Differences in Evaluating Fall Risk by Primary Care Provider Type

This study assessed differences in clinical fall risk assessment of older adults (65+) and clinical resources used by primary care providers (PCP). We used Porter Novelli\u27s 2016 DocStyles survey to examine clinical behavior data from PCPs (n=1128). Compared to other practitioners, nurse practitioners (NP) reported a higher percentage of their patients were older adults. The majority of NPs reported screening for falls risk routinely, but most did not use standardized fall-risk assessments to assess risk factors. There were also differences in the types of clinical resources used by NPs and other PCPs to evaluate the safety profile of medications

Urinary and serum neutrophil gelatinase-associated lipocalin as a biomarker in Egyptian systemic lupus erythematosus patients: Relation to lupus nephritis and disease activity

AbstractBackgroundNeutrophil gelatinase-associated lipocalin (NGAL) is an excellent structural biomarker for the early diagnosis of acute kidney injury, prognosis, dialysis requirement and mortality in several common clinical scenarios.Aim of the workThe aim of this work is to detect the levels of both urinary and serum NGAL in SLE patients with and without lupus nephritis (LN) and to correlate their levels with renal biopsy class and disease activity.Patients and methodsThe study included 35 SLE patients; 22 with LN and 13 without as well as 30 matched controls. The SLE Disease Activity Index (SLEDAI) was assessed and the renal biopsy class determined. Urinary and serum levels of NGAL were assessed by ELISA.ResultsThe 35 patients had a median age of 30years and disease duration of 4years. They were 31 females and 4 males. The SLE patients had an elevated urinary NGAL (UNGAL) (median 19ng/ml, IQR 8–87) as compared to controls (median 2ng/ml, IQR 1–18.3) (p<0.006). Levels of UNGAL were higher in patients with LN than those without (p<0.023). In patients with LN, serum levels of NGAL were not significantly different from controls (p=0.6). The UNGAL level significantly correlated with the renal score of SLEDAI (r=0.54, p=0.001) but serum NGAL level did not (r=0.25, p=0.15). UNGAL significantly correlated with grade III and IV of renal biopsy (r=0.67, p=0.009). The sensitivity of UNGAL levels for the diagnosis of LN was 85.7%, with a specificity of 80%.ConclusionUrinary NGAL is a sensitive marker of proliferative nephritis in SLE and disease activity

Comparison of Shiga toxin-encoding bacteriophages in highly pathogenic strains of Shiga toxin-producing Escherichia coli O157:H7 in the UK

Over the last 35 years in the UK, the burden of Shiga toxin-producing Escherichia coli (STEC) O157:H7 infection has, during different periods of time, been associated with five different sub-lineages (1983-1995, Ia, I/IIa and I/IIb; 1996-2014, Ic; and 2015-2018, IIb). The acquisition of a stx2a-encoding bacteriophage by these five sub-lineages appears to have coincided with their respective emergences. The Oxford Nanopore Technologies (ONT) system was used to sequence, characterize and compare the stx-encoding prophages harboured by each sub-lineage to investigate the integration of this key virulence factor. The stx2a-encoding prophages from each of the lineages causing clinical disease in the UK were all different, including the two UK sub-lineages (Ia and I/IIa) circulating concurrently and causing severe disease in the early 1980s. Comparisons between the stx2a-encoding prophage in sub-lineages I/IIb and IIb revealed similarity to the prophage commonly found to encode stx2c, and the same site of bacteriophage integration (sbcB) as stx2c-encoding prophage. These data suggest independent acquisition of previously unobserved stx2a-encoding phage is more likely to have contributed to the emergence of STEC O157:H7 sub-lineages in the UK than intra-UK lineage to lineage phage transmission. In contrast, the stx2c-encoding prophage showed a high level of similarity across lineages and time, consistent with the model of stx2c being present in the common ancestor to extant STEC O157:H7 and maintained by vertical inheritance in the majority of the population. Studying the nature of the stx-encoding bacteriophage contributes to our understanding of the emergence of highly pathogenic strains of STEC O157:H7

Norovirus whole genome sequencing by SureSelect target enrichment: a robust and sensitive method

Norovirus full genome sequencing is challenging due to sequence heterogeneity between genomes. Previous methods have relied on PCR amplification, which is problematic due to primer design, and RNASeq which non-specifically sequences all RNA in a stool specimen, including host and bacterial RNA.Target enrichment uses a panel of custom-designed 120-mer RNA baits which are complementary to all publicly available norovirus sequences, with multiple baits targeting each position of the genome, thus overcoming the challenge of primer design. Norovirus genomes are enriched from stool RNA extracts to minimise sequencing non-target RNA.SureSelect target enrichment and Illumina sequencing was used to sequence full genomes from 507 norovirus positive stool samples with RT-qPCR Ct values 10-43. Sequencing on an Illumina MiSeq in batches of 48 generated on average 81% on-target-reads per sample and 100% genome coverage with >12,000-fold read depth. Samples included genotypes GI.1, GI.2, GI.3, GI.6, GI.7, GII.1, GII.2, GII.3, GII.4, GII.5, GII.6, GII.7, GII.13, GII.14 and GII.17. Once outliers are accounted for, we generate over 80% genome coverage for all positive samples, regardless of Ct value.164 samples were tested in parallel with conventional PCR genotyping of the capsid shell domain. 164/164 samples were successfully sequenced, compared to 158/164 that were amplified by PCR. Four of the samples that failed capsid PCR had low titres, suggesting target enrichment is more sensitive than gel-based PCR. Two samples failed PCR due to primer mismatches; target enrichment uses multiple baits targeting each position, thus accommodating sequence heterogeneity between norovirus genomes

Patients with multiple sclerosis do not necessarily consume more alcohol or tobacco than the general population

Peer reviewedPublisher PD

Photodynamic Therapy of Inorganic Complexes for the Treatment of Cancer

Photodynamic therapy (PDT) is a medicinal tool that uses a photosensitiser and a light source to treat several conditions, including cancer. PDT uses reactive oxygen species (ROS) such as cytotoxic singlet oxygen 1O2 to induce cell death in cancer cells. Chemotherapy has historically utilized the cytotoxic effects of many metals, especially transition-metal complexes. However, chemotherapy is a systemic treatment so all cells in a patient\u27s body are exposed to the same cytotoxic effects. Transition metal complexes have also shown high cytotoxicity as PDT agents. PDT is a potential localized method for treating several cancer types by using inorganic complexes as photosensitizing agents. This review covers several in vitro and in vivo studies, as well as clinical trials that reported on the anti-cancer properties of inorganic pharmaceuticals used in PDT against different types of cancer

What are the perspectives of patients with hand and wrist conditions, chronic pain, and patients recovering from stroke on the use of patient and outcome information in everyday care?:A Mixed-Methods study

Purpose: To evaluate the patients’ perspectives on the use of patient- and outcome information tools in everyday care and to investigate which characteristics affect general understanding and perceived value of patient- and outcome information. Methods: This mixed-methods study included surveys and interviews on understanding, experience, decision-support, and perceived value in patients with hand and wrist conditions and chronic pain. We synthesized our quantitative and qualitative findings using a triangulation protocol and identified factors independently associated with general understanding and perceived value of patient- and outcome information using hierarchical logistic regression. Results: We included 3379 patients. The data triangulation indicated that patients understand the outcome information, they find it valuable, it supports decision-making, and it improves patient-clinician interaction. The following variables were independently associated with better general understanding: having more difficulty with questionnaires (standardized odds ratio 0.34 [95%-CI 031–0.38]), having a finger condition (0.72 [0.57–0.92]), longer follow-up (0.75 [0.61–0.91]), and undergoing surgical treatment (ref: non-surgical treatment, 1.33 [1.11–1.59]). For more general value, these were: having more difficulty with questionnaires (0.40 [0.36–0.44]), having a wrist condition (0.71 [0.54–0.92]), better hand function (1.12 [1.02–1.22]), and requiring help with questionnaires (1.65 [1.33–2.05]). Conclusion: Patients value the use of patient- and outcome information tools in daily care and find it easy to understand. The factors associated with understanding and value can be targeted to personalized and value-based healthcare. We recommend using outcome information to improve patient independence, empowerment, and involvement in decision-making.</p

What are the perspectives of patients with hand and wrist conditions, chronic pain, and patients recovering from stroke on the use of patient and outcome information in everyday care?:A Mixed-Methods study

Purpose: To evaluate the patients’ perspectives on the use of patient- and outcome information tools in everyday care and to investigate which characteristics affect general understanding and perceived value of patient- and outcome information. Methods: This mixed-methods study included surveys and interviews on understanding, experience, decision-support, and perceived value in patients with hand and wrist conditions and chronic pain. We synthesized our quantitative and qualitative findings using a triangulation protocol and identified factors independently associated with general understanding and perceived value of patient- and outcome information using hierarchical logistic regression. Results: We included 3379 patients. The data triangulation indicated that patients understand the outcome information, they find it valuable, it supports decision-making, and it improves patient-clinician interaction. The following variables were independently associated with better general understanding: having more difficulty with questionnaires (standardized odds ratio 0.34 [95%-CI 031–0.38]), having a finger condition (0.72 [0.57–0.92]), longer follow-up (0.75 [0.61–0.91]), and undergoing surgical treatment (ref: non-surgical treatment, 1.33 [1.11–1.59]). For more general value, these were: having more difficulty with questionnaires (0.40 [0.36–0.44]), having a wrist condition (0.71 [0.54–0.92]), better hand function (1.12 [1.02–1.22]), and requiring help with questionnaires (1.65 [1.33–2.05]). Conclusion: Patients value the use of patient- and outcome information tools in daily care and find it easy to understand. The factors associated with understanding and value can be targeted to personalized and value-based healthcare. We recommend using outcome information to improve patient independence, empowerment, and involvement in decision-making.</p