Search

Abstract Background Elderly patients admitted to Geriatric Assessment Units (GAU) typically have complex health problems that require multi-professional care. Considering the scope of human and technological resources solicited during hospitalization, as well as the many risks and discomforts incurred by the patient, it is important to ensure the communication of pertinent information for quality follow-up care in the community setting. Conventional discharge summaries do not adequately incorporate the elements specific to an aging clientele. Objective To develop a discharge summary adapted to the frail elderly patient (D-SAFE) in order to communicate relevant information from hospital to community services. Methods The items to be included in the D-SAFE have been determined by means of a modified Delphi method through consultation with clinical experts from GAUs (11 physicians and 5 pharmacists) and the community (10 physicians and 5 pharmacists). The consensus analysis and the level of agreement among the experts were reached using a modified version of the RAND®/University of California at Los Angeles appropriateness method. Results A consensus was reached after two rounds of consultation for all the items evaluated, where none was judged «inappropriate». Among the items proposed, four were judged to be « uncertain » and were eliminated from the final D-SAFE, which was divided into two sections: the medical discharge summary (22 main items) and the discharge prescription (14 main items). Conclusions The D-SAFE was developed as a more comprehensive tool specifically designed for GAU inpatients. Additional research to validate its acceptability and practical impact on the continuity of care is needed before it can be recommended for use on a broader scale.

The use of recorded video in medical education is increasing. Video material may be assigned before scheduled sessions to create a flipped classroom. Here, the instructor may lead a session that is organized for discussion, interpretation, and reflection of the previewed content. We established conditions that lead to increased student participation and engagement with prerecorded content for a medical genetics section in a first-year medical school basic sciences integrated course. Preliminary analysis of an asynchronous video-based pre-professional program directed the design of video material to support a first semester medical genetics course. We compared student participation in, and opinion of, a flipped-classroom session based on written vs. video presentation of material. Student opinion was surveyed with audience response devices (clickers). Shorter videos that were created specifically for the course were preferred by students compared to recordings of previously delivered lectures. Students preferred videos to assigned reading material and consistent scheduling throughout the teaching semester increased student participation. Presentation of medical school content with previously recorded video material can be a useful teaching tool if properly implemented.

Systems biology models are used to understand complex biological and physiological systems. Interpretation of these models is an important part of developing this understanding. These models are often fit to experimental data in order to understand how the system has produced various phenomena or behaviour that are seen in the data. In this paper, we have outlined a framework that can be used to perform Bayesian analysis of complex systems biology models. In particular, we have focussed on analysing a systems biology of the brain using both simulated and measured data. By using a combination of sensitivity analysis and approximate Bayesian computation, we have shown that it is possible to obtain distributions of parameters that can better guard against misinterpretation of results, as compared to a maximum likelihood estimate based approach. This is done through analysis of simulated and experimental data. NIRS measurements were simulated using the same simulated systemic input data for the model in a 'healthy' and 'impaired' state. By analysing both of these datasets, we show that different parameter spaces can be distinguished and compared between different physiological states or conditions. Finally, we analyse experimental data using the new Bayesian framework and the previous maximum likelihood estimate approach, showing that the Bayesian approach provides a more complete understanding of the parameter space., Competing Interests: The authors have declared that no competing interests exist.

Background: Alcohol-related motor vehicle crashes remain a significant and costly public health issue globally. Particularly young people are over-represented in these incidents. This study set out to explore the factors that influence individuals' perceptions of their safety to drive, and the factors related to a change in intention to drive., Methods: Four hundred nine young people aged 18-40 attending an Australian multi-day music festival completed a survey measuring demographics, alcohol use, amount of sleep obtained the previous night, intention to drive, number of passengers, perceived safety to drive, estimated BAC (measured in g/210 L) and change in intention to drive following a BAC measurement via breathalysers. Statistical analyses involved univariate tests of association and multivariate logistic regression., Results: Only one in five participants felt they were completely safe to drive. Males self-rated as less safe to drive than females. Multivariate analyses showed that licence class, sleep hours, units of alcohol consumed in the past 24 h and estimated BAC had statistically significant associations with driving safety perception. Participants who slept for greater than seven hours the previous night were three times more likely to feel safe to drive than those who had less than five hours of sleep (OR 3.05 (95% CI 1.25, 7.45)). Forty-one percent of participants changed their intended time of driving after having their BAC measured with a breathalyser. There was a statistically significant association between changing the intention to drive to a later time with an increase in each extra passenger in a participant's vehicle (OR 1.53 (95% CI 1.02, 2.30))., Conclusions: Whilst concerning behaviours relating to high-risk alcohol consumption were found, the study uncovered promising findings about young peoples' perceptions of their safety to drive, and their propensity to change their driving intention. The strong correlation between hours of sleep, estimated BAC, units of alcohol consumed and license class with perception of driving safety suggests an increased awareness among young people and promotion of these factors may potentially improve actual driver safety. The influence of number of passengers on intention to drive later is another important consideration for future road safety research or promotion.

Multimodal monitoring of the brain generates a great quantity of data, providing the potential for great insight into both healthy and injured cerebral dynamics. In particular, near-infrared spectroscopy can be used to measure various physiological variables of interest, such as haemoglobin oxygenation and the redox state of cytochrome-c-oxidase, alongside systemic signals, such as blood pressure. Interpreting these measurements is a complex endeavour, and much work has been done to develop mathematical models that can help to provide understanding of the underlying processes that contribute to the overall dynamics. BCMD is a software framework that was developed to run such models. However, obtaining, installing and running this software is no simple task. Here we present WeBCMD, an online environment that attempts to make the process simpler and much more accessible. By leveraging modern web technologies, an extensible and cross-platform package has been created that can also be accessed remotely from the cloud. WeBCMD is available as a Docker image and an online service., Competing Interests: Competing interests: No competing interests were disclosed.

Background: Human papillomavirus (HPV) DNA testing is more sensitive than cytology for detection of cervical intraepithelial neoplasia grade 3 and cancer (≥CIN3). Adding HPV testing to cytology is recommended for women ≥30 but long-term prospective studies of HPV testing are rare., Methods: Beginning in 1989-1990, ~20,000 women in a prepaid health maintenance organization (median age = 34) were followed passively by recommended annual cytology. We tested archived cervicovaginal lavage specimens collected at enrollment, primarily by MY09-MY11 PCR-based methods, for carcinogenic HPV types. We calculated positive and negative predictive values for the entire study period, and Kaplan-Meier estimates of cumulative probability for ≥CIN3, up to 18 years of follow-up., Results: We observed 47 cases of invasive cervical cancer during the study period, and 156 cases of CIN3. Predictive values and Kaplan-Meier analyses yielded the same conclusions. In women 30 and older, the reassurance against ≥CIN3 following a single negative HPV test was long-lasting (cumulative probability = 0.7% during follow-up). In this age group, a single HPV test (positive vs. negative, hazard ratio of 8.5, 95% CI = 4.8-15.1) provided greater long-term risk stratification than a single cytologic result (abnormal vs. normal, HR = 2.9, 95% CI = 1.2-6.6). The risk for ≥CIN3 was higher for HPV16 than for the average of the other carcinogenic types (hazard ratio = 2.7)., Conclusion and Impact: The data from this cohort study show the long-term predictive value of HPV testing, particularly in women ≥30, and a possible role for distinguishing particularly carcinogenic types like HPV16., (©2011 AACR)

The host immune response to human papillomaviruses (HPVs) is believed to be an important determinant of progression of HPV-associated cervical neoplasia. Human leukocyte antigens (HLAs) are important in the presentation of foreign antigens to the immune system. Previous studies have suggested a possible association between HLA and cervical neoplasia, but the specific alleles found to be associated with disease have varied between studies. To further evaluate this issue, we conducted a nested case-control study within a 24,000-woman cohort study in the United States. A total of 711 women were selected for the study: 141 women diagnosed with high-grade squamous intraepithelial lesions (HSILs) of the cervix; 202 women diagnosed with low-grade SILs (LSILs); 166 women with no history of cervical neoplasia, but evidence of HPV-16 infection; and 202 women with no history of cervical abnormalities and who were HPV negative during follow-up as part of our cohort. Cervicovaginal lavage samples collected from participants were used for HPV testing by L1 consensus primer PCR and the Hybrid Capture tube test methods. DNA extracted from these same lavage samples were used for PCR-based HLA genotyping. Our results suggest a positive association between HLA B7 and HLA DQB1*0302 and disease. A negative association with disease was observed for HLA DRB1*1501-DQB1*0602 and DRB1*13. Associations were strongest when analyses were restricted to HPV-16-positive cases as follows. Compared with women who were cytologically normal and HPV negative, HLA B7 was associated with a 1.5-fold increased risk of HPV/LSIL [95% confidence interval (CI) = 0.95-2.5] and a 2.5-fold increased risk of HSIL (95% CI = 1.2-5.1). HLA DQB1*0302 was associated with a 1.5-fold increased risk of HPV/LSIL (95% CI = 0.94-2.4) and a 1.7-fold increased risk of HSIL (95% CI = 0.84-3.5). HLA DRB1*1501-DQB1*0602 was associated with a decreased risk of HSIL [relative risk (RR) = 0.21; 95% CI = 0.07-0.62]. HLA DRB1*13 was associated with a decreased risk of HPV/LSIL (RR = 0.78; 95% CI = 0.51-1.2) and HSIL (RR = 0.63; 95% CI = 0.30-1.3). Individuals who were either homozygous for DQB1*0302 or carriers of both B7 and DQB1*0302 were found to be at highest risk of disease (RR = 4.5, 95% CI = 1.5-14 for HPV/LSIL; and RR = 9.0, 95% CI = 2.4-34 for HSIL). No synergistic effect was observed for the alleles found to be associated with reduced risk of cervical neoplasia. Our findings support previous studies that have found HLA B7 and DQB1*0302 to be positively associated with cervical neoplasia and are consistent with those that have suggested that DRB1*13 is negatively associated with disease, but do not confirm previous assertions that DRB1*1501-DQB1*0602 increases the risk of cervical disease.