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Due to the burden of tobacco-related illnesses among hospital inpatients, an evidence-based smoking cessation brief intervention tool was developed for clinicians working in hospitals in Queensland, Australia. The tool, called the Smoking Cessation Clinical Pathway (SCCP), is used by clinicians to support inpatient smoking cessation and manage nicotine withdrawal in hospital.
To investigate the impact of completed SCCP on nicotine replacement therapy (NRT) prescribing and use, and to explore clinician involvement in smoking cessation interventions.
A retrospective review was conducted to examine data regarding SCCP responses and NRT offering, prescribing and use. The statistical significance of the results was assessed using chi-squared and Fisher's exact tests.
Patients with a completed SCCP were more likely to be offered NRT (P < 0.0001). NRT prescribing on admission and discharge was higher in patients with a completed SCCP (P = 0.001 and P = 0.027). Intention to quit had no effect on whether NRT was offered (P = 0.276) and NRT acceptance was higher for patients that intended to quit smoking (P < 0.0001).
The SCCP prompted clinicians to offer NRT to patients, leading to increased NRT prescribing and use. These findings demonstrate the utility of the SCCP to assist clinicians to promote smoking cessation among hospital inpatients.
To examine the relationship between food security status, diet quality measured using Healthy Eating Index-2010 (HEI-2010) scores, demographics and the following factors: perceptions of healthy food availability, healthy eating identity and perceived control of healthy eating.
A cross-sectional study in 2016–2017 using three 24-h dietary recalls and one psychosocial survey.
Two urban communities in Cleveland and Columbus, Ohio, USA, with low access to healthy food retailers.
Primary food shoppers living in the targeted geographic areas (N 450).
Our results indicated that high school graduates had lower HEI-2010 scores compared with participants who had some college education or more (β = –2·77, P = 0·02). Participants receiving Supplemental Nutrition Assistance Program (SNAP) benefits had lower HEI-2010 scores (β = –2·69, P = 0·03). Healthy eating identity was associated with higher HEI-2010 scores (β = 1·85, P = 0·004). Food security status moderated the relationship between perception of healthy food availability and HEI-2010 scores. Among participants with very low food security (VLFS), greater perceptions of healthy food availability were associated with higher HEI-2010 scores (β = 3·25, P = 0·03), compared with food secure participants. Only 14 % of VLFS participants used a personal vehicle as transportation to their primary food shopping store.
Findings offer targets for future intervention development and evaluation to promote community nutrition. These targets include strategies to improve the value of SNAP benefits, promote access to quality education, increase transportation options to healthy food retailers and develop nutrition programming to promote healthy eating identity.
To review the currently available data on the use of ketamine in the treatment of depression among older adults from randomized controlled studies.
Randomized controlled trials.
60 years and older with depression.
Change in Montgomery–Asberg Depression Rating Scale (MADRS) scores.
Two studies met the inclusion criteria. The first study showed a significant reduction in depression symptoms with use of repeated subcutaneous ketamine administration among older adults with depression. The second study failed to achieve significance on its primary outcome measure but did show a decrease in MADRS scores with intranasal ketamine along with a higher response and remission rates in esketamine group compared with the placebo group. The adverse effects from ketamine generally lasted only a few hours and abated spontaneously. No cognitive adverse effects were noted in either trial from the use of ketamine.
The current evidence for use of ketamine among older adults with depression indicates some benefits with one positive and one negative trial. Although one of the trials did not achieve significance on the primary outcome measure, it still showed benefit of ketamine in reducing depressive symptoms. Ketamine was well tolerated in both studies with adverse effects being mild and transient.
Changed spatial configurations at sowing have been investigated as a strategy to minimize interspecific competition and improve the establishment and persistence of multi-species plantings in pastures, but the impact of this practice on the soil microbiome has received almost no previous research attention. Differences in populations of bacteria and fungi in the surface 10 cm of soil in the third year following pasture establishment were quantified using quantitative polymerase chain reaction and terminal restriction fragment length polymorphism methods. Populations were compared on, and between, drill rows sown to either the perennial grass phalaris (Phalaris aquatica L.), perennial legume lucerne (alfalfa; Medicago sativa L.) or the annual legume subterranean clover (Trifolium subterraneum L.). Results showed that soil microbial abundance and diversity were related to plant distribution across the field at the time of sampling and to soil chemical parameters including total carbon (C), mineral nitrogen (N), pH, and available phosphorus (P), potassium (K) and sulfur (S). Despite the 27-month lag since sowing, pasture species remained concentrated around the original drill row with very little colonization of the inter-row area. The abundance and diversity of bacterial and fungal populations were consistently greater under drill rows associated with higher total C concentrations in the surface soil compared with the inter-row areas. Our results showed that the pH and available nutrients were similar between the subterranean clover drill row and the inter-row, suggesting that soil microbial populations were not impacted directly by these soil fertility parameters, but rather were related to the presence or absence of plants. The abundance of bacteria and fungi were numerically lower under phalaris rows compared to rows sown to legumes. The richness and diversity of fungal populations were lowest between rows where lucerne was planted. Possible explanations for this observation include a lower C:N ratio of lucerne roots and/or a lack of fibrous roots at the soil surface compared to the other species, illustrating the influence of contrasting plant types on the soil microflora community. This study highlights the enduring legacy of the drill row on the spatial distribution of plants well into the pasture phase of a cropping rotation and discusses the opportunity to enhance the microbiome of cropping soils on a large scale during the pasture phase by increasing plant distribution across the landscape.
Field experiments were conducted to standardize protocols for site-specific fertilizer nitrogen (N) management in Bt cotton using Soil Plant Analysis Development (SPAD) chlorophyll meter. Performance of different SPAD-based site-specific N management scenarios was evaluated vis-à-vis blanket fertilizer N recommendation. The N treatments comprised a no-N (control), four fixed-time and fixed N doses (60, 90, 120, and 150 kg N ha-1) including the recommended dose (150 kg ha-1), and eight fixed-time and adjustable N doses based on critical SPAD readings of 45 and 41 at first flowering and boll formation stages, respectively. The results revealed that by applying 45 or 60 kg N ha-1 at thinning stage of the crop and critical SPAD value-guided dose of 45 or 30 kg N ha-1 at first flowering stage resulted in yields similar to that recorded by applying the recommended dose of 150 kg N ha-1. However, significantly higher N use efficiency as well as 30–40% less total fertilizer N use was recorded with site-specific N management. Applying 30 kg N ha-1 at thinning and SPAD meter-guided 45 kg N ha-1 at first flowering were not enough and required additional SPAD meter-guided 45 kg N ha-1 at boll formation for sustaining yield levels equivalent to those observed by following blanket recommendation but resulted in 20% less fertilizer N application. Our data revealed that SPAD meter-based site-specific N management in Bt cotton results in optimum yield with dynamic adjustment of fertilizer N doses at first flowering and boll formation stages. The total amount of N fertilizer following site-specific management strategies was substantially less than the blanket recommendation of 150 kg N ha-1, but the extent may vary in different fields.
Background: Curbing unnecessary laboratory testing represents a significant opportunity for cost reduction in the Canadian health care system. A Choosing Wisely report cited a 31% decline in the number of tests ordered in a Canadian emergency department (ED) after implementation of recommendations. The international normalized ratio (INR) remains frequently ordered in emergency departments without an appropriate indication. Aim Statement: We aimed to reduce the number of INR tests completed in the St. Joseph's Healthcare Hamilton Emergency Department by 50% by April 30, 2019. Measures & Design: We conducted the study in an urban, academic ED employing the Epic electronic health record (EHR). We tailored interventions according to the Hierarchy of Effectiveness to address root causes revealed by analysis of our baseline ordering behaviour. Interventions included provider education around evidence-based ordering indications and removal of the INR from our “chest pain” bloodwork panel. Our outcome measure was the weekly number of INR tests completed per ED visit. Process measures included the proportion of INR tests ordered for inappropriate indications on monthly audits of 20 charts where an INR was completed. Balancing measures included average ED length of stay for patients receiving INR testing. Evaluation/Results: We collected outcome, process, and balancing measures through the EHR and analyzed this data using statistical process control charts. Over the nine-month study period, we decreased weekly INR tests from 248.4 to 115.0, a reduction of 56% which met criteria for special cause variation. This amounts to a cost savings of $43,008 per year. ED length of stay for patients receiving INR testing did not change significantly. Discussion/Impact: Our interventions were successful in realising our 50% target reduction in INR tests without an increase in ED length of stay from repeat venipuncture. This result is in keeping with similar efforts in other Canadian EDs. Our interventions could likely be spread to other settings where an INR is included as part of a “chest pain” panel. This may represent a substantial cost reduction opportunity on a national scale. Further work is needed in order to assess long term sustainability, which can be supported by employing high effectiveness mechanisms such as automation of optimal behaviour.
Nipah virus (NiV) outbreak occurred in Kozhikode district, Kerala, India in 2018 with a case fatality rate of 91% (21/23). In 2019, a single case with full recovery occurred in Ernakulam district. We described the response and control measures by the Indian Council of Medical Research and Kerala State Government for the 2019 NiV outbreak. The establishment of Point of Care assays and monoclonal antibodies administration facility for early diagnosis, response and treatment, intensified contact tracing activities, bio-risk management and hospital infection control training of healthcare workers contributed to effective control and containment of NiV outbreak in Ernakulam.
Injecting drug users experience higher rates of death and poorer health than their non-injecting peers.
Accurate assessment of drug users physical health needs forms an essential precursor to treatment.
To determine the completeness of documentation and accuracy of medical evaluation for a sample of injecting drug users.
To establish the detection rate of medical co morbidity in injecting drug using patients.
20 injecting drug users were randomly selected from the computer database The case notes of each of these patients were then checked for any physical health documentation and the quality of the documentation.
The medical databases of the acute hospital were then checked to identify if these patients have presented there and the medical conditions with which they have presented.
The patients were then asked during their outpatient appointment about their physical health condition and the last time they have been checked by the GP.
80% of the patients had some health related information’s documented in the notes. However when these were compared with the history from the patients during the follow up OP appointments and medical notes, only 20% of the notes had good quality health documentation. 60% was found to meet standards.
50% of the patients had an acute hospital presentation with drug related complication. Of these 20% was in the previous 1 year. In terms of GP contact, 25% had seen the GP within the last 6 months and another 40% within the previous 1 year
To estimate the health-related quality of life (HRQOL) and impact of concurrent pain on HRQOL in patients seeking treatment for depression in a 6 month observational study in the United Kingdom (subsample results from pan-European study).
HRQOL was measured using two generic quality of life instruments: the Short Form 36 Health Status Survey (SF-36) and the EuroQol (EQ-5D). Pain was assessed using a visual analogue scale (range 0-100, no/mild pain [NMP] 0-29, clinically significant pain ≥30).
608 eligible patients were enrolled, mean age 42.8 years (SD 14.7) and 61.2% were female. 49.4% of patients reported NMP; 10.8% had significant pain from a co-morbid medical condition known to cause pain (PMC) and 39.8% had significant pain associated with a medical disorder not known to cause pain or without further co-morbidity (PD). SF-36 physical component scores were lowest in the PMC group, 36.7 (SD 9.7); with improving scores in the PD group, 44.4 (SD 10.0) and the NMP group, 54.5 (SD 8.3). There was no marked variation in mental component summary scores between the groups; 23.0 (SD 8.5), 20.4 (SD 9.1) and 21.7 (SD 10.8) respectively. A similar trend in HRQOL loss was observed for the EQ-5D health state index, where scores of 0.30 (SD 0.32), 0.41 (SD 0.30) and 0.60 (SD 0.25) were observed respectively.
A high proportion of patients presented with pain presumably related to depression. The presence of concurrent pain appears to be associated with reductions in SF-36 physical component scores and overall HRQOL (EQ-5D).
One in four people who attend hospital for physical health needs will have a mental health problem. the figures for patients over the age of 65 are significantly higher with 60% requiring mental health care during their hospital stay. (No Health without Mental Health, Academy of Medical Royal Colleges 2009).
Psychiatric co-morbidity affecting older people admitted to general hospitals is an independent predictor of poor outcome, including, increased mortality, length of stay, loss of independent function and discharge to care homes (Royal College of Psychiatrists, 2005).
To evaluate the quality of delivery of inpatient liaison psychiatry service to Mid Essex Hospitals.
To examine the referral pattern and reasons for referral.
To assess the timeliness of response and the effect of the consultation on the duration of stay.
To introduce measures to ensure better practice in the future.
All referrals to Old Age liaison psychiatry consultation service from August 2010 to February 2011 were identified from the computer database.
50 patients were randomly selected and their medical and psychiatric notes were analysed.
Information ‘s including Patient demographics, referring team, medical reason for admission, duration of stay, referral reason, clinical diagnosis, medical comorbidities, Psychiatric comorbidities and management by the liaison psychiatry team were collected using an audit tool.
The results have been collected and is currently being statistically analysed. They would available in the next few weeks.
The term endophenotype was first used by Gottesman to describe a trait that may be intermediate on the chain of causality from genes to diseases. An endophenotype may be neuropathological, neurocognitive, emotional, neuro-physiological or neurobiological in nature. There is dearth of studies about the use of neurocognive dysfunction as endophenotype marker of BPAD, particularly from developing countries.
Aim and Hypothesis-
We aimed to evaluate neurocognitive dysfunctions as endophenotype markers of bipolar affective disorder (BPAD) in first degree relative of BPAD patients. We hypothesized that first degree relative of BPAD patients differ significantly in regard to neurocognitive dysfunction from matched controls.
A cross sectional study was carried out. Sample was drawn from first degree relatives (FDR) of patients of BPAD and controls. After assessment of neurocognitive function first degree relatives of BPAD were compared with controls on measures of attention, verbal working memory, auditory verbal memory, Visuo spatial working memory, visual attention and executive functions.
Results indicated that, first degree relatives of BPAD scored poorly on measures of neurocognition then controls. On conducting comparison over composite neurocognitive score 'we found that cognitive index in combination better discriminate the first degree relatives of BPAD from controls.
Neurocognitive dysfunction on measures of attention, verbal episodic memory, auditory verbal working memory, visuospatial working memory and executive functions significantly differentiated first degree relatives of BPAD patients from controls.
60% of older people admitted to general hospital will have or develop a mental disorder (Department of Health, 2001). Mental disorder in this population is an independent predictor of poor outcome and is associated with increased mortality, greater length of stay, loss of independent function and higher rates of institutionalisation (The Royal College of Psychiatrists, 2005).
Aims & Objectives:
To examine if the liaison psychiatric intervention has improved the outcome for the patients and to introduce measures to improve quality, safety and efficiency within the service practice in the future
A total of 128 patients were referred to the geriatric liaison psychiatry service in a 6 months period between from an acute general hospital .50 patients were randomly selected from these referrals. Data's were collected from both the case notes as well as clinical information system using an audit data collection tool.
Majority (62%) were seen within 24 hours and 82% were seen within 48 hours. The main diagnosis was depression closely followed by dementia. Only a small minority (8%) of the patient needed inpatient psychiatric admission. 50% of the patients were discharged within a week of the Liaison assessment and majority of the cases (70%) patients were able to go back home.
Identification of mental illness in the acute hospital settings remains low. In spite of dementia being extremely common diagnosis, very few did appear to have been referred to the specialist memory service. Liaison Psychiatry intervention possibly improved outcomes for patients and the services.
The binary metal oxides are increasingly used as supercapacitor electrode materials in energy storing devices. Particularly NiCo2O4 has shown promising electrocapacitive performance with high specific capacitance and energy density. The electrocapacitive performance of these oxides largely depends on their morphology and electrical properties governed by their energy band-gaps and defects. The morphological structure of NiCo2O4 can be altered via the synthesis route, while the energy band-gap could be altered by doping. Also, doping can enhance crystal stability and bring in grain refinement, which can further improve the much-needed surface area for high specific capacitance. Given the above, this study evaluates the electrochemical performance of Ca-doped Ni1-xCaxCo2O4 (0 ≤ x ≤ 0.8) compounds. This stipulates promising applications for electrodes in future supercapacitors.
To assess the effect of tranexamic acid in head and neck surgical procedures.
A prospective, double-blind and randomised, parallel group, placebo-controlled clinical trial was conducted. Ninety-two patients undergoing various head and neck surgical procedures were randomised. Subjects received seven infusions of coded drugs (tranexamic acid or normal saline) starting at the time of skin closure. Haematological, biochemical, blood loss and other parameters were observed by the staff, who were blinded to patients’ group allocation (case or control).
Patients were analysed on the basis of type of surgery. Fifty patients who had undergone surgical procedures, including total thyroidectomy, total parotidectomy, and various neck dissections with or without primary tumour excision, were included in the first group. The second group comprised 41 patients who had undergone hemithyroidectomy, lobectomy or superficial parotidectomy. There was no statistical difference in blood parameters between both groups. There was a reduction in post-operative drain volume, but this was not significant.
Although this prospective, randomised, placebo-controlled clinical trial found a reduction in post-operative drain volume in tranexamic acid groups, the difference was not statistically significant between the various head and neck surgical procedure groups.
Mycetoma is a chronic granulomatous, suppurative and progressive inflammatory disease that usually involves the subcutaneous tissue and bones after traumatic inoculation of the causative organism. In India, actinomycotic mycetoma is prevalent in south India, south-east Rajasthan and Chandigarh, while eumycetoma, which constitutes one third of the total cases, is mainly reported from north India and central Rajasthan. The objective was to determine the epidemiological profile and spectrum of eumycetoma from a tertiary care hospital in Delhi, North India. Thirty cases of eumycetoma were diagnosed by conventional methods of direct microscopy, culture and species-specific sequencing as per standard protocol. The spectrum of fungal pathogens included Exophiala jeanselmei, Madurella mycetomatis, Fusarium solani, Sarocladium kiliense, Acremonium blochii, Aspergillus nidulans, Fusarium incarnatum, Scedosporium apiospermum complex, Curvularia lunata and Medicopsis romeroi. Eumycetoma can be treated with antifungal therapy and needs to be combined with surgery. It has good prognosis if it is timely diagnosed and the correct species identified by culture for targeted therapy of these patients. Black moulds required prolonged therapy. Its low reporting and lack of familiarity may predispose patients to misdiagnosis and consequently delayed treatment. Hence health education and awareness campaign on the national and international level in the mycetoma belt is crucial.
We study the setting up of relativistic ponderomotive non-linearity in an under-dense collisionless cold plasma. Using the fluid model, coupled system of equations of the laser beam and electron plasma oscillations has been derived. We present the numerical simulation for this coupled system of equations, when the coupling arises through relativistic ponderomotive non-linearity. The filamentation of the laser beam has been found to vary appreciably with perturbation wave number. The results show that with time, localized structures become more complex and the plasma oscillation frequency spectra have several harmonic peaks at terahertz frequencies when the electron plasma frequency is in terahertz range and laser frequency is around 2.35 × 1015 rad/s. We also present the semi-analytical model to capture the underlying physics.
Biochar has received attention due to its potential for mitigating climate change through carbon sequestration in soil and improving soil quality and crop productivity. This study evaluated the effects of rice straw biochar (RSB) and rice husk ash (RHA) each applied at 5 Mg ha−1 and four N levels (0, 40, 80, and 120 kg ha−1) on soil fertility, growth, and yield of rice and wheat for three consecutive rice–wheat rotations. RSB significantly increased electrical conductivity, dehydrogenase activity, and P and K contents when compared to control (no amendment) up to 7.5 cm soil depth. Both RSB and RHA did not influence shoot N concentration in wheat plant but significantly increased P and K concentrations at 60 days after sowing. Grain yields of both rice and wheat were significantly higher in RSB as compared to control (no amendment) and RHA treatments. While the highest grain yields of rice and wheat were observed at 120 kg N ha−1 in RHA and no biochar-treated plots, a significant increase in grain yields was observed at 80 kg N ha−1 in RSB treatment, thereby saving 40 kg N ha−1 in each crop. Both agronomic and recovery N efficiencies in rice and wheat were significantly higher in RSB-amended soil compared to control. Significant positive correlations were observed between soil N, P, and K concentrations and total N, P, and K concentrations in aboveground biomass of wheat at 60 days after sowing. This study showed the potential benefits of applying RSB for improving soil fertility and yields of rice and wheat in a rice–wheat system.
To compare round window niche visibility as seen endoscopically during cochlear implant surgery with pre-operative high-resolution computed tomography of the temporal bone.
Nineteen patients scheduled for cochlear implantation, aged 2–20 years, were referred for computed tomography from October 2016 to March 2018. Angles were measured between the lines passing through the mid-sagittal plane and cochlear basal turn on the scans. Endoscopic round window niche visibility during posterior tympanotomy was categorised as: type I = 100 per cent, type IIa = more than 50 per cent, type IIb = less than 50 per cent or type III = 0 per cent. Pre-operative computed tomography measurements were used to predict round window niche visibility before surgery and correlated with intra-operative findings.
The mean (range) of pre-operative angles on computed tomography for endoscopic visibility types I, IIa and IIb, were 64.06° (61.16–69.37°), 63.81° (58.61–71.35°) and 56.48° (50.37–59.05°), respectively, a statistically significant finding (one-way analysis of variance test, p = 0.016).
Pre-operative high-resolution temporal bone computed tomography measurements are useful in predicting round window niche visualisation as viewed endoscopically during posterior tympanotomy. The angle was more acute in type IIb compared to type I.
A mother's nutritional choices while pregnant may have a great influence on her baby's development in the womb and during infancy. There is evidence that what a mother eats during pregnancy interacts with her genes to affect her child's susceptibility to poor health outcomes including childhood obesity, pre-diabetes, allergy and asthma. Furthermore, after what an infant eats can change his or her intestinal bacteria, which can further influence the development of these poor outcomes. In the present paper, we review the importance of birth cohorts, the formation and early findings from a multi-ethnic birth cohort alliance in Canada and summarise our future research directions for this birth cohort alliance. We summarise a method for harmonising collection and analysis of self-reported dietary data across multiple cohorts and provide examples of how this birth cohort alliance has contributed to our understanding of gestational diabetes risk; ethnic and diet-influences differences in the healthy infant microbiome; and the interplay between diet, ethnicity and birth weight. Ongoing work in this birth cohort alliance will focus on the use of metabolomic profiling to measure dietary intake, discovery of unique diet–gene and diet–epigenome interactions, and qualitative interviews with families of children at risk of metabolic syndrome. Our findings to-date and future areas of research will advance the evidence base that informs dietary guidelines in pregnancy, infancy and childhood, and will be relevant to diverse and high-risk populations of Canada and other high-income countries.