Miracle-dz/UniFAR-FTUs huggingface dataset:
Communication and Outcomes of Visits Between Older Patients and Nurse Practitioners

Background:Effective patient-clinician communication is at the heart of good healthcare and may be even more vital for older patients and their nurse practitioners (NPs). Objectives:The objectives of this study were to examine 1)contributions of older patients' and NPs' characteristics and the content and relationship components of their communication to patients' proximal outcomes (satisfaction and intention to adhere) and longer term outcomes (changes in presenting problems, physical health, and mental health), and 2) contributions of proximal outcomes to longer term outcomes. Methods:Visits were video-recorded for a statewide sample of 31 NPs and 155 older patients. Patients' and NPs' communications during visits were measured using the Roter Interaction Analysis System for verbal activities, a check sheet for nonverbal activities, and an inventory of relationship dimension items. Proximal outcomes were measured with single items after visits. At 4 weeks, change in presenting problems was measured with a single item, and physical and mental health changes were measured with the SF-12 Version 2 Health Survey. Mixed-model regression with backward deletion was conducted until only predictors with p ≤ . 05 remained in the models. Results:With the other variables in the models held constant, better outcomes were related to background characteristics of poorer baseline health, nonmanaged care settings, and more NP experience; to a content component of seeking and giving biomedical and psychosocial information; and to a relationship component of more positive talk and greater trust and receptivity and affection, depth, and similarity. Poorer outcomes were associated with higher rates of lifestyle discussion and NPs' rapport building that patients may have perceived to be patronizing. Greater intention to adhere was associated with greater improvement in presenting problems. Discussion:Older patient-NP communication was effective regarding seeking and giving biomedical and psychosocial information other than that involving lifestyle. Studies of ways to improve older patient-NP lifestyle discussions and rapport building are needed.
Using the Colored Eco-Genetic Relationship Map With Children

Background: The Colored Eco-Genetic Relationship Map (CEGRM) is a hybridized assessment tool that combines the ecomap, the family genogram, and the genetic pedigree to produce a unique, participant-generated picture of an individual's social networks, information exchange patterns, and sources of support. To date, the CEGRM has been used successfully with adults, providing insights into their social networks and the communication patterns they use in the update and exchange of health-related information. Objective: To explore the feasibility and the utility of adapting elements of the CEGRM for use with children. Methods: Twenty children, 7 to 10 years of age, distributed by gender, socioeconomic status, and geographic heritage, participated in one-on-one sessions in which they created modified CEGRMs using adapted art directives. A qualitative descriptive design and approach to analysis were used. Results: Children were able to create a modified CEGRM, and resultant discussions provided considerable insights. A focused analysis revealed a kaleidoscope of social networks being accessed by today's children as well as surprising information exchange sources and patterns. Although all the children included one parent, family composition varied. Extended family, other adults, peers, and media sources were not only prevalent but also often preferred over the nuclear family as sources of health information. Of particular interest, mothers were rarely identified as children's primary source of health-related information. Discussion: Elements of the CEGRM are adapted easily for use with children using children's drawings and may prove to be an effective, adjunctive assessment and interventional tool for parents, researchers, educators, and providers working with young children.
Effectiveness of an Aspiration Risk-Reduction Protocol

Background: Aspiration of gastric contents is a serious problem in critically ill, mechanically ventilated patients receiving tube feedings. Objectives: The purpose of this study was to evaluate the effectiveness of a three-pronged intervention to reduce aspiration risk in a group of critically ill, mechanically ventilated patients receiving tube feedings. Methods: A two-group quasi-experimental design was used to compare outcomes of a usual care group (December 2002-September 2004) with those of an Aspiration Risk-Reduction Protocol (ARRP) group (January 2007-April 2008). The incidence of aspiration and pneumonia was compared between the usual care group (n = 329) and the ARRP group (n = 145). The ARRP had three components: maintaining head-of-bed elevation at 30° or higher, unless contraindicated; inserting feeding tubes into distal small bowel, when indicated; and using an algorithmic approach for high gastric residual volumes. Results: Two of the three ARRP components were implemented successfully. Almost 90% of the ARRP group had mean head-of-bed elevations of 30° or higher as compared to 38% in the usual care group. Almost three fourths of the ARRP group had feeding tubes placed in the small bowel as compared with less than 50% in the usual care group. Only three patients met the criteria for the high gastric residual volume algorithm. Aspiration was much lower in the ARRP group than that in the usual care group (39% vs. 88%, respectively). Similarly, pneumonia was much lower in the ARRP group than that in the usual care group (19% vs. 48%, respectively). Discussion: Findings from this study suggest that a combination of a head-of-bed position elevated to at least 30° and use of a small-bowel feeding site can reduce the incidence of aspiration and aspiration-related pneumonia dramatically in critically ill, tube-fed patients.
Donor PNPLA3 rs738409 genotype affects fibrosis progression in liver transplantation for hepatitis C

The rs738409 G>C single nucleotide polymorphism occurring in the patatin‐like phospholipase 3 gene has been identified as a novel genetic marker for hepatic steatosis. Recent studies also associated rs738409 with fibrosis in hepatitis C (HCV). Therefore, we sought to determine the impact of donor and recipient rs738409 genotype on the progression of fibrosis after liver transplantation for HCV. This cohort study included 101 patients infected with HCV who underwent liver transplantation between January 2008, and June 2011. Donor and recipient rs738409 genotypes were determined from donor wedge biopsies and recipient explants. The time to Ishak stage 3 fibrosis, or HCV‐related mortality/graft loss was analyzed by the Cox model adjusting for HCV‐Donor Risk Index, warm ischemic time, pretransplant Model for Endstage Liver Disease (MELD) and viral load. The rs738409 CC variant was present in 56% of donors and 57% of recipients. The median follow‐up period was 620 days. A total of 39 patients developed the primary outcome of ≥stage 3 fibrosis or HCV‐related mortality/graft loss, the time to which differed by donor (P = 0.019) but not recipient (P = 0.89) genotype. In the multivariate model, donor GC or GG variants had 2.53 times the risk (95% confidence interval [CI] 1.25‐5.02, P = 0.008) compared to CC variants. In the alternative endpoint: stage 3 fibrosis or all‐cause mortality/graft loss, the effect of donor genotype was attenuated but remained significant at 1.98 (95% CI 1.11‐3.53). Conclusions: The rs738409 genotype is an important predictor of posttransplant outcome in HCV. Liver, and not adipocytes, is the site at which this effect occurs. Our finding may be useful in donor selection for liver transplantation with HCV, and may guide decisions regarding early antiviral treatment. (Hepatology 2014;59:453–460)
Poly (ADP‐ribose) polymerase‐1 is a key mediator of liver inflammation and fibrosis

Poly (ADP‐ribose) polymerase 1 (PARP‐1) is a constitutive enzyme, the major isoform of the PARP family, which is involved in the regulation of DNA repair, cell death, metabolism, and inflammatory responses. Pharmacological inhibitors of PARP provide significant therapeutic benefits in various preclinical disease models associated with tissue injury and inflammation. However, our understanding the role of PARP activation in the pathophysiology of liver inflammation and fibrosis is limited. In this study we investigated the role of PARP‐1 in liver inflammation and fibrosis using acute and chronic models of carbon tetrachloride (CCl4)‐induced liver injury and fibrosis, a model of bile duct ligation (BDL)‐induced hepatic fibrosis in vivo, and isolated liver‐derived cells ex vivo. Pharmacological inhibition of PARP with structurally distinct inhibitors or genetic deletion of PARP‐1 markedly attenuated CCl4‐induced hepatocyte death, inflammation, and fibrosis. Interestingly, the chronic CCl4‐induced liver injury was also characterized by mitochondrial dysfunction and dysregulation of numerous genes involved in metabolism. Most of these pathological changes were attenuated by PARP inhibitors. PARP inhibition not only prevented CCl4‐induced chronic liver inflammation and fibrosis, but was also able to reverse these pathological processes. PARP inhibitors also attenuated the development of BDL‐induced hepatic fibrosis in mice. In liver biopsies of subjects with alcoholic or hepatitis B‐induced cirrhosis, increased nitrative stress and PARP activation was noted. Conclusion: The reactive oxygen/nitrogen species‐PARP pathway plays a pathogenetic role in the development of liver inflammation, metabolism, and fibrosis. PARP inhibitors are currently in clinical trials for oncological indications, and the current results indicate that liver inflammation and liver fibrosis may be additional clinical indications where PARP inhibition may be of translational potential. (Hepatology 2014;59:1998–2009)
Effect of Carvedilol and Nebivolol on Oxidative Stress‐related Parameters and Endothelial Function in Patients with Essential Hypertension

Oxidative stress and endothelial dysfunction have been associated with essential hypertension (EH) mechanisms. The purpose of this study was to evaluate the effect of carvedilol and nebivolol on the oxidative stress‐related parameters and endothelial function in patients with EH. The studied population included 57 patients, either sex, between 30 and 75 years of age, with mild‐to‐moderate EH complications. Participants were randomized to receive either carvedilol (12.5 mg) (n = 23) or nebivolol (5 mg) (n = 21) for 12 weeks. Measurements included; 24‐hr ambulatory blood pressure (BP), flow‐mediated dilatation, levels of nitric oxide estimated as nitrite – a nitric oxide metabolite ( NO 2 ) – in plasma, and oxidative stress‐related parameters in plasma and erythrocyte. EH patients who were treated with nebivolol or carvedilol showed systolic BP reductions of 17.4 and 19.9 mmHg, respectively, compared with baseline values (p < 0.01). Diastolic BP was reduced by 13.7 and 12.8 mmHg after the treatment with ebivolol and carvedilol, respectively (p < 0.01) (fig. 2B). Nebivolol and carvedilol showed 7.3% and 8.1% higher endothelium‐dependent dilatation in relation to baseline values (p < 0.05). Ferric‐reducing ability of plasma (FRAP) and reduced glutathione/oxidized glutathione (GSSH) ratio showed 31.5% and 29.6% higher levels in the carvedilol group compared with basal values; however, nebivolol‐treated patients did not show significant differences after treatment. On the other hand, the NO 2 plasma concentration was not modified by the administration of carvedilol. However, nebivolol enhanced these levels in 62.1% after the treatment. In conclusion, this study demonstrated the antihypertensive effect of both beta‐blockers. However, carvedilol could mediate these effects by an increase in antioxidant capacity and nebivolol through the raise in NO 2 concentration. Further studies are needed to determine the molecular mechanism of these effects.
The Contribution of Hospital Nursing Leadership Styles to 30-day Patient Mortality

Background:Nursing work environment characteristics, in particular nurse and physician staffing, have been linked to patient outcomes (adverse events and patient mortality). Researchers have stressed the need for nursing leadership to advance change in healthcare organizations to create safer practice environments for patients. The relationship between styles of nursing leadership in hospitals and patient outcomes has not been well examined. Objective:The purpose of this study was to examine the contribution of hospital nursing leadership styles to 30-day mortality after controlling for patient demographics, comorbidities, and hospital factors. Methods:Ninety acute care hospitals in Alberta, Canada, were categorized into five styles of nursing leadership: high resonant, moderately resonant, mixed, moderately dissonant, and high dissonant. In the secondary analysis, existing data from three sources (nurses, patients, and institutions) were used to test a hypothesis that the styles of nursing leadership at the hospital level contribute to patient mortality rates. Results:Thirty-day mortality was 7.8% in the study sample of 21,570 medical patients; rates varied across hospital categories: high resonant (5.2%), moderately resonant (7.4%), mixed (8.1%), moderately dissonant (8.8%), and high dissonant (4.3%). After controlling for patient demographics, comorbidities, and institutional and hospital nursing characteristics, nursing leadership styles explained 5.1% of 72.2% of total variance in mortality across hospitals, and high-resonant leadership was related significantly to lower mortality. Conclusions:Hospital nursing leadership styles may contribute to 30-day mortality of patients. This relationship may be moderated by homogeneity of leadership styles, clarity of communication among leaders and healthcare providers, and work environment characteristics.
Multislice computed tomography in blunt abdominal trauma

Blunt abdominal trauma is a frequent finding in patients with multiple trauma, and is associated with significant morbidity and mortality. Multislice computed tomography (MSCT), allowing for multiplanar reconstructions and three-dimensional images, has become the imaging modality of choice for these patients. MSCT is indicated in all haemodynamically stable patients with suspected blunt abdominal trauma. A `focussed CT' algorithm, as recommended by the Advanced Trauma Life Support (ATLS®) program, may be useful for patients with isolated abdominal trauma who are conscious and cooperative. For unconscious patients with or without multiple trauma `unfocussed' whole-body MSCT algorithms should be used, as these lead to earlier as well as more accurate diagnosis. MSCT allows for rapid diagnosis of abdominal and retroperitoneal injuries and for grading of solid organ injuries. Active haemorrhage may be detected with accuracy similar to angiography. Even bowel, diaphragmatic and bladder injuries, where CT used to miss a significant number of injuries, can be diagnosed with high accuracy by the new generation of MSCT scanners.
Pharmacological inhibition of the chemokine C‐C motif chemokine ligand 2 (monocyte chemoattractant protein 1) accelerates liver fibrosis regression by suppressing Ly‐6C+ macrophage infiltration in mice

Macrophages constitute a major proinflammatory component during chronic liver diseases and are considered a key factor in promoting hepatic fibrosis. However, there is increasing evidence that distinct monocyte and macrophage subsets exert critical functions in regression from organ fibrosis as well. Experimental mouse models of fibrosis regression have identified “restorative” macrophages as Ly‐6C (Ly6C, Gr1) low‐expressing, monocyte‐derived cells. We investigated molecular pathways balancing proinflammatory and restorative macrophages during fibrosis regression as well as pharmacologically augmenting beneficial macrophage functionality in fibrosis resolution. Therefore, we employed a Spiegelmer‐based inhibitor of the chemokine, C‐C motif chemokine ligand 2 (CCL2; monocyte chemoattractant protein 1), termed mNOX‐E36, in the regression phase of two murine models of toxic (CCl4) and metabolic (methionine‐choline–deficient diet) liver fibrosis. Although inflammation rapidly declined after cessation of injury, we observed a transient influx of Ly‐6C+ infiltrating monocytes (iMΦ), which are characterized by typical macrophage morphology, up‐regulated expression of CCR2, and the pro‐inflammatory cytokine, tumor necrosis factor (TNF), in injured liver. By inhibiting the early influx of Ly‐6C+ iMΦ by the CCL2 inhibitor, mNOX‐E36, the intrahepatic macrophage equilibration shifted toward the “restorative” Ly‐6C‐ subset of iMΦ. Consequently, fibrosis resolution was significantly accelerated upon mNOX‐E36 administration in both models. Blocking transient recruitment of infiltrating Ly‐6C+ monocytes, but not direct effects of the inhibitor on the remaining macrophages, resulted in reduced intrahepatic levels of proinflammatory cytokines. Conclusion: Transient CCL2‐dependent recruitment of infiltrating Ly‐6C+ monocytes during fibrosis regression counteracts scar resolution by perpetuating inflammatory reactions through release of proinflammatory cytokines such as TNF. Pharmacological inhibition of Ly‐6C+ monocyte recruitment using the CCL2‐inhibitor, mNOX‐E36, accelerates regression from toxic and metabolic liver fibrosis in two independent experimental models. (Hepatology 2014;59:1060–1072)
Advanced Applications of Cone Beam Computed Tomography in Orthodontics

This article describes the advanced cone beam computed tomography (CBCT) applications in orthodontic diagnosis and treatment planning. The limitations of conventional 2-dimensional planar film are discussed, and case examples are described that highlight the additional diagnostic information and many benefits derived from 3-dimensional imaging. CBCT software can manipulate the Digital Imaging and Communications in Medicine (ie, DICOM) data to visualize anatomic structures and accurately display relationships within the craniofacial complex. A combination of volumetric reconstruction and multiplanar views can provide the orthodontic clinician with skeletal hard tissue, soft tissue, dentition, and airway information. Nonstandard orthodontic cases, such as impacted teeth, supernumerary odontomas, or unexpected radiologic observations, such as pathologic lesions or incidental findings are best visualized with the 3-dimensinoal CBCT scan. Advanced CBCT software applications also can be used to quantify airway space (relevant for sleep apnea cases), perform superimpositions of objects at different time points to semiquantitatively visualize changes (eg, mandibular growth, temporomandibular joint, airway), and generate digital dental models to streamline the workflow in the orthodontic clinic.
Occupational exposure to blood and body fluids among a group of Turkish nursing and midwifery students during clinical practise training: frequency of needlestick and sharps injuries.

AIM To ascertain the number of needlestick and sharps injuries (NSSIs) in nursing and midwifery students and to assess the use of universal precautions among injured and non-injured students. METHODS A survey of a representative sample of nursing and midwifery students who did clinical practise in a hospital was conducted. In total, 203 students met the inclusion criterion of the study. Of these, 141 (69.46%) provided useable data. The survey form was designed by the researcher after reviewing the relevant literature. The data frequency, percentages, and χ(2) -values were examined. RESULTS According to the data, 35.5% of the participating students had experienced a NSSI, 54% of the students had received one NSSI, and 36.0% had two NSSIs. Sixty-six percent of the injured students had been injured by an ampoule and the majority of injuries occurred in the treatment room. Most of the students had washed their injury with antiseptic solution and 84% had not told anyone about their injury. While 86.5% of the students threw away used needles in the special sharps containers disposal box, 89.4% also stated that they always recapped used needles. Almost all the students had received the hepatitis B vaccine. Only 14% of the students stated that they always wore gloves. CONCLUSIONS This study shows that a significant percentage of nursing and midwifery students receive NSSIs. It is very important to frequently review information about preventive measures so that the students practise them during clinical practise every semester. Moreover, the instructors should monitor if the students are taking the necessary preventive measures without fail.
Underestimation of Adolescent Obesity

Background:Previous studies assessing the validity of adolescent self-reported height and weight for estimating obesity prevalence have not accounted for, potential bias due to nonresponse in self-reports. Objectives:The aim of this study was to assess the implications of selective nonresponse in self-reports of height and weight for estimates of adolescent obesity. Methods:The authors analyzed 613 adolescents ages 12–17 years from the 2006–2008 Los Angeles Family and Neighborhood Survey, a longitudinal study of Los Angeles County households with an oversample of poor neighborhoods. Obesity prevalence estimates were compared based on (a) self-report, (b) measured height and weight for those who did report, and (c) measured height and weight for those who did report. Results:Among younger teens, measured obesity prevalence was higher for those who did not report height and weight compared with those who did (40% vs. 30%). Consequently, obesity prevalence based on self-reported height and weight underestimated measured prevalence by 12 percentage points (when accounting for nonresponse) versus 9 percentage points (when nonresponse was not accounted for). Results were robust to the choice of difference child growth references. Discussion:Adolescent obesity surveillance and prevention efforts must take into account selective nonresponse for self-reported height and weight, particularly for younger teens. Results should be replicated in a nationally representative sample.