'Auspicious liaisons'-evaluating the impact of a liaison geriatrician initiative on older adults psychiatric wards.

BACKGROUND: Although liaison services in acute hospitals are now the norm, the reverse is not usually available for patients in mental health trusts. Following the introduction of support from geriatricians to older people's mental health inpatient wards, we wanted to see if this intervention was effective and acceptable to clinicians. METHODS: We performed a retrospective cohort service evaluation on the impact of a liaison geriatrician, using routinely collected data, and assessed acceptability among medical staff by semi-structured interview. INTERVENTION: Our service introduced regular sessions from consultant community geriatricians across older adults psychiatric wards including a mixture of video conference and face-to-face input. RESULTS: There was no significant decrease in emergency transfers but there was a significant reduction in length of stay with an associated cost benefit for the service after the introduction of a liaison geriatrician. There was a significant increase in geriatrician consultations and a decrease in specialty consultations to other specialists. There was no change in discharge prescriptions or destination. There was a significant reduction in falls in the intervention arm but not in falls leading to emergency hospital admissions geriatricians gave confidence to psychiatrists of all grades to treat physical health care issues. CONCLUSIONS: A liaison geriatrician service may be a component in reducing length of stay (although there are many others) and improving continuity of care, although it confers no impact on emergency transfers. The intervention was highly acceptable to clinicians.

Individual variation in diurnal cortisol in patients with knee osteoarthritis: Clinical correlates.

BACKGROUND: The cortisol awakening response (CAR) is a core biomarker of hypothalamic-pituitary-adrenal (HPA) axis regulation. To date, however, studies of HPA-axis function among patients with chronic pain are scarce and show equivocal results. The objectives of this study were to investigate the association between CAR and pain-related outcomes and to investigate potential sex differences in patients with knee osteoarthritis (KOA). METHODS: In this cross-sectional study, KOA patients (N = 96) completed self-report questionnaires assessing pain and psychosocial factors and underwent Quantitative Sensory Testing (QST) to assess pressure pain threshold (PPT). Additionally, salivary cortisol samples (N = 60) were collected to assess HPA-axis function at 6 time points (awakening, 15- and 30-minute post-awakening, 4 PM, 9 PM and bedtime). The CAR was calculated by examining increases in salivary cortisol from awakening to 30 min post awakening and the total post-awakening cortisol concentration by calculating the lower areas under the curve of cortisol with respect to ground (AUCG). RESULTS: Patients with a relatively blunted CAR had significantly higher anxiety levels and lower PPT than patients with relatively normal CAR. Similarly, patients with a relatively reduced AUCG had significantly higher pain interference and anxiety levels compared to patients with relatively normal AUCG. PPT was positively correlated with CAR and AUCG and negatively correlated with pain severity and anxiety. Men with KOA had significantly lower anxiety, higher PPT and higher CAR and AUCG than women with KOA. Mediation analysis results revealed a significant indirect effect of PPT on the relationship between sex and AUCG. CONCLUSIONS: The findings of this study suggest that neuroendocrine factors such as CAR and AUCG may contribute to individual differences in pain-related outcomes in patients with KOA. Additionally, our results show sex differences in the magnitude of morning HPA activation and pain-related outcomes. Finally, our findings are suggestive of a sex-dependent relationship between post-awakening cortisol concentrations and pain perception. Future research should examine these associations across various pain populations.

Modifiable Psychological Factors Affecting Functioning in Fibromyalgia.

OBJECTIVE: To examine the role of several interrelated, potentially modifiable psychological factors (i.e., mindfulness and catastrophizing) in influencing patient-reported functioning. METHODS: In this cross-sectional study, 107 patients with fibromyalgia completed self-report assessments of pain severity, functioning and impact of symptoms, mindfulness, and pain catastrophizing. Linear regression and bootstrapping mediation analyses were performed to assess the relationships between these factors. RESULTS: Pain intensity was significantly and positively associated with pain catastrophizing and impact of fibromyalgia on functioning. Linear regression analyses indicated that pain intensity, catastrophizing, and mindfulness affect functioning in fibromyalgia. Follow-up mediation analysis revealed a significant indirect effect of pain catastrophizing on the relationship between pain intensity and fibromyalgia functioning. CONCLUSION: Individuals with fibromyalgia who have higher levels of pain and catastrophizing, and lower levels of mindfulness, are more likely to experience impaired functioning. Our findings suggest that pain catastrophizing appears to be an especially important variable contributing to reduced functioning in women with fibromyalgia. Therefore, catastrophizing-reducing treatments (e.g., cognitive behavioral therapy) are likely to have direct, beneficial impacts on functioning.

The association between daily physical exercise and pain among women with fibromyalgia: the moderating role of pain catastrophizing.

INTRODUCTION: Fibromyalgia (FM) is a condition marked by widespread chronic pain and an array of somatic and psychological symptoms. The primary objective of this study was to explore daily associations between physical activity and pain intensity among a sample of women with FM and the potential moderation of this association by pain catastrophizing. METHODS: Women with FM (N = 107) completed questionnaires assessing pain, FM symptoms, and psychological measures and were then asked to report their levels of daily pain catastrophizing, physical activity, and pain intensity once per day for a period of 1 week using daily electronic diary-based tracking. In addition, objective measures of physical activity were collected using an activity tracker (Fitbit Flex), which measured step counts. Daily self-report physical activity was used as the independent variable and pain intensity (Brief Pain Inventory) was the outcome, whereas daily pain catastrophizing was tested in the model as the potential moderator. RESULTS: Moderation analyses demonstrated associations between physical activity and pain intensity, which were moderated by patient's level of catastrophizing (B = 0.003, SE = 0.001, P < 0.05), with patients scoring higher in daily catastrophizing showing a relatively stronger link between higher day-to-day physical activity and increased daily FM pain. Significant associations were observed between pain catastrophizing, pain intensity, and Fitbit Flex step count (P < 0.05). CONCLUSIONS: Our findings suggest that increases in daily physical activity is associated with more self-reported pain intensity in women with FM pain, particularly among those with higher levels of pain catastrophizing.

Plasma HbA1c in the investigation of suspected heart failure in general practice: An audit of the 2018 NICE guidelines update.

INTRODUCTION: Diabetes mellitus is a known risk factor for heart failure (HF); nevertheless, many HF patients remain undiagnosed. The National Institute for Health and Care Excellence in England updated their HF guidelines in 2018, replacing the use of fasting plasma glucose with glycated hemoglobin (HbA1c), in suspected HF investigation. This audit aimed to assess this update's uptake at a general practice partnership in Colchester, England. MATERIALS AND METHODS: The audit cycle consisted of a two-round electronic record search, for approximately 29,000 patients registered at the partnership. From November 1, 2017 to November 1, 2018 for the first round and from November 1, 2018 to March 6, 2019 for the second round, patients who had their NT pro-brain natriuretic peptide levels measured for the initial investigation of suspected HF were included in the study. Interventions put in place after the first round included an oral presentation and an illustrated guide for the general practitioners (GPs). RESULTS: One hundred and ten patients, 19 in cycle 1 and 91 in cycle 2, were identified and included in the analysis. At the first round, only 31.6% of the patients had their HbA1c level measured, while 36.8% had no diabetic investigation done. At the second round, the percentage of patients who had their HbA1c level assessed increased to 59.3%. A decrease from 36.8% of patients without diabetic status assessment to 20% was observed. CONCLUSIONS: Lack of awareness among GPs regarding this guideline update was identified and simple interventions achieved an increase in the guideline's uptake. Regular and complete audit cycles can help GPs adhere to up-to-date guidelines. Primary care can help other organizations such as pathology laboratories keep up to date with guidelines, while primary care technology can be amended in-house to help adherence to new guidelines. We recommend the National UK Heart Failure Audit considers auditing the use of HbA1c testing in inpatients investigated for new HF.

Health in All Policy Making Utilizing Big Data.

INTRODUCTION: Health in all Policies (HiAP) is a valuable method for effective Healthcare policy development. Big data analysis can be useful to both individuals and clinicians so that the full potential of big data is employed. AIM: The present paper deals with Health in All Policies, and how the use of Big Data can lead and support the development of new policies. METHODS: To this end, in the context of the CrowdHEALTH project, data from heterogeneous sources will be exploited and the Policy Development Toolkit (PDT) model will be used. In order to facilitate new insights to healthcare by exploiting all available data sources. RESULTS: In the case study that is being proposed, the NOHS Story Board (inpatient and outpatient health care) utilizing data from reimbursement of disease-related groups (DRGs), as well as medical costs for outpatient data, will be analyzed by the PDT. CONCLUSION: PDT seems promising as an efficient decision support system for policymakers to align with HiAP as it offers Causal Analysis by calculating the total cost (expenses) per ICD-10, Forecasting Information by measuring the clinical effectiveness of reimbursement cost per medical condition, per gender and per age for outpatient healthcare, and Risk Stratification by investigating Screening Parameters, Indexes (Indicators) and other factors related to healthcare management. Thus, PDT could also support HiAP by helping policymakers to tailor various policies according to their needs, such as reduction of healthcare cost, improvement of clinical effectiveness and restriction of fraud.

Neuro-Behçet's masquerading as progressive bulbar palsy: a case report and literature review.

In patients with progressive bulbar palsy without an obvious cause, there should be a high index of suspicion for the potential diagnosis of Neuro-Behçet's Disease, even in the absence of the acute classical peripheral manifestations of Bechet's Disease, with emphasis in prompt diagnosis using 'The International Criteria for Behçet's Disease' and rapid, effective treatment in order to improve outcome.

Plasma N-terminal pro-B-type natriuretic peptide (BNP) in mesalazine-induced myopericarditis.

Mesalazine (5-aminosalicylic acid)-based products are a widely used treatment for inflammatory bowel disease in children and adults. Associated myopericarditis is an uncommon but recorded phenomenon related to drug hypersensitivity. Unless recognised, this important complication may culminate in the development of dilated cardiomyopathy and severe heart failure. We report the case of a boy with Crohn's disease who developed myopericarditis 14 days after starting treatment with mesalazine. Discontinuation of the drug rapidly led to normalisation of left ventricular structure and function, and a parallel improvement in the levels of plasma N-terminal pro-B-type natriuretic peptide and other markers of myocardial damage. Clinicians should be aware of this potentially life-threatening adverse effect of mesalazine therapy, which is quickly and fully reversible on cessation of the agent.

Quality assurance of Siemen's virtual wedge(TM)by using film dosimetry.

A film dosi netry method is proposed for measuring the non-uniform dose distribution generated by Virtual Wedges of a 6 MV Siemens Pr mus accelerator. This method was chosen due to the dose integration capabilities and the improved spatial resolution that films offer, giving the opportunity of measuring dose distribution in a single beam irradiation. Dose profiles were obtained and analyzed using a 16-bit Vidar film scanner and OmniPro-Accept software. Results were compared with corresponding ones measured with an array ionization chamber for both virtual and conventional wedges. A good agreement was found between the two methods for all the examined wedge angles. This study shows that film, dosimetry can be incorporated in a monthly quality asseurance program for virtual wedges in order to reduce the required effort.