title stringlengths 1 1.19k | keywords stringlengths 0 668 | concept stringlengths 0 909 | paragraph stringlengths 0 61.8k | PMID stringlengths 10 11 |
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Data collection and measurements | PMC10193595 | |||
Unplanned ED return visits (URVs) | Data on ED return visits were collected from the electronic hospital system (EHS). ED return visits that could not be foreseen were defined as URVs [ | PMC10193595 | ||
Baseline data | We used baseline data that were associated with URVs in previous studies, including demographics (age [ | PMC10193595 | ||
Determination of reasons for URVs | Prior to the start of the study, reasons for URVs were defined and categorized, based on findings in the literature (see Additional file 1) [ | PMC10193595 | ||
Statistical analysis | Categorical data are presented as numbers and percentages. Continuous data were skewed and therefore presented as median and interquartile ranges (IQR). Differences in characteristics of patients with and without URVs were analyzed using XThe XInter-rater reliability regarding the initial determination of reasons and c... | PMC10193595 | ||
Results | Of the 1659 patients, 222 (13.4%) had at least one URV within 30 days. The total number of URVs within 30 days was 279. | PMC10193595 | ||
Reasons for unplanned ED return | EMERGENCY | Figure Reasons for unplanned Emergency Department (ED) return visits ( | PMC10193595 | |
Inter-rater reliability regarding assessment of reasons and categories for URVs | The inter-rater reliability after initial independent determination and categorization of the reasons for the URVs, measured with Cohen’s kappa coefficient, was 0.57. All disagreements concerning the determination of the reasons for URVs were solved by discussion between the two researchers and hence, the judgement of ... | PMC10193595 | ||
Discussion | DISEASE | In this study, we found that 222 of the 1659 (13.4%) older adults had at least one URV within 30 days after being discharged from the ED. Of them, 171 (77%) returned for medical reasons, including 95 (43%) for illness-related problems and 76 (34%) for new medical complaints unrelated to the presenting problem of the in... | PMC10193595 | |
Strengths and limitations | We were able to compare an extensive set of patient and ED visit characteristics between patients with and without URVs. Although previous studies mentioned reasons for URVs in older adults, this is one of the few studies that investigated the frequencies of the different reasons for URVs in older adults [Some limitati... | PMC10193595 | ||
Conclusion | In this study, most older patients returned unplanned to the ED for medical reasons, whereas URVs for patient-related reasons, such as uncertainty about health or misunderstanding of discharge instructions, were less common. These findings may explain why many transitional care programs that focus on patient education ... | PMC10193595 | ||
Acknowledgements | Not applicable | PMC10193595 | ||
Authors’ contributions | MvLvG and MCvdL conceived and designed the study, which was further developed with advice from IEV, JG and RCvdM. IEV and MvLvG independently determined and categorized the reason for each URV. MvLvG and IEV managed the data. MvLvG analyzed the data and MCvdL, JG and RCvdM provided statistical advice. MvLvG drafted the... | PMC10193595 | ||
Funding | The corresponding author (Merel van Loon-van Gaalen) received a grant from the Jacobus Foundation in The Hague, The Netherlands, for the conduction of this study. The Jacobus Foundation is a non-commercial trust that supports education and research projects with a focus on Neurology and Psychiatry within the Haaglanden... | PMC10193595 | ||
Availability of data and materials | The dataset used and analyzed during the current study is available from the corresponding author on reasonable request and with permission of the Board of Directors of Haaglanden Medical Center. | PMC10193595 | ||
Declarations | PMC10193595 | |||
Ethics approval and consent to participate | The Medical Ethics Review Committee of Southwest Holland waived the necessity for formal approval of the study as it closely followed routine care (nr. 17–028).Informed consent was obtained from all subjects and their legal guardian(s).All procedures performed in this study were in accordance with the 1964 Declaration ... | PMC10193595 | ||
Consent for publication | Not applicable. | PMC10193595 | ||
Competing interests | The authors declare that they have no competing interests. | PMC10193595 | ||
References | PMC10193595 | |||
Introduction and hypothesis | vaginal vault prolapse | The objective of this study was to evaluate long-term outcomes of laparoscopic sacrocolpopexy (LSC) versus abdominal sacrocolpopexy (ASC) for vaginal vault prolapse (VVP). | PMC9483545 | |
Methods | Long-term follow-up of a multicenter randomized controlled trial (SALTO trial). A total of 74 women were randomly assigned to LSC ( | PMC9483545 | ||
Results | GENITAL PROLAPSE | We analyzed 22 patients in the LSC group and 19 patients in the ASC group for long-term follow-up, with a median follow-up of 109 months (9.1 years). Disease-specific quality of life did not differ after long-term follow-up with median scores of 0.0 (LSC: IQR 0–17; ASC: IQR 0–0) on the “genital prolapse” domain of the ... | PMC9483545 | |
Conclusions | COMPLICATIONS | At long-term follow-up no substantial differences in quality of life, anatomical results, complications, or reinterventions between LSC and ASC were observed. Therefore, the laparoscopic approach is preferable, considering the short-term advantages. | PMC9483545 | |
Trial registration | Dutch Trial Register NTR6330, 18 January 2017, | PMC9483545 | ||
Keywords | PMC9483545 | |||
Introduction | pelvic organ prolapse, vaginal vault prolapse | The prevalence of vaginal vault prolapse (VVP), requiring apical surgery, has been reported in 23% of women who underwent vaginal hysterectomy for pelvic organ prolapse (POP) [Sacrocolpopexy is one of the surgical options in the treatment of VVP, with success rates between 93 and 99% [Evidence for long-term clinical ou... | PMC9483545 | |
Materials and methods | PMC9483545 | |||
Study design | Details of the SALTO trial were published previously [This observational long-term follow-up study was approved by the ethical research committee (METC) of the Máxima Medical Centre (file number METC W17.015, CCMO NL60618.015.17) and by the board of directors of each of the participating hospitals, separately from the ... | PMC9483545 | ||
Primary and secondary outcomes | STRESS URINARY INCONTINENCE, COMPLICATIONS | The primary outcome of this trial was long-term disease-specific quality of life, measured with the Urogenital Distress Inventory (UDI). The primary outcome in our follow-up study is similar to the original SALTO trial. Secondary outcomes were the effects of the surgical treatment on POP-related functional symptoms suc... | PMC9483545 | |
Data collection | RECURRENCE, VAGINA | All patients from the initial SALTO trial were sent a letter to ask for participation in this observational follow-up study. When they failed to respond, they were called and asked to participate. All participants gave new informed consent to participate in the long-term follow-up trial. They were asked to fill in vari... | PMC9483545 | |
Interventions | PMC9483545 | |||
Laparoscopic sacrocolpopexy | Laparoscopic sacrocolpopexy was performed under general anesthesia using four trocars, one for the scope and three side trocars. The vaginal vault was elevated with a vaginal probe. The peritoneum from the promontory to the vault was incised laparoscopically by scissors to expose the rectovaginal and vesicovaginal fasc... | PMC9483545 | ||
Abdominal sacrocolpopexy | VAGINA | The ASC was performed by a laparotomy under general anesthesia, preferably using a Pfannenstiel incision. The essence of the procedure was the same as for the laparoscopic procedure. The peritoneum from the promontory to the vault was incised to expose the rectovaginal and vesicovaginal fascia, extending to the sacral ... | PMC9483545 | |
Sample size | Sample size calculation was performed for the initial SALTO trial and 74 patients were included accordingly [ | PMC9483545 | ||
Statistical analysis | The domain scores were calculated for the UDI, DDI, IIQ, PISQ, and PGI-I questionnaires. To examine differences between the two groups the independent-samples | PMC9483545 | ||
Discussion | PMC9483545 | |||
Main findings | RECURRENCE, GENITAL PROLAPSE | This observational long-term follow-up study of a multicenter randomized controlled trial shows that there was no difference in disease-specific quality of life whether after laparoscopic or after abdominal sacrocolpopexy, with median scores of 0.0 (LSC: IQR 0–17; ASC: IQR 0–0) on the “genital prolapse” domain of the U... | PMC9483545 | |
Strengths and limitations | pelvic organ prolapse | We performed a randomized controlled trial, which is considered to yield the highest level of evidence when comparing two different treatment options. One of the main strengths of our study is the duration of follow-up, with a median of 109 months (9.1 years), which may be stated as “very long” (> 5 years) duration of ... | PMC9483545 | |
Interpretation | blood loss | BLOOD LOSS | The laparoscopic approach to sacrocolpopexy is preferable, compared with the open abdominal technique, mainly because of better short-term outcomes. The laparoscopic approach has less blood loss and a shorter hospital stay [ | PMC9483545 |
Authors’ contributions | Anique M.J. van Oudheusden: project development, data analysis, manuscript writing; Josephine Eissing: data collection, manuscript writing; Ivon M. Terink: project development, data collection, manuscript editing; Maarten D.H. Vink: data collection, manuscript editing; Sander M.J. van Kuijk: data analysis, manuscript e... | PMC9483545 | ||
Declarations | PMC9483545 | |||
Conflicts of interest | None. | PMC9483545 | ||
References | PMC9483545 | |||
Abbreviations: | The Scientific Advisory Committee on Nutrition (SACN) advised daily fibre intakes of 30 g for adults (with proportionally lower recommendations for children from the age of 2 years)It is well recognised that a diet rich in fibre contributes to maintaining a healthy gut microbiota associated with increased diversity and... | PMC10551484 | ||
Materials and methods | PMC10551484 | |||
Volunteer recruitment | ± | Nine healthy volunteers (four men and five women, age 54·1 ± 16·9, BMI: 25·6 ± 2·0 kg/mProspective volunteers who registered an interest in the study signed the consent form and attended a screening visit at the Human Nutrition Unit (HNU) at the Rowett Institute. The volunteers completed a general health questionnaire,... | PMC10551484 | |
Study design | digestive biscuit | BLOOD | Before one of the two intervention sessions, the volunteers recorded their habitual diet for seven consecutive days in food diaries. The evening before each visit, volunteers were provided with a standardised meal consisting of a vegetarian paella (made in-house), a glass of semi-skimmed milk, toffee yoghurt and a plai... | PMC10551484 |
Test meals | The preparation of the control and the bean hull bread rolls has been described previously | PMC10551484 | ||
General reagents | Standards and general laboratory reagents were purchased from Sigma-Aldrich (Gillingham, England) and Fisher Scientific UK Ltd or synthesised as described previously | PMC10551484 | ||
Macronutrient and micronutrients composition of bread rolls | Macronutrients (protein, fibre measured as soluble and insoluble NSP and fat) were measured as previously describedMicronutrient analysis was conducted as previously described | PMC10551484 | ||
Phytic acid content analysis of the bread rolls | The phytic acid content of the samples was measured and calculated using the Phytic Acid Assay Kit (Megazyme), as described previously | PMC10551484 | ||
Determination of | Anaerobic incubations were carried out in Hungate tubes as described previously | PMC10551484 | ||
Extraction of plant metabolites from bread rolls | The bread rolls were freeze-dried then freeze-milled in liquid nitrogen (Spex 6700; Edison). Plant metabolites were extracted as previously described | PMC10551484 | ||
Human sample processing | The blood sample at each time point was collected directly into 5 ml Aprotinin K | PMC10551484 | ||
Samples analysis | PMC10551484 | |||
Plasma and faecal metabolites | Plasma (baseline, 30, 60, 120, 180 and 240 min and the fasted sample from day 4) and faecal samples (days 1 and 4) were processed as previously described | PMC10551484 | ||
SCFA analysis | SCFA concentrations were measured in volunteers’ faecal samples and in | PMC10551484 | ||
DNA extractions and quantitative PCR | MP | DNA extractions were performed with a FastDNA spin kit for soil (MP Biomedicals) according to the manufacturer’s instructions. DNA concentrations were measured using Qubit 2·0 Fluorometer (Thermo Fisher Scientific). The total number of 16S rRNA gene copies per ml and abundance of several bacterial genera or species of ... | PMC10551484 | |
Metabolic profile | Total PYY (peptide YY), total ghrelin, total glucagon and total glucagon-like peptide 1 (GLP-1) were analysed from postprandial plasma samples at baseline, 15, 30, 45, 60, 90, 120, 180 and 240 min following the bean hull and control bread rolls using Human Metabolic Hormone Magnetic Bead Panel (Merck Millipore) as prev... | PMC10551484 | ||
Breath samples | Breath samples were collected at baseline (0 h) and every 15 min for 240 min and were analysed by MS. At each time point, five breath tubes were collected by the participants, and four of these were analysed using Elementar iso FLOW coupled to an isoprime precisION MS (Elementar). Gastric emptying rate analysis was com... | PMC10551484 | ||
The LC-MS/MS analysis | Bread plant metabolites were analysed as described previously | PMC10551484 | ||
Statistical analysis | The samples size of nine volunteers was predicted to detect a treatment effect 1·1 times the magnitude of the within-volunteer variation in the difference, with 80 % power at the 5 % significance level | PMC10551484 | ||
Results | PMC10551484 | |||
Human volunteer baseline characteristics | The baseline characteristics and body composition of the participants are summarised in
Baseline characteristics and body composition of the participantsAll values are mean ± | PMC10551484 | ||
Composition of the bread rolls | PMC10551484 | |||
Macronutrient content | Two bean hull bread rolls provide over 85 % of daily fibre recommendation: The monosaccharide composition of the soluble and insoluble NSP for each portion of the control and bean hull bread roll is shown in
Monosaccharide composition of soluble non-starch polysaccharides (NSP) and insoluble NSP content, expressed as ... | PMC10551484 | ||
Micronutrient content | Two bean hull bread rolls contribute towards daily micronutrient recommendations: bean hull bread roll was also a rich source of several minerals. Overall, the micronutrient content in the bean hull bread roll was higher than the control bread roll. Bean hull bread roll had a significantly higher content of P (
Main mi... | PMC10551484 | ||
Bean hull fibre fermentability | Bean hull fibre has a very low fermentability
Bean hull fibre fermentability | PMC10551484 | ||
Bread roll plant metabolite composition | The bean hull bread rolls are a rich source of phenolics, specifically flavonoids. The most abundant plant metabolites measured in the study bread rolls are presented in
The most abundant plant metabolites measured in the bean hull and control bread rolls (mg/portion of bread rolls consumed ± | PMC10551484 | ||
Plasma metabolite composition | The phenolics from bean hull bread rolls have a poor systemic availability. The PCA (
Plasma composition (over 4 h) following bean hull (orange) and control (blue) bread rolls consumption. (a) The PCA analysis of average postprandial plasma metabolites (The chronic consumption of bean hull bread rolls leads to a signif... | PMC10551484 | ||
Plasma gastrointestinal hormones composition | The consumption of bean hull bread rolls has no effect on postprandial plasma gut hormone levels. None of the test meals have significantly affected ghrelin and GLP-1 postprandial plasma concentrations over 4 hours (AUC, | PMC10551484 | ||
Plasma glucose and lipids profile | The consumption of bean hull bread rolls has no effect on blood glucose and lipid levels. The blood glucose levels were not significantly different following the consumption of bean hull bread compared with the control bread rolls on day 1, for 4 hours postprandially and on day 4, on faster plasma samples following 3 d... | PMC10551484 | ||
Faecal metabolites composition | The chronic consumption of the bean hull bread rolls significantly decreased faecal concentration of putrescine and deoxycholic acid while significantly increased taurocheno-deoxycholic acid. The PCA plot shows discrimination between the faecal metabolites produced on day 4 after 3 days of chronic consumption of the co... | PMC10551484 | ||
Faecal SCFA concentrations | Consumption of bean hull bread rolls does not promote microbial SCFA production. Total SCFA concentrations in faecal samples remained mostly unchanged after interventions (
Faecal SCFA concentrations (mM) Percentage change between baseline and post-intervention (day 1 % change between the two test meals on day 4. | PMC10551484 | ||
The gut microbiota composition | Bean hull bread rolls consumption did not affect the abundance and composition of the gut microbes. The absolute abundance of total bacteria was determined by qPCR, but no significant differences were observed. The abundance of several genera or species within the two major phyla Bacteroidetes and Firmicutes as well as... | PMC10551484 | ||
Gastric emptying | Consumption of bean hull bread rolls had no effect on gastric emptying markers. The latency and lag phases were significantly delayed (
Gastric emptying markers on day 1 following the control and bean hull bread rolls | PMC10551484 | ||
Satiety and hunger | fullness | Consumption of bean hull bread rolls has no effect on hunger. There were no significant differences between the intervention and control bread for the visual analogue scale measures (hunger, fullness, desire, quantity) from baseline to 4 hours post the bread consumption ( | PMC10551484 | |
Discussion | hyperglycaemia, mineral deficiencies | HYPERGLYCAEMIA, CHRONIC DISEASES | Most UK adults consume their dietary fibre from wheat-based cerealsOverall, bean hull bread had a significantly higher mineral content than the control bread roll. Thus, regular consumption of bean hull bread roll could further contribute towards meeting the recommended daily intake compared with the control bread, and... | PMC10551484 |
Study limitations | The present study has several limitations. A relatively small sample size of nine participants limits the conclusions that can be drawn from the study; however, this sample size does not weaken the significant differences which have been found. | PMC10551484 | ||
Conclusion | cancer, T2D | CANCER, DNA DAMAGE | The habitual consumption of the bean hull bread rolls could potentially provide some benefits against T2D due to the increased production of indole-3-propionic acid, and against cancer, by reducing the production of putrescine and deoxycholic acid, which can cause DNA damage. Bean hull fortified bread rolls could be ut... | PMC10551484 |
Acknowledgements | P. | The authors are grateful to all the volunteers for their participation in this human study. The authors also are thankful for the assistance from Karen Taylor for the diet design, Jean Bryce, Sylvia Stephen, David Bremner, Claire Kidd and Alicia Bryce for the food diary analysis and their support in the Human Nutrition... | PMC10551484 | |
Supplementary material | For supplementary material accompanying this paper visit https://doi.org/10.1017/S0007114523000491.click here to view supplementary material | PMC10551484 | ||
References | PMC10551484 | |||
Key Points | PMC10098968 | |||
Question | pleural infections | PLEURAL INFECTION | Is an algorithm comparing tissue plasminogen activator plus deoxyribonuclease therapy with surgical decortication in patients with complicated pleural infections feasible, safe, and efficacious? | PMC10098968 |
Findings | MINOR | In this pilot randomized clinical trial of 20 participants, there was 100% enrollment to study completion, no protocol deviations, 2 minor protocol amendments, and no screen to enrollment failures. | PMC10098968 | |
Meaning | pleural infections | PLEURAL INFECTION, CAVITY | The study algorithm was feasible, safe, and efficacious, providing evidence to move forward with a multicenter randomized clinical trial.This randomized clinical trial compares chest tube drainage of the pleural cavity using intrapleural fibrinolytic therapy and surgical decortication among patients with complicated pl... | PMC10098968 |
Importance | pleural infections | PLEURAL INFECTION | There is a paucity of high-quality prospective randomized clinical trials comparing intrapleural fibrinolytic therapy (IPFT) with surgical decortication in patients with complicated pleural infections. | PMC10098968 |
Objective | pleural infections | PLEURAL INFECTION | To assess the feasibility, safety, and efficacy of an algorithm comparing tissue plasminogen activator plus deoxyribonuclease therapy with surgical decortication in patients with complicated pleural infections. | PMC10098968 |
Design, Setting, and Participants | pleural infection | PLEURAL INFECTION | This parallel pilot randomized clinical trial was performed at a single urban community-based center from March 1, 2019, to December 31, 2021, with follow-up for 90 days. Seventy-four individuals were screened and 48 were excluded. Twenty-six patients 18 years or older with clinical pleural infection and positive findi... | PMC10098968 |
Interventions | Intrapleural tissue plasminogen activator plus deoxyribonuclease therapy vs surgical decortication. | PMC10098968 | ||
Main Outcomes and Measures | Primary outcomes were the percentage of patients enrolled to study completion and multidisciplinary adherence. Secondary outcomes included the number of patients with and the reason for inadequate screening, screening to enrollment failures, time to accrual of 20 patients or the number accrued at 1 year, and clinical d... | PMC10098968 | ||
Results | deaths, Infection, failure | RENAL, MINOR, COMPLICATIONS, INFECTION | Twenty-six patients were enrolled, 10 were randomized to each group, and 6 were observed. There was 100% enrollment to study completion in each treatment group, no protocol deviations, 2 minor protocol amendments, and no screening to enrollment failures. It took 32 months to enroll 26 patients. The 20 randomized patien... | PMC10098968 |
Conclusions and Relevance | In this pilot randomized clinical trial, the study algorithm was feasible, safe, and efficacious. This provides evidence to move forward with a multicenter randomized clinical trial. | PMC10098968 | ||
Trial Registration | ClinicalTrials.gov Identifier: | PMC10098968 | ||
Introduction | pleural infections, Sepsis, empyemas | PARAPNEUMONIC EFFUSION, CAVITY, SEPSIS, PLEURAL INFECTION | Complicated pleural infections (CPIs), including complicated parapneumonic effusions and empyemas, are common, affecting approximately 80 000 patients each year in the US and United Kingdom combined.Initial treatment of CPI requires antibiotic therapy and drainage; however, more aggressive management is often required.... | PMC10098968 |
Methods | PMC10098968 | |||
Study Design | This pilot parallel randomized clinical trial was conducted at a single center in Seattle, Washington, between March 1, 2019, and December 31, 2021, with follow-up for 90 days. Ethical and regulatory approval for the study was obtained from the Providence St Joseph Health Institutional Review Board. All participants pr... | PMC10098968 | ||
Patient Identification and Eligibility | pleural infection, purulent, fever | THORACIC, PLEURAL INFECTION, LEUKOCYTOSIS | Patients admitted to or consulting with the Department of Thoracic Surgery and Interventional Pulmonology were screened for eligibility daily. Patients were eligible if they were 18 years or older, had a clinical pleural infection (fever and/or leukocytosis, elevated procalcitonin level, and/or elevated C-reactive prot... | PMC10098968 |
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