Tag: pubmed

Clin Exp Immunol. 2021 Sep 6. doi: 10.1111/cei.13659. Online ahead of print.

ABSTRACT

Graft versus Host Disease (GvHD) is a major clinical problem with a significant unmet medical need. We examined the role of Cytotoxic T-Lymphocyte Antigen-4 (CTLA-4) in a xenogenic GvHD (xeno-GvHD) model induced by injection of human peripheral mononuclear cells (hPBMC) into irradiated NSG mice. Targeting CTLA4 pathway by treatment with CTLA-4 Ig prevented xeno-GvHD, while anti-CTLA-4 antibody treatment exacerbated the lethality and morbidity associated with the GvHD. The xeno-GvHD is associated with infiltration of hPBMCs into the lungs, spleen, stomach, liver, and colon, and an increase in human pro-inflammatory cytokines including IFN-γ, TNFα and IL-5. Infiltration of donor cells and increases in cytokines were attenuated by treatment with CTLA-4 Ig but remained either unaffected or enhanced by anti-CTLA-4 antibody. Further, splenic human T cell phenotyping showed that CTLA-4 Ig treatment prevented the engraftment of human CD45+ cells while anti-CTLA-4 antibody enhanced donor T cell expansion, particularly CD4+ (CD45RO⁺ ) subsets including, Tbet⁺ CXCR3⁺ and CD25⁺ Foxp3 cells. Comprehensive analysis of transcriptional profiling of human cells isolated from mouse spleen identified a set of 417 differentially expressed genes (DEGs) by CTLA-4 Ig treatment and 13 DEGs by anti-CTLA4 antibody treatment. The CTLA-4 Ig regulated DEGs mapped to down regulated apoptosis, inflammasome, Th17 and Treg pathways, and enhanced TLR receptor signaling, TNF family signaling, complement system, and epigenetic and transcriptional regulation, where as anti-CTLA-4 antibody produced minimal to no impact on these gene pathways. Our results show an important role of co-inhibitory CTLA-4 signaling in xeno-GvHD and suggest therapeutic utility of other immune checkpoint co-inhibitory pathways in the treatment of immune-mediated diseases driven by hyperactive T-cells.

PMID:34487545 | DOI:10.1111/cei.13659

Int Endod J. 2021 Sep 6. doi: 10.1111/iej.13628. Online ahead of print.

ABSTRACT

AIM: To investigate attitudes and approaches of UK primary care dentists to carrying out vital pulp treatment (VPT) after carious-exposure and with additional signs and symptoms indicative of irreversible pulpitis.

METHODOLOGY: An electronic questionnaire was openly distributed via publicly-funded (NHS) local dental committees, corporate dental service-providers, professional societies and social media. Principally NHS practitioners, and those from mixed and private practice were targeted, in addition to community and military dental officers, and dental therapists. Participants were asked questions relating to several clinical scenarios, with responses analysed using descriptive statistics. χ² tests with sequential Bonferroni correction were used to explore variables including the method of remuneration, practitioner type (dentist/therapist), postgraduate qualification(s), place of graduation and years since qualification. Variables with a relationship p≤0.2 were selected for backwards likelihood ratio logistic modelling.

RESULTS: In total, 648 primary care practitioners were included for analysis. Calcium hydroxide (CH) was most frequently used for direct pulp caps (DPCs) (398/600; 66.3%) with calcium-silicate cements (CSCs) less frequently used (119/600; 19.8%). Rubber dam was used by 222/599 (37.1%) practitioners. A definitive pulpotomy for the management of teeth with signs a symptoms indicative of irreversible pulpitis was selected by 65/613 (10.6%) dentists. The principal barrier for the provision of definitive pulpotomies was a lack of training (602/612; 98.4%). Regression analysis identified NHS practitioner’s as a good predictor for using CH for DPCs, having shorter emergency appointments, limited access to magnification and not using rubber dam. Non-UK graduates were more likely to select CSCs, appropriately control pulpal haemorrhage, undertake appropriate post-operative evaluation and use rubber dam.

CONCLUSIONS: Practitioners deviated from evidence-based guidelines in a number of aspects including material selection, asepsis and case selection. A number of other challenges exist in primary care in providing predictable VPTs, including lack of time and access to magnification. These were most evident in NHS practice, potentially exacerbating existing social health inequalities. Possible inconsistencies in the UK undergraduate curriculum were supported by a lack of association between years since qualification and technique employed as well as the fact that non-UK graduates and dentists with postgraduate qualifications adhered more to evidence-based VPT guidelines.

PMID:34487553 | DOI:10.1111/iej.13628

Brain Inj. 2021 Sep 6:1-8. doi: 10.1080/02699052.2021.1972451. Online ahead of print.

ABSTRACT

OBJECTIVE: Clinical practice guidelines (CPGs) synthesize research evidence for health professionals and improve consistency of clinical care. However, it is unclear if concussion clinicians use them in their practice. We aimed to describe which CPGs New Zealand clinicians used and facilitators and barriers to uptake of these resources.

MATERIALS AND METHODS: We used snowballing recruitment methods to survey New Zealand concussion clinicians. Descriptive statistics and qualitative description were used to evaluate survey responses.

RESULTS: Ninety-six clinicians took part in the survey. A majority (70%) indicated they were aware of and had used at least one concussion CPG. Facilitators and barriers to using CPGs related to clinician experience, nature of the CPG, the work context, characteristics of clients and whether strategies were provided to encourage their use.

CONCLUSIONS: Participants viewed concussion CPGs as helpful tools for informing clinical practice. That less experienced clinicians were less likely to use concussion CPGs than more experienced clinicians suggests there is an opportunity to develop strategies to improve the uptake of CPGs among newer clinicians. This and other areas of further research include how well CPGs capture relevant cultural factors and the role of case complexity in clinicians’ willingness to use concussion CPGs.

PMID:34487457 | DOI:10.1080/02699052.2021.1972451

Int J Qual Health Care. 2021 Sep 6:mzab130. doi: 10.1093/intqhc/mzab130. Online ahead of print.

ABSTRACT

BACKGROUND: Delays to the transfer of care from hospital to other settings represent a significant human and financial cost. This delay occurs when a patient is clinically ready to leave the inpatient setting but is unable to because other necessary care, support or accommodation is unavailable. The aim of this study was to interrogate administrative and clinical data routinely collected when a patient is admitted to hospital following attendance at the emergency department, to identify factors related to delayed transfer of care when the patient is discharged. We then used these factors to develop a predictive model for identifying patients at risk for delayed discharge of care.

METHODS: This is a single centre, retrospective, cross-sectional study of patients admitted to an English National Health Service university hospital following attendance at the emergency department between January 2018 and December 2020. Clinical information (e.g., NEWS scores), as well as administrative data that had significant associations with admissions that resulted in delayed transfers of care, were used to develop a predictive model using a mixed-effects logistic model. Detailed model diagnostics and statistical significance, including receiver operating characteristic analysis, were performed.

RESULTS: Three-year (2018-20) data were used; a total of 92,444 admissions (70%) were used for model development and 39,877 (30%) admissions for model validation. Age, gender, ethnicity, National Early Warning Score, Glasgow admission prediction score (GAPS), Index of Multiple Deprivation decile, arrival by ambulance and admission within the last year were found to have a statistically significant association with delayed transfers of care. The proposed eight-variable predictive model showed good discrimination with 79% sensitivity (95% confidence intervals: 79%, 81%), 69% specificity (95% CI: 68%, 69%) and 70% (95% confidence intervals: 69%, 70%) overall accuracy of identifying patients who experienced a delayed transfer of care.

CONCLUSION: Several demographic, socio-economic and clinical factors were found to be significantly associated with whether a patient experiences a delayed transfer of care or not following an admission via the emergency department. An eight-variable model has been proposed, which is capable of identifying patients who experience delayed transfers of care with 70% accuracy. The eight-variable predictive tool calculates the probability of a patient experiencing a delayed transfer accurately at the time of admission.

PMID:34487520 | DOI:10.1093/intqhc/mzab130

J Eur Acad Dermatol Venereol. 2021 Sep 6. doi: 10.1111/jdv.17643. Online ahead of print.

ABSTRACT

Alopecia areata (ΑΑ) is an inflammatory disease of the hair follicle unit characterised by non-scarring hair loss. The complex interplay and communication between cells of the immune system and the microenvironment around the hair follicle ensure a homeostasis which is compromised in AA.

PMID:34487410 | DOI:10.1111/jdv.17643

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Jul;29(4):977-983. doi: 10.32687/0869-866X-2021-29-4-977-983.

ABSTRACT

The inclusion of public health and health care measures in labor functions of professional standards of medical specialists increased significance of mastering of these standards by students during specialty training, since on this depends their successful completion of primary accreditation of specialists and implementation of job descriptions in the course of daily activities. The purpose of the study was to analyze factors determining qualitative of mastering the discipline “Public health and Health Care” by students of medical educational organizations. The analytical, logical, statistical, questionnaire survey and direct ranking methods were applied. The sampling of 316 students of the Sechenov University was involved in survey using questionnaire of 17 closed questions. The study established that the determining factors effecting quality of mastering by students the discipline “Public health and Health Care” are the need to use by physicians this knowledge in the course of their daily activities; the need of students to pass profile exam; the determination of up to 40% of trainees to work as heads of structural units or professionals of health care and public health; the dedication of student; organization of educational process at the Chair; the professionalism of faculty; the application of active learning methods in classroom; organization of career guidance among students.

PMID:34486869 | DOI:10.32687/0869-866X-2021-29-4-977-983

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Jul;29(4):963-965. doi: 10.32687/0869-866X-2021-29-4-963-965.

ABSTRACT

The enhancement of organization of palliative medical care to increase life quality of terminally ill patients is one of directions of development of health care system. To elaborate measures of improving accessibility and quality of palliative medical care, it is necessary to apply single unified methodology of calculating indices and criteria. One of them is provision of bed capacity. The purpose of the study is to elaborate methodology of calculating control indices of provision population with beds to render palliative medical care. The indices are calculated on the basis of statistical processing of monitoring corresponding data in the subjects of the Russian Federation.

PMID:34486866 | DOI:10.32687/0869-866X-2021-29-4-963-965

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Jul;29(4):971-976. doi: 10.32687/0869-866X-2021-29-4-971-976.

ABSTRACT

The common coding of main diagnosis (so-called “manual coding”) is accompanied by quite many errors associated with inobservance of classification algorithm and subjective causes that in statistical morbidity and mortality data corruption. The article presents the results of implementing automated system of diagnosis coding by the ICD-10 in the departments of the Medicosanitary Unit of MVD of Russia in City of Moscow. The functional and time losses and the error rate were studied under manual coding and automated coding system. In case of common coding of complete clinical diagnosis of one discharged patient per day, it takes from 5 to 15 minutes, for coding diagnoses of all discharged patients – about 1 hour. The number of errors in common coding made up to 14.1% (n=2472) and in case of automated coding it made up to 1.5% (n= 63, p>0.05). The application of automated coding system in medical organizations ensures exact correspondence of clinical and statistical diagnosis, unifies wording of clinical diagnosis, minimizes subjective deviations from algorithm of the ICD-10.

PMID:34486868 | DOI:10.32687/0869-866X-2021-29-4-971-976

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Jul;29(4):957-962. doi: 10.32687/0869-866X-2021-29-4-957-962.

ABSTRACT

In accordance with the Russian Federal Law No. 350 of January 2019 the retirement age for Russians is increased for men from 60 up to 65 years, for women from 55 up to 60 years that requires implementation of organizational technologies of health-preserving, promotion of life and labor potential of population of late able-bodied age. In this regard, the role of day hospitals (DH) functioning directed at maximal possible prolongation of autonomous life and working capacity of elderly population increases. Besides, DH also presents additional reserve of optimization of medical care costs. The purpose of the study is to elaborate guidelines of improving activities of DH for population of late able-bodied age, for the purpose of preventive hospitalization. The study was organized on the basis of pilot medical organization of the Moscow Oblast, consisted of hospital of 600 beds and day hospital of 120 beds. The methods applied included sociological survey, expert judgment, statistical direct observation. The primary data was obtained from the forms of federal and sectorial statistical monitoring for 2014-2018. The analysis of medical documentation concerning pilot medical organization functioning during the year of the study was applied. The sociological surveys of patients of late able-bodied age (5 years before retirement according to the new legislation – men 60-65 years old, women 55-60 years old) who received treatment in day hospital. The results. The analysis of main indices of round-the-clock functioning in-patient and day hospitals in the Russian Federation in 2014-2018 established trend towards improvement of using hospital beds due to development of day hospital. However, bed capacity of hospitals is used ineffectively and experts assume that more than 1/3 of patients could receive medical care or aftercare in day hospitals. The experimental study of planning hospitalization of patients with chronic diseases at out-patient level demonstrated that 11.5% of population of able-bodied age need planned and preventive hospitalization in day hospital. The cost of treatment of patient with chronic pathology is 2-3 times lower in day hospital than in common hospital at the stage of exacerbation. It is reliable to apply at the out-patient level experience of planning hospitalization of patients with chronic pathology in day hospitals followed by performance control. The organization of functioning of day hospital and common hospital requires particular enhancement, including issues of succession, financing of the DS, the remuneration of medical personnel through effective contract determining interest of physician in early discharge of patient to aftercare in day hospital. The day hospital functioning is to be implemented in 2-3 turns. The day hospital is to be located in detached placement and the departments of base medical institution are to used in fullness. The day hospital is be used more actively for purpose of health preservation of population of late able-bodied age who. This contingent suffers of chronic pathology and is in need of preventive and health-promoting therapy in conditions of day hospital.

PMID:34486865 | DOI:10.32687/0869-866X-2021-29-4-957-962

Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2021 Jul;29(4):904-908. doi: 10.32687/0869-866X-2021-29-4-904-908.

ABSTRACT

This article discusses clauses of national standards compatible with international standards of ISO 9000-9001 family,in section of measurement of degree of satisfaction of patients with medical services quality. The main methods applied are sociological survey SERVQUAL focused on measurement of degree of satisfaction of patients, GAP-analysis (identification of discrepancies and gaps) and technique of management decision-making concerning improvement of medical services quality. The SERVQUAL survey with its five qualitative criteria was applied. The primary data was obtained from sampling of 500 well structured questionnaires. In total, 365 respondents participated in the study. The produced correlation matrix confirmed strong relations between criteria estimating expected and interpreted quality of medical services and full average interpreted quality. The analysis of reliability confirmed that questions of questionnaire are reliable and the results of statistical calculations can be used in further analysis. The analysis of descriptive statistics, correlation matrix, patient profile, reliability and qualitative GAP analysis were carried out. The requirements of assuring reliability and adequacy of questionnaire, representativeness of sample size to carry out high quality measurements were kept. The results on every criterion were obtained. The qualitative results of discrepancy of and perceptions of patients are received. The negative values of indices of discrepancy of the interpreted and expected outcomes of medical services are received. The level of satisfaction of patients remains insufficient. The study proposes to improve quality of medical services in hospital, especially by criterion “Materiality” to justify expectations of patients. The results of the study are of practical importance for executives of regional health care administrations, head physicians of medical organizations engaged in improvement of medical care quality and increasing of efficiency of medical services.

PMID:34486856 | DOI:10.32687/0869-866X-2021-29-4-904-908