Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs

Health-care professionals frequently request systematic evidence-based guidance to facilitate decisionmaking in the provision of clinical care. They also need adequate support from hospital management to lead changes in practice (1). One approach to the provision of such guidance is the use of clinical pathways as an implementation tool. Clinical pathways are structured multidisciplinary care plans containing detailed essential steps in the care of patients with specific clinical problems. They are often developed by translating guidelines into local protocols for application in clinical practice (2). Although clinical pathways are being used worldwide, evidence about their usefulness has been unclear. This review (3) assesses the available evidence for the impact of use of clinical pathways on professional practice, patient outcomes (e.g. mortality, complications), length of hospital stay and hospital costs.
Coexistence of Chronic Complications among Diabetic Patients at Nigist Eleni Mohammed Memorial Hospital, Hossana, South Ethiopia

Background: Chronic complications reduce quality of life, increases diabetes related mortality and overburden the public health services. This study aims to assess the prevalence of chronic complications and its associated factors among diabetic patients at Nigist Eleni Mohammed Memorial Hospital, Hossana, South Ethiopia. Method and Materials: We conducted a hospital based cross-sectional study. A simple random sampling technique was used to select 266 participants from the follow up clinic of the hospital. Data were collected using semi structured questionnaire, weight, height, waist and hip circumference measurements and patients chart review. Descriptive statistics was used to describe the study variable. Bivariate and multivariate logistic regression analysis was used to identify factors associated with chronic diabetic complications. Result: Out of 247 diabetic subjects, 114 (46.2%) were found to have at least one chronic complication that included, hypertension 59 (23.9%), diabetes related eye disease 29 (11.7%), neuropathy 25 (10.1%) and nephropathy 16 (6.5%). Compared to age group 15 - 29 there was higher risk of chronic complications for those who were in age groups 45 - 64, [AOR = 2.50, (95% CI): (1.20, 5.22)] and ≥65 years, [AOR = 7.18, (95% CI): (2.10, 24.87)]. Duration of diabetes > 10 years [AOR = 2.87, (95% CI): (1.20, 6.88)], and not performing self-monitoring of blood glucose, [AOR = 15.22, (95% CI): (3.07, 75.48)] were also strongly associated with chronic complications of diabetes mellitus. Conclusion and Recommendation: Considerable number of diabetic participants in this study area had at least one chronic complication. Attention should be given to older diabetic patients and longer diabetic duration. Diabetic education should focus on health benefit of self-monitoring of blood glucose.
Prospective Monitoring for Invasive Aspergillosis Using Galactomannan and Polymerase Chain Reaction in High Risk Pediatric Patients

Background The diagnosis of invasive aspergillus remains a challenge in the care of high-risk patients. Outcomes are improved when invasive aspergillus is diagnosed early, prompting the initiation of appropriate antifungal therapy. We evaluated the utility of prospective monitoring for invasive aspergillosis (IA) using biomarkers such as serum galactomannan (GM) and/or blood polymerase chain reaction (PCR) in high-risk pediatric patients. Methods Patients with high-risk leukemia (HRL) or allogenic hematopoietic cell transplant (HCT) recipients were prospectively monitored twice weekly for IA using GM and PCR for Aspergillus species. Results Sixty-eight patients had collected ≥2 specimens. The 1086 specimens were collected; 627 from HRL (58%) and 459 (42%) from HCT recipients. Median specimens/patient was 11.0 (2 to 58), and median follow-up/patient was 98.5 days (14 to 437). Fifty-six percent of samples were obtained from patients receiving mold-active agents; 32% HRL and 89% HCT. There were no proven, 3 probable, and 20 possible episodes of IA. Thirteen specimens (1.2%) from 4 patients (5%) were GM+. None were positive by PCR. Conclusions The prospective use of GM and PCR in this high-risk pediatric population did not identify cases of proven IA. A high false positive rate was not detected. It is speculated that changes in clinical practice, such as early use of empiric and/or prophylactic mold-active agent and frequent imaging studies have impacted the epidemiology of IA. In a population with low incidence of IA, the use of these assays as a screening device on blood may not further enhance current outcomes.
Young people's exposure to and perceptions of smoking in cars and associated harms in the United Kingdom

Aims: To explore adolescents’ perceptions of smoking in cars and awareness of the potential harms associated with such exposure. Methods: Data were drawn from a 2011 cross-sectional study with 11–16 year olds (n = 1373) in the UK, who were asked how often they are exposed to smoking in cars, their support for banning smoking in cars and their perceptions of the harms associated with exposure, both to themselves and non-smokers in general. Findings: Almost half (46%) reported being exposed to smoking in cars, with 17% reporting travelling more than once a week with someone smoking. 85% supported a ban on smoking in cars carrying children under 16 years. 74% reported that they disliked being exposed to smoking in cars and 91% perceived exposure to be harmful. Logistic regression found that dislike of exposure, perceived harm and support for bans varied depending on smoking status, exposure to smoking in cars and their demographic profile. Conclusions: Many UK adolescents report exposure to smoking in cars. Adolescents’ opposition to such exposure, the associated health risks and their support for car smoking bans highlights the need for further consideration to be given to legislative options to protect children and others in private cars.
Impact of feeding tube choice on severe late dysphagia after definitive chemoradiotherapy for human papillomavirus–negative head and neck cancer

Severe late dysphagia is common after chemoradiotherapy for cancers of the larynx and oropharynx. Options for reduction of severe late dysphagia are limited for human papillomavirus (HPV)‐negative patients. In this study, the role of feeding tube choice in severe late dysphagia is investigated.
What if it is the other way around? Early introduction of peanut and fish seems to be better than avoidance

For many years, the advice to prevent food allergy was to postpone the introduction of allergens like egg, fish and peanut. However, elimination of food allergens during pregnancy and infancy failed to prevent food allergy. Instead, several studies indicate that early introduction of food like fish and peanuts may be beneficial. The most compelling illustration of this has been presented for peanuts. The prevalence of peanut allergy is lower in children in Israel than in the UK, despite introduction of peanut during infancy in Israel. Other studies have reported that early introduction of fish reduced the risk of allergic sensitization and allergic diseases like eczema.
Relationships among Social Support, Diabetes Outcomes, and Morale for Older Men and Women

The present study examined (a) whether a diabetes-specific measure of social support is more highly related to diabetes outcomes than is a general measure of social support, (b) if the relationship between social support and diabetes outcomes is different for men and women, and (c) if self-care behavior and metabolic control influences morale among older adults with diabetes. Study participants were 191 community-dwelling volunteers (81 men, 110 women) over the age of 60 with non-insulin-dependent diabetes mellitus. For men, social support specific to one's regimen affected metabolic control indirectly by increasing self-care behavior. For women, neither diabetes-specific nor general support was related to self-care behavior nor was self-care behavior related to metabolic control. For women, only high levels of overall support were associated with higher levels of morale. For men, higher levels of morale were found for those who were married and perceived high levels of available support, and for those who were in better metabolic control. These latter findings suggest that reciprocal relationships between psychosocial variables and health outcomes should be considered.
Response: Re: A Randomized, Controlled Trial of a Behavioral Intervention to Reduce Crying among Infants

To the Editor: We appreciate the thoughtful letter written by Dr. Karp[1][1] in response to the recent randomized controlled trial of The Happiest Baby on the Block (THB) video techniques,[2][2] a proprietary program which he has designed. [3][3] We find his critiques mostly fair and fully
Retrospective Study on the Combination of Desferrioxamine and Deferasirox for Treatment of Iron-overloaded Thalassemic Patients: First Evidence of More Than 2 Years

Some iron-overloaded patients have problems being treated with iron chelators. We therefore retrospectively studied 7 iron-overloaded thalassemic patients. Within the same week, patients received 20 to 30 mg/kg/d of oral deferasirox for 4 consecutive days, then a subcutaneous infusion of 20 to 40 mg/kg/d of desferrioxamine for 8 to 12 hours on the next 3 consecutive days. The median treatment duration was 25 months (range, 8 to 32). All of the patients showed a decrease in serum ferritin without any side effects. The protocol, combining deferasirox and desferrioxamine in sequence, was effective and safe: more cases should be studied.
The effect of ascorbate on minor recurrent aphthous stomatitis

Aim: Minor recurrent aphthous stomatitis (MRAS) is a common, painful and inflammatory ailment of the oral cavity with juvenile onset and unknown aetiology. The purpose of this study was to evaluate the potential of ascorbate (vitamin C) to reduce the frequency of MRAS and severity of pain.
Occupational Therapy Group Work in Psychiatric Settings

Traditionally, occupational therapists have used group therapy as part of their overall treatment regimens in psychiatric settings. The therapeutic factors evident in group therapy play an important part in the process of change. The traditional group therapy approach needs to accommodate modern trends, such as the shorter length of client stay, the rapid client turnover and the validity of client feedback. The purpose of the present article is to summarise recent research findings in order to provide information about the state of current research and to consider implications for occupational therapy practice.
Neopuff T‐piece mask resuscitator: is mask leak related to watching the pressure dial?

Abstract Aim: The aim of the study is to compare mask leak and delivered ventilation during Neopuff (NP) mask ventilation in two modes: (i) with NP pressure dial hidden and resuscitator watching chest wall (CW) rise with, (ii) CW movement hidden and resuscitator watching NP pressure dial.
Remifentanil in neonatal intensive care and anaesthesia practice

Remifentanil is a relatively new ultrashort action synthetic opioid. Studies on the use of remifentanil in neonatology have emerged demonstrating its effectiveness and safety in neonates. The present study describes the use of remifentanil in both full‐term and premature newborns, highlighting the theoretical benefits for this population in terms of both neonatal intensive care and anaesthesia. A Medline search was undertaken of all reviews and reports about the use of remifentanil in neonates published between 1996 and 2009 using MeSH search terms ‘remifentanil’, ‘analgesia’, ‘anaesthesia’, ‘newborn’ and ‘neonate’. The review points that remifentanil has been used with advantages in newborns including preterm neonates and even for foetal anaesthesia. It proved to be a good option to attenuate the hemodynamic/endocrine markers of stress related to surgery. Owing to its unique pharmacokinetic profile, shorter extubation times can be achieved what makes the drug also a good option for short duration invasive procedures in NICUs (InSurE). A concern on its use is that the hemodynamic response (hypotension) may become significant when the drug is associated to other drugs like sevoflurane.
Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status

Currently, positive surgical margins in head and neck cancer are considered to be an indicator for postoperative chemoradiotherapy (CRT) over radiotherapy (RT) alone. However, there are less data regarding the impact of margin status on human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (SCC).
Food Marketing in Irish Schools.

Purpose – Schools are thought to represent a growing marketing opportunity for food advertisers in many countries. Marketing of unhealthy food to children is linked to the increased prevalence of obesity worldwide. This paper aims to explore ways in which schools respond to commercial activity around food marketing.Design/methodology/approach – A census survey in the Republic of Ireland was employed to investigate the extent of commercial activity in post‐primary schools in Ireland, with a focus on food marketing. School policies related to commercialism and promoting healthy living to children and respondents' attitudes to these issues were explored.Findings – Food sales are a prevalent form of commercial activity in schools with 81.4 per cent operating shops or canteens that sell snacks, 44.7 per cent drinks vending machines and 28.0 per cent snack vending machines. A total of 38 per cent of schools reported that they accept for‐profit sponsorship and the primary reason was inadequate funding for equipm.
Ethnic inequity in neonatal survival: a case‐referent study in northern Vietnam

Aim: In this study from Quang Ninh province in northern Vietnam (sub‐study of the trial Neonatal Health – Knowledge into Practice, NeoKIP, ISRCTN 44599712), we investigated determinants of neonatal mortality through a case‐referent design, with special emphasis on socio‐economic factors and health system utilization.
Transoral robotic surgery for oropharyngeal squamous cell carcinoma in the era of human papillomavirus

The emergence of transoral robotic surgery (TORS) ignited the debate between surgical and nonsurgical strategies on oropharyngeal squamous cell carcinoma (SCC) management; a question further complicated by human papillomavirus (HPV). We evaluated the survival by treatment strategy independently in HPV‐related and HPV‐nonrelated oropharyngeal SCC.
Effects of Ticrynafen on Hepatic Excretory Function in the Isolated Perfused Rat Liver

Ticrynafen, a uricosuric diuretic agent which causes hepatocellular injury in man as an apparent idiosyncratic reaction, was found to impair the function of the isolated perfused rat liver. At concentrations in the perfusate equivalent to those produced in the blood of man by therapeutic doses, the drug led to a striking reduction in bile flow and sulfobromophthalein excretion and release of aspartate aminotransferase into the perfusate. These adverse effects were enhanced by treatment of rats with phenobarbital prior to removal of the liver, indicating that the adverse effect of ticrynafen is probably caused by a metabolite produced in the cytochrome P‐450 system.
In preparation for the International Symposium on ‘Obesity in the Elderly’

Obesity is a prevalent health problem among the elderly, where it contributes to the early onset of chronic morbidity and functional impairment and is related to premature mortality. The prevalence of sarcopenic obesity also increases with age in each sex. In these subjects, a significantly higher prevalence of physical impairment and disability is found, as well as a higher prevalence of the metabolic syndrome. We observe a natural phenomenon (aging) and a complex worldwide illness (obesity) that should not merely be treated as the sum of the treatments for the elderly and obese. The balance between the potential benefits of treatment interventions, reducing premature morbidity and mortality, and the impact on quality of life in old age may be different between young and adult ages in the case of obesity and needs to be seriously considered.
Glucocorticoid stimulates hepatitis B viral gene expression in cultured human hepatoma cells

Glucocorticoids have been shown to influence the severity of hepatitis B virus–related chronic hepatitis in human. However, very little is known about the effects of glucocorticoids on hepatitis B virus replication in vitro. In this report, we used a welldifferentiated human hepatoma cell line, Hep3B, transfected with hepatitis B virus complementary DNA as a model to show that a glucocorticoid analog, dexamethasone, can directly stimulate the production of HBsAg and HBeAg. Elevation of 3.5‐kb pregenomic RNA and all other viral RNAs in the transfected Hep3B cells after dexamethasone treatment supports the hypothesis that glucocorticoids directly stimulate hepatitis B virus gene expression in vitro. The concentration of dexamethasone for its half‐maximal stimulatory activity toward HBsAg, HBeAg and all viral transcripts was approximately 10–8 mol/L, close to the affinity of glucocorticoid receptors to [3H]triamcinolone acetonide in Hep3B cells ( ± 10–8 mol/L). Specific glucocorticoid antagonist RU38486 completely blocked dexamethasone‐induced HBV gene expression, suggesting that the stimulatory effect of dexamethasone was mediated through specific glucocorticoid receptors. (HEPATOLOGY 1992;16:13–18.)
Side effects of cancer treatment with recombinant human tumour necrosis factor alpha: a new challenge for the intensive care unit

The purpose of this paper is to familiarise intensive care staff with the concept of isolated limb perfusion with recombinant human tumour necrosis factor alpha (r-TNF-α), a new modality in cancer treatment, which has attracted considerable attention. The systemic toxicity of this type of treatment, and of cancer therapy with r-TNF-α in general, is reviewed. This review is based on Phase I and Phase II trials published in the English language, along with supportive documentation and data on 64 patients treated with r-TNF-α in our own institution. Guidelines are offered for the successful management of this type of patient. Treatment with r-TNF-α results in a characteristic clinical syndrome, which resembles the sepsis syndrome with hypotension and respiratory failure being the main features. Toxicity is largely independent of the route of administration. Very high serum concentrations of TNF-α, if shortlived, can be less toxic than sustained low serum concentrations. Treatment of patients who have undergone isolated limb perfusion with high-dose r-TNF-α is feasible and effective in a modern intensive care unit (ICU) setting, even if high serum concentrations of TNF-α, due to leakage from the perfusion circuit, cannot be avoided. Most patients can be discharged from the ICU within 24 hours.
Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy

Many health care decisions depend not only upon medical facts, but also on value judgments—patient goals and preferences. Until recent decades, patients relied on doctors to tell them what to do. Then ethicists and others convinced clinicians to adopt a paradigm shift in medical practice, to recognize patient autonomy, by orienting decision making toward the unique goals of individual patients. Unfortunately, current medical practice often falls short of empowering patients. In this article, we reflect on whether the current state of medical decision making effectively promotes patients' health care goals. We base our reflections, in part, on research in which we observed physicians making earnest efforts to partner with patients in making treatment decisions, but still struggling to empower patients—failing to communicate clearly to patients about decision-relevant information, overwhelming patients with irrelevant information, overlooking when patients' emotions made it hard to engage in choices, and making recommendations before discussing patients' goals.
Coexpression of liver‐specific and growth‐induced genes in perinatal and regenerating liver: Attainment and maintenance of the differentiated state during rapid proliferation

The liver shows maximal cellular growth during fetal development and after partial hepatectomy. Exploring overlaps in gene expression patterns in these two types of hepatic growth may provide insight into common regulatory pathways. The expression of a large number of growth‐induced and liver‐specific genes induced in liver regeneration has been examined in the perinatal liver from several days prenatal to 4 weeks postnatal when the major growth phase of the liver ceases. As in liver regeneration, many growth‐induced genes, such as PRL‐1 and β‐actin, are expressed at a high level throughout the temporal course of liver development and correlate with the proliferative state. The level of fetal liver expression of these genes is similar to peak expression found in the regenerating liver, suggesting that common pathways of transcriptional regulation exist in the two types of proliferation. A subset of liver‐restricted immediate‐early genes including, IGFBP‐1, CL‐6, and glucose‐6‐phosphatase (G6Pase) are induced in regenerating liver and may be important in maintaining hepatic metabolism during regeneration. In developing liver, these genes are expressed primarily in the perinatal period but, unlike the regenerating liver, are not coinduced. For instance, at birth, G6Pase is induced, whereas CL‐6 is downregulated. In situ analyses confirm that a proliferation associated gene PRL‐1 is expressed in multiple cell types throughout the developing liver, whereas the expression of liver‐specific genes is confined to hepatocytes. Taken together, these findings imply that significant similarities and differences in transcriptional regulation and hormonal milieu exist in liver during regeneration and development. The increased expression of genes responsible for glucose homeostasis in proliferative states of the liver suggests that maintenance of differentiated function is a component of the hepatic growth response. (Hepatology 1995; 22:906–914.)
Getting there and being there

Maintaining mother−child contact when a parent is imprisoned is accepted as important; the benefits of visiting are seen to extend beyond that relationship, to other members of the family and to the prison itself. This article discusses research findings about the extent and nature of visiting engaged in by adolescent children while their mothers were in prison, in Victoria, Australia, from the perspectives of the children and their mothers. In the current study, while findings confirm much of what is already known about barriers to prison visiting, the study extends this knowledge. Findings support the need to engage children’s views on this topic; to examine the current methodologies used to measure prison visitation; and to more fully understand the impact of arrest and imprisonment circumstances on arranging children’s care, including plans for visitation.