Background
Patients admitted to hospital with acute severe ulcerative colitis have a short-term in-hospital colectomy rate of 30%. The Oxford criteria state that if the CRP is greater than 45 mg/l or ...there are more than eight bowel movements in 24 h at day 3 of intravenous corticosteroids, there is an 85% risk of an in-hospital colectomy.
Aim
The aim of this study was to determine whether this high rate of colectomy continues to be accurate in this medically refractory patient population.
Methods
We performed a retrospective chart review of 80 patients admitted to a tertiary hospital between 2013 and 2017 with acute severe ulcerative colitis.
Results
Sixteen (20%) patients required an in-hospital colectomy. Of the 33 patients that fulfilled the Oxford criteria, 12 (36%) patients required a colectomy during admission. Only four (9.5%) patients who did not fulfill the Oxford criteria required a colectomy during admission. Twenty-two patients that had fulfilled the Oxford criteria received infliximab as second-line medical therapy.
Conclusion
In a patient population that fulfilled the Oxford criteria, the in-hospital colectomy rate has reduced from 85% in 1996 to 36% in 2017. These results should be considered when discussing with patients the opportunity to commence infliximab or cyclosporine as second-line medical therapy.
•Cardiovascular side-effects of clozapine are rare but include life-threatening myocarditis and dilated cardiomyopathy, but there is no clear evidence that the dose of clozapine has a direct effect ...on the risk of cardio-toxicity.•Clozapine-induced cardiotoxicity is likely over-reported in the literature with few patients receiving appropriate cardiac investigations.•Only one protocol for monitoring of clozapine-induced cardiotoxicity exists which recommend baseline troponin, C-reactive protein and transthoracic echocardiogram.
This review discusses the rare but potentially life-threatening cardiovascular side-effects of myocarditis and dilated cardiomyopathy associated with the use of Clozapine. The clinical presentation of these conditions is non-specific, making it difficult to both risk-stratify and identify patients who develop these consequences. This review aims to examine the proposed aetiologies, diagnostic approaches and subsequent management strategies of cardiotoxicity associated with clozapine use; offering guidance to psychiatrists and general physicians. Current evidence highlights the importance of accurate diagnosis to prevent premature and unnecessary cessation of clozapine. Guidance on monitoring and reintroduction of the drug is emerging and current practice recommends a combination of regular monitoring of biomarkers and imaging to make a diagnosis of cardiotoxicity although further work is needed to establish evidence-based guidelines.
Introduction
Play is viewed as an important occupation in childhood and consequently in children's occupational therapy. However, few studies have explored the place of play in therapy practice. This ...study aimed to contribute to this knowledge gap by exploring play in occupational therapy in three European countries.
Method
A cross-sectional survey of occupational therapists in Ireland, Sweden and Switzerland was conducted to examine the use of play with children under 12 years old. A web-based survey was distributed to 935 occupational therapists, resulting in 338 returned surveys (36%). Responses were analysed using descriptive statistics and content analysis.
Results
Results were organised into three themes: (1) demographics and practice context; (2) play education and (3) use of play in practice. Respondents reported that although they valued play as an occupation, their primary focus was on play as a means to achieving other goals. Lack of education on play (research, theory and interventions) and pressures in the workplace were identified as barriers to play-centred practice.
Conclusion
Findings indicate that there is a mismatch between therapists valuing play as an occupation and how play is utilised in therapy practice. There is a need to strengthen education and research on play occupation to strengthen play-centred practice.
IBDoc Canadian User Performance Evaluation Moore, Alice C; Huang, Vivian W; Bourdages, Raymond ...
Inflammatory bowel diseases,
05/2019, Letnik:
25, Številka:
6
Journal Article
Recenzirano
Abstract
Background
Fecal calprotectin (FC) is a stool biomarker that has been shown to be sensitive and specific for mucosal inflammation in patients with inflammatory bowel disease (IBD). The test ...is limited by the requirement for patients to collect and return stool samples. A home-based FC test may improve test adherence. The aim of this study is to evaluate the usability of the IBDoc, a home-based FC measuring test, and to determine the accuracy of results compared with traditional lab-based ELISA values.
Methods
Patients were prospectively enrolled from 3 tertiary sites across Canada between May and August 2017. Patients completed a questionnaire establishing ease-of-use of the IBDoc. Patients completed a FC measurement using the IBDoc, and results were compared with an ELISA-determined FC measurement on the same stool sample.
Results
Sixty-one participants were enrolled in the study (29 CD, 32 UC). Seventy-nine percent of patients (48 of 61) agreed that the IBDoc was easy to use, with 85% (52 of 61) of patients strongly agreeing that they were willing use the home kit in the future. The IBDoc and ELISA measurement comparison showed an 88% agreement across all values. There were no false positives or negatives using qualitative comparison.
Conclusions
The home-based IBDoc FC measuring test is acceptable to patients and correlates extremely well with the standard ELISA-determined FC value. The IBDoc enables clinicians to more easily adopt a treat-to-target approach, improve long-term outcomes, and patients' quality of life with IBD. This study is registered at ClinicalTrials.gov, number NCT03408249.
Purpose
Play occupation has been identified as an essential part of children’s lives, and it subsequently features in paediatric occupational therapy. However, few studies address the current place ...of play and play occupation in occupational therapy practice. This study aims to address this gap in knowledge by exploring paediatric occupational therapists’ perspectives on the place of play and play occupation in occupational therapy practice in Ireland.
Design/methodology/approach
A cross-sectional online survey was conducted to gather data about the current use of play in the occupational therapy for children under 12 years. Convenience sampling and snowball recruitment techniques were used to recruit paediatric occupational therapists. Data were analysed using descriptive statistics and qualitative content analysis.
Findings
In total, 65 therapists responded to the survey (estimated response rate, 32%). Results are organised into four sections: demographics and practice context, play assessment practices, use of play in practice and perceived barriers to play-centred practice. Respondents reported that they valued play as a childhood occupation. However, the survey findings identified that the primary focus was on play as a means to an end. Lack of education on play (research, theory and interventions) and pressures in the workplace have been identified as barriers to play-centred practice.
Research limitations/implications
Findings indicate that there is a mismatch between therapists valuing play as an occupation and how play is used in occupational therapy practice. Unless clarifications are made about play occupation as being different to skills acquisition in childhood, play occupation will continue to get overlooked as an authentic concern of occupation-centred practice. Thus, play as occupation deserves further attention from educators, researchers and practitioners as a means of strengthening occupation-centred practice, in particular play-centred practice in the paediatric context.
Originality/value
Play has been described as an important occupation in childhood, and consequently, it features in paediatric occupational therapy. However, little is known about the current place of play in occupational therapy practice. This study addresses this gap by considering the current place of play in occupational therapy practice in Ireland.
Heart failure (HF) readmissions are a common and serious problem of heterogeneous etiology. Left ventricular (LV) ejection fraction has not been found to be a consistent risk marker. However, LV ...strain has been shown to predict outcomes in other settings, so the aim of this study was to determine the association of LV strain with 30-day HF readmission, independent of and incremental to clinical and basic echocardiographic parameters.
A total of 468 patients who underwent echocardiography at the time of the first admission for HF from July 2009 to June 2012 were retrospectively studied. Clinical parameters were comprehensively assessed, and standard echocardiographic parameters and two strain parameters (global longitudinal strain GLS and global circumferential strain) were measured using speckle-tracking. Patients were followed for all-cause 30-day hospital readmission or death after discharge, and the associations of parameters with outcome were assessed using Cox proportional hazards models.
Readmission within 30 days (n = 92 patients 20%) was associated with greater impairment of LV GLS (-8.6% interquartile range, -10.9% to -5.9% vs -11.1% interquartile range, -14.6% to -7.7%, P < .01). The association of GLS with readmission (hazard ratio, 1.13; 95% confidence interval, 1.07-1.19; P < .01) was independent of age, male gender, systolic blood pressure, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and comorbidity, as well as renal function, sodium, hematocrit, LV mass, left atrial size, and mitral regurgitation. Global circumferential strain was associated with outcome but not was independent after adjustment with echocardiographic parameters. In sequential models for 30-day outcome, GLS added incremental information to clinical parameters and LV ejection fraction and significantly improved reclassification (categorical net reclassification improvement, 0.34; P = .04) when LV ejection fraction was >50%.
GLS is associated with HF readmission, independent of and incremental to clinical and basic echocardiographic parameters.
Fast-track cardiac anesthesia (FTCA) is a technique that may improve patient access to surgery and maximize workforce utilization. However, feasibility and factors impacting FTCA implementation ...remain poorly explored both locally and internationally. We describe the specific intraoperative and postoperative protocols for our FTCA program, assess protocol compliance and identify reasons for FTCA failure. We tested the program in 16 patients undergoing elective cardiac surgery requiring cardiopulmonary bypass. There was 100% compliance with the FTCA protocols. Four (25%) patients successfully completed the FTCA protocol (extubated < 4 h postoperatively and discharged from the intensive care unit on the same operative day).
Given that participation in occupation is a significant predictor of well-being, it seems plausible to argue that participation in play is imperative for child well-being, since play is a fundamental ...occupation in early childhood in most cultures across the world. However, play is neither included as an indicator nor as a domain in the national set of child well-being indicators in Ireland. In addition, few studies have asked children what they view as important for their own well-being. This qualitative ethnographic study explored children's conceptualisations of happiness (as a proxy measure of well-being) amongst children living in Ireland aged 6 to 8 years. The study employed a mosaic approach and data were collected through visual, spatial, and language-based methods. Analysis resulted in three core themes with eight subthemes. The first theme describes how the children perceived their participation in pleasurable occupations as vital contributors to their overall sense of happiness (well-being), which typically involved play. The second theme describes the social and physical influences that shape participation in their valued play occupations. The third theme describes the social nature of relationships with people and animals. Children's conceptualisation of well-being consistently related to play and playful occupation, with or without social partners. Findings illustrate the degree and complexity with which children understand the influences on their happiness (well-being) to be interrelated, highlighting an expanded view of play as a subjective aspect of childhood that is intrinsically connected to well-being and happiness. They also point to appropriate issues that should be addressed, both at a National data monitoring and policy level.
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