Feline urinary tract pathogens in western Canada: Prevalence of bacterial species and antimicrobial resistance from 2012 to 2018.

Objective: The aim of this study was to investigate the bacterial population and antimicrobial resistance of bacteria isolated from feline urine from 2012 to 2018 in the Canadian provinces of Alberta and British Columbia. Animals and procedure: IDEXX Reference Laboratories provided data from urine samples submitted from Alberta and British Columbia for aerobic culture and susceptibility testing from January 1, 2012 to December 31, 2018. The analysis included 8084 bacterial isolates from 7522 cystocentesis samples, with at least 1000 colony-forming units per mL. Results: Escherichia coli, Enterococcus species, and Staphylococcus species were the most commonly isolated bacteria, at 60.0%, 22.7%, and 11.8%, respectively. The proportions did not vary significantly throughout the study period or between British Columbia and Alberta. Apart from an increase in the resistance of Staphylococcus species to clindamycin, there was minimal change in the antimicrobial susceptibility of the 3 most commonly isolated bacteria over the study period. More than 85% of Gram-positive organisms were susceptible to amoxicillin with or without clavulanic acid, and > 85% of Gram-negative organisms were susceptible to amoxicillin with clavulanic acid and trimethoprim with sulfamethoxazole. Conclusion and clinical relevance: Treatment with amoxicillin, with or without clavulanic acid, may be considered for bacterial feline lower urinary tract disease in Alberta and British Columbia while awaiting culture results.

Agents pathogènes des voies urinaires félines dans l'Ouest canadien: prévalence des espèces bactériennes et résistance aux antimicrobiens de 2012 à 2018. Objectif: Le but de cette étude était d'étudier la population bactérienne et la résistance antimicrobienne des bactéries isolées de l'urine féline de 2012 à 2018 dans les provinces canadiennes de l'Alberta et de la Colombie-Britannique. Animaux et procédure: Les Laboratoires de référence IDEXX ont fourni des données à partir d'échantillons d'urine soumis par l'Alberta et la Colombie-Britannique pour une culture aérobie et des tests de sensibilité du 1er janvier 2012 au 31 décembre 2018. L'analyse comprenait 8084 isolats bactériens provenant de 7522 échantillons d'urine obtenus par cystocentèse, avec au moins 1000 unités formant des colonies/mL. Résultats: Escherichia coli, les espèces appartenant aux genres Enterococcus et Staphylococcus étaient les bactéries les plus couramment isolées, à 60,0 %, 22,7 % et 11,8 %, respectivement. Les proportions n'ont pas varié de manière significative tout au long de la période d'étude ni entre la Colombie-Britannique et l'Alberta. Hormis une augmentation de la résistance des espèces de Staphylococcus à la clindamycine, il y a eu un changement minime de la sensibilité aux antimicrobiens des 3 bactéries les plus couramment isolées au cours de la période d'étude. Plus de 85 % des organismes à Gram positif étaient sensibles à l'amoxicilline avec ou sans acide clavulanique, et > 85 % des organismes à Gram négatif étaient sensibles à l'amoxicilline avec acide clavulanique et à la combinaison triméthoprime-sulfaméthoxazole. Conclusion et pertinence clinique: Un traitement à l'amoxicilline, avec ou sans acide clavulanique, peut être envisagé pour les infections bactérienne urinaires félines en Alberta et en Colombie-Britannique en attendant les résultats de la culture.(Traduit par Dr Serge Messier).

Molecular MRD status and outcome after transplantation in NPM1-mutated AML.

Relapse remains the most common cause of treatment failure for patients with acute myeloid leukemia (AML) who undergo allogeneic stem cell transplantation (alloSCT), and carries a grave prognosis. Multiple studies have identified the presence of measurable residual disease (MRD) assessed by flow cytometry before alloSCT as a strong predictor of relapse, but it is not clear how these findings apply to patients who test positive in molecular MRD assays, which have far greater sensitivity. We analyzed pretransplant blood and bone marrow samples by reverse-transcription polymerase chain reaction in 107 patients with NPM1-mutant AML enrolled in the UK National Cancer Research Institute AML17 study. After a median follow-up of 4.9 years, patients with negative, low (<200 copies per 105ABL in the peripheral blood and <1000 copies in the bone marrow aspirate), and high levels of MRD had an estimated 2-year overall survival (2y-OS) of 83%, 63%, and 13%, respectively (P < .0001). Focusing on patients with low-level MRD before alloSCT, those with FLT3 internal tandem duplications(ITDs) had significantly poorer outcome (hazard ratio [HR], 6.14; P = .01). Combining these variables was highly prognostic, dividing patients into 2 groups with 2y-OS of 17% and 82% (HR, 13.2; P < .0001). T-depletion was associated with significantly reduced survival both in the entire cohort (2y-OS, 56% vs 96%; HR, 3.24; P = .0005) and in MRD-positive patients (2y-OS, 34% vs 100%; HR, 3.78; P = .003), but there was no significant effect of either conditioning regimen or donor source on outcome. Registered at ISRCTN (http://www.isrctn.com/ISRCTN55675535).

A multicenter retrospective comparison of induction chemoimmunotherapy regimens on outcomes in transplant-eligible patients with previously untreated mantle cell lymphoma.

Mantle cell lymphoma (MCL) is an uncommon and typically aggressive form of lymphoma. Although often initially chemosensitive, relapse is common. Several induction and conditioning regimens are used in transplant-eligible patients, and the optimal approach remains unknown. We performed an international, retrospective study of transplant-eligible patients to assess impact of induction chemoimmunotherapy and conditioning regimens on clinical outcomes. We identified 228 patients meeting inclusion criteria. Baseline characteristics were similar among the induction groups except for some variation in age. The type of induction chemoimmunotherapy received did not influence overall response rates (ORRs) (0.43), progression-free survival (PFS) (P > .67), or overall survival (OS) (P > .35) on multivariate analysis (PFS and OS). Delivery of autologous stem cell transplant (ASCT) was associated with favorable PFS and OS (0.01) on univariate analysis only; this benefit was not seen on multivariate analysis-PFS (0.36) and OS (0.21). Compared with busulfan and melphalan (BuMel), the use of the carmustine, etoposide, cytarabine, melphalan (BEAM)-conditioning regimen was associated with inferior PFS (HR = 2.0 [95% CI 1.1-3.6], 0.02) but not OS (HR = 1.1 [95% CI 0.5-2.3], 0.81) on univariate analysis only. Within the limits of a retrospective study and modest power for some comparisons, type of induction therapy did not influence ORR, PFS, or OS for transplant-eligible patients with MCL. International efforts are required to perform randomized clinical trials evaluating chemoimmunotherapy induction regimens.

Prevention of mood disorder after stroke: a randomised controlled trial of problem solving therapy versus volunteer support.

BACKGROUND: Mood disorder after stroke is common but drug and psychosocial treatments have been assessed with disappointing results. Preventing mood disorder from developing in the first place could be a better approach and might reduce the need for pharmacotherapy in this predominantly older patient group. We used a brief problem-solving therapy and evaluated its effect in reducing mood disorder in the 12 months after stroke. METHODS: A 3-group, parallel, randomised controlled trial. Four hundred fifty patients with stroke were randomised within 1 month of hospital admission to problem-solving therapy from a psychiatric nurse, non-specific support given by volunteers or treatment-as-usual. Follow up took place at 6 and 12 months after stroke. Standardised measures of mood (Present State Examination, GHQ-28), cognitive state (mini-mental state examination) and function (Barthel ADL index, Frenchay Activities Index) were taken at baseline, 6 and 12 months after randomisation. Satisfaction with care was recorded at follow up. RESULTS: At 6 months, all psychological and activity measures favoured problem-solving therapy. At 12 months, patients in the problem-solving therapy group had significantly lower GHQ-28 scores and lower median Present State Examination symptom scores. There were no statistically significant differences in activity. The problem-solving therapy group were more satisfied with some aspects of care. CONCLUSIONS: The results are encouraging and suggest it is possible to prevent mood disorder in stroke patients using a psychological intervention. The differences between the groups at 12 months may indicate a sustained impact of psychological therapies, by comparison with non-specific support. TRIAL REGISTRATION: ISRCTN: ISRCTN33773710 Registered: 23/01/2004 (Retrospectively).

A Randomized Feasibility Trial of a New Lifestyle Referral Assessment Versus Usual Assessment in an Acute Cardiology Setting.

BACKGROUND: A healthy diet, taking exercise, and not smoking or consuming alcohol in excess are important to reduce the risk of cardiovascular disease either alone or in combination with statin medication. Health education, including providing information to patients on healthy living and guidance on how to achieve it, is a key nursing function. OBJECTIVES: This study aims first to assess the feasibility of conducting a full-scale trial of lifestyle referral assessment as shown by recruitment rate, data collection, and follow-up and second to assess proof of concept and explore possible mechanisms of change. METHODS: This was a single-center, randomized, 2-arm, parallel-group, unblinded feasibility trial conducted in an acute teaching hospital trust. Participants were followed up at 3 and 6 months after randomization. RESULTS: Eight hundred eighty-seven patients were screened for eligibility, of whom 132 (15%) were randomized into the trial. Of the patients allocated to the individualized assessment, 27% accepted referral or self-referred by 3 months in comparison to 5% allocated to the usual assessment. CONCLUSIONS: We demonstrated that a full-scale trial is feasible and that an individualized approach increased the number of patients accepting referral to a formal program and initiating lifestyle change. However, we should consider the aim of the assessment and ways in which the process of change can be optimized in order to produce long-term benefit for patients. TRIAL REGISTRATION: current controlled trials ISRCTN41781196.

Testing measurement invariance of the GHQ-28 in stroke patients.

BACKGROUND: In order to combine self-reported measures data from multiple studies to conduct an integrated data analysis, the construct measured must have the same meaning across the studies. This study investigated the measurement invariance of the General Health questionnaire (GHQ-28) in two stroke studies before combining the data for an integrative data analysis. METHODS: The study used data from the Stroke Outcomes Study 1 (SOS1, n = 448) and second Stroke Outcomes Study (SOS2, n = 585). The initial analysis was a confirmatory factor analysis (CFA) for each study separately to confirm the four-factor structure of GHQ-28 questionnaire. Multi-group confirmatory factor analysis (MG-CFA) was used to assess the measurement invariance of the GHQ-28 questionnaire in the two stroke cohorts. Measurement invariance at configural invariance (same items associated with same factor across groups); factor loading invariance (equal factor loadings across groups) and scalar invariance (equal intercepts across groups) was examined. RESULTS: CFA supported all three invariances measured. CONCLUSION: Results showed that the GHQ-28 questionnaire has comparable measurement properties in the SOS1 and SOS2 stroke studies. Strong measurement invariance was established, and based on the results from this study, integrative data analysis of GHQ-28 scores from the two stroke studies is merited.

Initial analysis of a community-based bereavement programme.

It is well evidenced that childhood bereavement has a negative impact upon a range of psychological and educational outcomes. This article describes a service evaluation of the national child bereavement charity, Winston's Wish SWITCH programme. SWITCH is a community outreach bereavement programme targeted at children that are at risk of antisocial and self-destructive behaviour. A preliminary evaluation of baseline to follow up of parent (n=31) and young person (n=96) Strength and Difficulties (SDQ) data suggests that the programme contributes to a positive impact upon emotional distress, relationships, and concentration. Further, more robust evaluation needs to be conducted to understand the long-term implications of the programme on vulnerable young people.

Mixture modelling analysis of one-month disability after stroke: stroke outcomes study (SOS1).

PURPOSE: Understanding the heterogeneity in disability after stroke is important to guide treatment and rehabilitation planning. We explored mixture modelling analysis to identify subgroups of stroke disability and factors associated with disability subgroups. METHOD: Analyses were performed using secondary data from a cohort of 448 stroke patients who participated in a 2-year study of stroke outcomes. Mixture modelling approach was used to determine subgroups of early disability following stroke based on the Barthel Index, General Health Questionnaire (GHQ-28), Frenchay Activities Index and the Nottingham Extended Activities of Daily Living Scale. RESULTS: Five distinct disability groups were identified. Nineteen (4.2%) patients were classified as having very severe disability, 58 (12.9%) severe disability, 133 (29.7%) moderate disability, 198 (44.2%) mild disability and 40 (8.9%) a mood disorder. Compared to the mild group, patients in the "very severe" group were more likely to be elderly and to have had a previous stroke, and less likely to live alone and had a greater risk of mortality 2 years after stroke. Patients in the mood disorder group showed greater dependency in activities of daily living were younger compared to the other groups and had a greater risk of having mood symptoms 2 years after stroke. CONCLUSION: Mixture modelling of 1-month disability after stroke using a broad range of outcome measures has identified clinically meaningful groups relating to long-term outcomes.

Measuring patient-perceived continuity of care for patients with long-term conditions in primary care.

BACKGROUND: Continuity of care is widely acknowledged as important for patients with multi-morbidity but simple, service-orientated indices cannot capture the full impact of continuity in complex care delivery systems. The patient's perspective is important to assess outcomes fully and this is challenging because generic measures of patient-perceived continuity are lacking. We investigate the Chao Perception of Continuity (Chao PC) scale to determine its suitability as a measure of continuity of care for patients with a long-term condition (stroke), and co-morbidity, in a primary care setting. DESIGN AND SETTING: A questionnaire study embedded in a prospective observational cohort study of outcomes for patients following acute stroke. PARTICIPANTS: 168 community dwelling patients (58% male) mean age 68 years a minimum one year post-stroke. Functional status: Barthel Index mean =16. INTERVENTION: A 23-item questionnaire, the Chao Perception of Continuity (Chao PC) scale, sent by post to their place of residence or administered face to face as part of the final cohort study assessment. RESULTS: 310 patients were invited to participate; 168 (54%) completed a questionnaire. All 23 questionnaire items were entered into a Principal Component Analysis. Emergent factors from the exploratory analysis were (1) inter-personal trust (relational continuity); (2) interpersonal knowledge and information (informational and relational continuity) and (3) the process of care (managerial continuity). The strongest of these was inter-personal trust. CONCLUSION: The context-specific items in the Chao PC scale are difficult for respondents to interpret in a United Kingdom Primary Care setting resulting in missing data and low response rates. The Chao-PC therefore cannot be recommended for wider application as a general measure of continuity of care without significant modification. Our findings reflect the acknowledged dimensions of continuity and support the concept of continuity of care as a multi-dimensional construct. We demonstrate the overlapping boundaries across the dimensions in the factor structure derived. Trust and interpersonal knowledge are clearly identified as valuable components of any patient-perceived measure of continuity of care.

Factors Associated with Medication Noncompliance in Dogs in New Zealand.

Client compliance with prescribed medication instructions to treat their pets is a concern. This study describes factors associated with the noncompliance of dog owners with veterinary recommendations for medication, as well as client-reported barriers and aids to administering medications. A cross-sectional survey of dog owners' compliance with veterinary medication recommendations was performed from 9 January 2019 to 18 July 2020. A convenience sample of owners who prescribed medication for their dogs during or following elective veterinary examination was surveyed regarding medication administration experience and compliance. Owners were followed up to determine if the course of medication had been completed. Compliance data were analyzed descriptively. Logistic regression was performed with compliance as the outcome. Medication noncompliance was recorded for 47% (71/151) of owners. Increasing dog age was associated with better owner compliance (p < 0.05). Pet owners who used "nothing" as an aid to medicating were less likely to be noncompliant (p < 0.05). Forty-seven percent (71/151) of owners reported that "nobody" showed them how to administer the medication. One-third of dog owners (47/151) reported challenges in medicating their pets. The most common reason cited by clients reporting challenges was a resistant pet. Demonstration of medication administration techniques and discussion about available aids to medicating a pet may improve client compliance.

Arthroplasty Follow-Up Pathways: A Qualitative Study of Current Practice and Healthcare Professionals' Attitudes and Motivations for Change.

BACKGROUND: There is considerable diversity in arthroplasty follow-up pathways. This qualitative study aimed to understand healthcare professionals' practice and attitude to follow-up, their motivation for change and what evidence they considered before implementing new pathways. METHODS: The main UKSAFE study enroled 38 centres providing revision procedures across the United Kingdom. A purposive sample of professional leads and service managers was identified from site contacts. Individual interviews were conducted by telephone, transcribed verbatim and analysed using a theoretical framework derived from current evidence and the data collected in our previous studies. RESULTS: We found that there had been a shift away from bringing patients back into the clinic for repeat follow-up assessments, but that this was not universal, and some centres had long-established care pathways that involved long-term follow-up. The way in which those services were provided might be different or have common features, but centres were likely to face common problems including large patient numbers and funding restraints. CONCLUSION: The reliability of newer prosthetics and surgical skill has influenced some changes by increasing confidence in a pathway which does not routinely provide long-term follow-up. Service commissioners also have a role to play in how follow-up care pathways are configured, but scrutiny of the ratio of new to follow-up appointments can put pressure on clinical staff to follow-up only patients with identified clinical need. Virtual clinics can provide a service to patients and use scarce resources efficiently, but NHS IT systems that would be needed to support more remote working, for example, telemedicine and plans to collect PROMS data online from patients to assist with monitoring were not advanced.

Use of a biosimilar granulocyte colony-stimulating factor for peripheral blood stem cell mobilization: an analysis of mobilization and engraftment.

Peripheral blood haematopoietic progenitor cell mobilization has become a standard procedure prior to autologous stem cell transplantation. Biosimilar granulocyte colony-stimulating factors (GCSF) have recently been awarded European Union (EU) licences for stem cell mobilization but data for their use in this context remain limited. The biosimilar GCSF, Ratiograstim(®) (Ratiopharm, Ulm, Germany) was granted an EU licence in September 2008 and incorporated into clinical practice in the Wessex Blood and Marrow Transplantation Programme in December 2008. Data were retrospectively collected for 154 consecutive patients undergoing peripheral blood stem cell harvest between January 2009 and December 2011 using the biosimilar GCSF. 131 consecutive patients from the preceding 3 years, who had received Neupogen(®) , were used as a control. We analysed both parameters relevant to stem cell collection and engraftment data, where patients proceeded to transplantation. We found no statistically significant difference between the two groups when comparing CD34 predictors, total number of CD34(+) stem cells collected, number of days required for collection, or for time to engraftment. This is, to our knowledge, the largest direct comparison of a biosimilar GCSF with originator GCSF for stem cell mobilization. The use of biosimilar GCSF can produce a significant cost saving, allowing investment in other areas of stem cell transplantation.

A qualitative synthesis of factors influencing maintenance of lifestyle behaviour change in individuals with high cardiovascular risk.

BACKGROUND: Management of cardiovascular risk factors includes commitment from patients to adhere to prescribed medications and adopt healthy lifestyles. Unfortunately many fail to take up and maintain the four key healthy behaviours (not smoking, having a balanced diet, limiting alcohol consumption and being more active). Five factors (beliefs, knowledge, transport and other costs, emotions, and friends and family support) are known to predict uptake of lifestyle behaviour change. The key factors influencing maintenance of healthy lifestyles are not known but would be helpful to support the development of relapse prevention programmes for this population. Our review aimed to clarify the main patient perceived factors thought to influence maintenance of changed healthy lifestyles. METHODS: We performed a systematic review of qualitative observational studies and applied the principles of content synthesis and thematic analysis to extract reported factors (barriers and facilitators) considered by individuals to be influential in maintaining changed healthy lifestyle behaviours. Factors were then organised into an existing framework of higher order categories which was followed by an analysis of the interrelationships between factors to identify key themes. RESULTS: Twenty two studies met our inclusion criteria. Participants reported barriers and facilitators within 13 categories, the majority of which were facilitators. The most commonly reported influences were those relating to social support (whether provided formally or informally), beliefs (about the self or the causes and management of poor health, and the value of maintaining lifestyle behaviours), and other psychological factors (including attitude, thinking and coping styles, and problem solving skills). Physical activity was the most commonly investigated behaviour in four categories, but overall, the main barriers and facilitators were related to a range of behaviours. Through analysis of the interrelationships between factors within categories, 'social support', 'education and knowledge', and 'beliefs and emotions' were all considered key themes. CONCLUSIONS: Our review suggests that for the most part, factors that influence lifestyle change are also important for maintaining healthy behaviours. This indicates that addressing these barriers and facilitators within lifestyle support programmes would also be of value in the longer-term.

Differences in the perceived role of the healthcare provider in delivering vascular health checks: a Q methodology study.

BACKGROUND: The UK Department of Health introduced the National Health Service (NHS) Health Check Programme in April 2009 in an attempt to improve primary and secondary prevention of cardiovascular disease in the UK population and to reduce health inequalities. Healthcare professionals' attitudes towards giving lifestyle advice will influence how they interact with patients during consultations. We therefore sought to identify the attitudes of primary care healthcare professionals towards the delivery of lifestyle advice in the context of the NHS Health Check Programme. METHODS: Fifty-two primary care healthcare professionals undertook a Q sort with 36 statements that represented a range of viewpoints about the importance of lifestyle change, medication, giving lifestyle advice in the primary care setting, and the individual, social and material factors that might impact on lifestyle related behaviour change. Sorts were analysed by-person using principal components analysis and varimax rotation. RESULTS: Five statistically independent factors (accounts) reflected distinct views on the topic. Account 1 was supportive of initiatives like the NHS Health Check, and emphasised the importance of professionals working collaboratively with patients to facilitate lifestyle change. Account 2 expressed views on the potential overuse of statin medication and placed responsibility for lifestyle change with the patient. Account 3 viewed the healthcare professional role to be one of educator, emphasising the provision of information. Account 4 perceived lifestyle change to be difficult for patients and emphasised the need for healthcare professionals to be role models. Account 5 was inconsistent about the value of lifestyle change, or the role of healthcare professionals in promoting it, a finding that may be due to ambivalence about the health check or to lack of engagement with the Q sort task. We found no strong associations between any of the factors and, gender, role, age or ethnicity. CONCLUSIONS: Our findings suggest that healthcare professionals hold viewpoints that may influence how they interact with patients during health checks. When implementing programmes like the NHS Health Check, it would be useful to take healthcare professionals' views into account. Attitudes and beliefs could be explored during training sessions, for example.

Significant decline in Galactomannan Signal during storage of clinical serum samples.

Galactomannan (GM) is widely used for detection of invasive aspergillosis in high-risk haemato-oncology patients. Recent publications have reported a lack of repeatability of GM detection. The objective of this retrospective study was to assess the repeatability of GM levels during storage of clinical samples. In a GM screening strategy, positive sera were repeat tested as per manufacturer's recommendations. Short-term (ST) storage of samples was at +4 °C while long-term (LT) storage was at -80 °C. Bronchoalveolar (BAL) fluid was also repeating tested after ST storage and LT storage. Wilcoxon Signed Ranks Test was employed to assess the repeatability of GM levels. In a subset of 14 GM positive sera, repeat testing was performed on both the original serum and ethylenediaminetetraacetic acid (EDTA) pre-treated sample. There was a significant reduction in GM signals on repeat testing following ST storage (median GM index: 0.65 vs. 0.19; p < 0.001) and LT storage (median GM index: 0.56 vs. 0.10; p < 0.001) of serum samples. Of samples that were initially GM positive, an average GM index reduction of 50% was seen, with approximately two-thirds becoming GM negative on repeat testing of the same sample. In contrast, GM signal loss was not seen on repeat testing of BAL fluid following ST or LT storage. When GM positive serum samples were repeat tested using EDTA pre-treated serum from the first step of the testing protocol, all samples remained GM positive. In contrast, when the same samples were repeat tested from the original collected serum, 9 samples (64%) became GM negative. The significant reduction in GM signals during ST and LT storage of serum samples has implications for clinical management. Although the reasons for GM decline are unknown, they occur prior to the EDTA pre-treatment stage, indicating that the time from phlebotomy to testing should be minimized. BAL fluid GM index values remain stable.

Investigating the Influence of Assessment Question Framing on Undergraduate Biology Student Preference and Affect.

Nearly all undergraduate biology courses rely on quizzes and exams. Despite their prevalence, very little work has been done to explore how the framing of assessment questions may influence student performance and affect. Here, we conduct a quasi-random experimental study where students in different sections of the same course were given isomorphic questions that varied in their framing of experimental scenarios. One section was provided a description using the self-referential term "you", placing the student in the experiment; another section received the same scenario that used classmate names; while a third section's scenario integrated counterstereotypical scientist names. Our results demonstrate that there was no difference in performance throughout the semester between the sections, nor were there differences in students' self-reported stress and identity. However, students in all three sections indicated that they most preferred the self-referential framing, providing a variety of reasons that suggest that these variants may influence how well a student reads and processes the question. In addition, our results also indicate that the framing of these scenarios can also have a large impact on some students' affect and attitude toward the question. We conclude by discussing implications for the biology education research community and biology instructors.

Developing sustainable patient and public involvement in mesothelioma research: multi-method exploration with researchers, patients, carers, and patient organisations.

BACKGROUND: Rare diseases where prognosis is poor provide limited scope for patient and public involvement (PPI). One such disease is mesothelioma, a cancer of the lung pleura or of the peritoneum caused by exposure to asbestos, where PPI is poorly documented. We undertook to explore how PPI could be facilitated in mesothelioma research. METHODS: An online survey with mesothelioma researchers (n = 23) assessed the perceived benefits and challenges of PPI in mesothelioma. Six online workshops and thirteen in-depth interviews with patients and the public explored their views on how PPI could be increased in mesothelioma and their motivations to become PPI representatives in the future. The survey data were analysed using descriptive statistics and the interviews, using Thematic Analysis. RESULTS: In the survey, 26% (n = 6) of the researchers did not include PPI in their research, while 74% (n = 17) did, finding it most beneficial at the stages of applying for funding and dissemination. The main perceived benefits of PPI were clarifying the research question and outcome measures, making research more credible and relevant to patients' needs, and increasing its impact. The main perceived challenges to PPI were the general poor prognosis in mesothelioma, and funding timescales which hindered timely recruitment of PPI representatives. The analysis of the interviews with the patients and public revealed three main themes: "Motivations to become a PPI representative in the future", "Understanding the nature of PPI during the project", and "Perceived challenges to PPI in mesothelioma". Altruism and the need for hope were the main reasons to wish to become involved in PPI in the future. For many participants, the project proved to be a journey of understanding the nature of PPI, a concept that was not easy to grasp from the start. The participants perceived certain barriers to PPI such as high symptom burden in mesothelioma, the abstract concept of PPI, and the use of scientific language. CONCLUSIONS: The present research provides a detailed picture of the benefits and challenges of PPI in mesothelioma. We recommend long-term engagement with mesothelioma support groups so that researchers achieve meaningful and sustainable PPI in mesothelioma research.

Patient and public involvement (PPI) in research means research that is done 'with' or 'by' the public, not 'to', 'about', or 'for' them. Involving patients, family caregivers or the public (e.g. coordinators of patient organisations) in research activities means that they contribute to how research is designed, conducted, or disseminated. However, some diseases where patients have a short prognosis after diagnosis make it harder for patients or their family members to get involved. In this project we explored the perspectives of patients, public, and researchers on how PPI could be increased and maintained in research on mesothelioma­a rare cancer of the lining of the lung or of the peritoneum caused by exposure to asbestos. We conducted an online survey with mesothelioma researchers, and they indicated a number of PPI benefits but also challenges such as finding people living with mesothelioma well enough to participate. We also conducted six online workshops and thirteen interviews with patients, family members and coordinators of mesothelioma patient organisations­these were not PPI representatives but participants in research. All participants in the project were motivated by the wish to enhance outcomes for other patients. Their understanding of PPI improved during the project and they saw a number of challenges to others becoming involved in PPI, such as its abstract nature and the use of scientific language. We recommend that researchers engage long-term with mesothelioma support groups so that they have opportunities to explain what PPI means and involve people affected by mesothelioma in research.

Prothrombinex®-VF in chronic liver disease: Friend or foe?

OBJECTIVE: Management of coagulopathy in chronic liver disease (CLD) poses a challenge for critical care physicians. Prothrombinex®-VF is a low-volume product with rapid onset of action. Evidence for its efficacy and safety in CLD is limited and cases of acute intravascular coagulation and fibrinolysis (AICF) and/or disseminated intravascular coagulation (DIC) have been reported. Our objective was to evaluate the role of Prothrombinex®-VF in reversal of coagulopathy and the incidence AICF/DIC, thromboembolic events and mortality. METHODS: This was a retrospective, multi-centre study of Prothrombinex®-VF use in CLD across 11 hospitals over a 2-year period, excluding those on therapeutic anticoagulation. Patients were subclassified into acute on chronic liver failure (ACLF), acute decompensation (ADC) and compensated cirrhosis. Reversal of coagulopathy was defined as international normalised ratio (INR) <1.5× upper limit normal (ULN), prothrombin time <1.5× ULN, activated partial thromboplastin time <1.5× ULN and fibrinogen >1 g/L. Markers of AICF/DIC were recorded. RESULTS: Thirty CLD patients were included, and the median model for end-stage liver disease score was 23.5. Acute bleeding was the most common indication for Prothrombinex®-VF (60%). All had baseline coagulopathy and the majority did not achieve reversal. Key indicators of AICF/DIC were mainly observed in those with ACLF; bleeding from mucosa or lines (53%), worsening hypofibrinogenaemia (60%), worsening thrombocytopaenia (60%). The ADC and compensated cirrhosis groups were relatively unaffected. Incidence of venous thromboembolism was 6%. Overall mortality was 43% and 70% in ACLF. CONCLUSION: Prothrombinex®-VF did not lead to meaningful reversal of coagulopathy and should be used with caution in CLD. Patients with ACLF were more likely to develop AICF/DIC following Prothrombinex®-VF, although the association is uncertain. Further studies are needed to evaluate the safety and efficacy of Prothrombinex®-VF use in CLD.

A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change.

BACKGROUND: Healthy lifestyles are an important facet of cardiovascular risk management. Unfortunately many individuals fail to engage with lifestyle change programmes. There are many factors that patients report as influencing their decisions about initiating lifestyle change. This is challenging for health care professionals who may lack the skills and time to address a broad range of barriers to lifestyle behaviour. Guidance on which factors to focus on during lifestyle consultations may assist healthcare professionals to hone their skills and knowledge leading to more productive patient interactions with ultimately better uptake of lifestyle behaviour change support. The aim of our study was to clarify which influences reported by patients predict uptake and completion of formal lifestyle change programmes. METHODS: A systematic narrative review of quantitative observational studies reporting factors (influences) associated with uptake and completion of lifestyle behaviour change programmes. Quantitative observational studies involving patients at high risk of cardiovascular events were identified through electronic searching and screened against pre-defined selection criteria. Factors were extracted and organised into an existing qualitative framework. RESULTS: 374 factors were extracted from 32 studies. Factors most consistently associated with uptake of lifestyle change related to support from family and friends, transport and other costs, and beliefs about the causes of illness and lifestyle change. Depression and anxiety also appear to influence uptake as well as completion. Many factors show inconsistent patterns with respect to uptake and completion of lifestyle change programmes. CONCLUSION: There are a small number of factors that consistently appear to influence uptake and completion of cardiovascular lifestyle behaviour change. These factors could be considered during patient consultations to promote a tailored approach to decision making about the most suitable type and level lifestyle behaviour change support.