Patient Safety In Inpatient Psychiatry: A Remaining Frontier For Health Policy.

Behavioral health care has been slow to take up robust efforts to improve patient safety. This lag is especially apparent in inpatient psychiatry, where there is risk for physical and psychological harm. Recent investigative journalism has provoked public concern about instances of alleged abuse, negligence, understaffing, sexual assault, inappropriate medication use, patient self-harm, poor sanitation, and inappropriate restraint and seclusion.

Effects of axial forearm instability on force transmission across the elbow.

Background: The interosseous membrane (IOM) and distal radioulnar joint (DRUJ) provide axial stability to the forearm. Our hypothesis was that injury to these structures alters force transmission through the elbow.

Methods: A custom-designed apparatus that applies axial loads from the wrist to the elbow was used to test 10 cadaveric upper limbs under the following simulated conditions (1) intact, (2) DRUJ injury, (3) IOM injury, or (4) IOM + DRUJ injury.

Childhood Maltreatment as a Risk Factor for Arthritis: Findings From a Population-Based Survey of Canadian Adults.

Objective: To establish whether there is a relationship between the frequency and severity of different types of childhood maltreatment and adulthood arthritis.

Methods: Analysis of the 2012 Canadian Community Health Survey-Mental Health included 21,889 respondents ages ≥18 years. Severity and frequency of childhood physical abuse (CPA), and childhood sexual abuse (CSA), and the frequency of childhood exposure to intimate partner violence (CEIPV) were assessed by asking about "things that may have happened to you before you were 16 in your school, in your neighborhood, or in your family.

Mental health and the response to financial incentives: Evidence from a survey incentives experiment.

Although mental health disorders such as anxiety and depression are common, there is little research on whether individuals in poor mental health react differently from others to financial incentives. This paper exploits an experiment from the UK Understanding Society Innovation Panel to assess how the participation response to randomly-assigned financial incentives differs by mental health status. We find that individuals in good mental health are more likely to respond when offered a higher financial incentive, whereas those in poor mental health are indifferent to the increased incentive.

Neutrophil extracellular traps produced during inflammation awaken dormant cancer cells in mice.

Cancer cells from a primary tumor can disseminate to other tissues, remaining dormant and clinically undetectable for many years. Little is known about the cues that cause these dormant cells to awaken, resume proliferating, and develop into metastases. Studying mouse models, we found that sustained lung inflammation caused by tobacco smoke exposure or nasal instillation of lipopolysaccharide converted disseminated, dormant cancer cells to aggressively growing metastases.

Association between circulating fibrocytes and angiographic coronary collaterals in patients with obstructive coronary artery disease.

Circulating fibrocytes are a population of bone marrow-derived progenitor cells that have been implicated in neovascularization. The recruitment of coronary artery collaterals, a form of neovascularization, is associated with improved outcomes in coronary artery disease. In this study, we tested the hypothesis that, in subjects with stable chronic coronary artery disease, the blood concentration of fibrocytes is associated with the presence of angiographic coronary collaterals.

Pulmonary epithelial barrier and immunological functions at birth and in early life - key determinants of the development of asthma? A description of the protocol for the Breathing Together study.

  Childhood asthma is a common complex condition whose aetiology is thought to involve gene-environment interactions in early life occurring at the airway epithelium, associated with immune dysmaturation.  It is not clear if abnormal airway epithelium cell (AEC) and cellular immune system functions associated with asthma are primary or secondary.  To explore this, we will (i) recruit a birth cohort and observe the evolution of respiratory symptoms; (ii) recruit children with and without asthma symptoms; and (iii) use existing data from children in established STELAR birth cohorts.

Interplay between interferon regulatory factor 1 and BRD4 in the regulation of PD-L1 in pancreatic stellate cells.

The fibrotic reaction is a characteristic feature of human pancreatic ductal adenocarcinoma (PDAC) tumors. It is associated with activation and proliferation of pancreatic stellate cells (PSCs), which are key regulators of fibrosis in vivo. While there is increasing interest in the regulation of PD-L1 expression in cancer and immune cells, the expression and regulation of PD-L1 in other stromal cells, such as PSCs, has not been fully evaluated.

Does mandatory reporting legislation increase contact with child protection? - a legal doctrinal review and an analytical examination.

Background: Within Canadian provinces over the past half-century, legislation has been enacted to increase child protection organization (CPO) involvement in situations of child maltreatment (CM). This study had two objectives: 1) to document enactment dates of legislation for mandatory reporting of CM; 2) to examine reported CPO involvement among people reporting a CM history in relation to the timing of these legislative changes.

Methods: The history of mandatory reporting of CM was compiled using secondary sources and doctrinal legal review of provincial legislation.

The role of the posterior bundle of the medial collateral ligament in posteromedial rotatory instability of the elbow.

Aims: The aim of this study was to evaluate two hypotheses. First, that disruption of posterior bundle of the medial collateral ligament (PMCL) has to occur for the elbow to subluxate in cases of posteromedial rotatory instability (PMRI) and second, that ulnohumeral contact pressures increase after disruption of the PMCL.

Materials And Methods: Six human cadaveric elbows were prepared on a custom-designed apparatus which allowed muscle loading and passive elbow motion under gravitational varus.

The "Petechiae in children" (PiC) study: evaluating potential clinical decision rules for the management of feverish children with non-blanching rashes, including the role of point of care testing for Procalcitonin & Neisseria meningitidis DNA - a study protocol.

Background: Children commonly present to Emergency Departments (ED) with a non-blanching rash in the context of a feverish illness. While most have a self-limiting viral illness, this combination of features potentially represents invasive serious bacterial infection, including meningococcal septicaemia. A paucity of definitive diagnostic testing creates diagnostic uncertainty for clinicians; a safe approach mandates children without invasive disease are often admitted and treated with broad-spectrum antibiotics.

The impact of fetal umbilical artery Doppler pulsatility index on childhood respiratory function and atopy: a prospective case-control study.

To determine if an elevated fetal umbilical artery Doppler pulsatility index is associated with abnormal respiratory function and atopy in children aged 12 years. This prospective case-control study compared children that had an elevated fetal umbilical artery Doppler pulsatility index (>90th centile) to those with a normal pulsatility index (<90th centile). All subjects were delivered at full-term and with appropriate growth for gestational age.

Navigating the evidentiary turn in public health: Sensemaking strategies to integrate genomics into state-level chronic disease prevention programs.

In the past decade, healthcare delivery has faced two major disruptions: the mapping of the human genome and the rise of evidence-based practice. Sociologists have documented the paradigmatic shift towards evidence-based practice in medicine, but have yet to examine its effect on other health professions or the broader healthcare arena. This article shows how evidence-based practice is transforming public health in the United States.

A protocol for a systematic review of the diagnostic accuracy of Loop-mediated-isothermal AMPlification (LAMP) in diagnosis of invasive meningococcal disease in children.

Background: Meningococcal disease (MD) is notoriously difficult to diagnose in the early stages of the illness and presents similarly to many self-limiting viral infections. This mandates a cautious approach to diagnosis and initial management of suspected MD with many children receiving precautionary broad-spectrum intravenous antibiotics. Despite this approach, some children are still diagnosed late.

At-risk children with asthma (ARC): a systematic review.

Introduction: Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5-12 years) in order to inform and prioritise care.

Methods: We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions.

Meningococcal Disease in Northern Ireland - Past, Present & Future: MeningoNI Forum.

Meningococcal disease has had devastating consequences in Northern Ireland since its first description locally in 1859. The incidence of this disease has significantly declined in recent years, however it is important to understand reasons for this changing epidemiology and to acknowledge the diagnostic and clinical management developments that have been made locally. This review aims to examine the changing face of this disease in Northern Ireland over the years, with particular reference to local disease prevention, epidemiology, diagnosis, clinical treatment and management, post-disease sequelae and the role of meningitis charities locally, in terms of patient support and research.

Harms to Consumers of Inpatient Psychiatric Facilities in the United States: An Analysis of News Articles.

Inpatient psychiatric facilities in the United States lack systematic regulation and monitoring of a variety of patient safety concerns. We conducted a qualitative analysis of 61 news articles to identify common causes and types of harms within inpatient psychiatric facilities, with a focus on physical harm. The news articles reported on patient self-harm, patient-patient violence, and violence between patients and staff, noting that youth, older adults, and veterans were especially vulnerable.

Implant Survival and Patient-Reported Outcomes After Total Hip Arthroplasty in Young Patients.

Background: Younger patients are undergoing total hip arthroplasty (THA) for various conditions that affect the hip joint. This study evaluates the implant survival and long-term patient-reported outcomes of THA in patients aged 35 years or younger.

Methods: Data were collected through a retrospective chart review, and follow-up surveys were conducted to determine implant survival and patient-reported outcomes.

Mobile direct observation of therapy (MDOT) - A rapid systematic review and pilot study in children with asthma.

We describe, for the first time, the use of a mobile device platform for remote direct observation of inhaler use and technique. The research programme commenced with a rapid systematic review of mobile device (or videophone) use for direct observation of therapy (MDOT). Ten studies (mainly pilots) were identified involving patients with tuberculosis, sickle cell disease and Alzheimer's disease.