The challenges and opportunities for implementing group antenatal care ('Pregnancy Circles') as part of standard NHS maternity care: A co-designed qualitative study

OBJECTIVE: To identify the challenges and opportunities for rolling out a bespoke model of group antenatal care called Pregnancy Circles (PC) within the National Health Service: what kind of support and training is needed and what adaptations are appropriate, including during a pandemic when face-to-face interaction is limited. DESIGN: Exploratory qualitative study (online focus group). Study co-designed with midwives. Data analysed thematically using an ecological model to synthesise. SETTING: Five maternity services within the National Health Service. PARTICIPANTS: Seven midwives who facilitated PCs. Three senior midwives with implementation experience participated in the co-design process. FINDINGS: Three themes operating across the ecological model were identified: 'Implementing innovation', 'Philosophy of care' and 'Resource management'. Tensions were identified between group care's focus on relationships and professional autonomy, and concepts of efficiency within the NHS's market model of care. Midwives found protected time, training and ongoing support essential for developing the skills and confidence needed to deliver this innovative model of care. Integrating Pregnancy Circles with continuity of carer models was seen as the most promising opportunity for long-term implementation. Midwives perceived continuity and peer support as the most effective elements of the model and there was some evidence that the model may be robust enough to withstand adaptation to online delivery. KEY CONCLUSIONS: Midwives facilitating group care enjoyed the relationships, autonomy and professional development the model offered. Harnessing this personal (micro-level) satisfaction is key to wider implementation. Group care is well aligned with current maternity policy but the challenges midwives face (temporal, practical and cultural) must be anticipated and addressed at macro and meso level for wider implementation to be sustainable. The PC model may be flexible enough to adapt to online delivery and extend continuity of care but further research is needed in these areas. IMPLICATIONS FOR PRACTICE: Implementation of group care in the NHS requires senior leadership and expertise in change management, protected time for training and delivery of the model, and funding for equipment. Training and ongoing support, are vital for sustainability and quality control. There is potential for online delivery and integrating group care with continuity models

Talaromyces atroroseus, a new species efficiently producing industrially relevant red pigments

Some species of Talaromyces secrete large amounts of red pigments. Literature has linked this character to species such as Talaromyces purpurogenus, T. albobiverticillius, T. marneffei, and T. minioluteus often under earlier Penicillium names. Isolates identified as T. purpurogenus have been reported to be interesting industrially and they can produce extracellular enzymes and red pigments, but they can also produce mycotoxins such as rubratoxin A and B and luteoskyrin. Production of mycotoxins limits the use of isolates of a particular species in biotechnology. Talaromyces atroroseus sp. nov., described in this study, produces the azaphilone biosynthetic families mitorubrins and Monascus pigments without any production of mycotoxins. Within the red pigment producing clade, T. atroroseus resolved in a distinct clade separate from all the other species in multigene phylogenies (ITS, β-tubulin and RPB1), which confirm its unique nature. Talaromyces atroroseus resembles T. purpurogenus and T. albobiverticillius in producing red diffusible pigments, but differs from the latter two species by the production of glauconic acid, purpuride and ZG-1494α and by the dull to dark green, thick walled ellipsoidal conidia produced. The type strain of Talaromyces atroroseus is CBS 133442

The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively : a randomised clinical trial

Aim: Recent evidence suggests that the provision of energy-containing fluids is safe and may impact positively on markers of recovery. The aims of this study were to assess the tolerance of preoperative carbohydrate fluid administration and to determine its effect on postoperative metabolic and clinical responses. Methods: Patients admitted to the Royal Infirmary of Edinburgh for major, elective abdominal surgery were recruited to this double-blind, randomised study and received either a placebo drink or carbohydrate (12.6 g/100 ml) drink (CHOD). Patients consumed 800 ml of their drink on the evening before surgery and 400 ml on the day of surgery 2-3 h before the induction of anaesthesia. Nutritional status was determined using body mass index (BMI) and upper arm anthropometry; all measurements were taken preoperatively, postoperatively and at discharge. Blood glucose and insulin concentrations were also measured preoperatively and on the first post operative day. Length of hospital stay (LOS) and postoperative complications were recorded. Results: Seventy-two patients were recruited and 65 (34 male:31 female) completed this study. Thirty-four patients were randomised to receive the placebo drink (control group) and 31 patients to receive the carbohydrate drink (CHOD group). Groups were well-matched in terms of gender and age. There were no differences between the two groups at baseline for BMI (control: -25.11.7 kg/m2; CHOD -25.21.2 kg/m2), upper arm anthropometry or surgical procedure. At discharge loss of muscle mass (arm muscle circumference) was significantly greater in the control group when compared with the CHOD group (control: -1.10.15 cm; CHOD: -0.50.16 cm; P<0.05). Baseline insulin (control: 20.74.9mU/l; CHOD: 24.66.2mU/l) and glucose (control: 6.01.4 mmol/l; CHOD 5.71.4 mmol/l) were comparable in the two groups and did not differ postoperatively. No complications were recorded as a result of preoperative fluid consumption. Postoperative morbidity occurred in six patients from each group. Median LOS in the control group was 10 days (IQR=6), and 8 days (IQR=4) in the CHOD group. Conclusion: Preoperative consumption of carbohydrate-containing fluids is safe. Provision of a carbohydrate energy source prior to surgery may attenuate depletion of muscle mass after surgery. Further studies are required to determine if this preservation of muscle mass is reflected in improved function and reduced rehabilitation time.sch_die1. Ljungqvist O, Nygren J. Thorell A. Insulin resistance and elective surgery. Surgery 2000;128:757-60. 2. Ljungqvist O, Nygren J, Hausel J. Thorell A. Preoperative nutrition therapyFnovel developments. Scand J Nutrition 2000;44:3-7. 3. Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anaesthesia. Am J Obstet Gynaecol 1946;52:191-205. 4. Soop M, Nygren J, Myrenfors P, Thorell A, Ljungqvist O. Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance. Am J Physiol Endocrinol Metab 2000;280(4):E576-83. 5. Splinter WM, Schaeffer JD. Unlimited clear fluid ingestion two hours before surgery in children does not affect volume or pH of stomach contents. Anaesth Intensive Care 1990;18: 522-6. 6. Eriksson LI, Sandin R. Fasting guidelines in different countries. Acta Anaesthesiology Scandinavia 1996;40:971-4. 7. Maltby JR, Sutherland AD, Sale JP, Shaffer EA. Preoperative oral fluids: is a five-hour fast justified prior to elective surgery? Anaesth Analg 1986;65:1112-6. 8. Ljungqvist O, Thorell A, Guntiak M, H.aggmark T, Efendic S. Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance. J Am Coll Surg 1994;178: 329-36. 9. Nygren J, et al. Perioperative insulin and glucose infusion maintains normal insulin sensitivity after surgery. Am J Physiol 1998;275:E140-8. 10. Nygren J, Thorell A, Jacobsson H, Schnell PO, Ljungqvist O. Preoperative gastric emptying; the effects of anxiety and carbohydrate administration. Ann Surg 1995;222:728-34. 11. Nygren J, Soop M, Thorell A, Efendic S, Nair KS, Ljungqvist O. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clin Nutr 1998;17:65-71. 12. Bishop CW, Bowen PE, Ritchley SI. Norms for nutritional assessment of American adults by upper arm anthropometry. Am J Clin Nutr 1981;34:2530-9. 13. Fiore P, Merli M, Andreoli A, et al. A comparison of skinfold anthropometry and dual-energy X-ray absorptiometry for the evaluation of body fat in cirrhotic patients. Clin Nutr 1999;18(6):349-51. 14. Nygren J, Soop M, Thorell A, Sree Nair K, Ljungqvist O. Preoperative oral carbohydrates and postoperative insulin resistance. Clin Nutr 1999;18(2):117-20. 15. Ljungqvist O, Nygren A, Thorell A, Brodin U, Efendic S. Preoperative nutritionFelective surgery in the fed or the overnight fasted state. Clin Nutr 2001;20(Suppl 1):167-71. 16. Thorell A, H.aggmark T, Efendic S, Gutniak M, Ljungqvist O. Insulin resistance after abdominal surgery. Br J Surg 1994; 81:59-63. 17. Thorell A, Nygren J, Ljungqvist O. Insulin resistanceFa marker of surgical stress. Curr Op Clin Met Care 1999;2:69-79. 18. Bang P, Nygren J, Carlsson-Skwirut C, et al. Postoperative induction of insulin-like growth factor binding protein-3 proteolytic activity: relation to insulin and insulin sensitivity. J Clin Endocrinol Metab 1998;83:2509-15. 19. Nygren J, Carlsson-Skwirut C, Brismar K, et al. Insulin infusion increases levels of free IGF-1 and IGFBP-3 proteolytic activity in patients after surgery. Am J Physiol 2001. 20. Brandi L, Santoro D, Natali A, et al. Insulin resistance of stress: sites and mechanisms. Clin Sci 1993;85:525-35. 21. Frayn KN. Hormonal control of metabolism in trauma and sepsis. Clin Endocrinol 1986;24:577-99. 22. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate nutrition: an update. Curr Opin Clin Nutr Metab Care 2001;4(4):255-9. 23. Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate- rich drink reduces preoperative discomfort in elective surgical patients. Anaesth Analg 2001;93(5): 1344-50. 24. Ljungqvist O, Nygren J, Thorell A. Preoperative carbohydrates instead of overnight fasting reduces hospital stay following elective surgery (abstract). Clinical Nutrition 1998;17:10. 25. Henriksen M, Hansen H, Dela F, et al. Preoperative feeding might improve postoperative voluntary muscle function. Clinical Nutrition 1999;18(Suppl.1):82.24pub106pub

New Challenges in Psycho-Oncology Research III: A systematic review of psychological interventions for prostate cancer survivors and their partners: clinical and research implications

[Extract] The medical and social context of prostate cancer (PCa) has changed dramatically since the introduction of PSA testing for early detection in the late 1980s,¹ leading to a peak in incidence in the developed world in the 1990s and again a decade later.² Since that time, novel PCa treatments have rapidly emerged in the radiation and medical oncology field, as well as surgical advances.³ The recent emergence of active surveillance for low-risk disease has further expanded possible treatment approaches.⁴ Market forces from consumers, clinicians, and the therapeutic industry have driven changes in clinical and surgical management and treatment; however, psycho-oncological research and survivorship care arguably has lagged behind. Specifically, although men are surviving longer, they may not be surviving well. In 2012, there were over 1.1 million incident cases of PCa diagnosed and more than 300 000 deaths worldwide.⁵ Five-year prevalence estimates suggest that there are over 3.8 million PCa survivors globally⁶ with this expected to increase rapidly in future.⁷ The challenges we face in meeting the needs of these men and their families into the future are vast