Notes

A reaction to cardiac resynchronisation treatment in men and women: an extra research into the SMART-AV randomised controlled trial.
Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient's preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients.
Physical and cognitive symptoms of multiple sclerosis (MS) correlate with unemployment cross-sectionally. Prospective studies, rarely published, have not accounted for personality traits such as Conscientiousness.

In a 3-year study of 70 people with MS (PwMS) and 25 healthy controls (HCs), we evaluated employment status using online interviews capturing hours worked, negative work events, employee relations, and accommodations. Deteriorating employment status (DES) was defined as reduced employment (full-time to part-time or negative work events). In PwMS, we explored workplace accommodations, disclosure of disease status, and physical/psychological predictors of DES (e.g. Conscientiousness).

At follow-up, DES was 0% in HCs and 25.7% in MS, and 62.7% of work-stable PwMS used at least one work accommodation, most frequently, flexible hours. At baseline, DES-PwMS had lower education (
 = 0.009), lower Conscientiousness (
 < 0.001), more fatigue (
 = 0.033), and performed worse on Symbol Digit Modalities Test (
 = 0.013), Brief Visuospatial Memory Test-Revised (
 = 0.041), and Nine-Hole Peg Test (
 = 0.046) relative to work-stable. The model predicting DES was significant (χ
(7) = 30.936,
 < 0.001) and baseline Conscientiousness accounted for more variance in DES (
 = 0.004) than other factors. Higher Conscientiousness PwMS were more likely to disclose their condition at work (
 = 0.038).

Accommodations for low Conscientiousness, flexible hours, and physical/cognitive rehabilitation may prevent DES.
Accommodations for low Conscientiousness, flexible hours, and physical/cognitive rehabilitation may prevent DES.Rapid growth in the use of aluminium oxide nanoparticles (Al2O3 NPs) in various fields such as medicine, pharmacy, cosmetic industries, and engineering creates concerns since the literature is replete with data regarding their toxicity in living organisms. The objective of the present study was to demonstrate the potential toxicological manifestations of repeated exposure to Al2O3 NP at low doses in vivo. In the present study, Al2O3 NP was orally administered at 15, 30 or 60 mg kg-1 body weight for 5 days to Swiss albino male mice. A battery of well-defined assays was undertaken to evaluate aluminium (Al) bioaccumulation, haematological and histological changes, oxidative damage and genotoxicity. Physico-chemical characterisation demonstrated increases in hydrodynamic diameter along the concentration gradient of Al2O3 NP dispersed in MilliQ water. Brain, liver, spleen, kidney and testes showed high Al retention levels. Histopathological lesions were prominent in the brain and liver. Al2O3 NP treatment increased levels of lipid peroxidation and decreased glutathione content in the test organs at all dose levels. The enzyme activities of catalase and superoxide dismutase were also significantly altered. DNA damage quantified using the comet assay was markedly increased in all the soft organs studied. Anatomical abnormalities, redox imbalance and DNA damage were positively correlated with Al retention in the respective organs. Size, zeta potential and colloidal state might have contributed to the bio-physico-chemical interactions of the NPs in vivo and were responsible for the non-linear dose response. The overall data indicate that Al2O3 NP exposure may result in adverse health consequences, inclusive of but not limited to disturbed redox homeostasis, hepatocellular toxicity, neurodegeneration and DNA damage.
Differentiating multiple sclerosis (MS) from vascular risk factor (VRF)-small vessel disease (SVD) can be challenging.

In order to determine whether or not pontine lesion location is a useful discriminator of MS and VRF-SVD, we classified pontine lesions on brain magnetic resonance imaging (MRI) as central or peripheral in 93 MS cases without VRF, 108 MS patients with VRF and 43 non-MS cases with VRF.

MS without VRF were more likely to have peripheral pons lesions (31.2%, 29/93) than non-MS with VRF (0%, 0/43) (Exp(
) = 29.8; 95% confidence interval (CI) = (1.98, 448.3);
 = 0.014) but there were no significant differences regarding central pons lesions between MS without VRF (5.4%, 5/93) and non-MS with VRF patients (16.3%, 7/43) (Exp(
) = 0.89; 95% CI = (0.2, 3.94);
 = 0.87). The presence of peripheral pons lesions discriminated between MS and VRF-SVD with 100% (95% CI = (91.8, 100)) specificity. The proportion of peripheral pons lesions in MS with VRF (30.5%, 33/108) was similar to that seen in MS without VRF (31.2%, 29/93,
 = 0.99). Central lesions occurred in similar frequency in MS with VRF (8.3%, 9/108) and non-MS with VRF (16.3%, 7/43,
 = 0.15).

Peripheral pons lesion location is a good discriminator of MS from vascular lesions.
Peripheral pons lesion location is a good discriminator of MS from vascular lesions.The opioid stewardship model is born out of the antimicrobial stewardship model, and thus there are many shared characteristics. Both opioid stewardship and antimicrobial stewardship are based on the principle that there is an indication for a particular medication in the right patient at the right time. see more As antimicrobial stewardship is in a later stage of development, looking at the two in parallel can lead to interesting learning and development opportunities for opioid stewardship. Two requirements of antimicrobial stewardship that need to be applied to opioid stewardship for optimum outcomes are the requirement for dedicated resources, more specifically a trained pharmacist, and a declaration that opioid stewardship is essential for health-system accreditation.
Studies have consistently shown that patients with epilepsy could benefit from ketogenic diets (KDs). Recent evidence suggests that KD could be used in the treatment of central nervous system (CNS) diseases. The aim of this systematic review was to investigate the use and efficacy of KD, modified Atkins diet (MAD) and medium-chain triglyceride (MCT) diet in infants, children, adolescents, and adults with CNS diseases.

This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Main databases, i.e. EMBASE, PubMed and PsycINFO, were searched on 4 December 2019. Only randomized clinical trials (RCTs) were included and only if they reported KD, MCT or MAD interventions on patients with CNS diseases.

Twenty-four publications were eligible for inclusion (
 = 1221). Twenty-one publications concerned epilepsy, two concerned Alzheimer's disease (AD), and one concerned Parkinson's disease (PD). All studies regarding epilepsy reported of seizure reduction compared to baseline. MCT did not significantly change regional cerebral blood flow (rCBF) in patients with AD, but MAD significantly improved memory at 6weeks (
 = .03). KD significantly improved motor and nonmotor functions in patients with PD at 8weeks (
 < .001). There was a trend towards fewer adverse effects in MAD compared to KD.

In conclusion, various forms of KDs seem tolerable and effective as part of the treatment for epilepsy, AD and PD, although more investigation concerning the mechanism, efficacy and adverse events is necessary.
In conclusion, various forms of KDs seem tolerable and effective as part of the treatment for epilepsy, AD and PD, although more investigation concerning the mechanism, efficacy and adverse events is necessary.The UK population is rapidly ageing, and this is set to continue for many more years. Consequently, this projects a number of health problems and challenges that need to be addressed. Functional impairment and age-related diseases have a significant impact on oral health, leading to a poor quality of life. Dental diseases become more prevalent in older adults, partly as a result of their poor general health, medication side effects and, in some instances, due to limited access to good dental care. Healthcare staff should be aware of these problems and ensure that individuals are given the correct advice, care and treatment. This article outlines what is known about oral health among older adults and highlights some of the common health conditions that affect oral health status in this population. Community nurses are well placed to educate and empower older adults in maintaining good oral health.This paper presents the findings from an analysis of survey data which was collected from public health nurses (N = 136) as part of a larger study with more than 4000 nurses and midwives in Ireland. The purpose of the study was to examine the prevalence of burnout using the Oldenburg Burnout Inventory and to compare relationships between burnout, demographic and work characteristics across this group of nurses. Younger PHNs were most likely to report feeling burnout (68%) compared with those aged 51 or over (47%) who reported the lowest levels. PHNs whose highest level of qualification was a primary degree were least likely to report feeling burnout (31%) compared with those who held a Masters / Doctoral degree (54.5%). PHNs who reported working on a fixed-term full-time contract were most likely to report feeling burnout (70%) compared with those who were on a permanent part-time contract (49%). Quantitative analysis, using both descriptive and inferential statistics, was carried out and the findings show that PHNs reported moderate levels of burnout. The findings also show that burnout among PHNs is strongly correlated with the physical demands placed on individuals during work, having constant time pressures, too much being expected of individuals, the work environment being too demanding and dissatisfaction with the physical conditions.The article 'Social frailty the importance of social and environmental factors in predicting frailty in older adults' published in the British Journal of Community Nursing in 2019 reviewed the concept and models of frailty and how the role of social and environmental circumstances interplay. To better inform interventions within the community, the impact of social isolation and environmental disorder on frailty and the wellbeing of an individual patient are further explored. This paper describes the case of a 76-year-old man, Tommy, who was living with frailty and how an individualised care plan was undertaken, evidencing the positive effects that an integrated approach from health, social care, housing and the voluntary sector can offer. Multifaceted interventions are described, which were used to reverse frailty and change Tommy's future for the better.
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