It is impossible to predict or comprehend the impact of the ongoing COVID-19 pandemic. The UK Government's advice for vulnerable people, including older adults, to move towards self-isolation and ...social distancing is likely to reduce rates of transmission, the risk of severe illness and the impact on the acute health services. Although justified and necessary, this process of isolation is likely to have a negative impact on the mental health of these vulnerable groups, especially older people. It will become increasingly important for community health professionals to assess subtle changes in older persons' mental health, as the duration of this period of isolation remains unclear. The biopsychopharmacosocial model provides one method of assessing mental health and planning health and social care needs. This article hopes to guide community health professionals through the specifics of this assessment model in relation to the growing COVID-19 pandemic.
Xyrichis et al raise the awareness of restrictive practices in acute care settings. Restrictive practices, attitudes, behaviours and consequent interventions such as restraint, remains an emotive ...subject internationally and across all fields of nursing. The problem with restrictive practices in healthcare in general, and in acute care settings in particular, is not new but it has persisted over the years despite attempts to contain it. Xyrichis et al advance three key reasons for the lack of progress in this important area of international nursing practice: conceptual ambiguity, inadequate research attention, and fluctuating awareness.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
This article considers the development of hospitals and their funding mechanisms across the Ottoman imperial (ca. 1516-1830) and French colonial (1830-1962) states in Algeria. The first section of ...the article describes Islamic welfare structures introduced under the stewardship of the Ottoman Empire, and explains how these were appropriated, outlawed and reconfigured in the wake of the French invasion of Algiers. The second section discusses French and colonial policies on assistance publique (public assistance) and their implementation in rural zones of Algeria in the early decades of the twentieth century to create segregated infirmeries indigènes ('native' infirmaries). The third section of the article examines how officials contrived to limit the role of the state in financing hospitals by increasing taxes on ordinary Algerians, especially taxes based on Ottoman precedents. The final section uses financial audits conducted by the Cour des comptes (Court of Audit) in Paris, along with other administrative records, to reveal how revenues misrepresented as Islamic were spent, including their use to reduce the tax liabilities of elites associated with the French colonial state. This case shows the enduring importance of Ottoman and Islamic infrastructures to French colonial welfare in Algeria and helps open Algeria up for comparison with the politics of welfare provision in other imperial and post-imperial states.
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Background
Antithyroid drugs are widely used in the therapy of hyperthyroidism. There are wide variations in the dose, regimen or duration of treatment used by health professionals.
Objectives
To ...assess the effects of dose, regimen and duration of antithyroid drug therapy for Graves' hyperthyroidism.
Search methods
We searched seven databases and reference lists.
Selection criteria
Randomised and quasi‐randomised trials of antithyroid medication for Graves' hyperthyroidism.
Data collection and analysis
Two authors independently extracted data and assessed risk of bias. Pooling of data for primary outcomes, and select exploratory analyses were undertaken.
Main results
Twenty‐six randomised trials involving 3388 participants were included. Overall the quality of trials, as reported, was poor. None of the studies investigated incidence of hypothyroidism, changes in weight, health‐related quality of life, ophthalmopathy progression or economic outcomes. Four trials examined the effect of duration of therapy on relapse rates, and when using the titration regimen 12 months was superior to six months, but there was no benefit in extending treatment beyond 18 months. Twelve trials examined the effect of block‐replace versus titration block‐regimens. The relapse rates were similar in both groups at 51% in the block‐replace group and 54% in the titration block‐group (OR 0.86, 95% confidence interval (CI) 0.68 to1.08) though adverse effects (rashes (10% versus 6%) and withdrawing due to side effects (16% versus 9%)) were significantly higher in the block‐replace group. Three studies considered the addition of thyroxine with continued low dose antithyroid therapy after initial therapy with antithyroid drugs. There was significant heterogeneity between the studies and the difference between the two groups was not significant (OR 0.58, 95% CI 0.05 to 6.21). Four studies considered the addition of thyroxine alone after initial therapy with antithyroid drugs. There was no significant difference in the relapse rates between the groups after 12 months follow‐up (OR 1.15, 95% CI 0.79 to 1.67). Two studies considered the addition of immunosuppressive agents. The results which were in favour of the interventions would need to be validated in other populations.
Authors' conclusions
The evidence suggests that the optimal duration of antithyroid drug therapy for the titration regimen is 12 to 18 months. The titration (low dose) regimen had fewer adverse effects than the block‐replace (high dose) regimen and was no less effective. Continued thyroxine treatment following initial antithyroid therapy does not appear to provide any benefit in terms of recurrence of hyperthyroidism. Immunosuppressive therapies need further evaluation.
The aim of this study was to compare the circular transcriptome of divergent tissues in order to understand: i) the presence of circular RNAs (circRNAs) that are not exonic circRNAs, i.e. originated ...from backsplicing involving known exons and, ii) the origin of artificial circRNA (artif_circRNA), i.e. circRNA not generated in-vivo. CircRNA identification is mostly an in-silico process, and the analysis of data from the BovReg project (https://www.bovreg.eu/) provided an opportunity to explore new ways to identify reliable circRNAs. By considering 117 tissue samples, we characterized 23,926 exonic circRNAs, 337 circRNAs from 273 introns (191 ciRNAs, 146 intron circles), 108 circRNAs from small non-coding genes and nearly 36.6K circRNAs classified as other_circRNAs. Furthermore, for 63 of those samples we analysed in parallel data from total-RNAseq (ribosomal RNAs depleted prior to library preparation) with paired mRNAseq (library prepared with poly(A)-selected RNAs). The high number of circRNAs detected in mRNAseq, and the significant number of novel circRNAs, mainly other_circRNAs, led us to consider all circRNAs detected in mRNAseq as artificial. This study provided evidence of 189 false entries in the list of exonic circRNAs: 103 artif_circRNAs identified by total RNAseq/mRNAseq comparison using two circRNA tools, 26 probable artif_circRNAs, and 65 identified by deep annotation analysis. Extensive benchmarking was performed (including analyses with CIRI2 and CIRCexplorer-2) and confirmed 94% of the 23,737 reliable exonic circRNAs. Moreover, this study demonstrates the effectiveness of a panel of highly expressed exonic circRNAs (5-8%) in analysing the tissue specificity of the bovine circular transcriptome.The aim of this study was to compare the circular transcriptome of divergent tissues in order to understand: i) the presence of circular RNAs (circRNAs) that are not exonic circRNAs, i.e. originated from backsplicing involving known exons and, ii) the origin of artificial circRNA (artif_circRNA), i.e. circRNA not generated in-vivo. CircRNA identification is mostly an in-silico process, and the analysis of data from the BovReg project (https://www.bovreg.eu/) provided an opportunity to explore new ways to identify reliable circRNAs. By considering 117 tissue samples, we characterized 23,926 exonic circRNAs, 337 circRNAs from 273 introns (191 ciRNAs, 146 intron circles), 108 circRNAs from small non-coding genes and nearly 36.6K circRNAs classified as other_circRNAs. Furthermore, for 63 of those samples we analysed in parallel data from total-RNAseq (ribosomal RNAs depleted prior to library preparation) with paired mRNAseq (library prepared with poly(A)-selected RNAs). The high number of circRNAs detected in mRNAseq, and the significant number of novel circRNAs, mainly other_circRNAs, led us to consider all circRNAs detected in mRNAseq as artificial. This study provided evidence of 189 false entries in the list of exonic circRNAs: 103 artif_circRNAs identified by total RNAseq/mRNAseq comparison using two circRNA tools, 26 probable artif_circRNAs, and 65 identified by deep annotation analysis. Extensive benchmarking was performed (including analyses with CIRI2 and CIRCexplorer-2) and confirmed 94% of the 23,737 reliable exonic circRNAs. Moreover, this study demonstrates the effectiveness of a panel of highly expressed exonic circRNAs (5-8%) in analysing the tissue specificity of the bovine circular transcriptome.
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BFBNIB, GIS, IJS, KISLJ, NUK, PNG, UL, UM, UPUK
The reduction of restrictive practice has gained momentum in mental health services and it is now becoming evident in mainstream adult services. There remains confusion as to the definition of ...‘restrictive practices’ across all sectors of health care, including the difference between ‘restrictive practices’ (such as attitudes of control, limit setting and unnecessary ward rules) and ‘restrictive interventions’ (including physical, chemical or mechanical restraint). This article highlights the relevance of restrictive practice to children's nursing and argues that the principles apply across all health provision. Acts of restrictive practice may result in challenging behaviour, or even restrictive interventions, strategies to minimise both restrictive practice and subsequent acts of challenging behaviour are explored. Behavioural support plans adopting a bio-psycho-pharmaco-social approach have been shown to be effective in both mental health and adult nursing and are recommended for use in children's nursing.
The management of challenging behaviour, violence and aggression is not only an issue for mental health and learning disability nurses. Increasingly, nurses working in emergency departments (EDs), ...medical assessment units and general medical or surgical wards may encounter acts of challenging behaviour, violence and aggression on a regular basis. Restraint is sometimes used as a tool in the management of these patients; this may be in the form of physical, mechanical or chemical restraint. Rapid tranquillisation (RT) is often considered a form of chemical restraint, which may be used in an emergency situation when prescribed. If RT is given it should be done so as the least restrictive option, with intramuscular and intravenous administration as a last resort. Patient monitoring following administration is paramount. This article explores best practice in the administration of RT from a clinical perspective.
The goal of this special issue is to connect work done in colonial and post-colonial history and in European history through a focus on imperial and post-imperial healthcare. To date, imperial and ...post-imperial histories of healthcare have focused overwhelmingly on developments in European colonial empires. Europe's land empires, such as those of Central and Eastern Europe consolidated by Austria-Hungary and Prussia, have received comparatively less attention in English-language scholarship. This introduction highlights key debates in imperial and post-imperial histories of healthcare, and brings material and epistemological transformations in health and social welfare across different imperial formations and their successor states into dialogue. The editors also delineate some of the challenges and payoffs of a comparative approach in relation to the articles in this special issue, which encompass experiences in 10 imperial and post-imperial states, ca. 1870 to 1970. Finally, the editors review the articles, identifying a set of connecting themes that offer opportunities for future research making global comparisons.
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The pandemic caused by Covid-19 has long term ramifications for many, especially those patients who have experienced an intensive care unit (ICU) admission including ventilation and sedation. This ...paper will explore aspects of care delivery in the ICU regarding the current pandemic and the impact of such on the mental health of some of these patients. Post discharge, patients will be returning to a very different community incorporating social distancing, and in some cases, social isolation and/or shielding. Many may experience a multitude of physical and mental health complications which can ultimately impact upon each other, therefore a bio-psycho-pharmaco-social approach to discharge, case management, risk assessment and positive behavioural support planning is recommended.
Aim
(a) To report national trends for tonsillectomy, tonsillitis, peritonsillar abscess and deep neck space infection in secondary care. (b) To report national trends in sore throat consultations in ...primary care. (c) To report national trends in antibiotic prescribing in both primary and secondary care between 2011 and 2015.
Design
Retrospective nationwide cohort study. Data requested from Information Statistics Department (ISD) Scotland for tonsillectomy, tonsillitis admissions, peritonsillar abscess admissions and deep neck space infection (DNSI) admissions in Scotland, between 1993/94 and 2015/16. Data for antibiotic prescriptions in general practice and hospital admissions between 2011 and 2015.
Setting
Scottish ENT departments and GP practices.
Participants
Scottish patients who underwent tonsillectomy or were admitted to hospital with tonsillitis, peritonsillar abscess or deep neck space infection. Scottish patients that attended their GP with tonsillitis.
Results
Tonsillectomy rates between 1993/94 and 2015/16 decreased by 48% (P < 0.001). Over the same time period, there has been a corresponding 136% increase in tonsillitis admission (P < 0.001) and a 167% increase in peritonsillar abscess admissions, (P < 0.001). Between 1996/97 and 2015/16, there was a 500% increase in deep neck space abscesses (P < 0.001).
Conclusion
There has been a significant decrease in tonsillectomy rates over the past two decades. Over the same time period, there has been a significant increase in admissions to secondary care with tonsillitis, peritonsillar abscess and deep neck space infection. These changes have happened in the context of two separate national policies being introduced—Scottish Intercollegiate Guideline Network (SIGN) guidelines for management of sore throat and the Scottish Reduction in Antibiotic Prescribing.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
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