Miracle-dz/UniFAR-FTUs huggingface dataset:
Chemotherapy for resistant or recurrent gestational trophoblastic neoplasia.

BACKGROUND Gestational trophoblastic neoplasia (GTN) is a highly curable group of pregnancy-related tumours; however, approximately 25% of GTN tumours will be resistant to, or will relapse after, initial chemotherapy. These resistant and relapsed lesions will require salvage chemotherapy with or without surgery. Various salvage regimens are used worldwide. It is unclear which regimens are the most effective and the least toxic. OBJECTIVES To determine which chemotherapy regimen/s for the treatment of resistant or relapsed GTN is/are the most effective and the least toxic. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 4), MEDLINE and EMBASE up to October 2011. In addition, we handsearched the relevant society conference proceedings and study reference lists. SELECTION CRITERIA Only randomised controlled trials (RCTs) were included. DATA COLLECTION AND ANALYSIS We designed a data extraction form and planned to use random-effects methods in Review Manager 5.1 for meta-analyses. MAIN RESULTS The search identified no RCTs; therefore we were unable to perform any meta-analyses. AUTHORS' CONCLUSIONS RCTs in GTN are scarce owing to the low prevalence of this disease and its highly chemosensitive nature. As chemotherapeutic agents may be associated with substantial side effects, the ideal treatment should achieve maximum efficacy with minimal side effects. For methotrexate-resistant or recurrent low-risk GTN, a common practice is to use sequential five-day dactinomycin, followed by MAC (methotrexate, dactinomycin, cyclophosphamide) or EMA/CO (etoposide, methotrexate, dactinomycin, cyclophosphamide, vinblastine) if further salvage therapy is required. However, five-day dactinomycin is associated with more side effects than pulsed dactinomycin, therefore an RCT comparing the relative efficacy and safety of these two regimens in the context of failed primary methotrexate treatment is desirable.For high-risk GTN, EMA/CO is the most commonly used first-line therapy, with platinum-etoposide combinations, particularly EMA/EP (etoposide, methotrexate, dactinomycin/etoposide, cisplatin), being favoured as salvage therapy. Alternatives, including TP/TE (paclitaxel, cisplatin/ paclitaxel, etoposide), BEP (bleomycin, etoposide, cisplatin), FAEV (floxuridine, dactinomycin, etoposide, vincristine) and FA (5-fluorouracil (5-FU), dactinomycin), may be as effective as EMA/EP and associated with fewer side effects; however, this is not clear from the available evidence and needs testing in well-designed RCTs. In the UK, an RCT comparing interventions for resistant/recurrent GTN will be very challenging owing to the small numbers of patients with this scenario. International multicentre collaboration is therefore needed to provide the high-quality evidence required to determine which salvage regimen/s have the best effectiveness-to-toxicity ratio in low- and high-risk disease. Future research should include economic evaluations and long-term surveillance for secondary neoplasms.
Psychosocial Predictors of Adherence to Highly Active Antiretroviral Therapy

Abstract This article reviews studies of psychosocial predictors of Highly Active Antiretroviral Therapy (HAART) among HIV positive clients. Unstable housing and lack of HIV-specific social support predicted low HAART adherence in the studies where they were tested. The most consistent predictor of adherence problems across all populations and measures was active substance use, particularly cocaine use. Younger age and less than high school education were not consistently predictive. Depression predicted adherence problems measured by self-report but not by electronic monitoring. Supplementing the adherence support efforts by physicians, nurses, and pharmacists, clinicians in a range of disciplines and settings can assess and intervene on psychosocial risk factors and thereby reduce adherence problems regardless of their level of knowledge about HIV medications.
The Hypocholesterolemic Effects of β-Glucan in Oatmeal and Oat Bran M.H. DAVIDSON, L.D. DUGAN, J.H. BURNS, J. BOVA, K. STORY, K.B. DRENNAN JAMA 265:1833-1839, 1991

This study addresses the important issue of whether oat bran has an effect on serum cholesterol levels, independent of and additive to, that of a low-fat diet. Patients were maintained on the American Heart Association Step 1 diet for at least 8 weeks. This allowed stability to the low-fat, low-cholesterol diet. Two hundred eleven patients entered the initial 8-week dietary instruction/ stabilization phase. After the initial 8-week period, two qualifying serum lipid profiles were determined within 1 week. One hundred fifty-six men and women volunteers, ages 30 to 65 years, with mild to moderate hypercholesterolemia, as defined by LDL-cholesterol levels greater than 4.14 mmol/L (160 mg/dL) or between 3.37 and 4.14 mmol/L (130 and 160 mg/dL), qualified for entering the study. Patients were randomized in a parallel fashion into seven equal groups. Three groups received oat bran in either 1-, 2-, or 3-oz doses per day; three groups received oatmeal in either 1-, 2-, and 3-oz doses per day; and one control gro.
Effect of blood culture reports on antibiotics use by physicians in septic patients of intensive care unit.

Background: To limit the emergence and spread of antibiotic resistance, adjustments in the antibiotic regimen should be done according to the results of blood cultures as soon as they are available. This study was planned to determine the effect of blood culture and sensitivity tests on the antibiotics use in ICU patients of a tertiary care teaching hospital. Methods: This chart review retrospective study was carried out in ICU patients of a tertiary care teaching hospital. The data was collected from patients’ medical record file in a case record form which included patient’s demographic details, provisional diagnosis/or diagnosis, blood culture reports, and antimicrobial treatment (both the empiric treatment as well as the change made after the release of the blood culture results). The effect of blood culture results on antibiotic treatment was analysed. Results: A total of 245 patients were subjected to blood culture during the period of 6 months with an average of 40.8/month. 86 (35.1%) patients showed positive blood culture results, while 159 (64.9%) patients showed negative blood culture results. 55 patients discharged after the release of blood culture and sensitivity results. Antibiotic regimens were modified or changed in 26 (47.27%), and in 29 (52.72%) there was no modification. Most commonly used antibiotic after blood culture reports were meropenem (34.62%) followed by 11.54% of each teicoplanin, piperacillin+ tazobactum and tigecyclin. Conclusions: Blood culture reports help in management of critically ill patients if bacteria are resistant to previously used antibiotic, but do not help in narrowing the therapy in ICU patients.
FREQUENCY OF CAROTID ARTERY DISEASE IN CANDIDATES UNDERGOING CORONARY ARTERY BYPASS GRAFT

Objective: To determine the frequency of carotid artery disease in patients undergoing coronary artery bypass graft (CABG) and to assess the associationbetween carotid artery disease and coronary artery disease (CAD). Methodology: This cross sectional study was conducted at Rawalpindi Instituteof Cardiology, Rawalpindi, Pakistan from October 2013 to April 2014. Allparticipants underwent pre-operative carotid Doppler assessment for level ofstenosis and site of carotid plaque. Using the criteria defined by the Society ofRadiologists in the Ultrasound Consensus, the degree of stenosis was stratifiedinto the categories of normal (no stenosis), 50% non-obstructive carotid disease,50-69% significant stenosis, 70% critical stenosis to near occlusion, nearocclusion, and total occlusion. Results: The total number of patients were 140 with the mean age of 59.6±7.1years. Male to female ratio was 4:1. Normal carotid arteries were seen in 31(22.2%) patients, while 79 (56.4%) had non-obstructive carotid disease, 15(10.7%) had significant stenosis, 12 (8.5%) had critical stenosis, and 3 (2.1%)had near occlusion stenosis. Carotid bulb was the most common site of plaquewhile the left internal carotid artery was the commonest site of both significantand critical stenosis. Near occlusion was noted in left ICA in two patients and rightexternal carotid artery in one patient. Out of 128 patients who underwentCABG,128 had TVD, DVD in 8 and 4 had SVD on coronary angiography. Conclusion: We concluded that high number of patients(77.85%) have carotidartery disease on routine ultrasonic carotid assessment. Carotid bulb was themost common site of plaque while the left internal carotid artery was thecommonest site of both significant and critical stenosis.
Vertebral Artery Hypoplasia: Characteristics in a Croatian Population Sample

Vertebral arteries are responsible for 1/3 of the brain blood supply, supplying primarily posterior parts of the brain. About 15% of all strokes occur in posterior parts of the brain, which should be kept in mind when dealing with disorders that can cause hemodynamic changes in vertebral arteries. Vertebral artery hypoplasia (VAH) is an inborn abnormality of vertebral artery defined by smaller lumen diameter and lower blood flow velocities, and is most commonly found in healthy subjects. The aim of this study was to establish the characteristics of VAH in a Croatian population sample, and to determine differences in its presentation according to sex and affected side. Study results may prove valuable for future identification of individuals at an increased risk of cerebrovascular incidents or traumatic injuries that could lead to adverse changes of posterior circulation. Color Doppler flow imaging (CDFI) reports of 277 patients were analyzed. All measurements were obtained in the V2 segment of vertebral artery, between the C6-C5 vertebrae, using a linear 7, 5 MHz probe on an Aloka Prosound SSD-5500. The criteria for normal vertebral arteries were lumen diameter of 2, 5-4, 5 mm, systolic mean blood flow velocity of 0, 35-0, 70 m/s, and normal resistance pattern. Study results showed the left vertebral artery to be dominant in 57% of study subjects, VAH to be more common in women, and right vertebral artery to be more often involved by hypoplasia than the left one. The width of the "wider" vertebral artery was greater in the group with VAH, suggesting a way of the deficit compensation. The study demonstrated that the deficit caused by VAH cannot be fully compensated for despite larger arterial diameter.
Interventions for pregnant women with hyperglycaemia not meeting gestational diabetes and type 2 diabetes diagnostic criteria.

BACKGROUND Pregnancy hyperglycaemia without meeting gestational diabetes mellitus (GDM) diagnostic criteria affects a significant proportion of pregnant women each year. It is associated with a range of adverse pregnancy outcomes. Although intensive management for women with GDM has been proven beneficial for women and their babies, there is little known about the effects of treating women with hyperglycaemia who do not meet diagnostic criteria for GDM and type 2 diabetes (T2DM). OBJECTIVES To assess the effects of different types of management strategies for pregnant women with hyperglycaemia not meeting diagnostic criteria for GDM and T2DM (referred as borderline GDM in this review). SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2011). SELECTION CRITERIA Randomised and cluster-randomised trials comparing alternative management strategies for women with borderline GDM. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data and assessed risk of bias of included studies. Data were checked for accuracy. MAIN RESULTS We included four trials involving 543 women and their babies (but only data from 521 women and their babies is included in our analyses). Three of the four included studies had moderate to high risk of bias and one study was at low to moderate risk of bias. Babies born to women receiving management for borderline GDM (generally dietary counselling and metabolic monitoring) were less likely to be macrosomic (birthweight greater than 4000 g) (three trials, 438 infants, risk ratio (RR) 0.38, 95% confidence interval (CI) 0.19 to 0.74) or large-for-gestational (LGA) age (three trials, 438 infants, RR 0.37, 95% CI 0.20 to 0.66) when compared with those born to women in the routine care group. There were no significant differences in rates of caesarean section (three trials, 509 women, RR 0.93, 95% CI 0.68 to 1.27) and operative vaginal birth (one trial, 83 women, RR 1.37, 95% CI 0.20 to 9.27) between the two groups. AUTHORS' CONCLUSIONS This review found interventions including providing dietary advice and blood glucose level monitoring for women with pregnancy hyperglycaemia not meeting GDM and T2DM diagnostic criteria helped reduce the number of macrosomic and LGA babies without increasing caesarean section and operative vaginal birth rates. It is important to notice that the results of this review were based on four small randomised trials with moderate to high risk of bias without follow-up outcomes for both women and their babies.
Beyond equivalence of care in prison pharmacy

Prison healthcare has undergone a significant transformation over recent times. The main aim of these changes was to ensure prisoners received the same level of care as patients in the community. Prisons are a unique environment to provide healthcare within. Both the environment and the patient group provide a challenge to healthcare delivery. One of the biggest challenges currently being faced by healthcare providers is the misuse and abuse of prescription medication. It seems that the changes that have been made in prison healthcare, to ensure that prisoners receive the same level of care as patients in the community over recent times, have led to an increase in this problem. Prison pharmacy is ideally placed to help reduce the misuse and abuse of prescription medication. This can be achieved by using the skills and knowledge of the pharmacy department to ensure appropriate prescribing of medication liable to misuse and abuse.
Infectious Complications in Kidney Transplantation

Kidney transplantation is associated with lower risk for infection than other solid organ transplantations, reflecting the elective nature of kidney transplantation and clinical and nutritional status of recipients. Infection, however, remains a significant cause of morbidity and mortality in renal transplant recipients. Infections related to transplant surgical complications, acquisition of health care-associated pathogens, and reactivation of latent disease can affect graft function and transplant outcome. Graft dysfunction or chronic rejection leads to augmented immunosuppression, increasing the risk for infection with immunomodulating viruses. Although rare, donor-derived infections can arise by delayed donor seroconversion of unidentified pathogens in the organ donor at the time of organ procurement. Despite prophylactic therapy against common pathogens; infections are the second most common cause of death after cardiovascular disease in renal transplant recipients. According to the U.S. Renal Data System (USRDS), infections occurred at a rate of 45 per 100 patient-years during the first 3 years after transplantation (Snyder et al., 2009).
Safety of medication use in primary care

Medication errors are one of the leading causes of harmin health care. Review and analysis of errors have often emphasized their preventable nature and potential for reoccurrence. Of the few error studies conducted in primary care to date, most have focused on evaluating individual parts of the medicines management system. Studying individual parts of the system does not provide a complete perspective and may further weaken the evidence and undermine interventions.
Disaster Preparedness Among Members of Staff at Kenyatta National Hospital, Nairobi County, Kenya

Over the world, hospitals have suffered severe damage as a result of natural and anthropogenic disasters leading to the partial or total collapse of the structures and interruption of the health services urgently needed by the victims of the event. During the disaster strike, hospitals are confronted with a large number of casualties exceeding their capacity to cope. Despite the situation, many governments have paid less attention to disaster preparedness in health facilities. Hospitals from various parts of the world possess limited capital and staff time to spend on conducting comprehensive disaster response drills, emergency planning and preparedness. The main objective of this study was to find out whether members of staff at Kenyatta National Hospital are prepared for disasters. The study also looked into structures that the Kenyatta National Hospital has put in place to mitigate for disaster. This was a cross sectional descriptive study. Data collected in this study was both quantitative and qualitative. Data was collected using self -administered questionnaire containing both closed and open ended questions. The study involved 361 respondents sampled from 4646 being the total population of members of staff at Kenyatta National Hospital. The respondents were stratified according to departments of the hospital and then randomly selected based on the required sample size. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 16.2 and Microsoft office excel. The study established that terrorist attack is the leading potential threat followed by fire. Most members of staff of KNH were aware of the existence of a disaster management committee and the existence of a disaster plan in the hospital. Majority of the respondents felt that firefighting equipments and evacuation plans are inadequate. The results have been presented in tables and charts. Chi square was used to determine association and difference between responses. Terrorist attack and fire were identified as the main potential threats with 84% and 81% of the respondent identifying them as potential disasters respectively. The study found out that 58% of the respondents had no training on disaster management. Majority of the respondents indicated that there was no adequate infrastructure to manage disaster with 62.3 % indicating there was inadequate fire fighting equipments. The findings showed a significant association between age and disaster preparedness (Χ 2 =13.202, df=9, p=0.002); training on disaster management and disaster preparedness (Χ 2 =34.738, df=3, p=0.001); years of experience and disaster preparedness (Χ 2 =13.202, df=12, p=0.007); level of awareness and disaster preparedness (Χ 2 =8.477, df=1, p=0.004). The study will assist KNH and other health facilities in formulating policies on disaster preparedness. The study recommends that Kenyatta national Hospital improves on the training of staff on disaster management in order to respond to emergencies effectively and efficiently.
Limited pedicle screw constructs in adolescent idiopathic scoliosis surgery and clinical correlation

Study design: Retrospective study of 31 patients treated for adolescent idiopathic scoliosis utilising posterior double rod constructs with a limited number of strategically placed screws. Objective: Review of the radiological and clinical outcomes of strategic screw placement in posterior double rod constructs with respect to implant density. Summary of background data: The trend in scoliosis surgery dictates the use of pedicle screw constructs with anchors at every level. Favourable correction and clinical outcomes have been reported using this technique. The cost burden of such an implant construct is high; with the additional risk of pedicle breach and neurological compromise multiplied by the number of screws. The sustainability of this practice is questionable. Methods: Thirty-one patients, treated surgically for adolescent idiopathic scoliosis, with a minimum two-year follow-up, were included. Posterior double-rod constructs were used in all cases. Cobb angles were measured pre-operatively, post-operatively and at two-year follow-up. Patient satisfaction and clinical outcome were evaluated through the SRS22 questionnaire. Results: Lenke classification yielded 16 type I, seven type II, four type III, two type IV and two type VI curves. The average Cobb angle pre-surgery was 68.5° (±17.6°), with a flexibility of 38%. This was corrected to an average of 24°±11.9°. The correction was maintained at two-year follow-up. In terms of thoracic sagittal profile, 25 patients measured ‘normal’ (10°–40°) post-operatively, compared to 17 pre-operatively. This correction was achieved with a 52.2% metal density over an average of nine instrumented segments. Average SRS22 patient satisfaction score was at 89%. Conclusion: Strategic screw placement, in adolescent idiopathic scoliosis surgery, yields adequate correction and curve maintenance. High levels of patient satisfaction were achieved at a dramatically reduced cost, with a diminished risk for pedicle violation.
Practical strategies and perceptions from community pharmacists following their experiences with conducting pharmacy practice research: a qualitative content analysis

While prior research identified barriers to conducting research in community pharmacies, there remains a need to better understand facilitators to ensure successful collaborations between academic researchers and pharmacists. Our objective was to determine the experiences and perspectives of community pharmacists who have recently conducted a pharmacy practice‐based research study to gain in‐depth understanding of challenges as well as facilitators and identify strategies and solutions.
A hermeneutic phenomenology study of schooling experiences of Lumbee Indian students with high incidence disabilities

Dropout issue among ethnic minority students with disabilities has been a major issue for educational professionals in several decades. Among all student groups, American Indian students with disabilities continue to show a higher disproportionate representation in high school dropouts. Low student engagement has been documented as a major dropout predictor in the education literature. Therefore, this dissertation research was designed to understand the dropout phenomenon among American Indian students with disabilities by exploring school engaging experiences of Lumbee Indian students with disabilities. Because phenomenological research begins in lived experiences, this research adopts this research methodology to advance our understanding of students' engaging experiences. This research found that participants in this study may receive inappropriate education services, particularly those who exhibited behavioral challenges. We have noted that teacher-student relationship was described by all student participants as a major challenge they experienced at school. Their school engaging experiences were strongly influenced by their interactions with school teachers or other professionals. For students' misbehaviors, the disciplinary actions taken by teachers might be too severe. The control-oriented school context plays another factor intensifying students' misbehaviors at school. Family factor was observed as another factor influencing students' engaging experiences.