Huangdunlap8982

To examine the real-world cardiovascular effectiveness and safety associated with sodium-glucose co-transporter-2 (SGLT2) inhibitor compared with dipeptidyl peptidase-4 (DPP-4) inhibitor treatment in older adults with type 2 diabetes.

In this retrospective cohort study, older adults with type 2 diabetes (aged ≥65 years) were identified in the Korean National Health Insurance Service database from September 2014 to December 2016. In total, 408 506 new users of an SGLT2 inhibitor or DPP-4 inhibitor were propensity score matched. Cox regression was used to estimate the hazard ratios (HR) and 95% confidence interval (CI) for outcomes of interest hospitalization for heart failure (HHF), all-cause death, myocardial infarction, stroke, diabetic ketoacidosis (DKA), bone fracture, severe hypoglycaemia, genital infection and urinary tract infection (UTI).

Compared with DPP-4 inhibitors, new users of SGLT2 inhibitors had a lower risk of HHF (HR 0.86; 95% CI 0.76-0.97), all-cause death (HR 0.85; 95% CI 0.75-0.98) and stroke (HR 0.86; 95% CI 0.77-0.97), but a similar risk of myocardial infarction (HR 0.95; 95% CI 0.77-1.19). The risks of DKA, bone fracture and severe hypoglycaemia were similar between both groups, although genital infection (HR 2.44; 95% CI 2.22-2.67) and UTI (HR 1.05; 95% CI 1.00-21.11) were more frequent among new users of SGLT2 inhibitors compared with DPP-4 inhibitors.

Our findings suggest that initiation of SGLT2 inhibitors offers cardiovascular disease protection and can be used safely in older adults with type 2 diabetes.

Our findings suggest that initiation of SGLT2 inhibitors offers cardiovascular disease protection and can be used safely in older adults with type 2 diabetes.

Screening can detect cancer earlier. Uptake of breast, cervical, and bowel cancer screening in England is below 75%. This study identifies the barriers and facilitators underpinning HCP screening behaviours which can support screening uptake, and reviews the design of real-world interventions targeting these, assessing for congruence between the two. The aim was to provide recommendations to improve the design of interventions.

Barriers/facilitators were identified by a literature review and qualitatively coded using the theoretical domains framework (TDF). Interventions were identified by stakeholders and coded using the behaviour change wheel and the taxonomy of behaviour change techniques. Congruence was assessed through comparing the intervention designs with behavioural science experts' recommendations which link the TDF domains to intervention design. Recommendations targeted missed opportunities.

Barriers/facilitators were extracted from 60 papers and most frequently coded to the TDF domains environmental context and resources, knowledge and beliefs about consequences. Thirty-one interventions were identified, most frequently education, training or enablement functions, delivered via communication/marketing or service provision, and using BCTs designed to shape knowledge or highlight the consequences of or antecedents to screening. Intervention design was largely congruent with recommendations. However, there was less use of persuasion and modelling intervention functions and a reliance on BCTs such as providing instruction when other BCTs could be considered.

Recommendations include to consider a broader range of intervention functions and BCTs, particularly for training interventions which should make use of recommended BCTs such as 'graded tasks'.

Recommendations include to consider a broader range of intervention functions and BCTs, particularly for training interventions which should make use of recommended BCTs such as 'graded tasks'.

To investigate differences in presenting patient characteristics, investigation, management and related outcomes between culturally and linguistically diverse (CALD) and non-CALD chest pain (CP) patients presenting to the ED.

A cohort study of 258 patients was enrolled on presentation to Liverpool Hospital ED with a complaint of CP over a 2-week period. Main outcomes included frequency and timeliness of diagnostic and radiological investigations, medication administered and ED length of stay. Administrative and clinical data were extracted and linked from Cerner EMR FirstNet®, PowerChart® and paper records.

There were 155 (60%) CALD and 103 (40%) non-CALD patients. CALD patients were older by 10 years (95% CI 4, 15; P < 0.0001). There were no significant differences in the number of pathology and imaging investigations carried out in each group, and similarly there were no significant differences in the number of patients administered analgesia or cardiac-specific medications. Neither group differed in their ED length of stay (median 280 vs 259.5 min; P = 0.79) or hospital admission rate (median 56% vs 55%, P = 0.8).

Both CALD and non-CALD ED CP patients had similar test ordering, medication administration and clinical outcomes, but this was in the context of CALD patients being 10 years older together with a small study sample size. find more A larger cohort, matched for age, would provide further insights into potentially important differences.

Both CALD and non-CALD ED CP patients had similar test ordering, medication administration and clinical outcomes, but this was in the context of CALD patients being 10 years older together with a small study sample size. A larger cohort, matched for age, would provide further insights into potentially important differences.This study investigated the production of phosphate glass fiber/polylactic acid (PGF/PLA) commingled yarns, textiles and composites for biomedical applications. The PGF volume contents of the composites investigated were 25% and 40%. Plain weave textiles with yarn counts of 10 warp/cm and 6 weft/cm were produced using a commercial weaving machine. An orthogonal array design (OAD) was employed as a statistical method to investigate the effects of compression molding parameters (processing temperature, preheating time, compression time, and pressure) on flexural strength and porosity of PGF/PLA textile composites. Processing temperature showed the most significant effect in achieving maximum laminate flexural strength and molecular weight of PLA. Processing models were developed using regression techniques to predict the laminate flexural strength and the molecular weight of PLA. Composites with fiber contents of 25 and 40 vol% produced using optimized processing conditions identified by the processing models, provided flexural strengths of 236 MPa and 293 MPa, respectively.