BackgroundLung cancer survival rates in the UK are among the lowest in Europe, principally due to late-stage diagnosis. Alternative routes to earlier diagnosis of lung cancer are needed in ...socioeconomically deprived communities that are disproportionately affected by poor lung cancer outcomes. We assessed the feasibility and acceptability of a community-based pharmacy referral service to encourage earlier symptomatic referral for chest X-rays.MethodsSeventeen community pharmacies located in a deprived area of Wales participated between March 2019 and March 2020. Stakeholder interviews were conducted with four patients, seven pharmacy professionals and one general practitioner. Four focus groups were conducted, including one with healthcare professionals (n=6) and three with members of the public who were current and former smokers (n=13). Quantitative data regarding patient characteristics and clinical outcomes were collected from hospital records and patient referral questionnaires completed by pharmacists and analysed using descriptive statistics. Qualitative data sets were analysed thematically and triangulated.ResultsTwelve patients used the pharmacy referral service, all of whom were male. Average length of the pharmacy consultation was 13 min, with a mean 3 days to accessing chest X-rays in secondary care. Patients experienced a mean 46-day wait for results, with no lung cancer detected. Participants found the service to be acceptable and considered the pharmacy element to be broadly feasible. Perceived barriers included low awareness of the service and concerns about the role and capacity of pharmacists to deliver the service. Facilitators included perceived approachability and accessibility of pharmacists. A well-publicised, multifaceted awareness campaign was recommended.ConclusionsA community pharmacy referral service for lung symptoms was considered an acceptable alternative pathway to symptomatic diagnosis of lung cancer in deprived communities. Wider implementation of the service would require workforce capacity and training to be addressed to ensure optimum utilisation and promotion of the service.
Background
Discrimination toward gay and lesbian patients by health care providers has been documented. No study has determined if patient behavior would change when seeing a gay/lesbian provider.
...Objective
The objective of the study was to examine whether a provider’s sexual orientation would affect the choice of provider, practice, or preference for a chaperone during genital exams.
Design
The design of the study was an anonymous, cross-sectional survey.
Participants
The participants were a random national sample of persons 18 years or older residing in the USA able to read English.
Measurements
The measurements were self-reported perceptions and chaperone preference based on provider gender and sexual orientation.
Results
The response rate was 32% (
n
= 502). Many respondents indicated they would change providers upon finding out their provider was gay/lesbian (30.4%) or change practices if gay/lesbian providers were employed there (35.4%). Female respondents preferred chaperones most with heterosexual male providers (adjusted odds ratio OR 1.50, 95% confidence interval CI = 1.15 to 1.95) followed by homosexual male (OR 1.17, 95% CI = 0.93 to 1.47), lesbian (reference), and heterosexual female providers (OR 0.63, 95% CI = 0.51 to 0.77). Male respondents showed an increased preference for chaperones with gay/lesbian providers of either gender (OR 1.52, 95%, CI = 1.22 to 1.90, for gay male provider, reference for lesbian provider) than with either heterosexual male (OR 0.36, 95% CI = 0.26 to 0.52) or heterosexual female providers (OR 0.39, 95% CI = 0.29 to 0.54).
Conclusions
Patients may change providers, practices, or desire for chaperone based on a provider’s gender and sexual orientation. Although the low response rate may limit generalizability, these findings have the potential to impact aspects of practice structure including chaperone use and provider–patient relationships.
Abstract Background and Aims Haemodialysis (HD) is life sustaining for patients with end-stage kidney disease (ESKD). In healthy people, sodium balance is regulated by the kidneys; in ESKD this is ...achieved by sodium removal during HD. Recent evidence suggests non-osmotically stored sodium in the muscle and/or skin may be a critical factor impacting the development of hypertension and cardiovascular disease (CVD). Sodium (23Na) MRI allows skin and muscle sodium storage assessment and may provide a valuable tool in evaluating sodium storage in dialysis patients. Here, 23Na MRI is used to measure muscle and skin tissue sodium concentration (TSC) in HD participants. HD participants are scanned before and after a single haemodialysis session using 23Na MRI as well as 1H T2 relaxometry to study changes in fluid status. Method Data were collected on HD patients who underwent a pre-HD 23Na MRI calf scan, then had their usual dialysis session with a dialysate sodium of 137 mmol/L, followed by a repeat post-HD 23Na MRI scan. Patient dialysis vintage, residual renal function, and ultrafiltration volume, and blood measures pre- and post-HD were collected. 1H scans were acquired for localisation and muscle segmentation (mDIXON) along with T1 and T2 mapping. 23Na images were acquired for (TSC) quantification. Reference bottles (10, 20, 30 and 40 mmol/L NaCl) were placed above the leg to calibrate TSC muscle and skin maps. Regions-of-interest (ROIs) of each muscle group and the skin were manually segmented on mDIXON scans. In each muscle group the voxel-wise mode (to avoid influence of signals from vessels) of TSC and T2 was estimated. A paired-sample t-test was performed between metrics pre-HD and post-HD. Absolute measures of ΔTSC and ΔT2 were correlated with clinical measures. Results Ten people receiving HD were recruited (age 55-73 yrs, 5 M:5F). Figure 1 shows TSC maps of the HD patients pre-HD and post-HD, with a significant reduction (p < 0.05) in TSC in the extensor, peroneus and gastrocnemius muscles post-HD but skin sodium showed no detectable change. Post-HD TSC significantly positively correlated with post-HD Systolic Blood Pressure (SBP) (P < 0.004) but not with plasma sodium. 1H T2-maps (Fig. 2A) show a significant reduction (p < 0.01) in muscle T2 post-HD compared to pre-HD all muscle groups (Fig. 2B). There were no significant correlations between T2 and 23Na measures, or T2 and clinical measures. There was no significant detectable change in 1H T1. Conclusion Post-HD TSC values are consistent with published data from patients dialysed against a dialysate sodium of 137 mmol/L, and shows a significant correlation of post-HD TSC with post-HD SBP. 1H muscle T2 reduced post-HD, consistent with published data, as patients change from a pre-HD hypervolemia state closer to a post-HD to euvolemia state after fluid removal. There was no correlation of absolute or ΔTSC and 1H T2 and ΔT2 values, suggesting different mechanisms for equilibrium conditions of water and sodium ion concentrations. Future studies will study the effect of dialysate sodium on muscle TSC and mechanistic links to CVD, and include the use of a dedicated skin coil to study skin sodium alongside bioimpedance fluid measures.
Abstract
Background and Aims
Haemodialysis (HD) is life sustaining for patients with end-stage kidney disease (ESKD) but is associated with a marked increase in incidence of cardiovascular disease ...(CVD) and high annual mortality rates. Sodium balance is regulated by the kidneys in health but has to be achieved by sodium removal during HD for those with ESKD. Recent evidence suggests that non-osmotically stored sodium in the muscle and/or skin may be a critical factor impacting the development of hypertension and CVD. Sodium magnetic resonance imaging (23Na MRI) allows assessment of skin and muscle sodium storage and may provide a valuable tool in evaluating sodium storage in dialysis patients. In this study, we used 23Na MRI to measure muscle and skin sodium content in younger and older healthy individuals and people receiving HD, and investigated the effect of a single dialysis session on muscle and skin sodium content.
Method
23Na MRI was acquired on a 3T Philips Ingenia scanner using a custom-made 23Na RF coil. 3D GRE 23Na scans (3 × 3 × 30mm3, 10 slices) were acquired in a 15-minute scan. Four reference bottles of increasing sodium concentration were placed in the RF coil above the leg to calibrate sodium concentration. In the same imaging session, 1H MR images were acquired to delineate muscle groups, skin structures and tissue water content. 23Na concentration maps were generated using custom software and regions of interest of each muscle and the skin were manually segmented. Data was collected on 14 younger (23-38yrs,7M:7F) and three older (66-77yrs,3M:1F) healthy volunteers (HVs), and 5 male HD patients (55-68 yrs) who had been on HD for more than 3-months. HD patients underwent a pre-dialysis 23Na MRI calf scan, then had their usual dialysis session with a dialysate Na prescription of 137 mmol/L, followed by a repeat 23Na MRI calf scan post dialysis. Patient demographics, dialysis vintage, residual renal function, and ultrafiltration volume were collected, along with blood samples at the start and end of the dialysis session, including serum sodium.
Results
Figure 1 shows 23Na images in the younger and older HV group and HD patients pre-dialysis. Muscle and skin sodium was increased in older HVs compared to younger, with HD patients pre-dialysis tending to be lower than older HVs (Fig. 2). HD patients’ demographics and clinical measures pre- and post-dialysis are shown in Table 1. HD treatment reduced muscle sodium whilst skin sodium showed little change (Fig. 3).
Conclusion
We have optimised methods for measuring muscle and skin sodium. 23Na concentration in muscle and skin is higher in older subjects. HD patients’ 23Na values fall between those observed in the older and younger HV groups. These values are consistent with published data from patients dialysed against 137mmol/l sodium dialysate, but lower than other studies in which dialysate sodium levels were higher. Further studies are planned to study the effect of dialysate sodium on skin and muscle sodium concentrations and mechanistic links to cardiovascular disease.
order="0" lang="eng">Student behavior is an ongoing interest in schools. The author reviews a book that takes a fresh look at the issue, offering a unique perspective that may help educators and ...schools evolve to new insights and practices.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract only Introduction: Stroke survivors experience high levels of social isolation which hinder their rehabilitation and well-being. A gap in the field that impedes intervention development is a ...lack of real-time social interaction measurement tailored for this population. In response, we developed SocialBit, a smartwatch-based machine learning algorithm to discreetly and passively detect social interactions through privacy-preserving acoustic analysis. In this observational study, we estimated the accuracy of SocialBit to detect social interactions compared to human observers in stroke survivors. Methods: SocialBit was built as a neural network machine learning algorithm using features from YAMNet and a Transformer classifier. It was then trained and tested in stroke survivors for up to 8 days in hospital. Independently, human observers tallied the presence or absence of social interactions every minute to establish the ground truth. SocialBit performance of detecting social interactions was compared against the ground truth. Results: We analyzed 1137.7 hours of ambient audio data in 90 patients within 14 days of stroke onset. 16% of patients had aphasia, 25% reported symptoms of clinical depression, and 28% reported moderate to severe loneliness. SocialBit had an accuracy of 0.83 (SD = 0.2), sensitivity of 0.86 (SD = 0.2), specificity of 0.81 (SD = 0.02), and an area under the curve (AUC) of 0.90 (SD = 0.2) (Figure 1). Conclusion: SocialBit accurately detected the frequency of social interactions in stroke survivors in a hospital setting. These results will drive future planned studies to examine SocialBit's performance in patients’ home communities. SocialBit shows the potential to be the first real-time social sensor to quantify social interactions and social isolation in stroke survivors.
Background: Due to the progressive nature of T2D, patients often escalate in disease severity, burden, and complexity. Revita® Duodenal Mucosal Resurfacing (DMR) is a non-pharmacologic, ...investigational, endoscopic treatment intended to restore normal physiology of the duodenum, a key regulator of metabolic homeostasis. Previous studies to date with >300 patients have shown favorable safety and metabolic efficacy. Here we present initial data from open label phase of a pivotal study designed to improve glycemic control while reducing and/or eliminating insulin treatment burden.
Methods: Inclusion: 21-70yrs, BMI 24-40kg/m2, HbA1c 7.5-9.5%, FPG off insulin ≥180-<270mg/dL, fasting C-peptide ≥0.6 ng/ml, insulin (20-60 U/day) with background glucose lowering agents (GLAs). Prior to procedure, GLAs other than metformin and basal insulin were washed out for ≥8wks followed by 4wk run in. Post DMR, insulin was reinstated if needed by a pre-specified treat-to-target design with preexisting metformin and de novo empagliflozin.
Results: N=9. Median (min, max) baseline characteristics: age 60 (45, 68) yrs, 66.7% male, HbA1c 8.5 (7.6, 9.1)%, C-peptide 1.7 (0.7, 3.2) ng/mL, weight 96 (85, 128) kg, diabetes duration 13 (7, 24) yrs; long-acting insulin dose 33 (20, 60) U/day. No device or procedure related SAEs. Unrelated to DMR procedure, two patients discontinued early. N=7: 48-week median change from baseline (min, max); HbA1c -1.5% (-1.8,-0.4), FPG -82 mg/dL (-104,-48), total body weight -9.3% (-16.8,-2.9). All (7/7) patients reduced insulin dose with 2 patients discontinuing insulin entirely.
Conclusion: Results from open label phase thus far show promising safety and efficacy of Revita DMR and suggest broad metabolic benefit while reducing treatment burden. Further results forthcoming from currently enrolling REVITALIZE-1 study.
Disclosure
V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. J.Bergman: Consultant; Endogenex, Fractyl Health, Inc., Digma Medical, Research Support; Endogenex, Fractyl Health, Inc., Digma Medical. Z.I.Saeed: None. H.Rajagopalan: Employee; Fractyl Health, Inc. B.Sorondo: Employee; Fractyl Health, Inc., LG Chem. K.White: Employee; Fractyl Health, Inc. H.Zhang: None. G.Mingrone: Advisory Panel; Fractyl Health, Inc., Board Member; Novo Nordisk, Consultant; Novo Nordisk, Fractyl Health, Inc., ReCor Medical, Inc.
Funding
Fractyl Health, Inc.
High density single nucleotide polymorphism (SNP) genotyping panels provide an alternative to microsatellite markers for genome scans. However, genotype errors have a major impact on power to detect ...linkage or association and are difficult to detect for SNPs. We estimated error rates with the Affymetrix GeneChip SNP platform in samples from a family with a mixed set of monozygotic (MZ) and dizygotic (DZ) triplets using lymphocyte, buccal DNA and samples from whole genome amplification using the multiple displacement amplification (MDA) technique. The average call rate from 58,960 SNPs for five genomic samples was 99.48%. Comparison of results for the MZ twins showed only three discordant genotypes (concordance rate 99.995%). The mean concordance rate for comparisons of samples from lymphocyte and buccal DNA was 99.97%. Mendelian inconsistencies were identified in 46 SNPs with errors in one or more family members, a rate of 0.022%. Observed genotype concordance rates between parents, between parents and children, and among siblings were consistent with previously reported allele frequencies and Hardy-Weinberg equilibrium. Using the MDA technique, results for two samples had equivalent high accuracy to results with genomic samples. However, the SNP call rate for the remaining seven samples varied from 72.5% to 99.5%, with an average of 86.11%. Quality of the DNA sample following the MDA reaction appears to be the critical factor in SNP call rate for MDA samples. Our results demonstrate highly accurate and reproducible genotyping for the Affymetrix GeneChip Human Mapping Set in lymphocyte and buccal DNA samples.
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