Bevorratungsdüngung mit Schafwolle bei Bio-Frühjahrsblühern im Topf

Schafwolle wird im Zierpflanzenanbau als organischer Dünger eingesetzt. Bei der Erzeugung von Frühjahrsblühern (Bellis perennis und Myosotis sylvatica) wurde die vollständige Bevorratungsdüngung mit Schafwollpellets in drei verschiedenen Größen und mit geschnittenem Schafwollvlies getestet. Mit einer Düngungshöhe von 6-10 kg Schafwolle/m³  bei B. perennis und 10 kg/m³ bei M. sylvatica konnten gute Pflanzenqualitäten erzielt werden. Düngung mit kleinen Pellets führte zum höchsten Nmin-Gehalt im Substrat und zum besten Pflanzenwachstum, welches durch die Messung von Frischmasse, Höhe und Durchmesser der Pflanzen ermittelt wurde. Pflanzengesundheit und Gesamteindruck wurden bei Düngung mit geschnittenem Schafwollvlies am besten bewertet

Making the journey with me : a qualitative study of experiences of a bespoke mental health smoking cessation intervention for service users with serious mental illness

BACKGROUND: Smoking is one of the major modifiable risk factors contributing to early mortality for people with serious mental illness. However, only a minority of service users access smoking cessation interventions and there are concerns about the appropriateness of generic stop-smoking services for this group. The SCIMITAR (Smoking Cessation Intervention for Severe Mental Ill-Health Trial) feasibility study explored the effectiveness of a bespoke smoking cessation intervention delivered by mental health workers. This paper reports on the nested qualitative study within the trial. METHODS: Qualitative semi-structured interviews were conducted with 13 service users receiving the intervention and 3 of the MHSCPs (mental health smoking cessation practitioners) delivering the intervention. Topic guides explored the perceived acceptability of the intervention particularly in contrast to generic stop-smoking services, and perceptions of the implementation of the intervention in practice. Transcripts were analysed using the Constant Comparative Method. RESULTS: Generic services were reported to be inappropriate for this group, due to concerns over stigma and a lack of support from health professionals. The bespoke intervention was perceived positively, with both practitioners and service users emphasising the benefits of flexibility and personalisation in delivery. The mental health background of the practitioners was considered valuable not only due to their increased understanding of the service users' illness but also due to the more collaborative relationship style they employed. Challenges involved delays in liaising with general practitioners and patient struggles with organisation and motivation, however the MHSCP was considered to be well placed to address these problems. CONCLUSION: The bespoke smoking cessation intervention was acceptable to service users and the both service users and practitioners reported the value of a protected mental health worker role for delivering smoking cessation to this group. The results have wider implications for understanding how to achieve integrated and personalised care for this high-risk population and further underscore the need for sensitised smoking cessation support for people with serious mental illness. TRIAL REGISTRATION: Current Controlled Trials ISRCTN79497236 . Registered 3(rd) July 2009

Primary care consultation rates among people with and without severe mental illness:a UK cohort study using the Clinical Practice Research Datalink

OBJECTIVES: Little is known about service utilisation by patients with severe mental illness (SMI) in UK primary care. We examined their consultation rate patterns and whether they were impacted by the introduction of the Quality and Outcomes Framework (QOF), in 2004. DESIGN: Retrospective cohort study using individual patient data collected from 2000 to 2012. SETTING: 627 general practices contributing to the Clinical Practice Research Datalink, a large UK primary care database. PARTICIPANTS: SMI cases (346 551) matched to 5 individuals without SMI (1 732 755) on age, gender and general practice. OUTCOME MEASURES: Consultation rates were calculated for both groups, across 3 types: face-to-face (primary outcome), telephone and other (not only consultations but including administrative tasks). Poisson regression analyses were used to identify predictors of consultation rates and calculate adjusted consultation rates. Interrupted time-series analysis was used to quantify the effect of the QOF. RESULTS: Over the study period, face-to-face consultations in primary care remained relatively stable in the matched control group (between 4.5 and 4.9 per annum) but increased for people with SMI (8.8-10.9). Women and older patients consulted more frequently in the SMI and the matched control groups, across all 3 consultation types. Following the introduction of the QOF, there was an increase in the annual trend of face-to-face consultation for people with SMI (average increase of 0.19 consultations per patient per year, 95% CI 0.02 to 0.36), which was not observed for the control group (estimates across groups statistically different, p=0.022). CONCLUSIONS: The introduction of the QOF was associated with increases in the frequency of monitoring and in the average number of reported comorbidities for patients with SMI. This suggests that the QOF scheme successfully incentivised practices to improve their monitoring of the mental and physical health of this group of patients

Inequalities in physical comorbidity:a longitudinal comparative cohort study of people with severe mental illness in the UK

OBJECTIVES: Little is known about the prevalence of comorbidity rates in people with severe mental illness (SMI) in UK primary care. We calculated the prevalence of SMI by UK country, English region and deprivation quintile, antipsychotic and antidepressant medication prescription rates for people with SMI, and prevalence rates of common comorbidities in people with SMI compared with people without SMI. DESIGN: Retrospective cohort study from 2000 to 2012. SETTING: 627 general practices contributing to the Clinical Practice Research Datalink, a UK primary care database. PARTICIPANTS: Each identified case (346 551) was matched for age, sex and general practice with 5 randomly selected control cases (1 732 755) with no diagnosis of SMI in each yearly time point. OUTCOME MEASURES: Prevalence rates were calculated for 16 conditions. RESULTS: SMI rates were highest in Scotland and in more deprived areas. Rates increased in England, Wales and Northern Ireland over time, with the largest increase in Northern Ireland (0.48% in 2000/2001 to 0.69% in 2011/2012). Annual prevalence rates of all conditions were higher in people with SMI compared with those without SMI. The discrepancy between the prevalence of those with and without SMI increased over time for most conditions. A greater increase in the mean number of additional conditions was observed in the SMI population over the study period (0.6 in 2000/2001 to 1.0 in 2011/2012) compared with those without SMI (0.5 in 2000/2001 to 0.6 in 2011/2012). For both groups, most conditions were more prevalent in more deprived areas, whereas for the SMI group conditions such as hypothyroidism, chronic kidney disease and cancer were more prevalent in more affluent areas. CONCLUSIONS: Our findings highlight the health inequalities faced by people with SMI. The provision of appropriate timely health prevention, promotion and monitoring activities to reduce these health inequalities are needed, especially in deprived areas

Mikrocomputertomographische Analyse der trabekulären und kortikalen Architektur des kaninen und felinen Antebrachiums - mit besonderem Augenmerk auf Toy Rassen

Radius- und Ulnafrakturen lassen sich bei der Katze mit einer Inzidenz von 2,0 - 14,0% erfassen. Beim Hund treten antebrachiale Frakturen mit einer Inzidenz von 18,0% auf. Dabei zeigen Toy Rassen innerhalb der Hunderassen eine erhöhte Prä-disposition und Komplikationsrate für Radius- und Ulnafrakturen. Die kausalen Mechanismen hierfür sind noch nicht vollständig geklärt. Viele Studien befassen sich allein mit dem trabekulären und kortikalen Knochen-aufbau von Hunden, die Besonderheiten der Katze werden dabei häufig außer Acht gelassen. Um diesen Unterschieden zwischen Katzen und Hunden und denen innerhalb der Hunderassen auf den Grund zu gehen, war es das Ziel dieser Studie die trabekulä-ren Strukturparameter (Knochenvolumenanteil (BV/TV), Oberflächenvolumenan-teil (BS/BV), Trabekelanzahl (Tb.N), Trabekeldicke (Tb.Th), Trabekelabstand (Tb.Sp), Konnektivität (Conn. D), Anisotropie (DA)) und die diaphysäre Kortika-lisdichte (Mean Density) des Antebrachiums von Katzen, kleinen Hunden und Toy Rassen zu beurteilen und zu vergleichen. Insgesamt 86 Unterarme, stammend von Toy Rassen (n= 18), kleinen Hunden an-derer Rassen (n= 17) und Katzen (n= 8) wurden mikrocomputertomographisch evaluiert. Hierfür wurden zur Analyse der trabekulären Strukturparameter vier Regions of Interest (proximaler und distaler Radius, proximale und distale Ulna) und zur Evaluation der diaphysären Kortikalisdichte sechs Regions of Interest (proximaler, mittlerer und distaler diaphysärer Radius; proximale, mittlere und distale diaphysäre Ulna) gewählt. Beim Vergleich der Daten zwischen Hunden und Katzen zeigten die Ergebnisse der Studie, dass Katzen an Radius und Ulna höhere Werte für BV/TV, Tb.Th, Tb.Sp, DA und Mean Density aufwiesen. Die Werte für BS/BV, Tb.N und Conn.D waren geringer. Zur geringeren Frakturinzidenz des Unterarmes bei Kat-zen könnten demnach der höher angesiedelte Knochenvolumenanteil (BV/TV), die dickeren Trabekel (Tb.Th), die erhöhte Anisotropie (DA) und die deutlich hö-here Kortikalisdichte (Mean Density) beitragen. Allgemein sollten die Unter-schiede des trabekulären und kortikalen Aufbaus des Antebrachiums zwischen Hunden und Katzen nicht außer Acht gelassen werden. Bei der Gegenüberstellung der Ergebnisse der Toy Rassen und der kleinen Hunde anderer Rassen zeigten die Toy Rassen geringere Werte für BV/TV, Tb.Th und Mean Density, sowie höhere Werte für Tb.N und Tb.Sp in ihren Unterarmkno-chen. Diese Parameter könnten somit das erhöhte Frakturrisiko von Radius und Ulna bei Toy Rassen begünstigen. Entgegen der Erwartungen ergaben sich bei den Toy Rassen im Vergleich zu den kleinen Hunden anderer Rassen höhere Werte für Conn. D und ähnliche Werte für DA. Demnach scheinen diese trabekulären Struk-turparameter keinen Einfluss auf die antebrachiale Instabilität von Toy Rassen zu haben. Innerhalb der Toy Rassen differierten die Werte der Chihuahuas von denen der übrigen Toy Rassen. Diese Rasse wies signifikant dünnere Trabekel (Tb.Th) mit einem größeren Trabekelabstand (Tb.Sp), niedrigerem Knochenvolumenanteil (BV/TV) und geringerer diaphysärer Kortikalisdichte (Mean Density) auf. Diese Strukturparameter könnten somit für ein erhöhtes antebrachiales Frakturrisiko insbesondere der Chihuahuas sprechen. Bei allen Gruppen ließ sich an der distalen Diaphyse von Radius und Ulna eine geringere Kortikalisdichte als an der proximalen Diaphyse ermitteln. Dies könnte als Ursache für das distale diaphysäre Drittel als prädisponierte Frakturstelle der Kleintiere sprechen.Radius and ulna fractures can be detected in cats with an incidence of 2,0 – 14,0%. In dogs, antebrachial fractures occur with an incidence of 18,0%. Herein toy breed dogs show an increased predisposition and complication rate in radius and ulna fractures. The causal mechanisms are not fully understood yet. Many studies focus solely on the trabecular and cortical bone formation of dogs, often ignoring the peculiarities of cats. The aim of this study was to examine the differences in trabecular and cortical architecture between cats and dogs and within dog breeds by analysing the trabec-ular structural parameters (Bone Volume Fraction per Total Volume (BV/TV), Bone Surface per Total Volume (BS/BV), Trabecular Number (Tb.N), Trabecular Thickness (Tb.Th), Trabecular Separation (Tb.Sp), Connectivity Density (Conn. D), Degree of Anisotropy (DA)) and cortical bone density (Mean Density) of the antebrachium of cats, small dogs and toy breeds and to compare their results. A total number of 86 forearms of toy breed dogs (n= 18), small dogs of other breeds (n= 17) and cats (n= 8) were evaluated by microcomputed tomography. For the analysis of the trabecular structure parameters four Regions of Interest (proximal and distal radius; proximal and distal ulna) have been selected. The evaluation of diaphyseal cortical density is based on six Regions of Interest (prox-imal, middle and distal diaphyseal third of radius; proximal, middle and distal di-aphyseal third of ulna). While comparing the data of dogs and cats, the results of the study showed that the radius and ulna of cats had higher values for BV/TV, Tb.Th, Tb.Sp, DA and Mean Density. BS/BV, Tb.N and Conn.D values were lower. Thus, the higher bone volume ratio (BV/TV), the thicker trabecula (Tb.Th), the increased anisotro-py (DA) and the significantly higher cortical density (Mean Density) could con-tribute to the lower forearm fracture incidence in cats. In general, the differences in trabecular and cortical structure of the antebrachium of dogs and cats should not be disregarded. While comparing the results of the antebrachial bones of toy breeds and small dogs of other breeds, toy breeds showed lower values for BV/TV, Tb.Th and Mean Density. Tb.N and Tb.Sp values were higher in their antebrachial bones. As a result these parameters could favor the higher risk of radius and ulna fracture in toy breeds. Contrary to expectations, the toy breeds showed higher values for Conn. D than the small dogs of other breeds and similar values for DA. Within this mind, these structural parameters not seem to influence on the antebrachial instability of toy breeds. Within the toy breeds the values of the Chihuahuas deviated from the other toy breed dogs. This breed had significantly thinner trabeculae (Tb.Th) with a larger trabecular separation (Tb.Sp), a lower bone volume fraction (BV/TV) and a lower diaphyseal cortical density (Mean Density). These structural parameters could therefore indicate an increased antebrachial fracture risk in Chihuahuas. In all groups the distal diaphysis of radius and ulna had a lower cortical density than the proximal diaphysis. This could be the cause for the distal diaphyseal third as a predisposed fracture localization in small animals

Global burden of preventable medication-related harm in health care: a systematic review

A series of WHO initiatives, such as the Global Patient Safety Challenge: Medication Without Harm and the Global Patient Safety Action Plan 2021-2030, address patient harm associated with use of medications. Medication-related harm is considered preventable if it occurs as a result of an identifiable,modifiable cause and its recurrence can be avoided by appropriate adaptation to a process or adherence to guidelines. Understanding the prevalence, natureand severity of preventable medication-related harm is critical for setting targets for clinically relevant, implementable improvements in patient safety. This report presents an updated systematic review and meta-analysis of studies of the prevalence, nature and severity of preventable medication-related harm in theinternational literature including in low- and middle-income countries (LMICs). A total of 100 studies were included in the review, involving 487 162 patients. Ofthese reports, 70 were from high-income countries (HICs) and 30 from LMICs. The results were as follows. Global prevalence and severity of preventablemedication-related harm: The pooled prevalence of preventable medication-related harm in all 100 studies was 5% (1 in 20 patients). One fourth of the harm was severe or potentially life-threatening. Geographical distribution of preventable medication-related harm: The prevalence of preventable medication-related harm was 7% in 30 studies in LMICs and 4% (3–5%, one in 25 patients) in 70 studies in HICs. The highest prevalence rates of preventable medication-related harm were in the African (9%) and South-East Asian regions (9%). Health care settings in which the most vulnerable patients are managed for preventable medication-related harm: Globally, the highest prevalence ratesfor preventable medication-related harm are for patients managed in geriatric care units (17%) and among patients in highly specialized or surgical care (9%).Stages of medication at which most preventable medication-related harm occurs: Globally about half (53%) of all preventable medication-related harmoccurred at the “ordering/prescribing” stage and 36% at the monitoring/reporting” stage. In LMICs, almost 80% of preventable medication-related harm occurred during the “ordering/prescribing” stage. Medicines that contribute most to medication- related harm: Antibacterials, antipsychotics,cardiovascular medications, drugs for functional gastrointestinal disorders, endocrine therapy, hypnotics, sedatives and non-steroidal anti-inflammatory products contributed most to medication-related harm globally.Way forward: The analysis showed that at least one in 20 patients are affected by preventable medication-related harm globally and that more than one fourthof preventable harm is severe or life-threatening. The prevalence of preventable medication-related harm in LMICs was almost twice as high as in HICs;however, few data were available on the severity and nature of medication-related harm in LMICs. A prerequisite for the success of future strategiesto mitigate preventable medication-related harm in LMICs would be to encourage reporting of any preventable medication-related harm and commission high-quality studies with standard methods for assessing and reporting such harm and also studies of the underlying causes for designing interventions that are most likely to work in LMICs. There is also an urgent need to implement improvement strategies in settings in which patients are managed, especially those who are vulnerable to preventable medication related harm, such as geriatric care and surgical care settings. Finally, most of the evidence summarized in this report was produced in hospitals and should be strengthened with more research in major specialties, including primary care, and mental health

A Case of Stercoral Perforation Detected on CT Requiring Proctocolectomy in a Heroin-Dependent Patient

Stercoral perforation of the colon is rare but carries with it significant morbidity and mortality. Stercoral perforation usually occurs in elderly, immobile patients with chronic constipation. In this manuscript, we report the case of stercoral perforation in a patient due to chronic heroin dependence. We report the case of a 56-year-old male patient with stercoral perforation, diagnosed by computed tomography, secondary to heroin dependence, requiring proctocolectomy and an end ileostomy. There are very few reports in the literature describing cases of stercoral perforation and questions have been asked about the importance of preoperative cross-sectional imaging. In our case, the diagnosis of stercoral perforation was made only on CT. Although this is not the first such case to be reported, it is significant as preoperative CT imaging was influential not only in determining the aetiology of the abdominal distension seen on the plain film, but also in detecting the pneumoperitoneum which was not evident clinically or on plain radiographs

A systematic review of platinum and taxane resistance from bench to clinic: an inverse relationship

We undertook a systematic review of the pre-clinical and clinical literature for studies investigating the relationship between platinum and taxane resistance. Medline was searched for (1) cell models of acquired drug resistance reporting platinum and taxane sensitivities and (2) clinical trials of platinum or taxane salvage therapy in ovarian cancer. One hundred and thirty-seven models of acquired drug resistance were identified. 68.1% of cisplatin-resistant cells were sensitive to paclitaxel and 66.7% of paclitaxel-resistant cells were sensitive to cisplatin. A similar inverse pattern was observed for cisplatin vs. docetaxel, carboplatin vs. paclitaxel and carboplatin vs. docetaxel. These associations were independent of cancer type, agents used to develop resistance and reported mechanisms of resistance. Sixty-five eligible clinical trials of paclitaxel-based salvage after platinum therapy were identified. Studies of single agent paclitaxel in platinum-resistant ovarian cancer where patients had previously recieved paclitaxel had a pooled response rate of 35.3%, n=232, compared to 22% in paclitaxel naïve patients n=1918 (p<0.01, Chi-squared). Suggesting that pre-treatment with paclitaxel may improve the response of salvage paclitaxel therapy. The response rate to paclitaxel/platinum combination regimens in platinum-sensitive ovarian cancer was 79.5%, n=88 compared to 49.4%, n=85 for paclitaxel combined with other agents (p<0.001, Chi-squared), suggesting a positive interaction between taxanes and platinum. Therefore, the inverse relationship between platinum and taxanes resistance seen in cell models is mirrored in the clinical response to these agents in ovarian cancer. An understanding of the cellular and molecular mechanisms responsible would be valuable in predicting response to salvage chemotherapy and may identify new therapeutic targets