Notes

Percutaneous tracheostomy inside COVID sufferers. Expertise in our hospital heart following one full year regarding outbreak along with overview of your materials.
Cachexia and frailty can be described as independent entities yet are interrelated as constituents of malnutrition and the aging process. The unifying aspect is lean muscle loss, ultimately driven by inflammation and the adverse ramifications to pets with chronic, debilitating, or terminal disease states, including cancer. this website Modification to intake of dietary protein, fat, omega-3 fatty acids, and selected vitamins has shown benefit in management protocols as preventative and palliative care, but further investigation is imperative.There are several natural products and functional ingredients that, either alone or in combination with other ingredients, have shown evidence for decreasing signs associated with cognitive dysfunction and anxiety in dogs and cats, and in management of seizures in dogs with epilepsy. The evidence supporting the role that a healthy gastrointestinal tract plays in behavior is also growing as more is learned about the gut-brain axis. Nutritional support may play an important role in therapy for certain brain disorders and behavioral problems, in conjunction with other aspects of management. A multimodal approach provides the greatest likelihood of success.The nutritional management of canine and feline chronic kidney disease and protein-losing nephropathy is discussed. Special attention is paid to assessment of body composition (body weight, body condition score, and muscle condition score) and the dysrexia that often occurs with kidney disease. Various nutrients of concern are discussed and specific dietary options are provided.Although the companion animal population is predominantly canine and feline, the popularity of domesticated small mammals (or pocket pets) has been steadily increasing. As a result, ferrets, rabbits, and rodents can be expected to present for veterinary evaluation. link2 Many common medical problems in pocket pets are often associated with poor husbandry and/or inappropriate nutrition and are thus responsive to nutritional therapies. Although this article touches on minor background information and husbandry, the primary foci are the basic nutritional needs of, and common nutrition-responsive diseases in, pocket pets. Detailed husbandry needs are beyond the scope of this article.Sustainability has become a watchword for a wide array of resource-intensive goods and services. This is promulgated by an increasing global population and concerns that natural resources and a hospitable climate will not be preserved for future generations. Life-cycle analysis is a tool that provides a framework to determine the magnitude products contribute to carbon emissions and depletion of natural resources. In this review, published research has been summarized to provide an overview of the impacts that pet food production and pet ownership have on the environment and the prospective role of veterinary practitioners in advocating for sustainability.Veterinarians are faced with the challenge of understanding and discussing the wide array of commercial pet foods with their clients. To promote these discussions, a pet food processing categorization system is applied to define familiar heat processed dry and can pet foods as ultra-processed commercial diets (UPCD) and other less processed diets as minimally processed commercial diets. A review of the FDA pet food recalls on commercial diets are used to discuss well-known health risks, such as nutritional imbalances, bacterial pathogens, aflatoxin, and toxic contaminations. A less-known concern of advanced glycation end products found in UPCDs is presented.Commercial pet food in the United States includes a diverse range of products. There is a tremendous amount of variation among companies regarding the financial resources invested into producing their products, research, and marketing. Commercial pet food is a regulated industry at both the state and federal levels, and many of the same standards applied to the human food industry apply to pet food. Many foods that both pets and people consume are processed; however, the type and extent of processing do not correlate with the nutritional value. Commercial pet food does not meet the needs of every pet.The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) population is at a substantially elevated risk for myriad health complications, due in large part to structural and social inequities. As such, the LGBTQ population is an important demographic to survey regarding their health. As with many populations facing inequality, the LGBTQ population is often hard to sample. In light of this challenge, several approaches may be required in order to effectively surveying this population. Specifically, advances in sampling methodologies, leveraging community partnerships, and culturally aware question design appear to increase the likelihood of a successful LGBTQ-focused health survey. The Southern LGBTQ Health Study is examined as a case study in effectively conducting a large, multi-state LBTQ health survey. They used a simple snowball sampling strategy where their online health survey was distributed through a wide network of community organizations across several states. They also employed members of the LGBTQ community as "Survey Ambassadors" to help recruit their peers to participate in the study. This case study demonstrated several successful methods. Their combined sampling methodology resulted in almost 6000 respondents. Their question for sexual orientation ("Check all that apply") resulted in rich, easy to interpret data and was well received by the participants. However, this case study also provided valuable learning opportunities. Had they used a more formalized approach to their sampling, they would have had greater generalizability to their target population. link3 Also, the use of an open-ended question regarding gender identity generated data that was not conducive to formal analysis without significant resources dedicated to cleaning the data.
The opioid crisis is a worldwide public health concern. In North America, evidence suggests that the increase in opioid prescriptions correlates with the observed increase in opioid-related mortality and morbidity. Pharmacists are in a strategic position to promote effective opioid stewardship as they have a central role on healthcare teams. However, in many contexts, pharmacists do not have a harmonized scope of practice and no standardized opioid stewardship approach has been implemented.

A scoping review will be conducted to identify and summarize evidence on the role of pharmacists in opioid stewardship and identify areas for future study.

The scoping review will be conducted according to the methodological framework proposed by Arksey and O'Malley, which was further modified by the Joanna Briggs Institute. Six databases will be searched which include PubMed, Embase, International Pharmaceutical Abstracts, Scopus, Cochrane Library, and APA PsycInfo.

The findings of this review will identify opioid stewardship activities that can contribute towards reducing the impact of the opioid crisis. Additionally, it will provide foundational strategies to promote policy level change and foster a harmonized scope of practice. This review has the potential to inform future research, impact pharmacy practice, and drive policy change.
The findings of this review will identify opioid stewardship activities that can contribute towards reducing the impact of the opioid crisis. Additionally, it will provide foundational strategies to promote policy level change and foster a harmonized scope of practice. This review has the potential to inform future research, impact pharmacy practice, and drive policy change.
A growing body of scientific evidence points to the potentially harmful cognitive effects of anticholinergic medications among older adults. Most interventions designed to promote deprescribing of anticholinergics have directly targeted healthcare professionals and have had mixed results. Consumer-facing technologies may provide a unique benefit by empowering patients and can complement existing healthcare professional-centric efforts.

We initiated a randomized clinical trial to evaluate the effectiveness of a patient-facing mobile application (Brain Safe app) compared to an attention control medication list app in reducing anticholinergic exposure among community-dwelling older adults. Study participants are adults aged 60 years and above, currently using at least one prescribed strong anticholinergic, and receiving primary care. The trial plans to enroll a total of 700 participants, randomly allocated in 11 proportion to the two study arms. Participants will have the Brain Safe app (intervention arm) oralTrials.gov on October 10, 2019. Identifier number NCT04121858.
While the importance of pharmacists' involvement in disaster management is becoming increasingly recognised in the literature, there remains little research on methods for preparing pharmacists and pharmacy staff for disasters.

To investigate the use of a table-top disaster exercise to improve disaster awareness and preparedness for pharmacists and pharmacy staff attending The Society of Hospital Pharmacists of Australia (SHPA) Medicine Management conference 2019.

A table-top disaster exercise was developed by the research team and presented as a workshop at the SHPA's annual conference in 2019. The workshop presented attendees with the hypothetical 'Cyclone Oma' that was tracking across the fictional state of 'New Cardiff'. Each workshop table was assigned a different hospital and was required to respond to Cyclone Oma as the scenario evolved. Workshop attendees were invited to complete a pre- and post-survey assessing their perceptions of disaster management and preparedness for pharmacists and pharma Australia targeted specifically at the pharmacy workforce to be conducted and evaluated. The exercise improved understanding of disaster management and was well received by the participants. This research calls for further education and training opportunities in disaster management targeted at the pharmacy workforce.
The genetic basis of lacunar stroke is poorly understood, with a single locus on 16q24 identified to date. We sought to identify novel associations and provide mechanistic insights into the disease.

We did a pooled analysis of data from newly recruited patients with an MRI-confirmed diagnosis of lacunar stroke and existing genome-wide association studies (GWAS). Patients were recruited from hospitals in the UK as part of the UK DNA Lacunar Stroke studies 1 and 2 and from collaborators within the International Stroke Genetics Consortium. Cases and controls were stratified by ancestry and two meta-analyses were done a European ancestry analysis, and a transethnic analysis that included all ancestry groups. We also did a multi-trait analysis of GWAS, in a joint analysis with a study of cerebral white matter hyperintensities (an aetiologically related radiological trait), to find additional genetic associations. We did a transcriptome-wide association study (TWAS) to detect genes for which expression is assoces (SCL25A44, ULK4, CARF, FAM117B, ICA1L, NBEAL1) and lacunar stroke. Pathway analyses implicated disruption of the extracellular matrix, phosphatidylinositol 5 phosphate binding, and roundabout binding (false discovery rate <0·05). Mendelian randomisation analyses identified positive associations of elevated blood pressure, history of smoking, and type 2 diabetes with lacunar stroke.

Lacunar stroke has a substantial heritable component, with 12 loci now identified that could represent future treatment targets. These loci provide insights into lacunar stroke pathogenesis, highlighting disruption of the vascular extracellular matrix (COL4A2, LOX, SH3PXD2A, GPR126, HTRA1), pericyte differentiation (FOXF2, GPR126), TGF-β signalling (HTRA1), and myelination (ULK4, GPR126) in disease risk.

British Heart Foundation.
British Heart Foundation.
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