Objective: Research shows that personal relevance may affect the impact of alcohol-related health information. This study explored alcohol consumption during the UK Covid-19 lockdown, and whether a ...message emphasising the effect of alcohol on the immune system was more effective in altering intentions to follow low-risk drinking guidelines than other messages about the effects of alcohol on health.
Methods & Measures: From April to June 2020, 953 drinkers completed an online questionnaire, and were randomly allocated to exposure to a control condition or one of three messages emphasising the impact of alcohol on: the immune system; mental health; or physical health. Outcome variables were: concern about alcohol intake, and intention to adhere to low-risk drinking guidelines.
Results: Pre-post ANCOVAs revealed that participants in the immunity message group had significantly stronger intention to adhere to low-risk guidelines than the control group (after controlling for initial intention). Concern for the effect of alcohol on health was not significantly affected.
Conclusion: During Covid-19 lockdown, a message emphasising the impact of alcohol on the immune-system had a greater effect on intention to observe low-risk drinking guidelines than other messages. Contextually relevant messages could be used for alcohol health campaigns and for improving alcohol labelling.
Families of intensive care unit (ICU) decedents are at increased risk of experiencing complicated grief. However, factors associated with complicated grief in ICU and bereavement needs assessment are ...not available routinely. We aimed to conduct a systematic review identifying risk factors associated with complicated grief among family members of ICU decedents.
MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library and Web of Science were searched to identify relevant articles. Observational studies and randomised and non-randomised controlled trials were included. Studies were screened and quality appraised in duplicate. Risk of bias was assessed using Newcastle-Ottawa Scale. A narrative synthesis was undertaken.
Seven studies conducted across three continents were eligible. Four studies were of high quality. 61 risk factors were investigated across the studies. Factors associated with a decreased risk of complicated grief included age, patient declining treatment and involvement in decision-making. Factors associated with increased risk included living alone, partner, dying while intubated, problematic communication, and not having the opportunity to say goodbye.
This systematic review has identified risk factors which may help identify family members at increased risk of complicated grief. Many of the studies has small sample sizes increasing the risk of erroneously reporting no effect due to type II error. Some factors are specific to the ICU setting and are potentially modifiable. Bereavement services tailored to the needs of bereaved family members in ICU settings are required. (PROSPERO registration ID 209503).
Variation in preservation and sampling probability clouds our estimates of past biodiversity. The most extreme examples are Lagerstätten faunas and floras. Although such deposits provide a wealth of ...information and represent true richness better than other deposits, they can create misleading diversity peaks because of their species richness. Here, we investigate how Lagerstätten formations add to time series of vertebrate richness in the UK, Germany and China. The first two nations are associated with well‐studied fossil records and the last is a country where palaeontology has a much shorter history; all three nations include noted Lagerstätten in their fossil records. Lagerstätten provide a larger proportion of China's sampled richness than in Germany or the UK, despite comprising a smaller proportion of its fossiliferous deposits. The proportions of taxa that are unique to Lagerstätten vary through time and between countries. Further, in all regions, we find little overlap between the taxa occurring in Lagerstätten and in ‘ordinary’ formations within the same time bin, indicating that Lagerstätten preserve unusual faunas. As expected, fragile taxa make up a greater proportion of richness in Lagerstätten than the remainder of the fossil record. Surprisingly, we find that Lagerstätten account for a minority of peaks in the palaeodiversity curves of all vertebrates (18% in the UK; 36% in Germany and China), and Lagerstätten count is generally not a good overall predictor of the palaeodiversity signal. Vastly different sampling probabilities through taxa, locations and time require serious consideration when analysing palaeodiversity curves.
The use of standard dose low molecular weight heparin (LMWH) to anticoagulate women with mechanical valves in pregnancy is associated with morbidity and mortality. We conducted a prospective audit of ...the use of adjusted dose high intensity LMWH in 12 pregnancies in 11 women with prosthetic heart valves. LMWH +/- low-dose aspirin was started at therapeutic-dose with monitoring of anti-Xa levels to achieve a target level of 1.0-1.2 IU/mL (0.8-1.2 in the first 3/12 pregnancies). This necessitated a mean increase in the dose of LMWH of 54.4% (SD+/-33.2) over initial dose. Eleven of 12 pregnancies resulted in live births, with one intrauterine fetal death at 37 weeks. One non-fatal valve thrombosis occurred at 26 weeks gestation associated with subtherapeutic anti-Xa levels. Three patients experienced major bleeding. This regime provides a therapeutic option for women with mechanical heart valves during pregnancy, provided anti-Xa levels are kept within the target range. These patients require close surveillance for bleeding and thrombotic complications within a multi-disciplinary setting.
To present our experience of 'first-in-man' implantation of a new percutaneous pulmonary valve into a dilated pulmonary trunk, using patient specific data to influence the design of the device and ...ensure patient safety.
A 42-year-old with severe pulmonary insufficiency underwent computed tomography assessment of his pulmonary trunk. This information was utilised to create computer and rapid prototyping models that were used to customise and test the device, which was subsequently implanted into the patient. Following the procedure, the clinical, haemodynamic and morphological success of this approach was determined. The new device was safely and successfully implanted as predicted by the pre-procedural modelling. There was excellent device stability, no stent fractures, no pulmonary incompetence and only trivial para-device leak at six months follow-up. The patient described marked symptomatic improvement.
Safe, effective percutaneous pulmonary valve implantation is possible in a patient with a dilated, native pulmonary trunk. Our methodologies, which have evolved as a direct result of recent advances in four-dimensional imaging techniques, challenge the conventional stepwise pathway of bench and animal testing prior to human application, and may be safer and more relevant, potentially reducing the number of animal experiments necessary for testing new medical devices.
Respiratory medicine (RM) and palliative care (PC) physicians' management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) ...and lung cancer (LC), and the influence of practice guidelines was explored via an online survey.
A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists.
450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p < 0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both p < 0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, p < 0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both p < 0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (χ
= 13.8; p < 0.001), use opioids (χ
= 12.58, p < 0.001) and refer to pulmonary rehabilitation (χ
= 6.41, p = 0.011) in COPD; use antidepressants (χ
= 6.25; p = 0.044) and refer to PC (χ
= 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ
= 8.75, p = 0.003), fILD (χ
= 4.85, p = 0.028) and LC (χ
= 5.63; p = 0.018).
These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled.
Objective Chronic pulmonary regurgitation (PR) has deleterious effects on right ventricular (RV) function in repaired tetralogy of Fallot (ToF). However, there are little data regarding right ...ventricular outflow tract (RVOT) contractile dysfunction in response to chronic PR and on both RV and LV volumes and function. Methods We retrospectively identified consecutive patients with PR who were referred for magnetic resonance imaging quantification of “free PR” detected on echocardiography between 2003 and 2008. Patients had ToF and a transannular patch procedure (n = 30, 25.1 ± 1.2 years) or PR resulting from valvar pulmonary stenosis treated with surgical or percutaneous valvotomy (n = 30, 26.6 ± 1.8 years). Results The ToF and the PS groups were well matched for age at scan, age at repair surgery in ToF or initial valvotomy in PS, duration of exposure to PR, body surface area, heart rate, PR fraction, net forward pulmonary artery flow, and main and branch pulmonary artery dimensions. Severe PR fractions were identified in both groups (ToF: 40% ± 1% vs PS: 37% ± 2%, P = .2). Indexed RV and LV end-diastolic volumes were similar for both ToF and PS groups (RV end-diastolic volume index: 137 ± 6 mL/m2 vs 128 ± 5 mL/m2 , P = .2, and LV end-diastolic volume index: 72 ± 2 mL/m2 vs 67 ± 2 mL/m2 , P = .1, respectively). RV mass was also similar between groups (95 ± 5 g vs 81 ± 6 g, respectively, P = .08). However, indexed RV and LV end-systolic volumes were consistently higher in ToF when compared with PS (RV end-systolic volume index: 70 ± 5 mL/m2 vs 54 ± 3 mL/m2 , P < . 01, and LV end-systolic volume index: 29 ± 1 mL/m2 vs 22 ± 1 mL/m2 , P < . 01, respectively). These changes were reflected in lower biventricular systolic function in patients with ToF when compared with PS (RV ejection fraction: 52% ± 1.5% vs 59% ± 1%, P < . 001, and LV ejection fraction: 61% ± 1% vs 67 ± 1%, P < . 001, respectively). Although RV transannular plane systolic excursion was not significantly different between the groups ( P = .86), the RV outflow tract was considered contractile in only 50% of patients with ToF compared with 93% of patients with PS ( P = .0004). RV volumes and function were similar when only patients with contractile RV outflow tracts were compared. Conclusions RV outflow tract patch dysfunction in repaired ToF is responsible for higher end-systolic volumes and thus lower global measures of ventricular systolic function. These findings were not evident in cases of PS treated with valvotomy with comparable amount of PR. These observations highlight the importance of the initial repair surgery in ToF for late outcomes.
The primary objective was to evaluate performance of low concentration SDS decellularised porcine pulmonary roots in the right ventricular outflow tract of juvenile sheep. Secondary objectives were ...to explore the cellular population of the roots over time. Animals were monitored by echocardiography and roots explanted at 1, 3, 6 (n = 4) and 12 months (n = 8) for gross analysis. Explanted roots were subject to histological, immunohistochemical and quantitative calcium analysis (n = 4 at 1, 3 and 12 months) and determination of material properties (n = 4; 12 months). Cryopreserved ovine pulmonary root allografts (n = 4) implanted for 12 months, and non-implanted cellular ovine roots were analysed for comparative purposes. Decellularised porcine pulmonary roots functioned well and were in very good condition with soft, thin and pliable leaflets. Morphometric analysis showed cellular population by 1 month. However, by 12 months the total number of cells was less than 50% of the total cells in non-implanted native ovine roots. Repopulation of the decellularised porcine tissues with stromal (α-SMA+; vimentin+) and progenitor cells (CD34+; CD271+) appeared to be orchestrated by macrophages (MAC 387+/ CD163low and CD163+/MAC 387−). The calcium content of the decellularised porcine pulmonary root tissues increased over the 12-month period but remained low (except suture points) at 401 ppm (wet weight) or below. The material properties of the decellularised porcine pulmonary root wall were unchanged compared to pre-implantation. There were some changes in the leaflets but importantly, the porcine tissues did not become stiffer. The decellularised porcine pulmonary roots showed good functional performance in vivo and were repopulated with ovine cells of the appropriate phenotype in a process orchestrated by M2 macrophages, highlighting the importance of these cells in the constructive tissue remodelling of cardiac root tissues.
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