For people with untreatable bladder or bowel incontinence, effective containment of leakage is fundamental, but do they always receive enough continence pads to meet their needs? We interviewed 10 ...home-dwelling patients (or their carers) and 11 nurses at two trusts in England to explore their experience of NHS provision of absorbent pads. A majority said provision was inadequate, with negative repercussions on health, independence and dignity - not just for patients but also for their unpaid carers. Nurses described a worrying picture of restrictions on the quantity and type of pads provided. We have developed five standards for the provision of continence pads and urge service providers and commissioners to use these, so that people living with incontinence receive adequate and equitable care.
Introduction and AimsThe Children’s Acute Transport service (CATS) is a stand-alone paediatric critical care transport service in the North Thames and East Anglia region, transferring approximately ...1200 patients annually. There are 11 core nurses and 25 rotation nurses from Great Ormond Street, The Royal Brompton, and Royal London hospitals. A written record of each transport is completed by the teams, which should be an accurate reflection of the patient’s care (1, P.2).Referrals are reviewed in the daily meeting looking at key performance indicators (PI’s) and accurate prescribing. The nursing documentation is used to check these PI’s are correct.MethodsAn audit of 40 nursing forms, randomly selected from a 4-week period was undertaken. This demonstrated a varied approach, with the most common omissions being no recording of ventilation settings, blood glucose, size and length of nasogastric tube.A pro-forma was implemented to encourage a more consistent approach and reduce frequency of omissions. This was emailed to all nursing staff and discussed at the daily meetings to ensure staff were informed.Audits of the documentation were carried out at 3 and 6 monthly intervals to assess compliance and effectiveness.ResultsThe 3-month audit post implementation revealed an improvement in the overall structure of documentation and a reduction in all omissions. A subsequent audit at 6 months showed continued staff compliance in use of pro-forma however an increase in omissions. Specifically, size and Position of NGT and BM’s.Discussion and ConclusionThe structure and quality of the documentation improved after introduction of the pro-forma in combination with training, and regular reminders. A continued program of audit and education is essential to sustain improvement.
Ivacaftor produces significant clinical benefit in patients with cystic fibrosis (CF) with the G551D mutation. Prevalence of this mutation at the Cork CF Centre is 23%. This study assessed the impact ...of cystic fibrosis transmembrane conductance regulator modulation on multiple modalities of patient assessment.
Thirty-three patients with the G551D mutation were assessed at baseline and prospectively every 3 months for 1 year after initiation of ivacaftor. Change in ultra-low-dose chest CT scans, blood inflammatory mediators, and the sputum microbiome were assessed.
Significant improvements in FEV
, BMI, and sweat chloride levels were observed post-ivacaftor treatment. Improvement in ultra-low-dose CT imaging scores were observed after treatment, with significant mean reductions in total Bhalla score (P < .01), peribronchial thickening (P = .035), and extent of mucous plugging (P < .001). Reductions in circulating inflammatory markers, including interleukin (IL)-1β, IL-6, and IL-8 were demonstrated. There was a 30% reduction in the relative abundance of Pseudomonas species and an increase in the relative abundance of bacteria associated with more stable community structures. Posttreatment community richness increased significantly (P = .03).
Early and sustained improvements on ultra-low-dose CT scores suggest it may be a useful method of evaluating treatment response. It paralleled improvement in symptoms, circulating inflammatory markers, and changes in the lung microbiota.
Classifying indolent prostate cancer represents a significant clinical challenge. We investigated whether integrating data from different omic platforms could identify a biomarker panel with improved ...performance compared to individual platforms alone. DNA methylation, transcripts, protein and glycosylation biomarkers were assessed in a single cohort of patients treated by radical prostatectomy. Novel multiblock statistical data integration approaches were used to deal with missing data and modelled via stepwise multinomial logistic regression, or LASSO. After applying leave‐one‐out cross‐validation to each model, the probabilistic predictions of disease type for each individual panel were aggregated to improve prediction accuracy using all available information for a given patient. Through assessment of three performance parameters of area under the curve (AUC) values, calibration and decision curve analysis, the study identified an integrated biomarker panel which predicts disease type with a high level of accuracy, with Multi AUC value of 0.91 (0.89, 0.94) and Ordinal C‐Index (ORC) value of 0.94 (0.91, 0.96), which was significantly improved compared to the values for the clinical panel alone of 0.67 (0.62, 0.72) Multi AUC and 0.72 (0.67, 0.78) ORC. Biomarker integration across different omic platforms significantly improves prediction accuracy. We provide a novel multiplatform approach for the analysis, determination and performance assessment of novel panels which can be applied to other diseases. With further refinement and validation, this panel could form a tool to help inform appropriate treatment strategies impacting on patient outcome in early stage prostate cancer.
In this study, we built a novel statistical model across multiple omic platforms to predict indolent and aggressive prostate cancer. We demonstrate using ROC, calibration and decision curves that our combined biomarker panel significantly improves on the prediction of indolent disease compared to current clinical features. This will inform appropriate treatment strategies impacting on patient outcomes in early stage prostate cancer.
Activation of cyclin-dependent kinases (CDKs) contributes to the uncontrolled proliferation of tumour cells. Genomic alterations that lead to the constitutive activation or overexpression of CDKs can ...support tumourigenesis including glioblastoma (GBM), the most common and aggressive primary brain tumour in adults. The incurability of GBM highlights the need to discover novel and more effective treatment options. Since CDKs 2, 7 and 9 were found to be overexpressed in GBM, we tested the therapeutic efficacy of two CDK inhibitors (CKIs) (CYC065 and THZ1) in a heterogeneous panel of GBM patient-derived cell lines (PDCLs) cultured as gliomaspheres, as preclinically relevant models. CYC065 and THZ1 treatments suppressed invasion and induced viability loss in the majority of gliomaspheres, irrespective of the mutational background of the GBM cases, but spared primary cortical neurons. Viability loss arose from G2/M cell cycle arrest following treatment and subsequent induction of apoptotic cell death. Treatment efficacies and treatment durations required to induce cell death were associated with proliferation velocities, and apoptosis induction correlated with complete abolishment of Mcl-1 expression, a cell cycle-regulated antiapoptotic Bcl-2 family member. GBM models generally appeared highly dependent on Mcl-1 expression for cell survival, as demonstrated by pharmacological Mcl-1 inhibition or depletion of Mcl-1 expression. Further analyses identified CKI-induced Mcl-1 loss as a prerequisite to establish conditions at which the BH3-only protein Bim can efficiently induce apoptosis, with cellular Bim amounts strongly correlating with treatment efficacy. CKIs reduced proliferation and promoted apoptosis also in chick embryo xenograft models of primary and recurrent GBM. Collectively, these studies highlight the potential of these novel CKIs to suppress growth and induce cell death of patient-derived GBM cultures in vitro and in vivo, warranting further clinical investigation.
Chronic tic disorders (CTD) are characterized by motor and/or vocal tics. Existing data on the impact of tics in adulthood is limited by small, treatment-seeking samples or by data aggregated across ...adults and children. The current study explored the functional impact of tics in adults using a nationwide sample of 672 participants with a self-reported CTD. The impact of tics on physical, social, occupational/academic, and psychological functioning was assessed. Results suggested mild to moderate functional impairment and positive correlations between impairment and tic severity. Notable portions of the sample reported social or public avoidance and experiences of discrimination resulting from tics. Compared to previously reported population norms, participants had more psychological difficulties, greater disability, and lower quality of life. The current study suggests that CTDs can adversely impact functioning in adults and highlights the need for clinical interventions and systemic efforts to address tic-related impairments.
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