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Kathryn King,1 Serena McGuinness,1 Natalie Watson,1 Christine Norton,1 Trudie Chalder,2 Wladyslawa Czuber-Dochan1 1Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK; 2Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKCorrespondence: Kathryn King, Email Kathryn.king@kcl.ac.ukPurpose: Between 53% and 75% of people with inflammatory bowel disease, 30%– 80% with rheumatoid arthritis, and up to 50% with multiple sclerosis do not take medications as prescribed to maintain remission. This scoping review aimed to identify effective adherence interventions for inflammatory bowel disease, but with few studies found, multiple sclerosis and rheumatoid arthritis were included to learn lessons from other conditions.Methods: Full and pilot randomised controlled trials testing medication adherence interventions for inflammatory bowel disease, multiple sclerosis, and rheumatoid arthritis conducted between 2012 and 2021 were identified in six electronic databases.Results: A total of 3024 participants were included from 24 randomised controlled trials: 10 pilot and 14 full studies. Eight investigated inflammatory bowel disease, 12 rheumatoid arthritis, and four multiple sclerosis. Nine studies (37.5%) reported significantly improved medication adherence, all involving tailored, personalised education, advice or counselling by trained health professionals, with five delivered face-to-face and 1:1. Quality of effective interventions was mixed: five rated high quality, two medium and two low quality. Interventions predominantly using technology were likely to be most effective. Secondary tools, such as diaries, calendars and advice sheets, were also efficient in increasing adherence. Only 10 interventions were based on an adherence theory, of which four significantly improved adherence.Conclusion: Tailored, face-to-face, 1:1 interactions with healthcare professionals were successful at providing personalised adherence support. Accessible, user-friendly technology-based tools supported by calendars and reminders effectively enhanced adherence. Key components of effective interventions should be evaluated and integrated further into clinical practice if viable, whilst being tailored to inflammatory conditions.Plain Language Summary: Introduction: Inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA) are inflammatory diseases where the immune system causes inflammation by mistakenly attacking itself. These lifelong conditions cannot be cured, but can usually be controlled by medication. Medication is most effective when taken as prescribed, called “adherence”. For multiple reasons, between five and eight in 10 people with IBD, RA, and MS do not take medications as advised. This review aimed to identify research that tested ways to help people living with IBD, MS, and RA take medications as prescribed. Identifying and understanding what helps can increase patient well-being and improve quality of life through better controlled inflammatory conditions.Methods: Studies testing medication adherence interventions for IBD, MS, and RA conducted between 2012 and 2021 were identified from six electronic databases.Results: A total of 3024 people with inflammatory conditions took part in 24 studies (eight on IBD, four on MS, and 12 on RA). Nine studies reported significantly improved medication adherence, all involving personalised education, advice or counselling by trained health professionals, with five delivered face-to-face and individually. Interventions predominantly using technology were the most effective. Diaries, calendars, and advice sheets also increased adherence. Ten of the interventions were based on an adherence theory, of which four improved adherence.Conclusions: Personalised adherence support was successful when:tailored to patient,one-to-one and face-to-face,with healthcare professionals,involving technology-based tools, andsupported by calendars/reminders.Components of effective interventions should be used in clinical practice where possible, made specific to each inflammatory condition.Keywords: IBD, MS, RA, treatment, medicine, drug, concordance

In the network of reactions present in the Big Bang nucleosynthesis, the 3He(n, p)3H has an important role which impacts the final 7Li abundance. The Trojan Horse Method (THM) has been applied to the 3He(d, pt)H reaction in order to extract the astrophysical S(E)-factor of the 3He(n, p)3H in the Gamow energy range. The experiment will be described in the present work together with the first preliminary results.

This article discusses the challenges of completing advanced endoscopic procedures, such as EUS and ERCP, in a single session under conscious sedation. The use of enhanced sedation, specifically propofol, is recommended to optimize outcomes. However, the administration of propofol by non-anesthesiologists is restricted in Irish endoscopy, and access to propofol sedation delivered by an anesthesiologist is limited. The study analyzed a database of ERCP procedures and found that successful biliary cannulation was more difficult in combined EUS/ERCP cases under conscious sedation. The use of propofol sedation was beneficial in facilitating complex biliary endoscopy cases, particularly EUS/FNA procedures. [Extracted from the article]

Intrathecal morphine is an analgesic option for major hepatopancreaticobiliary procedures but is associated with a risk of respiratory depression. We hypothesised that a postoperative low-dose naloxone infusion would reduce the incidence of respiratory depression without an increase in pain scores. Patients scheduled for major open hepatopancreaticobiliary surgery and who were receiving 10 μg.kg-1 intrathecal morphine were eligible for inclusion. Patients were allocated randomly to receive a postoperative infusion of naloxone 5 μg.kg-1 .h-1 (naloxone group) or saline at an identical infusion rate (control group) until the morning after surgery. Clinicians, nursing staff and patients were blinded to group allocation. The primary outcome measure was the incidence of respiratory depression (respiratory rate < 10 breaths.min-1 and/or oxygen saturation < 90%). Secondary outcome measures included: arterial partial pressure of carbon dioxide; pain score; requirement for supplemental analgesic; and incidence of nausea and vomiting, pruritus and sedation. In total, data from 95 patients (48 in the naloxone group and 47 in the control group) were analysed. The incidence of respiratory depression was lower in the naloxone group compared with the control group (10/48 vs. 21/47 patients, respectively; p = 0.037, relative risk 0.47 (95%CI 0.25-0.87). Maximum pain scores were greater for patients allocated to the naloxone group compared with control (median 5 (95%CI 4-6) vs. 4 (95%CI 2-4), respectively; p < 0.001). A low-dose naloxone infusion decreases the incidence of respiratory depression following intrathecal morphine administration in patients having major hepatopancreaticobiliary surgery at the expense of a small increase in postoperative pain. [ABSTRACT FROM AUTHOR]

Leprosy remains an important global health concern, but little has been published about its diagnosis and management in developed settings. It has been postulated that delay in diagnosis is common in developed settings. We reviewed all the cases of leprosy seen at a major tertiary referral centre between 1999 and 2013 and demonstrated that delay in diagnosis is common, especially when patients present with symptoms of leprosy reactions rather than classical symptoms, such as hypo-pigmented hypo-aesthetic skin lesions and neuropathy. [ABSTRACT FROM AUTHOR]

Evidence is building about the impact of environmental contaminants on patients and health care providers. The nurse administrator has a professional responsibility to provide leadership in assuring that the health care organization does not have a negative impact on health. This article presents critical environmental health concerns and an overview of the nursing profession efforts to improve the environment, which includes development of the American Nurses Association's Principles of Environmental Health for Nursing Practice with Implementation Strategies. An example is provided as to how the nurse administrator can use Appreciative Inquiry to harness the nurses collaborative energy for an environmentally healthy organization. [ABSTRACT FROM AUTHOR]

Work structures that empower nurses contribute to a healthy work environment yet there are few studies that have looked at the relationship between nurse participation in formal work structures and their perception of empowerment. Nurses involved in power-sharing activities demonstrate a greater commitment to the organization and have improved job satisfaction. To measure the perception of structural empowerment by nurses and examine the relationship between staff registered nurse participation in organizational structures and perceived structural empowerment. A descriptive correlational survey design was used to measure staff nurses' perception of structural empowerment, using the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II). A purposive sample of staff registered nurses (N = 122) at a large Veterans Affairs urban teaching hospital was recruited to complete an online survey. The response rate was 33%. Nurses perceived a moderate amount of structural empowerment and a greater sense of empowerment in the areas of opportunity, support, and collaboration on the CWEQ-II. The total mean score for the CWEQ-II (M = 18.50, SD = 3.63) indicated a moderate amount of perceived structural empowerment. Of the 4 CWEQ-II subscales, opportunity (M = 3.78, SD = 0.87) was moderately high. Resources (M = 3.04, SD = 0.72) and support (M = 2.92, SD = 0.94) were rated as moderate, and participants rated information moderately low (M = 2.75, SD = 0.88). On 2 scales that measured sources of organizational power, informal power was moderately high (M = 3.37, SD = 0.79) compared with formal power (M = 2.64, SD = 0.81), which scored moderately low. In comparing nurses who participated in councils with those who did not, there were no significant differences in their total or subscale scores on the CWEQ-II. Of those who did participate in councils (n = 48, 39.3%), the number of council meetings nurses attended correlated significantly with support (r = 0.37, P = .009). The percentage of time council members communicated information to their peers at the unit level correlated positively with informal power (r = 0.30, P = .04). Organizational structures that provide opportunities for nurses to participate in professional matters that are important to them support empowerment that is essential for a healthy work environment. [ABSTRACT FROM AUTHOR]

This study evaluated the criterion validity of the Outcome and Assessment Instrument Set (OASIS) items that measure activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive functioning, and depression. A convenience sample of patients (n = 203) from five home care agencies participated in the study. Patient OASIS items were compared to data collected using gold standard instruments. Correlations range from .44 to .69 for ADLs and .20 to .68 for IADLs. A correlation of .62 was found for cognitive functioning while correlations for depressive symptoms are .36 and .26. OASIS ADLs and cognitive status items are sufficiently valid, but the OASIS depression item is not sufficiently sensitive to the prevalence of these conditions. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Outcome and Assessment Information Set (OASIS) is the universal clinical assessment tool for adult nonmaternity patients receiving skilled care at home from Medicare-certified home health agencies in the United States. Anticipating increased use of OASIS data for research purposes, this article explored the usefulness of Rasch modeling to address disability measurement challenges presented by the unique response category structure of the seven activities of daily living (ADL) and eight instrumental ADL (IADL) items in the OASIS. OBJECTIVES: To illustrate how Rasch model statistics can be used to evaluate OASIS ADL and IADL item unidimensionality and model fit; to illustrate how Rasch modeling simultaneously estimates ADL and IADL item difficulty, thresholds between item response categories, and person disability; and to compare Rasch estimates of item difficulty and person disability scores to estimates based on more conventional Likert scoring techniques. SUBJECTS: Medicare-eligible home health care patients (n = 583) served by one of 12 home care agencies in Ohio between November 1999 and September 2000. MEASURES: ADL and IADL items were measured three ways: according to the original OASIS scoring (raw Likert); transformed raw Likert scores accounting for the nonuniform item structure (corrected Likert); and Rasch Partial Credit model scores. RESULTS: The items bathing and telephone use showed evidence of unexpected response patterns; recoding of these items was necessary for good Rasch model fit. Partial Credit model results revealed that interval distances between response categories varied widely across the 15 ADL and IADL items. When ADL and IADL items were ranked by level of difficulty, results were similar between Rasch and corrected Likert measurement approaches; however, corrected Likert person scores were found to be nonlinear at highest and lowest disability levels when plotted against Rasch person scores. CONCLUSIONS: Rasch modeling can help improve the precision of disability measurement in Medicare home care patients when using ADL and IADL items from the OASIS instrument. [ABSTRACT FROM AUTHOR]

Abstract Background Given the expanding scope of extracorporeal membrane oxygenation (ECMO) and its variable impact on drug pharmacokinetics as observed in neonatal studies, it is imperative that the effects of the device on the drugs commonly prescribed in the intensive care unit (ICU) are further investigated. Currently, there are no data to confirm the appropriateness of standard drug dosing in adult patients on ECMO. Ineffective drug regimens in these critically ill patients can seriously worsen patient outcomes. This study was designed to describe the pharmacokinetics of the commonly used antibiotic, analgesic and sedative drugs in adult patients receiving ECMO. Methods/Design This is a multi-centre, open-label, descriptive pharmacokinetic (PK) study. Eligible patients will be adults treated with ECMO for severe cardiac and/or respiratory failure at five Intensive Care Units in Australia and New Zealand. Patients will receive the study drugs as part of their routine management. Blood samples will be taken from indwelling catheters to investigate plasma concentrations of several antibiotics (ceftriaxone, meropenem, vancomycin, ciprofloxacin, gentamicin, piperacillin-tazobactum, ticarcillin-clavulunate, linezolid, fluconazole, voriconazole, caspofungin, oseltamivir), sedatives and analgesics (midazolam, morphine, fentanyl, propofol, dexmedetomidine, thiopentone). The PK of each drug will be characterised to determine the variability of PK in these patients and to develop dosing guidelines for prescription during ECMO. Discussion The evidence-based dosing algorithms generated from this analysis can be evaluated in later clinical studies. This knowledge is vitally important for optimising pharmacotherapy in these most severely ill patients to maximise the opportunity for therapeutic success and minimise the risk of therapeutic failure. Trial registration ACTRN12612000559819

Abstract Background A real-time multiplex PCR assay was developed for the detection of multiple Salmonella serotypes in chicken samples. Poultry-associated serotypes detected in the assay include Enteritidis, Gallinarum, Typhimurium, Kentucky and Dublin. The traditional cultural method according to EN ISO 6579:2002 for the detection of Salmonella in food was performed in parallel. The real-time PCR based method comprised a pre-enrichment step in Buffered Peptone Water (BPW) overnight, followed by a shortened selective enrichment in Rappaport Vasilliadis Soya Broth (RVS) for 6 hours and subsequent DNA extraction. Results The real-time multiplex PCR assay and traditional cultural method showed 100% inclusivity and 100% exclusivity on all strains tested. The real-time multiplex PCR assay was as sensitive as the traditional cultural method in detecting Salmonella in artificially contaminated chicken samples and correctly identified the serotype. Artificially contaminated chicken samples resulted in a detection limit of between 1 and 10 CFU per 25 g sample for both methods. A total of sixty-three naturally contaminated chicken samples were investigated by both methods and relative accuracy, relative sensitivity and relative specificity of the real-time PCR method were determined to be 89, 94 and 87%, respectively. Thirty cultures blind tested were correctly identified by the real-time multiplex PCR method. Conclusion Real-time PCR methodology can contribute to meet the need for rapid identification and detection methods in food testing laboratories.

BACKGROUND: Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes. METHODS: We randomly assigned adults with coma who had been resuscitated after out-ofhospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 1:1 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco2], 50 to 55 mm Hg) or normocapnia (target Paco2, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the use of the Glasgow Outcome Scale-Extended (range, 1 [death] to 8, with higher scores indicating better neurologic outcome) at 6 months. Secondary outcomes included death within 6 months. RESULTS: A total of 1700 patients from 63 ICUs in 17 countries were recruited, with 847 patients assigned to targeted mild hypercapnia and 853 to targeted normocapnia. A favorable neurologic outcome at 6 months occurred in 332 of 764 patients (43.5%) in the mild hypercapnia group and in 350 of 784 (44.6%) in the normocapnia group (relative risk, 0.98; 95% confidence interval [CI], 0.87 to 1.11; P=0.76). Death within 6 months after randomization occurred in 393 of 816 patients (48.2%) in the mild hypercapnia group and in 382 of 832 (45.9%) in the normocapnia group (relative risk, 1.05; 95% CI, 0.94 to 1.16). The incidence of adverse events did not differ significantly between groups. CONCLUSIONS: In patients with coma who were resuscitated after out-of-hospital cardiac arrest, targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months than targeted normocapnia. (Funded by the National Health and Medical Research Council of Australia and others; TAME ClinicalTrials.gov number, NCT03114033.) [ABSTRACT FROM AUTHOR]

This article reports that a distressed 8 year old child presented to the emergency department with part of a pencil sharpener firmly attached to the tip of her tongue. The small opening at the base of the aluminum globe had acted as a constricting ring, causing the tip of the tongue to swell and fill the contents of the globe. Although baseline observations were normal the patient was unable to swallow effectively and was only able to breathe through her nose.