Lived experiences of end-of-life care at home in the UK: a scoping review of qualitative research.

Background Home is the preferred place of care and death for most people with advanced illness. Aim To examine and describe the published qualitative literature on the lived experiences of dying at home, to characterise the participants and their contexts and to identify key gaps, with a view to informing future research. Design and Setting A scoping literature review in accordance with the PRISMA-ScR guideline. Method The online databases CINAHL and MEDLINE were searched with relevant MeSH terms and keywords to identify primary qualitative research published between 2010 and 2022, exploring the lived experience of patients, families and/or unpaid carers in the United Kingdom. Results In total, 462 papers were screened, 58 underwent full text review and 13 studies were retained in the final set. All studies explored the experience of bereaved family and/or unpaid carers and only one study interviewed a dying person. Where specified, the majority of experiences related to deaths from cancer, many with specialist palliative care team involvement. Included papers yielded a breadth of diverse findings, with the most common subject themes relating to the availability and quality of care and support for families and carers. Conclusion There is limited published evidence exploring lived experiences of end-of-life care at home and this constrains the extent to which community services can be evidence-informed in their design and delivery. More research is needed to examine the first-hand experiences of people who are dying at home, particularly for those with non-cancer conditions and where specialist services are not involved.

Breed-Specific Vertebral Heart Scale for the Dachshund.

The objectives of this study were to determine a breed-specific vertebral heart scale (VHS) range for the dachshund and compare results to the established reference range of 9.7 ± 0.5, calculate inter-observer variability, and correlate VHS with echocardiography. Fifty-one normal dachshunds had radiographs and an echocardiogram performed. Five observers measured VHS to the nearest 0.25 vertebra. The data was analyzed using one-way analysis of variance, Wilcoxon Rank Sum test, Mann-Whitney rank sum test, calculation of reference and confidence intervals, Spearman rank-order correlations, and generation of intra-class correlations and confidence intervals. P < .05 was considered significant. The median for right lateral VHS was significantly larger than left (10.3 [range 9.25-11.55] versus 10.1 [range, 8.7-11.31], p < .0001). VHS for females was significantly larger than for males (left: 10.56 [9.2-11.31] versus 9.74 [8.7-10.88] and right: 10.8 [9.5-11.55] versus 9.99 [9.25-10.8], p = .0002). Observer consistency was high with an intra-class correlation coefficient of 0.95. No significant correlation was found between left atrial echocardiographic parameters and VHS. Results indicate normal dachshunds have a median VHS above the published generic canine reference range, and VHS can be reliably performed by observers with varying degrees of clinical experience.

Elevated Ca2+ transients and increased myofibrillar power generation cause cardiac hypercontractility in a model of Noonan syndrome with multiple lentigines.

Noonan syndrome with multiple lentigines (NSML) is primarily caused by mutations in the nonreceptor protein tyrosine phosphatase SHP2 and associated with congenital heart disease in the form of pulmonary valve stenosis and hypertrophic cardiomyopathy (HCM). Our goal was to elucidate the cellular mechanisms underlying the development of HCM caused by the Q510E mutation in SHP2. NSML patients carrying this mutation suffer from a particularly severe form of HCM. Drawing parallels to other, more common forms of HCM, we hypothesized that altered Ca(2+) homeostasis and/or sarcomeric mechanical properties play key roles in the pathomechanism. We used transgenic mice with cardiomyocyte-specific expression of Q510E-SHP2 starting before birth. Mice develop neonatal onset HCM with increased ejection fraction and fractional shortening at 4-6 wk of age. To assess Ca(2+) handling, isolated cardiomyocytes were loaded with fluo-4. Q510E-SHP2 expression increased Ca(2+) transient amplitudes during excitation-contraction coupling and increased sarcoplasmic reticulum Ca(2+) content concurrent with increased expression of sarco(endo)plasmic reticulum Ca(2+)-ATPase. In skinned cardiomyocyte preparations from Q510E-SHP2 mice, force-velocity relationships and power-load curves were shifted upward. The peak power-generating capacity was increased approximately twofold. Transmission electron microscopy revealed that the relative intracellular area occupied by sarcomeres was increased in Q510E-SHP2 cardiomyocytes. Triton X-100-based myofiber purification showed that Q510E-SHP2 increased the amount of sarcomeric proteins assembled into myofibers. In summary, Q510E-SHP2 expression leads to enhanced contractile performance early in disease progression by augmenting intracellular Ca(2+) cycling and increasing the number of power-generating sarcomeres. This gives important new insights into the cellular pathomechanisms of Q510E-SHP2-associated HCM.

Effectiveness of seasonal influenza vaccines in children -- a systematic review and meta-analysis.

AIM: To assess the efficacy and effectiveness of seasonal influenza vaccines in healthy children up to the age of 18 years. METHODS: MedLine, EMBASE, CENTRAL, CINAHL, WHOLIS, LILACS, and Global Health were searched for randomized controlled trials and cohort and case-control studies investigating the efficacy or effectiveness of influenza vaccines in healthy children up to the age of 18 years. The studies were assessed for their quality and data on the outcomes of influenza-like illness, laboratory-confirmed influenza, and hospitalizations were extracted. Seven meta-analyses were performed for different vaccines and different study outcomes. RESULTS: Vaccine efficacy for live vaccines, using random effects model, was as follows: (i) for similar antigen, using per-protocol analysis: 83.4% (78.3%-88.8%); (ii) for similar antigen, using intention to treat analysis: 82.5 (76.7%-88.6%); (iii) for any antigen, using per protocol analysis: 76.4% (68.7%-85.0%); (iv) for any antigen, using intention to treat analysis: 76.7% (68.8%-85.6%). Vaccine efficacy for inactivated vaccines, for similar antigen, using random effects model, was 67.3% (58.2%-77.9%). Vaccine effectiveness against influenza-like illness for live vaccines, using random effects model, was 31.4% (24.8%-39.6%) and using fixed-effect model 44.3% (42.6%-45.9%). Vaccine effectiveness against influenza-like illness for inactivated vaccines, using random effects model, was 32.5% (20.0%-52.9%) and using fixed-effect model 42.6% (38.3%-47.5%). CONCLUSIONS: Influenza vaccines showed high efficacy in children, particularly live vaccines. Effectiveness was lower and the data on hospitalizations were very limited.

Morphologic and Molecular Characterization of a Demodex (Acari: Demodicidae) Species from White-Tailed Deer (Odocoileus virginianus).

Demodex mites, although usually nonpathogenic, can cause a wide range of dermatological lesions ranging from mild skin irritation and alopecia to severe furunculosis. Recently, a case of demodicosis from a white-tailed deer (Odocoileus virginianus) revealed a Demodex species morphologically distinct from Demodex odocoilei. All life cycle stages were considerably larger than D. odocoilei and although similar in size to D. kutzeri and D. acutipes from European cervids, numerous morphometrics distinguished the four species. Adult males and females were 209.1 ± 13.1 and 225.5 ± 13.4 µm in length, respectively. Ova, larva, and nymphs measured 65.1 ± 4.1, 124.9 ± 11.6, and 205.1 ± 19.4 µm in length, respectively. For phylogenetic analyses, a portion of the 18S rRNA gene was amplified and sequenced from samples of the WTD Demodex sp., two Demodex samples from domestic dogs, and Demodex ursi from a black bear. Phylogenetic analyses indicated that the WTD Demodex was most similar to D. musculi from laboratory mice. A partial sequence from D. ursi was identical to the WTD Demodex sequence; however, these two species can be differentiated morphologically. This paper describes a second Demodex species from white-tailed deer and indicates that 18S rRNA is useful for phylogenetic analysis of most Demodex species, but two morphologically distinct species had identical partial sequences. Additional gene targets should be investigated for phylogenetic and parasite-host association studies.

Normal range of human left ventricular volumes and mass using steady state free precession MRI in the radial long axis orientation.

BACKGROUND: The radial long-axis orientation for the measurement of left ventricular (LV) volume and mass has been shown to have advantages over the short-axis orientation. Previous work has highlighted the need for technique specific normal ranges. The purpose of this study was therefore to establish normal ranges of LV volume and mass for the radial long-axis orientation. MATERIALS AND METHODS: Forty normal subjects (20 males, average age 32.3, age range 19-58; 20 females, average age 37.4, age range 21-54) were examined utilising a steady state free precession (SSFP) pulse sequence. Two observers analysed the images independently using in-house validated software. RESULTS: The normal ranges for LV end-diastolic volume measurements after adjustment to body surface area (BSA) were 62-120 ml for males and 58-103 ml for females. LV mass indexed to BSA ranged from 50-86 g for males and 36-72 g for females. The normal range for ejection fraction was 49-73% for males and 54-73% for females. CONCLUSION: A gender specific normal range using SSFP in the radial long-axis orientation was established.

The reproducibility of left ventricular volume and mass measurements: a comparison between dual-inversion-recovery black-blood sequence and SSFP.

The aim of this study was to compare a dual-inversion-recovery black-blood (BB) magnetic resonance imaging (MRI) sequence with steady-state free precession (SSFP) for the assessment of left ventricular parameters. The improved endocardial border definition seen with SSFP was not observed at the epicardial border. Improvements in segmentation at the left ventricular epicardial border have been observed with this black-blood sequence. Left ventricular (LV) mass and LV end-diastolic volume (EDV) measurements as well as inter-observer and intra-observer variability were compared between images acquired with a dual inversion BB and SSFP sequence. The mean+/-1 standard deviation (SD) for LV EDV was 178.3+/-52.7 ml measured with SSFP and 158.8+/-62.2 ml with BB. This difference was not statistically significant (p=0.22). For SSFP, the mean value of LV mass was 124.0+/-27.0 g and 147.5+/-37.4 g for BB, a statistically significant difference (p<0.0001). The dual-inversion-recovery BB imaging showed improved reproducibility for LV mass measurements compared with SSFP and improved spatial resolution. For studies requiring LV mass measurements, the dual-inversion-recovery BB sequence offers improved spatial resolution and improved reproducibility to SSFP.