática Clínica: Intervenções estruturadas de integração da família na salvaguarda da segurança do doente internado podem ter o potencial de contribuir para a segurança dos cuidados de saúde.info:eu-repo/semantics/publishedVersio

Sepsis, meningitis and cerebral abscesses caused by Citrobacter koseri

After a 36-week diamniotic dichorionic gestation, an infant was delivered by elective caesarean section due to growth restriction and altered diastolic flow in the umbilical artery. Birth weight was 2140 g. The patient was admitted for exclusive parenteral nutrition, with umbilical venous catheter placement. Sinus tachycardia and temperature instability with positive inflammatory markers occurred at 51 h. Penicillin and gentamicin were started, but 6 h later septic shock with disseminated intravascular coagulation was noted. Vancomycin and meropenem were started and penicillin suspended. Citrobacter koseri was isolated from blood culture. Generalised clonic convulsions occurred on day 4, and an electroencephalogram revealed severe encephalic dysfunction. Cerebrospinal fluid cytochemical analysis was suggestive of meningitis, although culture was negative. Cefotaxime was added to the drug regimen. Cranioencephalic MR showed a temporal abscess and diffuse hemispheric destruction, with no indications for neurosurgery. After 6 weeks of therapy, neuroimaging follow-up showed multiloculated cystic encephalomalacia. Currently, the patient is 14 months old with axial hypotonia and decreased movements. The source of infection has not been determined. Nosocomial infection cannot be excluded and vertical transmission is unlikely

Safety and Family-Centered Care during Restriction of Hospital Visits due to COVID-19: The Experience of Family Members

Background: Person and Family Centered Care (PFCC) has demonstrated important contributions to health care outcomes. However, in response to the need for safety due to the pandemic COVID-19, measures were taken to restrict hospital visits. So, the aim of this study was to understand the healthcare experience of family members of patients hospitalized during the pandemic period regarding safety and person- and family-centered care. Methods: Qualitative interpretative study, conducted through semi-structured interviews with six family members of people hospitalized during the pandemic period. Content analysis was performed using Atlas.ti software version 22 (Berlin, Germany) and Bardin’s methodology. Results and Conclusions: Restrictions on hospital visits due to the pandemic of COVID-19 have led to a distancing of families from the hospital setting and influenced healthcare practice, making it difficult to involve families in the care process. In some cases, healthcare professionals made efforts to provide PFCC, attempting to minimize the impact of the visitation restriction. However, there were reported experiences of care delivery that did not consider social and psychological factors and did not place the person and family at the center of the care process, relying instead on the biomedical model. These practices left out important factors for the provision of safe care. It is crucial, even in pandemic settings, that healthcare professionals provide person- and family-centered care to the extent possible, promoting the safety of care. The family should be involved in the care of the person in the inpatient setting.info:eu-repo/semantics/publishedVersio

Light Stop Decay in the MSSM with Minimal Flavour Violation

In supersymmetric scenarios with a light stop particle $\tilde{t}_1$ and a small mass difference to the lightest supersymmetric particle (LSP) assumed to be the lightest neutralino, the flavour changing neutral current decay $\tilde{t}_1 \to c \tilde{\chi}_1^0$ can be the dominant decay channel and can exceed the four-body stop decay for certain parameter values. In the framework of Minimal Flavour Violation (MFV) this decay is CKM-suppressed, thus inducing long stop lifetimes. Stop decay length measurements at the LHC can then be exploited to test models with minimal flavour breaking through Standard Model Yukawa couplings. The decay width has been given some time ago by an approximate formula, which takes into account the leading logarithms of the MFV scale. In this paper we calculate the exact one-loop decay width in the framework of MFV. The comparison with the approximate result exhibits deviations of the order of 10% for large MFV scales due to the neglected non-logarithmic terms in the approximate decay formula. The difference in the branching ratios is negligible. The large logarithms have to be resummed. The resummation is performed by the solution of the renormalization group equations. The comparison of the exact one-loop result and the tree level flavour changing neutral current decay, which incorporates the resummed logarithms, demonstrates that the resummation effects are important and should be taken into account.Comment: 29 page

Common Variants at 10 Genomic Loci Influence Hemoglobin A(1C) Levels via Glycemic and Nonglycemic Pathways

OBJECTIVE Glycated hemoglobin (HbA1c), used to monitor and diagnose diabetes, is influenced by average glycemia over a 2- to 3-month period. Genetic factors affecting expression, turnover, and abnormal glycation of hemoglobin could also be associated with increased levels of HbA1c. We aimed to identify such genetic factors and investigate the extent to which they influence diabetes classification based on HbA1c levels. RESEARCH DESIGN AND METHODS We studied associations with HbA1c in up to 46,368 nondiabetic adults of European descent from 23 genome-wide association studies (GWAS) and 8 cohorts with de novo genotyped single nucleotide polymorphisms (SNPs). We combined studies using inverse-variance meta-analysis and tested mediation by glycemia using conditional analyses. We estimated the global effect of HbA1c loci using a multilocus risk score, and used net reclassification to estimate genetic effects on diabetes screening. RESULTS Ten loci reached genome-wide significant association with HbA1c, including six new loci near FN3K (lead SNP/P value, rs1046896/P = 1.6 × 10−26), HFE (rs1800562/P = 2.6 × 10−20), TMPRSS6 (rs855791/P = 2.7 × 10−14), ANK1 (rs4737009/P = 6.1 × 10−12), SPTA1 (rs2779116/P = 2.8 × 10−9) and ATP11A/TUBGCP3 (rs7998202/P = 5.2 × 10−9), and four known HbA1c loci: HK1 (rs16926246/P = 3.1 × 10−54), MTNR1B (rs1387153/P = 4.0 × 10−11), GCK (rs1799884/P = 1.5 × 10−20) and G6PC2/ABCB11 (rs552976/P = 8.2 × 10−18). We show that associations with HbA1c are partly a function of hyperglycemia associated with 3 of the 10 loci (GCK, G6PC2 and MTNR1B). The seven nonglycemic loci accounted for a 0.19 (% HbA1c) difference between the extreme 10% tails of the risk score, and would reclassify ∼2% of a general white population screened for diabetes with HbA1c. CONCLUSIONS GWAS identified 10 genetic loci reproducibly associated with HbA1c. Six are novel and seven map to loci where rarer variants cause hereditary anemias and iron storage disorders. Common variants at these loci likely influence HbA1c levels via erythrocyte biology, and confer a small but detectable reclassification of diabetes diagnosis by HbA1c

Crystal Structure of HIV-1 gp41 Including Both Fusion Peptide and Membrane Proximal External Regions

The HIV-1 envelope glycoprotein (Env) composed of the receptor binding domain gp120 and the fusion protein subunit gp41 catalyzes virus entry and is a major target for therapeutic intervention and for neutralizing antibodies. Env interactions with cellular receptors trigger refolding of gp41, which induces close apposition of viral and cellular membranes leading to membrane fusion. The energy released during refolding is used to overcome the kinetic barrier and drives the fusion reaction. Here, we report the crystal structure at 2 Å resolution of the complete extracellular domain of gp41 lacking the fusion peptide and the cystein-linked loop. Both the fusion peptide proximal region (FPPR) and the membrane proximal external region (MPER) form helical extensions from the gp41 six-helical bundle core structure. The lack of regular coiled-coil interactions within FPPR and MPER splay this end of the structure apart while positioning the fusion peptide towards the outside of the six-helical bundle and exposing conserved hydrophobic MPER residues. Unexpectedly, the section of the MPER, which is juxtaposed to the transmembrane region (TMR), bends in a 90°-angle sideward positioning three aromatic side chains per monomer for membrane insertion. We calculate that this structural motif might facilitate the generation of membrane curvature on the viral membrane. The presence of FPPR and MPER increases the melting temperature of gp41 significantly in comparison to the core structure of gp41. Thus, our data indicate that the ordered assembly of FPPR and MPER beyond the core contributes energy to the membrane fusion reaction. Furthermore, we provide the first structural evidence that part of MPER will be membrane inserted within trimeric gp41. We propose that this framework has important implications for membrane bending on the viral membrane, which is required for fusion and could provide a platform for epitope and lipid bilayer recognition for broadly neutralizing gp41 antibodies

Perfusion by Arterial Spin Labelling following Single Dose Tadalafil in Small Vessel Disease (PASTIS): study protocol for a randomized controlled trial

Background Cerebral small vessel disease is a common cause of vascular cognitive impairment in older people, with no licensed treatment. Cerebral blood flow is reduced in small vessel disease. Tadalafil is a widely prescribed phosphodiesterase-5 inhibitor that increases blood flow in other vascular territories. The aim of this trial is to test the hypothesis that tadalafil increases cerebral blood flow in older people with small vessel disease. Methods/design Perfusion by Arterial Spin labelling following Single dose Tadalafil In Small vessel disease (PASTIS) is a phase II randomised double-blind crossover trial. In two visits, 7-30 days apart, participants undergo arterial spin labelling to measure cerebral blood flow and a battery of cognitive tests, pre- and post-dosing with oral tadalafil (20 mg) or placebo. Sample size: 54 participants are required to detect a 15% increase in cerebral blood flow in subcortical white matter (p < 0.05, 90% power). Primary outcomes are cerebral blood flow in subcortical white matter and deep grey nuclei. Secondary outcomes are cortical grey matter cerebral blood flow and performance on cognitive tests (reaction time, information processing speed, digit span forwards and backwards, semantic fluency). Discussion Recruitment started on 4th September 2015 and 36 participants have completed to date (19th April 2017). No serious adverse events have occurred. All participants have been recruited from one centre, St George’s University Hospitals NHS Foundation Trust. Trial registration European Union Clinical Trials Register: EudraCT number 2015-001235-20. Registered on 13 May 2015

Effective Rheology of Bubbles Moving in a Capillary Tube

We calculate the average volumetric flux versus pressure drop of bubbles moving in a single capillary tube with varying diameter, finding a square-root relation from mapping the flow equations onto that of a driven overdamped pendulum. The calculation is based on a derivation of the equation of motion of a bubble train from considering the capillary forces and the entropy production associated with the viscous flow. We also calculate the configurational probability of the positions of the bubbles.Comment: 4 pages, 1 figur