Recent clinical trials suggest that treating patients with hypertension to lower blood pressure (BP) targets improves cardiovascular outcomes.
To summarize the effects of intensive (or targeted) ...systolic BP (SBP) and diastolic BP (DBP) lowering with pharmacologic treatment on cardiovascular outcomes and harms in adults with hypertension.
Multiple databases, including MEDLINE and EMBASE, were searched for relevant systematic reviews (SRs) published in English from 15 December 2013 through 25 March 2019, with updated targeted searches through 8 January 2020.
8 SRs of randomized controlled trials examining either a standardized SBP target of -10 mm Hg (1 SR) or BP lowering below a target threshold (7 SRs).
One investigator abstracted data, assessed study quality, and performed GRADE assessments; a second investigator checked abstractions and assessments.
The main outcome of interest was reduction in composite cardiovascular outcomes. High-strength evidence showed benefit of a 10-mm Hg reduction in SBP for cardiovascular outcomes among patients with hypertension in the general population, patients with chronic kidney disease, and patients with heart failure. Evidence on reducing SBP for cardiovascular outcomes in patients with a history of cardiovascular disease (moderate strength) or diabetes mellitus (high strength) to a lower SBP target was mixed. Low-strength evidence supported intensive lowering to a 10-mm Hg reduction in SBP for cardiovascular outcomes in patients with a history of stroke. All reported harms were considered, including general adverse events, serious adverse events, cognitive impairment, fractures, falls, syncope, hypotension, withdrawals due to adverse events, and acute kidney injury. Safety results were mixed or inconclusive.
This was a qualitative synthesis of new evidence with existing meta-analyses. Data were sparse for outcomes related to treating DBP to a lower target or for patients older than 60 years.
Overall, current clinical literature supports intensive BP lowering in patients with hypertension for improving cardiovascular outcomes. In most subpopulations, intensive lowering was favored over less-intensive lowering, but the data were less clear for patients with diabetes mellitus or cardiovascular disease.
U.S. Department of Veterans Affairs, Veterans Health Administration.
We created a novel, preoperative wellness program (WP) that promotes recovery. This study assessed its impact on patient outcomes after pancreatectomy.
Pancreatoduodenectomies (PD) and distal ...pancreatectomies (DP) performed from 2015 to 2018 were reviewed using our institutional NSQIP database. Patients in the WP had their medical conditions optimized and were provided with the following: chlorhexidine, topical mupirocin, incentive spirometer, and immune-nutrition supplements.
Out of a total of 669 pancreatectomy patients (411 PD, 258 DP), 308 were enrolled in the WP (188 PD, 120 DP). In the PD subgroup, on multivariable analysis (MVA), the WP patients had shorter lengths of hospital stay (LOS) (12 vs. 10 days, p<0.001). On MVA, WP patients had less post-op transfusion (20 vs. 10%, p=0.027). For the combined groups on MVA, LOS continued to be significant (OR=0.89, 95%CI=0.82-0.97, p<0.007).
A preoperative patient centered WP may reduce the length of stay.
Recognition of the impact of social determinants on health care and surgical outcomes is imperative to improve patient care. This study aims to examine the impact social determinants have on hospital ...length of stay (LOS) after pancreatoduodenectomy (PD).
Retrospective review of a prospective American College of Surgeons-National Surgical Quality Improvement Program database identified patients who underwent PD from 2013 to 2018. Patients were categorized by insurance type (public/private/multiple), and electronic medical record review was performed to obtain distance from home, marital status, and race. Public insurance included Medicare and Medicaid; multiple types were defined as public insurance supplemented by a private insurance. Univariable analysis was used to identify potential confounders. Significant differences (P < 0.05) were controlled for using multivariable regression models to examine the effect of variables on LOS.
About 813 PDs were included (n = 341 public; n = 238 private; and n = 234 multiple). Patients with public insurance had significantly longer LOS than patients with private on univariate (P < 0.001) and multivariable analyses (P = 0.021) (8 versus 7 d). Patients with multiple insurance types showed significantly increased LOS compared with patients with private on univariable (P < 0.001) and multivariable analyses (P = 0.006) (8 versus 7 d). Single patients had significantly longer LOS compared with married patients on univariable (P = 0.012) and multivariable analyses (P = 0.005) (8 versus 7 d). Distance from home, race, gender, or age did not have a significant impact on LOS.
Single patients and patients with public or multiple insurance types are more likely to have longer hospital LOS after PD. These findings will enable physicians to identify patients at risk and target them for enhanced recovery programming.
•Insurance type impacts length of stay following pancreatoduodenectomy.•Marital status impacts length of stay following pancreatoduodenectomy.•Impact of social determinants on hospital length of stay.
OBJECTIVE:The objective of this study was to evaluate if a preoperative wellness bundle significantly decreases the risk of hospital acquired infections (HAI).
BACKGROUND:HAI threaten patient ...outcomes and are a significant burden to the healthcare system. Preoperative wellness efforts may significantly decrease the risk of infections.
METHODS:A group of 12,396 surgical patients received a wellness bundle in a roller bag during preoperative screening at an urban academic medical center. The wellness bundle consisted of a chlorhexidine bath solution, immuno-nutrition supplements, incentive spirometer, topical mupirocin for the nostrils, and smoking cessation information. Study staff performed structured patient interviews, observations, and standardized surveys at key intervals throughout the perioperative period. Statistics compare HAI outcomes of patients in the wellness program to a nonintervention group using the Fisherʼs exact test, logistic regression, and Poisson regression.
RESULTS:Patients in the nonintervention and intervention groups were similar in demographics, comorbidity, and type of operations. Compliance with each element was high (80% mupirocin, 72% immuno-nutrition, 71% chlorhexidine bath, 67% spirometer). The intervention group had statistically significant reductions in surgical site infections, Clostridium difficile, catheter associated urinary tract infections, and patient safety indicator 90.
CONCLUSIONS:A novel, preoperative, patient-centered wellness program dramatically reduced HAI in surgical patients at an urban academic medical center.
Abstract only
Uridine‐diphosphate‐
N
‐acetylglucosamine (UDP‐GlcNAc) is a ubiquitously used nucleotide sugar involved in bacterial cell wall biosynthesis and the posttranslational modification ...GlcNAcylation. If functionalized versions of UDP‐GlcNAc were more easily accessible, these chemical probes could be used to rapidly investigate biological systems. However, current chemical strategies for synthesizing UDP‐GlcNAc derivatives are difficult and lengthy. Herein we describe the chemoenzymatic synthesis of strategically functionalized UDP‐GlcNAc chemical probes from Glucosamine‐1‐Phosphate (GlcN‐1‐P) and synthetic acetyl donors known as
N
‐acetylcysteamine thioesters (SNAcs) using the bacterial cell wall biosynthesis enzyme GlmU.
Hypothesis
: If GlmU is shown to use GlcN‐1‐P and derivatized SNAcs to produce modified UDP‐GlcNAc's, then these altered building blocks will be used to investigate bacterial cell wall biosynthesis and O‐GlcNAc transferase (OGT) activity.
Support or Funding Information
We would like to thank the Koh Lab and the rest of the Grimes Group for their continuing help and support. We also thank the Howard Hughes Medical Institue (HHMI), the University of Delaware's Summer Scholars program, and the Pew Foundation for funding my work.
A high prevalence of germinomas has been observed in certain populations of Mya arenaria from eastern Maine. The etiology of these tumors is unknown. We are investigating the hypothesis that exposure ...to environmental contaminants, such as 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) contributes to gonadal carcinogenesis. Clams were exposed to TCDD with or without the initiating compound diethylnitrosamine (DEN) in an attempt to induce germinomas. A TCDD-dependent alteration in gametogenesis was observed in which 32.5±6.5% of individuals exhibited undifferentiated gonads. Analyses of AhR and p53 expression were carried out to identify similarities between naturally occurring neoplastic and TCDD (±DEN)-altered reproductive tissues. Neoplastic tissues had significantly less p53 protein than matched controls, whereas TCDD-induced undifferentiated samples exhibited no difference in p53 protein levels compared to controls. No gender-specific differences were observed in AhR mRNA, but there were significant differences in protein levels. AhR was undetectable in male gonadal tissue whereas females exhibited a significant positive relationship between AhR protein levels and stage of ovogenesis. Despite exhibiting some morphological similarity, we conclude the TCDD-induced pathology is not a germinoma. We further suggest the change in reproductive tissue is due to inhibition of cell differentiation and/or development by an AhR-independent mechanism.
Numerous reports have raised the level of national concern that chemicals found in the environment may have adverse effects on the health of humans and wildlife. Environmental exposure to pollutants, ...such as dioxin, has been implicated in gonadal tumor formation in Maine softshell clams (Mya arenaria). Prevalence of these tumors is as high as 40% in some populations. Although their etiology is still unknown, investigations into the mechanisms of tumor formation have revolved around a hypothesis of dioxin-induced toxicity. The aryl hydrocarbon receptor (AHR) was initially investigated, but was later determined to not bind the prototypical ligand, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), suggesting that dioxin toxicity is mediated through an AHR-independent pathway. An alternative mechanism of tumor formation has been investigated, involving a protein with significant sequence similarity to mammalian E6AP, a HECT (homologous to E6AP carboxy terminus) E3 ubiquitin-protein ligase. E6AP, in association with the high-risk human papillomavirus (HPV) E6 protein, is involved in the abnormal degradation of the p53 tumor suppressor protein in human cervical cancer. Tumorigenic clam reproductive tissue revealed higher M. arenaria E3 (MaE3) protein levels concomitant with lower M. arenaria p53 (Map53) levels. While the function of MaE3 as a HECT E3 was verified, results from three methods agree that MaE3 does not associate with Map53. However, alteration in Map53 levels may still play a role in clam gonadal tumorigenesis. Due to upregulation of MaE3 in neoplastic reproductive tissue, further investigations will focus on determining the proteolytic targets of MaE3. In conjunction with our previous findings that dioxin toxicity in the softshell clam is not mediated by AHR, the results from our current investigation suggest a complex etiology for the clam germinomas.
Young adults have limited access to comprehensive sex education. As such, they may seek sexuality information through such alternative sources, such as mass media. Previous research suggests that ...media, including films and television shows, can influence sexual behaviors and attitudes. Because sexual consent communication is important to sexual experiences, the purpose of this study was to assess how sexual consent and refusal communication were depicted in films. We also examined contextual factors that influence consent and refusal communication, such as gender, relationship status, location, and types of sexual behaviors. Four researchers analyzed popular mainstream films (N = 50) from 2013 based on a codebook developed inductively and deductively. The most common consent and refusal communication cues were nonverbal or implicit. The majority of scenes portrayed consent immediately before sexual activity. We also conducted chi-squared analyses to assess differences in consent and refusal communication based on gender and relationship status. There were no gender differences in the portrayal of consent cues; however, characters in established relationships used nonverbal cues more often than those in novel relationships. Mass media can normalize behaviors, and our results suggest that films may further normalize nonverbal or implicit consent cues.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective: College students may not view sexual consent communication while under the influence of substances (i.e., alcohol and drugs) as problematic if media models the co-occurrence of these ...behaviors. The purpose of this study was to assess the types of consent cues used by characters who are and are not under the influence of substances in mainstream films. Method: Four researchers inductively analyzed popular mainstream films (N = 50). Films were assessed for substance use and consent communication cues. Results: Characters using substances were depicted using implicit verbal and explicit nonverbal consent cues more than characters who had not used substances. Conclusion: Films may perpetuate cultural narratives that substance use can be part of the consent process and that consent is communicated differently when people have used substances. Prevention programs could include media literacy to address misleading messages college students may internalize about substance use and sexual consent communication.
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