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BACKGROUND: Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes and is occurring in more than 40 % of adults with type 1 diabetes. However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care. OBJECTIVE: To modify and adapt existing, evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with type 1 diabetes and moderate to severe diabetes distress. METHODS: The overall framework of this study was informed by the initial phase of the Medical Research Council complex intervention framework undertaking intervention identification and development to guide the adaptation of the intervention. This study took place at two specialised diabetes centres in Denmark from November 2019 to June 2021. A total of 36 adults with type 1 diabetes participated in 10 parallel workshops. Twelve diabetes-specialised nurses were interviewed and participated in one co-creation workshop and 12 multidisciplinary specialists (psychologists, educational specialists, and researchers) participated in four co-creation workshops and 14 feedback meetings. Data were analysed by applying a deductive analytical approach. RESULTS: The intervention included five bi-weekly 2½-hour small group sessions with adults with type 1 diabetes and diabetes distress delivered by two trained diabetes specialist nurses guided by a detailed step-by-step manual. The intervention material includes visual conversation tools, covering seven diabetes-specific sources derived from the 28-item diabetes distress scale for measuring diabetes distress: 1) powerlessness, 2) self-management, 3) fear of hypoglycaemia, 4) food and eating, 5) friends and family, 6) negative social perception, and 7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections as well as plenary- and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries, and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention nurses needed increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills. CONCLUSIONS: This co-design study has described the adaption of a complex intervention with a strong evidence base including detailed reporting of the theoretical underpinnings and core mechanisms.
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The healthcare sector is a major contributor of greenhouse gas emissions, and reduction and proper sorting of healthcare waste is essential to achieve sustainable healthcare. This study aimed to characterize the quantity and composition of pharmaceutical waste from a major Danish hospital. Pharmaceutical waste was collected from Odense University Hospital, including departments located in both Odense and Svendborg. The average daily production of pharmaceutical waste was 1150 g/day in Odense and 5967 g/day in Svendborg, with the operating rooms in Svendborg contributing 3143 g/day. The amount and composition of pharmaceutical waste varied greatly between departments, but some common patterns were identified. Propofol accounted for about one third of the pharmaceutical waste obtained from operating rooms. Antibiotics for systemic use constituted a significant proportion of the pharmaceutical waste from several departments and were the therapeutic group from which most different drugs were identified. Paracetamol accounted for 33.5% of the discarded tablets/capsules in Odense and 12.6% in Svendborg. Medications dispensed by automated dose dispensing accounted for a significant proportion of the discarded tablets/capsules in departments using this service. This study highlights some key areas for reduction and management of pharmaceutical waste and contributes to the currently limited evidence within this area.
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This review summarises the present knowledge of prophylactic progesterone and preterm birth. Preterm birth (less-than 37 weeks) is a leading cause of neonatal mortality and morbidity worldwide. The incidence varies globally but remains low in the Nordic countries (5-6%). Prediction and prevention are complicated due to diverse aetiology, but obstetric history and cervical length can improve prediction. Prophylactic vaginal progesterone initiated between 12 and 24 weeks of gestation is recommended to reduce preterm birth less-than 33-35 weeks in singleton pregnancies with a history of preterm birth or with a short cervix (less-than 25 mm) and can be considered for twin pregnancies with the same risk factors.
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Nascimento Prematuro , Progesterona , Progestinas , Humanos , Nascimento Prematuro/prevenção & controle , Gravidez , Progesterona/administração & dosagem , Progesterona/uso terapêutico , Feminino , Progestinas/administração & dosagem , Progestinas/uso terapêutico , Administração Intravaginal , Fatores de Risco , Medida do Comprimento Cervical , Colo do ÚteroRESUMO
BACKGROUND: O-(2-[18F]fluoroethyl)-L-tyrosine positron emission tomography ([18F]FET PET) scanning is used in routine clinical management and evaluation of gliomas with a recommended 4 h prior fasting. Knowledge of test-retest variation of [18F]FET PET imaging uptake metrics and the impact of accidental protein intake can be critical for interpretation. The aim of this study was to investigate the repeatability of [18F]FET-PET metrics and to assess the impact of protein-intake prior to [18F]FET PET scanning of gliomas. RESULTS: Test-retest variability in the non-protein group was good with absolute (and relative) upper and lower limits of agreement of + 0.15 and - 0.13 (+ 9.7% and - 9.0%) for mean tumour-to-background ratio (TBRmean), + 0.43 and - 0.28 (+ 19.6% and - 11.8%) for maximal tumour-to-background ratio (TBRmax), and + 2.14 cm3 and - 1.53 ml (+ 219.8% and - 57.3%) for biological tumour volume (BTV). Variation was lower for uptake ratios than for BTV. Protein intake was associated with a 27% increase in the total sum of plasma concentration of the L-type amino acid transporter 1 (LAT1) relevant amino acids and with decreased standardized uptake value (SUV) in both healthy appearing background brain tissue (mean SUV - 25%) and in tumour (maximal SUV - 14%). Oral intake of 24 g of protein 1 h prior to injection of tracer tended to increase variability, but the effects on derived tumour metrics TBRmean and TBRmax were only borderline significant, and changes generally within the variability observed in the group with no protein intake. CONCLUSION: The test-retest repeatability was found to be good, and better for TBRmax and TBRmean than BTV, with the methodological limitation that tumour growth may have influenced results. Oral intake of 24 g of protein one hour before a [18F]FET PET scan decreases uptake of [18F]FET in both tumour and in healthy appearing brain, with no clinically significant difference on the most commonly used tumour metrics.
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OBJECTIVE: Within the scope of the Exposome Project for Health and Occupational Research on applying the exposome concept to working life health, we aimed to provide a broad overview of the status of knowledge on occupational exposures and associated health effects across multiple noncommunicable diseases (NCDs) to help inform research priorities. METHODS: We conducted a narrative review of occupational risk factors that can be considered to have "consistent evidence for an association," or where there is "limited/inadequate evidence for an association" for 6 NCD groups: nonmalignant respiratory diseases; neurodegenerative diseases; cardiovascular/metabolic diseases; mental disorders; musculoskeletal diseases; and cancer. The assessment was done in expert sessions, primarily based on systematic reviews, supplemented with narrative reviews, reports, and original studies. Subsequently, knowledge gaps were identified, e.g. based on missing information on exposure-response relationships, gender differences, critical time-windows, interactions, and inadequate study quality. RESULTS: We identified over 200 occupational exposures with consistent or limited/inadequate evidence for associations with one or more of 60+ NCDs. Various exposures were identified as possible risk factors for multiple outcomes. Examples are diesel engine exhaust and cadmium, with consistent evidence for lung cancer, but limited/inadequate evidence for other cancer sites, respiratory, neurodegenerative, and cardiovascular diseases. Other examples are physically heavy work, shift work, and decision latitude/job control. For associations with limited/inadequate evidence, new studies are needed to confirm the association. For risk factors with consistent evidence, improvements in study design, exposure assessment, and case definition could lead to a better understanding of the association and help inform health-based threshold levels. CONCLUSIONS: By providing an overview of knowledge gaps in the associations between occupational exposures and their health effects, our narrative review will help setting priorities in occupational health research. Future epidemiological studies should prioritize to include large sample sizes, assess exposures prior to disease onset, and quantify exposures. Potential sources of biases and confounding need to be identified and accounted for in both original studies and systematic reviews.
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Neoplasias , Doenças não Transmissíveis , Exposição Ocupacional , Humanos , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos , Exposição Ocupacional/análise , Doenças não Transmissíveis/epidemiologia , Neoplasias/epidemiologia , Neoplasias/etiologia , Fatores de Risco , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/epidemiologia , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/epidemiologia , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia , Expossoma , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologiaRESUMO
Molybdenum cofactor deficiency classically presents in neonates with intractable seizures; however, milder cases generally present before age 2 years with developmental delays and may go undiagnosed. Early diagnosis, and safe, US Food and Drug Administration-approved substrate replacement are critical to preserve neurologic function. This article discusses 2 children who presented with late-onset molybdenum cofactor deficiency type A.
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Deficiências do Desenvolvimento , Erros Inatos do Metabolismo dos Metais , Humanos , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/diagnóstico , Erros Inatos do Metabolismo dos Metais/complicações , Erros Inatos do Metabolismo dos Metais/diagnóstico , MolibdoferredoxinaRESUMO
This study aims to describe the meat quality of young Holstein (HOL) beef-on-dairy heifers and bulls sired by Angus (ANG, n = 109), Charolais (CHA, n = 101) and Danish Blue (DBL, n = 127), and to investigate the performance of the handheld vision-based Q-FOM™ Beef camera in predicting the intramuscular fat concentration (IMF%) in M. longissimus thoracis from carcasses quartered at the 5th-6th thoracic vertebra. The results showed significant differences between crossbreeds and sexes on carcass characteristics and meat quality. DBL × HOL had the highest EUROP conformation scores, whereas ANG × HOL had darker meat with higher IMF% (3.52%) compared to CHA × HOL (2.99%) and DBL × HOL (2.51%). Bulls had higher EUROP conformation scores than heifers, and heifers had higher IMF% (3.70%) than bulls (2.31%). These findings indicate the potential for producing high-quality meat from beef-on-dairy heifers and ANG bulls. The IMF% prediction model for Q-FOM performed well with R2 = 0.91 and root mean squared error of cross validation, RMSECV = 1.33%. The performance of the prediction model on the beef-on-dairy veal subsample ranging from 0.9 to 7.4% IMF had lower accuracy (R2 = 0.48) and the prediction error (RMSEveal) was 1.00%. When grouping beef-on-dairy veal carcasses into three IMF% classes (2.5% IMF bins), 62.6% of the carcasses were accurately predicted. Furthermore, Q-FOM IMF% predictions and chemically determined IMF% were similar for each combination of sex and crossbreed, revealing a potential of Q-FOM IMF% predictions to be used in breeding, when aiming for higher meat quality.
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Tecido Adiposo , Músculo Esquelético , Carne Vermelha , Vértebras Torácicas , Animais , Bovinos , Masculino , Carne Vermelha/análise , Feminino , Tecido Adiposo/química , Músculo Esquelético/química , Fotografação , Cor , CruzamentoRESUMO
The objective of this study was to develop calibration models against rib eye traits and independently validate the precision, accuracy, and repeatability of the Frontmatec Q-FOM™ Beef grading camera in Australian carcasses. This study compiled 12 different research datasets acquired from commercial processing facilities and were comprised of a diverse range of carcass phenotypes, graded by industry identified expert Meat Standards Australia (MSA) graders and sampled for chemical intramuscular fat (IMF%). Calibration performance was maintained when the device was independently validated. For continuous traits, the Q-FOM™ demonstrated precise (root mean squared error of prediction, RMSEP) and accurate (coefficient of determination, R2) prediction of eye muscle area (EMA) (R2 = 0.89, RMSEP = 4.3 cm2, slope = 0.96, bias = 0.7), MSA marbling (R2 = 0.95, RMSEP = 47.2, slope = 0.98, bias = -12.8) and chemical IMF% (R2 = 0.94, RMSEP = 1.56%, slope = 0.96, bias = 0.64). For categorical traits, the Q-FOM™ predicted 61%, 64.3% and 60.8% of AUS-MEAT marbling, meat colour and fat colour scores equivalent, and 95% within ±1 classes of expert grader scores. The Q-FOM™ also demonstrated very high repeatability and reproducibility across all traits.
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Tecido Adiposo , Cor , Músculo Esquelético , Fotografação , Carne Vermelha , Animais , Austrália , Bovinos , Carne Vermelha/análise , Carne Vermelha/normas , Fotografação/métodos , Calibragem , Fenótipo , Reprodutibilidade dos Testes , CostelasRESUMO
Medical educator portfolios (MEP) are increasingly recognized as a tool for developing and documenting teaching performance in Health Professions Education. However, there is a need to better understand the complex interplay between institutional guidelines and how teachers decode those guidelines and assign value to teaching merits. To gain a deeper understanding of this dynamic, this study employed a sociological analysis to understand how medical educators aspiring to professorships use MEPs to display their teaching merits and how cultural capital is reflected in these artefacts. We collected 36 medical educator portfolios for promotion from a large research-intensive university and conducted a deductive content analysis using institutional guidelines that distinguished between mandatory (accounting for the total body of teaching conducted) and optional content (arguing for pedagogical choices and evidencing the quality, respectively). Our analysis showed that the portfolios primarily included quantifiable data about teaching activities, e.g., numbers of students, topics and classes taught. Notably, they often lacked evidence of quality and scholarship of teaching. Looking at these findings through a Bourdieusian lens revealed that teachers in this social field exchange objectified evidence of hours spent on teaching into teaching capital recognized by their institution. Our findings highlight how institutional guidelines for MEPs construct a pedagogical battlefield, where educators try to decode and exchange the "right" and recognized teaching capital. This indicates that MEPs reflect the norms and practices of the academic field more than individual teaching quality.
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OBJECTIVE: Standardised person-reported outcomes (PRO) data can contextualise clinical outcomes enabling precision diabetes monitoring and care. Comprehensive outcome sets can guide this process, but their implementation in routine diabetes care has remained challenging and unsuccessful at international level. We aimed to address this by developing a person-centred outcome set for Type 1 and Type 2 diabetes, using a methodology with prospects for increased implementability and sustainability in international health settings. METHODS: We used a three-round questionnaire-based Delphi study to reach consensus on the outcome set. We invited key stakeholders from 19 countries via purposive snowball sampling, namely people with diabetes (N = 94), healthcare professionals (N = 65), industry (N = 22) and health authorities (N = 3), to vote on the relevance and measurement frequency of 64 previously identified clinical and person-reported outcomes. Subsequent consensus meetings concluded the study. RESULTS: The list of preliminary outcomes was shortlisted via the consensus process to 46 outcomes (27 clinical outcomes and 19 PROs). Two main collection times were recommended: (1) linked to a medical visit (e.g. diabetes-specific well-being, symptoms and psychological health) and (2) annually (e.g. clinical data, general well-being and diabetes self management-related outcomes). CONCLUSIONS: PROs are often considered in a non-standardised way in routine diabetes care. We propose a person-centred outcome set for diabetes, specifically considering psychosocial and behavioural aspects, which was agreed by four international key stakeholder groups. It guides standardised collection of meaningful outcomes at scale, supporting individual and population level healthcare decision making. It will be implemented and tested in Europe as part of the H2O project.
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Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/terapia , Técnica Delphi , Consenso , Projetos de Pesquisa , Saúde MentalRESUMO
OBJECTIVES: The objective was to identify candidate patient reported outcomes with potential to inform individual patient care and service development for inclusion in a digital outcome set to be collected in routine care, as part of an international project to enhance care outcomes for people with diabetes. METHODS: PubMed, COSMIN and COMET databases were searched. Published studies were included if they recommended patient reported outcomes that were clinically useful and/or important to people with diabetes. To aid selection decisions, recommended outcomes were considered in terms of the evidence endorsing them and their importance to people with diabetes. RESULTS: Twenty-seven studies recommending 53 diabetes specific outcomes, and patient reported outcome measures, were included. The outcomes reflected the experience of living with diabetes (e.g. psychological well-being, symptom experience, health beliefs and stigma) and behaviours (e.g. self-management). Diabetes distress and self-management behaviours were most endorsed by the evidence. CONCLUSIONS: The review provides a comprehensive list of candidate outcomes endorsed by international evidence and informed by existing outcome sets, and suggestions for measures. PRACTICE IMPLICATIONS: The review offers evidence to guide clinical application. Integrated measurement of these outcomes in care settings holds enormous potential to improve provision of care and outcomes in diabetes.
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Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Humanos , Adulto , Diabetes Mellitus Tipo 2/terapia , Avaliação de Resultados em Cuidados de SaúdeRESUMO
BACKGROUND: Autonomy-supporting interventions, such as self-determination theory and guided self-determination interventions, may improve self-management and clinical and psychosocial outcomes in people with diabetes. Such interventions have never been systematically reviewed assessing both benefits and harms and concurrently controlling the risks of random errors using trial sequential analysis methodology. This systematic review investigates the benefits and harms of self-determination theory-based interventions compared to usual care in people with diabetes. METHODS: We used the Cochrane methodology. Randomized clinical trials assessing interventions theoretically based on guided self-determination or self-determination theory in any setting were eligible. A comprehensive search (latest search April 2022) was undertaken in CENTRAL, MEDLINE, Embase, LILACS, PsycINFO, SCI-EXPANDED, CINAHL, SSCI, CPCI-S, and CPCI-SSH to identify relevant trials. Two authors independently screened, extracted data, and performed risk-of-bias assessment of included trials using the Cochrane risk-of-bias tool 1.0. Our primary outcomes were quality of life, all-cause mortality, and serious adverse events. Our secondary outcomes were diabetes distress, depressive symptoms, and nonserious adverse events not considered serious. Exploratory outcomes were glycated hemoglobin and motivation (autonomy, controlled, amotivation). Outcomes were assessed at the end of the intervention (primary time point) and at maximum follow-up. The analyses were conducted using Review Manager 5.4 and Trial Sequential Analysis 0.9.5.10. Certainty of the evidence was assessed by GRADE. RESULTS: Our search identified 5578 potentially eligible studies of which 11 randomized trials (6059 participants) were included. All trials were assessed at overall high risk of bias. We found no effect of self-determination theory-based interventions compared with usual care on quality of life (mean difference 0.00 points, 95% CI -4.85, 4.86, I2 = 0%; 225 participants, 3 trials, TSA-adjusted CI -11.83, 11.83), all-cause mortality, serious adverse events, diabetes distress, depressive symptoms, adverse events, glycated hemoglobulin A1c, or motivation (controlled). The certainty of the evidence was low to very low for all outcomes. We found beneficial effect on motivation (autonomous and amotivation; low certainty evidence). CONCLUSIONS: We found no effect of self-determination-based interventions on our primary or secondary outcomes. The evidence was of very low certainty. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020181144.
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Diabetes Mellitus , Qualidade de Vida , Humanos , Diabetes Mellitus/terapia , Hemoglobinas Glicadas , Glicopirrolato , MEDLINERESUMO
AIM: To pilot-test an intervention, co-designed with people with type 1 diabetes (T1DM) and diabetes specialist nurses, to reduce diabetes distress (DD) in adults with T1DM and moderate-to-severe DD. METHODS: A group-based programme to reduce DD in people with T1DM and moderate-to-severe DD (REDUCE) was pilot-tested in four groups with five bi-weekly two and a half-hour meetings facilitated by two trained diabetes specialist nurses. Data collection included baseline and post-intervention questionnaires measuring DD and psychosocial outcomes and semi-structured interviews with participants post-intervention (n = 18). Data were analysed using descriptive statistics and systematic text condensation. RESULTS: Twenty-five adults with T1DM participated in the study. The median age and diabetes duration of participants were 50 (IQR: 32;57.5) years and 26 (IQR: 18;45) years, respectively. Seventeen (68%) were women. The pilot study showed a significant reduction in DD (measured by Type 1 Diabetes Distress Scale) between baseline and post-intervention from 2.6 ± 0.7 to 1.9 ± 0.6 (mean ± SD) (p < 0.001). The largest reductions were seen on the subscales: powerlessness 1.2 ± 1.1, eating distress 0.9 ± 1.2 and fear of hypoglycaemia 0.8 ± 1.0 (mean ± SD). Significant improvements were also seen for quality of life, diabetes empowerment and emotion regulation. Qualitative data showed that REDUCE supported participants in verbalizing emotions and seeing worries in a more constructive perspective. Acknowledgement of negative diabetes experiences eased negative self-judgments. Sharing experiences among peers increased relatedness and reduced loneliness. CONCLUSION: Participation in REDUCE was associated with significant reduction in DD and significant increase in quality of life. Larger scale studies are planned to determine sustained effectiveness of REDUCE.
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Diabetes Mellitus Tipo 1 , Hipoglicemia , Humanos , Adulto , Feminino , Masculino , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 1/psicologia , Projetos Piloto , Qualidade de Vida , Emoções , Hipoglicemia/psicologiaRESUMO
BACKGROUND: Individual dietary recommendations change as loss of kidney function progresses. Adopting these recommendations in everyday life poses major challenges for patients. Individualising dietary counselling is crucial to easy accessibility. AIM: To investigate patients' needs with regard to a dietary app for patients with chronic kidney disease, patients', and health professionals' immediate responses to such a dietary app and suggestions for improvement and further development of a prototype. DESIGN: A prototype of the dietary app has been developed and demonstrates how all information it provides can be tailored to the individual patient according to stage of disease, anthropometrics, and phosphate and potassium levels. A qualitative evaluation of the prototype was conducted using the Consolidated Criteria for Reporting Qualitative Research checklist for reporting. APPROACH: Seven individual interviews and four focus groups were analysed using interpretive description. PARTICIPANTS: Individual interviews with seven patients who have stage 4 or 5 chronic kidney disease and are not on dialysis, and four focus groups: one with participants from the individual interviews, one with six patients on haemodialysis, one with 13 kidney dieticians and one with seven health professionals. FINDINGS: Both patients and healthcare professionals were positive about the app. Individualisation is necessary for the app to work in practice. The patients reported access to a diet diary and recipes as important elements. CONCLUSION: There is a need to improve the tools we use today to enhance patient adherence to dietary recommendations. The development of an app for individual dietary counselling could be a useful solution.
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Person-specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self-determination method with people with various long-term health conditions. It explains the mechanisms of mobilizing relational capacity by including person-specific evidence in shared decision-making. Person-specific self-insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self-management challenges. This step paved the way for sharing these insights and challenges in a relationship with a supportive health professional, who could then rely on person-specific evidence instead of assumptions or a narrow disease perspective for shared decision-making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person-specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self-insights in daily life with other people, decreasing loneliness they experienced in self-management. Relational capacity, the core of the theory, is mobilized in both people with long-term health conditions and healthcare professionals. Further research on person-specific evidence and relational capacity in healthcare is recommended.
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Pessoal de Saúde , Autonomia Pessoal , Humanos , Teoria FundamentadaRESUMO
Background: The protease inhibitor inter-α-inhibitor heavy chain H4 (ITIH4) has been described as an acute-phase reactant and could potentially aid in sepsis monitoring and prognostication. Objectives: To investigate ITIH4 plasma levels in sepsis patients compared with healthy controls and to examine the association between ITIH4 and acute-phase response markers, blood coagulation, and organ dysfunction in sepsis. Methods: We performed a post hoc study to a prospective cohort study. Patients with septic shock (n = 39) were enrolled upon intensive care unit admission. ITIH4 was analyzed using an in-house immunoassay. Standard coagulation parameters, thrombin generation, fibrin formation and lysis, C-reactive protein, organ dysfunction markers, Sequential Organ Failure Assessment score, and disseminated intravascular coagulation (DIC) score were registered. ITIH4 levels were also investigated in a murine Escherichia coli sepsis model. Results: ITIH4 did not display acute-phase behavior as mean ITIH4 levels were not increased in patients with septic shock or in E. coli-infected mice. However, ITIH4 exhibited large interindividual variation in patients with septic shock compared with healthy controls. Low ITIH4 was associated with sepsis-related coagulopathy, including a high DIC score (mean ITIH4: DIC, 203 µg/mL vs non-DIC, 267 µg/mL, P = .01), low antithrombin (r = 0.70, P < .0001) and decreased thrombin generation (mean ITIH4: first peak thrombin tertile, 210 µg/mL vs third peak thrombin tertile, 303 µg/mL, P = .01). ITIH4 showed moderate correlation with arterial blood lactate (ρ = -0.50, P < .001) but only weak correlations with C-reactive protein, alanine transaminase, bilirubin, and Sequential Organ Failure Assessment score (all, ρ < 0.26, P > .05). Conclusion: ITIH4 is associated with sepsis-related coagulopathy but is not an acute-phase reactant during septic shock.
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OBJECTIVE: Patient-centred learning (PCL) allows medical students to practice a patient-centred approach; however, didactic characteristics of PCL have yet to be fully elucidated. Clinical placements structured as a student clinic (SC) enable authentic student-patient learning relations through enhanced student responsibility and can serve as examples of PCL. We explored the didactic characteristics of supervision and learning in SCs to provide recommendations for PCL-oriented medical education. METHODS: Triangulation mixed methods study based on qualitative data collected from in-depth interviews with clinical teachers and quantitative data collected from student evaluations of supervision and learning in the SCs. RESULTS: Supervision and learning in SCs were characterized by 1) a focus on student-patient compatibility and patient needs and resources, which indicated PCL, 2) person-centred explorative supervision to adjust challenges to students' needs and resources, and 3) support of student autonomy to take responsibility for patient treatment. CONCLUSION: PCL was facilitated by clinical teachers through a dual person-centred didactic approach combined with autonomy-supportive didactic practice. This enabled the integration of patients' and students' needs and resources in clinical teaching. PRACTICE IMPLICATIONS: Clinical teachers can stimulate student-patient learning relations by selecting patients, exploring students' needs and resources, and supporting student autonomy through reflective practice and backup.
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Educação Médica , Estudantes de Medicina , Humanos , Aprendizagem , Competência ClínicaRESUMO
AIM: To map existing research on psychosocial aspects of adult-onset type 1 diabetes (T1D), including psychosocial health status, ways psychosocial aspects may affect management of T1D in everyday life, and interventions targeting management of adult-onset T1D. METHODS: We conducted a systematic search in MEDLINE, EMBASE, CINAHL and PsycInfo. Search results were screened with predefined eligibility criteria, followed by data extraction of the included studies. Charted data were summarized in narrative and tabular form. RESULTS: We included 10 reports describing nine studies from the 7302 identified in the search. All studies were conducted in Europe. Participant characteristics were missing in several studies. Five of the nine studies incorporated psychosocial aspects as the main aim of the study. Limited information on psychosocial aspects was available in the remaining studies. We identified three overarching themes related to psychosocial aspects: (1) the impact of the diagnosis on everyday life, (2) the influence of psychosocial health on metabolic levels and adaptation, and (3) provision of self-management support. CONCLUSIONS: Research focussing on psychosocial aspects of the adult-onset population is scarce. Future research should involve participants across the adult life age span and from a wider geographical area. Sociodemographic information should be collected to explore different perspectives. Further exploration of suitable outcome measures considering adults' limited experience of living with the condition is needed. This would help to better understand how psychosocial aspects may affect management of T1D in everyday life and thus enable healthcare professionals to provide appropriate support to adults with new-onset T1D.
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Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Humanos , Adulto , Nível de Saúde , Pessoal de Saúde/psicologia , Europa (Continente)RESUMO
This study compared the accuracy of two methods for predicting carcass leanness (i.e., predicted lean yield) with fat-free lean yields obtained by manual carcass side cut-out and dissection of lean, fat, and bone components. The two prediction methods evaluated in this study estimated lean yield by measuring fat thickness and muscle depth at one location with an optical grading probe (Destron PG-100) or by scanning the entire carcass with advanced ultrasound technology (AutoFom III). Pork carcasses (166 barrows and 171 gilts; head-on hot carcass weights (HCWs) ranging from 89.4 to 138.0 kg) were selected based on their fit within desired HCW ranges, their fit within specific backfat thickness ranges, and sex (barrow or gilt). Data (n = 337 carcasses) were analyzed using a 3 × 2 factorial arrangement in a randomized complete block design including the fixed effects of the method for predicting lean yield, sex, and their interaction, and random effects of producer (i.e., farm) and slaughter date. Linear regression analysis was then used to examine the accuracy of the Destron PG-100 and AutoFom III data for measuring backfat thickness, muscle depth, and predicted lean yield when compared with fat-free lean yields obtained with manual carcass side cut-outs and dissections. Partial least squares regression analysis was used to predict the measured traits from image parameters generated by the AutoFom III software. There were method differences (P < 0.01) for determining muscle depth and lean yield with no method differences (P = 0.27) for measuring backfat thickness. Both optical probe and ultrasound technologies strongly predicted backfat thickness (R2 ≥ 0.81) and lean yield (R2 ≥ 0.66), but poorly predicted muscle depth (R2 ≤ 0.33). The AutoFom III improved accuracy [R2 = 0.77, root mean square error (RMSE) = 1.82] for the determination of predicted lean yield vs. the Destron PG-100 (R2 = 0.66, RMSE = 2.22). The AutoFom III was also used to predict bone-in/boneless primal weights, which is not possible with the Destron PG-100. The cross-validated prediction accuracy for the prediction of primal weights ranged from 0.71 to 0.84 for bone-in cuts and 0.59 to 0.82 for boneless cut lean yield. The AutoFom III was moderately (r ≤ 0.67) accurate for the determination of predicted lean yield in the picnic, belly, and ham primal cuts and highly (r ≥ 0.68) accurate for the determination of predicted lean yield in the whole shoulder, butt, and loin primal cuts.
Pork grading is a producer-feedback system that provides carcass trait information (i.e., carcass weight, fat/lean deposition) to determine the economic value of carcasses. Packing plants generally emphasize the optimization of carcass weight and leanness by providing premium or discounted prices using a grid system. Packing plants routinely collect carcass weights while carcass leanness can be more challenging to capture. Since the packing industry does not measure fat/lean deposition for each carcass or each meat cut within the carcass, various technologies are used to predict carcass leanness. These include optical probes, spectral imaging, artificial vision, and others that have been around for decades. A challenge with these technologies is that they often collect measurements at only one location on the carcass, providing information that is not necessarily representative of the entire carcass. The purpose of this study was to compare the accuracy of an advanced automated ultrasonic scanner (AutoFom III) that scans the entire carcass with that of a handheld optical probe (Destron PG-100) that collects measurements from one location on the carcass. In summary, the AutoFom III improved accuracy for determining lean yield with the additional advantage of predicting primal weights when compared with the Destron PG-100.
Assuntos
Carne de Porco , Carne Vermelha , Animais , Feminino , Tecido Adiposo/diagnóstico por imagem , Composição Corporal/fisiologia , Análise dos Mínimos Quadrados , Carne , Músculo Esquelético/diagnóstico por imagem , Sus scrofa , Suínos , UltrassomRESUMO
BACKGROUND: Research suggests that simulation-based surgical skills training translates into improved operating room performance. Previous studies have predominantly focused on training methods and design and subsequent assessable performances and outcomes in the operating room, which only covers some aspects of training engagement and transfer of training. The purpose of this qualitative study was to contribute to the existing body of literature by exploring characteristics of first-year trainees' engagement in and perceptions of transfer of surgical skills training. METHODS: We conducted an explorative study based on individual interviews with first-year trainees in General Surgery, Urology, and Gynaecology and Obstetrics who participated in a laparoscopic skills training program. Informants were interviewed during and two months after the training program. A thematic cross-case analysis was conducted using systematic text condensation. RESULTS: We interviewed 12 informants, which produced 24 transcripts for analysis. We identified four main themes: (1) sportification of training, (2) modes of orientation, (3) transferrable skills, and (4) transfer opportunities. Informants described their surgical training using sports analogies of competition, timing, and step-by-step approaches. Visual orientations, kinaesthetic experiences, and elicited dialogues characterised training processes and engagement. These characteristics were identified in both the simulated and the clinical environment. Experiences of specific skills transfer included ambidexterity, coordination, instrument handling, and visuospatial ability. General transfer experiences were salient in informants' altered training approaches. Informants considered the simulation-based training an entry ticket to perform in the operating room and mentioned supervisor-trainee relationships and opportunities in the workplace as critical conditions of transfer. CONCLUSIONS: Our findings elucidate characteristics of surgical training engagement that can be interpreted as self-regulated learning processes that transcend surgical training environments. Despite appreciating the immediate skills improvements resulting from training, trainees' narratives reflected a struggle to transfer their training to the clinical setting. Tensions existed between perceptions of transferable skills and experiences of transfer within the clinical work environments. These results resonate with research emphasising the importance of the work environment in the transfer process. Our findings provide insights that may inform the development of training programs that support self-regulated learning and transfer of training from the simulated to the clinical environment.