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Most (84-100%) participants agreed they would refer a heart failure patient later in the illness trajectory. There was a more favourable attitude towards the service name 'supportive care' than to 'palliative care'.
Comfort with end of life discussions is encouraging as it may lead to a greater likelihood of planning future care and identifying palliative care needs. Peer support and supervision may be useful for addressing feelings of failure. The use of needs-based assessment tools, adopting the service name 'supportive care' and further research focusing on primary palliative team-based approach is required to improve palliative care access.
Cardiovascular nurses and physicians are comfortable providing end of life care, but referrals to palliative care in the later stages of heart failure persists.
Cardiovascular nurses and physicians are comfortable providing end of life care, but referrals to palliative care in the later stages of heart failure persists.Diabetes presents significant self-care challenges that require sustained motivation. Motivational Interviewing (MI) has substantial support in enhancing motivation for behavioural change, but its effective application in routine healthcare requires practitioners to acquire and use related skills. The aim of this systematic review was to investigate the impact of MI training on MI-related skills of practitioners who provide diabetes healthcare. PubMed, EMBASE and PsycINFO were searched using the terms motivational interviewing, motivation enhancement, and diabetes. Two assessors independently screened titles, abstracts and full texts for papers reporting the impact of MI training on diabetes healthcare practitioners' outcomes. Of 625 abstracts screened, 22 papers from 17 unique studies were included. All 17 studies reported some improvement in MI skills, with 14 finding improvements in more than 50% and three less than 35%. However, the risk of bias and outcome measures varied widely between studies. All studies showed diabetes healthcare practitioners acquired and applied MI skills post-training, to varying levels. Findings suggest training should include education, role play, and ongoing supervision to maintain skills.The main-protease (Mpro) catalyzes a crucial step for the SARS-CoV-2 life cycle. The recent SARS-CoV-2 presents the main protease (MCoV2pro) with 12 mutations compared to SARS-CoV (MCoV1pro). Recent studies point out that these subtle differences lead to mobility variances at the active site loops with functional implications. We use metadynamics simulations and a sort of computational analysis to probe the dynamic, pharmacophoric and catalytic environment differences between the monomers of both enzymes. So, we verify how much intrinsic distinctions are preserved in the functional dimer of MCoV2pro, as well as its implications for ligand accessibility and optimized drug screening. We find a significantly higher accessibility to open binding conformers in the MCoV2pro monomer compared to MCoV1pro. A higher hydration propensity for the MCoV2pro S2 loop with the A46S substitution seems to exercise a key role. Quantum calculations suggest that the wider conformations for MCoV2pro are less catalytically active in the monomer. However, the statistics for contacts involving the N-finger suggest higher maintenance of this activity at the dimer. Docking analyses suggest that the ability to vary the active site width can be important to improve the access of the ligand to the active site in different ways. So, we carry out a multiconformational virtual screening with different ligand bases. The results point to the importance of taking into account the protein conformational multiplicity for new promissors anti MCoV2pro ligands. We hope these results will be useful in prospecting, repurposing and/or designing new anti SARS-CoV-2 drugs.Communicated by Ramaswamy H. Sarma.In commemorating Robbie Duschinsky's publication of Cornerstones of Attachment Research, I have decided that I could best serve this special issue by revisiting the founder of attachment theory, John Bowlby, and portraying him as a man above and beyond the founder of attachment theory based on my personal and intellectual relationship with him. The goal is to provide the reader, even those who were fortunate enough to have met him, an opportunity to reminisce or visualize Bowlby as husband, friend, mentor, and scholar. Thus, leaving the intellectual contributions to other scholars in this issue, this paper takes, although brief, the form of an emotional and personal memoir of John Bowlby.
Left ventricular thrombus (LVT) is a well-recognised complication of ischaemic and non-ischaemic heart disease. The incidence of this complication has drastically reduced due to reperfusion therapies. Current guidelines recommend using warfarin for at least three months. But, direct-acting oral anticoagulants (DOACs) are increasingly used as an off-label alternative to vitamin K antagonists (VKA) to treat LVT. In this article, we will review the use of DOACs for the treatment of LVT.
We conducted a literature search for published case series, meta-analyses, and review articles in four electronic databases PubMed, EMBASE, OVID, and Google Scholar from inception until 1 August 2020. AZD1480 inhibitor Fifteen articles including meta-analyses, review articles and case series were included. A total of 292 patients with LVT from 7 articles are analysed. The majority (
 = 110) were treated with rivaroxaban followed by apixaban (
 = 86), and warfarin (60). 26 patients from 292 were not included in the analysis. Of the 206 patients on DOACs, 180 (87.3%) had resolution of LVT. 22 had persistent LVT. Six patients had reported bleeding. Three patients had gastrointestinal (GI) bleeding. One patient had pulmonary haemorrhage while one other had epistaxis requiring blood transfusion. Five of six patients who had bleeding were on either single or dual antiplatelet therapy in addition to DOAC. One patient had reported a cardioembolic stroke while on a DOAC. Median follow-up duration varied from one month to two years.
Based on our review, DOACs are likely to be at least as effective and safer as VKA for stroke prevention and thrombus resolution in patients with LVT.
Based on our review, DOACs are likely to be at least as effective and safer as VKA for stroke prevention and thrombus resolution in patients with LVT.