Miracle-dz/UniFAR-FTUs huggingface dataset:
Drop‐out from inpatient treatment for anorexia nervosa: can risk factors be identified at point of admission?

Despite renewed interest in drop-out from eating disorders treatment, few studies have investigated the issue in respect to the most expensive and intensive form of treatment, that is, inpatient treatment for anorexia nervosa (AN). This study investigates whether risk of treatment drop-out can be determined from information routinely collected at point of admission. Using information from a multi-site database collected in Australia and New Zealand, demographic and clinical data at point of admission were collated for 213 inpatient treatment episodes. One in five admissions ended with the patient unilaterally deciding to leave treatment without clinician endorsement. A lower body mass index, AN purging subtype and active fluid restriction made significant independent contributions to this risk. Drop-out remains a highly disruptive method of discharge and while there is utility in predicting those most at risk, few variables commonly collated by clinicians contribute to their identification. The implications for clinical practice and future research are discussed. Copyright © 2003 John Wiley & Sons, Ltd and Eating Disorders Association.
Monitoring tolerance and rejection in organ transplant recipients

To avoid toxic side effects caused by permanent immunosuppressive treatment, research in transplantation focuses on new treatment strategies inducing tolerance or allowing drug weaning. Implementing drug minimization into clinical routine can be only safely achieved when guided by biomarkers reflecting the individual immune reactivity. We review recently described biomarkers and assays allowing identification of patients suitable for drug weaning or at risk of rejection. However, the majority of described biomarkers and assays have not been validated in prospective clinical trials. Thus, collaborative efforts are needed to design and perform prospective multicenter trials to validate the identified biomarkers across different laboratories.
Assessment of oxidative status and genotoxicity in photocopier operators: a pilot study

Occupational exposure to photocopiers has been indicated as being responsible for a number of health complaints, particularly effects on the respiratory, immunological, and nervous systems. In this study, we investigated oxidative and genotoxic damage in photocopier operators by assessing catalase activity (CAT), reduced vs. oxidized glutathione ratio (GSH/GSSG), level of lipid peroxidation (TBARS), damage index by Comet assay (DICA), and buccal cells with micronuclei (BCMN). Our results reveal that the TBARS levels in operators were increased (27%; p<0.05) but that no significant alterations to GSH/GSSG or CAT activity were observed. The DICA and the number of BCMN were significantly increased (134% and 100%, respectively; p<0.05) in the exposed group. There was a significant association between the time in months spent at work and DNA damage in lymphocytes (rs = 0.720; p<0.001) and buccal cell with MN (rs = 0.538; p<0.001). Because laser printers and photocopiers have become increasingly used, it is important to control human exposure using reliable biomarkers.
Duloxetine in the management of depression

Duloxetine is a serotonin and noradrenalin reuptake inhibitor, and is hence in the same pharmacological class as venlafaxine. Randomized controlled trials have demonstrated it to be effective in the treatment of depression and also that it has analgesic properties in diabetic neuropathic pain, fibromyalgia and depressed patients with pain. To date, there is limited published data comparing duloxetine with other antidepressants. However, what data are available suggest that duloxetine is more effective than selective serotonin reuptake inhibitors in severely depressed patients (although the magnitude of this difference is uncertain) and equally effective as venlafaxine. While, theoretically, a serotonin and noradrenalin reuptake inhibitor may be more effective than a selective serotonin reuptake inhibitor in depressed patients with pain, there are no randomized, controlled trial data to support this hypothesis. Generally, duloxetine is well tolerated and there is no suggestion of the recent concerns of car.
Prevalência e fatores associados à sintomatologia dolorosa entre profissionais da indústria têxtil

O trabalho tem um papel importante na vida do homem, pois, alem de ser fonte do seu sustento, e onde ele pode sentir-se util, produtivo e valorizado. Entretanto, quando realizado sob condicoes improprias, pode provocar diversos niveis de prejuizo a saude, como a dor musculo-esqueletica, que e caracterizada ainda por possuir origem multifatorial. Desta forma, foi realizado um estudo transversal objetivando analisar a influencia dos fatores sociodemograficos e aspectos relacionados ao trabalho e as condicoes de saude sobre a sintomatologia dolorosa, em profissionais do setor textil. A amostra foi constituida de 162 funcionarios que trabalhavam com corte-costura na divisao industrial da ACT (Associacao Comunitaria para o desenvolvimento do Trairi) no municipio de Santa Cruz - RN, Brasil. Apos analise bivariada e multivariada observou-se associacao independente da sintomatologia dolorosa com as variaveis sexo feminino (p= 0,013), tempo de ocupacao ha mais de seis meses (p= 0,005), presenca de outros problemas de saude (p= 0,002) e trabalhar em pe (p = 0,001). Nesse contexto, pode-se concluir que houve uma alta prevalencia de dor entre os profissionais estudados, e que esta possui associacao significativa com varios aspectos relacionados ao trabalho, e alguns fatores sociodemograficos e de saude, sendo portanto necessaria uma atuacao interdisciplinar, multiprofissional e intersetorial, de forma a interferir positivamente no processo de trabalho e na saude do trabalhador.
The Role of Intrauterine Insemination in the Therapy of Infertile Women with Endometriosis

Purpose Laparoscopy is considered the gold standard for the diagnosis and treatment of endometriosis. Controlled ovarian hyperstimulation-intrauterine insemination (COH-IUI) is often used to treat women with infertility associated with endometriosis. The objective of the study was to assess the pregnancy rate following surgery, and 6 month GnRH analogue (GnRH-a) therapy, and to assess whether a combined approach with laparoscopic surgery and GnRH-a followed by COH-IUI can improve the overall pregnancy rate. Methods A prospective study was performed on 119 infertile patients who underwent laparoscopic surgery and GnRH-a therapy for endometriosis and returned for a follow-up for a period of time between one and 10 years. Results The pregnancy rate attained after the integrated laparoscopy–GnRH-a–COH-IUI approach was 51.6%. The pregnancy rate after surgery and GnRH-a therapy was significantly lower (41.8%). The fecundity rate for spontaneous conception within 6 months of laparoscopy and GnRH-a treatment (27%) was significantly higher (P<.05) than for the following intervals. Cumulative fecundity in women aged older than 35 was significantly lower than in younger women. Conclusions In patients with endometriosis-associated infertility, surgery and GnRH-a therapy followed by COH-IUI is more effective than surgery and GnRH-a therapy. When patients fail to conceive spontaneously, after a maximum of one year following laparoscopic surgery and GnRH-a, COH-IUI or In Vitro Fertilization Embryo Transfer (IVF-ET) should be recommended.
Pulmonary hypertension in patients with advanced heart failure is associated with increased levels of interleukin-6

Abstract Context: Inflammatory, endothelial and neurohormonal biomarkers are involved in heart failure (HF) and pulmonary hypertension (PH) pathogenesis. Objective: To study these biomarkers in PH due to advanced HF. Materials and methods: Thirty adults with HF were included. Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hsCRP), endothelin-1 and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were measured in peripheral vein and pulmonary artery during right heart catheterisation. Results: IL-6, TNF-α, hsCRP and NT-proBNP correlated with pulmonary pressures independent of ventricular function, HF etiology and vascular bed. IL-6 was independent predictor of systolic pulmonary artery pressure (sPAP). Discussion and conclusion: Inflammatory biomarkers correlate to PH severity. IL-6 predicts sPAP in advanced HF.
Can interprofessional collaboration provide health human resources solutions? A knowledge synthesis

Many studies examine the impact of interprofessional (IP) interventions on various health practice and education outcomes. One significant gap is the lack of research on the effects of IP interventions on health human resource (HHR) outcomes. This project synthesized the literature on the impact of IP interventions at the pre- and post-licensure levels on quality workplace, staff satisfaction, recruitment, retention, turnover, choice of employment and cost effectiveness. Forty-one peer-reviewed articles and five IECPCP project reports were included in the review. We found that IP interventions at the post-licensure level improved provider satisfaction and workplace quality. Including IP learning opportunities into practice education in rural communities or in less popular healthcare specialties attracted a higher number of students and therefore may increase employment rates. This area requires more high quality studies to firmly establish the effectiveness of IP interventions in recruiting and retaining future healthcare professionals. There is strong evidence that IP interventions at the post-licensure level reduced patient care costs. The knowledge synthesis has enhanced our understanding of the relationships between IP interventions, IP collaboration and HHR outcomes. Gaps remain in the knowledge of staff retention and determination of staffing costs associated with IP interventions vis-à-vis patient care costs. None of the studies reported long-term data on graduate employment choice, which is essential to fully establish the effectiveness of IP interventions as a HHR recruitment strategy.
Prevalence and behavioral risk factors associated with road traffic accidents among medical students of Arabian Gulf University in Bahrain

Background: Road traffic accidents are ranked by the World Health Organization as the 10th leading cause of death globally. An estimated 1.3 million people were killed annually in car crashes and as many as 50 million were injured in 2011. Road injuries are the second leading cause of death among people aged 20–24 years, particularly males. Objective: To raise awareness about road traffic accidents and their causes and consequences among medical students in Arabian Gulf University (AGU) in Bahrain. Materials and Methods: A retrospective cross-sectional study was conducted in AGU, Bahrain, in the period between 22 September and 3 October, 2013. Medical students of AGU aged 20–24 years who drove in Bahrain during the period (January 2011–December 2012) were chosen. A total of 200 students were selected. A questionnaire was used to collect the demographic and driving behavior data for each participant. The data were entered and analyzed using SPSS program, version 18. Results: Most of the students (73.4%) were involved in an accident during 2011. The most important leading cause of accidents was the other driver (48.1%). The majority of the students (42.3%) experienced both physical and psychological injuries. The data showed that driving at excess speed when in a hurry, crossing red traffic lights, and wearing seatbelts are statistically significant behavioral factors. Conclusion: The prevalence of road traffic accidents is very high among medical students in AGU. The study revealed that the major cause of these accidents is attributed to the other driver. Of these accidents, 31.7% resulted in injuries; most of which were combined (physical and psychological).
Sistema de salud de Colombia

This document briefly describes the health conditions of the Colombian population and, in more detail, the characteristics of the Colombian health system. The description of the system includes its structure and coverage; financing sources; expenditure in health; physical material and human resources available; monitoring and evaluation procedures; and mechanisms through which the population participates in the evaluation of the system. Salient among the most recent innovations implemented in the Colombian health system are the modification of the Compulsory Health Plan and the capitation payment unit, the vertical integration of the health promotion enterprises and the institutions in charge of the provision of services and the mobilization of additional resources to meet the objectives of universal coverage and the homologation of health benefits among health regimes.
Interprofessional student experiences on the HAVEN free clinic leadership board

Abstract In this study, we examined the experiences of students serving on the leadership board of HAVEN – the student-run free clinic of the Yale University health professional schools. Open-ended responses were collected from 18 of the 28 members of the 2011–2012 leadership board through an online survey. Students reported an overall positive experience participating on the board and valued the opportunity to be part of a committed community creating change. The majority of students reported that their time as a board member had improved their attitude towards interprofessional collaboration (78%) and had also fostered their leadership skills (67%). Around two thirds (67%) reported that their experience had positively impacted their future career plans, either reinforcing their desire to work with underserved populations or encouraging them to pursue leadership roles. Based on these data, it is suggested that the HAVEN Free Clinic offers a useful opportunity for students to experience the demands of clinical care leadership while working together in an interprofessional context.
The Use of Honey in Diabetes Mellitus: Is It Beneficial or Detrimental?

Diabetes mellitus is a metabolic disorder that is characterized by chronic hyperglycemia, due to defects in insulin secretion and/or action activity (1). In the past decades, there has been a renewed interest in the use of natural products, including herbs and honey, in the treatment of diabetes. This commentary is written to allay fears that the use of honey is detrimental in diabetes. Recent findings indicate that honey improves glycemic control and exerts hypoglycemic effect in non-diabetic, alloxanand streptozotocin-induced diabetic rats (2-5). The combination of antidiabetic drugs with honey further improves glycemic control in diabetic rats (6). In humans, honey supplementation reduces hyperglycemia (3, 7). Only one study suggests that the use of honey in diabetes is detrimental, observing that honey-supplemented diabetic patients had significantly increased glycosylated hemoglobin (8). In contrast, no such effect was observed in diabetic controls (8). The findings from this study seem to suggest that the use of honey worsens glycemic control in diabetes. However, a closer examination of the study design and the honey that was used in the study indicates that such a conclusion is invalid. First, the honey-treated diabetic group received graded doses of honey orally for 8 weeks, starting from 1 g/kg/day for the first and second weeks, 1.5 g/kg/day for the third and fourth weeks, 2 g/kg/ day for the fifth and sixth weeks, and 2.5 g/kg/day for the seventh and eight weeks (8). Increasing the dose of any pharmacological agent, including honey, without proper therapeutic monitoring is inappropriate. Second, the majority of honey samples contain more fructose than glucose (or the same proportion) or fructose: glucose ratio ≥ 1.0 (6, 9). The honey used in the study had more glucose than fructose (fructose:glucose ratio, 0.46) (9), meaning that the amount of glucose in this honey was twice the amount of fructose. The reason for the unusually high glucose content in this honey remains unclear. Whether this honey was adulterated, in whatever form, without the authors’ knowledge is another subject entirely (10). This issue is significant due to its clinical implications in diabetic patients. Compelling evidence implicates the role of fructose in the hypoglycemic effect of honey (3). Therefore, administering honey that contains fructose levels that are twice as low compared with other honeys might not produce a similar effect as other honey varieties with high fructose contents. Further, administering Copyright c 2012 Kowsar M. P. Co. All rights reserved.
“A golden opportunity”: Exploring interprofessional learning and practice in rural clinical settings

Abstract Little is known about interprofessional practice (IPP) and interprofessional learning (IPL) in rural health services, despite national funding and continuing emphasis on increasing students’ clinical placements in rural areas. This short paper outlines a study in Tasmania, Australia, which investigated how and under what contexts and conditions IPP and IPL occur in rural clinical settings, and the enabling factors and strategies that promote this learning and practice. This study employed a mixed method design comprising focus group discussions and a survey involving health professionals from two rural health services. The findings demonstrate that formal and informal arrangements, the collaborative nature of small, close-knit healthcare teams and patient-centred models of care employed in rural practice settings, provide ideal contexts for IPP and IPL. The study has implications for promoting organisational readiness for IPP and IPL and harnessing the potential of rural services to promote and develop students’ interprofessional capability.
A review of instruments to measure interprofessional collaboration for chronic disease management for community-living older adults

ABSTRACT It is acknowledged internationally that chronic disease management (CDM) for community-living older adults (CLOA) is an increasingly complex process. CDM for older adults, who are often living with multiple chronic conditions, requires coordination of various health and social services. Coordination is enabled through interprofessional collaboration (IPC) among individual providers, community organizations, and health sectors. Measuring IPC is complicated given there are multiple conceptualisations and measures of IPC. A literature review of several healthcare, psychological, and social science electronic databases was conducted to locate instruments that measure IPC at the team level and have published evidence of their reliability and validity. Five instruments met the criteria and were critically reviewed to determine their strengths and limitations as they relate to CDM for CLOA. A comparison of the characteristics, psychometric properties, and overall concordance of each instrument with salient attributes of IPC found the Collaborative Practice Assessment Tool to be the most appropriate instrument for measuring IPC for CDM in CLOA.
“It goes beyond good camaraderie”: A qualitative study of the process of becoming an interprofessional healthcare “teamlet”

ABSTRACT Within the US, the patient-centred medical home has become a predominant model in the delivery of primary care. This model requires a shift from the physician-centric model to an interprofessional team-based approach. Thus, healthcare staff are being reorganized into teams, resulting in having to work and relate to one another in new ways. In 2010, the Veterans Health Administration implemented the patient aligned care team (PACT) model, its version of the patient-centred medical home. The transition to the PACT model involved restructuring primary care staff into “teamlets”, consisting of a registered nurse, licensed practical nurse, and administrative clerk for each full-time-equivalent primary care provider. This qualitative study used observation and semi-structured interviews to understand the factors that affect teamlet functioning as they implement this new model of care and how teams are interacting to address those factors. Findings suggest that role understanding includes understanding how each teamlet member’s tasks are performed in the daily operations of the clinic. In addition, willingness to perform tasks that benefit the teamlet and acceptance of delegation from all teamlet members were found to be important for teamlet functioning and cohesion. In order for healthcare teams to provide patient-centred care, it is important to provide guidance and support about what these new relationships and roles will entail. The building of team relationships is not a static process; ways of working together build over time and, therefore, should be seen as a continuous cycle of quality improvement.
Intravenous Iron Is Effective and Safe in Correcting Anemia in Erythropoietin-Treated Hemodialysis Patients

Abstract Objectives: To study the effect of intravenous iron in the management of anemia in erythropoietin (EPO) treated hemodialysis patients with poor response to treatment with oral iron. Methods: Thirty-six patients (27 men and 9 women) with serum hemoglobin of less than 10 g/dl and a serum ferritin level of less than 500 mcg /l were included in the study. Each patient received 100 mg of intravenous iron at end of dialysis for 10 consecutive dialysis treatments, and once weekly of regular intravenous iron supplementation for another 13 weeks included in the study. All patients were receiving oral iron supplements (ferrous sulphate 325 mg twice daily), and were all also receiving EPO, a total dose of 8000 units per week, given subcutaneous as 4000 unit twice weekly throughout the study. The primary end point of this study was hemoglobin level at 4 months of starting intravenous iron supplementation. Results: The mean hemoglobin increased from 8.88 g/dl to11.18 g/dl over the period of the study (4 months) (p<0.0001). The mean serum ferritin increased from 179 mcg/l to 444 mcg/l over the same period (P<0.0001). Conclusion: Intravenous iron supplementation is very effective in correcting a poor response to EPO in hemodialysis patients on oral iron supplements.
Interprofessional staff development: Changing attitudes and winning hearts and minds

As more educators are involved in interprofessional education (IPE) it is important to consider how participation affects those who are sceptical about IPE. We report a prospective study in which the attitudes of 13 educators, unfamiliar with IPE, were compared before and after facilitating their first IPE. Their views, obtained as personal stories, were analysed through cognitive dissonance theory. Prior to teaching, all novice educators had concerns about IPE. Post-facilitation all were more positive about the value and meaning of IPE.
Learning how to change: a selective analysis of literature and experience of how teams learn and organisations change

This paper draws on the authors' experience, derived from organising higher degree courses (in health care policy and in education) for practitioners from across the public sector, and from their respective experiences of research on change in higher education and the health services. It highlights the importance of understanding how teams learn to change and what actually constitutes ‘change’, in order to enhance professional effectiveness. Four key texts are identified, and analysed in depth, to focus on the concept of change and the process of team learning, from both theoretical and practical perspectives. Common themes from the papers are then elaborated in some detail before the implications arising from these themes are explored Examples, drawn from student experience demonstrate how theory can be used to illuminate and enhance practice. It is shown that it is better to use a limited theory, critically and with discrimination, than to use no theory at all.