A preliminary study identifying prescription factors associated with readmission

The LACE index (1) is used by Calderdale and Huddersfield NHS Foundation Trust to refer patients to a Virtual Ward, providing post discharge support with a view to preventing readmissions. Derivation of the LACE index found the Charlson comorbidity index (CCI) predictive of readmission; conditions in the CCI are likely to be treated with medication

An observational study to identify factors associated with readmission and to evaluate the impact of pharmacist validation of discharge prescriptions on readmission rate

To identify demographic and pharmaceutical factors associated with readmission and to determine whether pharmacist validation of discharge prescriptions impacted on readmission rate in a district general hospital. • The average number of items prescribed at discharge and the average age were found to be significantly higher in patients who were readmitted than those who were not, and mandating pharmacist validation of discharge prescriptions was associated with a reduction of around one-fifth in the readmission rate. • The study provides evidence of the patient groups it may be most appropriate for pharmacists to focus on in order to reduce readmissions. Introduction Readmission is a growing problem for the National Health Service. In England the rate has increased by almost one-third over ten years, reaching 11.5% in 2011/12.1 In 2009 the Care Quality Commission reported that 81% of General Practitioners recorded discrepancies in discharge medication information “all” or “most of the time.”2 Whilst pharmacist validation of discharge prescriptions (TTOs) is routine in Calderdale and Huddersfield NHS Foundation Trust, it was previously prompted by the need for supply, and due to the successful implementation of one-stop dispensing theTTOvalidation rate was surprisingly low. The study aimed to identify factors associated with readmission, to quantify the effect of enforcing pharmacist validation of TTOs and to determine whether this impacted on the readmission rate. Methods Retrospective analysis of data from all adults discharged from Calderdale Royal Hospital’s Short Stay Unit between 30th September 2013 and 19th January 2014 (pharmacist validation of TTOs became mandatory during normal working hours from the mid-point). Data collected from TTOs included admission and discharge dates, demographics and pharmaceutical details (e.g. number of items prescribed, number of prescription changes, validation status). The primary outcome measure was 30-day readmission status; readmission interval was the secondary outcome measure. Ethical approval was not required. Results Two hundred eighty-three TTOs were completed during the baseline evaluation: 101 (35.7%) were validated by a pharmacist and 42 (14.8%) resulted in readmission. Two hundred ninety-six TTOs were completed during the intervention evaluation: 223 (75.3%) were validated by a pharmacist and 36 (12.2%) resulted in readmission. The average age of those readmitted (73.2) was seven and a half years older than those not readmitted (65.7) (p < 0.01, 95% CI for the difference 3.20–11.8); patients aged 65 or older were significantly more likely to be readmitted (17.6%, 63/357) than younger patients (6.8%, 15/222) (p < 0.01). The number of prescription changes on the TTO was not found to differ significantly between those who were readmitted and those who were not; however, those readmitted were prescribed an average of two more items at discharge (10.8) than those who were not (8.4) (p < 0.01, 95% CI for the difference 0.989–3.90). The readmission behaviour of patients prescribed seven or less items at discharge (n = 221)was found to differ significantly (p < 0.01) from patients prescribed eight or more (n = 264). Discussion The results indicate where pharmacists may have the most impact on reducing readmissions; specifically patients over 65 years of age and those taking eight or more medicines. Further work is needed to determine whether readmission can be reduced in these groups by application of pharmaceutical interventions and to establish the long term benefits of focusing limited resources. Mandating pharmacist validation ofTTOs in working hours was associated with a substantial increase in proportion validated and a notable reduction in readmission rate. It is acknowledged that the activity of the Trust’s Virtual Ward varied during the study, however there was not a pharmacist on the team at that time; further work will be carried out to determine the influence of this on the results observed

Reorganizing for Transformational Change: The 21st Century Research Library at a Flagship Public University

Beginning in November 2010 and culminating in February 2012, the University of Colorado Boulder Libraries began planning a significant structural reorganization. Local, pragmatic drivers for the change included retirements at the executive level and the loss of professional librarian lines due to the Great Recession of 2008. But other, more important catalysts existed and are driving similar reorganization efforts in research libraries across the country. The increasingly interdisciplinary, digital, and inter-institutional nature of scholarship, research and teaching requires a more flexible, team-managed research library. Dramatic shifts in how institutions of higher education are funded are also fueling the need to reevaluate organizational structures. This article will explore the process, strategy, and on-going efforts to recreate the research library at the University of Colorado Boulder

Biofilm-stimulated epithelium modulates the inflammatory responses in co-cultured immune cells

The gingival epithelium is a physical and immunological barrier to the microbiota of the oral cavity, which interact through soluble mediators with the immune cells that patrol the tissue at the gingival epithelium. We sought to develop a three-dimensional gingivae-biofilm interface model using a commercially available gingival epithelium to study the tissue inflammatory response to oral biofilms associated with “health”, “gingivitis” and “periodontitis”. These biofilms were developed by sequential addition of microorganisms to mimic the formation of supra- and sub-gingival plaque in vivo. Secondly, to mimic the interactions between gingival epithelium and immune cells in vivo, we integrated peripheral blood mononuclear cells and CD14+ monocytes into our three-dimensional model and were able to assess the inflammatory response in the immune cells cultured with and without gingival epithelium. We describe a differential inflammatory response in immune cells cultured with epithelial tissue, and more so following incubation with epithelium stimulated by “gingivitis-associated” biofilm. These results suggest that gingival epithelium-derived soluble mediators may control the inflammatory status of immune cells in vitro, and therefore targeting of the epithelial response may offer novel therapies. This multi-cellular interface model, both of microbial and host origin, offers a robust in vitro platform to investigate host-pathogens at the epithelial surface

The Center of Excellence Model for Information Services (CLIR pub 163)

In 2013, The Andrew W. Mellon Foundation awarded a group of librarians from ARL\u27s Research Library Leadership Fellows program a planning grant to examine the center of excellence (CoE) model for information services. Used in a variety of industries, CoEs are designed to attract the most talented researchers in a particular field, enhance collaboration, and improve access to the resources needed for their research. The planning grant was awarded to determine whether the CoE model could serve as a means to provide the new services required for the effective use of digital information. This report describes the team\u27s approach to examining the feasibility of CoEs in the library setting. The team conducted preliminary investigations of more than 100 centers, which they narrowed to 35 for in-depth research. Interviews were conducted with staff at 19 centers and 7 funding organizations. In their conclusion, the team advises developing networks of expertise or expert networks, instead of CoEs, and provides a series of recommendations for building such networks

Polymicrobial oral biofilm models: simplifying the complex

Over the past century, numerous studies have used oral biofilm models to investigate growth kinetics, biofilm formation, structure and composition, antimicrobial susceptibility and host–pathogen interactions. In vivo animal models provide useful models of some oral diseases; however, these are expensive and carry vast ethical implications. Oral biofilms grown or maintained in vitro offer a useful platform for certain studies and have the advantages of being inexpensive to establish and easy to reproduce and manipulate. In addition, a wide range of variables can be monitored and adjusted to mimic the dynamic environmental changes at different sites in the oral cavity, such as pH, temperature, salivary and gingival crevicular fluid flow rates, or microbial composition. This review provides a detailed insight for early-career oral science researchers into how the biofilm models used in oral research have progressed and improved over the years, their advantages and disadvantages, and how such systems have contributed to our current understanding of oral disease pathogenesis and aetiology

Feasibility and design of a trial regarding the optimal mode of delivery for preterm birth:the CASSAVA multiple methods study

Background: Around 60,000 babies are born preterm (prior to 37 weeks’ gestation) each year in the UK. There is little evidence on the optimal birth mode (vaginal or caesarean section). Objective: The overall aim of the CASSAVA project was to determine if a trial to define the optimal mode of preterm birth could be carried out and, if so, determine what sort of trial could be conducted and how it could best be performed. We aimed to determine the specific groups of preterm women and babies for whom there are uncertainties about the best planned mode of birth, and if there would be willingness to recruit to, and participate in, a randomised trial to address some, but not all, of these uncertainties. This project was conducted in response to a Heath Technology Assessment programme commissioning call (17/22 ‘Mode of delivery for preterm infants’). Methods: We conducted clinician and patient surveys (n = 224 and n = 379, respectively) to identify current practice and opinion, and a consensus survey and Delphi workshop (n = 76 and n = 22 participants, respectively) to inform the design of a hypothetical clinical trial. The protocol for this clinical trial/vignette was used in telephone interviews with clinicians (n = 24) and in focus groups with potential participants (n = 13). Results: Planned sample size and data saturation was achieved for all groups except for focus groups with participants, as this had to be curtailed because of the COVID-19 pandemic and data saturation was not achieved. There was broad agreement from parents and health-care professionals that a trial is needed. The clinician survey demonstrated a variety of practice and opinion. The parent survey suggested that women and their families generally preferred vaginal birth at later gestations and caesarean section for preterm infants. The interactive workshop and Delphi consensus process confirmed the need for more evidence (hence the case for a trial) and provided rich information on what a future trial should entail. It was agreed that any trial should address the areas with most uncertainty, including the management of women at 26–32 weeks’ gestation, with either spontaneous preterm labour (cephalic presentation) or where preterm birth was medically indicated. Clear themes around the challenges inherent in conducting any trial emerged, including the concept of equipoise itself. Specific issues were as follows: different clinicians and participants would be in equipoise for each clinical scenario, effective conduct of the trial would require appropriate resources and expertise within the hospital conducting the trial, potential participants would welcome information on the trial well before the onset of labour and minority ethnic groups would require tailored approaches. Conclusion: Given the lack of evidence and the variation of practice and opinion in this area, and having listened to clinicians and potential participants, we conclude that a trial should be conducted and the outlined challenges resolved. Future work: The CASSAVA project could be used to inform the design of a randomised trial and indicates how such a trial could be carried out. Any future trial would benefit from a pilot with qualitative input and a study within a trial to inform optimal recruitment. Limitations: Certainty that a trial could be conducted can be determined only when it is attempted. Trial registration: Current Controlled Trials ISRCTN12295730. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 61. See the NIHR Journals Library website for further project information

Methane detection scheme based upon the changing optical constants of a zinc oxide/platinum matrix created by a redox reaction and their effect upon surface plasmons

We detect changes in the optical properties of a metal oxide semiconductor (MOS), ZnO, in a multi-thin-film matrix with platinum in the presence of the hydrocarbon gas methane. A limit of detection of 2% by volume with concentrations from 0 to 10% and maximum resolution of 0.15% with concentrations ranging from 30% to 80% at room temperature are demonstrated along with a selective chemical response to methane over carbon dioxide and the other alkane gases. The device yields the equivalent maximum bulk refractive index spectral sensitivity of 1.8 × 105 nm/RIU. This is the first time that the optical properties of MOS have been monitored to detect the presence of a specific gas. This single observation is a significant result, as MOS have a potentially large number of target gases, thus offering a new paradigm for gas sensing using MOSs

International collaborative study to assess cardiovascular risk and evaluate long-term health in cats with preclinical hypertrophic cardiomyopathy and apparently healthy cats:The REVEAL Study

Background: Hypertrophic cardiomyopathy is the most prevalent heart disorder in cats and principal cause of cardiovascular morbidity and mortality. Yet, the impact of preclinical disease is unresolved. Hypothesis/Objectives: Observational study to characterize cardiovascular morbidity and survival in cats with preclinical nonobstructive (HCM) and obstructive (HOCM) hypertrophic cardiomyopathy and in apparently healthy cats (AH). Animals: One thousand seven hundred and thirty client-owned cats (430 preclinical HCM; 578 preclinical HOCM; 722 AH). Methods: Retrospective multicenter, longitudinal, cohort study. Cats from 21 countries were followed through medical record review and owner or referring veterinarian interviews. Data were analyzed to compare long-term outcomes, incidence, and risk for congestive heart failure (CHF), arterial thromboembolism (ATE), and cardiovascular death. Results: During the study period, CHF, ATE, or both occurred in 30.5% and cardiovascular death in 27.9% of 1008 HCM/HOCM cats. Risk assessed at 1, 5, and 10 years after study entry was 7.0%/3.5%, 19.9%/9.7%, and 23.9%/11.3% for CHF/ATE, and 6.7%, 22.8%, and 28.3% for cardiovascular death, respectively. There were no statistically significant differences between HOCM compared with HCM for cardiovascular morbidity or mortality, time from diagnosis to development of morbidity, or cardiovascular survival. Cats that developed cardiovascular morbidity had short survival (mean \ub1 standard deviation, 1.3 \ub1 1.7 years). Overall, prolonged longevity was recorded in a minority of preclinical HCM/HOCM cats with 10% reaching 9-15 years. Conclusions and Clinical Importance: Preclinical HCM/HOCM is a global health problem of cats that carries substantial risk for CHF, ATE, and cardiovascular death. This finding underscores the need to identify therapies and monitoring strategies that decrease morbidity and mortality