Search

The sustainability of the salmon farming industry is being challenged by increased mortality rates. Scotland’s open-source salmon production data provides the possibility of developing an industry-wide mortality monitoring model, valuable for identifying and addressing unexpected increases in mortality without needing data sharing agreements across different companies. This study aimed to utilize these data to develop a hierarchical dynamic linear model (DLM) for monitoring monthly mortality of maricultured Atlantic salmon in Scotland. We evaluated whether considering the hierarchical structure present in the data (country, region, and site) would improve mortality predictions when compared to the production cycle level DLMs developed in a previous study. Our findings demonstrated that the hierarchical DLM outperformed the production cycle level DLMs, confirming the value of this more complex modelling approach. Nevertheless, the hierarchical model, like the production cycle level DLMs, exhibited some uncertainty in the mortality predictions. When mortality is higher than expected, site level warnings are generated, which can encourage producers and inspectors to further investigate the cause. Between 2015 and 2020, approximately 25% of the production cycles and 50% of the sites encountered at least one warning, with most warnings happening in the summer and autumn months. Additionally, the hierarchical model enabled monitoring mortality at multiple levels. This information is useful for various stakeholders as part of a monitoring system, offering insights into mortality trends at national, regional, and sites levels that may benefit from strategic resource management. Recommendations for model improvements include utilizing shorter data aggregation periods, such as weekly, which are not currently available as open-source data.

The mortality of Atlantic salmon is one of the main challenges to achieving its sustainable production. This sector benefits from generating many data, some of which are collated in a standardized way, on a monthly basis at site level, and are accessible to the public. This continuously updated resource might provide opportunities to monitor mortality and prompt producers and inspectors to further investigate when mortality is higher than expected. This study aimed to use the available open-source data to develop production cycle level dynamic linear models (DLMs) for monitoring monthly mortality of maricultured Atlantic salmon in Scotland. To achieve this, several production cycle level DLMs were created: one univariate DLM that includes just mortality; and various multivariate DLMs that include mortality and different combinations of environmental variables. While environmental information is not collated in a standardized way across all sites, open-source remote-sensed satellite resources provide continuous, standardized estimates. By combining environmental and mortality data, we seek to investigate whether adding environmental variables enhanced the estimates of mortality, and if so, which variables were most informative in this respect. The multivariate model performed better than the univariate DLM (P = .004), with salinity as the only significant contributor out of 12 environmental variables. Both models exhibited uncertainty related to the mortality estimates. Warnings were generated when any observation fell above the 95% credible interval. Approximately 30% of production cycles and more than 50% of sites experienced at least one warning between 2015 and 2020. Occurrences of these warnings were non-uniformly distributed across space and time, with the majority happening in the summer and autumn months. Recommendations for model improvement include employing shorter time periods for data aggregation, such as weekly instead of on a monthly basis. Furthermore, developing a model that takes hierarchical relationships into account could offer a promising approach.

Summary: A recurring trend in evidence scrutinized over the past few decades is that disease outbreaks will become more frequent, intense, and widespread on land and in water, due to climate change. Pathogens and the diseases they inflict represent a major constraint on seafood production and yield, and by extension, food security. The risk(s) for fish and shellfish from disease is a function of pathogen characteristics, biological species identity, and the ambient environmental conditions. A changing climate can adversely influence the host and environment, while augmenting pathogen characteristics simultaneously, thereby favoring disease outbreaks. Herein, we use a series of case studies covering some of the world’s most cultured aquatic species (e.g., salmonids, penaeid shrimp, and oysters), and the pathogens (viral, fungal, bacterial, and parasitic) that afflict them, to illustrate the magnitude of disease-related problems linked to climate change.

Abstract Background As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential to balance the potential benefits of surgical treatment against the risk of permanent loss of functional capacity and quality of life due to complications. European and US guidelines on perioperative care recommend preoperative multidisciplinary team (MDT) discussions for high-risk noncardiac surgical patients. However, the evidence underlying benefits from preoperative MDT meetings with all relevant perioperative specialties present is limited. The current study aims to investigate the effect of implementation of preoperative MDT discussions for high-risk patients undergoing noncardiac surgery on serious adverse events. Methods/design PREPARATION is a stepped-wedge cluster randomized trial in 14 Dutch hospitals without currently established preoperative MDT meeting. The intervention, preoperative MDT meetings, will be implemented sequentially with seven blocks of 2 hospitals switching from control (preoperative screening as usual) to the intervention every 3 months. Each hospital will be randomized to one of seven blocks. We aim to include 1200 patients. The primary outcome is the incidence of serious adverse events at 6 months. Secondary outcomes include (cost)effectiveness, functional outcome, and quality of life for up to 12 months. Discussion PREPARATION is the first study to assess the effectiveness of a preoperative MDT meeting for high-risk noncardiac surgical patients in the presence of an anesthesiologist. If the results suggest that preoperative MDT discussions for high-risk patients are (cost)-effective, the current study facilitates implementation of preoperative MDT meetings in clinical practice. Trial registration ClinicalTrials.gov NCT05703230. Registered on 11/09/2022.

ObjectiveApproximately 50% of adolescents who have undergone scoliosis surgery still experience severe pain one year postoperatively. We explored the postoperative pain trajectory and the potential value of preoperative Thermal Quantitative Sensory Testing (T-QST) as predictor of chronic postsurgical pain after scoliosis surgery.DesignSingle-center prospective cohort study in adolescents undergoing scoliosis surgery.OutcomesPrevalence of chronic postsurgical pain (CPSP) one year after scoliosis surgery and postsurgical pain course during this year. The need for rescue medication and the relationship between pre-operative T-QST, acute pain and CPSP.ResultsThirty-nine patients (mean age 13.9 years; SD 1.9 years) completed the study. One year postoperatively, ten patients (26%) self-reported pain [numeric rating scale (NRS) score ≥ 4]) when moving and two (5%) when in rest. Four of these patients (10.3%) experienced neuropathic pain. The pre-operative cold pain threshold was lower (p = 0.002) in patients with CPSP at 12 months. Preoperative cold and heat pain thresholds were correlated with the number of moderate or severe pain reports (NRS ≥ 4) in the first week postoperatively (r -.426; p = 0.009 and r.392; p = 0.016, respectively).ConclusionsOne year after scoliosis surgery, a significant part of patients (26%) still reported pain, some with neuropathic characteristics. Better diagnosis and treatment is needed; our study suggests that T-QST could be further explored to better understand and treat children with this negative outcome.

Abstract Background Although medication reconciliation (MedRec) is mandated and effective in decreasing preventable medication errors during transition of care, hospitals implement MedRec differently. Objective Quantitatively compare the number and type of MedRec interventions between hospitals upon admission and discharge, followed by a qualitative analysis on potential reasons for differences. Methods This explanatory retrospective mixed-method study consisted of a quantitative and a qualitative part. Patients from six hospitals and six different wards i.e. orthopaedics, surgery, pulmonary diseases, internal medicine, cardiology and gastroenterology were included. At these wards, MedRec was implemented both on hospital admission and discharge. The number of pharmacy interventions was collected and classified in two subcategories. First, the number of interventions to resolve unintended discrepancies (elimination of differences between listed medication and the patient’s actual medication use). And second, the number of medication optimizations (optimization of pharmacotherapy e.g. eliminating double medication). Based on these quantitative results and interviews, a focus group was performed to give insight in local MedRec processes to address differences in context between hospitals. Descriptive analysis (quantitative) and content analysis (qualitative) was used. Results On admission 765 (85%) patients from six hospitals, received MedRec by trained nurses, pharmacy technicians, pharmaceutical consultants or pharmacists. Of those, 36–95% (mean per patient 2.2 (SD ± 2.4)) had at least one discrepancy. Upon discharge, these numbers were among 632 (70%) of patients, 5–28% (mean per patient 0.7 (SD 1.2)). Optimizations in pharmacotherapy were implemented for 2% (0.4–3.7 interventions per patient upon admission) to 95% (0.1–1.7 interventions per patient upon discharge) of patients. The main themes explaining differences in numbers of interventions were patient-mix, the type of healthcare professionals involved, where and when patient interviews for MedRec were performed and finally, embedding and extent of medication optimization. Conclusions Hospitals differed greatly in the number of interventions performed during MedRec. Differences in execution of MedRec and local context determines the number of interventions. This study can support hospitals who want to optimize MedRec processes.

Abstract Aims Visceral adipose tissue inflammation is a fundamental mechanism of insulin resistance in obesity and type 2 diabetes. Translocation of intestinal bacteria has been suggested as a driving factor for the inflammation. However, although bacterial DNA was detected in visceral adipose tissue of humans with obesity, it is unclear to what extent this is contamination or whether the gut microbiota is causally involved. Effects of fecal microbiota transplantation (FMT) on bacterial translocation and visceral adipose tissue inflammation in individuals with obesity and insulin resistance were assessed. Material and Methods Eight individuals with clinically severe obesity (body mass index [BMI] >35 kg/m2) and metabolic syndrome received lean donor FMT 4 weeks prior to elective bariatric surgery. The participants were age‐, sex‐, and BMI‐matched to 16 controls that underwent no fecal transplantation. Visceral adipose tissue was collected during surgery. Bacterial translocation was assessed by 16S rRNA gene sequencing of adipose tissue and feces. Pro‐inflammatory cytokine expression and histopathological analyses of visceral adipose tissue were performed to assess inflammation. Results Fecal microbiota transplantation significantly altered gut microbiota composition. Visceral adipose tissue contained a very low quantity of bacterial DNA in both groups. No difference in visceral bacterial DNA content between groups was observed. Also, visceral expression of pro‐inflammatory cytokines and macrophage infiltration did not differ between groups. No correlation between inflammatory tone and bacterial translocation was observed. Conclusions Visceral bacterial DNA content and level of inflammation were not altered upon FMT. Thus, bacterial translocation may not be the main driver of visceral adipose tissue inflammation in obesity.

Introduction: This study reports on the translation, cultural adaptation, and validation of a Portuguese version of the Rotterdam Elderly Pain Observation Scale (REPOS), a Dutch scale to assess pain in patients who cannot communicate, with or without dementia. Methods: This is a multicenter study in pain and neurological units involving Brazil (clinical phase) and the Netherlands (training phase). We performed a retrospective cross-sectional, 2-staged analysis, translating and culturally adapting the REPOS to a Portuguese version (REPOS-P) and evaluating its psychometric properties. Eight health professionals were trained to observe patients with low back pain. REPOS consists of 10 behavioral items scored as present or absent after a 2-min observation. The REPOS score of ≥3 in combination with the Numerical Rating Scale (NRS) of ≥4 indicated pain. The Content Validity Index (CVI) in all items and instructions showed CVI values at their maximum. According to the higher correlation coefficient found between NRS and REPOS-P, it may be suggested that there was an adequate convergent validity. Results: The REPOS-P was administered to 80 patients with a mean age of 60 years (SD 11.5). Cronbach’s alpha coefficient showed a moderate internal consistency of REPOS-P (α = 0.62), which is compatible with the original study of REPOS. All health professionals reached high levels of interrater agreement within a median of 10 weeks of training, assuring reproducibility. Cohen’s kappa was 0.96 (SD 0.03), and the intraclass correlation coefficient was 0.98 (SD 0.02), showing high reliability of REPOS-P scores between the trainer (researcher) and the trainees (healthcare professionals). The Pearson correlation coefficient was 0.95 (95% confidence interval 0.94–0.97), showing a significant correlation between the total scores of REPOS-P and NRS. Conclusion: The REPOS-P was a valuable scale for assessing elderly patients with low back pain by different healthcare professionals. Short application time, ease of use, clear instructions, and the brief training required for application were essential characteristics of REPOS-P.

The sustainability of the salmon farming industry is being challenged by increased mortality rates. Scotland's open-source salmon production data provides the possibility of developing an industry-wide mortality monitoring model, valuable for identifying and addressing unexpected increases in mortality without needing data sharing agreements across different companies. This study aimed to utilize these data to develop a hierarchical dynamic linear model (DLM) for monitoring monthly mortality of maricultured Atlantic salmon in Scotland. We evaluated whether considering the hierarchical structure present in the data (country, region, and site) would improve mortality predictions when compared to the production cycle level DLMs developed in a previous study. Our findings demonstrated that the hierarchical DLM outperformed the production cycle level DLMs, confirming the value of this more complex modelling approach. Nevertheless, the hierarchical model, like the production cycle level DLMs, exhibited some uncertainty in the mortality predictions. When mortality is higher than expected, site level warnings are generated, which can encourage producers and inspectors to further investigate the cause. Between 2015 and 2020, approximately 25% of the production cycles and 50% of the sites encountered at least one warning, with most warnings happening in the summer and autumn months. Additionally, the hierarchical model enabled monitoring mortality at multiple levels. This information is useful for various stakeholders as part of a monitoring system, offering insights into mortality trends at national, regional, and sites levels that may benefit from strategic resource management. Recommendations for model improvements include utilizing shorter data aggregation periods, such as weekly, which are not currently available as open-source data. [ABSTRACT FROM AUTHOR]

The mortality of Atlantic salmon is one of the main challenges to achieving its sustainable production. This sector benefits from generating many data, some of which are collated in a standardized way, on a monthly basis at site level, and are accessible to the public. This continuously updated resource might provide opportunities to monitor mortality and prompt producers and inspectors to further investigate when mortality is higher than expected. This study aimed to use the available open-source data to develop production cycle level dynamic linear models (DLMs) for monitoring monthly mortality of maricultured Atlantic salmon in Scotland. To achieve this, several production cycle level DLMs were created: one univariate DLM that includes just mortality; and various multivariate DLMs that include mortality and different combinations of environmental variables. While environmental information is not collated in a standardized way across all sites, open-source remote-sensed satellite resources provide continuous, standardized estimates. By combining environmental and mortality data, we seek to investigate whether adding environmental variables enhanced the estimates of mortality, and if so, which variables were most informative in this respect. The multivariate model performed better than the univariate DLM (P = .004), with salinity as the only significant contributor out of 12 environmental variables. Both models exhibited uncertainty related to the mortality estimates. Warnings were generated when any observation fell above the 95% credible interval. Approximately 30% of production cycles and more than 50% of sites experienced at least one warning between 2015 and 2020. Occurrences of these warnings were non-uniformly distributed across space and time, with the majority happening in the summer and autumn months. Recommendations for model improvement include employing shorter time periods for data aggregation, such as weekly instead of on a monthly basis. Furthermore, developing a model that takes hierarchical relationships into account could offer a promising approach. [ABSTRACT FROM AUTHOR]

Abstract Background In palliative care, administration of opioids is often indispensable for pain treatment. Pain assessment may help recognize pain and guide treatment in non-communicative patients. In the Netherlands the Rotterdam Elderly Pain Observation Scale (REPOS) is recommended to this aim, but not yet validated. Therefore the objective of this study was to validate the REPOS in non-communicative or unconscious end-of-life patients. Methods In this observational study, the primary researcher applied the REPOS, while both the researcher and a nurse applied the Numeric Rating Scale (NRS). If possible, the patient in question applied the NRS as well. The NRS scores were compared with the REPOS scores to determine concurrent validity. REPOS scores obtained before and after a pain-reducing intervention were analysed to establish the scale’s sensitivity to change. Results A total of 183 REPOS observations in 100 patients were analysed. Almost 90% of patients had an advanced malignancy; observations were done a median of 3 days (IQR 1 to 13) before death. Internal consistency of the REPOS was 0.73. The Pearson product moment correlation coefficient ranged from 0.64 to 0.80 between REPOS and NRS scores. REPOS scores declined with median 2 points (IQR 1 to 4) after a pain-reducing intervention (p

Abstract Background The number of bariatric interventions for morbid obesity is increasing worldwide. Rapid weight loss is a major risk factor for gallstone development. Approximately 11 % of patients who underwent Roux-en-Y gastric bypass develop symptomatic gallstone disease. Gallstone disease can lead to severe complications and often requires hospitalization and surgery. Ursodeoxycholic acid (UDCA) prevents the formation of gallstones after bariatric surgery. However, randomized controlled trials with symptomatic gallstone disease as primary endpoint have not been conducted. Currently, major guidelines make no definite statement about postoperative UDCA prophylaxis and most bariatric centers do not prescribe UDCA. Methods A randomized, placebo-controlled, double-blind multicenter trial will be performed for which 980 patients will be included. The study population consists of consecutive patients scheduled to undergo Roux-en-Y gastric bypass or sleeve gastrectomy in three bariatric centers in the Netherlands. Patients will undergo a preoperative ultrasound and randomization will be stratified for pre-existing gallstones and for type of surgery. The intervention group will receive UDCA 900 mg once daily for six months. The placebo group will receive similar-looking placebo tablets. The primary endpoint is symptomatic gallstone disease after 24 months, defined as admission or hospital visit for symptomatic gallstone disease. Secondary endpoints consist of the development of gallstones on ultrasound at 24 months, number of cholecystectomies, side-effects of UDCA and quality of life. Furthermore, cost-effectiveness, cost-utility and budget impact analyses will be performed. Discussion The UPGRADE trial will answer the question whether UDCA reduces the incidence of symptomatic gallstone disease after Roux-en-Y gastric bypass or sleeve gastrectomy. Furthermore it will determine if treatment with UDCA is cost-effective. Trial registration Netherlands Trial Register (trialregister.nl) 6135 . Date registered: 21-Nov-2016.

Background: As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential to balance the potential benefits of surgical treatment against the risk of permanent loss of functional capacity and quality of life due to complications. European and US guidelines on perioperative care recommend preoperative multidisciplinary team (MDT) discussions for high-risk noncardiac surgical patients. However, the evidence underlying benefits from preoperative MDT meetings with all relevant perioperative specialties present is limited. The current study aims to investigate the effect of implementation of preoperative MDT discussions for high-risk patients undergoing noncardiac surgery on serious adverse events. Methods/design: PREPARATION is a stepped-wedge cluster randomized trial in 14 Dutch hospitals without currently established preoperative MDT meeting. The intervention, preoperative MDT meetings, will be implemented sequentially with seven blocks of 2 hospitals switching from control (preoperative screening as usual) to the intervention every 3 months. Each hospital will be randomized to one of seven blocks. We aim to include 1200 patients. The primary outcome is the incidence of serious adverse events at 6 months. Secondary outcomes include (cost)effectiveness, functional outcome, and quality of life for up to 12 months. Discussion: PREPARATION is the first study to assess the effectiveness of a preoperative MDT meeting for high-risk noncardiac surgical patients in the presence of an anesthesiologist. If the results suggest that preoperative MDT discussions for high-risk patients are (cost)-effective, the current study facilitates implementation of preoperative MDT meetings in clinical practice. Trial registration: ClinicalTrials.gov NCT05703230. Registered on 11/09/2022. [ABSTRACT FROM AUTHOR]