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It is unclear whether aspirin is beneficial for prevention of CVD in patients with CKD. We performed a secondary analysis of the ALLHAT trial to assess the effect of baseline aspirin use on nonfatal myocardial infarction (MI) or fatal coronary heart disease (CHD), all‐cause mortality, and stroke. Baseline characteristics of aspirin users and nonusers were used to generate propensity‐matched cohorts. Using conditional Cox proportional hazard regression models, we examined the effect of aspirin on the outcomes in the cohort at large and across 3 levels of kidney function (eGFR ≥90, 60–89, and

People who go missing in the wilderness make terrible decisions, but their mistakes are strangely predictable, says Michael Bond

Background and Aims\ud \ud This study evaluates a specialist weight management service and compares outcomes in participants referred to the service undergoing either surgery or non-surgical routes to support weight loss.\ud \ud \ud \ud Methods\ud \ud Four hundred and forty eight participants were assessed on various weight-related outcomes (body mass index [BMI], psychological distress, quality of life, nutrition, weight-related symptoms, physical activity) on referral to the service and on discharge. The effect of group (surgery or non-surgery) and time in the service were facilitated by doubly multivariate analyses of variance models.\ud \ud \ud \ud Results\ud \ud Between referral and discharge, participants improved significantly on a combination of outcomes (P

Study Design: Ambispective cohort study design. Objectives: Cervical spine metastases have distinct clinical considerations. The aim of this study was to determine the impact of surgical intervention (± radiotherapy) or radiotherapy alone on health-related quality of life (HRQOL) outcomes in patients treated for cervical metastatic spine tumours. Methods: Patients treated with surgery and/or radiotherapy for cervical spine metastases were identified from the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) international multicentre prospective observational study. Demographic, diagnostic, treatment, and HRQOL (numerical rating scale [NRS] pain, EQ-5D (3L), SF-36v2, and SOSGOQ) measures were prospectively collected at baseline, 6 weeks, 3 months, and 6 months postintervention. Results: Fifty-five patients treated for cervical metastases were identified: 38 underwent surgery ± radiation and 17 received radiation alone. Surgically treated patients had higher mean spinal instability neoplastic scores compared with the radiation-alone group (13.0 vs 8.0, P < .001) and higher NRS pain scores and lower HRQOL scores compared to the radiation alone group ( P < .05). From baseline to 6 months posttreatment, surgically treated patients demonstrated statistically significant improvements in NRS pain, EQ-5D (5L), and SOSGOQ2.0 scores compared with nonsignificant improvements in the radiotherapy alone group. Conclusions: Surgically treated cervical metastases patients presented with higher levels of instability, worse baseline pain and HRQOL scores compared with patients who underwent radiotherapy alone. Significant improvements in pain and HRQOL were noted for those patients who received surgical intervention. Limited or no improvements were found in those treated with radiotherapy alone.

‘After-hours’ non-elective spinal surgeries are frequently necessary, and often performed under sub-optimal conditions. This study aimed (1) to compare the characteristics of patients undergoing non-elective spine surgery ‘After-hours’ as compared to ‘In-hours’; and (2) to compare the perioperative adverse events (AEs) between those undergoing non-elective spine surgery ‘after-hours’ as compared to ‘in-hours’. In this retrospective study of a prospective non-elective spine surgery cohort performed in a quaternary spine center, surgery was defined as ‘in-hours’ if performed between 0700 and 1600 h from Monday to Friday or ‘after-hours’ if more than 50% of the operative time occurred between 1601 and 0659 h, or if performed over the weekend. The association of ‘after-hours’ surgery with AEs, surgical duration, intraoperative estimated blood loss (IOBL), length of stay and in-hospital mortality was analyzed using stepwise multivariate logistic regression. A total of 1440 patients who underwent non-elective spinal surgery between 2009 and 2013 were included in this study. A total of 664 (46%) procedures were performed ‘after-hours’. Surgical duration and IOBL were similar. About 70% of the patients operated ‘after-hours’ experienced at least one AE compared to 64% for the ‘in-hours’ group (p = 0.016). ‘After-hours’ surgery remained an independent predictor of AEs on multivariate analysis [adjusted OR 1.30, 95% confidence interval (CI) 1.02–1.66, p = 0.034]. In-hospital mortality increased twofold in patients operated ‘after-hours’ (4.4% vs. 2.1%, p = 0.013). This association lost significance on multivariate analysis (adjusted OR 1.99, 95% CI 0.98–4.06, p = 0.056). Non-elective spine surgery performed ‘after-hours’ is independently associated with increased risk of perioperative adverse events, length of stay and possibly, mortality. Research is needed to determine the specific factors contributing to poorer outcomes with ‘after-hours’ surgery and strategies to minimize this risk. These slides can be retrieved under Electronic Supplementary Material.

The objectives of this study were to (a) develop a standing MRI imaging protocol, tolerable to symptomatic patients with degenerative spondylolisthesis (DLS), and (b) to evaluate the morphometric changes observed in DLS patients in both supine and standing postures. Patients with single level, Meyerding grade 1 DLS undergoing surgery at a single institution between November 2015 to May 2017 were consented. Patients were imaged in the supine and standing positions in a 0.5T vertically open MRI scanner (MROpen, Paramed, Genoa, Italy) with sagittal and axial T2 images. The morphometric parameters measured were: cross-sectional area of the thecal sac (CSA), lateral recess height, disc height, degree of anterolisthesis, disc angle, lumbar lordosis, the presence of facet effusion and restabilization signs. Measures from both postures were compared using paired T-test. Associations of posture with the magnitude of change in the various measurements was determined using Pearson correlation or paired T-test when appropriate. All fourteen patients (mean age 64.4 years) included tolerated standing for the time required for image acquisition. All measurements with the exception of lumbar lordosis and disk height showed a statistically significant difference between the postures (p

Surgery for degenerative lumbar spondylolisthesis (DLS) has traditionally been indicated for patients with neurogenic claudication. Surgery improves patients' disability and lower extremity symptoms, but less is known about the impact on back pain.To evaluate changes in back pain after surgery and identify factors associated with these changes in surgically-treated DLS.Retrospective review of prospectively collected data.There were 486 consecutive patients with surgically-treated DLS who were enrolled in the Canadian Spine Outcomes Research Network prospective registry and identified for this study. Patients had demographic data, clinical information, disability (Oswestry Disability Index), and back pain rating scores collected prospectively at baseline, and 12 months follow-up RESULTS: Of the 486 DLS patients, 376 (77.3%) were successfully followed at 12 months. Mean age at baseline was 66.7 (standard deviation [SD] 9.2) years old, and 63% were female. Back pain improved significantly at 12 months, compared with baseline (p.001). Improvement in Numeric Rating Scale (NRS)-back pain ratings was on average 2.97 (SD 2.5) points at one year and clinically significant improvement in back pain was observed in 75% of patients (minimal clinically important difference (MCID) NRS-Pain 1.2 points). Multivariable logistic regression revealed five factors associated with meeting MCID NRS-back pain at 12 month follow up: higher baseline back pain, better baseline physical function (higher SF-12 Physical Component Score), symptoms duration less than 1 to 2 years, and having no intraoperative adverse events.Back pain improved significantly for patients treated surgically for DLS at 1-year follow-up.

Bond determines what befuddles people's brains when the unthinkable happens, and can they do anything about it. Prior knowledge is crucial, because when disaster strikes, their brain is in no state for rational deliberation. It takes just seconds for adrenaline to flood into their bloodstream, pushing their heart rate up from about 70 beats per minute to over 200. Then the body's central stress system releases the hormone cortisol, boosting blood sugar levels and suppressing non-essential functions such as digestion. This evolved fight or flight mechanism prepares them for physical action, but inhibits areas of the brain that govern working memory and process new information. In other words, it primes them to act but not to think. With their cognitive faculties hobbled, if the threatening situation is one they have never been in before, there's little chance of figuring out a solution.

Background Older people are sometimes challenged in maintaining a healthy diet but, because of age and disadvantage, are also more vulnerable to the adverse health consequences of poor nutrition. It has been claimed that older adults have low levels of health literacy regarding food and struggle to discern which foods are healthy from the vast range available in developed counties (Br Herne 1995;97:12). However, nutrition and eating behaviour are modifiable risk factors for health in old age (Appl Physiol Nutr Keller 2007;32:991) and health benefits can accrue from promoting healthy eating later in life. In order to achieve these health benefits, it is necessary to understand more about the capabilities and vulnerabilities of older people in terms of acquiring and maintaining a healthy diet. Objective To understand the potential for issues around food vulnerability to arise in that group and to characterize that vulnerability, if present. Design Narrative interviews were conducted to collect the data. An interpretative thematic approach to analysis was utilized. Participants Twenty older, bereaved men from two communities in the North of England. Findings Five overarching themes were identified: financial security, social networks, cooking skills, food and routine and single servings. Discussion Our findings suggest that some older men experience cumulative benefit from resources at their disposal, which contributes towards their capabilities to avoid food vulnerability.

Prospective Cohort OBJECTIVE.: The aim of this study was to evaluate which demographic, clinical, or radiographic factors are associated with selection for surgical intervention in patients with mild cervical spondylotic myelopathy (CSM).Surgery has not been shown superior to best conservative management in mild CSM comparative studies; trials of conservative management represent an acceptable alternative to surgical decompression. It is unknown what patients benefit from surgery.This is a prospective study of patients with mild CSM, defined as modified Japanese Orthopaedic Association Score (mJOA) ≥15. Patients were recruited from seven sites contributing to the Canadian Spine Outcomes Research Network. Demographic, clinical, radiographic and health related quality of life data were collected on all patients at baseline. Multivariate logistic regression modeling was used to identify factors associated with surgical intervention.There were 122 patients enrolled, 105 (86.0%) were treated surgically, and 17 (14.0%) were treated nonoperatively. Overall mean age was 54.8 years (SD 12.6) with 80 (65.5%) males. Bivariate analysis revealed no statistically significant differences between surgical and nonoperative groups with respect to age, sex, BMI, smoking status, number of comorbidities and duration of symptoms; mJOA scores were significantly higher in the nonoperative group (16.8 [SD 0.99] vs. 15.9 [SD 0.89], P 0.001). There was a statistically significant difference in Neck Disability Index, SF12 Physical Component, SF12 Mental Component Score, EQ5D, and PHQ-9 scores between groups; those treated surgically had worse baseline questionnaire scores (P 0.05). There was no difference in radiographic parameters between groups. Multivariable analysis revealed that lower quality of life scores on EQ5D were associated with selection for surgical management (P 0.018).Patients treated surgically for mild cervical myelopathy did not differ from those treated nonoperatively with respect to baseline demographic or radiographic parameters. Patients with worse EQ5D scores had higher odds of surgical intervention.3.

In the Western world work defines us as never before. That might be a good thing, argue Michael Bond and Joshua Howgego

This article addresses the educational issues associated with rare diseases (RD) and in particular the Neuronal Ceroid Lipofuscinoses (NCLs, or CLN diseases) in the curricula of Health Sciences and Professional's Training Programs. Our aim is to develop guidelines for improving scientific knowledge and practice in higher education and continuous learning programs.Rare diseases (RD) are collectively common in the general population with 1 in 17 people affected by a RD in their lifetime. Inherited defects in genes involved in metabolism are the commonest group of RD with over 8000 known inborn errors of metabolism. The majority of these diseases are neurodegenerative including the NCLs. Any professional training program on NCL must take into account the medical, social and economic burdens related to RDs. To address these challenges and find solutions to them it is necessary that individuals in the government and administrative authorities, academia, teaching hospitals and medical schools, the pharmaceutical industry, investment community and patient advocacy groups all work together to achieve these goals.The logistical issues of including RD lectures in university curricula and in continuing medical education should reflect its complex nature. To evaluate the state of education in the RD field, a summary should be periodically up dated in order to assess the progress achieved in each country that signed up to the international conventions addressing RD issues in society. It is anticipated that auditing current practice will lead to higher standards and provide a framework for those educators involved in establishing RD teaching programs world-wide. Fil: Cismondi, Inés Adriana. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina Fil: Kohan, Romina. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina Fil: Adams, Heather. University Of Rochester School Of Medicine And Dentistry; Estados Unidos Fil: Bond, Mike. Colegio Universitario de Londres; Reino Unido Fil: Brown, Rachel. Colegio Universitario de Londres; Reino Unido Fil: Cooper, Jonathan D.. King's College London; Reino Unido Fil: de Hidalgo, Perla K.. Universidad Nacional de Córdoba; Argentina Fil: Holthaus, Sophia Martha Kleine. Ucl Institute Of Ophthalmology; Reino Unido. Colegio Universitario de Londres; Reino Unido Fil: Mole, Sara E.. Colegio Universitario de Londres; Reino Unido Fil: Mugnaini, Julia. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Oller de Ramirez, Ana María. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina Fil: Pesaola, Favio Nicolas. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina Fil: Rautenberg, Gisela Evelín. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina Fil: Platt, Frances M.. University of Oxford; Reino Unido Fil: Noher, Rita Ines. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina

What makes an ordinary person risk their life for a stranger? Michael Bond delves into their stories to find out

Reports of the death of friendship are premature, but our fast-moving, globalised and increasingly urbanised existence has changed it dramatically

There are plenty of things that can be done to make people more successful. Yet our governments, schools and parents are not always doing the right things

BACKGROUND CONTEXT Cervical metastases have unique clinical considerations because of complex neighboring anatomy, and the unique biomechanical regions within the cervical spine. The literature regarding cervical metastases is limited to retrospective studies without comparison of different treatment regimens. PURPOSE The purpose of this study was therefore to compare surgery (+/− radiation) with radiation alone for the management of cervical metastases in a prospective manner. METHODS Patients treated with surgery and/or radiotherapy for cervical metastases between August 2013 and February 2017 were identified from the epidemiology, process and outcomes of spine oncology observational cohort. Demographic, diagnostic, treatment and health related quality of life (HRQOL) (NRS Pain, EQ-5D, SF-36v2, and SOSGOQ) measures were prospectively collected at baseline, 6 weeks, 3 months, and 6 months post-intervention. RESULTS Fifty-five patients treated for cervical metastases were identified: 38 underwent surgery (+/− radiation) and 17 received radiation alone. Surgically treated patients had higher SINS scores compared to the radiation-alone group (13.0 [SD 2.8] vs. 8.0 [SD 2.8], p CONCLUSIONS Surgically treated patients presented with significantly worse baseline pain and HRQOL scores compared to patients who underwent radiotherapy only. Preservation of pain and HRQOL was observed for patients treated with radiotherapy only compared to significant improvements for surgically treated patients.

From ants to birds, how do animals use their senses to guide them to food and breeding grounds