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Evidenced annual impact of a specialist commissioned regional tracheostomy team aiming to reduce the risk of community tracheostomies.There are an increasing number of tracheostomies being inserted nationally with no national framework for ongoing review following discharge to the community setting. This has the potential to result in poor clinical outcomes and ongoing dependence on acute care services and high cost packages of care. Prior to this service innovation, community tracheostomy patients were managed primarily by GP’s with very few patients receiving specialist input. We found that this was resulting in repeated hospital admissions, lack of specialist review to assess for weaning potential and due to the lack of tracheostomy competent placements, was causing individuals to be relocated away from their families. £301,000 investment from regional Clinical Commissioning Groups (CCG’s) was secured in April 2020 to create a specialist Nurse/Allied Health Professional led team consisting of 2.5 team members: Nurse (Clinical Lead), Physiotherapist and Speech and Language Therapist. Quantitative and qualitative data was collected during the first year of substantive funding to evidence service impact including: number of community decannulations with associated continuing healthcare cost saving, reduced dependence on secondary care, improved access to community placements, hospital admission avoidances and lived patient experiences. A total cost saving of £405,050.68 with an additional cost avoidance of £2,700,000 from acute in-reach decannulations during the first 6-month COVID-19 wave was achieved over this 12-month period. We have demonstrated the positive impact specialist tracheostomy services can have across primary and secondary care with the aim of this service model being used for national service provision pathway developments. Specialist tracheostomy services can achieve huge impact within the community setting both to improve clinical outcomes for this vulnerable patient group and to achieve substantial annual cost saving to the NHS.

Senescence-accelerated mice (SAM) strains are useful models to understand the mechanisms of age-dependent degeneration. In this study, measurements of the mitochondrial membrane potential (Deltapsi(m)) of platelets and the Adenosine 5(')-triphosphate (ATP) content of hippocampi and platelets were made, and platelet mitochondria were observed in SAMP8 (faster aging mice) and SAMR1 (aging resistant control mice) at 2, 6 and 9 months of age. In addition, an Abeta-induced (Amyloid beta-protein) damage model of platelets was established. After the addition of Abeta, the Deltapsi(m) of platelets of SAMP8 at 1 and 6 months of age were measured. We found that platelet Deltapsi(m), and hippocampal and platelet ATP content of SAMP8 mice decreased at a relatively early age compared with SAMR1. The platelets of 6 month-old SAMP8 showed a tolerance to Abeta-induced damages. These results suggest that mitochondrial dysfunction might be one of the mechanisms leading to age-associated degeneration in SAMP mice at an early age and the platelets could serve as a biomarker for detection of mitochondrial function and age related disease.

AbstractMore than half of older adults are frail or prefrail in the United States, and hospital-associated deconditioning likely increases this risk. However, the impact of frailty on potential functional improvements after hospital discharge is poorly understood. We sought to identify the influence of baseline frailty on gait speed change in older adults receiving home health physical therapy (PT) after hospital discharge. The severity of frailty was assessed using Cardiovascular Health Study frailty criteria (weakness, slowness, weight loss, physical inactivity, and exhaustion). Gait speed was measured at baseline and 60-days post-hospital discharge. Upon admission to home health rehabilitation services, half of older adults (total N=250) were considered frail, with slowness (90%) and weakness (75%) being the most common characteristics. Older adults, whether pre-frail or frail, demonstrated similar and clinically meaningful improvements in gait speed after receiving home health rehabilitation for 60 days following hospital discharge. These results suggest that clinicians caring for older adults in the hospital can counsel both pre-frail and frail patients that, with home health rehabilitation, clinically significant improvements in function can be expected over the 2 months following discharge. Furthermore, we observed encouraging gait speed improvement with physical therapy following hospitalization in older adults. Results can inform anticipatory guidance on hospital discharge.

High molecular weight alginate beads with 59% mannuronic acid content or 68% guluronic acid were prepared using a droplet generator and crosslinked in calcium chloride. The alginate beads were compared to current embolisation microspheres for compressibility and monitored over 12 weeks for size and weight change at 37°C in low volumes of ringers solutions. A sheep uterine model was used to analyse bead degradation and inflammatory response over 12 weeks. Both the in vitro and in vivo data show good delivery, with a compressibility similar to current embolic beads. In vitro, swelling was noted almost immediately and after 12 weeks the first signs of degradation were noted. No difference was noted in vivo. This study has shown that high molecular weight alginate gel beads were well tolerated by the body, but beads associated with induced thrombi were susceptible to inflammatory cell infiltration. The beads were shown to be easy to handle and were still observable after 3 months in vivo. The beads were robust enough to be delivered through a 2.7 Fr microcatheter. This study has demonstrated that high molecular weight, high purity alginate bead can be considered as semi-permanent embolisation beads, with the potential to bioresorb over time.

BACKGROUND: Most professions increased system-focused safety competencies after the release of the Institute of Medicine reports on errors, patient safety, and core competencies for health professions beginning in 1999. The physical therapy profession remained focused on individual safety, driven by accreditation requirements. PURPOSE: To describe change in the knowledge and attitudes Doctor of Physical Therapy (DPT) students following a longitudinal system-focused patient safety curriculum and 22 weeks of clinical education. METHODS: Nine sessions of systems-focused patient safety discipline-specific and interprofessional curricular content. Knowledge/attitude change assessed via a modified Attitudes of Patient Safety Questionnaire (APSQ-III) and culture and professional questions from the Patient Safety Attitudes, Skills and Knowledge Scale (PS-ASK) questionnaire. RESULTS: There was a 100% and 97% survey response rate to pre and post surveys, respectively. Statistically significant changes in the mean response pre to post-survey were found for four of nine APSQ-III subscales. Eighteen of the 25 APSQIII questions improved towards the desired direction, while 2 remained unchanged at 100%. Culture-focused attitude questions on the PS-ASK remained very low or did not change. CONCLUSION: Student knowledge and attitudes improved in several important domains of patient safety including patient safety training, situational awareness, role of provider competence, and disclosure responsibility. Challenges remain in understanding professional responsibility and healthcare culture and its connection to error.

Intestinal epithelial-derived IL-18 is critical for homeostatic intestinal barrier function and is secreted through Gasdermin D (GSDMD) pores. Inflammasome activation is a prerequisite for both IL-18 maturation and GSDMD pore formation. However, GSDMD pores also cause pyroptotic cell death, which could be detrimental to the intestinal epithelial barrier. How epithelial cells balance the need to secrete IL-18 and to maintain barrier integrity remains poorly understood. In human intestinal epithelial cell lines and in primary human epithelial intestinal organoids, but not in immune cells, GSDMD plasma membrane pore formation by LPS electroporation and by gram-negative bacterial infection induced a non-conventional p37 caspase-4 fragment that was associated with reduced levels of mature IL-18. By contrast, limiting GSDMD plasma membrane pores pharmacologically and via point-mutagenesis prevented caspase-4 cleavage and increased IL-18 production, suggesting that p37 caspase-4 cleavage may regulate IL-18 maturation in the intestinal epithelium. In support, co-expression of caspase-4 cleavage mutants and IL-18 in HEK293T cells revealed that non-cleavable caspase-4 produced more mature IL-18 than cleaved caspase-4. Overall, these studies suggest that epithelial inflammasomes encode feedback pathways that control the balance between cytokine secretion and cell death. This may be an important mechanism to ensure homeostatic IL-18 production in the intestinal epithelium. A study identifies a feedback mechanism in human intestinal epithelial cells whereby the formation of GSDMD pores leads to an inactivating cleavage of caspase-4, a process that may serve to regulate homeostatic IL-18 secretion.

Medical leaders have warned of the potential public health burden of a “parallel pandemic” faced by healthcare workers during the COVID-19 pandemic. These individuals may have experienced scenarios in which their moral code was violated resulting in potentially morally injurious events (PMIEs). In the present study, hierarchical linear modeling was utilized to examine the role of PMIEs on COVID-19 pandemic-related difficulties in psychosocial functioning among 211 healthcare providers (83% female, 89% White, and an average of 11.30 years in their healthcare profession [9.31]) over a 10-month span (May 2020 –March 2021). Reported exposure to PMIEs was associated with statistically significant poorer self-reported psychosocial functioning at baseline and over the course of 10-months of data collection. Within exploratory examinations of PMIE type, perceptions of transgressions by self or others (e.g., “I acted in ways that violated my own moral code or values”), but not perceived betrayal (e.g., “I feel betrayed by leaders who I once trusted”), was associated with poorer COVID-19 related psychosocial functioning (e.g., feeling connected to others, relationship with spouse or partner). Findings from this study speak to the importance of investing in intervention and prevention efforts to mitigate the consequences of exposure to PMIEs among healthcare providers. Interventions for healthcare providers targeting psychosocial functioning in the context of moral injury is an important area for future research.