Treating chronic wounds in an acute care setting: the forgotten diagnosis.

BACKGROUND: Chronic wounds include lower extremity ulcers, diabetic foot ulcers, and pressure injuries, and can take months or years to heal. Wounds place a high burden on outpatient and inpatient care settings. This burden is expected to increase markedly in the United States as the population ages and with increased rates of diabetes, obesity, and COVID-19. PURPOSE: To articulate the effect of chronic, hard-to-heal wounds on acute care facilities, and how a few days of inpatient care can have a significant effect on the healing trajectory. METHODS: An expert panel of 7 members, all with extensive knowledge and experience in the assessment and treatment of chronic wounds in an acute care setting, was convened in March 2022. The panel discussed the role of hospitals as part of the longer-term healing pathway of chronic wounds. RESULTS: Chronic wounds have a significant effect on hospitals that includes unseen costs, bed occupancy, demands on bedside nurses, and wound complications that lead to extended stays or readmissions. A successful inpatient wound program offers appropriate identification of previously undiagnosed wounds, elevation of bedside care through simplified protocols, quickly and easily understood education and easy dressing selection, and comprehensive discharge planning with a multidisciplinary team for continuity of care and reduced risk of readmission. CONCLUSION: Hospitals can play a key role in the management of chronic wounds, thus reducing the effect on each facility and the wider care network.

A Versatile Fluorescent Sensor Array for Platinum Anticancer Drug Detection in Biological Fluids.

Platinum complexes remain frontline anticancer therapies, even after 50 years of usage in clinical applications. However, there is still a lack of methodology to robustly detect and quantify these complexes in biological fluids. We report here a fluorescent sensor array comprising six sensors that demonstrates progress toward the detection of platinum levels in chemotherapy patients. Linear discriminant analysis was performed to examine each multidimensional data set, and the array was able to discriminate platinum from other biologically relevant metals and heavy metals and separately able to differentiate and identify platinum complexes with different coordination environments with 100% accuracy. Finally, the array showed sensitivity to various cisplatin and oxaliplatin concentrations in human plasma and was able to discriminate between a cohort of 27 cancer patients at different stages of platinum treatment. We envisage that our array system could lead to a better understanding of blood platinum concentrations of chemotherapy patients and could inform the modification of dosage regimes to minimize dose-limiting side effects.

Palliative Care in the Management of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in the Primary Care Setting.

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has metamorphosed in the past 40 years since the first cases were diagnosed. The advent of highly active antiretroviral treatment (HAART) transformed the disease trajectory for many patients with HIV/AIDS and transitioned the course from a terminal disease to a chronic disease model. This article reviews the epidemiology of HIV/AIDS, prognostic indicators, frailty, opportunistic infections, specific AIDS-defining malignancies and non-AIDS-defining malignancies, role of palliative care, advance care planning, and the role of HAART in patients dying of late-stage AIDS.

Pattern recognition of toxic metal ions using a single-probe thiocoumarin array.

Pattern recognition methods such as linear discriminant analysis and principal component analysis are useful tools for the identification of analytes such as metal ions. These typically use a number of distinct molecular probes that exhibit cross-reactivity. Here we report a single molecule that demonstrates varying response in different solvents, therefore enabling the combination of probe and solvent to generate the required array diversity. Seven toxic metal ions were introduced as aqueous samples, and PCA and LDA techniques applied. The array could correctly identify all metals in pure water samples, all metals in doped lake-water samples. Further, we have explored the limit of detection of the system for two metal ions, Cu(ii) and Hg(ii), confirming the promise of the system as a candidate to identify toxic metals in environmental water sources.

Evaluating Web-based Educational Modules on Genetic Testing for Autism among Parents of Children with Autism.

Objectives New genomic tests for Autism Spectrum Disorders (ASD) are being offered to children and families with ASD; however, these tests are underutilized by parents of children affected with ASD. Methods We designed, implemented and pilot-tested an educational intervention to enhance parental genetic knowledge and assist them to make informed decisions about genomic testing. We utilized a pre-/post-test design to evaluate genetic knowledge and test perceptions in a sample of parents of children with ASD. Results Fifty-three parents participated in our online training (5 modules) and completed pre- and post-assessments. Our surveys queried knowledge, attitudes, and intention to test. The knowledge section contained questions regarding autism, genes, and genetic testing for autism. The other 2 sections included attitudinal questions about testing as well as parents' behavioral intention to seek genetic testing for autism. Conclusions Our results indicate that knowledge significantly improved following the intervention (p < .001). Although attitude and intention scores changed from pre-to post-assessment, these changes were not statistically significant. Our results demonstrate that this first-of-its-kind educational program designed for parents of children with ASD was effective at increasing parents' knowledge related to genomic testing for autism.

Enantiomeric resolution of methylamphetamine and ephedrine: Does this affect the δ13 C, δ15 N, and δ2 H stable isotope ratios of the product?

The use of stable isotope ratio mass spectrometry (IRMS) as a profiling tool for methylamphetamine has evolved over the last decade. Stable isotope ratios of carbon (δ13 C), nitrogen (δ15 N), and hydrogen (δ2 H) of methylamphetamine are useful in determining the precursor used to manufacture methylamphetamine, and in many cases the synthetic origin of the methylamphetamine precursor. More recently, samples of seized methylamphetamine show that a resolution step is being employed in the manufacturing process. We sought to determine whether the δ13 C, δ15 N, and δ2 H values were affected by either a resolution performed on racemic methylamphetamine or a resolution on racemic ephedrine, a commonly used precursor to methylamphetamine. We found that for the types of resolution studied, IRMS is still able to provide useful information on the provenance of a methylamphetamine sample.

What Do Parents Think about Chromosomal Microarray Testing? A Qualitative Report from Parents of Children with Autism Spectrum Disorders.

Background. Chromosomal Microarray Analysis (CMA) is increasingly utilized to detect copy number variants among children and families affected with autism spectrum disorders (ASD). However, CMA is controversial due to possible ambiguous test findings, uncertain clinical implications, and other social and legal issues related to the test. Methods. Participants were parents of children with ASD residing in the North Eastern region of North Carolina, USA. We conducted individual, face-to-face interviews with 45 parents and inquired about their perceptions of CMA. Results. Three major themes dominated parents' perceptions of CMA. None of the parents had ever heard of the test before and the majority of the parents postulated positive attitudes toward the test. Parents' motivations in undergoing the test were attributed to finding a potential cause of ASD, to being better prepared for having another affected child, and to helping with future reproductive decisions. Perceived barriers included the cost of testing, risk/pain of CMA testing, and fear of test results. Conclusion. This study contributes to the understanding of psychosocial aspects and cultural influences towards adoption of genetic testing for ASD in clinical practice. Genetic education can aid informed decision-making related to CMA genetic testing among parents of children with ASD.

Effects of cobalt/vitamin B12 status in ewes on ovum development and lamb viability at birth.

Scottish Blackface ewes from cobalt-deficient farmland were fed a diet containing 0.06 mg cobalt per kg dry matter from approximately 30 days before embryo recovery/transfer until lambing. Ewes remained untreated (-Co; n = 82) or were given an intraruminal cobalt-containing bolus to compensate for the dietary deficit (+Co; n = 82). Ewes used as embryo donors (-Co, n = 17; +Co, n = 16) were artificially inseminated with semen from a single Suffolk sire. Day 6 embryos obtained from -Co and +Co donors were transferred in singleton to -Co and +Co recipients in a 2 x 2 factorial-designed experiment to determine the effects of cobalt/vitamin B12 status during the periconception period (factor 1) and pregnancy (factor 2) on lamb viability at birth. Mean (+/- s.e.m.) circulating concentrations of vitamin B12 in -Co and +Co donors at ovum recovery were 182 +/- 10 and 1288 +/- 64 pmol L(-1), respectively (P < 0.001), and the number of corpora lutea per ewe ovulating was 9.9 +/- 1.6 and 14.4 +/- 1.3, respectively (P < 0.05). Treatment did not affect the proportion of recovered ova that contained >32 cells (viable) or the median stage of development (late morula), but viable ova recovered from -Co v. +Co ewes had a better morphological grade (2.0 +/- 0.1 v. 2.20 +/- 0.04, respectively; P < 0.01). There was no effect of treatment on the proportion of recipient ewes that became pregnant. Circulating concentrations of vitamin B12 were lower in -Co than +Co ewes during pregnancy (P < 0.001) and at birth in lambs born to -Co ewes compared with those born to +Co ewes (P < 0.001). There was no effect of donor or recipient cobalt/vitamin B12 status on lamb birthweight, neonatal vigour or neonatal rectal temperatures, but lambs derived from +Co v. -Co embryo donors were more active in the first 3 days after birth (P < 0.05). Results show that sub-clinical cobalt/vitamin B12 deficiency reduces ovulatory response in superovulated ewes and that periconception nutrition can affect neonatal lamb behaviour.