Miracle-dz/UniFAR-FTUs huggingface dataset:
Retombées des ordonnances collectives dans le suivi diabétique conjoint en soins primaires : une étude de cas

Le fardeau des maladies chroniques commande de repenser l’organisation des services et la prestation des soins. Des amenagements parfois organisationnels, parfois legislatifs permettent aux non-medecins d’etre plus actifs dans le suivi des maladies chroniques. Au Quebec, depuis 2003, une nouvelle structure organisationnelle, les groupes de medecine de famille, et une nouvelle modalite d’ordonnance medicale, les ordonnances collectives (OC), se deploient progressivement. Un cas-type a ete retenu parmi 52 participants a une enquete provinciale afin d’explorer les retombees des OC sur les pratiques professionnelles, les interactions medecin-infirmiere-patient et l’autogestion dans le contexte du suivi diabetique. Quinze heures d’observation, 200 documents et des entrevues individuelles aupres de dix patients, trois infirmieres et huit medecins ont ete analyses. Unanimement, les participants reconnaissent que l’autogestion est stimulee par le suivi conjoint. Bien que des conditions liees aux professionnels et aux patients modulent leurs interactions, la triade s’orchestre efficacement selon un mouvement de convergence. Pour les professionnels, les OC permettent une meilleure concordance entre leur emploi du temps, leurs competences et le sens qu’ils accordent a leur pratique. Pour les patients, la progression de leurs competences a l’autogestion et l’acces aise aux soins sont rassurants. Des moyens concrets comme les OC modifient la prestation des soins en misant sur la collaboration professionnelle et facilitent la mobilisation des patients, en accord avec le Chronic Care Model (CCM) [1].
Treatment of growing teratoma syndrome.

To the Editor: Growing teratoma syndrome consists of an enlarging mature teratoma arising during or after chemotherapy for a nonseminomatous germ-cell tumor, with normal serum levels of alpha-fetoprotein and human chorionic gonadotropin.1 The preferred treatment is complete surgical resection2 because teratomas are resistant to chemotherapy and radiation therapy. Although embryonal carcinomas express little or no retinoblastoma protein (pRB),3 mature teratomas express high levels of pRB. Normally, cyclin-dependent kinase 4/6 (CDK4/6) stimulates cell growth by phosphorylating pRB. The development of selective CDK inhibitors,4 including PD0332991 (Pfizer), which selectively inhibits CDK4/6, suggests a new treatment for growing teratoma syndrome. We report on .
Prevalence of intestinal metaplasia and dysplasia in infectious and non-infectious chronic gastritis

Background: Objective of current study was to estimate the prevalence of intestinal metaplasia in dyspeptic patients in Duhok (Kurdistan region) and its association with H. pylori and dysplasia according to gender and age. Methods: This was a prospective observational study. Study was conducted from Jan 2012 to Jul 2014 at Azadi Teaching Hospital Duhok City. A total number of 205 antral gastric biopsies were collected in Azadi GIT-Centre and examined histologically to detect intestinal metaplasia. These biopsies were stained by Giemsa to detect H. pylori organisms. Results: H. pylori was found in 94 (46%) patients while intestinal metaplasia in general was found in 30 (15%) patients; (9.8% in association with H. pylori ) and (4.7% without H. pylori ). Among intestinal metaplasia 6 cases show dysplasia (6/205 = 3%). Conclusions: This study has documented mainly that the prevalence of intestinal metaplasia is significant among patients (In Duhok) with chronic gastritis and mainly in those patients who are positive for H. pylori with an active chronic gastritis. Intestinal metaplasia mostly affects patients above the age of 40 years with no significant gender difference.
Vergleichende Untersuchungen Über Blutspiegel Von Mepivagain Nach Resorption Aus Verschiedenen Geweben

Der Anteil der lokalen, regionalen und therapeutischen Anaesthesien an allen Betaubungen in unserem Bereich betragt etwa 37%. Fur diese Anaesthesien venvenden wir seit 1957 ausschliesslich Mepivacain ohne oder rnit Adrenalin-Zusatz 1 : 400.000 bis 1 : 200.000. In der klinischen Arbeit envies sich im allgemeinen eine Dosierung bis zu 6 mg pro kg Korpergewicht Mepivacain als sicher und ausreichend. Von dieser Dosis wichen wir bei Applikationen im Gesicht, Mundund Rachenbereich ab. Wegen der starken Vascularisation dieser Gewebe rnit gesteigerter Resorptionsmoglichkeit haben wir hier die Dosis von 2 mg pro kg Korpergewicht gewddt. Unter den aufgefuhrten Bedingungen interessierten uns die Blutspiegel nach ortlichen und regionalen Anaesthesien rnit Mepivacain. Einleitend mochten wir unsere friiheren Ergebnisse ( M A ~ H E S , CHABERT)~ bei der supraclavicularen Blockade des Plexus brachialis nach KULENKAMPFF~ in der Modifikation von PAT RICK^ im Vergleich mit der subcutanen Applikation in die Bauchdecke demonstrieren. Wir fanden bei einer Dosierung von 6 mg pro kg Korpergewicht Mepivacain ohne Adrenalin-Zusatz folgende Werte (Abb. 1). Das Blutspiegel-Maximum bei supraclavicularer Injektion wurde nach 15 Minuten rnit 2,l ,ug/ml, nach subcutaner Injektion in die Bauchdecke nach 30 Minuten rnit 1,25 ,ug/ml erreicht.
Sexual concerns among kidney transplant recipients

Little is known about the specific sexual concerns of kidney transplant (KTx) recipients. The primary objectives of this study were to: (i) describe the importance of sexuality to KTx recipients; (ii) investigate the sexual concerns of KTx recipients; and (iii) examine the relationship between sexual concerns and quality of life (QOL). A secondary objective was to examine potential sexual concern differences by gender, pre‐transplant dialysis status, and donor type.
Report of an audit of child protection research in Ireland 1990-2009.

A total of 190 research documents were identified in line with the criteria agreed between the researchers and the CAAB, and are included in the audit. The key findings from the analysis of the audit are as follows: - Research identified in the audit has tended to focus on child protection and the child protection system generally, as well as sexual abuse. This research has primarily been undertaken by clinicians and academics, and spans across sectors. - Over half, (110 or 58%) of the research falls under the heading of policy/practice reviews/analysis. This is further reflected in the fact that the research most commonly focused on operating procedures, followed by practice issues and the policy framework, both in studies with a single focus and those with multiple foci. - The most common type of publication was peer reviewed article (74 or 39%), with commissioned research accounting for just 7% (13). This is in line with the findings that 68% (128) of commissioning/publishing bodies and 74% (139) of research bodies were in the academic sector. - The research published and/or commissioned by the statutory sector follows the pattern found in the audit generally, with the most common type of study being policy/practice review/analysis (27 or 48%) and the most common focus being operating procedures (22 or 39%). - Information sources rarely incorporated primary research with children, with only 14 studies (8%) citing direct contact with children and young people. Information on children was more commonly gathered from case files, professionals and family members. - The topics covered in the identified research were very wide-ranging but closely related to the primary subject area (type of abuse) and the sector in which the research was located. One conclusion stated that: There is a shortage of child protection-focused research on the factors that cause and perpetuate child abuse, such as homelessness, addiction, parental mental illness and domestic violence. The need for material on these areas is demonstrated by the nature and scale of reports to the child protection system and the removal of some children from their families into out of home care as a result of the above mentioned adversities.
The potential of information technology for nurses in primary care: a review of issues and trends

This article presents a review of current issues and trends in the use of information technology (IT) by nurses in primary care. Its aim is to raise awareness of the particular problems faced by nurses, and so it is not aimed at the IT expert but at the primary care nurse, researcher or educator who seeks a wider perspective on the issues involved. It is not the purpose of this paper to offer specific solutions to the problems; these will be discussed in further publications. The first section highlights recent policy changes in the area of information technology that are already affecting nurses in primary care. The second section addresses some of the barriers to progress in this area, which should be taken into account if the Government's vision of an IT-rich health service is to be achieved. To draw attention to the fact that nurses in other countries face similar issues to those in the UK, we include a wide selection of international as well as national literature. Finally, the third section suggests how these barriers might be overcome, and identifies emerging trends.
ASSESSMENT OF OVARIAN CHANGES AROUND OVULATION IN BITCHES BY ULTRASONOGRAPHY, LAPAROSCOPY AND HORMONAL ASSAYS

To identify the time characteristics of ovulation, 5 bitches were evaluated during heat by ultrasonography, laparoscopy and hormonal assay. Blood collections for progesterone and oestradiol 17-β assys and ultrasonography were performed every day and laparoscopy every other day. At ultrasonography, ovaries appeared as anechoic structures about 5 days before the estimated LH peak and gradually increased in size. The greatest changes were observed between days 2 and 4 post-LH peak: echogenicity varied greatly from one animal to another and from one day to the following going from totally anechoic to mixed hypo and hyperechogenicity. Then from day 6, ovaries always appeared as hypoechoic structures assimilated to corpora lutea. At laproscopy, small follicies were seen as early as day 10 before the LH peak. Their size slowly increased to become large protubering follicies around the day of LH peak (day 0). At day 1, corpra luta were observed for the first time and were present in all animals by day 5. During that period preceeding day 5, some ovaries had both corpora lutea and follicies clearly visible on their surface. In one animal, haemorrhagic foci were observed at day 3. Neither ultrasonography, nor laparoscopy allowed precise determination of the time of ovulation. Indeed, follicle collapses was never observed, but changes in echogenicity and in the appearance of the ovaries observed by laparoscopy, suggested that ovulation occurred between days 2 and 4 when progestrone concentrations were 12.6 ± 6.2 and 32.1 ± 10.9 nmol/L, respectively.
EMMPRIN expression is involved in the development of interstitial fibrosis and tubular atrophy in human kidney allografts

Matrix metalloproteinases (MMP) are involved in the development of interstitial fibrosis and tubular atrophy (IF/TA) in renal disease. The synthesis of MMP is activated by the extracellular matrix metalloproteinases inducer protein (EMMPRIN). To analyze the role of EMMPRIN in IF/TA, we retrospectively detected EMMPRIN expression in specimens of human renal allografts with various levels of IF/TA.
Pharmacoepidemiology of cytomegalovirus prophylaxis in a large retrospective cohort of kidney transplant recipients with Medicare Part D coverage

We assembled a cohort of 21 117 kidney transplant patients from July 2006 to June 2011 with Medicare Part D coverage using US Renal Database System data to determine real‐world use of cytomegalovirus (CMV) prophylaxis. CMV prophylaxis was defined as filled prescriptions for daily oral valganciclovir (≤900 mg), ganciclovir (≤3 g), or valacyclovir (6–8 g) within 28 d of transplant. Multilevel logistic regression analyses were performed to determine factors associated with CMV prophylaxis. CMV prophylaxis (97% valganciclovir) was identified in 61% of kidney transplant recipients (median duration, 64 d); 71% of seronegative recipients of kidneys from seropositive donors (D+/R−); 63% of R+ patients; 60% of patients with unknown serostatus; and 34% of D−/R− patients. Variability in usage of prophylaxis among transplant centers was greater than variability within transplant centers. One in four transplant centers prescribed CMV prophylaxis to >60% of their D−/R− patients. CMV donor/recipient serostatus, lymphocyte‐depleting agents for induction and mycophenolate for maintenance were associated with CMV prophylaxis. CMV prophylaxis was commonly used among kidney transplant recipients. Routine prescription of CMV prophylaxis to D−/R− patients may have occurred in some transplant centers. Limiting unnecessary use of CMV prophylaxis may decrease healthcare costs and drug‐related harms.
The Aboriginal Mental Health Worker Program: The challenge of supporting Aboriginal involvement in mental health care in the remote community context

Abstract This paper draws on our experience as evaluators of the Aboriginal Mental Health Worker Program that has been operating in eight remote communities across the Top End of the Northern Territory, Australia, for over four years. The program aimed to fund the placement of Aboriginal Mental Health Workers (AMHWs) in remote community health centres, to work under the clinical leadership of General Practitioners and to contribute to development of a culturally appropriate community based mental health care service for Indigenous people. In this paper, we examine the key features of the AMHW program and the originating partnership, the degree of integration of AMHWs in health centre processes and the provision of support for the development of the AMHW role in community mental health work. While there are many examples in this program of AMHWs providing highly valued services within their communities, the evaluation showed that the program did not achieve clear commitments to develop mental health practice around the AMHWs’ role. In addition there was variability in levels of local managerial support for the AMHWs, vulnerability to staff turnover and other discontinuities, as well as tensions in views about what the role of the AMHWs should be. Should it be culturally informed, clinically-related mental health work or community ‘wellbeing work’, and how should each role be supported? Together these factors undermined the sustainability of positive achievements within the program.
Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial.

IMPORTANCE Sentinel lymph node (SLN) surgery provides reliable nodal staging information with less morbidity than axillary lymph node dissection (ALND) for patients with clinically node-negative (cN0) breast cancer. The application of SLN surgery for staging the axilla following chemotherapy for women who initially had node-positive cN1 breast cancer is unclear because of high false-negative results reported in previous studies. OBJECTIVE To determine the false-negative rate (FNR) for SLN surgery following chemotherapy in women initially presenting with biopsy-proven cN1 breast cancer. DESIGN, SETTING, AND PATIENTS The American College of Surgeons Oncology Group (ACOSOG) Z1071 trial enrolled women from 136 institutions from July 2009 to June 2011 who had clinical T0 through T4, N1 through N2, M0 breast cancer and received neoadjuvant chemotherapy. Following chemotherapy, patients underwent both SLN surgery and ALND. Sentinel lymph node surgery using both blue dye (isosulfan blue or methylene blue) and a radiolabeled colloid mapping agent was encouraged. MAIN OUTCOMES AND MEASURES The primary end point was the FNR of SLN surgery after chemotherapy in women who presented with cN1 disease. We evaluated the likelihood that the FNR in patients with 2 or more SLNs examined was greater than 10%, the rate expected for women undergoing SLN surgery who present with cN0 disease. RESULTS Seven hundred fifty-six women were enrolled in the study. Of 663 evaluable patients with cN1 disease, 649 underwent chemotherapy followed by both SLN surgery and ALND. An SLN could not be identified in 46 patients (7.1%). Only 1 SLN was excised in 78 patients (12.0%). Of the remaining 525 patients with 2 or more SLNs removed, no cancer was identified in the axillary lymph nodes of 215 patients, yielding a pathological complete nodal response of 41.0% (95% CI, 36.7%-45.3%). In 39 patients, cancer was not identified in the SLNs but was found in lymph nodes obtained with ALND, resulting in an FNR of 12.6% (90% Bayesian credible interval, 9.85%-16.05%). CONCLUSIONS AND RELEVANCE Among women with cN1 breast cancer receiving neoadjuvant chemotherapy who had 2 or more SLNs examined, the FNR was not found to be 10% or less. Given this FNR threshold, changes in approach and patient selection that result in greater sensitivity would be necessary to support the use of SLN surgery as an alternative to ALND. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00881361.
Heparin infusion in simultaneous pancreas and kidney transplantation reduces graft thrombosis and improves graft survival

Thrombosis of the pancreas after transplantation is the most common cause of relaparotomy and resultant graft loss. There is currently no standard protocol consistently proven to prevent thrombosis following transplantation. Our objective was to determine whether our protocol of post‐operative low‐dose intravenous (IV) heparin infusion would prevent graft thrombosis without additional complications in our patients.
Mortality attributable to smoking in China.

To the Editor: Gu and colleagues (Jan. 8 issue)1 report that in 2005, an estimated 673,000 deaths in China were attributable to smoking. The study is of timely importance. But it did not include some important variables in the analysis. First, the effects of family income were not considered. In China, social deprivation is a major risk factor for ill health,2 and data from a survey about household income and cigarette consumption3 and from a study involving low-income employees4 showed that smoking was associated with relatively high income. Without this adjustment, the association of mortality with smoking may have been attenuated. Second, the analysis did not include passive smoking. Nonsmokers may have been exposed to passive smoking, leading to the higher mortality in the reference group. Third, the number of deaths in rural China, where 70% of the population lives, may have been underestimated. It is interesting that the authors observed a lower relative risk of death associated with smoking in rural areas than in urban areas. In rural areas, persons who never smoked would be poorer and consume less nutritious foods than their counterparts who smoked and thus would have a higher mortality, reducing the association.
Cysteine-rich angiogenic inducer 61 (Cyr61): a novel soluble biomarker of acute myocardial injury improves risk stratification after acute coronary syndromes

Aims We aimed to identify a novel biomarker involved in the early events leading to an acute coronary syndrome (ACS) and evaluate its role in diagnosis and risk stratification. Methods and results Biomarker identification was based on gene expression profiling. In coronary thrombi of ACS patients, cysteine-rich angiogenic inducer 61 (Cyr61, CCN1) gene transcripts were highly up-regulated compared with peripheral mononuclear cells. In a murine ischaemia-reperfusion model (I/R), myocardial Cyr61 expression was markedly increased compared with the controls. Cyr61 levels were determined in human serum using an enzyme-linked immunosorbent assay. Cohorts of ACS (n = 2168) referred for coronary angiography, stable coronary artery disease (CAD) (n = 53), and hypertrophic obstructive cardiomyopathy (HOCM) patients (n = 15) served to identify and evaluate the diagnostic and prognostic performance of the biomarker. Cyr61 was markedly elevated in ST-elevation myocardial infarction patients compared with non-ST-elevation myocardial infarction/unstable angina or stable CAD patients, irrespective of whether coronary thrombi were present. Cyr61 was rapidly released after occlusion of a septal branch in HOCM patients undergoing transcoronary ablation of septal hypertrophy. Cyr61 improved risk stratification for all-cause mortality when added to the reference GRACE risk score at 30 days (C-statistic 0.88 to 0.89, P = 0.001) and 1 year (C-statistic 0.77 to 0.80, P < 0.001) comparable to high-sensitivity troponin T (30 days: 0.88 to 0.89, P < 0.001; 1 year: 0.77 to 0.79, P < 0.001). Similar results were obtained for the composite endpoint of all-cause mortality or myocardial infarction. Conversely, in a population-based case-control cohort (n = 362), Cyr61 was not associated with adverse outcome. Conclusion Cyr61 is a novel early biomarker reflecting myocardial injury that improves risk stratification in ACS patients.
Early conversion to belatacept after renal transplantation

Belatacept is a non‐nephrotoxic immunosuppressive agent, which may make it the ideal agent for patients with delayed or slow graft function on calcineurin inhibitors. There are limited data on conversion of patients to belatacept within 6 months of transplantation. Between January 2012 and December 2015, 16 patients were converted to belatacept for delayed or poor graft function (eGFR<30 mL/min/1.73 m2, MDRD); three were HIV positive. Conversion protocols were analyzed in patients ≤4 months and 4‐6 months post‐transplantation. Mean serum creatinine levels after belatacept conversion were compared with preconversion levels. Patient survival was 100%, and graft survival was 88%. The mean creatinine fell from 3.9±1.82 mg/dL prebelatacept conversion to 2.1±1.1 mg/dL at 6 months and 1.9±0.47 mg/dL (median 1.8 mg/dL) at 12 months postconversion. There was no significant increased risk of rejection, infection, or malignancy. HIV parameters remained largely stable. Early conversion to belatacept in patients with DGF or slow graft function is safe and efficacious, in a single‐center nonrandomized retrospective analysis.
Why and How do Latino Parents get Involved in their Children's Education? A Test of Hoover-Dempsey and Sandler's Model with Middle School Parents in a Community School

This study used qualitative interviews to explore and describe the perceptions of Latino and Puerto Rican parents in a community middle school about if, why, and how Latino families decide to engage in their children’s schooling. All 15 Latino parents perceived that they held or shared responsibility with the school for their child’s educational success (parent or partnership-focused). Parents reported involvement despite their perceptions of low levels of knowledge and skills, and/or time and energy. Parents responded to school, teacher, and student invitations for involvement; however, no parent described the school as a community school and few parents reported teacher invitations. Parents reported much more home-based involvement than school-based involvement. All parents reported talking to their children in ways that communicated values, goals, expectations, or aspirations, yet only one parent reported planning for postsecondary education. Implications for further research with Latino parents and school practice are presented.