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Editorial - The Value of Coronary CT Angiography in Patients with Stable Chest Pain
No full textCoronary artery disease (CAD) remains a major cause of morbidity and mortality worldwide. Despite advances in understanding the pathophysiology of CAD, studies demonstrating the implementation of these advances in diagnosis and therapy remain scarce. Clinical manifestations and conventional diagnostic methods, often limited in their ability to provide optimal clinical decisions, still guide most healthcare professionals. Non-invasive imaging techniques for CAD identification, crucial for improving risk stratification, are key in guiding patient management. While magnetic resonance imaging (MRI) provides detailed cardiac structure and function measurements, coronary computed tomographic angiography (CCTA) may offer superior diagnostic performance. Multiple large randomized clinical trials, including the landmark SCOT-HEART trial, have provided strong evidence supporting CCTA's utility in diagnosing and managing stable angina
Anatomic-Functional Frame for Middle Hepatic Vein Management in Right/Left Graft Living Donor Liver Transplantation: Venous Mapping in Healthy Human Livers
No full textObjectives: Variability in right and left hemiliver drainage volumes of the middle hepatic vein is of special relevance in living donor liver partitioning. Here, we present a comprehensive classification of middle hepatic vein drainage encompassing func-tional and anatomic components with special reference to middle hepatic vein management in adult living donor liver transplantation.
Materials and Methods: We evaluated 153 living donor livers among 100 cases of living donor liver transplantation. With 3-dimensional virtual venous reconstructions and maps, we addressed (1) hepatic venous dominance in the total liver, (2) middle hepatic vein/hemiliver-territorial belonging, (3) middle hepa-tic vein drainage contribution to right and left hemilivers based on middle hepatic vein/hemiliver-congestive volume index, and (4) middle hepatic vein anatomic branching patterns.
Results: With an established clinical threshold of 30% to 40% middle hepatic vein-congestive volume index for graft selection, a strong correlation between venous dominance, hemiliver belonging, and congestive volume index in overlap with anatomic branching classification was demonstrated. Functional middle hepatic vein variants b and c in overlap with middle hepatic vein branching types A and C implicated middle hepatic vein reconstruction/inclusion in right/left hemiliver grafts. Functional middle hepatic vein variant a (analog to middle hepatic vein branching type B) exhibited safe small congestive drainage volumes in both hemilivers.
Conclusions: The proposed middle hepatic vein classification addressed a triple correlation between hepatic vein (total liver volume) dominance and middle hepatic vein (hemiliver volume) belonging related to the middle hepatic vein-congestive volume index in right and left hemiliver as follows: (1) categorize functional middle hepatic vein variants based on congestion risk, (2) identify the left hepatic vein/left hemiliver non-congestive volume index as an additional key parameter in right graft selection, and (3) represent a predictive guide for middle hepatic vein management in right/left graft living donor liver transplantation
Differential impacts of addition and omission deviants on the working memory performance of adults with and without self-reported ADHD
No full textMany individuals usebackground noise to aid concentration on tasks, yet its effect on workingmemory, especially for those with ADHD, is not well understood. This studyexamined how background white noise influences short-term serial recall inadults with self-reported ADHD (n = 66) and those without (n = 66), controllingfor anxiety and depression. Participants performed a visual-verbal serialshort-term memory task under two conditions: continuous white noise interruptedby quiet intervals (omission deviant) and continuous quiet interrupted by whitenoise (addition deviant). Results showed that addition deviants disruptedperformance more in non-ADHD adults, while omission deviants had a greater disruptiveeffect on adults with self-reported ADHD. These findings suggest thatinterruptions in background sound may differently affect individuals with ADHDsymptoms. Exploratory analyses showed the absence of a primacy effect in adultswith self-reported ADHD. Future research might explore optimal auditoryenvironments tailored to attention differences in those with and without ADHD
Developing research collaborations and building capacity in palliative and end-of-life care in the north west coast of England: The PalCaRE-NWC partnership
Get PDFBackground: The North West Coast area of England (Lancashire, Merseyside, Cheshire, and South Cumbria) has high palliative care need (third highest prevalence in England) and historically low recorded NIHR research activity (second lowest research recruitment rate in England). To stimulate research activity a new research partnership was formed to support and encourage palliative care research, funded by the NIHR from January 2022 until June 2023.
Objectives:
i) Develop a sustainable palliative care research partnership infrastructure across North West Coast.
ii) Work with palliative care providers, patients and the public, and research staff to further understand local barriers and facilitators to palliative and end-of-life care research, and develop and implement solutions to these barriers.
iii) Build capacity in palliative and end-of-life care research through the mentorship of emerging research leaders and share expertise across organisations.
iv) Facilitate the development of high-quality research grant applications.
Activities: Phased activities were planned and actioned throughout the funded period to develop and embed an active palliative care research partnership across the region. These included: a survey and working groups to rapidly identify current local barriers to research and their sustainable solutions; individual and group support activities to build research capabilities and capacity; development and submission of high quality clinically relevant research proposals to the NIHR and other funders.
Results: Survey participants (n=293) were mainly from clinical settings (71%), with 45% being nurses. Whilst around three quarters of participants were not research active, most wanted to increase their involvement. Key barriers identified from both the survey and working groups (n=20 professional participants) included: lack of organisational research culture and capacity (including prioritisation and available time); research knowledge (including skills/expertise and funding opportunities); research infrastructure (including collaborative opportunities across multiple organisations and governance challenges); and patient and public perceptions of research (including vulnerabilities and burdens).
Based on these findings, the partnership is working with national stakeholders to develop user-friendly resources to facilitate hospice-based research. Three action learning sets, that met several times (n= 15 staff), and two networking events (n= 78 participants) took place to facilitate collaboration and research capacity building. Eleven research grant applications totalling £5,435,967 were submitted as a direct result of partnership activities between Jan2022-June 2023.
Limitations: Survey and working group findings and resulting activities represent the views and needs of staff within a particular UK geography and had limited public representation.
Conclusions:
Funding to support partnership work has been demonstrated to be effective in pump-priming research activities, leading to successful research grant submissions and building research capacity. However, consideration is needed about how to maintain partnership work, embed in local organisations, and further develop work across non-traditional stakeholders such as hospices and social care providers if ongoing funding is unavailable.
Future work: North West Coast CRN has provided short term funding (July 2023 to March 2024) to enable and sustain the expansion of PalCaRe-NWC
Dose-escalated Adaptive Radiotherapy for Bladder Cancer: Results of the Phase 2 RAIDER Randomised Controlled Trial
Get PDFDelivering radiotherapy to the bladder is challenging as it is a mobile, deformable structure. Dose-escalated adaptive image-guided radiotherapy could improve outcomes. RAIDER aimed to demonstrate the safety of such a schedule. RAIDER is an international phase 2 noncomparative randomised controlled trial (ISRCTN26779187). Patients with unifocal T2-T4a urothelial bladder cancer were randomised (1:1:2) to standard whole bladder radiotherapy (WBRT), standard-dose adaptive radiotherapy (SART), or dose-escalated adaptive radiotherapy (DART). Two fractionation (f) schedules recruited independently. WBRT and SART dose was 55 Gy/20f or 64 Gy/32f, and DART dose was 60 Gy/20f or 70 Gy/32f. For SART and DART, a radiotherapy plan (small, medium, or large) was chosen daily. The primary endpoint was the proportion of patients with radiotherapy-related late Common Terminology Criteria for Adverse Events grade ≥3 toxicity; the trial was designed to rule out >20% toxicity with DART. A total of 345 patients were randomised between October 2015 and April 2020: 41/46 WBRT, 41/46 SART, and 81/90 DART patients in the 20f/32f cohorts, respectively. The median age was 72/73 yr; 78%/85% had T2 tumours, 46%/52% had neoadjuvant chemotherapy, and 70%/71% had radiosensitising therapy. The median follow-up was 42.1/38.2 mo. Sixty-six of 77 (86%) 20f and 74 of 82 (90%) 32f participants planned for DART met the mandatory medium plan dose constraints. Radiotherapy-related grade ≥3 toxicity was reported in one of 58 patients (90% confidence interval [CI] 0.1, 7.9) with 20f DART and zero of 56 patients with 32f DART. Two-year overall survival was 77% (95% CI 69, 82) for WBRT + SART and 80% (95% CI 73, 85) for DART (hazard ratio = 0.84, 95% CI 0.59, 1.21, p = 0.4). Thirteen of 345 (3.8%) participants had salvage cystectomy. Grade ≥3 late toxicity was low. DART was safe and feasible to deliver, meeting preset toxicity thresholds. Disease-related outcomes are promising for dose-escalated treatments, with a low salvage cystectomy rate and overall survival similar to that seen in cystectomy cohorts
Detection asymmetry in solar energetic particle events
Get PDFContext. Solar energetic particles (SEPs) are detected in interplanetary space in association with flares and coronal mass ejections (CMEs) at the Sun. The magnetic connection between the observing spacecraft and the solar active region (AR) source of the event is a key parameter in determining whether SEPs are observed and the properties of the particle event. Aims. We investigate whether an east-west asymmetry in the detection of SEP events is present in observations and discuss its possible link to corotation of magnetic flux tubes with the Sun. Methods. We used a published dataset of 239 CMEs recorded between 2006 and 2017 and having source regions both on the front side and far side of the Sun as seen from Earth. We produced distributions of occurrence of in-situ SEP intensity enhancements associated with the CME events, versus \Delta \phi, the separation in longitude between the source active region and the magnetic footpoint of the observing spacecraft based on the nominal Parker spiral. We focused on protons of energy >10 MeV measured by the STEREO A, STEREO B and GOES spacecraft at 1 au. We also considered the occurrence of 71-112 keV electron events detected by MESSENGER between 0.31 and 0.47 au. Results. We find an east-west asymmetry in the detection of >10 MeV proton events and of 71-112 keV electron events. For protons, observers for which the source AR is on the east side of the spacecraft footpoint and not well connected (-180 0 it takes them away from it
Corrigendum to “Prevalence of mental health conditions and brain fog in people with long COVID: A systematic review and meta-analysis” [General Hospital Psychiatry volume 88 (2024)10–22 10.1016/j.genhosppsych.2024.02.009]
Get PDFDiscussing poverty within primary-care consultations: implications for mental health support
Get PDFBackground Poverty can have significant impacts on health and wellbeing. However, asking patients about their broader socio-economic circumstances is not routine within primary care consultations.
Aim To understand healthcare professionals’ experiences of communicating with patients about their socio-economic circumstances and how a bespoke training programme supported these conversations in routine consultations.
Design & setting Healthcare professionals from 30 GP practices across England received training to improve understanding and communication with patients about the ways that poverty impacted their mental health.
Method Semi-structured interviews were undertaken with 49 GPs and allied health professionals to understand barriers and enablers to communication around poverty and the impact of the training on their consultation practice.
Results Health professionals often lacked confidence in discussing socio-economic issues and welcomed information on how to do this sensitively. Asking questions relating to poverty-related stresses was felt to lead to better understanding around the causes of mental distress, avoidance of problematic assumptions and inappropriate antidepressant prescribing and to enable more coordinated and appropriate support from practice teams.
Conclusion Asking patients about their socio-economic circumstances can facilitate provision of appropriate support
Is anybody listening? Using participatory methods to co-create an impact measure for nurse education.
Get PDFFew impact measures in healthcare services and education are developed in full co-production with service users, patients and carers. This study aimed to address that gap. Service user and carer (patient and public) involvement in health and social care education is internationally recognised as crucial in helping to develop person-centred future professionals. The problem of how to ‘measure’ the impact of their involvement has become a dominant theme in the published literature in this field in recent years. Service users and carers also seek validation and assurance of their commitment and evidence to show they are making a difference. The drive towards co-production and co-design in education necessitates taking a fresh approach to evaluating the impact of involvement in higher education contexts and utilising the finite resource of service users and carers in the most effective way.
This four-staged doctoral study utilised participatory action research (PAR) methods to develop a measure of impact which could be used to evaluate the impact of public involvement in nurse education at a UK university. This article describes the early stages of this process which included a scoping study and qualitative data collection. It is beyond the scope of this article to include a description of the later development and testing of the impact measure. We hoped this would be useful to professionals developing and evaluating new approaches for pre-registration nurse education. Emphasis was given to service user and carers’ priorities throughout, in terms of appreciating their inputs and motivating future involvement in curriculum development.
This article includes reflections from the participatory group members which were shared throughout the study; we believe these contribute to the critical appraisal of PAR research. We will publish a full description of the development and testing stages of the measure in a later article
Putting earthworm conservation on the map: Shortfalls and solutions for developing earthworm conservation
Get PDFEarthworms are keystone organisms that influence both soil function and community assembly of other soil organisms. However, soils are increasingly threatened by global change, so there is an urgent need to consider earthworms in conservation strategies. Earthworm monitoring has been promoted in numerous European and country research programs, and the global interest in earthworm conservation is rising, resulting in a rapid increase in the availability of earthworm data. However, most research focuses on a limited number of local-scale indicators, mainly based on abundance, biomass, and species richness of assemblages along with Bouché's ecological categories. We argue that these metrics are insufficient to effectively address earthworm conservation issues. We suggest four ecological characteristics which may be more informative for the development of conservation plans. Measurement of how much a species is (i) rare or common, (ii) native/nonnative, endemic and invasive, (iii) a specialist or generalist, and (iv) a winner or loser in the Anthropocene are all promising tools to support earthworm diversity conservation. These metrics could also be applied to functional traits, but better definition of these traits is fundamental. Finally, we emphasize the need to broaden spatial scales in earthworm studies by analyzing alpha, beta and gamma components of diversity, as local diversity alone can be misleading