31 research outputs found
The effective, safe and appropriate use of anticoagulation medicines: A systematic overview of reviews
Digital interventions in alcohol and drug prevention, treatment and recovery: Systematic maps of international research and interventions available in England
Executive Summary
Background
Digital interventions in alcohol and drug prevention, treatment and recovery have the
potential to overcome barriers faced by non-digital interventions. However, we lack a
clear understanding of the types of digital interventions that have been evaluated and
where gaps in the evidence base exist. We also need to understand the effectiveness of
different types of digital alcohol and drug interventions for various population groups.
Further, we do not know which digital alcohol and drug interventions are being used
in England, and whether the interventions in use align with those that have been
evaluated.
Research questions
To address the above concerns, we sought to address the following questions:
ā¢ RQ1: What is the possible range of digital alcohol and drug interventions?
ā¢ RQ2: Which types of digital alcohol and drug interventions are currently
available for use in England?
ā¢ RQ3: What systematic reviews provide findings for digital alcohol and drug
intervention strategies within a prevention/treatment/recovery pathway?
ā¢ RQ4: Which types of digital alcohol and drug interventions have been evaluated
in primary research?
ā¢ RQ5: To what extent does the evaluation evidence overlap with digital alcohol
and drug interventions that are currently available for use in England?
ā¢ RQ6: What evidence is there that certain types of digital alcohol and drug
interventions are (cost-) effective or ineffective for specific population groups
or in particular contexts?
This report covers our findings in relation to questions RQ1 - RQ5. Based on these
findings we also provide suggestions as to what could be the focus of further work to
answer RQ6.
Methods
To address RQ1 an initial typology was drafted, adapting and building on existing
typologies of digital interventions. Through this process it became clear to OHID/PHE
that a pathway, presenting a route through services, with different types of
interventions recommended for use at different times would be more helpful than a
typology of intervention characteristics. This pathway was then developed by OHID/PHE and trialled by the research team, with refinements made over time with
discussions between the study team and PHE.
To address RQ2 we contacted people in England in 2019, who were involved in
developing, commissioning, prescribing, recommending or evaluating digital
alcohol/drug interventions. Using an online survey, we asked them to describe the
interventions they were involved with.
To address RQ3, RQ4 and RQ5 we conducted systematic searching and screening to
identify and describe existing systematic reviews (RQ3) and primary studies (RQ4).
Included systematic reviews were appraised for quality and detailed information was
extracted from full reports. For primary studies we extracted basic details using the
information contained within the title and abstract.
The pathway developed for RQ1 was employed to code and describe the nature of
available interventions (RQ2), systematic reviews (RQ3) and primary studies (RQ4).
EPPI-Mapper software was used to produce online interactive maps to visually display
the findings
A systematic investigation of conceptual color associations
Associations with colors are a rich source of meaning, and there has been considerable interest in understanding the capacity of color to shape our functioning and behavior as a result of color associations. However, abstract conceptual color associations have not been comprehensively investigated, and many of the effects of color on psychological functioning reported in the literature are therefore reliant on ad hoc rationalizations of conceptual associations with color (e.g., blue = openness) to explain effects. In the present work we conduct a systematic, cross-cultural, mapping of conceptual color associations using the full set of hues from the World Color Survey (WCS). In Experiments 1a and 1b we explored the conceptual associations that English monolingual, Chinese bilingual, and Chinese monolingual speaking adults have with each of the 11 Basic English Color Terms (black, white, red, yellow, green, blue, brown, purple, pink, orange, gray). In Experiment 2 we determined which specific physical WCS colors are associated with which concepts in these three language groups. The findings reveal conceptual color associations that appear to be universal across all cultures (e.g., white - purity; blue - water/sky related; green - health; purple - regal; pink - "female" traits) as well as culture specific (e.g., red and orange - enthusiastic in Chinese; red - attraction in English). Importantly, the findings provide a crucial constraint on, and resource for, future work that seeks to understand the effect of color on cognition and behavior, enabling stronger a priori predictions about universal as well as culturally relative effects of conceptual color associations on cognition and behavior to be systematically tested
Oral anticoagulants : a systematic overview of reviews on efficacy and safety, genotyping, self-monitoring, and stakeholder experiences
BACKGROUND: This systematic overview was commissioned by England's Department of Health and Social Care (DHSC) to assess the evidence on direct (previously 'novel') oral anticoagulants (OACs), compared with usual care, in adults, to prevent stroke related to atrial fibrillation (AF), and to prevent and treat venous thromboembolism (VTE). Specifically, to assess efficacy and safety, genotyping, self-monitoring, and patient and clinician experiences of OACs. METHODS: We searched MEDLINE, Embase, ASSIA, and CINAHL, in October, 2017, updated in November 2021. We included systematic reviews, published from 2014, in English, assessing OACs, in adults. We rated review quality using AMSTAR2 or the JBI checklist. Two reviewers extracted and synthesised the main findings from the included reviews. RESULTS: We included 49 systematic reviews; one evaluated efficacy, safety, and cost-effectiveness, 17 assessed genotyping, 23 self-monitoring or adherence, and 15 experiences (seven assessed two topics). Generally, the direct OACs, particularly apixaban (5 mg twice daily), were more effective and safer than warfarin in preventing AF-related stroke. For VTE, there was little evidence of differences in efficacy between direct OACs and low-molecular-weight heparin (prevention), warfarin (treatment), and warfarin or aspirin (secondary prevention). The evidence suggested that some direct OACs may reduce the risk of bleeding, compared with warfarin. One review of genotype-guided warfarin dosing assessed AF patients; no significant differences in stroke prevention were reported. Education about OACs, in patients with AF, could improve adherence. Pharmacist management of coagulation may be better than primary care management. Patients were more adherent to direct OACs than warfarin. Drug efficacy was highly valued by patients and most clinicians, followed by safety. No other factors consistently affected patients' choice of anticoagulant and adherence to treatment. Patients were more satisfied with direct OACs than warfarin. CONCLUSIONS: For stroke prevention in AF, direct OACs seem to be more effective and safer than usual care, and apixaban (5 mg twice daily) had the best profile. For VTE, there was no strong evidence that direct OACs were better than usual care. Education and pharmacist management could improve coagulation control. Both clinicians and patients rated efficacy and safety as the most important factors in managing AF and VTE. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017084263-one deviation; efficacy and safety were from one review
Copper complexes as a source of redox active MRI contrast agents
The study reports an advance in designing copper-based redox sensing MRI contrast agents. Although the data demonstrate that copper(II) complexes are not able to compete with lanthanoids species in terms of contrast, the redox-dependent switch between diamagnetic copper(I) and paramagnetic copper(II) yields a novel redox-sensitive contrast moiety with potential for reversibility
Epigenetics of a tandem DNA repeat: chromatin DNaseI sensitivity and opposite methylation changes in cancers
DNA methylation and chromatin DNaseI sensitivity were analyzed in and adjacent to D4Z4 repeat arrays, which consist of 1 to ā¼100 tandem 3.3-kb units at subtelomeric 4q and 10q. D4Z4 displayed hypomethylation in some cancers and hypermethylation in others relative to normal tissues. Surprisingly, in cancers with extensive D4Z4 methylation there was a barrier to hypermethylation spreading to the beginning of this disease-associated array (facioscapulohumeral muscular dystrophy, FSHD) despite sequence conservation in repeat units throughout the array. We infer a different chromatin structure at the proximal end of the array than at interior repeats, consistent with results from chromatin DNaseI sensitivity assays indicating a boundary element near the beginning of the array. The relative chromatin DNaseI sensitivity in FSHD and control myoblasts and lymphoblasts was as follows: a non-genic D4Z4-adjacent sequence (p13E-11, array-proximal)> untranscribed gene standards > D4Z4 arrays> constitutive heterochromatin (satellite 2; P < 10ā4 for all comparisons). Cancers displaying D4Z4 hypermethylation also exhibited a hypermethylation-resistant subregion within the 3.3-kb D4Z4 repeat units. This subregion contains runs of G that form G-quadruplexes in vitro. Unusual DNA structures might contribute to topological constraints that link short 4q D4Z4 arrays to FSHD and make long ones phenotypically neutral
Gene expression during normal and FSHD myogenesis
<p>Abstract</p> <p>Background</p> <p>Facioscapulohumeral muscular dystrophy (FSHD) is a dominant disease linked to contraction of an array of tandem 3.3-kb repeats (D4Z4) at 4q35. Within each repeat unit is a gene, <it>DUX4</it>, that can encode a protein containing two homeodomains. A <it>DUX4 </it>transcript derived from the last repeat unit in a contracted array is associated with pathogenesis but it is unclear how.</p> <p>Methods</p> <p>Using exon-based microarrays, the expression profiles of myogenic precursor cells were determined. Both undifferentiated myoblasts and myoblasts differentiated to myotubes derived from FSHD patients and controls were studied after immunocytochemical verification of the quality of the cultures. To further our understanding of FSHD and normal myogenesis, the expression profiles obtained were compared to those of 19 non-muscle cell types analyzed by identical methods.</p> <p>Results</p> <p>Many of the ~17,000 examined genes were differentially expressed (> 2-fold, <it>p </it>< 0.01) in control myoblasts or myotubes vs. non-muscle cells (2185 and 3006, respectively) or in FSHD vs. control myoblasts or myotubes (295 and 797, respectively). Surprisingly, despite the morphologically normal differentiation of FSHD myoblasts to myotubes, most of the disease-related dysregulation was seen as dampening of normal myogenesis-specific expression changes, including in genes for muscle structure, mitochondrial function, stress responses, and signal transduction. Other classes of genes, including those encoding extracellular matrix or pro-inflammatory proteins, were upregulated in FSHD myogenic cells independent of an inverse myogenesis association. Importantly, the disease-linked <it>DUX4 </it>RNA isoform was detected by RT-PCR in FSHD myoblast and myotube preparations only at extremely low levels. Unique insights into myogenesis-specific gene expression were also obtained. For example, all four Argonaute genes involved in RNA-silencing were significantly upregulated during normal (but not FSHD) myogenesis relative to non-muscle cell types.</p> <p>Conclusions</p> <p><it>DUX4</it>'s pathogenic effect in FSHD may occur transiently at or before the stage of myoblast formation to establish a cascade of gene dysregulation. This contrasts with the current emphasis on toxic effects of experimentally upregulated <it>DUX4 </it>expression at the myoblast or myotube stages. Our model could explain why <it>DUX4</it>'s inappropriate expression was barely detectable in myoblasts and myotubes but nonetheless linked to FSHD.</p
Pain Control in Breast Surgery: Survey of Current Practice and Recommendations for Optimizing ManagementāAmerican Society of Breast Surgeons Opioid/Pain Control Workgroup
Introduction: The opioid epidemic in the United States is a public health crisis. Breast surgeons are obligated to provide good pain control for their patients after surgery but also must minimize administration of narcotics to prevent a surgical episode of care from becoming a patient's gateway into opioid dependence.
Methods: A survey to ascertain pain management practice patterns after breast surgery was performed. A review of currently available literature that was specific to breast surgery was performed to create recommendations regarding pain management strategies.
Results: A total of 609 surgeons completed the survey and demonstrated significant variations in pain management practices, specifically within regards to utilization of regional anesthesia (e.g., nerve blocks), and quantity of prescribed narcotics. There is excellent data to guide the use of local and regional anesthesia. There are, however, fewer studies to guide narcotic recommendations; thus, these recommendations were guided by prevailing practice patterns.
Conclusions: Pain management practices after breast surgery have significant variation and represent an opportunity to improve patient safety and quality of care. Multimodality approaches in conjunction with standardized quantities of narcotics are recommended