Service‐user experiences of an integrated psychological intervention for depression or anxiety and tobacco smoking in improving access to psychological therapies services: A qualitative investigation into mechanisms of change in quitting smoking

IntroductionHigh smoking prevalence leads to increased morbidity and mortality in individuals with depression/anxiety. Integrated interventions targeting both smoking and mood have been found to be more effective than those targeting smoking alone, but the mechanisms of change of these interventions have not been investigated. This qualitative study aimed to understand participants'' experiences of the mechanisms underlying change in smoking behaviour following an integrated cognitive behavioural technique‐based intervention for smoking cessation and depression/anxiety.MethodsThis study was embedded within an ongoing randomized‐controlled acceptability and feasibility trial (http://www.isrctn.com/ISRCTN99531779). Semistructured interviews were conducted with 15 IAPT service users. Data were analysed using thematic analysis. During the interviews, participants were asked open‐ended questions about their quitting experience and perception of how the intervention aided their behaviour change.ResultsFive themes were identified. Acquiring an increased awareness of smoking patterns: participants described an increased understanding of how smoking was contributing towards their mental health difficulty. Developing individualized strategies: participants described acquiring ‘a couple of tricks up your sleeve’ that were helpful in making smoking cessation feel more ‘manageable’. Practitioner style as ‘supportive but not lecture‐y’: participants expressed how important the therapeutic alliance was in helping change their smoking behaviour. Importance of regular sessions: participants expressed the importance of ‘having someone that''s checking in on you’. Having the opportunity to access the intervention at ‘the right time’: participants described the intervention as the ‘push’ that they ‘needed’.ConclusionsParticipants identified key factors towards smoking behaviour change. Perceived increased awareness of how smoking negatively impacted participants'' mental health, and the opportunity to be offered smoking cessation treatment in a ‘non‐judgemental’, ‘supportive’ environment, with regular sessions and individualized strategies contributed to successful smoking cessation outcomes. If similar results are found in more diverse samples, these aspects should be embedded within integrated interventions for smoking cessation and depression/anxiety.Patient or Public ContributionPersons with lived experience of depression, anxiety and tobacco addiction contributed towards the design of the interview schedule, participant information sheets and the debriefing process. This was to ensure that interview questions were relevant, nonjudgemental and acceptable for those who did not manage to quit smoking.     

Impact of wearing personal protective equipment on the performance and decision making of surgeons during the COVID-19 pandemic: An observational cross-sectional study

During the coronavirus disease 2019 (COVID-19) pandemic, the mandatory use of personal protective equipment (PPE) has resulted in a significant reduction in the infection rate among health care workers (HCWs). However, there are some ongoing concerns about the negative impact of using PPE for prolonged periods.This study examined the impact of wearing PPE on surgeons’ performance and decision making during the COVID-19 pandemic.In this cross-sectional study, an anonymous online questionnaire was created and disseminated to surgeons all over the Eastern Province of Saudi Arabia. The questionnaire included the demographic data, the local hospital policies, the non-technical skills (e.g., communication, vision, and comfort) and the technical skills, and the process of decision making.From June 2020 to August 2020, 162 surgeons participated in this questionnaire. Of them, 80.2% were aged from 26 to 45 years, 70.4% have received a special training for PPE, and 59.3% of participants have operated on COVID-19 confirmed cases. A negative impact of wearing PPE was reported on their overall comfort, vision, and communication skills (92.6%, 95.1%, and 82.8%, respectively). The technical skills and decision making were not significantly affected (60.5% and 72.8%, respectively). More preference for conservative approach, damage control procedures, and/or open approach was reported.Despite its benefits, PPE is associated with a significant negative impact on the non-technical skills (including vision, communication, and comfort) as well as a non-significant negative impact on technical skills and decision making of surgeons. Extra efforts should be directed to improve PPE, especially during lengthy pandemics.     

Cross-linked starch microspheres: Effect of cross-linking condition on the microsphere characteristics

Cross-linked starch microspheres were prepared using different kinds of cross-linking agents. The influence of several parameters on morphology, size, swelling ratio and drug release rate from these microspheres were evaluated. These parameters included cross-linker type, concentration and the duration of cross-linking reaction. Microspheres cross-linked with glutaraldehyde had smooth surface compared with those prepared with epichlorhydrine or formaldehyde. The particle size increased with increasing the cross-linking time and increasing the drug loading. Swelling ratio of the particles was a function of cross-linker type but not the concentration or time of cross-linking. Drug release from starch microspheres was measured in phosphate buffer and also in phosphate buffer containing alpha-amylase. Results showed that microspheres cross-linked with epichlorhydrine released all their drug content in the first 30 minutes. However, cross-linking of the starch microspheres with glutaraldehyde or formaldehyde decreased drug release rate. SEM and drug release studies showed that cross-linked starch microspheres were susceptible to the enzymatic degradation under the influence of alpha-amylase. Changing the enzyme concentration from 5000 to 10,000 IU/L, increased drug release rate but higher concentration of enzyme (20,000 IU/L) caused no more acceleration.     

Minimally invasive local ablative therapies in combination with radioiodine therapy in benign thyroid disease: preparation,feasibility and efficiency – preliminary results

Abstract

Purpose: Initial studies of combinations of radioiodine therapy (RIT) and local ablative procedures for the treatment of thyroid nodules have shown promising results. The goal of this study was to evaluate the effectiveness of RIT combined with radiofrequency ablation (RFA) in patients with goitres and to determine which ablative procedure is the most suitable for a combined therapy.

Methods: Thirty patients with goitres were divided into two subgroups. A test group of 15 patients received combined therapy (RIT?+?RFA) and a control group of 15 patients received RIT mono therapy. All patients underwent assessments including ultrasound, laboratory evaluation (T3, T4, TSH, TG, TPOAb, TgAbTRAb) and scintigraphic imaging with Tc-99m-Pertechnetate. The 3-month volume reduction was used to evaluate therapy effectiveness.

Results: Combined therapy (subgroup 1) resulted in a significant (p?<?0.05) thyroid volume reduction (22.3?±?54?ml/32.2?±?58.2%) with better performance (p?>?0.05) than the control group (20.2?±?32.2?ml/29.6?±?42.1%). All patients became euthyroid after treatment. No major discomfort or complications occurred. A review of the literature investigating combinations of other local ablative procedures with RIT was performed to determine the most promising combination.

Conclusions: The present study confirms the positive experiences with the combined therapy of RIT and local ablative procedures shown in the current literature and approves this approach for the treatment of goitres with RFA?+?RIT. These findings, when confirmed by further studies, should expand the indication of combined therapy as a minimally invasive alternative to surgery.     

Microscopic magnetic resonance elastography (microMRE).

Magnetic resonance elastography (MRE) was extended to the microscopic scale to image low-frequency acoustic shear waves (typically less than 1 kHz) in soft gels and soft biological tissues with high spatial resolution (34 micromx34 micromx500 microm). Microscopic MRE (microMRE) was applied to agarose gel phantoms, frog oocytes, and tissue-engineered adipogenic and osteogenic constructs. Analysis of the low-amplitude shear wave pattern in the samples allowed the material stiffness and viscous loss properties (complex shear stiffness) to be identified with high spatial resolution. microMRE experiments were conducted at 11.74 T in a 56-mm vertical bore magnet with a 10 mm diameterx75 mm length cylindrical space available for the elastography imaging system. The acoustic signals were generated at 550-585 Hz using a piezoelectric transducer and high capacitive loading amplifier. Shear wave motion was applied in synchrony with the MR pulse sequence. The field of view (FOV) ranged from 4 to 14 mm for a typical slice thickness of 0.5 mm. Increasing the agarose gel concentration resulted in an increase in shear elasticity and shear viscosity. Shear wave motion propagated through the frog oocyte nucleus, enabling the measurement of its shear stiffness, and in vitro shear wave images displayed contrast between adipogenic and osteogenic tissue-engineered constructs. Further development of microMRE should enable its use in characterizing stiffer materials (e.g., polymers, composites, articular cartilage) and assessing with high resolution the mechanical properties of developing tissues.     

Reactivity of hydroxyl groups in cellulose towards chlorotri(p-tolyl)methane

The reactivity of primary and secondary hydroxyl groups of cellulose towards chlorotri(p-tolyl)methane in pyridine was studied in the temperature range of 60 to 100°C. The rate of reaction with the primary hydroxyl groups was found to be 43 times faster than that with the secondary hydroxyl groups of cellulose. The kinetic data showed that the reactivity of chlorotri(p-tolyl)methane towards primary hydroxyl groups of cellulose is higher than that of chlorotriphenylmethane (trityl chloride). The energies of activation for the reaction of primary and secondary hydroxyl groups of cellulose with chlorotri(p-tolyl)methane were found to be 39,6 and 43,1 kJ · mol^?1, respectively. The reaction was observed to be pseudo first order.     

Hepatitis caused by clometacin (Dupéran). Retrospective study of 30 cases. A model of autoimmune drug-induced hepatitis?

Thirty cases of clometacin-induced hepatitis were retrospectively collected over a nine-year period in hepatogastroenterological units of non university, public hospitals. There was a strong female predominance (90 percent). Clometacin (Dupéran) was taken because of arthritis in 8 out of 10 cases. Administration was continuous in 85 percent of cases and median duration was 445 days. median dose was 450 mg per day. Jaundice, fatigue, and weight loss were the most frequent symptoms, but edema, ascites and palmar erythema were not uncommon. Thrombopenia (38 percent) was the most frequent hematologic abnormality. Renal failure, always with benign course, was present in 1/4 of cases. Biochemical disorders indicated hepatocellular and cholestatic hepatitis in 3/4 and 1/4 of cases respectively. Hypoprothrombinemia below 50 percent was noted in 1 out of 6 cases, and was associated with death in half cases. Gamma-globulins were increased in 80 percent of cases, with a predominant increase of IgG. Antinuclear or anti-smooth muscle antibodies were present in 60 percent of cases, whereas antimitochondrial and antimicrosomes were absent. Histopathological examination of the liver biopsy specimens obtained in 25 patients showed acute hepatitis in 8 and chronic active hepatitis with fibrosis in 17--including 6 patients with cirrhosis; there were no epidemiological, clinical (except ascites), or biochemical differences between these two groups. Four of the 7 patients tested had HLA B8 antigens; they all had chronic active hepatitis, with autoantibodies in 3 cases. Median duration of hospitalization was 21 days. Hepatitis was directly responsible for death in 3 patients; biochemical sequelae (hypergammaglobulinemia or anicteric cholestasis) were present in 8 patients, 2 of whom most likely had cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Complications of diagnostic carotid/cerebral arteriography when performed by a vascular surgeon

Carotid stenting has recently been considered as an alternative treatment to carotid endarterectomy for certain patients with carotid stenosis. Hence, performing carotid arteriography with minimal morbidity and mortality is essential. The purpose of this study was to audit complications of diagnostic carotid/cerebral arteriography performed by a vascular surgeon with experience in endovascular interventions. One hundred one consecutive patients underwent 4-vessel arch aortography with selective carotid, subclavian, and/or vertebral arteriography with use of the Seldinger technique. Demographic data, indications, procedure approach (transfemoral, brachial), number of arteries punctured, type of selective injection, contrast volume, and procedure time were analyzed. Minor complications were those that do not significantly alter the health or activity of the patient or require extra hospitalization or treatment. Other complications were defined as major complications. The technical success rate was 99% (100/101 patients). These included the following: 82 patients with right carotid artery, 82 with left carotid artery, 15 with right subclavian artery, 21 with left subclavian artery, 11 with right vertebral artery, and 17 with left vertebral artery (a total of 228 selective injections). Indications for procedures included the following: transient ischemic attack (TIA)/stroke symptoms in 66%, asymptomatic carotid stenosis in 22%, upper limb claudication in 4%, and vertebrobasilar insufficiency in 4%. Right femoral puncture was used in 79%, left femoral in 12%, and left brachial in 9%. The mean amount of contrast used was 101 cc (45-250 cc) and the mean procedure time was 46 minutes (22-132 minutes). There were 5 complications in the whole series: 3 major complications (3%), including 1 minor stroke (1%) with carotid injection, 1 TIA, and 1 major retroperitoneal bleeding; and 2 (2%) minor complications. The major complication rate in this series compares favorably to published rates of 5.7% to 9.1%. There was no association between complications and specific risk factors except for a longer catheterization time (66 minutes versus 45 minutes, p=0.011). Carotid/cerebral arteriography can be done safely by experienced vascular surgeons with minimal perioperative complications that compare favorably with what has been reported in the radiology literature.