Screening for atrial fibrillation in care homes using pulse palpation and the AliveCor Kardia Mobile® device: a comparative cross-sectional pilot study.

BACKGROUND: Atrial fibrillation (AF) is a major cause of stroke in older people. Exacerbated by age and co-morbidities, residents of care homes are more likely to develop AF and less likely to receive oral anticoagulants. AIM: To determine the prevalence of AF using the design and methodology of the Pharmacists Detecting Atrial Fibrillation (PDAF) study in a care home setting. METHOD: A cross-sectional AF screening pilot study within four UK care homes, three residential and one residential/nursing. Screening followed the original PDAF protocol: a manual pulse check, followed by a single-Lead ECG (SLECG, AliveCor Kardia Mobile (KMD)) delivered by a pharmacist. All recorded SLECG were reviewed by a cardiologist and any residents requiring follow-up investigations were referred to their general practitioner. RESULTS: Fifty-three of 112 care home residents participated. From 52 SLECGs recorded, the cardiologist interpreted 13.5% (7/52) as having possible AF of which 9.6% (5/52) were previously unknown. One resident with previously unknown AF received anticoagulation. CONCLUSION: This study has shown a need for AF screening in care homes and that elements of the PDAF screening protocol are transferable in this setting. Early diagnosis and treatment of AF are essential to reduce the risk of stroke in this population.

Prevalence of Adverse Childhood Experiences of Parenting Women in Drug Treatment for Opioid Use Disorder.

Descriptive adverse childhood experience (ACE) prevalence data on parenting women seeking treatment for opioid use disorder (OUD) is limited, despite this group being one of the fastest growing sub-populations of the opioid epidemic. The aim of this study was to: (1) determine prevalence of ACEs) in a population of parenting women in treatment for OUD, (2) characterize ACEs, and (3) compare study ACE data to Pennsylvania Behavioral Risk Factor Surveillance System (PA BRFSS) to normalize study results. Between 2014 and 2018, ACEs were collected from parenting women (N = 152) enrolled in treatment for OUDs. Results showed on average women were 30.3 years of age (SD 4.6, range 22-41 years) non-Hispanic (87.0%), white (74.0%), and held a high school education or less (76.0%). The mean total ACE score was 4.3 (SD 2.3; range 0-8). Most women reported 4 ≥ ACEs (65.0%), while only 5.0% reported 0 ACEs. The current sample had higher mean ACE score (4.3 PSMDT vs. 1.4 PA BRFSS Data) than PA BRFSS Data. The burden of ACEs in parenting women in treatment for OUD is significant. Understanding the trauma parenting women in drug treatment have experienced, may support efforts to reduce stigma of this population. Public health intervention and policy work that is trauma proactive is needed to address this growing epidemic.

Patient experiences of perioperative nutrition within an Enhanced Recovery After Surgery programme for colorectal surgery: a qualitative study.

AIM: Nutrition is an important element of the Enhanced Recovery After Surgery (ERAS) programme. Patients have previously indicated that nutrition is a key component of ERAS that requires improvement. Our aim was to explore the perioperative nutrition experiences of colorectal surgical patients to identify barriers and facilitators to the integration of nutrition within ERAS. METHOD: Sixteen individuals undergoing colorectal surgery participated in a semi-structured interview between postoperative day three and hospital discharge. The topic guide was developed iteratively throughout the study; topics included preoperative counselling, carbohydrate loading, fasting and postoperative nutrition. A constant comparison technique was employed during coding, and an inductive thematic analysis was used. Validity was ensured by double coding a sample of transcripts. RESULTS: Findings are presented in the context of the following clinical themes: preoperative information, preoperative fasting, carbohydrate loading and nutritional drinks, postoperative diet and discharge. Individuals received too much general information which was repetitive, contradictory and not disease specific; this formed a key barrier affecting nutrition. Other barriers were negative experiences of nutritional drinks, stoma management, nausea and vomiting, and challenges from the hospital environment. Facilitators included interactions with staff, food accessibility and choice, and motivation for discharge. CONCLUSION: The key barrier to adherence of perioperative nutrition protocols was poor provision of information. Targeted information regarding postoperative diet, stoma management and coping with nausea and vomiting would be beneficial for colorectal surgical patients. Easily accessible food provided by ward staff was considered a facilitator.

The demographic, sexual health and behavioural correlates of Mycoplasma genitalium infection among women with clinically suspected pelvic inflammatory disease.

OBJECTIVE: Mycoplasma genitalium has been identified as a cause of pelvic inflammatory disease (PID), a clinical syndrome associated with inflammation of the female upper genital tract and serious reproductive sequelae. As the demographic, behavioural and sexual risk profile of women with M genitalium-associated PID is not well understood, the characteristics of M genitalium-infected women presenting with clinically suspected PID were investigated. METHODS: Data from 586 participants in the PID Evaluation and Clinical Health Study were analysed. Demographic, sexual history and behavioural characteristics, including age, race, marital status, education level, sexual activity, number of sexual partners, history of sexually transmitted infection (STI), bacterial vaginosis and PID, contraception use, oral and anal sex, age at sexual debut, douching practices and drug, alcohol and tobacco use, were compared between 88 women testing positive and 498 women testing negative for M genitalium by PCR in the cervix and/or endometrium. Twenty-two women with M genitalium mono-infections were compared with 172 women who tested positive for Neisseria gonorrhoeae by culture and/or Chlamydia trachomatis by PCR. RESULTS: Age under 25 years, douching two or more times per month and smoking were independently associated with M genitalium. Women with M genitalium mono-infections were significantly less likely to be African-American (59.1% vs 86.0%, p = 0.001) than women with N gonorrhoeae and/or C trachomatis. CONCLUSIONS: Women infected with M genitalium had some characteristics commonly associated with PID and other STI. The demographic, sexual and behavioural characteristics of M genitalium-positive women were similar to women with chlamydial and/or gonococcal PID.

Co-ordinate changes in enzymes of fatty acid synthesis, activation and esterification in rabbit mammary gland druing pregnancy and lactation.

1. The activities of fatty acid synthetase, acyl-CoA synthetase, glycerol phosphate acyltransferase and phosphatidate phosphatase were measured in the mammary glands of rabbits from day 16 of pregnancy to day 15 of post partum. 2. There were significant correlations between the increases in activities of these enzymes during this period. This was the case whether the activities were expressed per mg of homogenate protein, per g wet wt. of tissue or per total wet weight of the whole glands. The only exception was the lack of correlation between the activities of fatty acid synthetase and of phosphatidate phosphatase per g wet wt. of tissue. 3. These co-ordinate increases are discussed in relation to the changes which occur in fatty acid metabolism in the mammary gland during pregnancy and lactation.

Enzymes of glycerolipid synthesis in small-intestinal mucosa of foetal and neonatal guinea pigs.

1. The activities of some enzymes of glycerolipid synthesis were measured in homogenates obtained from the intestinal scrapings of 62-66-day foetuses and 2- and 8-day-old guinea pigs. 2. The ratio of protein concentration/DNA concentration was significantly higher (P greater than 0.001) in homogenized tissue from the neonatal compared with the foetal guinea pigs. Enzyme activities were therefore expressed relative to both protein and to DNA. 3. The specific activities (relative to DNA) of palmitoyl-CoA synthetase, glycerol phosphate acyltransferase and phosphatidate phosphatase were higher in homogenized tissues from neonatal than in those from the foetal guinea pigs. These activities are probably involved more in cell proliferation than in the absorption and transport of triacylglycerol. Its activity was not significantly different in the foetal and neonatal guinea pigs when expressed relative to DNA but it was lower in the neonatal guinea pigs when expressed relative to protein. The entry of food into the intestine after birth is therefore not necessary for its activity.

A new assay procedure for monoglyceride acyltransferase.

1. A new assay system is described for monoglyceride acyltransferase (acylglycerol palmitoyltransferase, EC 2.3.1.22) in which palmitoyl-CoA is generated from palmitoyl-(-)-carnitine. 2. With the microsomal fraction from homogenates of guinea-pig intestinal mucosa, the V(max.) of this enzyme decreased with different acyl acceptors in the order 2-monopalmitoylglycerol>2-hexadecylglycerol>rac-1-monopalmitoylglycerol. 3. There were highly significant correlations between the monoglyceride acyltransferase activity as measured with these three substrates. This demonstrates that each of these substrates can be used to measure the same enzyme activity. 4. The advantages of using generated palmitoyl-CoA with 2-hexadecylglycerol and rac-1-monopalmitoylglycerol as model substrates for this enzyme are discussed.