Transitional ‘hospital to home’ care of older patients: healthcare professionals’ perspectives

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Wiley in Scandinavian Journal of Caring Sciences on 27/08/2020.Available online: https://onlinelibrary.wiley.com/doi/epdf/10.1111/scs.12904acceptedVersio

Pharmacological Alterations of Anxious Behaviour in Mice Depending on Both Strain and the Behavioural Situation

A previous study comparing non-emotive mice from the strain C57BL/6/ByJ with ABP/Le mice showed ABP/Le to be more anxious in an open-field situation. In the present study, several compounds affecting anxiety were assayed on ABP/Le and C57BL/6/ByJ mice using three behavioural models of anxiety: the elevated plus-maze, the light-dark discrimination test and the free exploratory paradigm. The compounds used were the full benzodiazepine receptor agonist, chlordiazepoxide, and the antagonist, flumazenil, the GABAA antagonist, bicuculline, the full 5-HT1A agonist 8-OH-DPAT, and the mixed 5-HT1A/5-HT1B agonist, RU 24969. Results showed the effect of the compounds to be dependent on both the strain and the behavioural task. Several compounds found to be anxiolytic in ABP/Le mice had an anxiogenic effect on C57BL/6/ByJ mice. More behavioural changes were observed for ABP/Le in the elevated plus-maze, but the clearest findings for C57BL/6/ByJ mice were observed in the light-dark discrimination apparatus. These data demonstrate that anxious behaviour is a complex phenomenon which cannot be described by a single behavioural task nor by the action of a single compound

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Connected Health in Europe: Where are we today?

This report, which has grown out of an ENJECT survey of 19 European countries, examines the situation of Connected Health in Europe today. It focuses on creating a clear understanding of the current and developing presence of Connected Health throughout European healthcare systems under five headings: The Policy Environment, Education, Business and Health Models, Interoperability, and The Perso

Perencanaan Perencanaan Sruktur Jembatan Lengkung Pada Sungai Sombe-Lewara

Kecamatan Kinovaro secara geografis memiliki banyak sungai yang panjang dan lebar yang menjadi kendala dalam proses pemenuhan kebutuhan masyarakat dan perkembangan daerah tersebut. Maka perlu adanya fasilitas penunjang, salah satunya adalah jembatan. Jembatan merupakan konstruksi vital maka  harus didesain sedemikian rupa agar mampu menerima beban dengan baik. Jembatan tipe portal lengkung dapat menjadi alternatif untuk jembatan bentang panjang, karena selain bentuknya yang memiliki nilai estetika, jembatan dengan tipe pelengkung juga dapat mereduksi momen lentur sehingga penampang yang diperoleh menjadi lebih efisien. Abstract Kinovaro is a subdistrict where has many long and wide rivers and being obstacles in the process of fulfilling community needs and the development of the area. So that it needs to have a facilitis, one of that is a bridge. Bridges is important constructions so it needs to be designed carepully in order to have a proper calculation. Curved bridge type can be an alternative for long span bridges, because it has a nice aesthetic value, can also reduce bending moments so that it can provide an optimum cross section. The purpose of this Final Project is to obtain bending moments and curved axial forces, dimensions and reinforcement. The method used for structural analysis is the finite element method through the SAP2000 program, while for reinforcement design using the strength method based on SNI 2847-2013. The results of structural analysis, the are critical bending moment is 21869.332 kN.m and the critical axial force is 15944.307 kN, both of which are in the arching position. From the design results is found out that the girder dimensions of 60 x 80 cm. Thickness of the top arch is 60 cm and nearby support is 140 cm. While the column thickness at the top of the arch is 40 cm and nearby support is 80 cm. From the results of reinforcement design, the girder reinforcement of 16D25 mm was obtained on the support, and of 10D25 mm was at the middle length of the beam. Reinforcement of columns was obtained of D25-100 mm nearby support area and D25-200 mm at the top area. Whereas for the arches obtained of D25-80 mm for the supporting area and D25-100 mm at the top of the arch area. Tujuan dari penulisan Tugas Akhir ini adalah untuk mendapatkan momen lentur dan gaya aksial pelengkung, dimensi dan tulangan struktur yang efisien. Metode yang digunakan untuk analisa struktur adalah metode elemen hingga menggunakan program SAP2000, sedangkan untuk perencanaan tulangan menggunakan metode kekuatan berdasarkan SNI 2847-2013. Dari hasil analisa struktur diperoleh momen lentur pelengkung terbesar adalah 21869,332 kN.m dan gaya aksial terbesar adalah 15944,307 kN, keduanya berada pada perletakan pelengkung. Dari hasil perencanaan diperoleh dimensi gelagar 60 x 80 cm, tebal pada puncak pelengkung adalah 60 cm dan pada perletakan adalah 140 cm, sedangkan untuk tebal kolom pada puncak pelengkung adalah 40 cm dan pada perletakan adalah 80 cm. Dari hasil perencanaan tulangan diperoleh tulangan gelagar pada tumpuan 17D25 mm dan lapangan 10D25 mm. Tulangan kolom diperoleh tulangan D25-100 mm untuk daerah perletakan pelengkung dan D25-200 mm pada daerah puncak. Sedangkan untuk pelengkung diperoleh D25-80 mm untuk daerah perletakan dan D25-100 mm pada daerah puncak pelengkung