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1.
Nature ; 597(7876): 360-365, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34526707

RESUMEN

Fish and other aquatic foods (blue foods) present an opportunity for more sustainable diets1,2. Yet comprehensive comparison has been limited due to sparse inclusion of blue foods in environmental impact studies3,4 relative to the vast diversity of production5. Here we provide standardized estimates of greenhouse gas, nitrogen, phosphorus, freshwater and land stressors for species groups covering nearly three quarters of global production. We find that across all blue foods, farmed bivalves and seaweeds generate the lowest stressors. Capture fisheries predominantly generate greenhouse gas emissions, with small pelagic fishes generating lower emissions than all fed aquaculture, but flatfish and crustaceans generating the highest. Among farmed finfish and crustaceans, silver and bighead carps have the lowest greenhouse gas, nitrogen and phosphorus emissions, but highest water use, while farmed salmon and trout use the least land and water. Finally, we model intervention scenarios and find improving feed conversion ratios reduces stressors across all fed groups, increasing fish yield reduces land and water use by up to half, and optimizing gears reduces capture fishery emissions by more than half for some groups. Collectively, our analysis identifies high-performing blue foods, highlights opportunities to improve environmental performance, advances data-poor environmental assessments, and informs sustainable diets.


Asunto(s)
Acuicultura , Ecosistema , Monitoreo del Ambiente , Alimentos Marinos , Desarrollo Sostenible , Animales , Acuicultura/tendencias , Cambio Climático , Dieta , Ecología , Política Ambiental , Explotaciones Pesqueras , Abastecimiento de Alimentos/métodos , Gases de Efecto Invernadero , Humanos , Moluscos , Nitrógeno , Fósforo , Alimentos Marinos/provisión & distribución , Algas Marinas , Desarrollo Sostenible/tendencias
2.
Vet Rec ; : e948, 2021 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-34570896

RESUMEN

BACKGROUND: Previously national surveillance data for monitoring strangles (Streptococcus equi infection) in UK horses was limited. Improved awareness and knowledge of positive diagnoses would permit the optimisation of biosecurity protocols, decreasing the prevalence of strangles. METHODS: Seven UK laboratories reported positive strangles diagnoses between 1 January 2015 and 31 December 2019 based on identifying Streptococcus equi via agent detection assays from field-based practitioner-submitted samples. Associated clinical history and animal signalment were collected where provided, and descriptive analysis undertaken. RESULTS: Within the study period, 1617 laboratory-confirmed diagnoses occurred from samples submitted by 315 veterinary practices. Of these, 51.6% were swabs and 44.0% guttural pouch lavages. Diagnoses were primarily based on qPCR alone (59.6%), qPCR and culture (35.8%), or culture alone (4.6%). A total of 1791 clinical signs were reported for 713 diagnoses, where nasal discharge (31.3%) and pyrexia (20.5%) were most frequently reported. Regions with the highest number of diagnoses included North Yorkshire (n = 75, 4.6%), Staffordshire (n = 71, 4.4%) and West Sussex (North East) (n = 63, 3.9%). CONCLUSION: This study presents important insights into the diagnosis and clinical features of strangles in UK horses, even though limited and/or missing clinical history and signalment on laboratory submission forms restricts the completeness of the data.

3.
Cochrane Database Syst Rev ; 6: CD003031, 2021 06 16.
Artículo en Inglés | MEDLINE | ID: mdl-34131913

RESUMEN

BACKGROUND: Febrile seizures occurring in a child older than one month during an episode of fever affect 2-4% of children in Great Britain and the United States and recur in 30%. Rapid-acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the adverse effects of continuous antiepileptic drugs. This is an updated version of a Cochrane Review previously published in 2017. OBJECTIVES: To evaluate primarily the effectiveness and safety of antiepileptic and antipyretic drugs used prophylactically to treat children with febrile seizures; and also to evaluate any other drug intervention where there is a sound biological rationale for its use. SEARCH METHODS: For the latest update we searched the following databases on 3 February 2020: Cochrane Register of Studies (CRS Web), MEDLINE (Ovid, 1946 to 31 January 2020). CRS Web includes randomised or quasi-randomised controlled trials from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), the Cochrane Central Register of Controlled Trials (CENTRAL), and the specialised registers of Cochrane Review Groups including the Cochrane Epilepsy Group. We imposed no language restrictions and contacted researchers to identify continuing or unpublished studies. SELECTION CRITERIA: Trials using randomised or quasi-randomised participant allocation that compared the use of antiepileptics, antipyretics or recognised Central Nervous System active agents with each other, placebo, or no treatment. DATA COLLECTION AND ANALYSIS: For the original review, two review authors independently applied predefined criteria to select trials for inclusion and extracted the predefined relevant data, recording methods for randomisation, blinding, and exclusions. For the 2016 update, a third review author checked all original inclusions, data analyses, and updated the search. For the 2020 update, one review author updated the search and performed the data analysis following a peer-review process with the original review authors. We assessed seizure recurrence at 6, 12, 18, 24, 36, 48 months, and where data were available at age 5 to 6 years along with recorded adverse effects. We evaluated the presence of publication bias using funnel plots. MAIN RESULTS: We included 42 articles describing 32 randomised trials, with 4431 randomised participants used in the analysis of this review. We analysed 15 interventions of continuous or intermittent prophylaxis and their control treatments. Methodological quality was moderate to poor in most studies. We found no significant benefit for intermittent phenobarbital, phenytoin, valproate, pyridoxine, ibuprofen, or zinc sulfate versus placebo or no treatment; nor for diclofenac versus placebo followed by ibuprofen, paracetamol, or placebo; nor for continuous phenobarbital versus diazepam, intermittent rectal diazepam versus intermittent valproate, or oral diazepam versus clobazam. There was a significant reduction of recurrent febrile seizures with intermittent diazepam versus placebo or no treatment at six months (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.48 to 0.85; 6 studies, 1151 participants; moderate-certainty evidence), 12 months (RR 0.69, 95% CI 0.56 to 0.84; 8 studies, 1416 participants; moderate-certainty evidence), 18 months (RR 0.37, 95% CI 0.23 to 0.60; 1 study, 289 participants; low-certainty evidence), 24 months (RR 0.73, 95% CI 0.56 to 0.95; 4 studies, 739 participants; high-certainty evidence), 36 months (RR 0.58, 95% CI 0.40 to 0.85; 1 study, 139 participants; low-certainty evidence), 48 months (RR 0.36, 95% CI 0.15 to 0.89; 1 study, 110 participants; moderate-certainty evidence), with no benefit at 60 to 72 months (RR 0.08, 95% CI 0.00 to 1.31; 1 study, 60 participants; very low-certainty evidence). Phenobarbital versus placebo or no treatment reduced seizures at six months (RR 0.59, 95% CI 0.42 to 0.83; 6 studies, 833 participants; moderate-certainty evidence), 12 months (RR 0.54, 95% CI 0.42 to 0.70; 7 studies, 807 participants; low-certainty evidence), and 24 months (RR 0.69, 95% CI 0.53 to 0.89; 3 studies, 533 participants; moderate-certainty evidence), but not at 18 months (RR 0.77, 95% CI 0.56 to 1.05; 2 studies, 264 participants) or 60 to 72 months follow-up (RR 1.50, 95% CI 0.61 to 3.69; 1 study, 60 participants; very low-certainty evidence). Intermittent clobazam compared to placebo at six months resulted in a RR of 0.36 (95% CI 0.20 to 0.64; 1 study, 60 participants; low-certainty evidence), an effect found against an extremely high (83.3%) recurrence rate in the controls, a result that needs replication. When compared to intermittent diazepam, intermittent oral melatonin did not significantly reduce seizures at six months (RR 0.45, 95% CI 0.18 to 1.15; 1 study, 60 participants; very-low certainty evidence). When compared to placebo, intermittent oral levetiracetam significantly reduced recurrent seizures at 12 months (RR 0.27, 95% CI 0.15 to 0.52; 1 study, 115 participants; very low-certainty evidence). The recording of adverse effects was variable. Two studies reported lower comprehension scores in phenobarbital-treated children. Adverse effects were recorded in up to 30% of children in the phenobarbital-treated groups and 36% in benzodiazepine-treated groups. We found evidence of publication bias in the meta-analyses of comparisons for phenobarbital versus placebo (seven studies) at 12 months but not at six months (six studies); and valproate versus placebo (four studies) at 12 months. There were too few studies to identify publication bias for the other comparisons. The methodological quality of most of the included studies was low or very low. Methods of randomisation and allocation concealment often did not meet current standards, and 'treatment versus no treatment' was more commonly seen than 'treatment versus placebo', leading to obvious risks of bias.  AUTHORS' CONCLUSIONS: We found reduced recurrence rates for intermittent diazepam and continuous phenobarbital, with adverse effects in up to 30% of children. The apparent benefit for clobazam treatment in one trial needs to be replicated. Levetiracetam also shows benefit with a good safety profile; however, further study is required. Given the benign nature of recurrent febrile seizures, and the high prevalence of adverse effects of these drugs, parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management, and, most importantly, the benign nature of the phenomenon.


Asunto(s)
Anticonvulsivantes/uso terapéutico , Antipiréticos/uso terapéutico , Convulsiones Febriles/prevención & control , Anticonvulsivantes/efectos adversos , Antipiréticos/efectos adversos , Niño , Preescolar , Intervalos de Confianza , Humanos , Lactante , Placebos/uso terapéutico , Sesgo de Publicación , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia
4.
Obes Surg ; 31(7): 3151-3158, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33847876

RESUMEN

BACKGROUND: Obesity is a chronic disease with multisystem morbidity. There are multiple studies reporting the effect of bariatric surgery on cardiovascular and metabolic disease, but few examine its impact on lower urinary tract symptoms. This article aims to perform a systematic review with meta-analysis, to determine the effects of bariatric surgery on lower urinary tract symptoms in male patients. METHODS: Medline, Embase, conference proceedings, and reference lists were searched for studies reporting the quantitative measurement of lower urinary tract symptoms score pre- and postweight loss surgery. The primary outcome was International Prostate Symptom Score (IPSS) before and after bariatric surgery. Secondary outcomes were changed in body mass index (BMI) and total body weight (TBW). Weighted mean differences (MD) were calculated for continuous outcomes. RESULTS: Seven studies were included in the analysis of 334 patients undergoing bariatric surgery. Mean study follow-up was between 3 and 36 months. IPSS score ranged from 3-12.7 preoperatively and 1.9-6.9 postoperatively. There was a statistically significant improvement in the IPSS score following bariatric surgery (MD 2.82, 95% CI 0.96 to 4.69, p=0.003). Bariatric surgery also resulted in statistically significant reduction of BMI and TBW. CONCLUSION: Bariatric surgery produces a significant improvement on lower urinary tract symptoms in men with obesity. This may be due to improvement of insulin sensitivity, testosterone levels or lipid profile associated with weight loss.


Asunto(s)
Cirugía Bariátrica , Síntomas del Sistema Urinario Inferior , Obesidad Mórbida , Humanos , Síntomas del Sistema Urinario Inferior/etiología , Masculino , Obesidad/cirugía , Obesidad Mórbida/cirugía , Pérdida de Peso
5.
Br Dent J ; 2021 Apr 21.
Artículo en Inglés | MEDLINE | ID: mdl-33883704

RESUMEN

Aim The use of tier 2 practitioners has been suggested as an intermediate tier in the NHS workforce completing cases of moderate difficulty previously referred to secondary care. Provision of such services varies depending on speciality and local commissioning priorities. This service evaluation investigated reasons for and outcomes of endodontic referrals to an NHS tier 2 service in Powys, Wales.Methods A sample of endodontic referrals was analysed with reasons for referral, referral outcome, requests for consultant support and patient demographic data recorded producing results with frequencies and percentage distributions.Results Of 401 referrals evaluated, common reasons for referral were management of post-treatment disease (56.4%) followed by inability to locate or negotiate root canals (26.9%). Mandibular molar teeth were the most frequently referred. Additionally, 44.1% of patients referred went on to receive treatment. Consultant advice and/or treatment was required in the management of 3.5% of referrals, most frequently relating to referral of traumatic dental injuries, root resorption and immature apices.Conclusions Results demonstrate tier 2 practitioners can effectively manage and treat the majority of NHS endodontic referrals. Remote consultant advice is effective in supporting tier 2 practitioners in the management of complex presentation, allowing effective treatment delivery.

6.
Ambio ; 50(9): 1739-1756, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33675016

RESUMEN

Trends in aquatic food consumption were matched against farm production surveys within Hubei province and compared to official production data and statistics. Surveys showed that consumer tastes were changing to a much broader aquatic food menu as their spending power increased. Traditional aquaculture species were becoming less profitable due to reduced profit margins as input costs increased and consumption preferences changed. Consequently, many producers were diversifying their production to meet local demand. Some farmers were also de-intensifying by reducing commercial aquafeed inputs and reverting to more traditional methods of dyke-crop culture to optimise trade-offs between input costs and labour, and manage their risk more effectively. In addition, analysis of local data showed that wholesale changes were occurring to aquaculture production as environmental protection legislation took effect which reduced the growing area for carps considerably.


Asunto(s)
Acuicultura , Conservación de los Recursos Naturales , China
7.
Postgrad Med J ; 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33637641

RESUMEN

Lower respiratory infections are often caused or precipitated by viruses and are a leading cause of global morbidity and mortality. Mutations in these viral genomes can produce highly infectious strains that transmit across species and have the potential to initiate epidemic, or pandemic, human viral respiratory disease. Transmission between humans primarily occurs via the airborne route and is accelerated by our increasingly interconnected and globalised society. To this date, there have been four major human viral respiratory outbreaks in the 21st century. Healthcare workers (HCWs) are at particular risk during respiratory epidemics or pandemics. This is due to crowded working environments where social distancing, or wearing respiratory personal protective equipment for prolonged periods, might prove difficult, or performing medical procedures that increase exposure to virus-laden aerosols, or bodily fluids. This review aims to summarise the evidence and approaches to occupational risk and protection of HCWs during epidemic or pandemic respiratory viral disease.

8.
Equine Vet J ; 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33566383

RESUMEN

BACKGROUND: Surveillance of antimicrobial resistance (AMR) in horses is important to aid empirical treatment decisions and highlight emerging AMR threats. OBJECTIVE: To describe the AMR patterns of common groups of bacteria from clinical submissions from horses in the UK during 2018, and to determine how this varies by sample site and type of submitting veterinary practice. STUDY DESIGN: Prospective observational study. METHODS: All data on bacterial culture and subsequent antimicrobial susceptibility testing (AST) collected in 2018 from six large equine diagnostic laboratories were included. Resistance patterns were analysed including resistance to 1 or 2 antimicrobial classes, multidrug resistance (MDR), extensively drug resistant (XDR), resistance to highest priority critically important antimicrobials and isolates where there was no readily available treatment for adult horses in the UK. Submitting practices were classified according to whether they treated referral cases or not (first opinion). Comparisons between proportions and resistance for each bacterial group and sample site was performed using Chi-squared (or Fisher's exact test). RESULTS: A total of 6,018 bacterial isolates from 4,038 diagnostic submissions were included from respiratory (n = 1555), urogenital (n = 1,010), skin/hair/wound/abscess (n = 753), surgical site infection (SSI) /catheter-related-infection (CRI) /orthopaedic infections (n = 347) and unknown/'other' submissions (n = 373). There were 2,711 Gram-negative isolates and 3,307 Gram-positive isolates. Prevalence of MDR for E. coli was 31.7%, Staphylococcus spp. 25.3% and > 25% for the majority of bacterial isolates from SSI/CRI/orthopaedic submissions. For Enterococcus spp. there was no readily available treatment for adult horses in the UK in 30.2% of positive submissions. MDR was significantly higher from referral hospital than first opinion submissions for the majority of pathogens (except Actinobacillus spp. and Pasteurella spp. and ß-haemolytic Streptococcus spp.). MAIN LIMITATIONS: Since culture and susceptibility results are not systematic analyses based on harmonised methods, selection bias could impact the findings. CONCLUSIONS: Ongoing surveillance is essential to understand emerging patterns of resistance. MDR is high in SSI/CRI/orthopaedic infections, which is important for hospital biosecurity and guiding treatment decisions. Harmonisation of diagnostic procedures and interpretation of results amongst veterinary laboratories will improve AMR surveillance and data comparison among laboratories.

9.
Emerg Infect Dis ; 27(2): 517-528, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33496240

RESUMEN

The lack of population health surveillance for companion animal populations leaves them vulnerable to the effects of novel diseases without means of early detection. We present evidence on the effectiveness of a system that enabled early detection and rapid response a canine gastroenteritis outbreak in the United Kingdom. In January 2020, prolific vomiting among dogs was sporadically reported in the United Kingdom. Electronic health records from a nationwide sentinel network of veterinary practices confirmed a significant increase in dogs with signs of gastroenteric disease. Male dogs and dogs living with other vomiting dogs were more likely to be affected. Diet and vaccination status were not associated with the disease; however, a canine enteric coronavirus was significantly associated with illness. The system we describe potentially fills a gap in surveillance in neglected populations and could provide a blueprint for other countries.


Asunto(s)
Infecciones por Coronavirus/veterinaria , Coronavirus Canino , Brotes de Enfermedades , Enfermedades de los Perros/epidemiología , Vómitos/veterinaria , Animales , Enfermedades de los Perros/virología , Perros/virología , Reino Unido/epidemiología
10.
Aust N Z J Psychiatry ; 55(12): 1178-1190, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33423519

RESUMEN

OBJECTIVE: In Victoria, Prevention and Recovery Care Services have been established to provide a partial alternative to inpatient admissions through short-term residential mental health care in the community. This study set out to determine whether Prevention and Recovery Care Services are achieving their objectives in relation to reducing service use and costs, fostering least restrictive care and leading to positive clinical outcomes. METHODS: We matched 621 consumers whose index admission in 2014 was to a Prevention and Recovery Care ('PARCS consumers') with 621 similar consumers whose index admission in the same year was to an acute inpatient unit and who had no Prevention and Recovery Care stays for the study period ('inpatient-only consumers'). We used routinely collected data to compare them on a range of outcomes. RESULTS: Prevention and Recovery Care Services consumers made less subsequent use of acute inpatient services and, on balance, incurred costs that were similar to or lower than inpatient-only consumers. They were also less likely to spend time on an involuntary treatment order following their index admission. Prevention and Recovery Care Services consumers also experienced positive clinical outcomes over the course of their index admission, but the magnitude of this improvement was not as great as for inpatient-only consumers. This type of clinical improvement is important for Prevention and Recovery Care Services, but they may place greater emphasis on personal recovery as an outcome. CONCLUSION: Prevention and Recovery Care Services can provide an alternative, less restrictive care option for eligible consumers who might otherwise be admitted to an acute inpatient unit and do so at no greater cost.

11.
Curr Med Res Opin ; 37(1): 109-121, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33095689

RESUMEN

BACKGROUND: Schizophrenia is a heterogeneous disorder with a burden that can vary greatly depending on the severity and the duration. Previous research has suggested that patients in the earlier stages of schizophrenia (typically first-episode schizophrenia) benefit from effective early treatment, however, a comprehensive review of the burden specifically in this population has not been undertaken. A systematic literature review was therefore conducted to characterize the clinical, economic, and humanistic burden, as reported in naturalistic studies of schizophrenia populations specifically at an early stage of disease in comparison with healthy controls, patients with chronic schizophrenia, and patients with other psychiatric disorders. METHODS AND MATERIALS: Searches were conducted in MEDLINE, MEDLINE In-Process, Embase, PsycINFO, and EconLit databases for records published between January 2005 and April 2019, and of relevant conference abstracts published between January 2014 and May 2019. Data were extracted from relevant publications and subjected to qualitative evaluation. RESULTS: Fifty-two publications were identified for inclusion and revealed a considerable burden for early schizophrenia with regards to mortality, psychiatric comorbidities such as substance abuse and depression, poor social functioning, and unemployment. Comparisons with chronic schizophrenia suggested a greater burden with longer disease duration, while comparisons with other psychiatric disorders were inconclusive. This review uncovered various gaps in the available literature, including limited or no data on incarcerations, caregiver burden, and costs associated with early schizophrenia. CONCLUSIONS: Overall, the burden of schizophrenia is apparent even in the early stages of the disease, although further research is required to quantify the burden with chronic schizophrenia and other psychiatric disorders.


Asunto(s)
Costo de Enfermedad , Esquizofrenia , Comorbilidad , Depresión , Humanos , Desempleo
12.
Obes Surg ; 31(1): 439-444, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32748201

RESUMEN

Metabolic surgery provision is severely limited despite extensive supportive trial evidence. This study estimated the eligible population and the unmet need for metabolic surgery within English regions. Health Survey for England, National Diabetes Audit and population estimates were used to estimate the metabolic surgery eligible population by English region. Hospital Episode Statistics data was examined for metabolic surgery procedure volume by region (2013-2019). Regression analysis examined factors associated with metabolic surgery eligibility. 7.3% of the English population is potentially eligible for metabolic surgery; equivalent to 3.21 million people. Only 0.20% of the eligible English population receive metabolic surgery per year (regional variation 0.08-0.41%). The metabolic surgery eligible population was more likely to be female, older, have fewer educational qualifications and live in more deprived areas.


Asunto(s)
Cirugía Bariátrica , Obesidad Mórbida , Determinación de la Elegibilidad , Inglaterra/epidemiología , Femenino , Humanos , Obesidad Mórbida/cirugía , Estudios Retrospectivos
13.
Equine Vet J ; 53(4): 670-681, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32853420

RESUMEN

BACKGROUND: Respiratory disease is a common cause for presentation of working horses to clinics in Ethiopia and a priority concern for owners. OBJECTIVES: To identify risk factors for and association of pathogens with respiratory signs in working horses. STUDY DESIGN: Unmatched case-control study. METHODS: Cases were those animals recently coughing (last 7 days) or observed with coughing, nasal discharge or altered respiration at the time of examination. A physical exam and respiratory endoscopy were performed including a tracheal wash sample to detect the presence of pathogens and serology performed on blood. An owner questionnaire was administered. Risk factors were determined using multivariable logistic regression. RESULTS: Data on 108 cases and 93 unmatched control horses were obtained. Case horses often had underlying lower airway pathology and were significantly more likely to have Streptococcus zooepidemicus detected (OR: 12.4, 95% CI: 3.6-42.4). There was no evidence of a major role for viral respiratory pathogens. Risk factors included completion of strenuous work (OR: 2.7, 95% CI: 1.2-6.3), drinking from stagnant water sources (OR: 2.3, 95% CI: 1.0-5.2) or being housed on a cobbled floor (OR: 2.0, 95% CI: 1.1-3.8). There were increased odds of respiratory disease in young and old horses in this population. MAIN LIMITATIONS: Samples for pathogen detection and cytology were only taken from the trachea. CONCLUSION: S. zooepidemicus, a common commensal, may play a role in clinical respiratory disease in this population.


Asunto(s)
Enfermedades de los Caballos , Infecciones Estreptocócicas , Streptococcus equi , Animales , Estudios de Casos y Controles , Etiopía/epidemiología , Enfermedades de los Caballos/diagnóstico , Enfermedades de los Caballos/epidemiología , Enfermedades de los Caballos/etiología , Caballos , Factores de Riesgo , Infecciones Estreptocócicas/veterinaria
14.
Australas Psychiatry ; 29(3): 309-314, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33297748

RESUMEN

OBJECTIVE: To assess the rates of serious medical issues on psychiatry wards by determining the rate, indication and outcomes of rapid response calls. METHOD: Using retrospective file review, information regarding rapid response calls during an 8-month period was analysed. RESULTS: Seventy-two rapid response calls were recorded; 7.5% of the admissions involved a rapid response call. Of patients who required a rapid response call, 88.6% had medical comorbidities. Also, 29.2% of rapid response calls required transfer to another ward. CONCLUSIONS: Patients on psychiatry wards frequently require urgent medical intervention. Improved collaboration and service planning between general medical and psychiatric service is required to improve clinical care and outcomes for this high-risk group.

15.
J Eat Disord ; 8: 29, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32626579

RESUMEN

Background: After receiving intensive medical treatment; individuals with eating disorders often require ongoing care to maintain their recovery, build social networks, and reduce risk of relapse. Methods: To address this important transition period, a six-month peer mentoring program was developed and piloted in Melbourne, Australia. Twelve adults with a past history of an eating disorder (mentors) were paired with 14 individuals with a current eating disorder (mentees). Pairs met for thirteen mentoring sessions in community settings. Throughout the program mentees and mentors completed reflective questions online. Upon completion of the program, qualitative interviews were conducted. Both online reflections and interviews explored themes relating to perceived benefits and challenges of participation in the peer mentoring program, and the differences between mentoring and traditional treatment. Results: Thematic analysis identified several benefits for mentees; including hope, reconnection with others, and re-engaging with the world. The majority of mentees described their mentor as uniquely supportive due to their past experience of an eating disorder. Mentors reported experiencing benefits such as increased connection with self and others, and indicated that the experience helped them positively reframe their past experience of an eating disorder. Ending the relationship at the completion of the program was a significant challenge for both groups, and managing boundaries was deemed a main challenge by mentors. Conclusions: Overall, results indicated that this mode of informal support may be worthy of further investigation as an adjunct to clinical treatment programs for this population. Trial registration: Australian and New Zealand Clinical Trials registration number - ACTRN12617001412325 - Date of registration - 05/10/2017 (Retrospectively registered).

16.
Obes Surg ; 30(8): 3201-3207, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32440778

RESUMEN

BACKGROUND: The functional aspects of obesity are increasingly recognised as a significant clinical and public health concern. Whilst there is substantial evidence for the beneficial impact of bariatric surgery on metabolic and cardiovascular disease, there is less understanding of the quantitative effect of bariatric surgery on back pain. The aim of this meta-analysis was to assess the impact of bariatric surgery on back pain in reported studies. METHODS: Medline, Embase, conference proceedings and reference lists were searched for studies assessing quantitative back pain scores both before and after bariatric surgery. The primary outcome was visual analogue score for back pain pre- and post-bariatric surgery. Secondary outcomes were change in BMI, SF-36 quality of life scores and Oswestry Disability Index (ODI) scores. Weighted mean differences (MD) were calculated for continuous outcomes. RESULTS: Seven studies were included in the analysis of 246 patients undergoing bariatric surgery. Mean study follow-up was between 3 and 24 months. There was a statistically significant reduction in visual analogue score for back pain following bariatric surgery (MD - 3.01; 95% CI - 4.19 to - 1.89; p < 0.001). Bariatric surgery also resulted in statistically significant improvements in BMI, SF-36 score and ODI score. CONCLUSIONS: Bariatric surgery produces significant and quantifiable reductions in back pain. This may be commuted through reductions in axial load or improved quality of life, but further studies will improve understanding and aid preoperative counselling.


Asunto(s)
Cirugía Bariátrica , Obesidad Mórbida , Dolor de Espalda/etiología , Humanos , Obesidad Mórbida/cirugía , Calidad de Vida , Resultado del Tratamiento
18.
Br Dent J ; 228(5): 333-337, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32170243

RESUMEN

Internal bleaching is an effective and minimally invasive way of bleaching non-vital teeth. A commonly cited risk associated with it is external cervical resorption (ECR), which is a potentially significant complication that could result in loss of the tooth. This is an important point of discussion with a patient during the consent process. Legally, patients are required to be made aware of material risks to which they would be likely to attach significance, such as the loss of a tooth. The risk of ECR is therefore a key component in the patient's decision-making process as they weigh it against the perceived benefits. Over the last ten years, both clinical and legal reasons have resulted in a number of changes in the materials and protocols used for internal bleaching. This leads to the question of what the current quality of evidence is regarding the association of ECR following internal bleaching with modern protocols. Other restorative options for discoloured teeth, such as veneers or crowns, involve the irreversible removal of tooth tissue and these may be chosen by patients over internal bleaching based on out-of-date evidence.


Asunto(s)
Blanqueamiento de Dientes , Decoloración de Dientes , Diente no Vital , Diente , Humanos , Peróxido de Hidrógeno
20.
J Orthod ; 47(1): 82-90, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31920162

RESUMEN

Autotransplantation is a treatment option with high reported survival rates to replace failing teeth in the anterior maxilla. This treatment requires a multidisciplinary approach from orthodontists, paediatric dentists, restorative dentists, and oral and maxillofacial surgeons to achieve successful outcomes. Success is dependent on many factors including stage of root development, handling of the periodontal ligament, extra-alveolar time and splinting. This case report presents the novel use of digitally designed and three-dimensional (3D) printed surgical templates to aid intraoperatively and reduce the extra-alveolar time. A preoperative cone-beam computed tomography scan allowed digital planning and construction of surgical templates that replicated the exact root dimensions of impacted maxillary canines. These templates were subsequently 3D printed in resin, sterilised and utilised intraoperatively to aid socket preparation before the surgical autotransplantation.


Asunto(s)
Diente Canino , Diente Impactado , Diente Premolar , Niño , Tomografía Computarizada de Haz Cónico , Humanos , Maxilar , Impresión Tridimensional , Trasplante Autólogo
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