Response to Letter to the editor Woodcroft‐Brown, Victoria; Bell, Jack; Pulle, Chrysanth Ranjeev ...
Australasian journal on ageing,
08/2024
Journal Article
The Asian citrus psyllid, Diaphorina citri Kuwayama (Hemiptera: Psyllidae), is a key vector of the phloem-limited bacteria Candidatus Liberibacter asiaticus (CLas) associated with huanglongbing ...(HLB), the most serious and currently incurable disease of citrus worldwide. Here we report the first investigation into the potential use of a spider venom-derived recombinant neurotoxin, ω/κ-HxTx-Hv1h (hereafter HxTx-Hv1h) when delivered alone or when fused to snowdrop lectin (Galanthus nivalis agglutinin; GNA) to control D. citri. Proteins, including GNA alone, were purified from fermented transformed yeast Pichia pastoris cultures. Recombinant HxTx-Hv1h, HxTx-Hv1h/GNA and GNA were all orally toxic to D. citri, with Day 5 median lethal concentrations (LC50) derived from dose-response artificial diet assays of 27, 20 and 52 μM, respectively. Western analysis of whole insect protein extracts confirmed that psyllid mortality was attributable to protein ingestion and that the fusion protein was stable to cleavage by D. citri proteases. When applied topically (either via droplet or spray) HxTx-Hv1h/GNA was the most effective of the proteins causing >70 % mortality 5 days post treatment, some 2 to 3-fold higher levels of mortality as compared to the toxin alone. By contrast, no significant mortality or phenotypic effects were observed for bumble bees (Bombus terrestris L.) fed on the recombinant proteins in acute toxicity assays. This suggests that HxTx-Hv1h/GNA has potential as a novel bioinsecticide for the management of D. citri offering both enhanced target specificity as compared to chemical pesticides and compatibility with integrated pest management (IPM) strategies.
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•Recombinant spider venom peptide HxTx-Hv1h and snowdrop lectin GNA were orally and topically toxic to Diaphorina citri.•Fusion of HxTx-Hv1h to GNA enhanced the topical insecticidal efficacy of the venom peptide against Diaphorina citri.•HxTx-Hv1h, GNA, and HxTx-Hv1h/GNA were non-toxic to adult bumble bees.•The fusion protein HxTx-Hv1h/GNA has potential as a novel bioinsecticide for the management of Diaphorina citri.
Anal squamous cell carcinoma (ASCC) has a generally acceptable outlook in terms of survival. 18-fluorodeoxyglucose-positron emission tomography/computer tomography (FDG PET-CT) is not recommended for ...routine monitoring post-ASCC treatment. We examine herein if FDG PET-CT has a use in the prognostic evaluation of patients with ASCC, what FDG PET-CT metrics are of value and if a pre- or post-chemo/radiotherapy scan is more prognostic of outcomes. PubMed, EMBASE and Cochrane Central Registry of Controlled Trials were comprehensively searched until 3 May, 2023. A modified Newcastle Ottawa scale was used to assess for study bias. We present our systematic review alongside pooled hazard ratios (HR) for maximum standardised uptake values (SUV) as a predictor of overall survival (OS) and progression-free survival (PFS). Seven studies including 523 patients were included in our systematic review. Current evidence suggests that SUV maximum and median, metabolic tumour volume, total lesion glycolysis and complete and partial metabolic response may be prognostic when considering overall or progression-free survival (OS)/(PFS) along with local recurrence (LR). Pooled HR from two included studies indicate SUV max is prognostic of OS, HR 1.179, CI (1.039-1.338), P = 0.011 and PFS 1.176, CI (1.076-1.285), P < 0.01. FDG PET-CT may have a role to play in the prognostic evaluation of ASCC patients. Current evidence suggests post-treatment scanning may hold superior prognostic value at this time.
Introduction There is conflicting evidence on the benefits of parathyroidectomy (PTx) in reducing the incidence of cardiovascular disease (CVD) in patients with primary hyperparathyroidism (PHPT). ...Aim To perform a systematic review and meta-analysis to investigate the impact of PTx in PHPT on cardiovascular outcomes. Methods A systematic review was performed as per PRISMA guidelines. Pre- and post-operative data were expressed as continuous outcomes, reported as mean differences, and expressed with 95% confidence intervals following estimation using the Mantel-Haenszel method. Results In total, there were 16 studies included in the meta-analysis with a combined total of 796 patients. Fourteen studies were prospective, one was retrospective and one was a randomised control trial. This analysis found a significant reduction in SBP post-operatively ( P = 0.003). The difference in DBP was NS ( P = 0.050). Fasting blood glucose levels were also significantly reduced after surgery ( P < 0.0001). Echocardiographic values showed that left ventricular mass index was not significantly reduced ( P = 0.070) and left ventricular ejection fraction was not affected ( P = 0.680). Cholesterol levels were not impacted by surgery. Conclusion This meta-analysis shows that PTx likely improves SBP and blood glucose levels in patients with PHPT. It is unclear if this in turn has any impact on long-term outcomes.
Background: Assessing and monitoring food intake and body weight of all hospital patients is considered part of “best practice” nutrition care. This study presents case examples describing the impact ...of behavior change strategies on embedding these 2 monitoring processes in hospitals. Methods: Four hospital medical units that participated in the More‐2‐Eat implementation study to improve nutrition care focused on improving food intake and/or weight monitoring practices. The percentage of admitted patients who received these care practices were tracked through chart audits over 18 months. Implementation progress and behavior change strategies were documented through interviews, focus groups, scorecards, and monthly telephone calls. Case examples are explored using mixed methods. Results: Of the 4 units, 3 implemented food intake monitoring. One provided food service workers the opportunity to record food intake, with low intake discussed by an interdisciplinary team during bedside rounds (increased from 0% to 97%). Another went from 0% to 61% of patients monitored by introducing a new form (“environmental restructuring”) reminding staff to ask patients about low intake. A third unit increased motivation to improve documentation of low intake and improved from 3% to 95%. Two units focused on regularity of body weight measurement. One unit encouraged a team approach and introduced 2 weigh days/week (improved from 14% to 63%), while another increased opportunity by having all patients weighed on Saturdays (improved from 11% to 49%). Conclusion: Difficult‐to‐change nutrition care practices can be implemented using diverse and ongoing behavior change strategies, staff input, a champion, and an interdisciplinary team.
Aim: Healthcare climate changes demand a paradigm shift in how inpatient malnutrition care is managed. This study describes the process for developing, implementing, and evaluating a locally ...adaptable model for managing malnutrition in Australian hospitals. Methods: A 2-year, multiphase mixed-methods, action research implementation program applying a separate-sample before-and-after design. Action cycle-I (AC-I) focused on problem identification and building a case for change, including a cross-sectional survey of 21 Queensland public hospitals. Diverse stakeholders were engaged to identify and adapt existing frameworks to produce a model for implementation in Australian hospitals through informal and structured interviews (AC-II). Facilitated implementation, iterative adaptation and evaluation processes were consequently undertaken across 6 diverse Queensland Hospitals, purposively sampled for maximum variation (AC-III). Multiphase mixed-methods evaluation is targeted for completion by April 2018 (AC-IV) with all phases on schedule. Results: AC-I demonstrated inconsistent, fragmented approaches to malnutrition care across metropolitan (n=11), regional (n=8), and rural/remote (n=2) settings. Limited systematic, interdisciplinary or delegated malnutrition care processes were identified; most remained focused towards highly individualized, dietitian delivered care. AC-II failed to identify a consistent model of care integrated into practice across sites. The INPAC was identified as a key model for adaptation to fit when developing a Systematized, Interdisciplinary Malnutrition Pathway for impLementation and Evaluation (SIMPLE). Preliminary findings for 5 sites (AC-III) compared nutritionally at-risk patients audited at baseline (n=168) with at-risk patients audited 5-6 months after SIMPLE implementation (n=174). Significantly improved inpatient food and nutrient delivery (67.9 versus 83.9%; X2(1) 12.081, p=0.001) and coordination of care (45.8 versus 57.5%; X2(1) 4.636, p=0.031) processes were observed following early implementation of the new model. A non-significant improvement was observed for nutrition education processes (44.0 versus 52.9%; X2(1) 2.666, p=0.103). Mixed-methods data demonstrated the need for local stakeholder engagement and context analysis, adaptation to fit, data feedback, iterative change, and reflexivity to support successful implementation. Conclusions: Preliminary findings indicate that the wicked problem of malnutrition in Australian hospitals may be managed by a SIMPLE adaptation of INPAC. However, the success of any model supporting systematized, integrated inpatient malnutrition care appears predicated on application of robust implementation processes in local sites.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Poor food intake is common in hospital patients and can extend the hospital stay. Barriers to food intake, such as inability to open packages, or mealtime interruptions, are prevalent and lead to ...inadequate food intake, estimated at approximately one-third of patients. More2-Eat is an implementation study focused on improving nutrition care by applying the Integrated Nutrition Pathway for Acute Care (INPAC). Along with facilitating appropriate identification of malnourished patients on admission, INPAC aims to prevent in-hospital malnutrition by promoting a standard of care that ensures adequate food intake for all patients by reducing organizational and physical barriers to food consumption, among other practice changes. The purpose of this analysis was to demonstrate how mealtime barriers were reduced during the More-2-Eat study with the implementation of new standard of care procedures. In 2015-16, 1250 medical patients were recruited over the course of the study in five diverse hospital units from four provinces. Mealtime barriers were tallied with the Mealtime Audit Tool after a meal. Three periods of implementation (pre-, early, and late) were compared to demonstrate change over time and with implementation of new standard care activities (e.g. volunteers supporting food intake). Regression analyses determined the effect of time while adjusting for key covariates (e.g. site, handgrip strength, diagnosis, nutritional status, age, gender) that could also influence the outcome of mealtime barriers reported by patients. A variety of strategies were used to promote food intake (e.g. volunteer assistants, monitoring of food intake, providing ward stock of nutrient dense food staples etc.). The number of mealtime barriers was reduced over the implementation periods (Period 1= 2.5 +/− 2.1; Period 3= 1.8 +/− 1.7), with site differences noted. This decrease over implementation periods was statistically significant in regression analyses (-0.28 95% CI -0.44, -0.11), even after adjusting for important covariates. Mealtime barriers can be reduced and sustained by implementing a variety of standard care procedures such as volunteer assistance and food intake monitoring. The More-2-Eat study provides an example of how to implement changes in practice to support the detection, prevention, and treatment of malnutrition. (Funding: Canadian Frailty Network.)
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aim
Postoperative delirium is common among elderly hip surgery patients. We aimed to pragmatically evaluate whether type of anaesthesia influenced postoperative delirium in an orthogeriatric ...population following hip fracture.
Method
This observational study comprises prospectively collected data on hip fracture patients admitted between October 2010 and November 2011. Delirium was diagnosed clinically by geriatricians.
Results
Of the 344 patients admitted, seven managed conservatively and 19 with incomplete data were excluded; 318 patients were analysed. Average age was 81.6 (SD 9.8) years; 28% were men and 167 (53%) were administered general anaesthesia. Mean length of stay was 18 (SD 9.4) days. Overall, 172 patients (54%) experienced delirium. There was no apparent difference in postoperative delirium by anaesthetic type (88 vs 84, P = 0.15).
Conclusion
Delirium was common in both general and spinal anaesthetic patients. Further randomised controlled trials would be required to determine whether anaesthesia type influenced delirium rates.
Aim
Poorly controlled Cystic Fibrosis‐Related Diabetes (CFRD) is associated with adverse impacts on lung function and nutritional status. Insulin therapy is the only recommended medical treatment. ...Carbohydrate Counting (CC) is used to guide insulin doses and can assist in achieving optimal postprandial blood glucose levels. This study aimed to determine the prevalence of individuals with CFRD who carbohydrate count, explore barriers to its use and assess the accuracy of CC in hospitalised patients.
Methods
A cross‐sectional, mixed‐methods, descriptive study recruited individuals with CFRD hospitalised at an Australian tertiary hospital. Consenting patients completed a questionnaire. Patients were asked to estimate the carbohydrate content of their ordered meals provided by hospital foodservices. The study dietitian assessed each meal's estimation against the actual content.
Results
17 individuals were recruited to this study and five declined. Seven had a fixed insulin regimen, and ten had a flexible insulin regimen and used CC. Patients in the fixed insulin group reported lower levels of confidence in their ability to carbohydrate count (P < .001) and placed less importance on CC (P < .001). 53% of the fixed insulin group's and 41.7% of the flexible insulin group's estimations of the carbohydrate content of the hospital food items were accurate.
Conclusion
Of those patients recruited to this study, 59% used CC as a tool to guide insulin dosing, and patients estimated accurate carbohydrate values in only 46% of meals. Further research is warranted to investigate the most suitable method to assist accurate carbohydrate content estimations in a hospital setting.
Background
Hip fracture is a common clinical problem with historically high morbidity and mortality, and various model of acute and subacute care have been employed. We describe 12‐month results from ...the first dedicated hip fracture unit in Australia, and compare it with other models of care both locally and internationally.
Methods
This was performed as a prospective uncontrolled study over a 12‐month period. After application of exclusion criteria, a total of 346 patients were yielded. Outcomes measured included performance indicators as well as morbidity and mortality data.
Results
Improvements in performance indicators (adequate preoperative medical assessment, time to surgery, return to premorbid residence, etc.) and morbidity and mortality data (such as pressure sores, infections and in‐hospital death) are noted.
Conclusions
Early results suggest more comprehensive preoperative assessment, shorter times to theatre, reduced post‐operative complications and diminished mortality rates when the principles undermining this unit are instituted.
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