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Using existing data from clinical registries to support clinical trials and other prospective studies has the potential to improve research efficiency. However, little has been reported about staff experiences and lessons learned from implementation of this method in pediatric cardiology.
We describe the process of using existing registry data in the Pediatric Heart Network Residual Lesion Score Study, report stakeholders’ perspectives, and provide recommendations to guide future studies using this methodology.
The Residual Lesion Score Study, a 17-site prospective, observational study, piloted the use of existing local surgical registry data (collected for submission to the Society of Thoracic Surgeons-Congenital Heart Surgery Database) to supplement manual data collection. A survey regarding processes and perceptions was administered to study site and data coordinating center staff.
Survey response rate was 98% (54/55). Overall, 57% perceived that using registry data saved research staff time in the current study, and 74% perceived that it would save time in future studies; 55% noted significant upfront time in developing a methodology for extracting registry data. Survey recommendations included simplifying data extraction processes and tailoring to the needs of the study, understanding registry characteristics to maximise data quality and security, and involving all stakeholders in design and implementation processes.
Use of existing registry data was perceived to save time and promote efficiency. Consideration must be given to the upfront investment of time and resources needed. Ongoing efforts focussed on automating and centralising data management may aid in further optimising this methodology for future studies.
Chronic spontaneous urticaria (CSU) has been associated with depression and can have an impact on quality of life. Therefore, researchers have suggested the potential utility of psychological interventions for targeting depression among CSU patients. Psychological interventions that may hold the most promise are those that are brief and easily transportable, such as brief behavioural activation treatment for depression. We report results of a preliminary investigation of an uncontrolled open trial of a one-session behavioural activation treatment for depression designed for patients with CSU (BATD-CSU) at a university-based allergy and immunology clinic. Participants were 11 females with chronic, poorly controlled urticaria and symptoms of depression. Following the completion of pretreatment questionnaires, participants were administered BATD-CSU primarily by non-mental health professionals trained and supervised in its delivery. One month post-BATD-CSU, participants completed follow-up questionnaires. Participants exhibited significant reductions in depression severity, avoidance/rumination, and work/school impairment. BATD-CSU was also associated with improvements in urticaria control one month post-treatment. Moreover, five of nine patients reported reliable and clinically significant improvement on at least one outcome. Results demonstrate that BATD-CSU may have benefits for CSU patients even when consisting of one session and delivered by professionals with limited background in psychological interventions, thus speaking to its feasibility and transportability.
The ability to use the internet frequently is likely to provide a useful means of engaging with society and using services in later life, yet older people are the most likely to suffer digital exclusion, with those of the oldest ages at the greatest risk. Using six waves (2002–2012) of the English Longitudinal Study of Ageing, we model cohort-specific patterns of frequent internet use for people aged 50 and over. Multi-level growth models are used to observe trajectories of internet use over the ten-year period. Firstly, analyses are stratified by gender and wealth, and secondly we additionally test for health effects. The study finds cohort-specific differences in patterns of internet use. Rates of internet use increase faster among younger cohorts yet, despite initially increasing, begin to decline among older cohorts. Poor health is shown to be a key factor in shaping the trajectory of internet use over time. Rates of internet use are consistently lower for women than men and for those in poorer financial circumstances, independently of age cohort. The findings demonstrate the importance of ensuring older people can remain digitally included throughout later life, including after the onset of poorer health, especially as some of these individuals might benefit the most from some of the services the internet can provide.
Deposition of snow from precipitation and wind events creates layering within seasonal snowpacks. The thickness and horizontal continuity of layers within seasonal snowpacks can be highly variable, due to snow blowing around topography and vegetation, and this has important implications for hydrology, remote sensing and avalanche forecasting. In this paper, we present practical field and post-processing protocols for recording lateral variations in snow stratigraphy using near-infrared (NIR) photography. A Fuji S9100 digital camera, modified to be sensitive to NIR wavelengths, was mounted on a rail system that allowed for rapid imaging of a 10 m long snow trench excavated on the north side of Toolik Lake, Alaska (68°38′ N, 149°36′ W). Post-processing of the images included removal of lens distortion and vignetting. A tape measure running along the base of the trench provided known locations (control points) that permitted scaling and georeferencing. Snow layer heights estimated from the NIR images compared well with manual stratigraphic measurements made at 0.2 m intervals along the trench (n = 357, R2 = 0.97). Considerably greater stratigraphic detail was captured by the NIR images than in the manually recorded profiles. NIR imaging of snow trenches using the described protocols is an efficient tool for quantifying continuous microscale variations in snow layers and associated properties.
To examine the association between level of food security and diabetes self-management among food pantry clients, which is largely not possible using clinic-based sampling methods.
Cross-sectional descriptive study.
Community-based food pantries in California, Ohio and Texas, USA, from March 2012 through March 2014.
Convenience sample of adults with diabetes queuing at pantries (n 1237; 83 % response). Sampled adults were stratified as food secure, low food secure or very low food secure. We used point-of-care glycated Hb (HbA1c) testing to determine glycaemic control and captured diabetes self-management using validated survey items.
The sample was 70 % female, 55 % Latino/Hispanic, 25 % white and 10 % black/African American, with a mean age of 56 years. Eighty-four per cent were food insecure, one-half of whom had very low food security. Mean HbA1c was 8·1 % and did not vary significantly by food security status. In adjusted models, very-low-food-secure participants, compared with both low-food-secure and food-secure participants, had poorer diabetes self-efficacy, greater diabetes distress, greater medication non-adherence, higher prevalence of severe hypoglycaemic episodes, higher prevalence of depressive symptoms, more medication affordability challenges, and more food and medicine or health supply trade-offs.
Few studies of the health impact of food security have been able to examine very low food security. In a food pantry sample with high rates of food insecurity, we found that diabetes self-management becomes increasingly difficult as food security worsens. The efficacy of interventions to improve diabetes self-management may increase if food security is simultaneously addressed.
Healthcare provider hands are an important source of intraoperative bacterial transmission events associated with postoperative infection development.
To explore the efficacy of a novel hand hygiene improvement system leveraging provider proximity and individual and group performance feedback in reducing 30-day postoperative healthcare-associated infections via increased provider hourly hand decontamination events.
Randomized, prospective study.
Dartmouth-Hitchcock Medical Center in New Hampshire and UMass Memorial Medical Center in Massachusetts.
Patients undergoing surgery.
Operating room environments were randomly assigned to usual intraoperative hand hygiene or to a personalized, body-worn hand hygiene system. Anesthesia and circulating nurse provider hourly hand decontamination events were continuously monitored and reported. All patients were followed prospectively for the development of 30-day postoperative healthcare-associated infections.
A total of 3,256 operating room environments and patients (1,620 control and 1,636 treatment) were enrolled. The mean (SD) provider hand decontamination event rate achieved was 4.3 (2.9) events per hour, an approximate 8-fold increase in hand decontamination events above that of conventional wall-mounted devices (0.57 events/hour); P<.001. Use of the hand hygiene system was not associated with a reduction in healthcare-associated infections (odds ratio, 1.07 [95% CI, 0.82–1.40], P=.626).
The hand hygiene system evaluated in this study increased the frequency of hand decontamination events without reducing 30-day postoperative healthcare-associated infections. Future work is indicated to optimize the efficacy of this hand hygiene improvement strategy.
The number of older drivers will continue to increase as the population ages. Health care professionals have the responsibility of providing care and maintaining confidentiality for their patients while ensuring public safety. This article discusses the ethics of clinical decision-making pertaining to reporting health-related driving risk of older drivers to licensing authorities. Ethical considerations inherent in reporting driving risk, including autonomy, confidentiality, therapeutic relationships, and the uncertainty about determining individual driving safety and risk, are discussed. We also address the moral agency of reporting health-related driving risk and raise the question of whose responsibility it is to report. Issues of uncertainty surrounding clinical reasoning and concepts related to risk assessment are also discussed. Finally, we present two case studies to illustrate some of the issues and challenges faced by health care professionals as they seek to balance their responsibilities for their patients while ensuring road safety for all citizens.
Results from Chandra-HST-VLA observations of 13 hybrid sources are presented. Data from ten sources in the literature are analysed along with new data from three hybrid blazars belonging to the MOJAVE sample. Studies of such hybrid sources displaying both FRI and FRII jet characteristics could provide the key to resolving the long-standing Fanaroff-Riley dichotomy issue. A majority of the 13 hybrid sources show FRII-like total radio powers, i.e., they are “hybrid” in radio morphology but not in total radio power. VLBI observations of ten of the 13 sources show that the X-ray jet is on the same side as the one-sided VLBI jet. X-rays are therefore emitted from relativistically-boosted approaching jets. This is consistent with the X-ray emission being IC/CMB in origin in the majority of sources. It is not completely clear from our study that asymmetries in the surrounding medium can create hybrid sources. Hybrid radio morphologies could also be indicative of intrinsically asymmetric jets.
Recent radiocarbon dates obtained from two soil cores taken through the Marlborough Castle mound, Wiltshire, show the main body of it to be a contemporaneous monument to Silbury Hill, dating to the second half of the 3rd millennium cal bc. In light of these dates, this paper considers the sequence identified within the cores, which includes two possible flood events early in the construction of the mound. It also describes four cores taken through the surrounding ditch, as well as small-scale work to the north-east of the mound. The topographic location of the mound in a low-lying area and close to rivers and springs is discussed, and the potential for Late Neolithic sites nearby is set out, with the land to the south of the mound identified as an area for future research. The paper ends with the prospect that other apparent mottes in Wiltshire and beyond may well also have prehistoric origins
The recording and analysis of a burnt mound and adjacent palaeochannel deposits on the floodplain of the River Soar in Leicestershire revealed that the burnt mound was in use, possibly for a number of different purposes, at the transition from the Neolithic to the Bronze Age. An extensive radiocarbon dating programme indicated that the site was revisited. Human remains from the palaeochannel comprised the remains of three individuals, two of whom pre-dated the burnt mound by several centuries while the partial remains of a third, dating from the Late Bronze Age, provided evidence that this individual had met a violent death. These finds, along with animal bones dating to the Iron Age, and the remains of a bridge from the early medieval period, suggest that people were drawn to this location over a long period of time.
An understanding of anatomy is paramount to the ability to safely anesthetize the head and neck surgery patient. The basic underlying structure of the face is formed by the skull, facial bones and mandible. The cochlear hair cells activate the cochlear nerve, resulting in hearing transmission. The labyrinthine and tympanic portions of the facial nerve lie in close proximity to these structures and may be dehiscent, necessitating lack of neuromuscular blockade and close monitoring of facial movements during certain otologic procedures. The nose projects from the face largely based on the amount of cartilage. The oral cavity therefore includes the lips, buccal mucosa, maxillary and mandibular alveolar ridges/teeth/gingiva, floor of the mouth, hard palate, the retromolar trigone and the anterior oral tongue. Neck anatomy can be significantly altered by cancer or cancer treatments including surgery and radiation or chemoradiation therapy.
Sport-related concussion (SRC) is typically followed by clinical recovery within days, but reports of prolonged symptoms are common. We investigated the incidence of prolonged recovery in a large cohort (n = 18,531) of athlete seasons over a 10-year period. A total of 570 athletes with concussion (3.1%) and 166 controls who underwent pre-injury baseline assessments of symptoms, neurocognitive functioning and balance were re-assessed immediately, 3 hr, and 1, 2, 3, 5, 7, and 45 or 90 days after concussion. Concussed athletes were stratified into typical (within 7 days) or prolonged (> 7 days) recovery groups based on symptom recovery time. Ten percent of athletes (n = 57) had a prolonged symptom recovery, which was also associated with lengthier recovery on neurocognitive testing (p < .001). At 45–90 days post-injury, the prolonged recovery group reported elevated symptoms, without deficits on cognitive or balance testing. Prolonged recovery was associated with unconsciousness [odds ratio (OR), 4.15; 95% confidence interval (CI) 2.12–8.15], posttraumatic amnesia (OR, 1.81; 95% CI, 1.00–3.28), and more severe acute symptoms (p < .0001). These results suggest that a small percentage of athletes may experience symptoms and functional impairments beyond the typical window of recovery after SRC, and that prolonged recovery is associated with acute indicators of more severe injury. (JINS, 2012, 18, 1–12)