Quality of Blood Pressure Monitoring During Telehealth Visits for Pregnant Patients at Risk of Preeclampsia.

Introduction: Preeclampsia is a significant cause of morbidity and mortality. The United States Preventative Services Task Force released 2023 recommendations encouraging more research on telehealth's role in facilitating blood pressure monitoring for patients with hypertensive disorders of pregnancy, including preeclampsia. This study evaluates the integration of self-measured blood pressure (SMBP) into telehealth obstetric visits during the COVID-19 pandemic for pregnant patients at risk of preeclampsia. Methods: A retrospective chart review was conducted of patients with one or more preeclampsia risk factors who delivered at a tertiary hospital from January to March 2021. Information pertaining to patients' number of antepartum, postpartum, and telehealth visits, blood pressure cuff access, and documentation of SMBP readings was recorded. Analyses were conducted in RStudio version 2022.12.0 + 353 (R Foundation for Statistical Computing). Results: Of 721 eligible patients, 244 (33.8%) had 2 or more ante- or postpartum telehealth visits. Of these 244 patients, 142 (58.2%) had chart documentation of owning a home blood pressure cuff. Only 106 (43.4%) had 1 or more SMBP documented in their telehealth visit notes, and they were more likely to have received care at federally qualified health centers than maternal fetal medicine clinics (p = 0.018) or private clinics (p < 0.001). Charts revealed no explanation for lack of blood pressure documentation during telehealth visits for most cases (n = 129, 93.5%). Conclusions: Opportunities exist to standardize blood pressure recording and documentation during telehealth visits, especially for patients with risk factors for preeclampsia, and to advocate for greater access to home blood pressure cuffs for all pregnant patients.

Dropping Off and Picking Up.

In this narrative medicine essay, a first-year medical student contrasts the life of her young daughter with the older cadaver that she dissects and explores in her anatomy laboratory.

Assessing pig farm biosecurity measures for the control of Salmonella on European farms.

Salmonella spp. is a common zoonotic pathogen, causing gastrointestinal infections in people. Pigs and pig meat are a major source of infection. Although farm biosecurity is believed to be important for controlling Salmonella transmission, robust evidence is lacking on which measures are most effective. This study enrolled 250 pig farms across nine European countries. From each farm, 20 pooled faecal samples (or similar information) were collected and analysed for Salmonella presence. Based on the proportion of positive results, farms were categorised as at higher or lower Salmonella risk, and associations with variables from a comprehensive questionnaire investigated. Multivariable analysis indicated that farms were less likely to be in the higher-risk category if they had '<400 sows'; used rodent baits close to pig enclosures; isolated stay-behind (sick) pigs; did not answer that the hygiene lock/ anteroom was easy to clean; did not have a full perimeter fence; did apply downtime of at least 3 days between farrowing batches; and had fully slatted flooring in all fattener buildings. A principal components analysis assessed the sources of variation between farms, and correlation between variables. The study results suggest simple control measures that could be prioritised on European pig farms to control Salmonella.

A longitudinal study reveals persistence of antimicrobial resistance on livestock farms is not due to antimicrobial usage alone.

Introduction: There are concerns that antimicrobial usage (AMU) is driving an increase in multi-drug resistant (MDR) bacteria so treatment of microbial infections is becoming harder in humans and animals. The aim of this study was to evaluate factors, including usage, that affect antimicrobial resistance (AMR) on farm over time. Methods: A population of 14 cattle, sheep and pig farms within a defined area of England were sampled three times over a year to collect data on AMR in faecal Enterobacterales flora; AMU; and husbandry or management practices. Ten pooled samples were collected at each visit, with each comprising of 10 pinches of fresh faeces. Up to 14 isolates per visit were whole genome sequenced to determine presence of AMR genes. Results: Sheep farms had very low AMU in comparison to the other species and very few sheep isolates were genotypically resistant at any time point. AMR genes were detected persistently across pig farms at all visits, even on farms with low AMU, whereas AMR bacteria was consistently lower on cattle farms than pigs, even for those with comparably high AMU. MDR bacteria was also more commonly detected on pig farms than any other livestock species. Discussion: The results may be explained by a complex combination of factors on pig farms including historic AMU; co-selection of AMR bacteria; variation in amounts of antimicrobials used between visits; potential persistence in environmental reservoirs of AMR bacteria; or importation of pigs with AMR microbiota from supplying farms. Pig farms may also be at increased risk of AMR due to the greater use of oral routes of group antimicrobial treatment, which were less targeted than cattle treatments; the latter mostly administered to individual animals. Also, farms which exhibited either increasing or decreasing trends of AMR across the study did not have corresponding trends in their AMU. Therefore, our results suggest that factors other than AMU on individual farms are important for persistence of AMR bacteria on farms, which may be operating at the farm and livestock species level.

Investigating relationships between climate controls and nutrient flux in surface waters, sediments, and subsurface pathways in an agricultural clay catchment of the Great Lakes Basin.

Water quality within agricultural catchments is governed by management practices and climate conditions that control the transport, storage, and exchange of nutrients between components of the hydrologic cycle. This study aims to improve knowledge of nitrogen (N) and phosphorus (P) transport in low permeability agricultural watersheds by considering spatial and temporal trends of surface water nutrient concentrations in relation to hydroclimatic drivers, sediment quality, shallow hyporheic exchange, groundwater quality, and tile drain discharge over a 14-month field study in a clay hydrosystem of the Lake Huron basin, one of the five Great Lakes. Results found that events of varying magnitude and intensity enhanced nutrient release from overland flow and subsurface pathways. Tile drain discharge was found to be a consistent and elevated source of P and N to surface waters when flowing, mobilizing both diffuse nutrients from fertilizer application and legacy stores in the vadose zone. Surface water quality was temporally variable at the seasonal and event scale. Targeted sampling following fertilization periods, snowmelt, and moderate precipitation events revealed catchment wide elevated nutrient concentrations, emphasizing the need for targeted sampling regimes. Controls other than discharge magnitude and overland flow were found to contribute to peak nutrient concentrations, including internal nitrate loading, soil-snowmelt interaction, catchment wetness, and freeze thaw cycles. Sediments were found to store P in calcium minerals and have a high P storage capacity. Instream mechanisms such as sediment P fixation and hyporheic exchange may play a role in mediating surface water quality, but currently have no discernable benefit to year-round surface water nutrient concentrations. Best management practices need to focus on reducing sources of agricultural nutrients (e.g., field phosphorus concentrations and tile drain discharge loading) at the watershed scale to reduce nutrient concentrations and export in flashy clay catchments.

Having permission not to remember: perspectives on interventions for post-traumatic stress disorder in the absence of trauma memory.

Background: It is possible for people to have post-traumatic stress disorder (PTSD) without memory of the trauma event, such as in drug-facilitated sexual assault. However, there is little evidence available on treatment provision for this population. Objective: This study aimed to address this gap by exploring the experiences of people who have had psychological intervention for PTSD without memories (PwM). Method: Interpretative phenomenological analysis was used to explore the lived experience of nine women with PwM, who had sought psychological assessment/therapy. Participants were recruited via social media and completed semi-structured interviews online/via telephone. Results: Identified themes concerned two broad areas: (i) the challenges of having therapy whilst lacking memories and (ii) what was helpful in therapy. Challenges included: delayed help-seeking; having emotional/sensory reactions in the absence of recognisable triggers; experiencing therapy as more applicable to remembered trauma (vs. unremembered); and difficulty discussing and processing unremembered trauma. However, participants also described helpful aspects of therapy including: feeling safe and supported; working with emotional and sensory forms of experience; having scientific explanations for trauma and memory; and having 'permission' from therapists not to remember. Conclusions: Recommendations for clinicians included: being aware that clients with PwM may have more difficulty accessing treatment and perceive it as less applicable to them; focussing on clients' emotions and sensations (not cognitive memories) in therapy; and supporting clients to develop a more self-compassionate understanding of their experiences and lack of memory, thus supporting them to accept that not remembering is 'permitted'. HIGHLIGHTS: • Having therapy for unremembered trauma involves unique challenges, but aspects of therapy can still be helpful.• Suggested 'dos and don'ts' for therapists include recognising the additional barriers to treatment, focussing on emotions (not memories), and normalising memory loss.

Antecedentes: Es posible que las personas tengan un trastorno de estrés postraumático (TEPT) sin recordar el evento traumático, como en una agresión sexual facilitada por drogas. Sin embargo, hay poca evidencia disponible sobre la provisión de tratamiento para esta población.Objetivo: Este estudio tuvo como objetivo abordar esta brecha mediante la exploración de las experiencias de las personas que han tenido una intervención psicológica para TEPT sin recuerdos (PwM en su sigla en inglés).Método: Se usó análisis fenomenológico interpretativo para explorar la experiencia vivida de nueve mujeres con PwM, quienes habían buscado una evaluación/terapia psicológica. Las participantes fueron reclutadas a través de redes sociales y completaron entrevistas semiestructuradas en línea o por teléfono.Resultados: Los temas identificados se referían a dos grandes áreas: (i) los desafíos de tener terapia mientras se carece de memoria; y (ii) lo que fue útil en la terapia. Los desafíos incluyeron: búsqueda de ayuda retardada; tener reacciones emocionales/sensoriales en ausencia de desencadenantes reconocibles; experimentar la terapia como más aplicable al trauma recordado (frente no recordado); y dificultad en discutir y procesar el trauma no recordado. Sin embargo, los participantes tambien describieron aspectos útiles de la terapia incluidos: sentirse seguros y apoyados; trabajar con formas de experiencia emocional y sensorial; tener explicaciones científicas para el trauma y el recuerdo; y tener 'permiso' de los terapeutas para no recordar.Conclusiones: Las recomendaciones para el clínico incluyeron: ser conscientes de que los clientes con PwM pueden tener más dificultades para acceder al tratamiento y percibirlo como menos aplicable a ellos; en la terapia centrarse en las emociones y sensaciones de los clientes (no en los recuerdos cognitivos); y apoyar a los clientes a desarrollar una comprensión más compasiva de sus experiencias y falta de recuerdos, apoyando así que acepten que no recordar está 'permitido'.

TP53 Combined Phenotype Score Is Associated with the Clinical Outcome of TP53-Mutated Myelodysplastic Syndromes.

Mutations of TP53 are observed in 5-10% of patients in myelodysplastic syndrome (MDS) and are associated with adverse outcomes. Previous studies indicate that the TP53 allelic state and variant allele frequency of TP53 mutation impact patient outcomes, but there is significant heterogeneity within this MDS subgroup. We performed retrospective review of clinicopathologic and genomic information of 107 patients with TP53-mutated MDS. We assessed each mutation according to the phenotypic annotation of TP53 mutations (PHANTM) and analyzed the associations between predicted TP53 mutant function, represented by the PHANTM combined phenotype score, and overall survival (OS) using the log rank test and Cox regression. Our results indicated that patients with PHANTM combined phenotype score above the median (>1) had significantly shorter OS compared to those with scores below the median (median OS: 10.59 and 16.51 months, respectively, p = 0.025). This relationship remained significant in multivariable analysis (HR (95%CI): 1.62 (1.01-2.58), p = 0.044) and identified to have an independent prognostic influence, accounting for known risk such as IPSS-R and other standard risk variables. Our results suggest that the functional information of TP53 mutations, represented by PHANTM combined phenotype score, are associated with the clinical outcome of patients with TP53-mutated MDS.

Transforming postgraduate medical education during the COVID-19 pandemic: creating a trainee-led virtual teaching platform.

The COVID-19 pandemic has had a significant impact on the provision of postgraduate medical education across the country. There has been a widespread need to upskill and empower the medical workforce in order to tackle the evolving clinical situation. At Lewisham and Greenwich NHS Trust, traditional face-to-face group teaching was suspended due to the need for social distancing, but the appetite for learning was high. We recognised the need for alternative teaching methods and identified two key educational areas that required attention: topics related to COVID-19 and its management, and education for doctors being redeployed to other specialties. We developed an innovative method of education delivery to regularly provide high-quality, relevant material to hundreds of healthcare professionals at both hospital sites. We believe that our methods could help other organisations to maintain teaching as the pandemic progresses.

The great escape? The rise of the escape room in medical education.

Medical education has changed focus to a more learner-centred model, placing learners at the centre of innovations in training. The escape room is one such innovative learner-focused activity, in which a team of players cooperatively discover clues, solve puzzles and complete tasks in order to progress through the challenge to achieve a specific goal. Escape rooms can be used in medical education as a tool for team building, an entertaining way of delivering technical and non-technical skills, to read and acquire or refresh knowledge, as well as for educational research. Despite appearing to be a superficial form of entertainment, escape rooms can be grounded in sound educational theory and, when used effectively, act as a low-cost, high-impact resource for a variety of learners. While escape rooms may well be an example of yet another educational 'fad' demonstrating the rising influence of 'Millennial MedEd', it signals a promising shift to more learner-centred, team-based methods which are essential to the practice of safe modern healthcare during the current COVID-19 pandemic and beyond.

Young People's Experiences of Attending a Theater-in-Education Program on Child Sexual Exploitation.

Child sexual exploitation and abuse (CSEA) has grave implications for the mental health and wellbeing of children and young people. It has been linked to a wide range of difficulties which may extend into adulthood. School-based prevention programs that aim to raise awareness (and thereby have the potential to prevent CSEA) are popular, however, have historically lacked robust and consistent evaluation. The purpose of the present study was therefore to explore young people's experiences of attending a school-based theater-in-education program, and the impact this had on their awareness and understanding of CSEA. Four focus groups of between four to six participants each were conducted with young people from two co-educational State schools in the United Kingdom. The approach of Template Analysis was used to analyze the data, and revealed a number of themes related to the superordinate themes of "Information and Detail Delivered" and "Format and Timing." The results suggest that participants gained new awareness and understanding of aspects related to CSEA, including other forms of (criminal) exploitation, as well as how to avoid harm and what to do "if bad things happen." Participants further reported that the theater performance/live element of the program was particularly impactful, feeling that this was delivered to them at the right time, but suggesting that younger people would also benefit from the important messages. In addition, areas for improvement were identified in terms of the delivery of the program, and the issue of victim blaming. Findings are discussed with a view to practical implications and directions for future research.

Chondrocyte channel transcriptomics: do microarray data fit with expression and functional data?

To date, a range of ion channels have been identified in chondrocytes using a number of different techniques, predominantly electrophysiological and/or biomolecular; each of these has its advantages and disadvantages. Here we aim to compare and contrast the data available from biophysical and microarray experiments. This letter analyses recent transcriptomics datasets from chondrocytes, accessible from the European Bioinformatics Institute (EBI). We discuss whether such bioinformatic analysis of microarray datasets can potentially accelerate identification and discovery of ion channels in chondrocytes. The ion channels which appear most frequently across these microarray datasets are discussed, along with their possible functions. We discuss whether functional or protein data exist which support the microarray data. A microarray experiment comparing gene expression in osteoarthritis and healthy cartilage is also discussed and we verify the differential expression of 2 of these genes, namely the genes encoding large calcium-activated potassium (BK) and aquaporin channels.