Evaluation of Huawei smart wearables for detection of atrial fibrillation in patients following ischemic stroke: The Liverpool-Huawei stroke study.

BACKGROUND: Atrial fibrillation (AF) often remains undetected following stroke. Documenting AF is critical to initiate oral anticoagulation, which has proven benefit in reducing recurrent stroke and mortality in patients with AF. The accuracy and acceptability of using smart wearables to detect AF in patients following stroke is unknown. METHODS: The aims of the Liverpool-Huawei Stroke Study are to determine the effectiveness, cost-effectiveness and patient and staff acceptability of using Huawei smart wearables to detect AF following ischemic stroke. The study plans to recruit 1,000 adults aged ≥18 years following ischemic stroke from participating hospitals over 12 months. All participants will be asked to wear a Huawei smart band for 4 weeks postdischarge. If participants do not have access to a compatible smartphone required for the study, they will be provided with a smartphone for the 4-week AF monitoring period. RESULTS: Participants with suspected AF detected by the smart wearables, without previous known AF, will be referred for further evaluation. To determine the effectiveness of the Huawei smart wearables to detect AF, the positive predictive value will be determined. Patient acceptability of using this technology will also be examined. Additional follow-up assessments will be conducted at 6 and 12 months, and clinical outcomes recorded in relation to prevalent and incident AF post-stroke. The study opened for recruitment on May 30, 2022, and is currently open at 4 participating hospitals; the first 106 participants have been recruited. One further hospital is preparing to open for recruitment. CONCLUSIONS: This prospective study will examine the effectiveness and acceptability of the use of smart wearables in patients following ischemic stroke. This could have important implications for detection of AF and therefore, earlier prophylaxis for recurrent stroke. The study is registered on https://www.isrctn.com/ (Identifier ISRCTN30693819).

The role of interleukin-6 trans-signalling on cardiovascular dysfunction in inflammatory arthritis.

OBJECTIVES: Cardiovascular (CV) mortality in RA patients is 50% higher than in the general population. There is increasing recognition that systemic inflammation is a major driver of this. IL-6 is implicated in cardiovascular disease (CVD) in the general population but its role in CVD in RA is undefined. Of the two modes of IL-6 signalling, trans-signalling is pro-inflammatory whereas classical signalling is linked with inflammation resolution. This study examines the role of IL-6 trans-signalling in CVD in a mouse model and patients with RA. METHODS: Myography determined the effect of IL-6 trans-signalling blockade, using sgp130Fc, on aortic constriction in murine collagen-induced arthritis. Serum CCL2 and sVCAM-1 as soluble biomarkers of sIL-6R trans-signalling were investigated in a human cross-sectional study. An observational longitudinal study investigated the association between these biomarkers and progression of subclinical atherosclerosis in early RA by measuring carotid intima-media thickness (CIMT). RESULTS: sgp130Fc reduced arthritis severity, serum CCL2 and sVCAM-1 and restored vascular function in collagen-induced arthritis (CIA). In established RA, sVCAM-1 correlated with the 28-joint DAS (DAS28) and CV risk. In early RA, baseline DAS28 was associated with CIMT change at 6 months. CIMT 'rapid progressors' at 12 months had higher baseline sVCAM-1, haemoglobin A1c, cholesterol:high-density lipoprotein cholesterol ratio and LDL cholesterol. CONCLUSIONS: IL-6 trans-signalling plays a pivotal role in vascular dysfunction in CIA. In early RA, sVCAM-1 was associated with progression of subclinical atherosclerosis. Inflammation from RA onset in CVD-susceptible individuals may accelerate atherosclerosis. IL-6 trans-signalling blockade may be beneficial to RA patients and perhaps for atherosclerosis in the general population.

Inhibition of CCL3 abrogated precursor cell fusion and bone erosions in human osteoclast cultures and murine collagen-induced arthritis.

Objective: Macrophage inflammatory protein 1-alpha (CCL3) is a chemokine that regulates macrophage trafficking to the inflamed joint. The agonistic effect of CCL3 on osteolytic lesions in patients with multiple myeloma is recognized; however, its role in skeletal damage during inflammatory arthritis has not been established. The aim of the study was to explore the role of osteoclast-associated CCL3 upon bone resorption, and to test its pharmacological blockade for protecting against bone pathology during inflammatory arthritis. Methods: CCL3 production was studied during osteoclast differentiation from osteoclast precursor cells: human CD14-positive mononuclear cells. Mice with CIA were treated with an anti-CCL3 antibody. The effect of CCL3 blockade through mAb was studied through osteoclast number, cytokine production and bone resorption on ivory disks, and in vivo through CIA progression (clinical score, paw diameter, synovial inflammation and bone damage). Results: Over time, CCL3 increased in parallel with the number of osteoclasts in culture. Anti-CCL3 treatment achieved a concentration-dependent inhibition of osteoclast fusion and reduced pit formation on ivory disks (P ⩽ 0.05). In CIA, anti-CCL3 treatment reduced joint damage and significantly decreased multinucleated tartrate-resistant acid phosphatase-positive osteoclasts and erosions in the wrists (P < 0.05) and elbows (P < 0.05), while also reducing joint erosions in the hind (P < 0.01) and fore paws (P < 0.01) as confirmed by X-ray. Conclusion: Inhibition of osteoclast-associated CCL3 reduced osteoclast formation and function whilst attenuating arthritis-associated bone loss and controlling development of erosion in murine joints, thus uncoupling bone damage from inflammation. Our findings may help future innovations for the diagnosis and treatment of inflammatory arthritis.

Clinical experience of IL-6 blockade in rheumatic diseases - implications on IL-6 biology and disease pathogenesis.

Interleukin 6 (IL-6) plays a significant role in many rheumatological diseases and has been described as both a pro- and anti-inflammatory cytokine. IL-6 blockade has been investigated in various rheumatic diseases and a humanised anti-IL-6 receptor antibody has been licensed for use in rheumatoid arthritis, systemic and polyarticular juvenile idiopathic arthritis. The increasing clinical experience of IL-6 blockade in rheumatic diseases adds to the existing knowledge regarding the physiological and pathological roles of IL-6.

Chronic oedema 'on-the-ground' education programme.

The impact of chronic oedema on community nurses' work, the NHS and those directly affected by the condition is immense. As chronic oedema prevalence is projected to rise and financial austerity continues, innovative, sustainable solutions that ensure positive outcomes for patients must be found. This paper reports findings from a focus group (n=3) investigation of the effects of an innovative workplace education intervention designed to enhance community nurses' knowledge for practice in chronic oedema prevention and management in Wales. The main findings indicated that the programme had enhanced community nurses' awareness, knowledge and understanding of chronic oedema management. By enhancing their knowledge base, benefit might be conferred for patients with chronic oedema in terms of improved quality of life, self-efficacy and self-management. However, the magnitude of perceived benefit was variable and contingent on engagement with and support for self-management. Findings indicate the need for a longitudinal study.

Anti cytokine therapy in chronic inflammatory arthritis.

This is a review looking at anti cytokine therapy in Rheumatoid Arthritis (RA), Psoriatic Arthritis (PSA) and Ankylosing Spondylitis (AS). The review explores the similarities and differences in the clinical features, as well as treatments and cytokines involved in the development and propagation of the disease. Particular attention is paid to TNFα inhibitors IL-1ra, IL-6 and JAK kinase Inhibitors, anti IL23 and IL-12 and the new developments with anti-IL-17.

A qualitative national focus group study of the experience of living with lymphoedema and accessing local multiprofessional lymphoedema clinics.

AIM: The aim of this study was to explore people's experiences of living with lymphoedema and to assess the impact of access to local lymphoedema clinics on their condition and thus their lives. BACKGROUND: A chronic condition caused by reduced lymphatic function, lymphoedema leads to swelling, pain and mobility problems and can adversely affect quality-of-life. It is of international concern as its prevalence is rising. Yet lymphoedema awareness is limited, diagnostic delay common and access to specialist treatment restricted. The concept of local lymphoedema clinics is gaining support and in 2011 the All Wales Lymphoedema Service was founded. However, empirical investigation of local lymphoedema services remains limited. DESIGN: A qualitative exploratory study consisting of focus group interviews in every Welsh lymphoedema clinic (n = 8). METHODS: A convenience sample of adults living with lymphoedema in Wales was recruited. Data were collected in digitally recorded focus groups during July and August 2013. Interviews were fully transcribed and analysed using a qualitative content approach. FINDINGS: Fifty-nine people participated in eight focus groups. Analysis revealed three themes: Living with lymphoedema is a battle; delays in obtaining a correct diagnosis and the positive impact of lymphoedema clinics on participants' lives. Locally accessible clinics made meaningful differences to peoples' lymphoedema, engendered positive outcomes and improved engagement with and adherence to lymphoedema self-management. CONCLUSIONS: Local specialist lymphoedema clinics can make a positive difference. They may be cost-effective and further investigation, including economic evaluation is necessary.

Fathers' experiences of supporting breastfeeding: challenges for breastfeeding promotion and education.

Increasing breastfeeding rates is a strategic priority in the UK and understanding the factors that promote and encourage breastfeeding is critical to achieving this. It is established that women who have strong social support from their partner are more likely to initiate and continue breastfeeding. However, little research has explored the fathers' role in breastfeeding support and more importantly, the information and guidance he may need. In the current study, 117 men whose partner had given birth in the previous 2 years and initiated breastfeeding at birth completed an open-ended questionnaire exploring their experiences of breastfeeding, the information and support they received and their ideas for future breastfeeding education and promotion aimed at fathers and families. Overall, the findings showed that fathers were encouraging of breastfeeding and wanted to be able to support their partner. However, they often felt left out of the breastfeeding relationships and helpless to support their partner at this time. Many reported being excluded from antenatal breastfeeding education or being considered unimportant in post-natal support. Men wanted more information about breastfeeding to be directed towards them alongside ideas about how they could practically support their partner. The importance of support mechanisms for themselves during this time was also raised. The results highlight the need for health professionals to direct support and information towards fathers as well as the mother-infant dyad and to recognise their importance in promoting and enabling breastfeeding.

Protecting, providing, and participating: fathers' roles during their child's unplanned hospital stay, an ethnographic study.

AIM: To gain an increased understanding of fathers' experiences during their child's stay in hospital as an unplanned admission for acute illness or injury. BACKGROUND: Family-centred care is promoted in children's nursing as providing high quality care but internationally, research has in the main focused on mothers whilst fathers' contribution to care remains relatively under explored. DESIGN: A qualitative field study. METHODS: The study was conducted from August 2009-December 2010 involving 150 hours of ethnographic observation on two children's wards and interviews with 12 fathers and seven qualified children's nurses. FINDINGS: Fathers wanted to be with their sick child in hospital and made essential contributions to the whole family's experience. Three aspects of the fathers role in caring for their sick child in hospital were identified which included: protecting, providing for the family, and participating in care. CONCLUSION: Fathers, no less than mothers, want to be with and care for their sick child in hospital, yet they face challenges in doing so. The working practices of children's nurses and other healthcare professionals must take into account that fathers play a significant role in caring for their sick child in hospital but may do this alongside paid work and caring for well siblings.

Fathers' roles when their child is in hospital.

BACKGROUND: In the UK and elsewhere, family-centred care is the cornerstone of children's nursing. Fathers' roles in families have evolved in recent decades and they are increasingly involved in their children's lives and healthcare. However, few studies of parents' experiences of their children's hospitalisation refer to fathers. To address this gap in the evidence and to support family-centred care, we focused this research on fathers' experiences during their acutely ill children's stay in hospital. AIM: To gain an understanding of fathers' experiences of care during their child's unplanned admission and their interactions with children's nurses. METHOD: An ethnographic design was used that involved participant observation and interviews with fathers and nurses. RESULTS: Fathers played active roles during hospitalisation. They adopted a protective role, continued to provide for their families through paid work, provided emotional and material support to mothers and siblings and participated directly in care. Despite this active involvement, children's nurses sometimes perceived fathers as marginal to their child's care. CONCLUSION: Fathers are active participants in care and children's nurses need to be aware of the importance of practising truly family-centred care.

Her-2/neu gene amplification in esophageal adenocarcinoma and its influence on survival.

BACKGROUND: HER-2/neu (c-erbB-2, HER2) gene amplification and protein overexpression have been associated with poor prognosis in several solid tumors, including breast and gastric cancer. Its incidence and significance in esophageal adenocarcinoma is unknown. MATERIALS AND METHODS: Tissue microarrays were successfully constructed from 89 paraffin-embedded archival specimens of esophageal adenocarcinomas for HER2 gene amplification by silver-enhanced in situ hybridization (SISH). No patients had undergone neoadjuvant therapy. Protein overexpression was tested with immunohistochemistry (IHC) using automated immunostaining (Ventana Benchmark). Incidence of HER2 positivity, correlation to clinicopathological variables in esophageal cancer patients, and concordance between SISH and IHC were determined. RESULTS: True HER2 gene amplification was detected in 14 esophageal cancer specimens (16%), and 92% of those with high-level HER2 amplification showed positive HER2 protein overexpression. No significant associations were found among gene amplification and clinicopathological factors. The 5-year survival rates were 57% for esophageal cancer patients with HER2 amplification compared with 32% without, but the difference in overall survival was not significant (P = .37). The correlation between SISH and IHC was statistically significant (P < .0001). CONCLUSION: While molecular targeting may be possible for approximately 16% of esophageal adenocarcinoma patients, HER2 oncogene amplification did not influence survival in this study.

Acute ischemic stroke management: concepts and controversies.A narrative review.

INTRODUCTION: Amongst the 25.7 million survivors and 6.5 million deaths from stroke between 1990 and 2013, ischemic strokes accounted for approximately 70% and 50% of the cases, respectively. With patients still suffering from complications and stroke recurrence, more questions have been raised as to how we can better improve patient management. AREAS COVERED: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Newcastle-Ottawa Scale (NOS) were adopted to ensure a comprehensive inclusion of quality literature from various sources. PubMed and Embase were searched for evidence on thrombolysis, mechanical thrombectomy, artificial intelligence (AI), antiplatelet therapy, anticoagulation and hypertension management. EXPERT OPINION: The directions of future research in these areas are dependent on the current level of validation. Endovascular therapy and applications of AI are relatively new compared to the other areas discussed in this review. As such, future studies need to focus on validating their efficacy. As for thrombolysis, antiplatelet and anticoagulation therapy, their efficacy has been well-established and future research efforts should be directed toward adjusting its use according to patient-specific factors, starting with factors with the most clinical relevance and prevalence.

Human gastrointestinal neoplasia-associated myofibroblasts can develop from bone marrow-derived cells following allogeneic stem cell transplantation.

This study characterized the contribution of bone marrow-derived cells to human neoplasia and the perineoplastic stroma. The Australasian Bone Marrow Transplant Recipient Registry was used to identify solid organ neoplasia that developed in female recipients of male allogeneic stem cell transplants. Eighteen suitable cases were identified including several skin cancers, two gastric cancers, and one rectal adenoma. Light microscopy, fluorescence and chromogenic in situ hybridization, and immunohistochemistry were performed to determine the nature and origin of the neoplastic and stromal cells. In contrast to recent reports, donor-derived neoplastic cells were not detected. Bone marrow-derived neoplasia-associated myofibroblasts, however, were identified in the rectal adenoma and in a gastric cancer. Bone marrow-derived cells can generate myofibroblasts in the setting of human gastrointestinal neoplasia.

CD28- Cells Are Increased in Early Rheumatoid Arthritis and Are Linked With Cytomegalovirus Status.

Objective: CD3+CD8+CD28- cells are higher in Rheumatoid Arthritis (RA). The aim of this study was to assess CD3+CD8+CD28- cells in patients with early RA and assess the effects of cytomegalovirus (CMV) seropositivity. Method: In this prospective observation study, 50 RA patients were recruited from Cardiff University Hospital of Wales (UHW) rheumatology outpatient, 25 patients with early disease (disease duration 0-6 months) and 25 patients with established disease (>2 years). These were compared with 25 healthy controls. Clinical and serological markers of inflammation were noted, and peripheral blood mononuclear cells were analyzed using flow cytometry. Results: The percentage of the CD8+CD28- T cells was increased in RA patients and was associated with disease duration. The percentage of CD8+CD28- T cells was increased in CMV positive early and established RA grouped and early RA patients in comparison to CMV negative patients (p < 0.05). There is a weak but statistically significant correlation between the percentage of CD3+CD8+CD28- cells and CRP in CMV positive RA patients (r = 0.227, p < 0.05). Conclusion: The percentage of CD8+CD28- T cells is higher in RA patients and correlates with disease duration, highlighting a potential role early in the disease process. These cells were also higher in CMV positive early RA patients which may suggest a role of CMV in disease development.

Remote Monitoring of Patient-Reported Outcomes in Ulcerative Colitis: A Prospective Real-World Pilot Study.

INTRODUCTION: The 6-point version of the Mayo score relies on two patient-reported outcomes (PRO2): stool frequency and rectal bleeding. We assessed the feasibility and acceptability of remote online PRO2 reporting for golimumab-treated ulcerative colitis (UC) patients. PATIENTS AND METHODS: This was a UK-based, multi-centre, prospective, real-world, non-interventional pilot study. Eligible patients completed PRO2 scores at baseline and every 4 weeks over a period of 6 months. Demographics were collected at baseline and a satisfaction questionnaire was completed at study end. Each patient provided data anonymously via an online platform. RESULTS: Fifty-two patients enrolled in the study. Mean (SD) patient age was 40.8 (13.6); 52% were male. Patients provided data on a personal computer (44%), mobile phone (38%) or tablet (18%). Forty-seven (90%) patients completed the baseline questionnaire within the accepted time range. Subsequent scores were reported on time by eligible patients with a success rate of 94%, 92%, 90%, 87%, 90% and 81% at end of months 1-6, respectively. CONCLUSIONS: Remote monitoring of PRO2 in UC was feasible amongst the sample tested. Of those initially willing to provide data in this way, attrition was low. Formal roll-out of this system could be used to support a more frequent assessment of UC symptoms without over-burdening the healthcare system.

Children's nursing and future directions: learning from 'memorable events'.

At present, the UK provides pre-registration education in four distinct branches, including child, but this is under threat with calls for a single generalist register in line with most of the developed world. Debate about this may be understood by placing 'memorable events' associated with this in their historical context. Analysis of quantitative data, obtained from the Nursing and Midwifery Council identifies a clear correlation between the numbers of registered children's nurses and changes in child health and welfare policies as well as nurse education over the last century. This interpretation of 'memorable events,' showing the growth and influence of this branch of the profession, should enable present day reformers of nurse education to make a rational and informed decision as they debate and decide upon the future of children's (and young people's) nursing in the UK.

The Bologna process: the quiet revolution in nursing higher education.

This paper will trace the history and continuing development of the 'Bologna Process' whose aim is to create convergence of higher education across the European Union by 2010. It will identify how this will have profound implications for graduate nurse education and present opportunities for students, graduate nurses, teachers and researchers in terms of mobility and employment as well as collaborative research. Although supportive, the paper questions whether these reforms will provide the much-needed impetus to raise the educational status of the vast majority of European nurses from diploma to graduate level. Barriers to achieving the ideal of an all-graduate EU nursing workforce are discussed in an economic and political context. The main thrust of the paper is that, if this were achieved, it would have a positive impact on the health care systems and populations of participating countries as well as their economies.

CD59a deficient mice display reduced B cell activity and antibody production in response to T-dependent antigens.

CD59a is the primary regulator of membrane attack complex in mice. Recently, we have shown that CD59a-deficient (Cd59a-/-) mice exhibit enhanced CD4+ T cell responses. Here, we explored the effects of CD59a on B cell function and antibody production. Contrary to our expectations, Cd59a-/- mice showed a decreased humoral immune response to a T cell dependent antigen, sheep red blood cells. We found that the decreased humoral immune response was associated with a reduction in plasma cell number in vivo and reduced ability to respond to stimuli during in vitro culture experiments. Using MLR studies in which purified wild type or Cd59a-/- CD4+ T cells were mixed with purified B cells from each source, we found that the reduced B cell activation was largely due to the absence of CD59a on CD4+ T cells. Furthermore, a CD59a fusion protein bound specifically to mouse B cells, and enhanced B cell proliferation in a MLR, demonstrating that B cells express an as yet unidentified ligand for CD59a that aids in B cell activation.

Cardiovascular risk factors predicting cardiac events are different in patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis.

OBJECTIVES: Increased cardiovascular risk in rheumatoid arthritis (RA) is well established. Examining traditional cardiovascular risk factors alone underestimates cardiovascular risk in RA. Systematic inflammation, measured by erythrocyte sedimentation rate or C-reactive protein is also a major risk factor. However, the contribution of traditional cardiovascular risk factors (such as obesity and hyperlipidaemia) compared to inflammation is uncertain in psoriatic arthritis (PsA) and RA. We examine the incidence of major adverse cardiac events (MACE) among patients with RA, PsA psoriasis, and controls adjusting for risk factors, inflammation and disease modifying anti-rheumatic drug treatment, to better define cardiovascular risk. METHODS: Using the Secure Anonymised Information Linkage databank, comprising routinely collected Welsh health data from 1999 to 2013, the incidence and first occurrence of a MACE in individuals with RA (n = 8650), PsA (n = 2128) and psoriasis (n = 24,630) compared to controls (n = 11,87,706) was investigated. RESULTS: Traditional cardiovascular risk factors are higher in RA, PsA and psoriasis than controls. After adjusting for these factors, additional cardiovascular risk was only significantly increased in female RA patients (HR = 1.3; 95% CI: 1.0-1.7; p = 0.05) and psoriasis (HR = 1.2; 95% CI: 1.0-1.4; p = 0.02) but not statistically significant for PsA (HR = 1.5; 95% CI: 0.9-2.5; p = 0.13). ESR and CRP were increased in patients with RA but not in patients with psoriasis. CONCLUSION: Additional increased cardiovascular risk was observed in female RA and psoriasis but not PsA. Systematic inflammation is higher in RA but not psoriasis, indicating that there are varying mediators of cardiovascular risk across these conditions.

A study of the efficacy and cost-effectiveness of MRSA screening and monitoring on surgical wards using a new, rapid molecular test (EMMS).

BACKGROUND: MRSA is a significant contributor to prolonged hospital stay, poor clinical outcome and increased healthcare costs amongst surgical patients. A PCR test has been developed for rapid detection of MRSA in nasal swabs. The aims of this study are (1) to estimate the effectiveness of screening using this rapid PCR tests vs culture in reducing MRSA cross-infection rates; (2) to compare the cost of each testing strategy, including subsequent health care costs; and (3) to model different policies for the early identification and control of MRSA infection in surgical patients. METHODS/DESIGN: The study is a prospective two-period cross-over study set in 7 surgical wards covering different surgical specialities. A total of 10,000 patients > 18 years will be tested over 16 months. The only difference between the two study periods is the method used for the detection of MRSA in each ward (rapid v conventional culture), with all other infection control practices remaining consistent between the arms. The study has been designed to complement routine practice in the NHS. Outcomes are MRSA cross-infection rates (primary outcome) and need for antibiotic therapy and MRSA-related morbidity. Parallel economic and modelling studies are being conducted to aid in the interpretation of the results and to evaluate the cost-effectiveness of the rapid PCR screening strategy. DISCUSSION: This paper highlights the design, methods and operational aspects of a study evaluating rapid MRSA screening in the surgical ward setting.