Short-term Harm Research Articles

The Food Source and Gut Bacteria Show Effects on the Invasion of Alien Pests-A Case of Bactrocera dorsalis (Hendel) (Diptera: Tephritidae).

How alien pests invade new areas has always been a hot topic in invasion biology. The spread of the Bactrocera dorsalis from southern to northern China involved changes in food sources. In this paper, in controlled conditions, we take Bactrocera dorsalis as an example to study how plant host transformation affects gut bacteria by feeding it its favorite host oranges in the south, its favorite host peaches and apples in the north, and feeding it cucumbers as a non-favorite host plant, thereby further affecting their fitness during invasion. The result showed that, after three generations of feeding on cucumbers, Bactrocera dorsalis took longer to develop as a larva while its longevity and fecundity decreased and pre-adult mortality increased. Feeding it cucumbers significantly reduced the overall diversity of gut microbiota of Bactrocera dorsalis. The relative abundance of Enterobacter necessary for survival decreased, while the Empedobacter and Enterococcus increased, resulting in decreased carbohydrate transport and metabolism and increased lipid transport and metabolism. Feeding Bactrocera dorsalis Empedobacter brevis and Enterococcus faecalis resulted in a 26% increase in pre-adult mortality and a 2-3 d increase in adult preoviposition period (APOP). Additionally, Enterococcus faecalis decreased the longevity of female and male adults by 17 and 12 d, respectively, and decreased fecundity by 11%. We inferred that the shifted plant hosts played an important role in posing serious harm to Bactrocera dorsalis invading from the south to the north. Therefore, after an invasion of Bactrocera dorsalis into northern China, it is difficult to colonize cucumbers for a long time, but there is still a risk of short-term harm. The findings of this study have established that the interactions between an insect's food source and gut bacteria may have an important effect on insect invasions.

Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design.

Alcohol consumption is causally associated with long-term health-related consequences, such as cancer and cardiovascular disease, and short-term harms, such as accidents and injuries. Alcohol consumption has increased among midlife women (aged 40-65) over the last two decades in high-income countries. This study aimed to centre women's voices by using co-design methodologies to investigate what women identify as strategies that could assist them and other women their age to reduce their alcohol consumption. Human-centred design workshops were undertaken with 39 women, and conventional qualitative content analysis was used to analyse information from written workshop materials to develop categories in the data and count their occurrence. Six categories, or strategies, emerged, listed here from most to least represented: 'Participate in alternative activities to drinking alcohol', 'Track alcohol consumption and set goals', 'Seek support from family and friends', 'Drink alcohol-free beverages', 'Reduce supply of alcohol in the home' and 'Seek professional support'. Our findings identify strategies that are realistic and feasible to midlife women; our sample, however, likely reflects a more affluent subsection of this group, and as such, any focus on individual-level strategies must be complemented by policies that increase equitable access to healthcare and act on the social and commercial determinants of health. An intersectional approach to alcohol and other drug research is required to examine how the interplay of gender and other markers of social identities shape alcohol consumption.

Situational features of smartphone betting are linked to sports betting harm: An ecological momentary assessment study.

Smartphones extend the situational characteristics of sports betting beyond those available with land-based and computer platforms. This study examined 1) the role of situational features and betting platforms in harmful betting behaviours and short-term betting harm, and 2)whether people with more gambling problems have preferred situational features, engage more in harmful betting behaviours, and experience more severe short-term betting harm. An ecological momentary assessment analysed 1,378 betting sessions on sports, esports or daily fantasy sports, reported by 267 respondents (18-29 years; 50.9% male) over 10 weeks. Factor analysis revealed five situational features of betting sessions: 1) quick, easy access from home, 2) ability to bet anywhere anytime, 3) privacy while betting, 4) greater access to promotions and betting options, and 5)ability to use electronic financial transactions. Regression models underpinned the analyses. Greater short-term betting harm was significantly associated with the ability to bet anywhere anytime, privacy when betting, and greater access to promotions and betting options. Betting sessions when these features were prioritised were more likely to involve impulsive betting, use of betting inducements, and betting with more operators. Respondents with more gambling problems were more likely to prioritise privacy and the ability to bet anywhere anytime; and to bet on in-game events, use promotional inducements, bet with more operators, and report greater betting harm. Certain situational features of sports betting are empirically associated with engagement and subsequent harm. Only smartphone betting combines all three features associated with betting harm.

#3143 MEASURING CLINICAL JUDGEMENT IN PROSPECTIVE KIDNEY TRANSPLANT RECIPIENTS: A FEASIBILITY STUDY

Abstract Background and Aims Exercising clinical judgement is becoming more challenging in the context of ageing populations, increasing prevalence of multimorbidity and frailty, and insufficient evidence regarding how best to manage increasing complexity in clinical practice. Measures of clinical judgement are surprisingly absent from health information systems despite their clear importance and the potential costs of poor decisions. Suitability for kidney transplantation is a high-stake clinical judgement, requiring consideration of complex biopsychosocial patient and organ-utilisation factors. This study aimed to test if it is feasible to assess clinical judgement quantitatively from routine clinical documentation in kidney transplant recipients. Method Participants were identified from a regional register of patients on haemodialysis, who underwent deceased donor kidney transplantation (KTR) and had at least 1 year of follow-up. We identified 15 KTR who had poor outcomes, defined as more than 6 hospital admissions or death within one-year of transplantation. Fifteen KTR controls were matched using the United Kingdom Renal Recipient Index (UKRRI: a composite score of age, dialysis requirement at listing, wait time on dialysis and diabetes status). Six blinded raters (two nephrologists, two transplant surgeons and two kidney transplant coordinators) scored clinical letters written at the time of transplant assessment across four domains (Clinician Belief of Appropriateness [CBA] for perceived suitability, perceived benefit, predicted short-term harm, predicted long-term harm: from 1 = worst, to 5 = best). The total CBA score was calculated as the mean score across the 4 domains. CBA scores were compared between raters using the intra-class correlation coefficient (ICC: for two-way agreement). Logistic regression models tested odds of poor outcome by CBA scores across 4 domains. Results Practicing clinicians were eager to participate, suggesting this type of research will be worthwhile and feasible. Among 30 KTR, the median total CBA transplant suitability score was 3 (IQR 3-4, range 1-5). Overall agreement was moderate (ICC for the total CBA score: 0.63, 95% CI 0.51-0.74; p < 0.001), but with substantial variation in CBA scores across the domains and between raters (Figure 1). In 3 of the 4 domains (perceived suitability: OR 0.91, 95% CI 0.48-1.73; predicted short-term: OR 0.70, 95% CI 0.33-1.51; and predicted long-term harms: OR 0.82, 95% CI 0.35-1.91), CBA scores adjusted for UKRRI were associated with poor outcome after transplantation in the expected direction. For predicted benefit, the point estimate was not in the expected direction; individuals with greater predicted benefits were more likely to have poor outcomes (OR 1.46, 95% CI 0.28-7.47). Unsurprisingly, given the small numbers in this pilot and the substantial influence of the donor organ on outcomes in kidney transplantation, all the confidence intervals were wide and crossed the null, indicating considerable uncertainty. Conclusion In patients undergoing assessment for kidney transplantation, measuring clinical judgement retrospectively is feasible, though subject to variability across domains and between raters. We did not identify any clear associations between retrospective assessment of CBA and outcome after kidney transplantation in this small pilot. In future work, we will develop and validate measures of clinical judgement, collect these measures prospectively, and examine the relationship of measured clinical judgement with health outcomes.

Estimates of compliance with Canada's guidelines for low and moderate risk alcohol consumption: the importance of adjustment for underreporting in self-report surveys.

Alcohol is a leading cause of premature mortality; however, awareness of this and of some specific risks is low. Survey-based estimates of drinking at risk levels suffer from substantial underreporting. We show that alcohol use reported in the 2019 Canadian Alcohol and Drug Survey (CADS) accounted for just 38.06% of recorded alcohol consumption. This contributes to alcohol's risks being minimized, by researchers, the public, and policymakers. The new Canada's Guidance on Alcohol and Health (CGAH) defines "moderate risk" as 3 to 6 drinks/week for men and women. Employing published methods to correct for underreporting in the CADS, we estimate that in 2019 the proportion of drinkers at moderate risk of long-term harm to be 50.43% (up from 23.34% without adjustment). We further estimate that, collectively, these drinkers consumed 90.17% of all drinks consumed that year. Similarly, 92.82% of drinks were consumed on days when upper limits for short-term harm (2 drinks/day) were exceeded (up from 65.02% without adjustment). We conclude that adjustments for underreporting of alcohol use in Canada need to be incorporated routinely in public health monitoring. This might help mitigate the widespread underestimation of risky alcohol use as well as the neglect of this public health issue by policymakers.

Minimum legal drinking age and alcohol-attributable morbidity and mortality by age 63 years: a register-based cohort study based on alcohol reform

Minimum legal drinking age (MLDA) is an effective policy tool in preventing youth drinking and short-term alcohol-attributable harm, but studies concerning long-term associations are scarce. In this register-based, national cohort study, we assessed alcohol-attributable morbidity and mortality of cohorts born in 1944-54 in Finland. Data were from the 1970 census, the Care Register for Healthcare (maintained by the Finnish Institute of Health and Welfare), and the Cause-of-Death Register (maintained by Statistics Finland). As MLDA was lowered from 21 years to 18 years in 1969, these cohorts were effectively allowed to buy alcohol from different ages (18-21 years). We used survival analysis to compare their alcohol-attributable mortality and hospitalisations with a 36-year follow-up. Compared with the first cohort (1951) allowed to buy alcohol from age 18, the hazard ratios (HRs) for alcohol-attributable morbidity and mortality were lower in cohorts who could not buy alcohol until age 20 or 21 years. For alcohol-attributable morbidity in those aged 21 years when the reform took place, HR was 0·89 (95% CI 0·86-0·93) for men and 0·87 (0·81-0·94) for women versus those aged 17 years. For alcohol-attributable mortality, HR was 0·86 (0·79-0·93) for men and 0·78 (0·66-0·92) for women aged 21 years when the reform took place. The outcomes of the later-born 1952-54 cohorts did not differ from the 1951 cohort. Earlier cohorts had consistently lower alcohol-attributable mortality and morbidity; however, other simultaneous increases in alcohol availability probably contributed to increased alcohol-related harm among the younger cohorts. Overall, differences between cohorts born only a few years apart highlight late adolescence as a crucial period for the establishment of lifelong patterns of alcohol use and suggest that higher MLDA could be protective for health beyond young adulthood. Yrjö Jahnsson Foundation, Foundation for Economic Education, Emil Aaltonen Foundation, Academy of Finland, European Research Council, and NordForsk.

Is paid sick leave bad for business? A systematic review.

Vigorous legislative activity both for and against paid sick leave has occurred over the last decade. Although a compelling body of evidence suggests thatpaid sick leave supports personal and public health goals, a notable barrier in opposition to paid sick leave is apprehension about the potential short-term and long-term harms to business. This review critically assesses the relationship between paid sick leave and favorable or unfavorable business conditions. Utilizing thePreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically review six research databases between 2000 and November 2022. Of 2664 studies identified, 123 were considered potentially relevant and 43 were included in the review. In addition to absence from work, paid sick leave was associated with favorable business conditions such as increased job satisfaction; improved retention;andreductions in occupational injury, contagion, presenteeism, and death; as well as some measures of firm performance and labor market conditions. Overall, our review discovered more evidence supporting the relationship between paid sick leave and favorable business conditions ascompared with evidence thatsupported unfavorable business conditions. Although more research is needed, these findings can be used to inform firm-level and public policy decisions about paid sick leave.

Ractopamine at legal residue dosage accelerates atherosclerosis by inducing endothelial dysfunction and promoting macrophage foam cell formation

Ractopamine, a synthetic β-adrenoreceptor agonist, is used as an animal feed additive to increase food conversion efficiency and accelerate lean mass accretion in farmed animals. The U.S. Food and Drug Administration claimed that ingesting products containing ractopamine residues at legal dosages might not cause short-term harm to human health. However, the effect of ractopamine on chronic inflammatory diseases and atherosclerosis is unclear. Therefore, we investigated the effects of ractopamine on atherosclerosis and its action mechanism in apolipoprotein E-null (apoe−/−) mice and human endothelial cells (ECs) and macrophages. Daily treatment with ractopamine for four weeks increased the body weight and the weight of brown adipose tissues and gastrocnemius muscles. However, it decreased the weight of white adipose tissues in apoe−/− mice. Additionally, ractopamine exacerbated hyperlipidemia and systemic inflammation, deregulated aortic cholesterol metabolism and inflammation, and accelerated atherosclerosis. In ECs, ractopamine treatment induced endothelial dysfunction and increased monocyte adhesion and transmigration across ECs. In macrophages, ractopamine dysregulated cholesterol metabolism by increasing oxidized low-density lipoprotein (oxLDL) internalization and decreasing reverse cholesterol transporters, increasing oxLDL-induced lipid accumulation. Collectively, our findings revealed that ractopamine induces EC dysfunction and deregulated cholesterol metabolism of macrophages, which ultimately accelerates atherosclerosis progression.

Comparative Effectiveness of Opioid Tapering or Abrupt Discontinuation vs No Dosage Change for Opioid Overdose or Suicide for Patients Receiving Stable Long-term Opioid Therapy

Opioid dosage tapering has emerged as a strategy to reduce harms associated with long-term opioid therapy; however, evidence supporting this approach is limited. To identify the association of opioid tapering or abrupt discontinuation with opioid overdose and suicide events among patients receiving stable long-term opioid therapy without evidence of opioid misuse. This comparative effectiveness study with a trial emulation approach used a large US claims data set of individuals with commercial insurance or Medicare Advantage who were aged 18 years or older and receiving stable long-term opioid therapy without evidence of opioid misuse between January 1, 2010, and December 31, 2018. Statistical analysis was performed from January 17, 2020, through November 12, 2021. Three opioid dosage strategies: stable dosage, tapering (dosage reduction ≥15%), or abrupt discontinuation. Time to opioid overdose or suicide event identified from International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes in medical claims over 11 months of follow-up. Inverse probability weighting was used to adjust for baseline confounders. The primary analysis used an intention-to-treat approach; follow-up after assignment regardless of changes in opioid dose was included. A per-protocol analysis was also conducted, in which episodes were censored for lack of adherence to assigned treatment. A cohort of 199 836 individuals (45.1% men; mean [SD] age, 56.9 [12.4] years; and 57.6% aged 45-64 years) had 415 123 qualifying, long-term opioid therapy episodes; 87.1% of episodes were considered stable, 11.1% were considered a taper, and 1.8% were considered abrupt discontinuation. The adjusted cumulative incidence of opioid overdose or suicide events 11 months after baseline was 0.96% (95% CI, 0.92%-0.99%) with a stable dosage strategy, 1.10% (95% CI, 0.99%-1.22%) with a tapered dosage strategy, and 1.28% (95% CI, 0.93%-1.38%) with an abrupt discontinuation strategy. The risk difference between a taper and a stable dosage was 0.15% (95% CI, 0.03%-0.26%), and the risk difference between abrupt discontinuation and a stable dosage was 0.33% (95% CI, -0.03% to 0.74%). Results were similar using the per-protocol approach. This study identified a small absolute increase in risk of harms associated with opioid tapering compared with a stable opioid dosage. These results do not suggest that policies of mandatory dosage tapering for individuals receiving a stable long-term opioid dosage without evidence of opioid misuse will reduce short-term harm via suicide and overdose.

Food as harm reduction during a drinking session: reducing the harm or normalising harmful use of alcohol? A qualitative comparative analysis of alcohol industry and non-alcohol industry-funded guidance

BackgroundThe aim of this study was to critically analyse information concerning the relationship between alcohol and food consumption provided via alcohol industry (AI) funded and non-AI-funded health-oriented websites, to determine the role it plays within the alcohol information space, and how this serves the interests of the disseminating organisations.MethodsInformation on food as a harm reduction measure while drinking alcohol was extracted from 15 AI websites and websites of AI-funded corporate social responsibility (CSR) organisations. As a comparison group, non-AI-funded health websites were also searched (n = 16 websites with food and alcohol-related content). Information was included from webpage content and associated downloadable documents. Critical discourse analysis (CDA) was adopted to allow the texts analysed to be situated within the broader political and social context.Analysis was carried out iteratively, involving continuous comparison within and between websites. Discursive themes were identified by three researchers. Identified discursive elements were discussed to reach a consensus, and a final coding framework was then developed. “Tone” analysis was used to assess whether the overall tone within individual websites was considered to be pro-alcohol consumption, neutral or discouraging of alcohol consumption.ResultsThere were some commonalities across AI and non-AI-funded websites, whereby both appeared to normalise alcohol consumption and to encourage use of food as a measure to enable sustained drinking, to avoid drinking in a way that results in short-term harms, and to prevent or “cure” a hangover. The fact that both AI-funded and non-AI-funded organisations shared many of these narratives is particularly concerning. However, a discourse of food and alcohol that served to promote “moderate” drinking as beneficial to health was used exclusively by AI-funded organisations, focusing on special occasions and individual-blaming.ConclusionsAlcohol consumption, including heavy and harmful consumption, is frequently normalised within the online information space. Emphasising food consumption with alcohol may have the effect of supporting consumers to drink for longer periods of time. Health professionals and independent health organisations should review the information they provide in light of our findings and challenge why AI-funded organisations, with a major conflict of interest, and a history of health misinformation, are often given the responsibility for disseminating health information to the public.

Quantitatively Evaluating the Impact of Eliminating Risk Assessment Checklists for Granting Leave in a Specialist Personality Disorder Ward

AimsSpringbank Ward, in the CPFT NHS trust, is a specialist unit for patients with a diagnosis of emotionally unstable personality disorder (EUPD). Psychiatric wards often use restrictive practices to try and minimise suicide risk. Using risk assessment checklists to decide whether to grant leave is one example. Research shows that it is not possible to predict suicide or self-harm risk at an individual level, regardless of the assessment method used, so we questioned the utility of such an approach. A previous evaluation of our leave protocol showed that patients and staff would favour a less restrictive and more personalised approach. We introduced a new protocol that eliminated use of checklists, replacing them with an optional 1:1 conversation with staff before leaving the ward. Our aim in this service evaluation was to determine whether there was any significant change in rates of incidents on the ward and during leave as a result of this new, less restrictive leave protocol.MethodsData were obtained from the records of incidents on Springbank ward from March 2019 to March 2021. These incidents were recorded by members of staff on the ward, and ranked according to the severity of harm that resulted from these incidents. The rankings from least severe to most severe recorded during the study were ‘No harm’, ‘Low (Minimal Harm)’, and ‘Moderate (Short term harm)’. The number of incidents which occurred for the year before and the year after the policy change were compared. The comparison compared both the total amount of incidents and the sub-types of incidents.ResultsIn the 365 days following the change in protocol, there was a 15.5% decrease in total incidents and a 51.0% decrease in incidents occurring off the ward compared to the 365 days before the change in protocol. Notably there was a 61% decrease in total (both on and off the ward) Moderate (Short term harm) incidents, the most harmful type of incident recorded, following the change in protocol.ConclusionThe decrease in incidents following the change in protocol suggests that replacing the use of a formal risk assessment checklist with a holistic alternative improves patient safety.

(Almost) Everything You Always Wanted to Know About Cannabis Science, but Were Afraid to Ask!

Aim: It is estimated that approximately 25% of cancer patients are currently taking cannabis to alleviate symptoms of their disease and/or cope with the side effects of their treatment. Patients want to learn more about cannabis from their cancer healthcare team, but most Radiation Therapists (RTs) feel too uninformed to discuss this subject. The purpose of this abstract is to provide information about cannabis that is relevant and useful for RTs. Process: Cannabis is a broad term used to describe organic products derived from the Cannabis plant. The unique group of active chemical compounds found in cannabis are called cannabinoids. Among the more than 100 different types of cannabinoids, the most abundant and well-studied are delta9 tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the primary intoxicating compound of cannabis, which is responsible the euphoric “high”. CBD is a non-intoxicating constituent of cannabis. Terpenes are the third most prevalent compound in cannabis, these give cannabis its distinctive fragrance. Plants are selectively bred to produce particular THC/CBD ratios, and there are more than 200 medical strains currently available from licensed producers in Canada. Cannabis comes in many forms, including dried flower, processed oil, pharmaceutical grade pills and topical patches. Cannabis can be ingested by inhalation, orally, sublingually and topically. Each of these methods has its own rate of onset and duration of effects, and differences in the bioavailability of cannabinoids. Cannabinoids are absorbed into the blood, then rapidly distributed into the brain and other high perfusion tissues. They are then metabolized by CYP liver enzymes and eventually eliminated via feces or urine. All forms of cannabinoids work on the endocannabinoid system within the human body, which consists of a series of neuromodulators and their associated receptors located throughout the brain, peripheral nervous system and immune system. Benefits/Challenges: Cancer patients most frequently take cannabis to improve nausea and appetite, pain, stress and sleep, with 51% - 83% self-reporting a major benefit. The Canadian Cannabis Act (2018) provides access to cannabis for those over 18yrs via medical cannabis programs, prescription pharmaceuticals, pharmacies, provincial websites and retail storefronts. Despite widespread availability, there are multiple precautions and contraindications when considering taking cannabis. These include patient risk factors (e.g. schizophrenia, cardio-metabolic disorders, respiratory conditions), drug-on-drug interactions (e.g. anti-coagulants, statins, SSRIs), lifestyle risk factors (e.g. driving, working, travelling) and the development of a use disorder. Short term harms associated with cannabis use include impaired cognitive and motor function, tachycardia, anxiety and paranoia. Long term harms include impaired learning and memory and development of chronic bronchitis. Evidence-based guidelines are now available to lower the risks associated with taking cannabis. Impact/Outcomes Most RTs have little knowledge about the therapeutic use of cannabis by cancer patients, and <15% of patients receive any information about cannabis from their healthcare team. This leaves our patients exposed to cannabis myths and misrepresentations found during internet searches. Educational opportunities are urgently needed to provide RTs with information about the science of cannabis so they can support and advise their patients.

Bisphosphonates Likely Beneficial for Most Older Women with Osteoporosis.

A meta-analysis suggests that the short-term benefits of bisphosphonate therapy likely outweigh the short-term harms for most older postmenopausal women who have osteoporosis.

Short-Term Harm, Long-Term Prosperity? Democracy, Corruption and Foreign Direct Investments in Sino-African Economic Relations

Short-Term Harm, Long-Term Prosperity? Democracy, Corruption and Foreign Direct Investments in Sino-African Economic Relations

Expanding Horizons: Laparoscopic Management of Unruptured Cornual Heterotopic Pregnancy Safeguarding Intrauterine Pregnancy

<h3>Study Objective</h3> Feasibility of Minimally invasive surgery to handle extremely rare conditions of heterotopic cornual ectopic pregnancy. <h3>Design</h3> Compilation of videos consisting of four surgical procedures over six years performed on a patient with specific focus on heterotopic cornual ectopic pregnancy managed laparoscopically. <h3>Setting</h3> Operative laparoscopy for cornual ectopic pregnancy was performed under general anaesthesia in semi lithotomy position. Optical 11 mm trocar was introduced from umbilicus and other three ancillary 6 mm ports were used. C section of same patient at full term was carried out under regional anaesthesia with Pfannenstiel incision. <h3>Patients or Participants</h3> The patient had undergone laparoscopic bilateral neosalpingostomy as a part of fertility restoration surgery which was followed by bilateral salpingectomy for recurrent hydrosalpinx and tubal ectopic pregnancy. Following which patient underwent Assisted reproductive technique but unfortunately developed rare form of multiple gestation (heterotopic pregnancy with one left cornual ectopic component and second healthy intrauterine pregnancy). It was diagnosed in time and treated with operative laparoscopy. The intrauterine pregnancy continued till term and a healthy singleton child was delivered by C section at 37th week. <h3>Interventions</h3> I was prudent to avoid prolonged use of general anaesthesia and to reduce use of electrocautery on gravid uterus. For achieving effective hemostasis four stay sutures with delayed absorbable suture material was taken on both sides and base of ectopic gestation which was very vascular lesion due to gravid uterus. <h3>Measurements and Main Results</h3> With minimal use of electrocautery and without using vasoconstrictors or uterine artery ligation, extremely vascular cornual ectopic pregnancy was safely removed by operative laparoscopy. Myometrial defect was properly reconstructed with delayed absorbable sutures, without causing any short term or long-term harm to ongoing precious intrauterine pregnancy. <h3>Conclusion</h3> Extremely rare and complex situation of heterotopic cornual ectopic pregnancy can be very safely managed with proper application of principles of minimal invasive surgery safeguarding the intrauterine pregnancy.

NeuroSAFE frozen section during robot-assisted radical prostatectomy: peri-operative and histopathological outcomes from the NeuroSAFE PROOF feasibility randomized controlled trial.

To report on the methods, peri-operative outcomes and histopathological concordance between frozen and final section from the NeuroSAFE PROOF feasibility study (NCT03317990). Between May 2018 and March 2019, 49 patients at two UK centres underwent robot-assisted radical prostatectomy (RARP). Twenty-five patient were randomized to NeuroSAFE RARP (intervention arm) and 24 to standard RARP (control arm). Frozen section was compared to final paraffin section margin assessment in the 25 patients in the NeuroSAFE arm. Operation timings and complications were collected prospectively in both arms. Fifty neurovascular bundles (NVBs) from 25 patients in the NeuroSAFE arm were analysed. When analysed by each pathological section (n = 250, average five per side), we noted a sensitivity of 100%, a specificity of 99.2%, and an area under the curve (AUC) of 0.994 (95% confidence interval [CI] 0.985 to 1; P ≤0.001). On an NVB basis (n = 50), sensitivity was 100%, specificity was 92.7%, and the AUC was 0.963 (95% CI 0.914 to 1; P ≤0.001). NeuroSAFE RARP lasted a mean of 3h 16min (knife to skin to off table, 95% CI 3h 2min-3h 30min) compared to 2h 4min (95% CI 2h 2min-2h 25min; P ≤0.001) for standard RARP. There was no morbidity associated with the additional length of operating time on in the NeuroSAFE arm. This feasibility study demonstrates the safety, reproducibility and excellent histopathological concordance of the NeuroSAFE technique in the NeuroSAFE PROOF trial. Although the technique increases the duration of RARP, this does not cause short-term harm. Confirmation of feasibility has led to the opening of the fully powered NeuroSAFE PROOF randomized controlled trial, which is currently under way at four sites in the UK.

Prevalence, Mechanisms, Treatment, and Complications of Hypertension Postliving Kidney Donation.

Living kidney donors represent a unique population of patients. Potential donors are selected based on the belief that their preoperative fitness is likely to mitigate the risks of long- and short-term harm following uninephrectomy. Studies performed on postdonation outcomes have largely focused on mortality and the risk of end-stage renal failure, but have also investigated secondary outcomes such as cardiovascular morbidity and hypertension. It has been postulated that hypertension is a possible outcome of living kidney donation. A variety of studies have been conducted to investigate the prevalence, epidemiology, mechanisms, treatment strategies, and long-term ramifications of hypertension postdonation. These studies are heterogeneous in their population, design, methodology, and outcome measures and have presented contradicting outcomes. Additionally, the absence of a well-matched control group has made it challenging to interpret and generalise the reported findings. As such, it is not possible to definitively conclude that hypertension occurs at a higher rate among donors than the general population. This article will review the evidence of postdonation hypertension prevalence, mechanisms, treatment, and complications.

Understanding local government responses to alcohol-related harm.

Local governments (LG) have a key role in reducing alcohol-related harm, yet, Australian research investigating this is limited. This study aimed to explore Australian LGs' role in alcohol policy by investigating how LGs respond to alcohol-related harm and what influences their responses. A collective case study approach guided two-stage purposive sampling. Victorian metropolitan and regional LGs were invited to participate based on alcohol-related harm profiles. Officers within LGs with alcohol policy knowledge participated in semi-structured interviews. Transcripts were analysed deductively using a pre-existing alcohol policy framework and inductively using thematic analysis. Nine officers from eight LGs participated. LG responses to alcohol-related harm predominately included bans on alcohol in public spaces, licensed premises planning and alcohol-free youth events. Half implemented liquor forums/accords and most implemented education programs in sporting clubs, schools or workplaces. In some LGs, the reduction of alcohol-related harm was not considered a priority. Key influences on alcohol initiatives were legislation, the composition of licensed venues, extent of alcohol-related harms, resources and priorities, and stakeholder feedback. While particular policies were widespread, participating LGs varied greatly in activity in, and responses to, reducing alcohol-related harm. LGs reported varied influences on their responses. LGs recognised the long-term health harms of alcohol in their health planning documents, however, most prioritised interventions targeting short-term amenity and safety harms. Changes to Victorian planning and liquor licensing legislation to give additional powers to LGs and providing pre-developed alcohol programs with dedicated funding should be considered.

Screening for Hepatitis C Virus Infection in Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance A 2013 review for the US Preventive Services Task Force (USPSTF) of hepatitis C virus (HCV) screening found interferon-based antiviral therapy associated with increased likelihood of sustained virologic response (SVR) and an association between achieving an SVR and improved clinical outcomes. New direct-acting antiviral (DAA) regimens are available. Objective To update the 2013 review on HCV screening to inform the USPSTF. Data Sources Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews through February 2019, with surveillance through September 2019. Study Selection Randomized clinical trials (RCTs) and nonrandomized treatment studies of HCV screening and DAA therapy; cohort studies on screening, antiviral therapy, and the association between an SVR after antiviral therapy and clinical outcomes. Data Extraction and Synthesis One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Main Outcomes and Measures Mortality, morbidity, quality of life, screening and treatment harms, and screening diagnostic yield. Results Eight RCTs of DAA therapy vs placebo or an outdated antiviral regimen, 48 other treatment studies, and 33 cohort studies, with a total of 179 230 participants, were included. No study evaluated effects of HCV screening vs no screening. One new study since the 2013 review (n = 5917) found similar diagnostic yield of risk-based screening (sensitivity, 82%; number needed to screen to identify 1 HCV case, 15) and birth cohort screening (sensitivity, 76%; number needed to screen, 29), assuming perfect implementation. Ten open-label studies (n = 3292) reported small improvements in some quality-of-life and functional outcomes (eg, less than 3 points on the 0 to 100 36-Item Short Form Health Survey physical and mental component summary scales) after DAA treatment compared with before treatment. Two cohort studies (n = 24 686) found inconsistent associations of antiviral therapy vs no therapy with risk of hepatocellular carcinoma. Forty-nine treatment studies (n = 10 181) found DAA regimens associated with pooled SVR rates greater than 95% across genotypes, and low short-term rates of serious adverse events (1.9%) and withdrawal due to adverse events (0.4%). An SVR after antiviral therapy was associated with decreased adjusted risk of all-cause mortality (13 studies, n = 36 986; pooled hazard ratio [HR], 0.40 [95% CI, 0.28-0.56) and hepatocellular carcinoma (20 studies, n = 84 491; pooled HR, 0.29 [95% CI, 0.23 to 0.38]) vs no SVR. Conclusions and Relevance Direct evidence on the effects of HCV screening on clinical outcomes remains unavailable, but DAA regimens were associated with SVR rates greater than 95% and few short-term harms relative to older antiviral therapies. An SVR after antiviral therapy was associated with improved clinical outcomes compared with no SVR.

Intravenous infusion practices across England and their impact on patient safety: a mixed-methods observational study

Background Intravenous (IV) medication administration has traditionally been regarded to be error-prone with high potential for harm. A recent US multisite study revealed surprisingly few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error. Objectives To determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation in errors, discrepancies and practices, including the contribution of smart pumps. Design Phase 1 comprised an observational point-prevalence study of IV infusions, with debrief interviews and focus groups. Observers compared each infusion against the medication order and local policy. Deviations were classified as either errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs, and analytically in supplementary analyses. Phase 2 comprised in-depth observational studies at five of the participating sites to better understand causes of error and how safety is maintained. Workshops were held with key stakeholder groups, including health professionals and policy-makers, the public and industry. Setting Sixteen English NHS hospital trusts. Results Point-prevalence data were collected from 1326 patients and 2008 infusions. In total, 240 errors were observed in 231 infusions and 1489 discrepancies were observed in 1065 infusions. Twenty-three errors (1.1% of all infusions) were considered potentially harmful; one might have resulted in short-term patient harm had it not been intercepted, but none was judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of deviations varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or to respond to patient need. Smart pumps, as currently implemented, had little effect. Staff had developed practices to manage efficiency and safety pragmatically by working around systemic challenges. Limitations Local observers may have assessed errors differently across sites, although steps were taken to minimise differences through observer training, debriefs, and review and cleaning of data. Each in-depth study involved a single researcher, and these were limited in scale and scope. Conclusions Errors and discrepancies are common in everyday infusion administration but most have low potential for patient harm. Findings are best understood by viewing IV infusion administration as a complex adaptive system. Better understanding of performance variability to strategically manage risk may be more helpful for improving patient safety than striving to eliminate all deviations. Future work There is potential value in reviewing policy around IV infusion administration to reduce unnecessary variability, manage staff workload and engage patients, while retaining the principle that policy has to be fit for purpose, contextualised to the particular ward situation and treatment protocol, and sensitive to the risks of different medications. Further work on understanding infusion administration as a complex adaptive system might deliver new insights into managing patient safety. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.