Telephonic descriptions of out-of-hospital cardiac arrest by laypersons calling the dispatch centre of a private emergency medical service in South Africa

Background: The incidence of out-of-hospital cardiac arrest (OHCA) is expected to increase in South Africa. In order to encourage bystander cardiopulmonary resuscitation (CPR), international guidelines recommend call-taker recognition of the arrest and the initiation of telephone-guided CPR. One of the only ways that a call-taker can identify OHCA is through the description of the incident offered by the caller. The aim of this study was to identify the keywords and phrases that are used by callers to describe patients who are experiencing OHCA during calls made to a South African private Emergency Medical Service (EMS). Methods: A qualitative exploratory design was used and employed inductive dominant content analysis to identify the keywords and phrases that are used by callers to describe patients who are experiencing OHCA during calls made to a South African private EMS. The initial sampling frame was all cases of the “Cardiac Arrest” incident type recorded between 1 January 2019 and 31 December 2019. Results: A total of 28 call recordings were analysed. Keywords and phrases were organised into five categories: 1) Cardiac activity; 2) Level of consciousness; 3) Breathing descriptors; 4) Ill health; and 5) Clinical features. Conclusion: Callers into a private emergency dispatch centre used consistent descriptors of OHCA, which were similar to those found in previous South African studies. Future research should focus on determining the accuracy of these descriptors to differentiate between OHCA and other conditions, and integrate them into OHCA recognition algorithms, call-taker training and telephone-guided CPR protocols

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Clinical efficacy of lead revisions during the test phase in sacral neuromodulation for fecal incontinence

Background Success rates of up to 80% have been reported for the SNM screening period in the treatment of fecal incontinence (FI). Some patients who have an unsuccessful index implantation are successfully treated with SNM after a lead revision. There is a lack of studies comparing the outcomes of successful index implantations and successful lead revision. Therefore, the results of index implantations were compared with lead revisions in a single-center cohort. Methods Patients treated with SNM for FI between 2008 and 2016 were retrospectively reviewed. Patients with a successful index implantation were compared with patients who underwent lead revision after SNM screening. Primary outcome was a decrease in episodes of fecal incontinence of >= 50% documented by a 3-week bowel habit diary. Results Two hundred sixty-one patients (232 index group, 29 revision group) were eligible for SNM. Two hundred thirty-one patients (208 index group, 23 revision group) received permanent SNM. Follow-up was 68.8 months for the index group and 62.2 months for the revision group. The number of episodes of FI decreased from 20.6 (SD 19.3) to 3.4 (SD 4.2) in the index group and from 12.6 (SD 5.8) to 2.0 (SD 2.3) in the revision group. This effect was maintained up to 5 and 2 years in the index and revision group, respectively. Adverse events such as loss of efficacy which required surgical intervention did not differ between the two groups. Conclusion Lead revision during the test phase is a valid option in patients with FI treated by SNM who suffer from loss of efficacy of the index electrode

Die einkommensteuerrechtliche Zurechnung der Einkünfte und güterrechtliche Vereinbarungen

BackgroundIt is well known that adiposity is a risk factor for insulin resistance and type 2 diabetes mellitus. In the present study, we aimed to investigate the associations of measures of adiposity with indices of glycemia and of glycemic variability over a 72-h period in non-diabetic older adults.MethodsThis cross-sectional study was conducted in non-diabetic individuals from the Active and Healthy Aging Study (N = 228), Switchbox (N = 116), and the Growing Old Together Study (N = 94). Body mass index (BMI) and waist circumference were measured, and indices of glycemia and glycemic variability were derived from continuous glucose monitoring (CGM) using the Mini-Med® CGM system. Associations between adiposity and CGM were studied separately for the three cohorts, and derived estimates were subsequently meta-analyzed.ResultsAfter meta-analyzing the results from the separate cohorts, individuals with a higher BMI had higher levels of glycemia. Individuals with BMI between 30 and 35 kg/m2 had 0.28 mmol/L [95% confidence interval (CI): 0.12–0.44] higher 72 h-mean glucose concentration, 0.26 mmol/L (0.10–0.42) higher diurnal glucose (6:00 a.m. to 0:00 a.m.), and 0.39 mmol/L (0.19; 0.59) higher nocturnal glucose (3:00 a.m. to 6:00 a.m.) than participants with a normal weight (BMI 18.5–25 kg/m2). However, no associations were observed between higher BMI and glycemic variability. Results for glycemia and glycemic variability were similarly observed for a high waist circumference.ConclusionHigh adiposity associates with constant higher mean glucose levels over the day in non-diabetic older adults