Miracle-dz/UniFAR-FTUs huggingface dataset:
Association Between Cancer and Immunosuppressive Therapy—Analysis of Selected Studies in Pemphigus and Pemphigoid

Objective: To determine whether there is an association between the use of immunosuppressive agents (ISAs) and cancer in patients with pemphigus and pemphigoid—rare, potentially fatal diseases of the skin and mucous membranes, often requiring long-term use of ISAs. Data Source: Literature was accessed through PubMed (all years available), using the search terms cancer, immunosuppressive agents, pemphigoid, and pemphigus. Study Selection and Data Extraction: A retrospective review of the literature was conducted. Inclusion criteria for studies were: (1) English language, (2) diagnosis of pemphigus and/or pemphigoid based on histology and immunopathology, (3) more than 10 patients evaluated, (4) investigators had a high index of suspicion of cancer and patients were monitored for it, (5) follow-up information was provided for at least 1 year after initiation of therapy, and (6) absence of diagnosis of cancer before initiation of an ISA. Case reports were not included in the analysis. Data Synthesis: A total of 929 patients diagnosed with either pemphigus or pemphigoid in 17 studies were identified. Patients were divided into 2 groups. Group A comprised patients treated with azathioprine, cyclophosphamide, cyclosporins, or mycophenolate mofetil in combination with prednisone. In Group A. 22 cases of cancer were reported in 21 of the 218 patients (9.6%). Group B comprised patients treated with systemic corticosteroids only. In this group, cancer was reported in 11 of the 711 patients (1.5%). In this study there was no control group (untreated patients) and the sample sizes were small. Conclusions: Preliminary data suggest a possible association between the use of azathioprine, cyclophosphamide, and cyclosporine and increased susceptibility to cancer in patients with pemphigus and pemphigoid.
Use of Gabapentin for the Management of Natural or Surgical Menopausal Hot Flashes

Objective: To review the literature examining the use of gabapentin for treatment of hot flashes during natural or surgically Induced menopause. Data Sources: A literature search was conducted via PubMed, MEDLINE, and International Pharmaceutical Abstracts (1948-November 2010) using the search terms gabapentin, hot flashes, and menopause. Literature was limited to English-language, human studies. Additional material was identified by reviewing reference citations of the articles retrieved. Study Selection and Data Extraction: Studies with data describing gabapentin for hot flash management during natural or surgically induced menopause were included. Any studies including women with a history of breast cancer were excluded. Four studies met the inclusion criteria. Data Synthesis: Gabapentin significantly decreased hot flash frequency and hot flash composite scores by 45-71% from baseline in the 4 trials included in this review. In 2 of the trials, gabapentin was comparable to hormone replacement therapy (71 % vs 72%, respectively, p = 0.63) in decreasing hot flash composite scores at the end of 12 weeks and in decreasing hot flash frequency at the end of 8 weeks (58.9% vs 70.1 %, p > 0.05). In all trials, the most common adverse effects with gabapentin were somnolence/drowsiness, unsteadiness, and dizziness. These adverse effects were most pronounced during the first 1-2 weeks of therapy, but resolved and were similar to those reported with placebo by week 4. These trials were short (<12 weeks) and had small sample sizes; however, their results appear to show that gabapentin is safe and effective for short-term treatment of hot flashes in women who have entered menopause either naturally or surgically. Conclusions: Gabapentin 600-2400 mg/day in divided doses may be a viable option for treating hot flashes in menopausal women who do not want to use hormone replacement therapy.
Proprioceptive shoulder taping

Abstract Proprioceptive shoulder taping is a useful adjunct to expert manual and exercise therapy in the management of shoulder girdle pathology and dysfunction. Although the exact mechanisms of action are as yet unproven, hypotheses based on the available literature are presented. These are accompanied by clinical guidelines for application and case scenarios.
Regional, Geographic, and Ethnic Differences in Medication Adherence among Adults with Type 2 Diabetes

BACKGROUND: Medication adherence, a critical component of glycemic control for patients with type 2 diabetes, differs by race/ethnicity. However, few studies have examined regional and rural/urban differences in medication adherence and whether racial/ethnic differences persist after controlling for these differences. OBJECTIVE: To examine regional, rural/urban, and racial/ethnic differences in medication adherence in a national sample of veterans with type 2 diabetes. METHODS: We performed a cohort study of a national sample of veterans with diabetes (N = 690,968) receiving prescriptions for insulin or oral hypoglycemic agents in 2002. Patients were followed until death, loss to follow-up, or through December 2006. We calculated the annual medication possession ratio (MPR) for each veteran across 4 groups of medication users: individuals using (1) insulin only, (2) oral hypoglycemic agents only, (3) insulin combined with hypoglycemic agents, and (4) insulin or oral hypoglycemic agents (primary analysis). RESULTS: In longitudinal models for the primary analysis, adjusting for relevant covariates and time trends, MPR was significantly lower among non-Hispanic blacks (NHBs), Hispanics, and individuals with other/missing/unknown race/ethnicity (6.07%, 1.76%, and 2.83% lower, respectively) relative to non-Hispanic whites (NHWs). MPR was also 2.0% higher in rural versus urban veterans and 1.28% higher in the mid-Atlantic, 2.04% higher in the Midwest, and 0.76% lower in the West, relative to the South. There was a significant race/ethnicity and urban/rural interaction. In NHWs and NHBs, MPR was 1.91 % and 2.00% higher, respectively, in rural versus urban veterans; in contrast, in Hispanics, MPR was 1.0% lower in rural veterans relative to urban veterans. CONCLUSIONS: In a national longitudinal cohort of veterans with type 2 diabetes, we found significant regional, rural/urban, and racial/ethnic differences in MPR. Rural/urban residence modified the effect of race/ethnicity on MPR. Recognition of these differences can enable clinicians to better allocate resources and target quality improvement programs.
Use of Anticholinergic Drugs and Cholinesterase Inhibitors and Their Association with Psychological Well-Being Among Frail Older Adults in Residential Care Facilities

Background Drugs with anticholinergic properties have harmful effects among frail older people and they may antagonize the effects of cholinesterase inhibitors (ChEIs). However, their association with psychological well-being has not been studied. Objective: To determine (1) the prevalence of the use of anticholinergic drugs, ChEIs, or their combination among older adults in residential care facilities and their association with psychological well-being, and (2) the association of anticholinergic drugs with an individual's psychological well-being. Methods: In 2007, all older adults (N = 1475) living in residential care facilities in the cities of Helsinki and Espoo, Finland, were assessed in a cross-sectional study. A trained nurse retrieved data on demographic factors, regularly administered medications, and diagnoses from medical charts. Psychological well-being was assessed using 6 questions concerning life satisfaction, zest for life, plans for the future, feeling needed, and feeling depressed or lonely, and a psychological well-being score was created (range 0-1). Results: Residents taking anticholinergic drugs (n = 613) were significantly younger, used more drugs, and were more often on ChEIs compared with nonusers (n = 862). There was no significant difference in Charlson comorbidity index, stage of cognition, or dependence on activities of daily living between the users or nonusers of anticholinergic drugs. The anticholinergic drug users had significantly lower psychological well-being scores compared with the nonusers. Of the participants, 10.7% used ChEIs and anticholinergic drugs concomitantly. In logistic regression analysis where age, sex, comorbidities, and use of ChEIs were used as covariates, lower psychological well-being was associated with the use of anticholinergic drugs (OR 1.40; 95% CI 1.00 to 1.94; p = 0.048). Conclusions: Concomitant use of anticholinergic drugs and ChEIs is common among older adults. The use of anticholinergic drugs is associated with poor psychological well-being.
An assessment of self-perceived health status of patients of diabetes mellitus, hypertension and comorbidity using physical functioning

Introduction: Perceived health is a subjective assessment of the health and includes so many aspects that are difficult to capture clinically such as incipient disease, disease severity, physiological, psychological reserves and social functions. Aims & Objective: To assess the impact of Diabetes Mellitus, Hypertension, comorbidity and other associated factors on the physical functioning of the patients attending the Outpatient department (OPD), Inpatient department (IPD), Rural Health Training Centre (RHTC) and Urban Health Training Centre (UHTC) of Shri Ram Murti Smarak Institute of Medical Sciences (SRMS,IMS), Bareilly. Methods: Perceived health status of the patients was assessed by the Physical Functioning (PF) dimension of the Physical Component Summary using the 36-item short form health survey (SF-36). Results: The presence of both Diabetes Mellitus and Hypertension was associated with lower Physical Functioning scores compared to those with diabetes and hypertension alone (p > 0.05). Age was inversely related with Physical Functioning scores (p 0.05). Conclusions: The presence of Comorbidity was found to have greater impact on Physical Functioning compared to individual disease. The impact of various socio-demographic characteristics on the perceived health status was also evident in the study. However, the results were interpreted in terms of the study’s limitations.
Educational success for children in public care: advice from a group of high achievers

Research over the past 20 years has consistently shown that children in public care fall behind at school, seldom achieve good qualifications, and are much less likely than their peers to go on to further or higher education. However, a small minority of looked-after children do well academically. This paper examines the opinions of 38 highachieving young people who spent at least a year in residential or foster care on what they think are the best ways to enhance the educational experience of looked-after children. An evaluation of four key questions from a semistructured interview highlighted the importance of foster carers, residential workers, social workers and teachers in providing support and encouragement for academic achievement. On the other hand, many of these individuals emphasized their dislike of being ‘singled out’ by the teacher. A third of the participants believed that negative stereotypes and low expectations of children in care among professionals and care providers were major obstacles to their educational success. Over half the sample reported that in many children’s homes basic necessities such as books, a desk and a quiet place to do homework were lacking. In addition their opportunity to engage in outside interests and hobbies was severely limited. By contrast, for these individuals foster care had provided better opportunities. On entering higher education the majority of the participants had faced severe problems. They stressed the need for continuing financial support and adequate year-round accommodation, because, unlike most students, these care leavers usually have no parental home to return to during university vacations. A third of participants also felt a strong desire for a ‘guardian angel’ to support and encourage them during their time at university. The paper concludes that the views of these thoughtful and resilient individuals should be taken very seriously and translated into improvements in policy and practice. Official guidance now highlights the importance of education for looked-after children, but changing attitudes and priorities at ground level presents a major challenge.
Comparison of the Effects of Energy Drink Versus Caffeine Supplementation on Indices of 24-Hour Ambulatory Blood Pressure

Background: Cardiovascular events associated with energy drink consumption have been reported, but few data exist to delineate the hemodynamic effects of energy drinks. Objective: To compare the effects of an energy drink versus caffeine supplementation on blood pressure (BP) Indices as measured by 24-hour ambulatory BP monitoring (ABPM). Methods: Healthy, nonsmoking, normotensive volunteers (aged 18-45 years) taking no medications were enrolled in a single-center, open-label, 2-period crossover pilot study. During each study period, subjects received either an energy drink (Red Bull Energy Drink, each dose containing 80 mg of caffeine and 1000 mg of taurine in an 8.3-oz serving) or a control (compounded caffeine solution, each dose containing 80 mg of caffeine solution in 8 oz of bottled water) at 0800,1100, 1500, and 1900 hours and underwent 24-hour ABPM. The study periods were separated by a washout period (4-30 days). Mean 24-hour, daytime, and nighttime systolic (SBP), diastolic (DBP), and mean arterial (MAP) BP; BP load; and percent nocturnal dipping were compared between study periods. Results: Mine subjects (5 females, mean [SD] age 27.7 [5.0] years) completed the study. Mean 24-hour SBP (123.2 vs 117.4 mm Hg, p = 0.04), DBP (73.6 vs 68.2 mm Hg, p = 0.02), and MAP (90.1 vs 84.8 mm Hg, p = 0.03) were significantly higher during energy drink supplementation versus caffeine supplementation. Daytime DBP (77.0 vs 72.0 mm Hg, p = 0.04) also was significantly higher with the energy drink versus caffeine supplementation. Trends in higher daytime SBP (127.0 vs 121.9 mm Hg, p = 0.05) and MAP (93.6 vs 88.6 mm Hg, p = 0.05) were recorded with energy drink supplementation versus caffeine supplementation. Nighttime SBP and DBP toads were significantly higher with the energy drink, but nocturnal dipping did not differ significantly between study periods. Conclusions: Single-day energy drink supplementation increased mean 24-hour and daytime BP compared to caffeine control in this pilot study. Additional research Is warranted to better understand the hemodynamic effects of energy drink consumption.
Researching the implementation of pioneering roles in nursing and midwifery

This paper presents research on the implementation of pioneering roles in nursing and midwifery in the United Kingdom—namely lecturer practitioners, consultant nurses and nurse registrars. It seeks to critique the empirical insights gained from studying new roles aimed at better integrating distinct aspects of nursing and midwifery, at solving long-standing ‘problems’ in nursing and midwifery, at extending traditional roles and at improving and advancing practice, education and research. The paper draws upon knowledge derived from three empirical projects—an ethnographic study and survey of the role of lecturer practitioners, conducted in one setting in the UK (Lathlean, 1997), a study of the role of consultant nurses within healthcare Trusts (Lathlean and Masterson, 2004) and an action-based evaluation of an innovative work based pilot training programme for the development of nurse registrars as aspiring consultant nurses (Surridge and Lathlean, 2006). The paper sets these within the context of an extensive literature on lecturer practitioners and consultant nurses, and encompasses both a national and international perspective through the inclusion of UK, North American and Australian experiences. The theoretical understandings gleaned from these studies include the apparent inevitability of certain challenges in new roles such as role ambiguity and role overload, the need for organisational commitment to establish and sustain such roles, the variability of roles and the uncertainty as to the achievements of these posts or, at the very least, the extent to which these achievements can be measured. Conclusions drawn include the value of longitudinal studies over short-term cross-sectional research, incorporating approaches that reflect the diversity of the roles; the complexity of ascertaining role impact; and the value of undertaking a qualitative meta-analysis or meta-ethnography of existing studies.
Confiabilidade de escalas de comprometimento neurológico em pacientes com acidente vascular cerebral

Scales for the assessment of neurological impairment are employed in clinical trials, outcome evaluation and in therapeutic decisions. We evaluated the reliability of the Portuguese version of the Rankin Scale (RS), Barthel Index (BI) and the NIHSS (National Institute of Health Stroke Scale) in 51 stroke patients, estimating the agreement of the results for examiners. The interrater reliability was measured using the Kappa Coefficient and Intraclass Correlation Coefficient. The RS showed moderate, substantial and excellent coefficients of agreement. The BI showed from substantial to excellent coefficients of agreement as a whole and also for its constituents. This scale was stratified in prognostic and functional groups, both presenting coefficients of agreement from substantial to excellent. The NIHSS presented excellent agreement on its total and substantial agreements on its individual items. The NIHSS was also stratified in groups of points, which presented moderate or excellent coefficient, and in groups of congruous items, wich showed a moderate to excellent agreement. These results suggest that the Portuguese version of the RS, BI and the NIHSS present adequate reliability.
The Application Effect of a Medical Information Management System for the Prevention of Depression in Mastectomy Patients

This study was conducted to examine the application effect of a medical information management system for the prevention of depression in mastectomy patients. The subjects were divided into an experimental group (n=62) and a control group (n=62). To verify the effects of the information mediation, this study used a progress method for measurement in the form of an application test and a follow-up test. The results of this study are as follows: First, it showed significantly the factors of health behavior on depression in the degree of education, nutrient intake, exercise, insomnia, and personality type (p<.05). Secondly, it was found that the experimental group had a tendency toward gradually developing more variation from 70.2% to 83.1% in health behavior performance than the control group with regard to the measurement of depression over the application timeframe. Therefore, it is concluded that a medical information management system is effective in relieving mastectomy patients from depression over the physical, psychological, and social changes they experience.
Safety of Mineralocorticoid Receptor Antagonists in Patients Receiving Hemodialysis

OBJECTIVE: To evaluate the literature supporting the safe use of mineralocorticoid antagonists (MRAs) in patients with end-stage renal disease who are receiving hemodialysis. DATA SOURCES: A review of the literature was performed using MEDLINE (1950 through week 2 of February 2012) using the key words and MeSH terms mineralocorticoid antagonists, aldosterone antagonists, spironolactone, or eplerenone combined with dialysis, renal disease, or kidney disease. STUDY SELECTION AND DATA EXTRACTION: Studies eligible for inclusion evaluated the impact of MRAs on serum potassium levels in patients with end-stage renal disease receiving hemodialysis. Data related to the patient populations and outcomes of interest were extracted from each publication. DATA SYNTHESIS: Ten studies were included in this review (spironolactone, 9; eplerenone, 1) and reported on the impact of MRAs on potassium levels in this population. In aggregate, the studies, with spironolactone doses ranging from 25 mg 3 times/week after dialysis to 300 mg/day and eplerenone doses of 25 mg twice daily, have shown little increases in serum potassium, particularly with the lower doses. The overall incidence of severe hyperkalemia was low. The literature base is limited by significant methodologic weaknesses of the studies, including low patient numbers, short follow-up periods, and lack of a blinded control group. CONCLUSIONS: The current literature suggests that MRAs may be used safely in patients with end-stage renal disease receiving hemodialysis, although additional large controlled trials are needed before definitive treatment recommendations can be made.
Drug-Related Problems and Hospital Admissions in Cardiac Transplant Recipients

Background: Drug-related problems (DRPs) in the general population account for 15% of all hospital admissions, of which approximately 30% are preventable. Cardiac transplant patients may be at increased risk for DRPs because of their complicated medication regimens that include drugs with a narrow therapeutic index. Objective: To determine the incidence and praventability of DRPs causing hospital admission in cardiac transplant patients at a single institution. Methods: Between November 2009 and January 2010, a prospective longitudinal study investigated the incidence and preventability of DRPs in a single cardiac transplant center. Three independent reviewers used validated scoring systems to determine the incidence and preventability of drug-related hospital admissions. DRPs were classified by type, pharmacologic class, and impact on length of stay. Results: During the 3-month study period, 48 cardiac transplant patients were hospitalized. DRPs accounted for 40% (19/48) of these admissions and 58% (11/19) were adjudicated to be preventable. Common DRPs included supratherapeutic (32%) and subtherapeutic (16%) dosage, adverse drug reaction (32%), drug interaction (5%), and nonadherence (5%). Pharmacologic classes implicated included immunosuppressant (63%), antimicrobial (11%), electrolyte/fluid (11%). and anticoagulant (5%). Average length of stay in drug-related compared to non-drug-related admissions was 11.4 versus 8.5 days (p = 0.458). When annualized, 44 hospitalizations or 500 hospital days may have been prevented. Conclusions: Hospital admissions following cardiac transplantation are often drug related (40%) and preventable (58%). Incorporating this insight into the multidisciplinary transplant team may improve outcomes, assist in meeting national quality mandates by the United Network for Organ Sharing and Centers for Medicare Services, and lead to new benchmarks for transplant centers.