Impact of regional multi-disciplinary team on the management of complex urogynaecology conditions

Introduction and hypothesis: Following the publication of the National Institute for Health and Care Excellence guidelines on the management of pelvic floor dysfunction, articles speculating on the benefits and costs of local and regional multi-disciplinary teams (MDTs) have been in circulation. To date, there has been no formal assessment of the impact of a regional MDT on the management of women with complex urogynaecological conditions. Methods: Throughout the existence of the West of Scotland (WoS) Regional Urogynaecology MDT, from May 2010 to December 2015, 60 patients with complex Urogynaecology conditions were discussed. Data were collected on presenting condition, pre- and post-MDT management plans, and treatment outcomes. Results: The average age was 52.6 years (range 21–91 years). All meetings had at least 1 urogynaecologist, 1 gynaecologist, 1 reconstructive female urologists, 1 urodynamicist and, on average, 3 continence nurses, 4 physiotherapists, as well as 1 clinical librarian to conduct a literature search and 1 secretary for administrative support. The majority of the referrals dealt with urinary incontinence (n=34) and 8 patients presented with mesh complications alongside other pelvic floor disorders. The MDT made changes to the original referrer’s management plan in at least 25 (41.7%) patient presentations. Twenty-two out of all the patients discussed (36.7%) were reported as cured or improved in their condition following the MDT-recommended management. Conclusion: The WoS Regional Urogynaecology MDT had a positive impact on the management of women presenting with complex condition(s). Cross-sharing of resources between hospitals within the region provided a wider range of management plans, better tailored to each individual

Kinetic retention of sialic acid and antioxidants in Malaysian edible bird's nest during low-temperature drying

Drying is one of the essential processing steps for dried edible bird’s nest; however, sialic acid and antioxidant can be highly thermosensitive and unstable. Therefore, aim of this study was to determine the degradation kinetics of sialic acid and antioxidants during low-temperature drying at 25–40°C as compared to conventional hot air-drying at 70°C. These compounds’ degradation exhibited first-order kinetics. Sialic acid and antioxidant retentions were 83.9 and 96.6%, respectively, at 25°C, and 78.7 and 91.5% at 40°C, respectively, by low-temperature drying; while, 42.5 and 38.7%, respectively, at 70°C by conventional hot air-drying. Finally, empirical models were significantly fitted to predict sialic acid and antioxidant retention as edible bird’s nest reached a certain level of drying, which may be useful from the processing standpoint and validate the usage of low-temperature drying as a process tool for retention of sialic acid and antioxidant in edible bird’s nest

A comparative quality study and energy saving on intermittent heat pump drying of Malaysian edible bird's nest

This paper aims to study the influence of temperature and relative humidity (RH) during intermittent heat pump drying at 28.6–40.6°C, 16.2–26.7% RH, α = 0.2–1.0, and the comparison was made against fan drying (27°C, 39.7% RH, α = 1.00). It was observed that the effects of temperature and RH on drying rate were significant when moisture content was high. Experimental results showed that intermittent heat pump drying at 28.6°C, 26.7% RH, α = 0.2 of edible bird’s nest greatly reduced effective drying time by 84.2% and color change compared to fan drying, and retained the good energy efficiency

Retention of sialic acid content in Malaysian edible bird's nest by heat pump drying

This paper presents the results of an experimental attempt to improve the drying kinetics for the retention of colour and sialic acid in edible bird’s nest through heat pump drying. Kinetics of hot air drying and heat pump drying were studied by performing various drying trials on edible bird’s nest. Isothermal drying trials were conducted in hot air drying and heat pump drying at a temperature range of 40 °C-90 °C and 28.6 °C-40.6 °C, respectively. Intermittent drying trials were carried out in heat pump drying with two different modes, which are periodic air flow supply and step-up air temperature. Experimental results showed that heat pump drying with low temperature dehumidified air not only enhanced the drying kinetics but also produced a stable final product of edible bird’s nest. Heat pump-dried edible bird’s samples retained a high concentration of sialic acid when an appropriate drying mode was selected

Advancing Personalized Medicine Through the Application of Whole Exome Sequencing and Big Data Analytics

There is a growing attention toward personalized medicine. This is led by a fundamental shift from the ‘one size fits all’ paradigm for treatment of patients with conditions or predisposition to diseases, to one that embraces novel approaches, such as tailored target therapies, to achieve the best possible outcomes. Driven by these, several national and international genome projects have been initiated to reap the benefits of personalized medicine. Exome and targeted sequencing provide a balance between cost and benefit, in contrast to whole genome sequencing (WGS). Whole exome sequencing (WES) targets approximately 3% of the whole genome, which is the basis for protein-coding genes. Nonetheless, it has the characteristics of big data in large deployment. Herein, the application of WES and its relevance in advancing personalized medicine is reviewed. WES is mapped to Big Data “10 Vs” and the resulting challenges discussed. Application of existing biological databases and bioinformatics tools to address the bottleneck in data processing and analysis are presented, including the need for new generation big data analytics for the multi-omics challenges of personalized medicine. This includes the incorporation of artificial intelligence (AI) in the clinical utility landscape of genomic information, and future consideration to create a new frontier toward advancing the field of personalized medicine

Comparative analysis of current diagnostic PCR assays in detecting pathogenic Leptospira isolates from environmental samples

Objective: To compare the efficiency of routine diagnostic PCR assays in detecting pathogenic Leptospira isolated from water and soils. Methods: Seven routine assays targeting six genes (lipL32, flaB, gyrB, lfb1, secY and ligB) were evaluated and compared on the cultures of two groups of pathogenic Leptospira from different sources. One group included 19 described reference strains recovered from infected human or animals, and another group included 22 environmental isolates from recreational and residential sites in Malaysia. The latter have been confirmed for presence of pathogenic Leptospira DNA. PCR positivity or detection sensitivity of each assay was determined and compared between the two groups. Results: Validation on reference strains showed 100.0% PCR sensitivity for all assays except ligB-PCR (95.0%) that failed to amplify Leptospira interrogans serovar Pomona. In marked contrast, there was a notable decline in sensitivity in the environmental isolates (lipL32-PCR, 95.5%; flaB-PCR, 90.9%; gyrB-PCR, 77.3%; lfb1-PCR, 59.1%; secY-PCRs, 40.9% G1/G2-PCR, 36.4%; ligB-PCR, 13.6%), implying a large genetic distance between the two groups, as well as nucleotide polymorphism among environmental isolates. Conclusions: High proportion of false-negative PCR results suggests a need of prudent selection of primers in detecting environmental pathogenic Leptospira. These findings offer valuable insights on the extensive biodiversity of genus Leptospira and its impact on the efficacy and development of molecular detection tool

Kalman Filter Models for the Prediction of Individualised Thermal Work Strain

It is important to monitor and assess the physiological strain of individuals working in hot environments to avoid heat illness and performance degradation. The body core temperature (Tc) is a reliable indicator of thermal work strain. However, measuring Tc is invasive and often inconvenient and impractical for real-time monitoring of workers in high heat strain environments. Seeking a better solution, the main aim of the present study was to investigate the Kalman filter method to enable the estimation of heat strain from non-invasive measurements (heart rate (HR) and chest skin temperature (ST)) obtained ‘online’ via wearable body sensors. In particular, we developed two Kalman filter models. First, an extended Kalman filter (EFK) was implemented in a cubic state space modelling framework (HR versus Tc) with a stage-wise, autoregressive exogenous model (incorporating HR and ST) as the time update model. Under the second model, the online Kalman filter (OFK) approach builds up the time update equation depending only on the initial value of Tc and the latest value of the exogenous variables. Both models were trained and validated using data from laboratory- and outfield-based heat strain profiling studies in which subjects performed a high intensity military foot march. While both the EKF and OKF models provided satisfactory estimates of Tc, the results showed an overall superior performance of the OKF model (overall root mean square error, RMSE = 0.31°C) compared to the EKF model (RMSE = 0.45°C)

Developing a lifestyle intervention program for overweight or obese preconception, pregnant and postpartum women using qualitative methods.

The time period before, during and after pregnancy represents a unique opportunity for interventions to cultivate sustained healthy lifestyle behaviors to improve the metabolic health of mothers and their offspring. However, the success of a lifestyle intervention is dependent on uptake and continued compliance. To identify enablers and barriers towards engagement with a lifestyle intervention, thematic analysis of 15 in-depth interviews with overweight or obese women in the preconception, pregnancy or postpartum periods was undertaken, using the integrated-Promoting Action on Research Implementation in Health Services framework as a guide to systematically chart factors influencing adoption of a novel lifestyle intervention. Barrier factors include time constraints, poor baseline knowledge, family culture, food accessibility, and lack of relevant data sources. Enabling factors were motivation to be healthy for themselves and their offspring, family and social support, a holistic delivery platform providing desired information delivered at appropriate times, regular feedback, goal setting, and nudges. From the findings of this study, we propose components of an idealized lifestyle intervention including (i) taking a holistic life-course approach to education, (ii) using mobile health platforms to reduce barriers, provide personalized feedback and promote goal-setting, and (iii) health nudges to cultivate sustained lifestyle habits

Acute decompensated heart failure in a non cardiology tertiary referral centre, Sarawak General Hospital (SGH‑HF)

Abstract Background: Data on clinical characteristics of acute decompensated heart failure (ADHF) in Malaysia especially in East Malaysia is lacking. Methods: This is a prospective observational study in Sarawak General Hospital, Medical Department, from October 2017 to September 2018. Patients with primary admission diagnosis of ADHF were recruited and followed up for 90 days. Data on patient’s characteristics, precipitating factors, medications and short-term clinical outcomes were recorded. Results: Majority of the patients were classified in lower socioeconomic group and the mean age was 59 years old. Hypertension, diabetes mellitus and dyslipidaemia were the common underlying comorbidities. Heart failure with ischemic aetiology was the commonest ADHF admission precipitating factor. 48.6% of patients were having preserved ejection fraction HF and the median NT-ProBNP level was 4230 pg/mL. Prescription rate of the evidencebased heart failure medication was low. The in-patient mortality and the average length of hospital stay were 7.5% and 5 days respectively. 43% of patients required either ICU care or advanced cardiopulmonary support. The 30-day, 90-day mortality and readmission rate were 13.1%, 11.2%, 16.8% and 14% respectively. Conclusion: Comparing with the HF data from West and Asia Pacific, the short-term mortality and readmission rate were high among the ADHF patients in our study cohort. Maladaptation to evidence-based HF prescription and the higher prevalence of cardiovascular risk factors in younger patients were among the possible issues to be addressed to improve the HF outcome in regions with similar socioeconomic background. Keywords: Acute decompensated heart failure, Epidemiology, Sarawak, Southeast Asia, Malaysi