Gastrointestinal disorders are common in elderly patients, and the clinical presentation, complications, and management may differ from those in younger patient. Most impairment occurs in the ...proximal and distal tract of the gastrointestinal system. Swallowing abnormalities with a wide span of symptoms and pelvic floor pathologies involving all the pelvic compartments are common. Acute abdomen, often from small bowel obstruction or mesenteric ischemia, can pose a diagnostic challenge, because a mild clinical presentation may hide serious visceral involvement. In this setting, the radiologist often is asked to suggest the appropriate management options and to guide the management.
Abstract Hodics TM, Nakatsuka K, Upreti B, Alex A, Smith PS, Pezzullo JC. Wolf Motor Function Test for characterizing moderate to severe hemiparesis in stroke patients. Objective To extend the ...applicability of the Wolf Motor Function Test (WMFT) to describe the residual functional abilities of moderate to severely affected stroke patients. Design Data were collected as part of 2 double-blind, sham-controlled, randomized interventional studies: the Transcranial Direct Current Stimulation (tDCS) in Chronic Stroke Recovery and the tDCS Enhanced Stroke Recovery and Cortical Reorganization. Stroke patients were evaluated with the upper extremity Fugl-Meyer (UFM) and the WMFT in the same setting before treatment. Setting University inpatient rehabilitation and outpatient clinic. Participants Stroke patients (N=32) with moderate to severe hemiparesis enrolled in the tDCS in Chronic Stroke Recovery and the tDCS Enhanced Stroke Recovery and Cortical Reorganization studies. Interventions Not applicable. Main Outcome Measures WMFT scores were calculated using (1) median performance times and (2) a new calculation using the mean rate of performance. We compared the distribution of values from the 2 methods and examined the WMFT-UFM correlation for the traditional and the new calculation. Results WMFT rate values were more evenly distributed across their range than median WMFT time scores. The association between the WMFT rate and UFM was as good as the association between the median WMFT time scores and UFM (Spearman ρ, .84 vs −.79). Conclusions The new WMFT mean rate of performance is valid and a more sensitive measure in describing the functional activities of the moderate to severely affected upper extremity of stroke subjects and avoids the pitfalls of the median WMFT time calculations.
Grade IV astrocytoma or glioblastoma multiforme (GBM) is one of the most aggressive and lethal tumors affecting humans. ADAR2-mediated A-to-I RNA editing, an essential post-transcriptional ...modification event in brain, is impaired in GBMs and astrocytoma cell lines. However, the role of ADAR2 editing in astrocytomas remains to be defined. Here, we show that ADAR2 editing rescue in astrocytomas prevents tumor growth in vivo and modulates an important cell cycle pathway involving the Skp2/p21/p27 proteins, often altered in glioblastoma. We demonstrate that ADAR2 deaminase activity is essential to inhibit tumor growth. Indeed, we identify the phosphatase CDC14B, which acts upstream of the Skp2/p21/p27 pathway, as a novel and critical ADAR2 target gene involved in glioblastoma growth. Specifically, ADAR2-mediated editing on CDC14B pre-mRNA increases its expression with a consequent reduction of the Skp2 target protein, as shown both in vitro and in vivo. We found that, compared to normal brain, both CDC14B editing and expression are progressively impaired in astrocytomas from grade I to IV, being very low in GBMs. These findings (1) demonstrate that post-transcriptional A-to-I RNA editing might be crucial for glioblastoma pathogenesis, (2) identify ADAR2-editing enzyme as a novel candidate tumor suppressor gene and (3) provide proof of principle that ADAR2 or its substrates may represent a suitable target(s) for possible novel, more effective and less toxic approaches to the treatment of GBMs.
Abstract
Patients’ increasing needs and expectations demand for an overall assessment of hospital performances. Several Agencies described sets of performance indicators and there is not a unanimous ...classification. The ImpactHTA Horizon2020 Project wants to address this aspect, developing a toolkit of key indicators to measure hospital organizational performance. The aim of this review is to identify the dimensions of quality in which hospital performance indicators are grouped, and to assess if there has been an evolution over time of the above-mentioned dimensions.
Following the PRISMA statement, PubMed, Ovid and Web of Science databases were queried to perform an umbrella review. Articles focusing on secondary care settings, published January 2000-May 2018 were considered. The study design included was systematic review.
3680 records were screened and 6 systematic reviews ranging 2002-2014 were included. The following dimensions were described in at least 50% of the studies: 6 studies classified efficiency (53 indicators analyzed); 5 studies classified effectiveness (12 indicators), patient centeredness (10 indicators) and safety (8 indicators); 3 studies responsive governance (2 indicators), staff orientation (8 indicators) and timeliness (4 indicators). 3 reviews did not specify the indicators related to the dimensions listed, 1 gave a complete definition of the meaning of each dimension and related indicators.
The research shows steady awareness of the importance of patient centeredness, effectiveness, efficiency, and safety dimensions; apparently, there is still not much attention to sustainability, appropriateness and accessibility in terms of indicators measuring, although those dimensions are described in one of the latest review. Another review described a new dimension, resources and capacity, which focuses on the availability of new technologies, underlining the growing importance of the adoption of digitalization in healthcare.
Key messages
Main dimensions of performance indicators: efficiency, effectiveness, patient centeredness, safety.
More emphasis to sustainability and appropriateness to align with today’s healthcare challenges.
With the increased survival of very low birthweight (VLBW) infants, weighing less than 1500 g at birth, the incidence of retinopathy of prematurity (ROP), a significant cause of blindness among ...children in the United States, is also increasing. Preterm infants with a positive diagnosis of ROP during the perinatal period are at increased risk for ocular abnormalities and for deficits in visual function during later periods of development. Human milk has many antioxidant constituents including inositol, vitamin E, and beta-carotene that may protect against the development of ROP.
The objective of this study was to examine the effect of human milk feedings on the incidence of ROP among VLBW infants.
Observational cohort study.
We identified 283 VLBW infants admitted to the Georgetown University Medical Center Neonatal Intensive Care Unit (NICU) from January 1992 through September 1993. All infants surviving to receive enteral feeding and ophthalmologic examinations for ROP (n=174) were included in the analysis.
Type of feeding (human milk versus exclusive formula), presence of ROP, and potential confounding variables were abstracted retrospectively from medical records. ROP was present if any stage of ROP was diagnosed at any age during the initial NICU hospitalization; each case was counted once based on the worse severity of ROP in either eye. Multiple logistic regression was used to control for confounders.
ROP.
Major predictors of ROP were similar in both feeding groups including gestational age, days on mechanical ventilation, and total number of days on supplemental oxygen. The incidence of ROP differed significantly by type of feeding (human milk -41.0% vs. formula -63.5%, p=0.005). Human milk feeding independently correlated with a reduced odds of ROP (OR: 0.42, 95% CI: 0.19 to 0.93) (p=0.03), controlling for gestational age, duration of supplemental oxygen therapy, 5-minute Apgar score, and race. Human milk feeding independently correlated with a reduced odds of ROP (OR: 0.46, 95% CI: 0.18 to 0.91) (p=0.03), controlling for birthweight, duration of supplemental oxygen therapy, 5-minute Apgar score, and race.
Human milk feeding among VLBW infants was associated with a lower incidence of ROP compared to exclusively formula-fed VLBW infants after adjusting for confounding variables.
Abstract
Background
Healthcare systems are facing great challenges due to increased share of aging population, growing health needs and economic restraints. To keep a high quality of assistance it is ...important to invest in health technologies (HTs) that have the potential of improving health outcomes. Even though a lot of guidance does exist on how HTs should be introduced, used and dismissed, there is a surprising gap in literature concerning the awareness of hospitals in the actual utilization of HTs, namely utilization in daily practice after formal adoption.
Methods
We performed a systematic literature review of qualitative and quantitative studies aimed at investigating hospital contextual factors that influence the actual utilization of HTs at hospital level. PubMed, Scopus, Web of Science, Econlit and Ovid were searched to retrieve studies published in English from 1st January 2010 to 31st May 2018.
Results
A total of 33 studies were included mostly addressing information and communication technologies (ICTs). Findings suggest that contextual factors that impact on actual utilization of HTs at hospital level are ascribable to four main families: financial factors, leadership styles, human resource management and hospital infrastructure. It emerges also that involving professionals at all levels and planning people’s work and competencies are major determinants of HTs actual utilization.
Conclusions
The evidence suggests that several contextual factors play a major role in HTs actual utilization at hospital level even though data are mostly referred to ICTs being the other HTs unexplored. Indeed, findings from this study suggest that numerous items should be evaluated when considering to use a new HTs at hospital level. Nevertheless, evidence regarding actual utilization of medical and surgical HTs is still lacking and future research is needed.
Key messages
Financial factors, leadership styles, human resource management, hospital infrastructure are relevant determinants of actual utilization of new HTs at hospital level.
The evidence on contextual factors that influence actual utilization of HTs is mostly referred to ICTs and further research is indeed deserved.
Abstract
Background
The Balanced-Scorecard (BSC) is a management tool developed in the early 1990s to balance the impact of financial and non-financial parameters and analyse the organisational ...performance in private companies according to four determinants. The original BSC has spread to different sectors in the last decades, including healthcare services, in numerous amended versions. The aim of our project was to identify potential indicators of BSC for performance evaluation in general hospitals.
Methods
We performed a systematic review of literature on Pubmed and Web of Science using the search string “balanced scorecard AND healthcare AND indicators”. We found 102 papers; 80 papers were removed for irrelevance, absence of full text or performance indicators. We only considered articles that followed the classic structure of BSC (Customer, Internal Processes, Financial, and Learning and Growth). The indicators listed in them were classified according to the four determinants of organisational performance.
Results
Eight articles out of 22 followed the classic structure of the BSC. The most represented category was Internal Processes (59 indicators), followed by Learning and Growth (52), Customer (40) and Financial (33). The number of common/overlapping indicators was low (5 for Internal Processes and 4 for the three other categories).
Conclusions
While BSC has spread to different settings, the list of indicators used in the classic four determinants for performance evaluation is heterogeneous. While common points can be identified between indicators, our review highlighted that every BSC is developed in a unique way which makes it difficult to identify a general framework adaptable to different hospital settings.
Key messages
The use of the Balanced Scorecard as management tool has spread to healthcare settings in the last decade.
Indicators in BSC for healthcare settings are heterogeneous and only a limited number follow the standard structure of BSC.
Abstract
Background
Nowadays having leadership skills is critical to manage healthcare systems. The World Health Organization Collaborating Centre on Health Policy, Governance and Leadership ...organized the 1st European Academy for Healthcare Leaders in Rome from 15th to 17th November 2018. Senior officials of the Ministries of Health of 16 Members Countries of the WHO European Region attended and actively participated to the event, led by experienced Italian and European experts. The Academy could be considered a moment of high training on leadership and governance of health systems.
Objectives
The event was aimed at creating effective networks among participants to share ideas and strategies to improve leadership skills, providing practical tools to be applied in healthcare systems and to develop a common and transferrable leadership framework in Europe. Frontal lectures and interactive workshops covered three main areas: leadership skills, current challenges of health systems and sustainability of health systems today.
Results
The 3-days event gave the opportunity to discuss the main issues in Public Health highlighting how to be an effective leader in healthcare. Leadership should enable the translation of knowledge into productive action pathways, providing health equity and improving population’s health. At the end of the event, participants filled a survey and the results showed high satisfaction about contents (100% out of 16 participants).
Conclusions
Health systems need to change in order to face the formidable challenges of our times. This event empowered the participants in order to support the creation of strategies and to develop leadership tools to apply at country level. The experiences, ideas and good practices shared during this event strengthened a collaborative network and have been useful to identify common goals and solutions.
Key messages
These kinds of events are fundamental to improve knowledge about leadership in healthcare.
Leadership should have a major role to play in healthcare worldwide.
Summary
Background TZP‐101 is a synthetic, selective ghrelin agonist in development for gastroparesis.
Aim To assess safety and effects of TZP‐101 in diabetes patients with symptomatic ...gastroparesis.
Methods Adults with type 1 or type 2 diabetes mellitus received placebo and TZP‐101 (80, 160, 320 or 600 μg/kg) infusions in a cross‐over manner following a radiolabelled meal. Blood glucose levels were stabilized using a hyperinsulinemic‐euglycemic clamp. Primary endpoints were gastric half emptying and latency times. Secondary measures included assessment of gastroparesis symptoms and endocrine responses.
Results Ten patients with type 1 (n = 7) or 2 (n = 3) diabetes, moderate‐to‐severe gastroparesis symptoms and ≥29% retention 4 h after a radiolabelled solid meal were enrolled. TZP‐101 produced significant reductions in solid meal half‐emptying (20%, P = 0.043) and latency (34%, P = 0.037) times vs. placebo. Reductions in overall postmeal symptom intensity (24%) and postprandial fullness (37%) following TZP‐101 infusion were not statistically significant. Most adverse events were mild and self‐limiting and there were no identifiable differences in numbers or types of adverse events between TZP‐101 and placebo.
Conclusions This proof‐of‐concept study demonstrates that the ghrelin agonist TZP‐101 is well‐tolerated in diabetes patients with moderate‐to‐severe chronic gastroparesis and shows statistically significant improvements in gastric emptying.
The authors compared the frequency of epilepsy onset in perimenarche with epilepsy onset in other childhood periods in 94 postmenarchial patients aged <55 years. Seizure onset was higher for the 12 ...to 15 year age bracket than for other ages and clustered around menarche. Epilepsy began during the year of menarche in 17% of patients vs 5.5% expected (p < 0.001), and during +/-2 years of menarche in 38% patients vs 22% expected (p < 0.001). Seizures worsened during perimenarche in 29% of girls with pre-existing epilepsy. Perimenarche may be a risk for the development and worsening of epilepsy.
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