An evaluation of properties related to wear time of four dressings during a five-day period

This study evaluated skin tolerance and other properties relating to wear time, such as conformability and comfort, pain on dressing removal, adhesion and premature detachment, of four advanced hydrated dressings applied to the knees and elbows of 22 healthy volunteers over a fixed five-day period. The dressings all incorporate silicone-based adhesives and are designed to provide a moist wound environment while managing exudate. Skin tolerance was good for all four dressings but there was variation in regards to wear time and fluid-handling properties. Conflict of interest: this work was supported by a grant from Mölnlycke Health Care, Swede

An investigation of the potential influence of serum uric acid concentration on regulation of the human cardiovascular system

Background There are strong epidemiological associations between high serum uric acid concentrations and increased cardiovascular risk. However, it is unclear if uric acid is an independent causal risk factor, serves a protective role due to its antioxidant properties, or simply acts as a passive marker of risk through association with other factors. The distinction is important because, if acting as a causal risk factor, treatment to lower uric acid concentrations might reduce cardiovascular risk.Aims: To study the cardiovascular effects of raising and lowering circulating uric acid concentrations, so as to identify potential mechanisms by which uric acid could impair cardiovascular function or, as an antioxidant, serve a protective role.Methods: I developed a technique of uric acid administration that allowed the effects of raised concentrations to be examined in vivo. The potential impact on serum antioxidant capacity, plasma viscosity, platelet aggregability, systemic haemodynamics, baroreflex sensitivity, large arterial stiffness, and endothelial function were studied in healthy subjects. The effects of high uric acid concentrations were studied in a model of acute exercise-induced oxidative stress, and in regular smokers and patients with type 1 diabetes who are ordinarily exposed to chronic oxidative stress. The effects of lowering uric acid, by means of urate oxidase, were studied in patients with type 2 diabetes to explore whether this might improve vascular function in these patients.Results: Raising and lowering uric acid concentrations had no effect on vascular function in healthy subjects. Uric acid administration significantly increased serum antioxidant capacity, reduced oxidative stress during acute aerobic exercise, and improved endothelium-dependent vascular responses in regular smokers and patients with type 1 diabetes. Lowering uric acid concentrations did not influence vascular function in healthy subjects or patients with type 2 diabetes.Conclusions: High uric acid concentrations did not impair vascular function, at least in the acute situation, and appear to preserve vascular function by protecting against oxidative stress in smokers and patients with type 1 diabetes. These findings do not support a causal link between high serum uric acid concentrations and increased cardiovascular risk. Further research is required to define the mechanisms by which high uric acid concentrations ameliorate endothelial dysfunction, and to examine whether these properties have therapeutic potential in diseases characterised by oxidative stress

Fetal membrane bacterial load is increased in histologically confirmed inflammatory chorioamnionitis: A retrospective cohort study

Introduction It is widely debated whether fetal membranes possess a genuine microbiome, and if bacterial presence and load is linked to inflammation. Chorioamnionitis is an inflammation of the fetal membranes. This research focussed on inflammatory diagnosed histological chorioamnionitis (HCA) and aimed to determine whether the bacterial load in fetal membranes correlates to inflammatory response, including histological staging and inflammatory markers in HCA. Methods Fetal membrane samples were collected from patients with preterm spontaneous labour and histologically phenotyped chorioamnionitis (HCA; n = 12), or preterm (n = 6) and term labour without HCA (n = 6). The bacterial profile of fetal membranes was analysed by sequencing the V4 region of the 16S rRNA gene. Bacterial load was determined using qPCR copy number/mg of tissue. The association between bacterial load and bacterial profile composition was assessed using correlation analysis. Results Bacterial load was significantly greater within HCA amnion (p = 0.002) and chorion (p = 0.042), compared to preterm birth without HCA. Increased bacterial load was positively correlated with increased histological staging (p = 0.001) and the expression of five inflammatory markers; IL8, TLR1, TLR2, LY96 and IRAK2 (p=<0.050). Bacterial profiles were significantly different between membranes with and without HCA in amnion (p = 0.012) and chorion (p = 0.001), but no differences between specific genera were detected. Discussion Inflammatory HCA is associated with infection and increased bacterial load in a dose response relationship. Bacterial load is positively correlated with HCA severity and the TLR signalling pathway. Further research should investigate the bacterial load threshold required to generate an inflammatory response in HCA

Codesigning a Mental Health Discharge and Transitions of Care Intervention: A Modified Nominal Group Technique

Background: Discharge from acute mental health services has long been associated with mortality, risk, and related adverse outcomes for patients. Many of the interventions that currently aim to reduce adverse outcomes focus on a single group of healthcare professionals within a single healthcare setting. A recent systematic review highlights very few robust interventions that specifically aim to improve communication across services. However the importance of promoting interagency working and improving information flow between services is continually highlighted as a key priority.Methods: Using a novel codesign and experience based approach we worked with a multistakeholder group to develop possible solutions to reduce the adverse outcomes commonly associated with discharge from acute mental health services. This utilized a modified Nominal Group Technique and creative problem solving method to follow a four-stage process: Problem Identification, Solution Generation, Decision-Making, Prioritization and Implementation. Thirty-two healthcare professionals and an expert by lived experienced engaged with the process that took place over two stakeholder events.Results: Stakeholders at the first event identified and agreed upon 24 potential ideas to improve discharge from acute mental health services. These were refined at the second event to four elements of an interagency intervention: a multiagency ‘Discharge Team’ (with designated discharge coordinator), inclusive technology enabled team meetings, universal documentation and a patient generated discharge plan.Conclusion: This is the first study to codesign an interagency mental health discharge intervention based around a discharge team. We developed a model for working that places a greater focus on a patient generated discharge plan, interagency working, and information flow. A pilot of the proposed intervention is now needed to test the feasibility and effectiveness in reducing adverse outcomes

Global cocaine intoxication research trends during 1975–2015: a bibliometric analysis of Web of Science publications

Density view of terms map based on the co-occurrence matrix of terms from text data in the title and abstract of retrieved publications related to cocaine toxicity by periods. Figure S1. Density view of terms map in Period I (1975–1995); colors show the density of relevance, sorting from blue (lowest density) to red (highest density). (number of publications related to cocaine intoxication = 954). Figure S2. Density view of terms map in Period II (1996–2005); colors show the density of relevance, sorting from blue (lowest density) to red (highest density). (Number of publications related to cocaine intoxication = 987). Figure S3. Density view of terms map in Period III (2006–2015); colors show the density of relevance, sorting from blue (lowest density) to red (highest density). (Number of publications related to cocaine intoxication = 961). Figure S4. Density view of terms map in Period 1975–1995; colors show the density of relevance, sorting from blue (lowest density) to red (highest density). (Number of publications related to cocaine intoxication = 2,902). (DOCX 794 kb

The challenge of inclusive coproduction: the importance of situated rituals and emotional inclusivity in the coproduction of health research projects

Previous studies highlight that coproduced research initiatives are influenced by how individuals interact together, and that group inclusivity amongst diverse members is crucial. However, it not fully understood how inclusivity is sustained over time, particularly through routine encounters. Our study examines how coproduction occurs through routine and ritualistic patterns of everyday practices which have the potential to facilitate sustainable and inclusive research initiatives. Using ethnographic data with four applied health research projects, we explored how everyday rituals generate and sustain inclusivity. Informed by interactional ritual change theory, we identify two types of interlinked inclusivity: relational, individuals routinely engaging together, and emotional, the feeling of being included. The process of producing and maintaining both types requires ongoing reflexivity from members. Groups with sustained inclusivity build interpersonal momentum through situated practices that enable them to mitigate external pressures and internal disagreements. Where groups experience a breakdown in inclusivity, they also experience a loss of momentum that makes them vulnerable to disintegration and collapse. Building and sustaining inclusivity are worked out through everyday interactions and operate as a feedback loop that sustains the cohesiveness of the network and supports coproduction of knowledge

Understanding variation in unplanned admissions of people aged 85 and over:a systems-based approach

AIM: To examine system characteristics associated with variations in unplanned admission rates in those aged 85+.DESIGN: Mixed methods.SETTING: Primary care trusts in England were ranked according to changes in admission rates for people aged 85+ between 2007 and 2009, and study sites selected from each end of the distribution: three 'improving' sites where rates had declined by more than 4% and three 'deteriorating' sites where rates had increased by more than 20%. Each site comprised an acute hospital trust, its linked primary care trust/clinical commissioning group, the provider of community health services and adult social care.PARTICIPANTS: A total of 142 representatives from these organisations were interviewed to understand how policies had been developed and implemented. McKinsey's 7S framework was used as a structure for investigation and analysis.RESULTS: In general, improving sites provided more evidence of comprehensive system focused strategies backed by strong leadership, enabling the development and implementation of policies and procedures to avoid unnecessary admissions of older people. In these sites, primary and intermediate care services appeared more comprehensive and better integrated with other parts of the system, and policies in emergency departments were more focused on providing alternatives to admission.CONCLUSIONS: Health and social care communities which have attenuated admissions of people aged 85+ prioritised developing a shared vision and strategy, with sustained implementation of a suite of interventions.</p

Adolescent Healthcare Contacts in the Year Before Suicide: a case control study

Introduction: Suicide rates among adolescents have risen steadily since 2007, creating a dire need to expand prevention protocols. Healthcare systems have been identified as a key avenue for identification and intervention. To date, no comprehensive analysis has been done to understand adolescent-specific characteristics and healthcare utilization prior to suicide death. Methods: A case-control study was conducted using records from eight healthcare systems nationwide. Data from 450 subjects aged 10-24 who died by suicide between the years 2000-2013 was matched with 4500 controls based on health system and time period of membership. We examined past-year health diagnoses and patterns of visit types and frequency. Results: Adolescents who died by suicide were more likely to have at least one mental health disorder (52% vs 16%), as well as each individual disorder. Physical health disorders were also more likely among this group. Close to half (49%) and nearly all (89%) of youth who died by suicide had a health care visit in the month and year prior to their death, respectively. Outpatient visits were most common, with suicide decedents averaging 8 in the year before death. Conclusion: With nearly half (48%) of adolescents who died by suicide lacking a mental health diagnosis in the year prior to their death, it is no longer sufficient to rely on mental health services to capture at-risk youth. High rates of healthcare utilization among those who died by suicide indicate a strong need for improving identification of youth while they are seeking services, thereby preventing future deaths

Probe dependency in the determination of ligand binding kinetics at a prototypical G protein-coupled receptor

© 2019, The Author(s). Drug-target binding kinetics are suggested to be important parameters for the prediction of in vivo drug-efficacy. For G protein-coupled receptors (GPCRs), the binding kinetics of ligands are typically determined using association binding experiments in competition with radiolabelled probes, followed by analysis with the widely used competitive binding kinetics theory developed by Motulsky and Mahan. Despite this, the influence of the radioligand binding kinetics on the kinetic parameters derived for the ligands tested is often overlooked. To address this, binding rate constants for a series of histamine H1 receptor (H1R) antagonists were determined using radioligands with either slow (low koff) or fast (high koff) dissociation characteristics. A correlation was observed between the probe-specific datasets for the kinetic binding affinities, association rate constants and dissociation rate constants. However, the magnitude and accuracy of the binding rate constant-values was highly dependent on the used radioligand probe. Further analysis using recently developed fluorescent binding methods corroborates the finding that the Motulsky-Mahan methodology is limited by the employed assay conditions. The presented data suggest that kinetic parameters of GPCR ligands depend largely on the characteristics of the probe used and results should therefore be viewed within the experimental context and limitations of the applied methodology

Constrictive pericarditis is an easily overlooked cause of right heart failure: a case report

We describe a patient who suffered progressive right heart failure of unknown aetiology, despite a lengthy series of hospital investigations. Constrictive pericarditis had not been suspected during life, and was ultimately diagnosed as an autopsy finding. The salient clinical features and confirmatory investigations for this unusual disorder are reviewed. The case reminds us to consider the possibility of constrictive pericarditis in patients with unexplained chronic right heart failure, so that prompt investigation and treatment can be instigated