Gatesbengtson3347

The aim of this study was to explore hospital discharge processes and the self-management of recovery in the early post-discharge period after blunt thoracic injury from a patient perspective.

Qualitative interview study.

Interviews were conducted with participants recruited from 8 sites across England and Wales between November 2019-May 2020. Semi-structured interviews were conducted between 5-8weeks after hospital discharge, and in total, 14 interviews were undertaken. These interviews were recorded, transcribed and analysed using thematic coding.

Three main themes were identified from the analysis (a) challenges in the discharge process, (b) coping at home after discharge and (c) managing medications at home. Pain was a dominant thread running throughout all themes which represented an important quality and safety concern for all participants. Associated concerns included insufficient preparation and education for hospital discharge, ineffective communication and subsequent unsafe use of opioids at home highlighting unmet patient care needs.

Three main themes were identified from the analysis (a) challenges in the discharge process, (b) coping at home after discharge and (c) managing medications at home. Pain was a dominant thread running throughout all themes which represented an important quality and safety concern for all participants. Associated concerns included insufficient preparation and education for hospital discharge, ineffective communication and subsequent unsafe use of opioids at home highlighting unmet patient care needs.

Results of experimental studies have indicated the possibility of muscle and bone mass being negatively regulated by renin-angiotensin system (RAS) activation, but that possibility has not been analysed in patients with heart failure (HF).

Data for HF patients who received a dual-energy X-ray absorptiometry scan in our hospital were reviewed. Propensity scores for the use of RAS inhibitors (RASIs) were calculated using a multivariate logistic regression model to minimize selection bias. One hundred sixty pairs of patients were extracted. Plasma aldosterone concentration was significantly lower in the RASIs group than in the no-RASIs group (119 [IQR 71-185] vs. 94 [IQR 60-131] pg/mL, P=0.003), confirming RAS inhibition in the RASIs group. Skeletal muscle mass index tended to be higher in the RASIs group than in the non-RASIs group (15.6 [IQR 14.0-17.2] vs. 15.0 [IQR 13.3-16.6] pg/mL, P=0.065). The proportion of patients with muscle wasting, defined as appendicular skeletal muscle mass indexes of <7.00 and <5.40kg/m

for males and females, respectively, was significantly lower in the RASIs group than in the non-RASIs group (53% vs. 64%, P=0.041). Multivariate logistic regression analysis showed that the no use of RASIs was associated with presence of muscle wasting independently of age, presence of diabetes, renal function, and severity of HF. Bone mineral densities and proportions of patients with osteoporosis were similar in the two groups.

Renin-angiotensin system inhibition is associated with a lower prevalence of muscle wasting in HF patients independently of established risk factors.

Renin-angiotensin system inhibition is associated with a lower prevalence of muscle wasting in HF patients independently of established risk factors.Heart failure (HF) does not occur in a vacuum and is commonly defined and exacerbated by its co-morbid conditions. Neurohormonal imbalance and systemic inflammation are some of the key pathomechanisms of HF but also commonly encountered co-morbidities such as arterial hypertension, diabetes mellitus, cachexia, obesity and sleep-disordered breathing. A cornerstone of HF management is neurohormonal blockade, which in HF with reduced ejection fraction has been tied to a reduction in morbidity and mortality. Pharmacological treatment effective in patients with HF with reduced ejection fraction did not show substantial effects in HF with preserved ejection fraction. Here, we review novel device-based therapies using neuromodulation of extra-cardiac targets to treat cardiometabolic disease.Global climate change is altering patterns of temperature variation, with unpredictable consequences for species and ecosystems. The Metabolic Theory of Ecology (MTE) provides a powerful framework for predicting climate change impacts on ectotherm metabolic performance. MTE postulates that physiological and ecological processes are limited by organism metabolic rates, which scale predictably with body mass and temperature. The purpose of this study was to determine if different metabolic proxies generate different empirical estimates of key MTE model parameters for the aquatic frog Xenopus laevis when allowed to exhibit normal diving behavior. We used a novel methodological approach in combining a flow-through respirometry setup with the open-source Arduino platform to measure mass and temperature effects on 4 different proxies for whole-body metabolism (total O2 consumption, cutaneous O2 consumption, pulmonary O2 consumption, and ventilation frequency), following thermal acclimation to one of 3 temperatures (8°C, 17°C, or 26°C). Different metabolic proxies generated different mass-scaling exponents (b) and activation energy (EA ) estimates, highlighting the importance of metabolic proxy selection when parameterizing MTE-derived models. Animals acclimated to 17°C had higher O2 consumption across all temperatures, but thermal acclimation did not influence estimates of key MTE parameters EA and b. Cutaneous respiration generated lower MTE parameters than pulmonary respiration, consistent with temperature and mass constraints on dissolved oxygen availability, SAV ratios, and diffusion distances across skin. Our results show that the choice of metabolic proxy can have a big impact on empirical estimates for key MTE model parameters.SMAD4, a tumor suppressor gene, is lost in up to 60%-90% of pancreatic adenocarcinomas (PDAs). Loss of SMAD4 allows tumor progression by upregulating autophagy, a cell survival mechanism that counteracts apoptosis and allows intracellular recycling of macromolecules. Hydroxychloroquine (HCQ) is an autophagy inhibitor. We studied whether HCQ treatment in SMAD4 deficient PDA may prevent therapeutic resistance induced by autophagy upregulation. We retrospectively analyzed the SMAD4 status of patients with PDA enrolled in two prospective clinical trials evaluating pre-operative HCQ. The first dose escalation trial demonstrated the safety of preoperative gemcitabine with HCQ (NCT01128296). More recently, a randomized trial of gemcitabine/nab-paclitaxel +/- HCQ evaluated Evans Grade histopathologic response (NCT01978184). The effect of SMAD4 loss on response to HCQ and chemotherapy was studied for association with clinical outcome. read more Fisher's exact test and log-rank test were used to assess response and survival. Fifty-two patients receiving HCQ with neoadjuvant chemotherapy were studied.