An in-depth inquiry into how stroke patients are supported with eating and drinking in stroke units

Background An estimated eighty percent of stroke patients have difficulties with eating and drinking, with over fifty percent requiring some form of assistance. Evidence suggests those receiving nutrition and hydration via enteral or parenteral routes receive adequate nutrition. In contrast, stroke patients who require assistance to eat and drink via the oral route do not always meet their nutritional requirements, affecting their well-being and recovery from stroke. This study explores this phenomenon in contemporary stroke unit settings. Methods A qualitative collective case study using non-participant observation, documentary analysis and semi-structured interviews was undertaken. The study gathered data from two sites incorporating acute and rehabilitation stroke services (cases). Forty-six multidisciplinary team (MDT) members, 31 patients and 13 informal carers (ICs) were recruited to the study. Data was thematically analysed using a six components approach developed by Braun and Clarke (2006). Findings All MDT members considered adequate nutrition paramount to stroke patients’ recovery with nursing staff responsible for supporting eating and drinking. However, patients did not receive consistently adequate support to eat and drink. This was due to multiple, interwoven factors including lack of formalised assessment of eating and drinking abilities unless under SLT management; poor communication and monitoring of patients’ support requirements, nutritional intake and nutritional status; other work/ tasks given priority over supervision at mealtimes; inconsistent provision of accessible, nutritious, appealing food. Knowledge to support this activity varied hugely across the MDT, particularly with HCAs who reported variable levels of training but predominantly carried out this work unsupervised. Conclusion and implications for practice Stroke patients do not receive consistent support with eating and drinking. Further research and the inclusion of specific recommendations for support with this activity in national guidance may promote this activity

The Telling Room

Poetry

Light years

Creative work: poetry Research Background Recent developments in animal studies and ecocriticism have revealed a need for creative research to respond to the depletion of natural habitats of the animal world, and to contend with human agency as a prime driver in environmental threat and degradation. Animal philosophers such as Matthew Calarco have called for a radical reenvisaging of the way in which we think about the categories of animal and human, and an ontologically integrated and unified understanding of humans and animals as deeply interconnected

Rosser Park

Poe

DprE2 is a molecular target of the anti-tubercular nitroimidazole compounds pretomanid and delamanid

Abstract Mycobacterium tuberculosis is one of the global leading causes of death due to a single infectious agent. Pretomanid and delamanid are new antitubercular agents that have progressed through the drug discovery pipeline. These compounds are bicyclic nitroimidazoles that act as pro-drugs, requiring activation by a mycobacterial enzyme; however, the precise mechanisms of action of the active metabolite(s) are unclear. Here, we identify a molecular target of activated pretomanid and delamanid: the DprE2 subunit of decaprenylphosphoribose-2’-epimerase, an enzyme required for the synthesis of cell wall arabinogalactan. We also provide evidence for an NAD-adduct as the active metabolite of pretomanid. Our results highlight DprE2 as a potential antimycobacterial target and provide a foundation for future exploration into the active metabolites and clinical development of pretomanid and delamanid

EPICOG-SCH: A brief battery to screen cognitive impact of schizophrenia in stable outpatients

Brief batteries in schizophrenia, are needed to screen for the cognitive impact of schizophrenia. We aimed to validate and co-norm the Epidemiological Study of Cognitive Impairment in Schizophrenia (EPICOG-SCH) derived brief cognitive battery. A cross-sectional outpatient evaluation was conducted of six-hundred-seventy-two patients recruited from 234 centers. The brief battery included well-known subtests available worldwide that cover cognitive domains related to functional outcomes: WAIS-III-Letter-Number-Sequencing-LNS, Category Fluency Test-CFT, Logical-Memory Immediate Recall-LM, and Digit-Symbol-Coding-DSC. CGI-SCH Severity and WHO-DAS-S were used to assess clinical severity and functional impairment, respectively. Unit Composite Score (UCS) and functional regression-weighted Composite Scores (FWCS) were obtained; discriminant properties of FWCS to identify patients with different levels of functional disability were analyzed using receiver-operating characteristic (ROC) technique. The battery showed good internal consistency, Cronbach's alpha = 0.78. The differences between cognitive performance across CGI-SCH severity level subscales ranged from 0.5 to 1 SD. Discriminant capacity of the battery in identifying patients with up to moderate disability levels showed fair discriminant accuracy with areas under the curve (AUC) > 0.70, p < 0.0001. An FWCS mean cut-off score ≥ 100 showed likelihood ratios (LR) up to 4.7, with an LR+ of 2.3 and a LR− of 0.5. An FWCS cut-off ≥ 96 provided the best balance between sensitivity (0.74) and specificity (0.62). The EPICOG-SCH proved to be a useful brief tool to screen for the cognitive impact of schizophrenia, and its regression-weighted Composite Score was an efficient complement to clinical interviews for confirming patients' potential functional outcomes and can be useful for monitoring cognition during routine outpatient follow-up visits

In cats undergoing midline ovariohysterectomy, is the use of local anaesthesia with bupivacaine associated with a reduction in postoperative pain score?

PICO question In cats undergoing midline ovariohysterectomy, is the use of local anaesthesia with bupivacaine via intraperitoneal or subcutaneous injections, in comparison with the use of a control substance or other analgesic measure, associated with a reduction in postoperative pain score?   Clinical bottom line The category of research question: Treatment. The number and type of study designs that were critically appraised: Three studies were critically appraised in this Knowledge Summary. They included two prospective, blinded, randomised, controlled clinical trials and one prospective randomised, blinded clinical trial. Strength of evidence: Weak. The outcomes reported: Bupivacaine does not eliminate postoperative pain in cats undergoing ovariohysterectomies; minimal evidence was found to suggest that it was better at reducing postoperative pain scores in comparison to other analgesics. However, bupivacaine may provide analgesic benefits to cats when administered via intraperitoneal or subcutaneous injections as local anaesthesia and in combination with other analgesic agents. The need for postoperative rescue analgesia was minimised when bupivacaine was administered prior to or during the ovariohysterectomy. Conclusion: When compared to a control, pain scores for the participating cats were lower after administration of bupivacaine, however, statistical significance was only reached in one of the studies. Additionally, other medications were found to lower the post operative pain score to a greater effect. However, bupivacaine administration is cheap and simple to perform, so it’s use as part of a multimodal analgesic protocol is supported. Confounding factors within the studies may have altered the perceived effectiveness of the analgesic properties of bupivacaine though, so further investigation involving larger cohorts with standardised controls would be prudent.   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care