by Takeshi Horii, Kenji Momo, Takeo Yasu, Yusuke Kabeya, Koichiro AtsudaBackground
The extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan.Methods
This retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient’s possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value Results
Of the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50– Conclusions
We surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50–
by Jin Ling, Hong Wang, Gaomin Li, Zhen Feng, Yufei Song, Peng Wang, Hong Shao, Hu Zhou, Gang ChenBackground
Escherichia coli is currently unable to be reliably differentiated from Shigella species by routine matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis. In the present study, a reliable and rapid identification method was established for Escherichia coli and Shigella species based on a short-term high-lactose culture using MALDI-TOF MS and artificial neural networks (ANN).Materials and methods
The Escherichia coli and Shigella species colonies, treated with (Condition 1)/without (Condition 2) a short-term culture with an in-house developed high-lactose fluid medium, were prepared for MALDI-TOF MS assays. The MS spectra were acquired in linear positive mode, with a mass range from 2000 to 12000 Da and were then compared to discover new biomarkers for identification. Finally, MS spectra data sets 1 and 2, extracted from the two conditions, were used for ANN training to investigate the benefit on bacterial classification produced by the new biomarkers.Results
Twenty-seven characteristic MS peaks from the Escherichia coli and Shigella species were summarized. Seven unreported MS peaks, with m/z 2330.745, m/z 2341.299, m/z 2371.581, m/z 2401.038, m/z 3794.851, m/z 3824.839 and m/z 3852.548, were discovered in only the spectra from the E. coli strains after a short-term high-lactose culture and were identified as belonging to acid shock protein. The prediction accuracies of the ANN models, based on data set 1 and 2, were 97.71±0.16% and 74.39±0.34% (n = 5), with an extremely remarkable difference (p Conclusions
In summary, adding a short-term high-lactose culture approach before the analysis enabled a reliable and easy differentiation of Escherichia coli from the Shigella species using MALDI-TOF MS and ANN.
by Mizuki Tanaka, Shiori Hasegawa, Satoshi Nakao, Kazuyo Shimada, Ririka Mukai, Kiyoka Matsumoto, Mitsuhiro NakamuraMany drugs can cause hearing loss, leading to sensorineural deafness. The aim of this study was to evaluate the risk of drug-induced hearing loss (DIHL) by using the Japanese Adverse Drug Event Report (JADER) database and to obtain profiles of DIHL onset in clinical settings. We relied on the Medical Dictionary for Regulatory Activities preferred terms and standardized queries, and calculated the reporting odds ratios (RORs). Furthermore, we applied multivariate logistic regression analysis, association rule mining, and time-to-onset analysis using Weibull proportional hazard models. Of 534688 reports recorded in the JADER database from April 2004 to June 2018, adverse event signals were detected for platinum compounds, sulfonamides (plain) (loop diuretics), interferons, ribavirin, other aminoglycosides, papillomavirus vaccines, drugs used in erectile dysfunction, vancomycin, erythromycin, and pancuronium by determining RORs. The RORs of other aminoglycosides, other quaternary ammonium compounds, drugs used in erectile dysfunction, and sulfonamides (plain) were 29.4 (22.4–38.6), 18.5 (11.2–30.6), 15.4 (10.6–22.5), and 12.6 (10.0–16.0), respectively. High lift score was observed for patients with congenital diaphragmatic hernia treated with pancuronium using association rule mining. The median durations (interquartile range) for DIHL due to platinum compounds, sulfonamides (plain), interferons, antivirals for treatment of hepatitis C virus (HCV) infections, other aminoglycosides, carboxamide derivatives, macrolides, and pneumococcal vaccines were 25.5 (7.5–111.3), 80.5 (4.5–143.0), 64.0 (14.0–132.0), 53.0 (9.0–121.0), 11.0 (3.0–26.8), 1.5 (0.3–11.5), 3.5 (1.3–6.8), and 2.0 (1.0–4.5), respectively. Our results demonstrated potential risks associated with several drugs based on their RORs. We recommend to closely monitor patients treated with aminoglycosides for DIHL for at least two weeks. Moreover, individuals receiving platinum compounds, sulfonamides (plain), interferons, and antivirals for HCV infection therapy should be carefully observed for DIHL for at least several months.
by Diogo Silva Vilela, Ricardo Koroiva, Adolfo Cordero-Rivera, Rhainer Guillermo-FerreiraThe genus Franciscobasis Machado & Bedê, 2016 is endemic to the Serra da Canastra National Park in Minas Gerais state, Brazil. Two species of Franciscobasis were described simultaneously with the genus description: F. franciscoi and F. sonia, the latter described only from females. Through morphological and molecular analysis, we investigated if F. sonia may represent the young female of F. franciscoi. Resulting data did not present adequate differences between females to characterize them as different species. Therefore, we suggest that F. sonia is a junior synonym of F. franciscoi, and the female of F. franciscoi goes through a complex ontogenetic color change.
by Marta Rossi, Davide De Battisti, Jeremy Edward NivenExtrusion of xenobiotics is essential for allowing animals to remove toxic substances present in their diet or generated as a biproduct of their metabolism. By transporting a wide range of potentially noxious substrates, active transporters of the ABC transporter family play an important role in xenobiotic extrusion. One such class of transporters are the multidrug resistance P-glycoprotein transporters. Here, we investigated P-glycoprotein transport in the Malpighian tubules of the desert locust (Schistocerca gregaria), a species whose diet includes plants that contain toxic secondary metabolites. To this end, we studied transporter physiology using a modified Ramsay assay in which ex vivo Malpighian tubules are incubated in different solutions containing the P-glycoprotein substrate dye rhodamine B in combination with different concentrations of the P-glycoprotein inhibitor verapamil. To determine the quantity of the P-glycoprotein substrate extruded we developed a simple and cheap method as an alternative to liquid chromatography–mass spectrometry, radiolabelled alkaloids or confocal microscopy. Our evidence shows that: (i) the Malpighian tubules contain a P-glycoprotein; (ii) tubule surface area is positively correlated with the tubule fluid secretion rate; and (iii) as the fluid secretion rate increases so too does the net extrusion of rhodamine B. We were able to quantify precisely the relationships between the fluid secretion, surface area, and net extrusion. We interpret these results in the context of the life history and foraging ecology of desert locusts. We argue that P-glycoproteins contribute to the removal of xenobiotic substances from the haemolymph, thereby enabling gregarious desert locusts to maintain toxicity through the ingestion of toxic plants without suffering the deleterious effects themselves.
by Silvia Pierandrei, Giovanna Blaconà, Benedetta Fabrizzi, Giuseppe Cimino, Natalia Cirilli, Nicole Caporelli, Antonio Angeloni, Marco Cipolli, Marco LucarelliTwo novel and related pathogenic variants of the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) gene were structurally and functionally characterized. These alterations have not been previously described in literature. Two patients with diagnosis of Cystic Fibrosis (CF) based on the presence of one mutated allele, p.Phe508del, pathological sweat test and clinical symptoms were studied. To complete the genotypes of both patients, an extensive genetic and functional analysis of the CFTR gene was performed. Extensive genetic characterization confirmed the presence of p.Phe508del pathogenic variant and revealed, in both patients, the presence of an insertion of part of intron 10 in intron 9 of the CFTR gene, within the (TG)m repeat, with a variable poly-T stretch. The molecular lesions resulted to be very similar in both patients, with only a difference in the number of T in the poly-T stretch. The functional characterization at RNA level revealed a complete anomalous splicing, without exon 10, from the allele with the insertion of both patients. Consequently, the alleles with the insertions are expected not to contribute to the formation of a functional CFTR protein. Molecular and functional features of these alterations are compatible with the definition of novel CF-causing variants of the CFTR gene. This also allowed the completion of the genetic characterization of both patients.
by Daniel Nyato, Jacqueline Materu, Evodius Kuringe, Jeremie Zoungrana, Deusdedit Mjungu, Ruth Lemwayi, Esther Majani, Baltazar Mtenga, Soori Nnko, Grace Munisi, Amani Shao, Mwita Wambura, John Changalucha, Mary Drake, Albert KombaBackground
Little has been documented about partner violence among adolescent girls and young women (AGYW) who are out of school, a factor associated with HIV acquisition. To understand areas for prioritising HIV prevention intervention efforts, we explored the prevalence and correlates of partner violence among out of school AGYW in Shinyanga, Tanzania.Methods
A cross-sectional analysis of data from AGYW aged 15–23 years recruited in a cluster randomised trial conducted between October and December 2017 was used to examine correlates of partner violence. Data were collected through an Audio Computer-Assisted Self-interview. Multivariate logistic regression analysis was used to evaluate the association.Results
2276 (75.5%) AGYW were sexually active. Of these, 816 (35.9%) reported having experienced violence from partners in the last six months. After adjusting for other covariates, being formerly married (AOR = 1.55, 95% CI:1.02, 2.37), having children (AOR = 1.79, 95% CI:1.47, 2.16), anxiety and depression symptoms (AOR = 3.27, 95%CI: 2.15, 4.96), having engaged in sex work in the past six months (AOR = 1.92, 95% CI: 1.45, 2.53) and economic deprivation (AOR = 1.61, 95% CI: 1.34,1.92) were significantly associated with partner violence.Conclusions
Almost one in three sexually active AGYW had experienced partner violence in the 6 months preceding the survey. The findings underscore the need for future research to focus on understanding the reasons and dynamics underlying high level of partner violence among AGYW. Furthermore, there is a need for implementing intervention programs that aim to reduce economic deprivation among AGYWs and address social norms and structures perpetuating violence against AGYW.Trial registration
by Sarit Kumar Rout, Yashwant R. Gabhale, Ambarish Dutta, Sudha Balakrishnan, Mamatha M. Lala, Maninder Singh Setia, Khanindra Bhuyan, Mamta V. ManglaniBackground
India has recently introduced telemedicine initiatives to enhance access to specialized care at a low cost for the pediatric HIV patients, who face multiple challenges due to growing disease burden and limited preparedness of the health system to address it. There are limited evidences on the cost-effectiveness of these interventions. This study was undertaken in Maharashtra, a province, located in the western region of the country, to inform policy regarding the effectiveness of this programme. The objective was to estimate the unit cost of ART services for pediatric HIV patients and examine the efficiency in the use of resource and treatment compliance resulting from telemedicine initiatives in pediatric HIV compared to usual ART services.Methods
We selected 6 ART centers (3 from linked centers linked to Pediatric HIV Centre of Excellence (PCoE) and 3 from non-linked centers) randomly from three high, middle and low ART centers, categorized on the basis of case load in each arm. A bottom up costing methodology was adopted to understand the unit cost of services. Loss to follow up and timeliness of the visits were compared between the two arms and were linked to the cost.Results
The average cost per-visit was INR 1803 in the linked centers and that for the non-linked centers was INR 3412. There has been 5 percentage point improvement in lost to follow-up in the linked centers compared to non-linked centers against a back-drop of a reduction in per-pediatric patient cost of INR 557. The linkage has resulted in increase in timeliness of the visits in linked centers compared to non-linked centers.Discussion and conclusion
The telemedicine linkage led to an increase in the case load leading to a decrease in cost. The evidence on efficiency in the use of resource and improvement in treatment compliance as suggested by this study could be used to scale up this initiative.
by Hirofumi Kato, Mutsuyo Takayama-Ito, Itoe Iizuka-Shiota, Shuetsu Fukushi, Guillermo Posadas-Herrera, Madoka Horiya, Masaaki Satoh, Tomoki Yoshikawa, Souichi Yamada, Shizuko Harada, Hikaru Fujii, Miho Shibamura, Takuya Inagaki, Kinjiro Morimoto, Masayuki Saijo, Chang-Kweng LimMiddle East respiratory syndrome-coronavirus (MERS-CoV) is an emerging virus that causes severe disease with fatal outcomes; however, there are currently no approved vaccines or specific treatments against MERS-CoV. Here, we developed a novel bivalent vaccine against MERS-CoV and rabies virus (RV) using the replication-incompetent P-gene-deficient RV (RVΔP), which has been previously established as a promising and safe viral vector. MERS-CoV spike glycoprotein comprises S1 and S2 subunits, with the S1 subunit being a primary target of neutralizing antibodies. Recombinant RVΔP, which expresses S1 fused with transmembrane and cytoplasmic domains together with 14 amino acids from the ectodomains of the RV-glycoprotein (RV-G), was developed using a reverse genetics method and named RVΔP-MERS/S1. Following generation of RVΔP-MERS/S1 and RVΔP, our analysis revealed that they shared similar growth properties, with the expression of S1 in RVΔP-MERS/S1-infected cells confirmed by immunofluorescence and western blot, and the immunogenicity and pathogenicity evaluated using mouse infection experiments. We observed no rabies-associated signs or symptoms in mice inoculated with RVΔP-MERS/S1. Moreover, virus-specific neutralizing antibodies against both MERS-CoV and RV were induced in mice inoculated intraperitoneally with RVΔP-MERS/S1. These findings indicate that RVΔP-MERS/S1 is a promising and safe bivalent-vaccine candidate against both MERS-CoV and RV.
by Kristian Magnus Gundersen, Christoffer Nyborg, Øyvind Heiberg Sundby, Jonny Hisdal
by Robert Hammond, Rodoniki Athanasiadou, Silvia Curado, Yindalon Aphinyanaphongs, Courtney Abrams, Mary Jo Messito, Rachel Gross, Michelle Katzow, Melanie Jay, Narges Razavian, Brian Elbel
by Brett P. Hughes, Torbjorn Falkmer, Anna Anund, Melissa H. BlackWhile road safety in the United States (U.S.) has been continually improving since the 1970's, there are indications that these improvements are becoming increasingly difficult to sustain. Strategic Highway Safety Plans (SHSPs) are prepared by States to guide road safety management, however assessing the appropriateness of these plans remains a significant challenge, especially for the future in which they are to be applied. This study developed a new methodology to assess SHSPs from the perspectives of comprehensive system-based safety management and relevant future issues that can be applied before SHSPs are implemented, thereby avoiding long periods after implementation before assessing the appropriateness of the plans. A rating scale was developed and applied to assess 48 U.S. SHSPs against two key criteria: 1. a comprehensive framework for road safety, and 2. the anticipated changing, difficult and unpredictable nature of future transport and its context. The analysis concluded that current SHSPs have good national oversight with several strengths but were weak in some areas of content and did not address future challenges. Improvements are suggested to strengthen the plans’ thoroughness by being consistent with systems theory and practice, as well as ways that these SHSPs can be more resilient to future circumstances. Implementing the recommendations in this paper provides the opportunity to adopt a system-based safety management practice that has been successful in other hazardous industries. Doing so is expected to most efficiently and effectively continue the recent improvements to road safety, which is likely to be increasingly difficult otherwise.
by Takashi Kanamaru, Kazuyuki AiharaTo understand the effect of attention on neuronal dynamics, we propose a multi-module network, with each module consisting of fully interconnected groups of excitatory and inhibitory neurons. This network shows transitive dynamics among quasi-attractors as its typical dynamics. When the release of acetylcholine onto the network is simulated by attention, the transitive dynamics change into stable dynamics in which the system converges to an attractor. We found that this network can reproduce three experimentally observed properties of attention-dependent response modulation, namely an increase in the firing rate, a decrease in the Fano factor of the firing rate, and a decrease in the correlation coefficients between the firing rates of pairs of neurons. Moreover, we also showed theoretically that the release of acetylcholine increases the sensitivity to bottom-up inputs by changing the response function.
To examine qualified intensive care nurses’ implicit and explicit attitudes towards obese intensive care patients and whether their attitudes are associated with their behavioural intentions towards these patients.
Obese intensive care patients may experience more stress than do normal‐weight patients. Intensive care nurses’ attitudes and the way they address their care are thus vital. Despite a range of studies revealing that health professionals hold anti‐fat attitudes towards obese patients, there is a lack of knowledge about intensive care nurses’ implicit and explicit attitudes and if such attitudes are associated with behavioural intention.
A cross‐sectional survey.
From November 2017 ‐ January 2018, a web‐based survey was conducted with 159 qualified intensive care nurses (84.3% women, mean age 45.52 years) recruited through 16 intensive care units and Facebook. The survey consisted of implicit attitude tests, explicit bias scales, the Anti‐fat Attitude questionnaire, vignettes measuring behavioural intention, and demographic questions.
Intensive care nurses reported implicit preferences for thin over thick people and found obese individuals slightly ‘worse’ and ‘lazy’, comprising less willpower than thin individuals. Attitudes were not associated with behavioural intention.
This study provides new knowledge about qualified intensive care nurses’ anti‐fat attitudes and behavioural intention towards obese intensive care patients. These findings should be acknowledged by policymakers, clinical healthcare providers and educators to secure optimal care for these patients.
These results should be used in nursing attitude change programmes, in intensive care units, and among nursing educators, focusing on increasing nurses’ knowledge of the complexities of obesity. Further research on obese intensive care patients’ healthcare experiences and the impact that healthcare providers’ anti‐fat attitudes and behaviours has on patients’ perceived care quality is needed.
An available strategy to counteract academic failure is the development and implementation of student academic self‐efficacy; however, to date, there are no instruments measuring it. The aim of this study was to develop and psychometrically test an academic nurse self‐efficacy scale.
A longitudinal study design was used in accordance with Consensus‐based Standards for the Selection of health status Measurement Instruments guidelines.
A convenience sample of 1,129 nursing students attending the first year of the course were involved. The data collection began in 2014 and went on for three years. Data were collected at the beginning of the first (T0), at the end of the first (T1), at the end of the second (T2) and at the end of the third (T3) year. The academic nurse self‐efficacy scale was evaluated for content and face validity, for construct validity with explorative, confirmative factor analysis and hypothesis testing and for reliability. The standard error and the smallest detectable difference were also evaluated.
Scree plot analysis suggested a four‐factor solution and confirmative factor analysis model reached a good fit. We verified the first hypothesis, partially the second and not the third. The dimensions show a Cronbach's α 0.72–0.83. The smallest detectable difference was 26%.
The academic nurse self‐efficacy scale had good validity and reliability and should be considered for nursing students.
These findings may have an impact on universities, mainly in nursing degree programmes because nurse educators can identify nursing students with low academic self‐efficacy and help them in their academic duties. Indirectly, academic self‐efficacy monitoring can be used for evaluating the effect of different teaching strategies or mentorship support over time.
To obtain a comprehensive insight of the impact of patient and family engagement on patient safety and identify issues in implementing this approach.
Patient and family engagement is increasingly emerging as a potential approach for improving patient safety.
Mixed method multi‐level synthesis.
PubMed, CINAHL, Embase and Cochrance Library (January 2009 ‐ April 2018).
The review was conducted according to the principles recommended by the Cochrane Handbook for Systematic Review and in accordance with the PRISMA guidelines.
Forty‐two relevant studies were identified. Common intervention groups included “direct care” and “organization” levels with “consultation” and “involvement” approaches, while the “health system” level and “partnership and shared leadership” approaches were rarely implemented. Findings revealed positive effects of the interventions on patient safety. Most study participants expressed their willingness to engage in or support patient and family engagement. However, existing gaps and barriers in implementing patient and family engagement were identified.
Future research should further focus on issuing consensus guidelines for implementing patient and family engagement in patient safety, extending the research scope for all aspects of patient and family engagement and patient safety and identifying priority areas for action that is suitable for each health facility.
Policymakers should issue guidelines for implementing patient and family engagement in health‐care systems which would enable health‐care providers to implement patient and family engagement and improve patient safety appropriately and effectively.
To assess randomized controlled trials evaluating the impact of nurse practitioner‐led cardiovascular care.
Systematic review of nurse practitioner led‐care in patients with cardiovascular disease has not been completed.
Systematic review and meta‐analysis.
The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, Web of Science, Scopus, & ProQuest were systematically searched for studies published January 2007‐ June 2017.
Cochrane methodology was used for risk of bias, data extraction and meta‐analysis. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach.
Out of 605 articles, five articles met inclusion criteria. There was no statistical difference between nurse practitioner‐led care and usual care for 30‐day readmissions, health related quality of life and length of stay. A 12% reduction in Framingham risk score was identified.
There are few randomized control trials assessing nurse practitioner‐led cardiovascular care.
Low to moderate quality evidence was identified with no statistically significant associated outcomes of care.
Nurse practitioner roles need to be supported to conduct and publish high quality research.
To examine the role of community‐based nursing interventions in improving outcomes for community‐dwelling individuals exhibiting risk factors of cardiovascular disease.
A systematic review and narrative synthesis.
Seven electronic databases (MEDLINE, CINAHL, Global Health, LILACS, Africa‐Wide Information, IMEMR and WPRIM) were searched from inception to 16 March 2018.
This review included outcomes from studies that were led by or delivered primarily by nurses for individuals exhibiting risk factors of cardiovascular diseases in community settings. At least two independent reviewers performed study selection, data extraction and risk of bias.
46 studies met the eligibility criteria. Community nursing interventions were found to be effective in improving clinical outcomes of symptom control, symptom awareness, symptom management and social outcomes. Effective interventions were found to be facilitated by a community‐centric approach, participant empowerment, reinforcement strategies, a targeted approach towards underserved populations, as well as home visits. These resulted in positive outcomes such as significant reductions in HbA1c for diabetic patients, attainment of blood pressure targets for hypertensive patients and greater improvement in self‐reported dietary intake for patients with hyperlipidemia.
Community‐based nurse‐led interventions can result in positive outcomes for patients with risk factors of cardiovascular disease. However, the success of such interventions needs to be facilitated by appropriate funding, thoughtful intervention design and training opportunities for nurses.
Community‐based nursing interventions are largely effective in improving clinical and social outcomes for community‐dwelling individuals with risk factors of cardiovascular disease.
Professionalism in nursing has long been steeped in controversy. For many years some argued nurses were only semi‐professional due to a lack of university education and qualifications and a knowledge base and skillset that were not distinctly unique (Adams & Miller, 2001). Nurses are now an established profession with clear and robust educational frameworks, codes of professional conduct and standards of practice (Sills, 1998), regulated by an independent agency or governing body.
This is a study protocol to investigate nurses’ perspectives on refugee healthcare in two countries. The aims are to: 1) explore self‐reported work environment factors, including work stressors, self‐rated leadership, staffing and resources adequacy and teamwork among Jordanian and Lebanese nurses caring for refugees; 2) investigate the relationship between nurse related outcomes (physical health; emotional exhaustion) and their psychosocial work environment; and 3) assess the association between nurses’ perceived work environment factors and implicit rationing of care and quality of patient care.
Globally, the care of refugees is achieving increased attention. Over 6.3 million people are internally displaced and 4.8 million recorded Syrian expatriates are residing in and receiving healthcare services in host neighboring countries.
This is a cross‐sectional, comparative study using a survey design.
The study setting involves both private and public hospitals and primary healthcare centers that provide care to refugees on regular basis in Lebanon and Jordan. The estimated sample size includes 3,000 Registered Nurses from Lebanon and 2,500 nurses and midwives from Jordan.
Workplace factors affecting quality of nursing care and psychosocial status of nurses caring for refugees will be identified. Potential findings will help leaders design interventions to support nurses who are serving refugees for safer care and better patient outcomes. Findings will assist in more efficient resource allocation and management.
New knowledge on the impact of providing healthcare for refugees will be generated based on the structure of nursing care (e.g. work environment), on the nursing process (e.g. implicit rationing of care) and nurse outcomes (health) in two hosting communities. Moreover, factors enabling resilience in patients, providers and systems will be identified and be of potential use in addressing the growing global problem of caring for displaced persons.