Abstract Background We aimed to define characteristics and needs of Facebook users in relation to congenital anomalies. Methods Cross-sectional analysis of Facebook related to four congenital ...anomalies: Anorectal Malformation(ARM), Congenital Diaphragmatic Hernia(CDH), Congenital Heart Disease(CHD) and Hypospadias/Epispadias(HS/ES). A keyword search was performed to identify relevant Groups/Pages. An anonymous survey was posted to obtain quantitative/qualitative data on users and their healthcare needs. Results 54 Groups and 24 Pages were identified (ARM:10 Groups; CDH:9 Groups, 7 Pages; CHD:32 Groups, 17 Pages; HS/ES: 3 Groups), with 16,191 Group members and 48,766 Page likes. 868/1103 (79%) of respondents were parents. Male:female ratio 1:10.9. 65% of users were 26-40 years old. Common reasons for joining these Groups/Pages included: seeking support, education, making friends, providing support to others. 932/1103 (84%) would like healthcare professionals (HCPs) actively participating in their Group. 31% of the respondents felt they did not receive enough support from their healthcare system. 97% of the respondents would like to join a Group linked to their primary hospital. Conclusions Facebook Groups/Pages related to congenital anomalies are highly populated and active. There is a need for HCPs and policy makers to better understand and participate in social media to support families and improve patient care.
BackgroundIn-situ simulation (ISS) has benefits on an organisational level including highlighting patient safety concerns and economical use of resources. For individuals, it negates the need for ...travel to a simulation centre and enhances team working.1 However, stakeholders may feel that in-situ education can distract clinical staff thereby reducing efficiency and patient flow. We responded to this by developing a novel tool of ‘micro’ simulation sessions.Summary of workIn order to create ‘learning in context’ for emergency department (ED) staff, a dynamic team of interprofessional clinical educators developed ‘micro’ ISS. This could be delivered to ED staff without removing them from clinical duty for more than 15 minutes. This allows for rapid education without disruption to departmental flow. Each scenario was adaptable to a multiprofessional team with one-on-one teaching for participants. Scenario flexibility allowed for a balance between debrief, teaching and practical skills. Scenarios were designed in response to near-misses and critical incidents logged via the datix reporting system, responding directly to patient safety concerns.Summary of resultsA package of scenarios was delivered (Management of diabetic emergencies; Phenytoin administration; Trauma/head injury; Sepsis/preparation for transfer; Management of hyperkalaemia; Starting non-invasive ventilation). Key stakeholders from ED, pharmacy, physiotherapy, outreach, intensive care and anaesthetics were involved in the development and delivery of the sessions. 14–25 participants attended every session: a mixture of nurses, doctors (foundation to consultant), health care assistants and students (medical, nursing and physician associates). The interprofessional faculty each taught a diverse group and peer-to-peer learning was encouraged. The scenarios were adaptable to the training needs of the individual. Participants all reported increased confidence levels pre and post-session, their feedback of current learning needs shaped future sessions. Findings from each scenario were collated and a standardised proforma was disseminated to the ED with global learning outcomes and required departmental actions such as equipment orders or change in stock drug concentrations.Discussion and conclusionsOur programme was well received, allowed for departmental training in addition to addressing patient safety concerns. We have shown that ISS does not require large scale scenarios; targeted clinical skills can be addressed in a ‘micro’ session whilst still allowing overall functioning of a busy ED.RecommendationsThis model is easily replicable throughout a hospital setting. Key stakeholder involvement as well as an enthusiastic and adaptable clinical education team ensure well managed and received education.ReferencesSorensen JL, Ostergaard D, LeBlanc V, Ottesen B, Konge L, Dieckmann P, Van der Vleuten C. 2017.Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation. BMC Med Educ. 17:20.
Renal involvement is a major cause of morbidity in patients with systemic lupus erythematosus (SLE). Histologic examination of renal tissue using light microscopy, immunofluorescent staining, and ...electron microscopy permit identification of glomerular immune complex deposits in virtually all patients with SLE. We report a patient who fulfilled four American College of Rheumatology criteria for the classification of SLE whose clinical course was consistent with SLE, yet whose renal failure resulted from focal glomerulosclerosis that was not mediated by immune complexes. The characteristics of this case of focal glomerulosclerosis that differentiate it from healed focal proliferative glomerulonephritis are discussed.
Hereditary angioedema due to C1 inhibitor deficiency is characterized by recurrent acute attacks of swelling that can be painful and sometimes life-threatening.
We conducted two randomized trials to ...evaluate nanofiltered C1 inhibitor concentrate in the management of hereditary angioedema. The first study compared nanofiltered C1 inhibitor concentrate with placebo for treatment of an acute attack of angioedema. A total of 68 subjects (35 in the C1 inhibitor group and 33 in the placebo group) were given one or two intravenous injections of the study drug (1000 units each). The primary end point was the time to the onset of unequivocal relief. The second study was a crossover trial involving 22 subjects with hereditary angioedema that compared prophylactic twice-weekly injections of nanofiltered C1 inhibitor concentrate (1000 units) with placebo during two 12-week periods. The primary end point was the number of attacks of angioedema per period, with each subject acting as his or her own control.
In the first study, the median time to the onset of unequivocal relief from an attack was 2 hours in the subjects treated with C1 inhibitor concentrate but longer than 4 hours in those given placebo (P=0.02). In the second study, the number of attacks per 12-week period was 6.26 with C1 inhibitor concentrate given as prophylaxis, as compared with 12.73 with placebo (P<0.001); the subjects who received the C1 inhibitor concentrate also had significant reductions in both the severity and the duration of attacks, in the need for open-label rescue therapy, and in the total number of days with swelling.
In subjects with hereditary angioedema, nanofiltered C1 inhibitor concentrate shortened the duration of acute attacks. When used for prophylaxis, nanofiltered C1 inhibitor concentrate reduced the frequency of acute attacks. (Funded by Lev Pharmaceuticals; ClinicalTrials.gov numbers, NCT00289211, NCT01005888, NCT00438815, and NCT00462709.)
Purpose Subclinical coronary artery calcification is an established predictor of cardiovascular events. While a history of kidney stones has been linked to subclinical carotid atherosclerosis, to our ...knowledge no study has examined its relationship with coronary artery calcification. We studied the association between kidney stone history and prevalent coronary artery calcification in MESA (Multi-Ethnic Study of Atherosclerosis). Materials and Methods MESA is a multisite cohort study of participants 45 to 84 years old without known cardiovascular disease at baseline from 2000 to 2002. Computerized tomography was done in 3,282 participants at followup in 2010 to 2012 to determine coronary artery calcification and kidney stone history was assessed by self-report. Coronary artery calcification scores were categorized as none—0, mild—1 to 99, moderate—100 to 399 or severe—400 or greater. Cross-sectional analysis was performed adjusting for demographic and dietary factors related to kidney stones. Results The prevalence of kidney stone disease history was approximately 9%, mean ± SD participant age was 69.5 ± 9.3 years, 39% of participants were caucasian, 47% were men and 69% had detectable coronary artery calcification (score greater than 0). No difference in the score was seen between single stone formers and nonstone formers. Recurrent kidney stone formation was associated with moderate or severe calcification on multivariable logistic regression vs none or mild calcification (OR 1.80, 95% CI 1.22–2.67). When coronary artery calcification scores were separated into none, mild, moderate and severe calcification, recurrent stone formation was associated with a higher score category on multivariable ordinal logistic regression (OR 1.44 per category, 95% CI 1.04–2.01). Conclusions Recurrent kidney stone formation is associated with subclinical coronary atherosclerosis. This association appeared stronger with coronary artery calcification severity than with coronary artery calcification presence.
We investigated inter-arm systolic blood pressure (sIAD) difference, reproducibility, and incident cardiovascular disease (CVD). We hypothesized that higher sIAD values have low prevalence and ...nonpersistence over years, but that CVD risk is higher starting from the time of first high absolute sIAD. In Multi-Ethnic Study of Atherosclerosis participants (n = 6725, 53% female, 45-84 years old), Doppler systolic blood pressure (SBP) measurements were made in both arms (10-minute interval) thrice over 9.5 years. Proportional hazards for CVD (coronary heart disease, heart failure, stroke, peripheral arterial disease (PAD)) over 16.4 years were tested according to time-varying absolute inter-arm difference with covariates: (1) age, gender, race, and clinic; (2) model 1 plus height, heart rate, BP, antihypertensives, BMI, smoking status, lipids, lipid lowering medication, and diabetes. High sIAD was not persistent across exams. Maximum absolute sIAD ≥ 15 mmHg was found at least once in 815 persons. Maximum absolute sIAD had a graded relationship with incident stroke or PAD: 6.2% events; model 2 hazard ratio per 10 mmHg 1.34 (95% CI, 1.15-1.56) and this risk was approximately doubled for maximum absolute sIAD ≥ 15 mmHg vs 0-4 mmHg. Total CVD risk (18.4% events) was increased only for maximum absolute sIAD ≥25 mmHg. Associations with incident CVD did not differ for higher SBP in left vs right arm. A higher maximum absolute sIAD at any exam was associated with greater risk for stroke and PAD especially for values ≥ 15 mmHg, and ≥25 mmHg for other CVD. Measuring SBP between arms may help identify individuals at risk for CVD.
Depression, chronic stress, and low levels of social support have known associations with cardiovascular disease (CVD). Physical activity has been shown to promote psychological health, reduce the ...frequency of depressive symptoms, and is associated with fewer cardiovascular events in depressed subjects with known CVD. The purpose of the present study was to test the hypothesis that physical activity attenuates the association between psychosocial factors and incident CVD. The Multi-Ethnic Study of Atherosclerosis cohort includes 6,814 participants free of clinical CVD at baseline. Complete data on physical activity were available for 6,795 subjects (mean age 62 years; 47% men). Psychosocial factors were assessed using standardized questionnaires. Cox proportional hazard models were used to evaluate the association between psychosocial factors and CVD events and its modulation by physical activity. In models adjusted for age, gender, and race/ethnicity, both depression and chronic burden were associated with CVD events (hazard ratio HR = 1.38 1.04 to 1.84, p = 0.028 for depression; HR = 1.15 1.05 to 1.24, p = 0.001 for chronic burden). Adjusting for physical activity, the relation between depression, chronic burden, and CVD events was not significantly reduced (HR = 1.35 1.02 to 1.80, p = 0.039 for depression; HR = 1.14 1.05 to 1.23, p = 0.001 for chronic burden). Although physical activity is an important component of physical and psychological health and well-being, it did not significantly attenuate the strong relation between depression or chronic burden and incident CVD.
Men often make riskier decisions than women across a wide range of real-life behaviors. Whether this sex difference is accentuated, diminished, or stable under stressful conditions is, however, ...contested in the scientific literature. A critical blind spot lies amid this contestation: Most studies use standardized, laboratory-based, cognitive measures of decision making rather than complex real-life social simulation tasks to assess risk-related behavior. To address this blind spot, we investigated the effects of acute psychosocial stress on risk decision making in men and women (
= 80) using a standardized cognitive measure (the Iowa Gambling Task; IGT) and a novel task that simulated a real-life social situation (an online chatroom in which participants interacted with other men and women in sexually suggestive scenarios). Participants were exposed to either an acute psychosocial stressor or an equivalent control condition. Stressor-exposed participants were further characterized as high- or low-cortisol responders. Results confirmed that the experimental manipulation was effective. On the IGT, participants characterized as low-cortisol responders (as well as those in the Non-Stress group) made significantly riskier decisions than those characterized as high-cortisol responders. Similarly, in the online chatroom, participants characterized as low-cortisol responders (but not those characterized as high-cortisol responders) were, relative to those in the Non-Stress group, significantly more likely to make risky decisions. Together, these results suggest that at lower levels of cortisol both men and women tend to make riskier decisions in both economic and social spheres.
ABSTRACT
Aims To determine whether substituting Seeking Safety (SS), a manualized therapy for comorbid substance use disorders (SUD) and post‐traumatic stress disorder (PTSD) for part of ...treatment‐as‐usual (TAU) improves substance use outcomes.
Design Randomized controlled effectiveness trial.
Settings Out‐patient Veterans Administration Health Care System SUD clinic.
Participants Ninety‐eight male military Veterans with a SUD and co‐occurring PTSD symptomatology.
Measurements Drug and alcohol use and PTSD severity, measured on the first day of treatment, and 3 (i.e. the planned end of SS sessions) and 6 months following the baseline assessment. Treatment attendance and patient satisfaction were measured following treatment (3‐month follow‐up). Active coping was measured at treatment intake and following treatment.
Findings SS compared to TAU was associated with better drug use outcomes (P < 0.05), but alcohol use and PTSD severity decreased equally under both treatments (P's < 0.01). SS versus TAU was associated with increased treatment attendance, client satisfaction and active coping (all P's < 0.01). However, neither these factors nor decreases in PTSD severity mediated the effect of treatment on drug use.
Conclusions The manualized treatment approach for substance use disorder, Seeking Safety, is well received and associated with better drug use outcomes than ‘treatment as usual’ in male veterans with post‐traumatic stress disorder. However, the mechanism of its effect is unclear.
PDF
