Notes

Exposure to a Clinical Review Dependence on Interns inside the Urgent situation Section.
This overview aims to synthesise global evidence on factors affecting healthcare access, and variations across low- and middle-income countries (LMICs) vs. high-income countries (HICs); to develop understanding of where barriers to healthcare access lie, and in what context, to inform tailored policies aimed at improving access to healthcare for all who need it.

An overview of systematic reviews guided by a published protocol was conducted. Medline, Embase, Global Health and Cochrane Systematic Reviews databases were searched for published articles. Additional searches were conducted on the Gates Foundation, WHO and World Bank websites. Study characteristics and findings (barriers and facilitators to healthcare access) were documented and summarised. The methodological quality of included studies was assessed using an adapted version of the AMSTAR 2 tool.

Fifty-eight articles were included, 23 presenting findings from LMICs and 35 presenting findings from HICs. While many barriers to healthcare access occur in HICs as well as LMICs, the way they are experienced is quite different. In HICs, there is a much greater emphasis on patient experience; as compared to the physical absence of care in LMICs.

As countries move towards universal healthcare access, evaluation methods that account for health system and wider cultural factors that impact capacity to provide care, healthcare finance systems and the socio-cultural environment of the setting are required. Consequently, methods employed in HICs may not be appropriate in LMICs due to the stark differences in these areas.
As countries move towards universal healthcare access, evaluation methods that account for health system and wider cultural factors that impact capacity to provide care, healthcare finance systems and the socio-cultural environment of the setting are required. Consequently, methods employed in HICs may not be appropriate in LMICs due to the stark differences in these areas.A bioassay-guided fractionation led to the isolation of hangtaimycin (HTM) from Streptomyces spectabilis CCTCC M2017417 and the discovery of its hepatoprotective properties. Structure elucidation by NMR suggested the need for a structural revision. A putative HTM degradation product was also isolated and its structure was confirmed by total synthesis. The biosynthetic gene cluster was identified and resembles a hybrid trans-AT PKS/NRPS biosynthetic machinery whose first PKS enzyme contains an internal dehydrating bimodule, which is usually found split in other trans-AT PKSs. The mechanisms of such dehydrating bimodules have often been proposed, but have never been deeply investigated. Here we present in vivo mutations and in vitro enzymatic experiments that give first and detailed mechanistic insights into catalysis by dehydrating bimodules.Adsorptive separation of propylene/propane (C3 H6 /C3 H8 ) mixture is desired for its potential energy saving on replacing currently deployed and energy-intensive cryogenic distillation. Realizing efficient C3 H6 /C3 H8 separation in the emerging hydrogen-bonded organic frameworks (HOFs) is very challenging owing to the lack of functional sites for preferential gas binding. By virtue of crystal engineering, we herein report a functionalized HOF (HOF-16) with free -COOH sites for the efficient separation of C3 H6 /C3 H8 mixtures. Under ambient conditions, HOF-16 shows a significant C3 H6 /C3 H8 uptake difference (by 76 %) and selectivity (5.4) in contrast to other carboxylic acid-based HOFs. Modeling studies indicate that free -COOH groups together with the suitable pore confinement facilitate the recognition and high-density packing of gas molecules. The separation performance of HOF-16 was validated by breakthrough experiments. HOF-16 is stable towards strong acidity and water.
Colorectal cancer is the second most common cause of cancer-related mortality in Australia. As such, timely access to colonoscopy following a positive faecal occult blood test (FOBT) is an important aspect of the National Bowel Cancer Screening Program to reduce morbidity & mortality related to this condition. To reduce waiting times, a Sydney-based referral centre introduced a nurse-led virtual clinic (VC) in order to facilitate direct access colonoscopy for patients referred with a positive FOBT.

To evaluate the efficacy of a nurse-led VC model to reduce waiting time to colonoscopy and to determine the patient experience of the model.

The VC model, piloted for a 14-month period, was compared to the standard outpatient clinic (SOC) model over the 14-month period preceding the VC. Primary outcomes were time to colonoscopy and secondary outcomes included adverse events, bowel preparation and cancellation rates. Patient experience was evaluated via an emailed survey.

Compared to the SOC model, the VC model reduced waiting time to colonoscopy from date of positive FOBT by 71 days (p=0.0006) and from date of referral by 66 days (p <0.0001). There was no significant difference in secondary outcomes. All respondents to the survey (n=30) reported a positive experience.

Nursing-led Virtual clinics, with DAC for patients at increased risk of CRC, reduce waiting times to colonoscopy without an increase in adverse events and is well received by patients. This article is protected by copyright. check details All rights reserved.
Nursing-led Virtual clinics, with DAC for patients at increased risk of CRC, reduce waiting times to colonoscopy without an increase in adverse events and is well received by patients. This article is protected by copyright. All rights reserved.
Understanding factors responsible for the increased bleeding tendency in acute-on-chronic liver failure (ACLF) would improve the management of these complications. We investigated coagulation alterations in ACLF and assessed whether they were predictive of bleeding.

Cirrhosis patients with ACLF (cases) and acute decompensation (AD, controls) were prospectively recruited and underwent an extensive haemostatic assessment including standard tests, pro and anticoagulant factors, thrombomodulin-modified thrombin generation (TG) and thromboelastometry (ROTEM
). In study part 1 (case-control), we compared coagulation in ACLF vs AD. In study part 2 (prospective), all patients were followed for bleeding, and predictors of outcome were assessed.

Ninety-one patients were included (51 with ACLF, 40 with AD). Infections and ascites/renal dysfunction were the most common precipitating and decompensating events. Platelet count was lower while INR and activated partial thrombin time were longer in ACLF cohort vs AD. Regarding clotting factors, fibrinogen and factor VIII were comparable between groups while protein C and antithrombin were significantly reduced in ACLF.
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